[Indirubin relieves inflammatory injury of chondrocytes in a mouse model of osteoarthritis]

OBJECTIVE

To investigate the effect of indirubin for relieving joint inflammation and injury in a rat model of osteoarthritis.

METHODS

Articular cartilage chondrocytes were isolated from adult rat knee joint and cultured in the presence of interleukin-1β (IL-1β) and 0.1, 0.5, 1.0, or 2.0 μmol/L indirubin. The cells were transfected with NPAS2 siRNA or a non-specific siRNA, and the cell proliferation and apoptosis were evaluated using tetramethylthiazole blue staining and flow cytometry. The protein expression levels of Bax, Bcl-2, ACAN, COL2A1, MMP-13 and NPAS2 were detected with Western blotting, and the levels of NO, PGE2 and TNF-α in the culture supernatant were determined with ELISA. The mRNA expression levels of NPAS2, ACAN, COL2A1 and MMP-13 were detected using fluorescence quantitative PCR. In a C57BL/6 mouse model of osteoarthritis, the effect of indirubin on BAX, Bcl-2, ACAN and MMP-13 protein expressions in the bone and joint tissues were evaluated with Western blotting.

RESULTS

Treatment with 0.1 μmol/L indirubin produced no significant changes in chondrocyte proliferation, apoptosis, caspase-3 activity, or BAX and Bcl-2 protein expressions. At higher doses (0.5, 1.0 and 2.0 μmol/L), indirubin significantly promoted cell proliferation, increased Bcl-2 protein expression, and lowered cell apoptosis rate, caspase-3 activity and Bax protein expression (P < 0.05). Indirubin treatment at 0.5 μmol/L up-regulated the protein and mRNA expressions of NPAS2, ACAN and COL2A1, and down-regulated the expressions of MMP-13, NO, PGE2 and TNF-α (P < 0.05). Interference of NPAS2 expression significantly attenuated the protective effect of 0.5 μmol/L indirubin against IL-1β-induced chondrocyte injury. The mouse model of osteoarthritis showed obviously increased protein levels of BAX and MMP-13 (P < 0.01) and decreased levels of Bcl-2 (P < 0.05) and ACAN (P < 0.01) in the knee joint, and indirubin treatment of the mouse models significantly inhibited the increase of BAX and MMP-13 protein expressions (P < 0.01) and up-regulated the protein expressions of Bcl-2 and ACAN (P < 0.05).

CONCLUSION

Indirubin has a protective effect on osteoarthritis tissue and alleviates inflammation and damage of osteoarthritis chondrocytes possibly through NPAS2.

[Progress in clinical diagnosis and treatment of multiple primary lung cancer]

With the application of high-resolution chest imaging system and lung cancer screening program, patients with multiple primary lung cancer (MPLC) are becoming a growing population in clinical practice. However, the diagnostic criteria of MPLC and its differentiation from intrapulmonary metastasis of lung cancer (IM) are still controversial, especially in cases with similar histology. On the basis of reviewing the existing literature, this paper discusses the changes of the diagnostic criteria of MPLC and the differential diagnosis methods of imaging, histology and molecular genetics of MPLC and IM, and briefly introduces the application of multidisciplinary diagnosis, algorithm, predictive model and artificial intelligence in the differential diagnosis of MPLC. In addition, we also discuss the latest progress in the treatment of MPLC. Radical surgery is the main method for the treatment of MPLC. Stereotactic body radiation therapy (SBRT) is safe and feasible for inoperable MPLC patients, and targeted therapy and immunotherapy can also be used in MPLC after appropriate patient selection.

[Soluble egg antigen of Schistosoma japonicum induces macrophage apoptosis in mice]

OBJECTIVE

To investigate the dynamic changes of macrophage numbers and apoptosis during Schistosoma japonicum infection, and to investigate the possible mechanisms of macrophage apoptosis induced by S. japonicum soluble egg antigen (SEA).

