scholarly journals 351 Prevalence and prognostic significance of RV uptake (biventricular uptake) at planar scintigraphy in patients with ATTR cardiac amyloidosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Aldostefano Porcari ◽  
Linda Pagura ◽  
Marco Canepa ◽  
Elena Biagini ◽  
Francesco Cappelli ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Spect Imaging ◽  
Prognostic Role ◽  
Planar Scintigraphy ◽  
Bone Uptake ◽  
Prognostic Stratification ◽  
Grade 3 ◽  
The Right

Abstract Aims The validation of cardiac scintigraphy with bone tracers for nonbiopsy confirmation of transthyretin cardiac amyloidosis (ATTR-CA) has revolutionized the diagnosis of this condition. While most studies focused on left ventricle (LV) uptake, the significance of bone tracers uptake in the right ventricle (RV) leading to biventricular (BiV) uptake has not been investigated so far. BiV uptake at planar scintigraphy might reflect a more advanced ATTR-CA. To estimate the prevalence of BiV uptake and its potential prognostic role in ATTR-CA. Methods and results Multicentre, retrospective, observational study performed among four Italian referral centres for CA. Data of ATTR-CA patients who underwent bone tracers scintigraphy with acquisition of planar and SPECT imaging between November 2014 and June 2020 at participating centres were centrally revised. ATTR-CA was diagnosed according to the Gilmore’s algorithm. LV uptake was assessed by Perugini visual scale. RV uptake was defined as: 0 = absent, 1 ≤ bone uptake, 2 = equal to bone uptake, and 3 ≥ bone uptake. Images were independently assessed by six experienced operators, blinded to all patients’ data. Cardiological data included clinical examination, ECG, echocardiography and blood tests. The primary outcome was a composite of cardiac death and hospitalization for heart failure. Of the 124 patients with ATTR-CA included in this analysis, 93 (75%) had BiV uptake at planar scintigraphy and all had RV free wall uptake confirmed at SPECT imaging. The prevalence of planar BiV uptake increased along with the LV Perugini grade: 14% in Perugini grade 1, 70% in Perugini grade 2, and 92% in Perugini grade 3. Compared to those with planar LV uptake, patients with planar BiV uptake were older (81 vs. 77 years, P = 0.006), more frequently in NYHA ≥3 (32% vs. 10%, P = 0.018), had increased NT-proBNP values (4293 vs. 2492 pg/ml, P = 0.046), LV wall thickness (18 vs. 17 mm, P = 0.007). They had higher rates of LV ejection fraction <50% (42% vs. 10%, P = 0.001) and lower TAPSE (16 vs. 20 mm, P = 0.048). At 18 months, patients with BiV uptake experienced the primary endpoint more frequently than those with LV uptake (P = 0.021, Figure), with the highest risk observed in patients with grade 2–3 RV uptake (P = 0.010). The LV Perugini grade did not affect prognosis (P = 0.20). At multivariate analysis, NYHA ≥3, eGFR <60 ml/min and BiV uptake had independent prognostic value (HR 8.0, P = 0.007; HR 2.1, P = 0.025; HR 1.7, P = 0.007; respectively). Conclusions The presence of BiV uptake at planar scintigraphy identified ATTR-CA patients at worse cardiovascular outcome, potentially serving as novel marker for prognostic stratification in this population.

Breast carcinoma in young females below the age of 35 years - histopathological and prognostic significance

1970 ◽  
Vol 2 (3) ◽  
pp. 198-202
Author(s):  
D Ghartimagar ◽  
A Ghosh ◽  
OP Talwar ◽  
R Narasimhan
Keyword(s):  
Breast Carcinoma ◽  
Young Women ◽  
Early Stage ◽  
Prognostic Significance ◽  
Age Group ◽  
Breast Cancers ◽  
Young Females ◽  
Younger Age ◽  
Grade 3 ◽  
Group Grade

