Echocardiographic reference ranges for normal left ventricular layer-specific strain: results from the EACVI NORRE study

Abstract Aims To obtain the normal range for 2D echocardiographic (2DE) measurements of left ventricular (LV) layer-specific strain from a large group of healthy volunteers of both genders over a wide range of ages. Methods and results A total of 287 (109 men, mean age: 46 ± 14 years) healthy subjects were enrolled at 22 collaborating institutions of the EACVI Normal Reference Ranges for Echocardiography (NORRE) study. Layer-specific strain was analysed from the apical two-, three-, and four-chamber views using 2DE software. The lowest values of layer-specific strain calculated as ±1.96 standard deviations from the mean were −15.0% in men and −15.6% in women for epicardial strain, −16.8% and −17.7% for mid-myocardial strain, and −18.7% and −19.9% for endocardial strain, respectively. Basal-epicardial and mid-myocardial strain decreased with age in women (epicardial; P = 0.008, mid-myocardial; P = 0.003) and correlated with age (epicardial; r = −0.20, P = 0.007, mid-myocardial; r = −0.21, P = 0.006, endocardial; r = −0.23, P = 0.002), whereas apical-epicardial, mid-myocardial strain increased with the age in women (epicardial; P = 0.006, mid-myocardial; P = 0.03) and correlated with age (epicardial; r = 0.16, P = 0.04). End/Epi ratio at the apex was higher than at the middle and basal levels of LV in men (apex; 1.6 ± 0.2, middle; 1.2 ± 0.1, base 1.1 ± 0.1) and women (apex; 1.6 ± 0.1, middle; 1.1 ± 0.1, base 1.2 ± 0.1). Conclusion The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain.

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Abstract 12605: Defining the Reference Range for Left Ventricular Strain by Echocardiography in Healthy Subjects: A Novel Meta-analysis Strategy

Circulation ◽

10.1161/circ.142.suppl_3.12605 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tom Kai Ming Wang ◽

Milind Y Desai ◽

Patrick H Collier ◽

Richard A Grimm ◽

Brian Griffin ◽

...

Keyword(s):

Blood Pressure ◽

Confidence Intervals ◽

Healthy Subjects ◽

Meta Analysis ◽

Left Ventricular ◽

Reference Ranges ◽

Global Strain ◽

Echocardiographic Parameters ◽

The Mean ◽

2D And 3D

Background: Left ventricular global longitudinal strain (LVGLS), circumferential strain (LVGCS) and radial strain (LVGRS) are established echocardiographic parameters of systolic function with wide clinical applicability and prognostic implications. Despite this, the reference ranges of left ventricular (LV) strain, particularly the lower limit of normal (LLN), are not well established. This meta-analysis aims to determine the mean and LLN of two- (2D) and three-dimensional (3D) LV strain in healthy subjects and factors that may influence strain measurements. Methods: We searched Pubmed, Embase and Cochrane databases until 30 November 2019 for studies reporting left ventricular (LV) global strain in at least 50 healthy subjects. We pooled the mean and LLN of 2D and 3D LV strain using random-effects models, and performed subgroup and meta-regression analysis for 2D-LVGLS. Results: Forty-four studies were eligible totaling 8747 subjects. The pooled means and LLNs (95% confidence intervals) were -20.0% (-20.6%, -19.5%) and -15.6% (-16.2%, -15.0%) respectively for 2D-LVGLS; -22.1% (-23.7%, -20.5%) and -15.7% (-17.3%, -14.1%) respectively for 2D-LVGCS; and 48.0% (43.8%, 52.1%) and 23.2% (20.9%, 25.5%) respectively for 2D-LVGRS; all listed in Table 1. Significant heterogeneity was observed for almost all pooled LV strain analyses. The only factors associated with significant differences in both pooled mean and LLN of 2D-LVGLS were systolic blood pressure and vendor software. Conclusion: Pooled means and LLNs of 2D- and 3D- LV global strain parameters in healthy subjects were reported. Based on the pooled LLNs and their confidence intervals, the thresholds for abnormal, borderline and normal LV strains can be defined. Systolic blood pressure and vendor software were the most important parameters influencing 2D-LVGLS mean and LLN. Our novel methodology can also be applied to the meta-analysis of other echocardiographic parameters to define reference ranges.

