Sperm morphology of Tingidae Laporte, 1833 (Miroidea: Cimicomorpha)

Here, we describe for the first time the sperm morphology of Tingidae (Heteroptera). They are small insects presenting lacy patterns on their pronotum and hemielytra and are exclusively phytophagous, with many economically important species. We studied five species of the tribe Tingini (Tinginae): Teleonemia scrupulosa, Vatiga illudens, Gargaphia lunulata, Leptopharsa sp., and Corythucha arcuata. Their spermiogenesis process is similar to other Heteroptera, with some differences in the formation of the centriole adjunct. This structure extends in the anteroposterior spermatid axis, flanking the nucleus, possibly contributing to nucleus remodeling and sperm elongation. The mature sperm of Tingidae is also similar to that of other Heteroptera, with features that corroborate the group's monophyly. Our data support previous results for their sister family, Miridae, which exhibits some characteristics exclusive to this taxon, not present in Tingidae or other Heteroptera. They also support the sister relationship of the genera Gargaphia and Leptopharsa and suggest closer relationship between Vatiga and Corythucha. Overall, this study sheds light on the sperm ultrastructure of Tingidae and provides information for understanding the evolution and diversity of Heteroptera. RESEARCH HIGHLIGHTS: The spermiogenesis process and mature sperm are similar to other Heteroptera The centriole adjunct is derived from a strip of a pericentriolar material extending from the centriole Tingidae and Miridae are distinguishable using sperm morphology.

Morphology of the male reproductive system and sperm of Leptoglossus zonatus (Dallas, 1852) (Heteroptera: Coreidae)

Taxonomic data on Coreidae have been fragmented over time and need to be revised. Likewise, data related to the development of germ cells and the features of the male reproductive system, including sperm, will contribute to understanding the biological mechanisms of reproduction and the systematics of its representatives. Aiming to provide these data, we describe the morphology of the male reproductive system and spermatozoa of Leptoglossus zonatus using light and transmission electron microscopies, respectively. Each of the two testes is surrounded by a bright red-pigmented sheath and formed by seven follicles arranged side by side. The two vasa deferentia are filled with individualized sperm, especially in their final portion, which is dilated and curved. After dilation, the vasa deferentia receive the ducts of the accessory glands of mesodermal origin. The other unpaired accessory gland is of ectodermal origin and opens into the ejaculatory duct. Both glandular types are densely coiled and have lumens filled with secreted material. Testicular follicles contain cysts with germ cells at different stages of spermatogenesis, indicating continuous production of gametes throughout adult life. Mature sperm measure around 310 μm long, with a nucleus of 36 μm and a flagellum formed only by an axoneme of 9 + 9 + 2 microtubules and two symmetrical mitochondrial derivatives. Like the sperm of other Heteroptera, the acrosome has a single structure (without perforatorium), there are no accessory bodies in the flagella, and the mitochondrial derivatives are connected to the axonemes, supporting the synapomorphic condition of these characteristics for this suborder of bedbugs. RESEARCH HIGHLIGHTS: The Leptoglossus zonatus sperm are slender and long, about 310 μm in length, and a nucleus 36 μm long. Spermatogenesis occurs throughout adult life and equally in the seven testicular follicles. The centriole adjunct in L. zonatus sperm does not give rise to accessory bodies. The ectodermal gland produces a filamentous secretion, whereas in the ectodermal sac, the secretion is globular.

Morphology of the male reproductive system and spermatozoa of Mahanarva fimbriolata (Stål, 1854) (Hemiptera: Cercopidae) with evidence of a spermatostyle in the sperm conjugation

Changes in harvesting methods in the early 1990s led to Mahanarva fimbriolata becoming the most prevalent pest in sugarcane plantations. Encouraged by the scarcity of research on the reproductive system and spermatology of Auchenorrhyncha, we provide a detailed description of the male reproductive system and spermatozoa of this cercopid. This will not only aid in taxonomic purposes but also help in understanding the reproductive biology of the species. The male reproductive system, spermatozoa, and sperm bundles of M. fimbriolata were investigated using light microscopy. Our results reveal a reproductive system consisting of a pair of testes, each with 36 follicles, two vasa deferentia, two well-developed seminal vesicles, a single pair of accessory glands, and an ejaculatory duct. Here, we also describe and explore the particularities of the formation of secondary sperm bundles, where cells interestingly bind only to the apical region of the spermatostyle. We also propose some possible benefits of this unusual organization for the reproductive success of the species.