Background: Breast cancers rarely occur in young women but are known to have more aggressive behaviors and poorer outcome. We here compare the significance of breast carcinoma in female below the age of 35 to the age over 35 whose specimens were submitted to Manipal teaching hospital, Pokhara. Materials and Methods: All cases of mastectomy with carcinoma from January 2000 to September 2011 were included in the study. Clinical and histopathological datas of all cases were reviewed and collated. Results: A total of 148 mastectomy specimens were received, among which, 23 cases (16%) were below 35 years; whereas 125 cases (84%) were above 35 years of age. In both groups, Stage II was the commonest stage but stage III was much more common in older group (33% versus 9%) and stage I was more common in younger age group (39% versus 27%). Bloom Richardson grading showed that in the older age group, grade 1 is the commonest grade (50%) while in the younger group; grade 3 is the commonest (39%). Patients were followed for a varying period of 6 months to 5 years. Two cases (2% of followed up cases) in older group and 3 cases (15% of followed up cases) in the younger group showed recurrence. Conclusion: Breast carcinoma in the patients younger than 35 years though presented at an early stage has higher grade tumor and poorer outcome. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6021 JPN 2012; 2(3): 198-202

scholarly journals Assessment of cardiac amyloidosis with 99mTc-pyrophosphate (PYP) quantitative SPECT

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Chao Ren ◽  
Jingyun Ren ◽  
Zhuang Tian ◽  
Yanrong Du ◽  
Zhixin Hao ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Activity Concentration ◽  
Standardized Uptake Value ◽  
Blood Pool ◽  
Systematic Difference ◽  
Repeated Measurements ◽  
Quantitative Spect ◽  
Phantom Studies ◽  
Grade 3 ◽  
Operator Reproducibility

Abstract Background 99mTc-PYP scintigraphy provides differential diagnosis of ATTR cardiomyopathy (ATTR-CM) from light chain cardiac amyloidosis and other myocardial disorders without biopsy. This study was aimed to assess the diagnostic feasibility and the operator reproducibility of 99mTc-PYP quantitative SPECT. Method Thirty-seven consecutive patients who underwent a 99mTc-PYP thorax planar scan followed by SPECT and CT scans to diagnose suspected ATTR-CM were enrolled. For the quantitative SPECT, phantom studies were initially performed to determine the image conversion factor (ICF) and partial volume correction (PVC) factor to recover 99mTc-PYP activity concentration in the myocardium for calculating the standardized uptake value (SUV) (unit: g/ml). SUVmax was compared among groups of ATTR-CM, AL cardiac amyloidosis, and other pathogens (others) and among categories of Perugini visual scores (grades 0–3). The intra- and inter-operator reproducibility of quantitative SPECT was verified, and the corresponded repeatability coefficient (RPC) was calculated. Results The ICF was 79,327 Bq/ml to convert count rate in pixel to 99mTc activity concentration. PVC factor as a function of the measured activity concentration ratio in the myocardium and blood-pool was [y = 1.424 × (1 − exp(− 0.759 × x)) + 0.104]. SUVmax of ATTR-CM (7.50 ± 2.68) was significantly higher than those of AL (1.96 ± 0.35) and others (2.00 ± 0.74) (all p < 0.05). SUVmax of grade 3 (8.95 ± 1.89) and grade 2 (4.71 ± 0.23) were also significantly higher than those of grade 1 (1.92 ± 0.31) and grade 0 (1.59 ± 0.39) (all p < 0.05). Correlation coefficient (R2) of SUVmax reached 0.966 to 0.978 with only small systematic difference (intra = − 0.14; inter = − 0.23) between two repeated measurements. Intra- and inter-operator RPCs were 0.688 and 0.877. Conclusions 99mTc-PYP quantitative SPECT integrated with adjustable PVC factors is feasible to quantitatively and objectively assess the burden of cardiac amyloidosis for diagnosis of ATTR-CM.

scholarly journals Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuta Seko ◽  
Takao Kato ◽  
Yuhei Yamaji ◽  
Yoshisumi Haruna ◽  
Eisaku Nakane ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Conduction Block ◽  
Primary Outcome Measure ◽  
Excess Risk ◽  
Major Adverse Cardiovascular Events ◽  
Prognostic Impact ◽  
Axis Deviation ◽  
The Right