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Urinary Excretion and Bactericidal Activities of a Single Oral Dose of 400 Milligrams of Fleroxacin versus a Single Oral Dose of 800 Milligrams of Pefloxacin in Healthy Volunteers

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.42.7.1659 ◽

1998 ◽

Vol 42 (7) ◽

pp. 1659-1665 ◽

Cited By ~ 15

Author(s):

Kurt G. Naber ◽

Ursula Theuretzbacher ◽

Martina Kinzig ◽

Orlin Savov ◽

Fritz Sörgel

Keyword(s):

Oral Dose ◽

Healthy Volunteers ◽

Single Oral Dose ◽

E Coli ◽

Wide Range ◽

The Mean ◽

Bactericidal Activities ◽

Tract Infections ◽

Time Kill ◽

Randomized Crossover Study

ABSTRACT Twelve healthy volunteers participated in this randomized crossover study to compare the concentrations and recovery levels of fleroxacin and pefloxacin in urine and to assess their bactericidal activities against 12 strains of urinary pathogens with different susceptibilities over a wide range of MICs. The volunteers received a single oral dose of 400 mg of fleroxacin or 800 mg of pefloxacin. The mean cumulative renal excretion of unchanged fleroxacin,N-demethyl-fleroxacin, and N-oxide-fleroxacin accounted for 67, 7, and 6% of the total dose, respectively. The total urinary recovery of pefloxacin and the active metabolite norfloxacin was 34%. In the time-kill and the urinary bactericidal titer (UBT) studies, only the subjects’ urine not supplemented with broth was used. With most tested organisms and both quinolones it took more than 8 h to achieve a reduction in CFU of 99.9% (3 log units). Overall, there was a good correlation between UBTs and MICs for the strains. Against Escherichia coli ATCC 25922 the median UBTs were similar for both antibiotics and at least 1:8 for 96 h; against the E. coli strain for which the MIC was 0.5 μg/ml the UBT was at least 1:4 for 48 h. The UBTs of both drugs against Klebsiella pneumoniae were at least 1:16 for 72 h. The UBTs for Staphylococcus aureus (the MIC for which was 16 μg/ml) of both antibiotics were low, and in some of the samples, no bactericidal titers were observed. UBTs for Proteus mirabilis of pefloxacin are significantly higher than those of fleroxacin. For Pseudomonas aeruginosa the median UBTs were present for the 24-to-48-h interval. The same is true forEnterococcus faecalis. Against Staphylococcus saprophyticus, UBTs were present for at least 48 h with both quinolones. Overall, a single oral dose of 400 mg of fleroxacin exhibits UBTs comparable to those of 800 mg of pefloxacin. Therefore, it may be expected that half of the dose of fleroxacin gives comparable results in the treatment of urinary tract infections; this should be substantiated in comparative clinical trials.

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Cardiovascular magnetic resonance-determined left ventricular myocardium impairment is associated with C-reactive protein and ST2 in patients with paroxysmal atrial fibrillation

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00732-5 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Lei Zhao ◽

Songnan Li ◽

Chen Zhang ◽

Jie Tian ◽

Aijia Lu ◽

...

Keyword(s):