Morphology of the male reproductive system and spermatozoa of Smicridea (Rhyacophylax) iguazu Flint, 1983 (Trichoptera, Hydropsychidae)

The Trichoptera, holometabolous aquatic insects found worldwide except in Antarctica, exhibit a unique feature in their sperm, which are solely nucleated (eupyrene). Current knowledge on Trichoptera sperm is limited to Old World species. To enhance our understanding of their reproductive biology and contribute to systematic discussions, we describe the male reproductive system and spermatozoa of Smicridea (Rhyacophylax) iguazu Flint, 1983 (Hydropsychidae). This species lacks seminal vesicles, possesses piriform to oval-shaped testes with spermatozoa grouped in apical bundles and dense filamentous material filling other areas. The vasa deferentia are long and a pair of elongated accessory glands displays distinct proximal and distal regions. The relatively short (∼40 μm) spermatozoa are nucleated, aflagellated, and immobile. Further research could explore variations and assess the taxonomic utility of these features for genus identification within Hydropsychidae.

Sperm ultrastructure of Pycnoderes incurvus (Hemiptera: Miridae)

The sperm morphology can provide helpful information about sexual selection, phylogeny, and the evolutionary history of a given animal group. However, there is limited or no knowledge of many taxa, especially those belonging to insects, a vast and highly diverse group. An example is the Miridae, or plant bugs, which belong to the infraorder Cimicomorpha (Heteroptera), where only three out of 17 families have published data on their sperm morphology. Here we described the Miridae sperm structure by analyzing Pycnoderes incurvus sperm under light and transmission electron microscopy. In this species, the spermatozoa were as long and slender as those of most insects. However, the anterior-most region was twisted, a characteristic first reported for Heteroptera. The acrosome was coated with electron-dense material, most likely extra-acrosomal. The centriole adjunct was a notably long, cylindrical and compact structure connecting the nucleus to the flagellar elements, with just clove-like electron-lucent points in cross-section, also features unique to Miridae so far. The flagella exhibited an axoneme of 9 + 9 + 2 microtubules and two symmetrical mitochondrial derivatives. The latter two partially embrace the axoneme, and each exhibits two paracrystalline areas and a bridge connecting it to the axoneme; these are considered Heteroptera synapomorphies that support their monophyly. RESEARCH HIGHLIGHTS: The P. incurvus sperm showed a twisted acrosome, the first reported for Heteroptera. The centriolar adjunct is a sole structure linking the nucleus and flagellum. The flagella presented the synapomorphies supporting Heteroptera monophyly.

New Findings on the Sperm Structure of Tenebrionoidea (Insecta, Coleoptera)

Simple Summary

Tenebrionoidea, with more than 30,000 described species and 30 currently recognized families, is a superfamily of difficult taxonomy. The aim of this work is to support the basal position of the Mordellidae among the beetle tenebrionoids. They have a low number of sperm cells per cysts, contrary to the more derived families of the group; moreover, their sperm are not distributed in two bundles at the opposite poles of the cysts, as occurs in the higher taxa, but their sperm flagella form a loop in the median region so that sperm nuclei are positioned close to the tail end. The sperm structure of two members of higher families, Oedemeridae and Tenebrionidae, are investigated to confirm the data mentioned above. The sperm looping, which also occurs in the closely related Ripiphoridae, could be the consequence of the growth asynchrony between the cyst size and the sperm length. The Mordellidae sperm are characterized, not by small mitochondrial derivatives and accessory bodies, but by a peculiar stiff and immotile thin flagellar posterior region provided with only accessory tubules.

Abstract

The sperm ultrastructure of a few representative species of Tenebrionoidea was studied. Two species belong to the Mordellidae (Mordellistena brevicauda and Hoshihananomia sp.), one species to Oedemeridae (Oedemera nobilis), and one species to Tenebrionidae (Accanthopus velikensis). It is confirmed that Mordellidae are characterized by the lowest number of spermatozoa per cyst (up to 64), a number shared with Ripiphoridae. In contrast, in the two other families, up to 512 spermatozoa per cyst are observed, the same number present, for example, in Tenebrionidae. Also, as in the other more derived families of tenebrionoids studied so far, during spermatogenesis in O. nobilis and A. velikensis, sperm nuclei are regularly distributed in two sets at opposite poles of the cysts. On the contrary, the Mordellidae species do not exhibit this peculiar process. However, during spermiogenesis, the bundles of sperm bend to form a loop in their median region, quite evident in the Hoshihananomia sp., characterized by long sperm. This process, which also occurs in Ripiphoridae, probably enables individuals to produce long sperm without an increase in testicular volume. The sperm looping could be a consequence of the asynchronous growth between cyst size and sperm length. The sperm ultrastructure of the Mordellidae species reveals that they can be differentiated from other Tenebrionoidea based on the shape and size of some sperm components, such as the accessory bodies and the mitochondrial derivatives. They also show an uncommon stiff and immotile posterior flagellar region provided with only accessory tubules. These results contribute to a better knowledge of the phylogenetic relationship of the basal families of the large group of Tenebrionoidea.

Prognostic value of exercise stress echocardiography in patients with known coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Background

Exercise stress echocardiography (EE) is useful for diagnosis and risk stratification in patients (pts) with suspected coronary artery disease (CAD). Pts with known CAD carry a high risk of events. Our aim was to assess the utility of EE in predicting outcomes in this population.

