Non-invasive Global and Regional Myocardial Work Predicts High-Risk Stable Coronary Artery Disease Patients With Normal Segmental Wall Motion and Left Ventricular Function

Background: Previous studies suggested that myocardial work (MW) may identify abnormalities in the left ventricular (LV) function and establish a more sensitive index for LV dysfunction at the early stage. This study aimed to explore the value of global and regional MW parameters in predicting high-risk stable coronary artery disease (SCAD) patients with normal wall motion and preserved LV function.Patients and Methods: A total of 131 patients, who were clinically diagnosed as SCAD with normal wall motion and LV function, were finally included in this study. Global MW parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE) were measured with non-invasive LV pressure-strain loops constructed from speckle-tracking echocardiography. Regional myocardial work index (RWI) and work efficiency (RWE) were also calculated according to the perfusion territory of each major coronary artery. All patients underwent coronary angiography and were divided into the high-risk SCAD group, the non-high-risk SCAD group, and the No SCAD group according to the range and degrees of coronary arteries stenosis.Results: The global longitudinal strain (GLS), GWI and GCW were statistically different (P < 0.001) among the three groups. In the high-risk SCAD group, GLS, GWI, and GCW were significantly lower than the other two groups (P < 0.05). Receiver operating characteristic analysis demonstrated GWI and GCW could predict high-risk SCAD at a cutoff value of 1,808 mm Hg% (sensitivity, 52.6%; specificity, 87.8%; predictive positive value, 76.3%; predictive negative value, 69.9%) and 2,308 mm Hg% (sensitivity, 80.7%; specificity, 64.9%; predictive positive value, 63.3%; predictive negative value, 80.0%), respectively. Multivariate analyses showed that carotid plaque, decreased GWI, and GCW was independently related to high-risk SCAD. The cutoff values of RWILAD, RWILCX, and RWIRCA were 2,156, 1,929, and 1,983 mm Hg% in predicting high-risk SCAD, respectively (P < 0.001). When we combined RWI in two or three perfusion regions, the diagnostic performance of SCAD was improved (P < 0.001).Conclusions: Both global and regional MW parameters have great potential in non-invasively predicting high-risk SCAD patients with normal wall motion and preserved LV function, contributing to the early identification of high-risk patients who may benefit from revascularization therapy.

New Insight Into the Evaluation of Abnormal Left Ventricular Wall Motion

BackgroundEvaluation of mechanical dyssynchrony using echocardiography has failed to improve refractory heart failure in patients treated with cardiac resynchronization therapy. Previous predictors may not accurately reflect cardiac dyssynchrony. It was hypothesized that the spatially and temporary continuous information of the whole endocardium is required when the mechanical dyssynchrony is assessed using echocardiography. This study aimed to examine differences in the locus of the centroid of the left ventricle between abnormal and normal wall motion. MethodsTwenty-seven patients with dilated cardiomyopathy (left ventricular ejection fraction [LVEF]: 43±7%) and 45 old myocardial infarction patients with aneurysm (LVEF: 38±11%) were compared with 188 individuals with normal wall motions (LVEF: 61±5%). In an off-line system, the border of the endocardium was defined for each coordinate via the two-dimensional speckle tracking method. The centroid of the three-dimensional left ventricle was defined as the central point between both centroids calculated from four- and two-chamber images using an original application. ResultsThe locus of the centroid of the left ventricle in the normal wall motion group showed a horizontally inverted β shape, whereas this shape was absent in the other groups. When corrected by left ventricular end-systolic volume, the total and each directional length of the locus of the centroid of the left ventricle in the abnormal wall motion groups were clearly reduced compared with those recorded in the normal wall motion group. The acceleration of the centroid was also reduced in the abnormal wall motion groups. Multiple regression analysis with a stepwise method revealed a corrected antero-posterior shift of the centroid of left ventricle by left ventricular end-systolic volume and N-terminal pro-brain natriuretic peptide, which strongly correlated with the LVEF (adjusted R2: 0.6818, p≤2.2e-16).ConclusionUse of the locus of the centroid of the left ventricle provides novel insight into the evaluation of abnormal left ventricular contractions. Trial registrationretrospectively registered

Reactive oxygen species are required for spore-wall formation in Physcomitrella patens