Cardiovascular Disease ◽

Healthy Subjects ◽

T1 Mapping ◽

Circumferential Strain ◽

Myocardial Strain ◽

Left Ventricular ◽

Healthy Controls ◽

C Reactive Protein ◽

Reactive Protein ◽

Native T1

Abstract Background Myocardial strain assessed with cardiovascular magnetic resonance (CMR) feature tracking can detect early left ventricular (LV) myocardial deformation quantitatively in patients with a variety of cardiovascular diseases, but this method has not yet been applied to quantify myocardial strain in patients with atrial fibrillation (AF) and no coexistent cardiovascular disease, i.e., the early stage of AF. This study sought to compare LV myocardial strain and T1 mapping indices in AF patients and healthy subjects, and to investigate the associations of a portfolio of inflammation, cardiac remodeling and fibrosis biomarkers with LV myocardial strain and T1 mapping indices in AF patients with no coexistent cardiovascular disease. Methods The study consisted of 80 patients with paroxysmal AF patients and no coexistent cardiovascular disease and 20 age- and sex-matched healthy controls. Left atrial volume (LAV), LV myocardial strain and native T1 were assessed with CMR, and compared between the AF patients and healthy subjects. Biomarkers of C-reactive protein (CRP), transforming growth factor beta-1 (TGF-β1), collagen III N-terminal propeptide (PIIINP), and soluble suppression of tumorigenicity 2 (sST2) were obtained with blood tests, and compared between the AF patients and healthy controls. Associations of these biomarkers with those CMR-measured parameters were analyzed for the AF patients. Results For the CMR-measured parameters, the AF patients showed significantly larger LAV and LV end-systolic volume, and higher native T1 than the healthy controls (max P = 0.027). The absolute values of the LV peak systolic circumferential strain and its rate as well as the LV diastolic circumferential strain rate were all significantly reduced in the AF patients (all P < 0.001). For the biomarkers, the AF patients showed significantly larger CRP (an inflammation biomarker) and sST2 (a myocardium stiffness biomarker) than the controls (max P = 0.007). In the AF patients, the five CMR-measured parameters of LAV, three LV strain indices and native T1 were all significantly associated with these two biomarkers of CRP and sST2 (max P = 0.020). Conclusions In patients with paroxysmal AF and no coexistent cardiovascular disease, LAV enlargement and LV myocardium abnormalities were detected by CMR, and these abnormalities were associated with biomarkers that reflect inflammation and myocardial stiffness.

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The use of a neck brace does not influence visual vertical perception

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000400019 ◽

2011 ◽

Vol 69 (3) ◽

pp. 509-512 ◽

Cited By ~ 6

Author(s):

Martha Funabashi ◽

Natya N.L. Silva ◽

Luciana M. Watanabe ◽

Taiza E.G Santos-Pontelli ◽

José Fernando Colafêmina ◽

...

Keyword(s):

Healthy Volunteers ◽

Healthy Subjects ◽

Afferent Input ◽

Subjective Visual Vertical ◽

Sensory Receptors ◽

Ocular Torsion ◽

Vertical Orientation ◽

Mean Values ◽

Visual Vertical ◽

The Mean

Subjective visual vertical (SVV) evaluates the individual's capacity to determine the vertical orientation. Using a neck brace (NB) allow volunteers' heads fixation to reduce cephalic tilt during the exam, preventing compensatory ocular torsion and erroneous influence on SVV result. OBJECTIVE: To analyze the influence of somatosensory inputs caused by a NB on the SVV. METHOD: Thirty healthy volunteers performed static and dynamic SVV: six measures with and six without the NB. RESULTS: The mean values for static SVV were -0.075º±1.15º without NB and -0.372º±1.21º with NB. For dynamic SVV in clockwise direction were 1.73º±2.31º without NB and 1.53º±1.80º with NB. For dynamic SVV in counterclockwise direction was -1.50º±2.44º without NB and -1.11º±2.46º with NB. Differences between measurements with and without the NB were not statistically significant. CONCLUSION: Although the neck has many sensory receptors, the use of a NB does not provide sufficient afferent input to change healthy subjects' perception of visual verticality.

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Abstract 290: Circulating miRNAs as Biomarkers in Acute Coronary Syndrome

Circulation Research ◽

10.1161/res.111.suppl_1.a290 ◽

2012 ◽

Vol 111 (suppl_1) ◽

Author(s):

Lina Cordeddu ◽

Anna P Pilbrow ◽

Vicky A Cameron ◽

Richard W Troughton ◽

Mark A Richards ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Left Ventricular Function ◽