AbstractWhile the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

scholarly journals Lactobacillus Kefiri LKF01 (Kefibios®) for Prevention of Diarrhoea in Cancer Patients Treated with Chemotherapy: A Prospective Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 385
Author(s):  
Michele Ghidini ◽  
Mariaceleste Nicoletti ◽  
Margherita Ratti ◽  
Gianluca Tomasello ◽  
Veronica Lonati ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Final Analysis ◽  
Clinical Effectiveness ◽  
High Grade ◽  
Combination Therapies ◽  
Grade 3 ◽  
Lactobacillus Kefiri ◽  
A Prospective Study

Diarrhoea is one of the main side effects that cancer patients face. The literature showsthat the incidence of chemotherapy (CT)-induced diarrhoea (grade 3–4) in treated patients is in the range of 10–20%, particularly after 5-fluorouracil (5-FU) bolus or some combination therapies of irinotecan and fluoropyrimidines. The aim of the present study was to evaluate the clinical effectiveness of Lactobacillus kefiri LKF01 (Kefibios®) in the prevention or treatment of CT-related diarrhoea in the cancer population. We conducted a prospective observational study. Patients enrolled were adults treated for at least four months with 5-FU-based CT. Kefibios® was administered to patients every day. The primary outcome was the evaluation of the incidence of grade 3–4 CT-induced diarrhoea. We included 76 patients in the final analysis. A 6.6% incidence of high-grade diarrhoea was found in the evaluated population (4.7% of patients treated with 5-FU-based therapy and 8.5% of patients treated with capecitabine-based CT). The overall incidence of high-grade diarrhoea observed was higher in the 1st and 2nd cycles (3.9%), with a subsequent sharp reduction from the 3rd cycle (1.3%) and negativisation from the 5th cycle. Lactobacillus kefiri LKF01 (Kefibios®) is safe and effective in preventing severe diarrhoea in cancer patients receiving 5-FU or capecitabine-based treatment.

scholarly journals MBCL-04. 5 – AZACYTIDINE IN TREATMENT OF CHILDREN WITH DE NOVO AND RELAPSED METASTATIC MEDULLOBLASTOMA: RESULTS OF INTERCENTER PILOT STUDY

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii387-iii387
Author(s):  
Andrey Levashov ◽  
Dmitry Khochenkov ◽  
Anna Stroganova ◽  
Marina Ryzhova ◽  
Sergey Gorelyshev ◽  
...  
Keyword(s):  
Gene Amplification ◽  
De Novo ◽  
Prognostic Significance ◽  
N Gene ◽  
Free Survival ◽  
Tumor Bed ◽  
Craniospinal Radiation ◽  
Therapeutic Program ◽  
Grade 3

Abstract The aim of this study was to estimate treatment toxicity and event-free survival (EFS) according to therapeutic program, MYC/MYC-N gene amplification and MGMT/DNMT (1, 3a, 3b) proteins expression in tumor cells. From 2016 to 2018 twenty four patients were included in trial. Children underwent adjuvant therapy: craniospinal radiation (CSI) or local radiation therapy (RT) to the relapsed site up to 23.4Gy with 5-azacytidine, 2 cycles methotrexate/5-azacytidine/cisplatin/etoposide, 3 cycles 5-azacytidine/temozolomide - for relapsed group (arm A, n = 5); for patients with de novo medulloblastoma: arm B, n = 11 – vincristine/cyclophosphamide/cisplatin/etoposide (OPEC) - based induction, CSI 36Gy + local RT to the tumor bed up to 54Gy with 5-azacytidine, 1 cycle OPEC and 2 cycles thiophosphamide/carboplatin with auto stem cell transplantation (auto-SCT); arm C, n = 8 – cyclophosphamide/cisplatin - based induction, CSI 23.4 Gy followed by 2 cycles 5-azacytidine/thiophosphamide/carboplatin with auto-SCT, local RT with 5-azacytidine. The combination of 5-azacytidine with local RT or temozolomide was safety and tolerability. Arm C was discontinued due to severe gastrointestinal grade 3/4 toxicity, hemorrhagic syndrome after combination of 5-azacytidine with thiophosphamide/carboplatin. EFS was 0% in arm A, 53.0 ± 15.5%, 50.0 ± 17.7% in arms B and C, a median follow-up 8.8 ± 1.1 months (arm A), 18.8 ± 2.5 months (arm B), 25.0 ± 4.4 months (arm C). Addition of 5-azacytidine to RT or chemotherapy did not improve EFS of patients with MYC/MYC-N gene amplification positive tumor. There was not determined any prognostic significance of MGMT/DNMT (1, 3a, 3b) proteins expression in this cohort.