A robust spore wall was a key requirement for terrestrialization by early plants. Sporopollenin in spore and pollen grain walls is thought to be polymerized and cross-linked to other macromolecular components, partly through oxidative processes involving H2O2. Therefore, we investigated effects of scavengers of reactive oxygen species (ROS) on the formation of spore walls in the moss Physcomitrella patens (Hedw.) Bruch, Schimp & W. Gümbel. Exposure of sporophytes, containing spores in the process of forming walls, to ascorbate, dimethylthiourea, or 4-hydroxy-TEMPO prevented normal wall development in a dose, chemical, and stage-dependent manner. Mature spores, exposed while developing to a ROS scavenger, burst when mounted in water on a flat slide under a coverslip (a phenomenon we named “augmented osmolysis” because they did not burst in phosphate-buffered saline or in water on a depression slide). Additionally, the walls of exposed spores were more susceptible to alkaline hydrolysis than those of the control spores, and some were characterized by discontinuities in the exine, anomalies in perine spine structure, abnormal intine and aperture, and occasionally, wall shedding. Our data support the involvement of oxidative cross-linking in spore-wall development, including sporopollenin polymerization or deposition, as well as a role for ROS in intine/aperture development.

Longitudinal Tissue Velocity and Deformation Imaging in Patients with Significant Stenosis of Left Anterior Descending Artery

Introduction: Myocardial longitudinal tissue velocity imaging (TVI) and strain rate imaging (SRI) indices may have a role in the prediction of significant proximal stenosis of left anterior descending (LAD) by echocardiography. Materials And Methods: Total 20 patients with proximal LAD stenosis >70% by angiography and ejection fraction ≥50%, without wall motion abnormality at resting echo (stenotic group) and 20 angiographically normal coronaries subjects with normal echocardiography (non-stenotic group) were included in the study. SRI and TVI were performed in nine segments of the LAD territory at rest. Parameters of interest included: peak systolic strain (ST, %), strain rate (SR, Second-1), and peak systolic velocity (Sm, cm/s). Results: Overal mean ST and SR showed a significant reduction in the stenotic group compared to non-stenotic group (P<0.001), while the mean Sm had no significant difference. A segment-by-segment comparison revealed a reduction of ST in 4/9 (two apical and two anteroseptal) and SR in 5/9 (three apical, septal, and anteroseptal midportion) in the stenotic group (P<0.05). Both ST and SR showed a significant reduction in three segments: anterior-apical, lateral-apical, and anteroseptal-midportion. When both ST and SR decreased in one segment, specificity and sensitivity for the diagnosis of proximal LAD stenosis was more than 80% and 55%, respectively, by Roc analysis. Conclusion: There is an overall reduction in the mean ST and SR in the segments of LAD territory with significant proximal stenosis and normal wall motion at rest and an acceptable specificity and sensitivity of SRI for the detection of stenosis in these segments.

Point-Based Virtual Environment for Detecting Scaffolding, Wearing, and Cracks of Furnace Walls

Maintenance of production facilities is important in various industries. Since production facilities degrade their original functions during their long life-cycle, it is necessary to periodically make deterioration diagnosis and renovate to restore functions. In recent years, the terrestrial laser scanner allows us to capture dense point-clouds from large production facilities. Point-based virtual environment is promising for supporting maintenance of production facilities. In this paper, we discuss the deterioration diagnosis of production facilities based on point-clouds when the original shapes of production facilities are unknown. As an example of production facilities, we consider the blast furnace, which is mainly used to produce metals from molten materials. We classify deterioration on the blast furnace as wearing, scaffolding, and cracks, and automatically detect them from point-clouds. In our method, the normal wall shape is estimated by fitting low-resolution B-spline surfaces to point-clouds, and deterioration is detected as the difference between the reference surface and the point-clouds. While wearing and scaffolding regions are relatively large, cracks are thin lines. In order to detect different scales of deterioration, we introduce the reference surfaces with multiple resolutions. In our experiments, the three types of deterioration could be successfully detected from dense point-clouds.