Healthy Volunteers ◽

Ventricular Function ◽

Plasma Levels ◽

Left Ventricular ◽

Coronary Syndrome ◽

Normal Left Ventricular ◽

Unstable Atherosclerotic Plaque ◽

Plasma Microrna

Introduction Acute coronary syndrome is characterized by the active, inflamed and unstable atherosclerotic plaque that is vulnerable to rupture, predisposing to lumen occlusion and varying extents of myocardial injury. Plasma microRNA have been examined in the hope of identifying an easily accessible biomarker for acute coronary syndrome. But so far studies have taken a candidate approach and screened only for miRNA that are potentially released from the injured myocardium. Even so, data from these studies are inconsistent and a consensus is yet to be reached. Aim We set out to screen for circulating plasma microRNAs to serve as biomarkers for patients with Acute Coronary Syndrome. Methods and results We selected patients who suffered from 2 ends of the severity spectrum of acute coronary syndrome vs age-matched healthy controls. These were 20 μsevere” (STEMI: troponin-positive with subsequent rapid deterioration in left ventricular function or death within 5 years), 20 μmild” (unstable angina: troponin-negative with sustained normal left ventricular function and survival at 5 years), and 20 normal healthy volunteers. Blood samples were obtained from patients within 2 weeks of the acute event. We took a non-constrained approach and screened using an array panel consisting of 379 miRNA. We found 32 miRNA that were significantly upregulated (29/32) or downregulated (3/32) in the comparison between patient vs. control (sum of t-statistic>2). We have made a preliminary analysis of these in relation to a full panel of other classical biomarkers and patient clinical details. We selected 4 candidate microRNAs (miR-27b, -103, -323-3p, -652) and proceeded to test the plasma levels of these in a validation cohort of 100 troponin-positive, 100 troponin-negative patients and 100 normal healthy volunteers. miR 27b, -323-3p, -652 were significantly upregulated in disease and hence robustly validated. Conclusion miR 27b, -323-3p, -652 strongly associates with the event of acute coronary syndrome. Further work will be required to determine the origin and physiological function of these candidate miRNA, and whether their plasma levels can be used for prognostication purposes.

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Variability in echocardiography and MRI for detection of cancer therapy cardiotoxicity

Heart ◽

10.1136/heartjnl-2019-316297 ◽

2020 ◽

Vol 106 (11) ◽

pp. 817-823 ◽

Cited By ~ 7

Author(s):

James Lambert ◽

Mariana Lamacie ◽

Babitha Thampinathan ◽

Mustafa A Altaha ◽

Maryam Esmaeilzadeh ◽

...

Keyword(s):

Healthy Volunteers ◽

Temporal Variability ◽

Global Longitudinal Strain ◽

Cancer Therapeutics ◽

Temporal Changes ◽

Left Ventricular ◽

Lv Function ◽

Intraobserver Variability ◽

2D Echocardiography ◽

The Mean

ObjectivesTo compare variability of echocardiographic and cardiovascular magnetic resonance (CMR) measured left ventricular (LV) function parameters and their relationship to cancer therapeutics-related cardiac dysfunction (CTRCD).MethodsWe prospectively recruited 60 participants (age: 49.8±11.6 years), 30 women with human epidermal growth factor receptor 2-positive breast cancer (15 with CTRCD and 15 without CTRCD) and 30 healthy volunteers. Patients were treated with anthracyclines and trastuzumab. Participants underwent three serial CMR (1.5T) and echocardiography studies at ~3-month intervals. Cine-CMR for LV ejection fraction (LVEF), myocardial tagging for global longitudinal strain (GLS) and global circumferential strain (GCS), two-dimensional (2D) echocardiography for strain and LVEF and three-dimensional (3D) echocardiography for LVEF measurements were obtained. Temporal, interobserver and intraobserver variability were calculated as the coefficient of variation and as the SE of the measurement (SEM). Minimal detected difference (MDD) was defined as 2xSEM.ResultsPatients with CTRCD demonstrated larger mean temporal changes in all parameters compared with those without: 2D-LVEF: 4.6% versus 2.8%; 3D-LVEF: 5.2% vs 2.3%; CMR-LVEF: 6.6% versus 2.7%; 2D-GLS: 1.9% versus 0.7%, 2D-GCS: 2.5% versus 2.2%; CMR-GCS: 2.7% versus 1.6%; and CMR-GLS: 2.1% versus 1.4%, with overlap in 95% CI for 2D-LVEF, 2D-GCS, CMR-GLS and CMR-GCS. The respective mean temporal variability/MDD in healthy volunteers were 3.3%/6.5%, 1.8%/3.7%, 2.2%/4.4%, 0.8%/1.5%, 1.9%/3.7%, 1.8%/3.6% and 1.4%/2.8%. Although the mean temporal variability in healthy volunteers was lower than the mean temporal changes in CTRCD, at the individual level, 2D-GLS, 3D-LVEF and CMR-LVEF had the least overlap. 2D-GLS and CMR-LVEF had the lowest interobserver/intraobserver variabilities.ConclusionTemporal changes in 3D-LVEF, 2D-GLS and CMR LVEF in patients with CTRCD had the least overlap with the variability in healthy volunteers; however, 2D-GLS appears to be the most suitable for clinical application in individual patients.

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