Evaluation of Histopathological Heterogeneity After Preoperative Chemotherapy in Patients With Liver Metastases from Colorectal Cancer

2021 ◽  
Author(s):  
Nobuhisa matsuhashi ◽  
Hiroyuki Tomita ◽  
Takazumi Kato ◽  
Yoshinori Iwata ◽  
Satoshi Matsui ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Surgical Oncology ◽  
Resected Specimen ◽  
Histopathological Changes ◽  
School Of Medicine ◽  
Response To Chemotherapy ◽  
Grade 3 ◽  
The Right

Abstract Background: Patients with liver metastases from colorectal cancer (CRLMs) frequently receive chemotherapy prior to liver resection. Histopathological assessment of the resected specimen can evaluate the response to chemotherapy. This study analyzed the correlation between histopathological changes in the primary site and liver metastases. Patients and Methods: This study comprised 45 patients with resectable CRLMs at the Surgical Oncology Department of Gifu University School of Medicine from January 2006 to August 2015. Results: The study included 24 men and 21 women. The primary colonic tumor was located in the right side in 13 (28.9%) patients and the left side in 32 (71.9%) patients. We evaluated patients with metastatic colorectal cancer (31/45) after excluding those in whom histopathological heterogeneity between the primary and liver metastasis changed to grade 3 after chemotherapy. We compared the group which underwent hepatectomy after chemotherapy (n=25) with that underwent hepatectomy alone (n=6). In 16 (53.3%) out of 25 patients, histopathological heterogeneity of the liver metastasis was lost (p=0.04). Conclusion: Chemotherapy appears to change histopathological heterogeneity.Our study suggests that the change of intratumoral heterogeneity reflect by the response of chemotherapy.

Multiple biomarkers covering distinct pathways for predicting outcomes after ischemic stroke

Neurology ◽  
2018 ◽  
Vol 92 (4) ◽  
pp. e295-e304 ◽  
Author(s):  
Chongke Zhong ◽  
Zhengbao Zhu ◽  
Aili Wang ◽  
Tan Xu ◽  
Xiaoqing Bu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Complement C3 ◽  
Vascular Events ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
Multiple Biomarkers ◽  
Novel Biomarkers ◽  
Integrated Discrimination Improvement

ObjectiveTo study the prognostic significance of multiple novel biomarkers in combination after ischemic stroke.MethodsWe derived data from the China Antihypertensive Trial in Acute Ischemic Stroke, and 12 informative biomarkers were measured. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.ResultsIn 3,405 participants, 866 participants (25.4%) experienced major disability or died within 3 months. In multivariable analyses, elevated high-sensitive C-reactive protein, complement C3, matrix metalloproteinase-9, hepatocyte growth factor, and antiphosphatidylserine antibodies were individually associated with the primary outcome. Participants with a larger number of elevated biomarkers had increased risk of all study outcomes. The adjusted odds ratios (95% confidence intervals) of participants with 5 elevated biomarkers were 3.88 (2.05–7.36) for the primary outcome, 2.81 (1.49–5.33) for major disability, 5.67 (1.09–29.52) for death, and 4.00 (1.22–13.14) for vascular events, compared to those with no elevated biomarkers. Simultaneously adding these 5 biomarkers to the basic model with traditional risk factors led to substantial reclassification for the combined outcome (net reclassification improvement 28.5%, p < 0.001; integrated discrimination improvement 2.2%, p < 0.001) and vascular events (net reclassification improvement 37.0%, p = 0.001; integrated discrimination improvement 0.8%, p = 0.001).ConclusionWe observed a clear gradient relationship between the numbers of elevated novel biomarkers and risk of major disability, mortality, and vascular events. Incorporation of a combination of multiple biomarkers observed substantially improved the risk stratification for adverse outcomes in ischemic stroke patients.