Methods

Single center retrospective study of consecutive pts with known CAD who performed an EE between 2018 and 2019. The primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up.

Results

A total of 76 pts were included (mean age 59±9 years; 87% male). Fifty-nine (78%) pts had history of ACS, 51 (67%) of percutaneous coronary intervention (PCI) and 14 (18%) of coronary artery bypass graft. The majority of pts had 2 or more vessel disease (42 pts; 55%).

The main reason for performing EE was new onset of chest pain (38 pts; 50%) followed by functional assessment of coronary stenoses after incomplete revascularization (29 pts; 38%). The majority of pts had a preserved left ventricular ejection fraction (67; 88%). The exam was performed under beta-blocker effect in 35 (46%) pts.

The results of EE were positive for myocardial ischemia in 7 (9%) pts, negative in 37 (49%) pts and inconclusive in 32 (42%) pts. Mean exercise time was 8±3 minutes and mean METs achieved was 9.4±2.6. ST-segment depression fulfilling electrocardiographic criteria for ischemia occurred in 17 (22%) pts. Eleven (14%) pts complained of chest pain during the exam.

During a median follow up of 22 months (IQR 15-26), the primary endpoint occurred in 9 pts (admission for ACS in 5 pts; revascularization for chronic coronary syndrome in 4 pts). No cardiovascular death occurred. The positive predictive value of EE for the primary endpoint was 57.1% and the negative predictive value (NPV) 97.3%.

In a survival analysis, the predictors of the primary endpoint were lower exercise time, lower METs achieved, untreated significant coronary lesions and a positive EE (figure).

After adjustment in a multivariate analysis, a positive EE was an independent predictor of the primary endpoint (HR 4.6, 95%CI: 1.1-16.7, p=.044).

Conclusion

In pts with known CAD, EE had a high NPV and a positive result was an independent predictor of future cardiovascular events.

A left systolic dysfunction study in a group of breast cancer patients and its clinical impact

Funding Acknowledgements

Type of funding sources: None.

Background

 Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in patients with breast cancer (BC) under chemotherapy, in particular with anthracyclines (A) or trastuzumab (T). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) >10% to a value <50% or as a relative reduction of global longitudinal strain (GLS) >15%.

Purpose

We aim to evaluate the frequency of CTRCD and its clinical impact on BC patients.

Methods

 Retrospective study of patients with BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a  transthoracic echocardiography (TTE) before, during, and after chemotherapy. We analysed their baseline characteristics and outcomes based on the type of treatment received, and focusing specially on parameters of ventricular function.

Results

 We included 128 females with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%).

At the end of A therapy, there was a significant decrease in LVEF (64,2 ± 5,4% vs 62.6 ± 5,3%, p < 0.05) and in GLS (-20,7 ± 1.9% vs -18.8 ± 2.2%, p < 0.001) compared to baseline. No change in tricuspid annular systolic velocity (S") (p = 0,842) was observed. At 2 years of follow-up, this group of patients had no significant difference in LVEF (64,58 ± 5,58 vs 62,63 ± 6,48, p = 0,053) but maintained a significant lower GLS (-20,84 ± 2,13 vs -18,51± 2,52, p < 0,001) compared to baseline. A significant decrease in S’ (14,36 ± 2,55 vs 13,25 ± 2,26, p < 0,05) was observed.

During T therapy, there was a significant decrease in LVEF (65,04 ± 5,41 vs 59,30 ± 6,21, p < 0,001), in GLS (-21,21 ± 2,75 vs -17,89 ± 2,77, p < 0,001) and in S’ (14,39 ± 3,05 vs 12,19 ± 1,62, p < 0,001) compared to baseline. At the end of T therapy (with or without A), this group of patients maintained a significant decrease in LVEF (65,11 ± 5,65 vs 61,29 ± 6,39, P < 0,001) and in GLS (-21.41%±2,86 vs -19.54%±3,50, p < 0,01). S’ returned to normal values (p = 0,10). At 2 years of follow-up, this group of patients maintained a significant decrease in LVEF (65,00 ± 5,99 vs 61,18 ± 6,30, p < 0,05) but GLS (p = 0,235) returned to normal values. No change in S’ was observed (p =0,379).

During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD with a higher prevalence in patients who took A followed by T (18; 14%), 9 (7%) presented with clinical heart failure, 1 (1%) needed hospitalization, 5 (4%) needed to temporarily suspend treatment and 3 (2%) needed to definitely stop treatment.

Conclusions

 Treatment with A was associated with a decrease in LV systolic function at the end of therapy. A decrease in right ventricular (RV) systolic function was observed at 2 years of follow-up. Treatment with T was associated with a decrease in RV and LV systolic function during therapy. CTRCD occurred in 27%, mainly on patients with both A and T therapy, a frequency within literature data. CTRCD had clinical impact leading to HF and suspension of chemotherapy.

