Plasma metabolomic profiling of hypertrophic cardiomyopathy patients before and after surgical myectomy suggests postoperative improvement in metabolic function

Abstract Background Hypertrophic cardiomyopathy (HCM) is a common inherited heart disorder complicated by left ventricle outflow tract (LVOT) obstruction, which can be treated with surgical myectomy. To date, no reliable biomarkers for LVOT obstruction exist. We hypothesized that metabolomic biomarkers for LVOT obstruction may be detectable in plasma from HCM patients. Methods We conducted metabolomic profiling on plasma samples of 18 HCM patients before and after surgical myectomy, using a commercially available metabolomics platform. Results We found that 215 metabolites were altered in the postoperative state (p-value < 0.05). 12 of these metabolites were notably significant after adjusting for multiple comparisons (q-value < 0.05), including bilirubin, PFOS, PFOA, 3,5-dichloro-2,6-dihydroxybenzoic acid, 2-hydroxylaurate, trigonelline and 6 unidentified compounds, which support improved organ metabolic function and increased lean soft tissue mass. Conclusions These findings suggest improved organ metabolic function after surgical relief of LVOT obstruction in HCM and further underscore the beneficial systemic effects of surgical myectomy.

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Plasma Metabolomic Profiling of Hypertrophic Cardiomyopathy Patients Before and After Surgical Myectomy Suggests Postoperative Improvement in Liver and Kidney Function

10.20944/preprints202104.0629.v1 ◽

2021 ◽

Author(s):

Nicole L. Wolter ◽

Madison J. LeClair ◽

Michael T. Chin

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Kidney Function ◽

Heart Function ◽

P Value ◽

Tissue Mass ◽

Metabolomic Profiling ◽

Before And After ◽

Liver And Kidney ◽

Surgical Myectomy ◽

Postoperative State

Hypertrophic cardiomyopathy (HCM) is a common inherited heart disorder complicated by left ventricle outflow tract (LVOT) obstruction, which can be treated with surgical myectomy. To date, no reliable biomarkers for LVOT obstruction exist. To determine whether metabolomic biomarkers for obstruction can be identified, we conducted metabolomic profiling on plasma samples of 18 HCM patients before and after undergoing surgical myectomy to measure changes in the plasma metabolome in the postoperative state. Plasma was collected approximately 4 weeks before surgery at the preoperative visit and approximately 3 months after the surgery at the postoperative visit. We found that 215 metabolites were altered in the postoperative state (p-value &lt; 0.05). Identified metabolites that were significantly reduced post-myectomy included metabolites of heme, such as bilirubin, and phenylacetylglutamine, a biomarker of urea cycle disorders, which suggests that liver and kidney function are improved in the postoperative state. Markers of arginine metabolism such as homoarginine and dimethylarginine are also decreased in the postoperative state, suggestive of reduction in nitric oxide production, inflammation and heart failure after surgery. 3-hydroxybutyrate (BHBA) was also decreased, suggesting possible increased fatty acid utilization and a return to normal heart function. 12 of these metabolites were notably significant after adjusting for multiple comparisons (q-value &lt; 0.05), including bilirubin, PFOS, PFOA, 3,5-dichloro-2,6-dihydroxybenzoic acid, 2-hydroxylaurate, trigonelline and 6 unidentified compounds, which support improved kidney and liver function and increased lean soft tissue mass. These findings suggest improved organ metabolic function after surgical relief of LVOT obstruction in HCM and further underscore the beneficial systemic effects of surgical myectomy.

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Echocardiography before and after Resect-Plicate-Release Surgical Myectomy for Obstructive Hypertrophic Cardiomyopathy

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2015.07.002 ◽

2015 ◽

Vol 28 (11) ◽

pp. 1318-1328 ◽

Cited By ~ 20

Author(s):

Dan G. Halpern ◽

Daniel G. Swistel ◽

Jose Ricardo Po ◽

Rajeev Joshi ◽

Glenda Winson ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Before And After ◽

Obstructive Hypertrophic Cardiomyopathy ◽

Surgical Myectomy

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CMR derived ventricular arterial coupling in hypertrophic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.051 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

A Kharabish ◽

M Eid ◽

W Elmozy ◽

A Elguindy ◽

M Yacoub

Keyword(s):

Clinical Practice ◽

Hypertrophic Cardiomyopathy ◽

Systolic Pressure ◽

Ventricular Outflow Tract ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Left Ventricular ◽