METHODS

C57BL/6 mice at ages of 6~8 weeks were randomly divided into 4 groups, including three experimental groups and a normal control group. Each mouse in the experimental groups was infected with (12 ± 1) cercariae of S. japonicum via the abdominal skin, and all mice in an experimental group were sacrificed 3, 5, 8 weeks post-infection, respectively, while mice in the control group were not infected with S. japonicum cercariae and sacrificed on the day of S. japonicum infection in the experimental group. Mouse liver specimens and peritoneal exudation cells were sampled in each group, and the dynamic changes of macrophage numbers and apoptosis were detected. Mouse peritoneal macrophages were isolated, purified and treated with S. japonicum SEA, PBS and ovalbumin (OVA) in vitro, and the macrophage apoptosis was detected using flow cytometry. The mRNA and protein expression of BCL-2 protein family members were determined in macrophages using real-time quantitative PCR (qP-CR) and Western blotting assays, and the activation of caspase 3 was determined using flow cytometry and Western blotting. In addition, macrophages were in vitro treated with S. japonicum SEA in presence of a caspase inhibitor, H₂O₂ or N-acetyl-L-cysteine, and the apoptosis of macrophages was detected using flow cytometry.

RESULTS

The total macrophage numbers continued to increase in mouse liver [(0.873 ± 0.106) × 106, (2.737 ± 0.460) × 10⁶ and (3.107 ± 0.367) × 10⁶ cells, respectively; F = 81.900, P < 0.01] and peritoneal specimens [(5.282 ± 1.136) × 105, (7.500 ± 1.200) × 10⁵ and (12.800 ± 0.800) × 10⁵ cells, respectively; F = 55.720, P < 0.01] 3, 5 and 8 weeks post-infection with S. japonicum, and the numbers of apoptotic macrophages also continued to increase in mouse liver [(0.092 ± 0.018) × 10⁶, (0.186 ± 0.025) × 10⁶ and (0.173 ± 0.0270) × 10⁶ cells; F = 57.780, P < 0.01] and peritoneal specimens [(0.335 ± 0.022) × 10⁵, (0.771 ± 0.099) × 10⁵ and (1.094 ± 0.051) × 10⁵ cells; F = 49.460, P < 0.01] 3, 5 and 8 weeks post-infection with S. japonicum. The apoptotic rate of SEA-treated macrophages [(24.330 ± 0.784)%] was significantly higher than that of PBS-[(18.500 ± 1.077)%] and OVA-treated macrophages [(18.900 ± 1.350)%] (both P values < 0.01). There were no significant differences in the mRNA or protein expression of Bcl-2 [Bcl - 2 mRNA expression: (1.662 ± 0.943) vs. (1.000 ± 0.000), t = 1.215, P > 0.05; BCL protein expression: (0.068 ± 0.004) vs. (0.070 ± 0.005), t = 0.699, P > 0.05], Bax [Bax mRNA expression: (0.711 ± 0.200) vs. (1.000 ± 0.000), t = 2.507, P > 0.05; BAX protein expression: (0.089 ± 0.005) vs. (0.097 ± 0.003), t = 2.232, P > 0.05] and Bak [Bak mRNA expression: (1.255 ± 0.049) vs. (1.00 ± 0.00), t = 0.897, P > 0.05; BAK protein expression: (0.439 ± 0.048) vs. (0.571 ± 0.091), t = 2.231, P > 0.05] between in SEA- and PBS-treated macrophages. S. japonicum SEA induced macrophage apoptosis in the presence of a caspase inhibitor (F = 0.411, P > 0.05); however, SEA failed to induce macrophage apoptosis in the presence of H₂O₂ or NAC (F = 11.880 and 9.897, both P values < 0.05).

CONCLUSIONS

S. japonicum SEA may induce macrophage apoptosis through promoting reactive oxygen species expression during S. japonicum infections in mice.

POS0071 THE EFFICACY OF PIRFENIDONE COMBINED WITH IMMUNOSUPPRESSANT THERAPY IN THE CONNECTIVE TISSUE DISEASE-ASSOCIATED PULMONARY INTERSTITIAL DISEASE, A 24-WEEK PROSPECTIVE CONTROLLED COHORT STUDY

Background

Pulmonary interstitial disease(ILD)is very common in connective tissue disease (CTD). Different subtypes display significant differentiations in prognosis. Pirfenidone (PFD), the targeted anti-fibrosis and anti-inflammatory drug, started to apply in CTD-ILD, while its strategy of combination with immunotherapy, bridging time and service time are worth discussing.

Objectives

To evaluate the efficacy and safety of PFD combined with immunosuppressant (IS) in the treatment of several CTD- ILD.