Cancer therapeutics-related cardiac dysfunction: what is the role of cardioprotective medication?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in patients with breast cancer (BC) under chemotherapy, in particular with anthracyclines (A) or trastuzumab (T). Guidelines recommend regular left ventricular ejection fraction (LVEF) assessments and CTRCD management with cardioprotective medication (CPM). However, while secondary prevention has already entered clinical practice, primary prevention is still in the research domain.

Purpose

Our aim was to evaluate the role of CPM and the risk of CTRCD in BC patients.

Methods

Retrospective study of BC patients treated with A and/or T between Jan 2017 and Dec 2018 who underwent a transthoracic echocardiography (TTE) before, during, and after chemotherapy. Patients with baseline LVEF <50% were excluded. CTRCD is defined as reduction of EF >10% to a value <50% or as relative reduction of global longitudinal strain (GLS) >15%. As CPM we considered angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB) and beta-blockers (BB).

Results

We included 128 patients, all female with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%).

At baseline, mean LVEF was 64,7 ± 5,7% and mean GLS was -20,8 ± 2,3.

During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD with a higher prevalence in patients who took A followed by T (18; 14%), 9 (7%) presented with clinical heart failure, 1 (1%) needed hospitalization, 5 (4%) needed to temporarily suspend treatment and 3 (2%) needed to definitely stop treatment. ACEI/ARB therapy was initiated in 12 (34%) and BB therapy was initiated in 10 (29%). Twenty-one (60%) of CTRCD patients recovered. CPM initiation after CTRCD was not associated with a significant higher rate of cardiac function recovery (p = 0,682).

When comparing patients already medicated with CPM before cancer treatment (39; 30,5%) to those naïve of CPM, the first group presented a lower incidence of CTRCD (7% vs 20%) but it was not statistically significant (p = 0,473).

In patients treated with T or A + T, the group of patients treated with CPM before cancer treatment did not present a significantly lower incidence of CTRCD (p = 0,449) compared to patients CPM naïve. Nonetheless, there was a significant higher LVEF in the TTE during T therapy, after chemotherapy and at 2 years of follow-up (P <0,05) in patients treated with CPM before cancer treatment compared to patients CPM naïve.

In patients treated with A (without T) there was no statistically significant difference between the two groups.

Conclusion

 In our study, pre-treatment with CPM was associated with a significant higher LVEF in patients treated with T but no significant association was found with respect to the occurrence of CTRCD. CPM initiation after CTRCD was not associated with a statistically significant cardiac function recovery.

Impact of an inconclusive exercise stress echocardiogram on cardiovascular outcomes

Funding Acknowledgements

Type of funding sources: None.

Background

Exercise stress echocardiography (ESE) is used for the assessment of suspected or known coronary artery disease (CAD); however, a certain percentage of ESE studies are inconclusive. We aim to evaluate the prognostic impact of an inconclusive ESE on cardiovascular outcomes.

Methods

Single-center retrospective study of consecutive patients (pts) who performed an ESE between 2018 and 2019 for diagnosis or stratification of CAD. All pts performed a symptom-limited Bruce protocol. ESE was considered inconclusive when 85% of age-predicted maximum HR was not reached. Primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up.

Results

A total of 141 pts were included (76% male; mean age 60 ± 9 years). ESE was inconclusive in 51 (36%) pts, positive in 11 (8%) and negative in 79 (56%).

The mean exercise time of pts with inconclusive ESE was 7 ± 2 minutes and 76% had normal functional capacity. Fatigue (25 pts; 49%) and lower extremities pain (11 pts; 22%) were the main reasons for ESE stopping. Five pts (10%) complained of chest pain during exam.

Pts with an inconclusive ESE were more diabetic (inconclusive 43%, positive 9%, negative 13%; p=.001), had more chronic obstructive pulmonary disease (COPD) (14%, 0%, 2.5%; p=.026), performed more frequently the exam under beta blocker (BB) therapy (59%, 27%, 18%; p=.041) and had less ST-segment depression fulfilling electrocardiographic criteria for ischemia (10%, 64%, 27%, p<.001). Their functional capacity was worse than negative ESE pts (p<.001).

During a median follow up of 22 months (IQR 15-27), 13 (9.2%) pts had the primary endpoint, including 5 pts (3.5%) with ACS.

Pts with an inconclusive ESE had a lower incidence of the primary outcome than pts with a positive ESE and a higher incidence of events than pts with negative results (figure).

In multivariate analysis, after adjusting for functional capacity and electrocardiographic criteria for ischemia, an inconclusive ESE was an independent predictor of the primary endpoint (HR 9.7, IC95% 1.1-87,6 p= .042)

Conclusions

The frequency of inconclusive ESE is not negligible (36%). These pts had more diabetes and COPD and performed the exam under BB therapy more frequently, highlighting the importance of proper patient selection. An inconclusive ESE was associated to a higher risk of cardiovascular events compared to negative ESE. Abstract Figure.