Restrictive cardiomyopathy

Restrictive cardiomyopathy (RCM) is an uncommon myocardial disease, characterized by impaired filling of the ventricles in the presence of normal wall thickness and systolic function. Most patients have both left- and right-sided heart failure which are often accompanied by severe symptoms. Enlargement of both atria is usually present and thromboembolic events are common. The prognosis is generally poor and a significant proportion of patients require a cardiac transplantation. RCM may appear in the context of diseases involving multiple organs or it may be confined to the heart. In addition, the condition appears in both familial and non-familial forms. The majority of familial forms are caused by sarcomeric gene mutations, which are also frequently identified in hypertrophic, dilated, and non-compaction cardiomyopathy. This implies that familial evaluation should be considered whenever an individual is diagnosed with RCM. In non-familial RCM, the most frequent aetiology is amyloidosis due to haematological diseases or senile forms. There are no randomized clinical trials of therapy in patients with symptomatic RCM. Diuretics remain the cornerstone of treatment and require careful titration since RCM patients are very sensitive to hypovolaemia. Since the condition is very rare with a severe disease expression and poor prognosis, it is recommended that RCM patients should be followed in expert centres in order to optimize management of the individual patient.

Finite element analysis of stresses in a flexible bulk solid container

Current theories and design codes pertaining to storage structures for bulk solids have been developed in the context of rigid-walled silos and may not be applicable for smaller and highly flexible containers that are often used for industrial packaging and intermediate storage. The focus of this study is to investigate the effect of wall flexibility on the bulk stresses and wall pressures during storage using finite element analysis. The results show that when the wall stiffness is low, the computed bulk stresses in the vertical bin section are dominated by plasticity, while the stresses in the hopper section remain in the elastic state. In this situation, the wall pressure in the bin section is heavily influenced by the strength of the stored solid, which controls the extent of plastic flow. Overall, the normal wall pressure in the bin section is found to decrease with wall flexibility leading to a corresponding increase in vertical stress in the stored solid. As a consequence, the stresses in the hopper also increase leading to increasing loads on the hopper walls and potential exacerbation of handling issues for cohesive materials in highly flexible containers.

Case Report: My lung broke my heart! Takotsubo cardiomyopathy due to pneumonia

Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is a cardiac syndrome that often mimics acute myocardial infarction. TTC is commonly triggered by physical or emotional stress; however, acute infection is a rarer etiology. This report concerns the case of an 82-year-old female who presented with non-positional and non-pleuritic chest pain, with an associated fever and cough and chest x-ray findings consistent with pneumonia. Cardiac enzymes and ECG findings were consistent with acute coronary syndrome (ACS); however, during coronary angiography, no coronary artery disease could explain the patient’s ACS. A post-catheterization echocardiogram revealed an ejection fraction of 25%, with apical akinesis. A repeat echocardiogram 4 weeks after presentation showed a normal EF and normal wall motion, confirming a diagnosis of TTC.

Incidence of Gallbladder Carcinoma in Thick Walled Gallbladder in Comparison with that of Normal Thickness – A Study of 300 Cases

Background: Gall bladder carcinoma (GBC) is the most common biliary tract cancer. Delayed presentation and early spread of tumor made it one of the lethal tumors with poor prognosis.Objective: The objective of this study is to find out the incidence of GBC in thick walled gall bladder (GB) in comparison with that of normal wall thickness.Methods: This prospective study was carried out in Combined Military Hospital (CMH) Dhaka, CMH Momenshahi and CMH Ghatail during the period of June 2007 to June 2014. A total 300 patients underwent cholecystectomy were studied retrospectively. Diagnosis was confirmed by histopathological examination.Results: Out of 300 patients 254 (84.88%) were female (male : female = 1:5.52), age range 28 to 79 years. Maximum number of the patients fall into fourth and fifth decades. 42 (14%) patients were found to have thick walled GB by preoperative sonography and during surgery. Histopathologically 13 (4.33%) patients were diagnosed as GBC. Maximum patient (52.33%) had chronic cholecystitis. Incidence of malignancy were higher (84.62%) in patients having thicke walled GB.Conclusion: GBC may present as focal or diffuse asymmetric wall thickening or even in GB having normal wall thickness. As early diagnosis and effective treatment can significantly reduce the morality and morbidity all specimen should be examined histopathologically.J Bangladesh Coll Phys Surg 2016; 34(4): 193-198