Methods

111 CTD-ILD patients were involved from Aug 2019 to Dec 2021 (ClinicalTrials.gov Identifier NCT04928586), including systemic sclerosis (SSc, n=30), inflammatory myopathy (IIM, n=51), rheumatoid arthritis (RA, n=17) and other CTDs (such as systemic lupus erythematosus, sjogren’s syndrome, n=13). Patients were treated with relative stable dose of glucocorticoid (GC) and/or IS since screening.After the evaluation of HRCT, pulmonary function (FVC% and DLCo%) and basic disease activity, PFD was added or not and followed up regularly for 24 weeks. The changes of lung function and imaging were recorded in different subgroups.

Results

At baseline, The FVC% in the SSc-PFD (n=14), IIM-PFD (n=25) pts were lower than that of SSc-no-PFD (n=16), IIM-no-PFD (n=26) respectively, that was 81.06 vs 99.63(p = 0.014), 78.23 vs 91.12, (p= 0.010). And IIM-PFD group present a lower baseline DLCo% than IIM-no-PFD pts (64.25 vs 72.82, p =0.034). DLCo% in the other CTDs was lower than SSc, IIM, RA pts (54.58 vs 65.55, 68.71, 66.89, p=0.036), while there were no significant differences in baseline FVC% among these disease.

After 24 weeks of treatment, FVC% in SSc-PFD group was improved by 7.15%, while that was -0.91% in SSc-no-PFD pts (p=0.042). The elevation in FVC% was also significant between the IIM-PFD and IIM-no-PFD control (8.00 vs 1.40, p=0.016). On the other hand, DLCo% of RA-PFD obviously enhanced 7.40%, compared with RA-no-PFD decrease 5.50% from baseline(p=0.002) (Figure 1).

Figure 1.

The changes of FVC% and DLco% in PFD treated CTD-ILD for 24 weeks. (A) FVC% changes in SSc, IIM, RA and other CTD-ILD from baseline.; (B) DLco% changes in SSc, IIM, RA and other CTD-ILD from baseline. * p< 0.05, compared to no PFD treatment group.

When performing subgroup analysis with manifestations in HRCT, the change of FVC% in SSc-PFD pts with usual interstitial pueumonia tendency(SSc-PFD-UIP) was higher than SSc-PFD-non-UIP group (8.05 vs -3.20, p=0.014). However, the non-UIP tendency in IIM-PDF pts displayed superior therapeutic effects than IIM-PDF-UIP pts (10.50 vs 1.00, p=0.005). In addition, DLCo% improved significantly in RA-PDF-non-UIP subgroup, compared with RA-PDF-UIP pts (10.40 vs -4.45, p=0.017).

According to whether the baseline FVC% and DLCo% value was less than 70%, the improvement of FVC% was significantly higher in PFD treatment group than no-PFD pts of SSc and IIM with baseline High-FVC%(6.60 vs 0.10, p=0.047),(6.30 vs 1.10, p= 0.089).In RA-PFD pts, DLCo% showed a significant increase in baseline DLCo% less than 70% subgroup, compared to RA-no-PDF (7.40% vs -6.60%, p=0.011).The basic IS were considerable between PFD andno-PFD pts throughout the study and no differences of GS and IS dosages at baseline and follow up among all subgroups.

Multiple linear regression analysis found that baseline FVC%<70%(HR=4.56,6.81) and prescription of PFD(HR=4.56,4.37) could positively affect the changes of FVC% and DLCo% (all p<0.05).

Conclusion

The response of pulmonary function to PFD were varied in different CTD-ILD subsets. SSc and IIM pts acquired obviously improvement on FVC%, especially with high baseline FVC group. DLco% elevated in RA-PFD, highlight those baseline Low-DLco and No-UIP pts.

Acknowledgements

Funded by ECCM Program of Clinical Research Center of Shandong University (No. 2021SDUCRCB010)

Disclosure of Interests

None declared

Understanding the Complex Interactions between Coffee, Tea Intake and Neurologically Relevant Tissues Proteins in the Development of Anxiety and Depression

OBJECTIVES

Coffee and tea intake might be associated with psychiatry diseases. However, it is unclear whether the effect of coffee/tea on anxiety and depression depending on the different types of proteins.

DESIGN

This was a cross-sectional study.

SETTING

Our datasets were downloaded from online.

PARTICIPANTS

Phenotypic and genotypic data for coffee intake(N=376,196) and tea intake (N=376,078) were derived from UK Biobank. GWAS data of proteins (N=1,537) from neurologically relevant tissues (brain, cerebrospinal fluid (CSF) and plasma) were obtained from a recently published study.