Prevalence and clinical impact of latent obstruction in hypertrophic cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is characterized by varying degrees of left ventricular outflow tract obstruction (LVOTobs). We aim to define the prevalence, clinical profile and impact of LVOTobs under physiological exercise in HCM patients (pts).

METHODS

Single center retrospective study of consecutive HCM pts without LVOTobs at rest (resting gradient <30mmHg), referred for exercise stress echocardiogram (ESE) between 2015 and 2019. Significative latent obstruction was defined as a LVOT gradient ≥50 mmHg during exercise or at early recuperation.

RESULTS

A total of 56 pts were included (64% men, mean age 57 ± 11 years, 61% septal HCM). The majority of pts (47; 84%) were in NYHA I functional class, 20 (36%) had history of syncope or pre-syncope (S/pS) and 7 (13%) had an implantable cardioverter defibrillator (ICD). Twelve (21%) pts had systolic anterior motion (SAM) of the mitral valve at rest.

Thirty-five (63%) pts performed ESE under beta-blocker (BB) therapy. Mean exercise time was 8 ± 3 min. During ESE, 2 (4%) pts developed a LVOT gradient between 30 to 50 mmHg and 17 pts (30%) developed a significative LVOTobs gradient (mean 85 ± 18 mmHg).

Pts with significative latent LVOTobs had more previous complaints of S/pS (59% vs 26%, p=.017), a tendency for a higher NYHA functional class (p=.082) and were more frequently on BB therapy (82% vs 18%, p=.043). Mean septum thickness was similar between groups (17 ± 0.7 vs 16 ± 0.6 mm, p=.536). The presence of SAM at rest was more frequent in the significative latent LVOTobs pts (p<.001). No differences were noted in exercise tolerance (p=.526).

During a median follow-up of 43 (IQR 15-53) months, 7 (41%) pts with significative latent LVOTobs had a pre-syncope, 3 (18%) were diagnosed with atrial fibrillation and 2 (12%) had a cardiovascular admission . There was up-titration/initiation of BB therapy in 5 (29%) pts, referral for septal myectomy in 3 (18%) and ICD implantation for primary prevention in 3 (18%) pts. No proper ICD shocks, sustained ventricular arrythmias or deaths occurred.

Comparing significative latent to non LVOTobs pts, the first ones had more ICD implantation (log rank p =.04) and performed a surgical myectomy more frequently (log rank p= .018) during the follow-up.

CONCLUSION

In our study, significative latent LVOTobs was observed in 30% of pts. Its presence can have clinical implications in HCM pts approach and should be suspected in more symptomatic pts and when SAM is present at rest.

Characterization of temporal trends of systolic and diastolic indexes over time in breast cancer patients treated with trastuzumab

Funding Acknowledgements

Type of funding sources: None.

Background

Trastuzumab therapy increases survival in patients (pts) with HER2 positive breast cancer, however, it is associated with a risk of cardiotoxicity (CT). Our aim was to: 1) assess the temporal evolution of systolic and diastolic left and right ventricular indexes during and after T therapy and 2) study the incidence of CT in this group.

Methods

Retrospective study of breast cancer pts treated with T in a single center, during 2017 and 2018, who underwent a comprehensive echocardiographic examination before, quarterly, and after conclusion of T therapy. Pts with a baseline left ventricular ejection fraction (EF) <50% were excluded. CT was defined as a reduction of EF >10% to a value <50% or as a relative reduction of global longitudinal strain (GLS) of more than 15%.

Results

We included 50 women with mean age of 56 ± 10 years and mean body mass index (BMI) of 27 ± 5 kg/m2. Thirty-six (72%) patients underwent anthracycline chemotherapy prior to T and 44 (88%) had performed radiotherapy.

During treatment with T there was an increase of indexed left ventricle end-diastolic volume (38.6 ± 7.8 to 46.5 ± 10.3 ml/m2, p<.001) and a reduction of LVEF (65.1 ± 5.4 to 59.3 ± 6.2%, p < 0.001), GLS (-21.2 ± 2.7 to -17.9 ± 2.8%, p<.001) and right ventricle S’ (14.4 ± 13.1 to 12.2 ± 1.6 cm/s, p<.001) compared to baseline. There was no change in diastolic function parameters.

CT occurred in 23 (46%) pts, the majority based on GLS criteria (18; 78%). Heart failure symptoms were reported in 4 (8%) of these pts (1 in the GLS group and 3 in the EF group) and 3 (6%) pts had to permanently suspend therapy with T due to CT.

Patients with CT had a lower BMI (25 ± 4 vs 29 ± 4 kg/m2), but were otherwise similar to pts without CT. No association was found between pre-treatment with anthracyclines or radiotherapy with the risk of CT.