Systolic Volume ◽

Funding Sources ◽

Before And After ◽

Surgical Myectomy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ventriculoarterial coupling (VAC) is an important surrogate measurement of global cardiovascular efficiency. However, up till recently, this measurement has been rarely used in clinical practice. This could be due to its invasive nature, and the relatively complex methods required for acquisition and interpretation. We here describe a noninvasive method of measuring VA coupling using cardiac magnetic resonance (CMR) in a cohort of hypertrophic cardiomyopathy (HCM). Methods Cardiac MRI was performed in 61 patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after undergoing extended surgical myectomy. Cardiac MRIs from 15 patients with non-obstructive HCM were also included for comparison. Hypertensive patients were excluded from this study. Vitals signs were recorded during each MRI study. Arterial end-systolic pressure (AESP) was determined non-invasively as previously described (0.9x brachial blood pressure). Left ventricular end-systolic pressure (LVESP) was calculated by adding the echo-derived peak systolic gradient across the left ventricular outflow tract to the arterial end-systolic pressure. Indexed stroke volume (SVI) in the ascending aorta as well as indexed end systolic volume (ESVI) were calculated from CMR. Indexed arterial (Ea) and ventricular (Ev) elastance were calculated as AESP/SVI and LVESP/ESVI. VA coupling was then calculated as Ea/Ev. Results Compared to the baseline measurements, VAC increased significantly post myectomy (mean VAC pre-myectomy and post-myectomy 0.38 vs. versus 0.62 respectively, p= 0.00001). VAC in non-obstructive HCM patients (mean = 0.64) was statistically similar to that in post-myectomy (p = 0.82) and statistically different from pre-myectomy (p = 0.00016). The mean of LVOTO gradients post- and pre-myectomy were significantly different (p = 0.00001). Significant correlation of the delta-VAC with the delta gradient in the LVOTO was found (r= 0.35, p = 0.005). Conclusion Non-invasive assessment of VA coupling using CMR is feasible and could be a useful tool in the evaluation of patients with various cardiovascular disorders. Further studies with larger numbers of patients are required to establish the utility of this method in clinical practice.

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Accuracy of measurements of small changes in soft tissue mass by use of dual-photon absorptiometry

Journal of Applied Physiology ◽

10.1152/jappl.1991.71.2.698 ◽

1991 ◽

Vol 71 (2) ◽

pp. 698-702 ◽

Cited By ~ 7

Author(s):

L. C. Lands ◽

G. J. Heigenhauser ◽

C. Gordon ◽

N. L. Jones ◽

C. E. Webber

Keyword(s):

Soft Tissue ◽

Total Mass ◽

Soft Tissue Mass ◽

Dual Photon Absorptiometry ◽

Weight Changes ◽

Soft Mass ◽

Tissue Mass ◽

Photon Absorptiometry ◽

Before And After ◽

Highly Correlated

Dual-photon absorptiometry (DPA) has recently been applied to the assessment of body composition. To evaluate the accuracy of DPA in detecting small changes in the lean soft tissue mass, we performed DPA with the use of the Norland 2600 Dichromatic densitometer on six healthy adult males before and after a 30-ml/kg transfusion of saline and before and after exercise in a warm environment, resulting in a greater than or equal to 1-kg weight loss. Absolute weight [baseline pretransfusion r2 = 0.999, standard error of estimate (SEE) = 590 g; posttransfusion r2 = 0.999, SEE = 300 g; baseline pretranspiration r2 = 0.999, SEE = 230 g; posttranspiration r2 = 0.999, SEE = 240 g] was accurately reflected in DPA total mass. Weight changes due to transfusion were poorly reflected by changes in DPA total mass (r2 = 0.417, SEE = 404 g). However, changes posttranspiration were accurately reflected in the DPA total mass (r2 = 0.886, SEE = 106 g posttranspiration). Similarly, weight changes due to transfusion were poorly measured by changes in DPA soft mass (r2 = 0.478, SEE = 365 g), but changes posttranspiration were highly correlated with DPA soft mass changes (r2 = 0.909, SEE = 92 g). Weight changes were not reflected by changes in the DPA lean soft tissue mass (r2 = 0.006, SEE = 1,737 posttransfusion, r2 = 0.094, SEE = 1,038 g posttranspiration). DPA-derived nonfat mass was highly correlated with skinfold-derived nonfat mass (r2 = 0.96, SEE = 2,400 g). Accuracy of total and soft tissue measurements implied correct mineral mass assessment.(ABSTRACT TRUNCATED AT 250 WORDS)

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Thymoma in an aged backyard Leghorn chicken, with reviews of a database and literature

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638721990896 ◽

2021 ◽

Vol 33 (2) ◽

pp. 336-339

Author(s):

Julia Blakey ◽

Carmen Jerry ◽

Ana da Silva ◽

Simone Stoute

Keyword(s):