MEASUREMENTS

Multivariate linear analysis was then used to evaluate the potential interaction effect between coffee/tea intake and proteins polygenetic risk score (PRS) on the risks of anxiety and depression controlling for age, sex, Townsend deprivation index (TDI), smoke, drinking and education level.

RESULTS

34 coffee intake-proteins interactions and 15 tea intake-proteins interactions were observed in anxiety individuals, such as coffee intake-c-Jun interaction (β=0.0169, P=4.131×10-3), coffee intake-Fas interaction (β=-0.0190, P=8.132×10-4), tea intake-sL-Selectin interaction (β=0.0112, P=5.412×10-3) and tea intake-IL-1F6 (β=0.0083, P=4.471×10-2). 25 coffee intake-proteins and 14 tea intake-proteins interactions were observed in depression individuals, including coffee intake- IL-1 sRI (β=0.0171, P=4.888×10-3) and coffee intake-NXPH1 interaction (β=0.0156, P=9.819×10-3), tea intake-COLEC12 interaction (β=0.0127, P=3.280×10-3), and tea intake-Layilin interaction (β=0.0117, P=7.926×10-3).

CONCLUSIONS

Our results suggested the important role of multiple proteins in neurologically relevant tissues in the associations between coffee/tea intake and psychiatry diseases, providing entry points to explore the mechanisms underlying anxiety and depression.

[Study on the genetic characteristics of enteric viral pathogens of sporadic adult diarrhea in Chaoyang district, Beijing in 2019]

Objective: To analyze the distribution and genetic characteristics of sporadic adult diarrhea virus in Chaoyang District, Beijing. Methods: Fecal samples from 177 adult patients with sporadic diarrhea were collected from 4 enteric outpatient clinics in Chaoyang District, Beijing from May to December 2019. Nucleic acid detection of Norovirus, Sappovirus, Rotavirus, Enteric Adenovirus and Astrovirus in the samples was performed by real-time quantitative PCR. The positive samples were amplified by RT-PCR/PCR and sequenced. The phylogenetic analysis was performed by neighbor-Joining (NJ) methods of Mega 6.0 software. Results: There were 60 of 177 (33.90%) adult sporadic diarrhea samples positive for enteric viral pathogens. Among them, 47 cases were infected with single virus, including 29 cases of Norovirus, 9 cases of Sappovirus, 8 cases of Astrovirus and 1 case of Enteric Adenovirus, in addition with 13 cases of multiple infections. None of rotavirus was detected. Partial sequences were successfully obtained for analysis, including 16 cases of GI Norovirus (7 subtypes and GI.3[P13] predominant), 10 cases of GII Norovirus (5 subtypes and GII.6[P7] predominant), 12 cases of Sappovirus (4 subtypes and GI.2 predominant), and 7 cases of Astrovirus (2 subtypes and AST-1 predominant). Conclusion: Norovirus, Astrovirus and Sappovirus are main pathogens among sporadic adult diarrhea in Beijing in 2019, and and different pathogenic gene subtypes show diverse characteristics.

The clinical characteristic of biliary-hyperlipidemic etiologically complex type of acute pancreatitis: a retrospective study from a tertiary center in China

OBJECTIVE

Biliary and hyperlipidemic acute pancreatitis (AP) has become the second most common AP in China. Currently, AP is exclusively diagnosed as biliary or hyperlipidemic AP. However, as suggested by some reports, biliary and hyperlipidemic AP might coexist in a single patient. Moreover, acute lipotoxicity was shown to regulate the severity of biliary AP in the mouse model. Thus, whether these two etiologies coexist in AP patients and potentially worsen the clinical course remains unclear. To elucidate the clinical feature of a new complex type of acute pancreatitis with both biliary and hyperlipidemic etiologies.

PATIENTS AND METHODS

This retrospective study included AP patients who were admitted into our department within 7 days after the onset of the disease. 267 AP patients were enrolled in this study and were classified as BAP (biliary acute pancreatitis, n=153), HLAP (hyperlipidemic acute pancreatitis, n=65) and BHAP (biliary-hyperlipidemic acute pancreatitis, n=49). All the enrolled patients met the classification criteria of biliary etiology, hyperlipidemic etiology, and both etiologies, respectively. BHAP was compared with BAP and HLAP in terms of general information, inflammatory biomarkers, organ dysfunction, disease severity and clinical outcomes.