An echocardiographic revaluation at 2 years from treatment with T revealed a tendency for LVEF improvement (58.7 ± 7.1 to 61.2 ± 6.3%, p=.059) and a significative recovery of GLS (-17.4 ± 3.5 to -19.1 ± 3.3%, p=.026). No significative variations were found on right ventricular systolic function indexes or on diastolic parameters.

During a follow-up of 43 (IQR 32–47) months, 7 (14%) pts had tumor relapse and 1 (2%) died. CT was not associated with the composite endpoint of tumor relapse or death (p = 0.585).

Conclusion

T therapy is associated with a significative reduction on left and right ventricle systolic indexes during treatment. Although left ventricle systolic function tends to normalize over time, this does not happen with the right ventricle. CT induced by T had clinical impact leading to overt heart failure in 8% of pts and treatment discontinuation in 6% of pts.  A lower BMI was associated with CT, which may be taken into account when defining the treatment strategy.

The sperm ultrastructure of members of basal Tenebrionoidea (Coleoptera)

The sperm ultrastructure of some beetles of Tenebrionoidea was studied with particular attention to those of the Ripiphoridae, Mordellidae, and Meloidae. These three groups are often thought to form a clade, which is the sister group of the remaining Tenebrionoidea. The testes of the two former families have thinner but longer spermatic cysts containing fewer and longer sperm. Within each cyst all sperm cells have the same orientation, but cross sections showed that the orientation of the axonemes alternate between adjacent cysts, possibly due to the cysts bending on themselves. In both families the sperm has a bilayered acrosome and the flagellum, which shows mitochondrial derivatives starting laterally to the nuclear base, has a typical 9 + 9+2 axoneme with accessory tubules provided with 16 protofilaments in their wall, and well-structured triangular shaped accessory bodies. In Mordellistena sp (Mordellidae) sperm, both mitochondrial derivatives and accessory bodies are somewhat asymmetrical. Moreover, the flagellum shows a very thin and long tail end provided with only accessory tubules. Meloidae species have testes with thicker sperm cysts containing numerous shorter sperm. Within the individual cysts the sperm flagella exhibit an alternating orientation of their axonemes as consequence of a peculiar spermatogenetic process. The flagellar structure is similar to that of the above-mentioned species, but the accessory bodies are not well defined and constituted by fuzzy material. In Mylabris hieracii (Meloidae) sperm, the acrosome is flat with a conspicuous perforatorium and its nucleus has a peculiar quadrangular section. Berberomeloe majalis sperm has a large acrosome with an unusual pentagonal perforatorium. The centriolar structure of Mylabris variabilis shows a complex of dense radial links connecting the microtubular structures to the plasma membrane. These results suggest that Ripiphoridae have a closer relationship with Mordellidae than with Meloidae. These findings are in agreement with results obtained with molecular data.

Family screening in brugada syndrome patients

Background

Brugada syndrome (BS) is a rare inherited channelopathy associated with sudden cardiac death (SCD) and family screening (FS) of index patients (pts) is recommended. However, data about pts identified through FS is lacking.

Aim

To compare index pts to non-index pts identified through systematic FS.

Methods

Single-center retrospective study of BS pts followed by the Arrhythmology Department. FS was offered to 1st degree relatives of all index pts through primary care services and a once-weekly voluntary open appointment. Genetic counselling was performed when indicated. Index and non-index pts were compared regarding baseline characteristics and events during the follow-up (syncope of probable arrhythmic origin, ventricular tachycardia/ventricular fibrillation (VT/VF) and SCD).

Results

We included 165 pts (61% males, mean age 47±15 years) and 72 (44%) were identified through FS. Non-index pts were diagnosed at a younger age (42±14 vs 51±14 years, p <.001), were more often female (57% vs 25%, p<.001), were diagnosed predominantly through provocative test with ajmaline/flecainide (88% vs 47%, p<.001) and had less documented spontaneous type 1 ECG pattern (17% vs 59%, p<.001). A type 2 pattern was identified in 18 (25%) non-index pts.

Genetic testing was performed in 38 (53%) non-index pts: 6 had a pathogenic SCN5A mutation, 18 a likely pathogenic SCN5A mutation and 12 a mutation of uncertain significance.

At diagnosis, 24 (33%) non-index pts had history of syncope, 3 (4%) had nocturnal agonal respiration and 11 (15%) had palpitations with no differences between both groups (p=.119). Non-index pts were less likely to implant a cardioverterdefibrillator (14% vs 38%, p=.001).

During a median follow-up of 28 (IQR 16–41) months, 10 (6%) pts had an event - 2 (3%) in the non-index group (2 syncope) and 8 (9%) in the index group (1 syncope; 7 VT/VF) - with no significative differences between groups (p=.432). There were nocardiovascular deaths.