Soft Tissue Mass ◽

Animal Health ◽

Postmortem Examination ◽

Cervical Region ◽

Laboratory System ◽

Unexpected Death ◽

Tissue Mass ◽

Microscopic Features ◽

History Of ◽

Backyard Chickens

A 7-y-old backyard Leghorn chicken ( Gallus domesticus) was submitted to the California Animal Health and Food Safety Laboratory System (CAHFS)–Turlock branch for postmortem examination, with a history of unexpected death. At postmortem examination, a hemorrhagic soft tissue mass was observed in the cervical region. Microscopically, a densely cellular neoplasm of polygonal epithelial cells and small lymphocytes was observed. The microscopic features of the neoplasm in combination with positive immunohistochemistry for pancytokeratin and CD3 were used to classify the lesion as a thymoma. Thymoma was diagnosed in only 5 birds submitted to CAHFS from 1990 to 2019. Thymoma has been described only rarely in birds, and is an unusual diagnosis in backyard chickens.

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Extradural Peripheral Nerve Sheath Tumour at T7 Level in a 2-Year-Old Dog

VCOT Open ◽

10.1055/s-0041-1731438 ◽

2021 ◽

Vol 04 (01) ◽

pp. e41-e46

Author(s):

Federica Aragosa ◽

Chiara Caterino ◽

Giovanni Della Valle ◽

Ilaria D'Aquino ◽

Dario Costanza ◽

...

Keyword(s):

Clinical Presentation ◽

Soft Tissue Mass ◽

Resonance Imaging ◽

Tissue Mass ◽

Nerve Sheath Tumour ◽

Free Interval ◽

Nerve Sheath ◽

Dorsal Laminectomy ◽

Intervertebral Foramina ◽

Peripheral Nerve Sheath Tumour

AbstractThe aim of this report is to describe an unusual localization of nerve sheath tumour (NST), clinical presentation, imaging, surgical management, and outcome in a 2-year-old dog. A 2-year-old female American Staffordshire Terrier presented with nonambulatory paraparesis, thoracolumbar hyperaesthesia, hindlimb hyperreflexia, and mild muscle atrophy. Computed tomography and magnetic resonance imaging revealed an extradural mass at T7-T8, without vertebral lesions. Surgical treatment consisted in resection of the soft tissue mass through dorsal laminectomy. The dog was ambulatory within 24 hours and free of recurrence at 18 months postoperatively. Histopathologic and features of immunohistochemistry were consistent with NST. The NST of this report was similar to those described before, but exhibited unusual characteristics, such as being extradural, without extension into intervertebral foramina, and being located in an atypical region (T7-T8). Moreover, survival time and relapse-free interval are greater than previously reported for similar cases.

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CLINICAL IMPLICATIONS OF POSTOPERATIVE ATRIAL FIBRILLATION IN HYPERTROPHIC CARDIOMYOPATHY PATIENTS UNDERGOING SURGICAL MYECTOMY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)01893-3 ◽

2021 ◽

Vol 77 (18) ◽

pp. 534

Author(s):

Sara Hoss ◽

Mahdi Montazeri ◽

Deacon Lee ◽

Olga Katz ◽

Cindy Chow ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Postoperative Atrial Fibrillation ◽

Clinical Implications ◽

Surgical Myectomy

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Primary renal synovial sarcoma presenting with a retroperitoneal bleed

BMJ Case Reports ◽

10.1136/bcr-2020-237099 ◽

2021 ◽

Vol 14 (3) ◽

pp. e237099

Author(s):

Daanesh Huned ◽

Juinn Huar Kam ◽

Lui Shiong Lee ◽

Raj Vikesh Tiwari

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Synovial Sarcoma ◽

Soft Tissue Mass ◽

Renal Angiomyolipoma ◽

Right Hepatectomy ◽

Tissue Mass ◽

Biopsy Confirmation ◽

Synovial Sarcomas ◽

Neo Adjuvant Chemotherapy

Synovial sarcomas are most commonly localised in extremities, especially in the lower thigh and knee areas. Comprising less than 1% of all malignancies, retroperitoneal synovial sarcoma is very rare with primary synovial sarcoma of the kidney being even more infrequent and difficult to diagnose. We describe a case report of a renal synovial sarcoma in a young adult who was initially managed as a case of Wunderlich’s syndrome secondary to what was believed to be a ruptured renal angiomyolipoma. After biopsy confirmation, the patient was eventually managed with neo-adjuvant chemotherapy followed by a right radical nephrectomy and right hepatectomy. Despite its rarity, synovial sarcoma should be considered as differential diagnosis of a bleeding retroperitoneal soft tissue mass detected in young adults.

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