RESULTS

BHAP (41 vs. 53) patients were younger than BAP patients. Serum procalcitonin of BHAP patients was higher than BAP and HLAP patients. Serum CRP of BHAP patients was higher than BAP patients. BHAP patients had the highest diagnosis rate of severe acute pancreatitis (SAP) (46.9% vs. 17.6% or 21.5%) compared to BAP and HLAP. Prevalences of persistent respiratory, acute renal, and circulatory failure were highest in BHAP patients (44.9%, 28.6%, 12.2%, respectively). Requirements for mechanical ventilation, renal replacement therapy and vasoactive agents were also highest in BHAP patients (36.7%, 34.7%, 12.2%, respectively). Hospital stay was longer in BHAP patients (33 days) compared with BAP patients (24 days).

CONCLUSIONS

Patients with both biliary and hyperlipidemic etiologies suffer from more severe clinical course of the disease and have worse prognosis than single-etiology BAP or HLAP patients in the early stage of AP (within 7 days). It should be recognized as a new etiological type named biliary-hyperlipidemic acute pancreatitis (BHAP).

CBD Promotes Oral Ulcer Healing via Inhibiting CMPK2-Mediated Inflammasome

Oral ulcer is a common oral inflammatory lesion accompanied by severe pain but with few effective treatments. Cannabidiol (CBD) is recently emerging for its therapeutic potential in a range of diseases, including inflammatory conditions and cancers. Here we show that CBD oral spray on acid- or trauma-induced oral ulcers on mice tongue inhibits inflammation, relieves pain, and accelerates lesion closure. Notably, the enrichment of genes associated with the NOD, LRR, and NLRP3 pyrin domain-containing protein 3 (NLRP3) inflammasome pathway is downregulated after CBD treatment. The expression of cleaved-gasdermin D (GSDMD) and the percentage of pyroptotic cells are reduced as well. In addition, CBD decreases the expression of cytidine/uridine monophosphate kinase 2 (CMPK2), which subsequently inhibits the generation of oxidized mitochondria DNA and suppresses inflammasome activation. These immunomodulating effects of CBD are mostly blocked by peroxisome proliferator activated receptor γ (PPARγ) antagonist and partially antagonized by CB₁ receptor antagonist. Our results demonstrate that CBD accelerates oral ulcer healing by inhibiting CMPK2-mediated NLRP3 inflammasome activation and pyroptosis, which are mediated mostly by PPARγ in the nucleus and partially by CB₁ in the plasma membrane.

CT texture analysis for the presurgical prediction of superior mesenteric-portal vein invasion in pancreatic ductal adenocarcinoma: comparison with CT imaging features

AIM

To investigate the value of computed tomography (CT) texture analysis (TA) and imaging features for evaluating suspected surgical superior mesenteric-portal vein (SMPV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).

MATERIALS AND METHODS

Fifty-four patients with PDAC in the pancreatic head or uncinate process with suspected SMPV involvement were analysed retrospectively. SMPV invasion status was identified by surgical exploration. For each patient, 396 texture features were extracted on pretreatment CT. Non-parametric tests and minimum redundancy maximum relevance were used for feature selection. A CTTA model was constructed using multivariate logistic regression, and the area under the receiver operating characteristic (AUROC) of the model was calculated. Two reviewers evaluated qualitative imaging features independently for SMPV invasion and interobserver agreement was investigated. The diagnostic performance of the imaging features and the CTTA model for SMPV invasion was compared using the McNemar test.

RESULTS

Of the 54 patients with PDAC, SMPV invasion was detected in 23 (42.6%). The CTTA model yielded an AUROC of 0.88 (95% confidence interval, 0.76-0.97) and achieved significantly higher specificity (0.90) than the two reviewers (0.61 and 0.65; p=0.027 and 0.043). Interobserver agreement was moderate between the two reviewers (κ = 0.517). Of the 13 cases with disagreement between the two reviewers, 11 cases were predicted accurately by the CTTA model.

CONCLUSION

CTTA can predict suspected SMPV invasion in PDAC and may be a beneficial addition for qualitative imaging evaluation.

Immigration and Oral Health in Older Adults: An Integrative Approach

The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.