Conclusions

FS identified a considerable proportion of BS pts. Non-index pts were younger at the time of the diagnosis and had less spontaneous type 1 pattern. No differences were found in events between index and non-index pts, however, the event rate was low. Systematic FS can identify individuals at risk of SCD earlier, allowing close monitoring and, when indicated, appropriate treatment.

Funding Acknowledgement

Type of funding sources: None.

Gender related differences in brugada syndrome

Background

Brugada syndrome (BS) is a heritable channelopathy with male predominance. Males (M) seem to have a higher risk of arrhythmic events, although, there is limited data regarding gender differences in BS.

Aim

To compare the differences between genders in a Portuguese sample of BS patients (pts).

Methods

Single-center retrospective study of BS pts followed by the Arrhythmology Department. Pts were divided according to gender and compared regarding baseline characteristics and electrocardiographic (ECG) parameters that possibly predict the arrhythmic risk (significative S wave in DI, R wave sign, Tpeak-Tend interval and fragmented QRS). The events during follow-up were syncope of probable arrhythmic origin, ventricular tachycardia/ventricular fibrillation (VT/VF) and sudden cardiac death (SCD).

Results

A total of 165 pts were included; 64 (39%) were female (F) and the mean age at diagnosis was 47±15 years. The diagnosis was made by family screening (FS) in 72 (44%) pts. Sixty-seven pts (41%) had spontaneous type 1 pattern, 59 (36%) had history of syncope and 5 (3%) had history of aborted SCD. A positive genetic test was identified in 41 (25%) pts. Sixty-three (38%) pts were referred for an electrophysiological study (EEF) which was positive in 17 (27%) pts. A cardioverter-defibrillator was implanted in 45 (27%) pts. Females were more often diagnosed by FS (64% vs 31%, p <.001), had less type 1 spontaneous pattern (22% vs 53%, p<.001) and had no atrial fibrillation (0% vs 7%, p=.043). They performed EEF less frequently (22% vs 49%, p<.001) and had less spontaneous pattern during treadmill stress test (8% vs 33%, p=.004).

Regarding ECG parameters, females had shorter QRS interval (104±12 vs 115±18 ms, p<0.001), less frequent aVR sign (3% vs 27%, p<0.001), less significative S wave in DI (31% vs 55%, p=0.004), and a tendency for a shorter Tp-Te interval (80 vs 100 ms, p=0.051). Corrected QT interval was longer in females (396 vs 392ms, p=0.044). During a median follow-up of 28 (IQR 16–41) months, 7 pts had VT/VF (2F, 5M) and 3 had syncope (3M), with no differences between gender (p=0.287). There were no cardiovascular deaths.

Conclusion

In BS, female pts are more often diagnosed by FS and have less spontaneous type 1 pattern. Gender appears to affect basal ECG characteristics in BS, namely in parameters that may predict arrhythmic risk. Further studies are important to clarify the role of gender in prognosis and risk stratification of BS pts.

Funding Acknowledgement

Type of funding sources: None.

Impact of atrial fibrillation and biventricular pacing percentage on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

Introduction

A history of preoperative atrial fibrillation (AF) has been found to be associated with unfavorable outcomes, higher risks of non-response to cardiac resynchronization therapy (CRT) and loss of biventricular pacing (BivP). We aimed to assess the impact of AF and BivP on long-term outcomes in heart failure patients treated with CRT.

Methods

We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the current guidelines. 118 patients were included in our analysis, from whom all data were available. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and 6 months after CRT. Response to CRT was defined as an increase in left ventricular ejection fraction (LVEF) >10%. We considered an effective delivery of BivP >98%. The primary endpoint was the composite endpoint of hospitalization due to HF or death for any cause.

Results

118 patients were included (mean age 69±11 years, 66.1% males, 39.8% ischemic etiology; baseline LVEF was 27,6±6%). Patients were divided into AF (n=42; 35,6%) and sinus rhythm (SR (n=76); 18 patients had permanent AF. AF patients had higher index left atrial volume and left ventricular mass (p<0.001). Mean follow-up time was 43±18 months. BivP percentage was significantly superior in SR than in AF patients (98.1±2.1% vs 94.7±4.5%, p<0.001), with 75% of SR patients having BivP>98% vs 30,3% of AF patients (p<0.001). There were no differences in preoperative parameters between them. The response rate to CRT was higher in SR patients when compared to AF patients (63,2% vs 40,5%, p=0.021). Indeed, the variation of LVEF was higher in SR patients (12±10% vs 7±9%, p=0.012).

During follow-up, there were significant differences between AF and SR patients in the primary endpoint (73,8% vs 42,6%, p<0.001), and mortality for any cause (26,2% vs 9,2% p=0.014; p<0.001). In a multivariate logistic regression analysis pre-procedural AF and BivP (%) were the only independent predictors of primary endpoint (HR 8.949, 95% CI 2.429 – 32.972, p=0.001; HR 0.719, 95% CI 0.526 – 0.982, p=0.038, respectively). Kaplan-Meier curves showed that event survival free was higher in SR patients when compared to AF (69±4 vs 24±3 months, p<0.001)

Conclusion

Pre - procedural AF and BivP are independent predictors of the occurrence of a primary endpoint of hospitalization due to HF or death for any cause in HF patients submitted to CRT.