scholarly journals CLINICAL AND MORPHOLOGICAL JUSTIFICATION OF THE SURGICAL TREATMENT OF CHRONIC ABDOMINAL SYNDROME IN CHILDREN

2019 ◽  
Vol 20 (5) ◽  
pp. 270-276
Author(s):  
Igor N. Khvorostov ◽  
A. G. Sinitsyn ◽  
G. L. Snigyr
Keyword(s):  
Surgical Treatment ◽  
Acute Inflammation ◽  
Prognostic Significance ◽  
Morphological Examination ◽  
Moderate Amount ◽  
Muscular Layer ◽  
Collagen Iii ◽  
The Right ◽  
Immunohistochemical Studies

The chronic recurrent abdominal syndrome (CRAS) in the right lower fossa in children is believed not to be independent nosological unit and is diagnosed as an exception. We carried out comparative studies of the clinical picture, results of morphological and immunohistochemical studies of remote appendicitis in 55 CRAS children and 35 children with acute destructive appendicitis. The low prognostic significance of appendicular scales for the determination of indications to the surgical treatment of CRAS was established. Morphological examination in most cases revealed signs of chronic inflammation with fibrosis of the mucosa and submucosa of the appendix in CRAS children. Immunohistochemical studies revealed the pronounced expression of protein VEGF, MMP-9 and VCAM-1 predominantly in the submucosal and the muscular layer, moderate expression for Collagen-III-alpha-1. The low number of positively stained cells for the VIP protein located both in the mucosa and in the submucosa. The number of MMP-9-positive cells was the largest, there was seen a moderate amount of VEGF, VIP and Collagen-III-alpha-1-positive cells. The disappearance of the abdominal syndrome after appendectomy was noted in 6% of CRAS patients. Recurrence of pain was observed in girls of pubertal age with the irregular menstrual cycle. The established changes in remote appendicitis, other than acute inflammation, make it possible to consider reasonable appendectomy as a way of treating CRAS in children.

scholarly journals Prognostic Implication of Liver Function Tests in Heart Failure With Preserved Ejection Fraction Without Chronic Hepatic Diseases: Insight From TOPCAT Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Weihao Liang ◽  
Xin He ◽  
Dexi Wu ◽  
Ruicong Xue ◽  
Bin Dong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Function ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Liver Function Tests ◽  
Preserved Ejection Fraction ◽  
Hepatic Diseases ◽  
Function Tests

Background: Liver dysfunction is prevalent in patients with heart failure (HF), but the prognostic significance of liver function tests (LFTs) remains controversial. Heart failure with preserved ejection fraction (HFpEF) had been introduced for some time, but no previous study had focused on LFTs in HFpEF. Thus, we aim to evaluate the prognostic significance of LFTs in well-defined HFpEF patients.Methods and Results: We conveyed a post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). The primary outcome was the composite of cardiovascular mortality, HF hospitalization, and aborted cardiac arrest, and the secondary outcomes were cardiovascular mortality and HF hospitalization. In Cox proportional hazards models, aspartate transaminase (AST) and alanine transaminase (ALT) were not associated with any of the outcomes. On the contrary, increases in total bilirubin (TBIL) and alkaline phosphatase (ALP) were associated with increased risks of the primary outcome [TBIL: adjusted hazard ratio (HR), 1.17; 95% confidence interval (CI) 1.08–1.26; ALP: adjusted HR, 1.12; 95% CI 1.04–1.21], cardiovascular mortality (TBIL: adjusted HR, 1.16; 95% CI 1.02–1.31; ALP: adjusted HR, 1.16; 95% CI 1.05–1.28), and HF hospitalization (TBIL: adjusted HR, 1.22; 95% CI 1.12–1.33; ALP: adjusted HR, 1.12; 95% CI 1.03–1.23).Conclusion: Elevated serum cholestasis markers TBIL and ALP were significantly associated with a poor outcome in HFpEF patients without chronic hepatic diseases, while elevated ALT and AST were not.

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