Effect of Polyphenols on Cognitive Function: Evidence from Population-Based Studies and Clinical Trials

Due to progressive population aging, a new dementia case occurs at every 3 seconds, placing a heavy burden of disease. Identifying potential risk or preventive factors is emphasized owing to a lack of effective treatment for dementia. There has been emerging evidence on the link of certain dietary components, particularly polyphenols, to brain wellness and cognitive outcomes. Findings from animal and in vitro studies appear more consistent and conclusive. However, such an association has not been investigated in depth in human beings. In this review, we examined studies on the effect of dietary polyphenols (including flavonoids, curcumin, and resveratrol) on cognitive function. Intervention in early stages of dementia/Alzheimer's disease might be a target to slow down age-related cognitive decline before disease onset. We summarized 28 epidemiological studies (8 cross-sectional and 20 cohort studies) and 55 trials in this review. Preliminary evidence from epidemiological data provides the necessity for intervention trials, even though the measures of polyphenol intake tend to be less precise. Clinical trials are in favor of the role of some polyphenols in benefiting specific domains of cognition. This review also describes the divergence of results and current limitations of research in this field.

Patterns of left ventricular longitudinal myocardial dysfunction in mitral valve prolapse and effects of valve repair

Background

Regional longitudinal left ventricular (LV) dysfunction in patients with mitral regurgitation (MR) due to valve prolapse (MVP) with normal ejection fraction has been recently described, with data pointing at dysfunction of the LV base related to dilatation of the mitral annulus.

Purpose

To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP and severe acute (MRa, n=27) or chronic (MRc, n=41) MR and no coronary disease, undergoing surgical valve repair with 3 months follow-up (FU); 20 normal subjects were used as controls (N).

Methods

Speckle-tracking echocardiography was performed pre- (Bas), 1 week (1w) and 4 months (4mo) post-operatively to measure longitudinal global (GLPSS, %), regional (RPSS, %) and segmental (SPSS) peak systolic strain. Maximum and minimum mitral annulus (MA) diameters were measured with 3D echo at Bas. We also evaluated: LV end-diastolic volume index (EDVi, ml/m2); ejection fraction (EF, %); left atrial end-systolic volume index (LAVi, ml/m2); non-invasive pulmonary systolic pressure (PSP, mmHg).

Results

Risk factors (hypertension, diabetes, atrial fibrillation, smoke and previous stroke) were similar in MRc and MRa. At Bas EDVi was larger by definition in MRc (MRc: 102±21, MRa: 67±10 ml/m2, p&lt;0.001) as LAVi (101±46 vs 76±31 ml/m2, p=0.035). Both EF (65±8 vs 64±8 ml/m2) and GLPSS (−20±4 vs −21±5%) were normal, but RPSS was reduced, only at the base (−13±6 vs −13±6%, p= ns; N: −18±2, p&lt;0.03 vs MRc and MRa) in MRc and MRa, with reduced SPSS localized at anterior, lateral and posterior – but not septal – segments. At 1w, EF decreased in both MRc (47±14%, p&lt;0.001 vs Bas) and MRa (56±10%, p=0.014 vs Bas), together with GLPSS (MRc: −11±4%, p&lt;0.001 vs Bas; MRa; −13±4, p&lt;0.001 vs Bas) driven by a prevalent marked decrease in RPSS (MRc: −7±4%, p&lt;0.001 vs Bas; MRa; −8±5, p&lt;0.001 vs Bas) of the LV base. All patients were alive at 3 months with no MACEs, similar reduction of mean MR grade (MRc: 4±0 to 1.9±0.7, p&lt;0.001; MRa: 3.9±0.3 to 0.9±0.9, p&lt;0.001) and PSP (MRc: 50±23 to 29±5 mmHg, p&lt;0.001; MRa: 42±22 to 32±6 mmHg, p=0.039), normal EDVi (MRc: 70±27, MRa: 49±10 ml/m2), dilated LAVi (MRc: 101±46, MRa: 54±13 ml/m2), and reduced GLPSS (MRc: −12±5%, p&lt;0.001 vs Bas; MRa; −15±3, p=0.001 vs Bas) and base RPSS (MRc: −7±6%, p=0.004 vs Bas; MRa; −10±4, p= ns vs Bas). At multivariate analysis, regional dysfunction was not related to the prolapsing scallop, presence of flail, commissure involvement, dimension and geometry of the MA, EF or pulmonary pressures.

Conclusions

In patients with MVP and severe MR, there is a specific regional longitudinal dysfunction pattern prevalent at the LV base which may be related to the duration of MR but not to annular dilatation or morphology of the prolapsing leaflets. The dysfunction worsens greatly following acute reduction of preload after surgical repair and is still significant at 4mo FU.

Funding Acknowledgement

Type of funding source: None