Funding Acknowledgement

Type of funding sources: None.

Right ventricular dysfunction is a predictor of non-response to cardiac resynchronization therapy

Introduction

Cardiac resynchronization therapy (CRT) has been of great benefit to many heart failure (HF) patients with reduced ejection fraction (EF) and intraventricular conduction delay. However, approximately 30% of patients fail to respond to CRT. We investigated baseline characteristics that might influence response to CRT.

Methods

We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the guidelines. 118 patients were included in our analysis, from whom all data were available. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and 6 months after CRT implantation. Response to CRT was defined as an increase in left ventricular ejection fraction (LVEF) >10%. Right ventricular systolic dysfunction (RVSD) was defined as S' velocity <9.5 cm/s or tricuspid anular plane systolic excursion (TAPSE) <17 mm. Chronic kidney disease (CKD) was defined as GFR <60 ml/min/1.73m2.

Results

118 patients were included (mean age 69±11 years, 66.1% males, 39.8% ischemic etiology; 35,6% atrial fibrillation, baseline LVEF 27,6±6%). After 6 months of CRT, 65 patients (55.1%) were considered responders. Responders were more frequently female than non responders (43,1% vs 22,6, p=0.02). Atrial fibrillation and CKD were more prevalent in non responders (47,2% vs 26,2%, p=0.018; 62,3% vs 21,5%, p<0.001, respectively). RVSD was present in 60,4% of non responders vs 16,9% of responders (p<0.001). In responder group, the mean S' velocity was 10,9±2,1 cm/s vs 9,1±2,1 cm/s in non responder group, p<0.001. The mean TAPSE was also higher in responder group (20,3±7,2 mm vs 16,5±4,4 mm, p=0.031). On multivariate analysis only RVSD (OR 7,754; 95% CI 2,968 – 20,282 p<0.001] and CKD (OR 5,434; 95% CI 2,109 – 14,002; p<0.001) were independently associated with non-response to CRT.

Conclusion

From a range of preoperative characteristics, multivariate analysis only identified RVSD and CKD as independent predictors of CRT response, with S' <9,5 cm/s and TAPSE <17 mm associated with non-response to CRT. This study highlights the importance of routine RV assessment in order to improve patient selection and optimize CRT response in heat failure patients.

Funding Acknowledgement

Type of funding sources: None.

QRS narrowing predicts left ventricular reverse remodelling after resynchronization therapy in patients with end-stage heart failure

Introduction

Cardiac resynchronization therapy (CRT) is an established treatment for heart failure (HF) patients, however one-third of the patients fail to benefit from CRT. The relationship between the QRS duration, severity of mechanical dyssynchrony and efficacy of CRT is not completely understood. We determined if QRS duration shortening after CRT implantation was predictive of left ventricular reverse remodelling.

Methods

We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the guidelines. 88 patients were included in our analysis, from whom all data were available, and these represent our sample. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and after 6 months of CRT implantation. Response to CRT was defined as a reduction in left ventricular end-diastolic volume (LVEDV) >15%. Linear regression models were used.

Results

88 patients were included (mean age 69±10 years, 62.5% males, 36.4% ischemic etiology). Baseline left ventricular ejection fraction (LVEF) was 27,5±5,8% and LVEDV was 181±69 ml. After 6 months of CRT, 52 patients (59.1%) were considered responders. Baseline LVEDV was superior in responders when compared with non responders (199±85 ml vs 168±53 ml, p=0.038). No significant differences were noted in male gender (p=0.823), ischemic cardiomyopathy (p=0.065), LVEF (p=0.853), atrial fibrillation (p=0.390), left bundle branch block (p=0.950) or biventricular pacing (p=0.154) between them.

QRS duration at baseline was similar between responders and non-responders (165±17 ms vs 163±17 ms, p=0.620). After 6 months of CRT, the reduction of QRS duration in responders was significantly higher than non-responders (p<0.001).

QRS duration was reduced from 165±17 ms to 136±15 ms in responders vs 163±17 ms to 160±17 ms in non-responders, (p<0.001). The change in QRS duration positively correlated with the change in LVEDV (0. 654; p<0.001). Multi-linear regression analysis suggested that QRS duration shortening had a significant effect on LVEDV (y = 14,375 + 1.354 X, R2 0.337, p<0.001)

Conclusion

QRS duration shortening after CRT implantation was predictive of LV reverse remodelling in end-stage heart failure patients. Further prospective studies should be conducted to assess the prognostic value of QRS narrowing in response to CRT.

Funding Acknowledgement

Type of funding sources: None.

The sperm ultrastructure of Pytho depressus (Linnaeus, 1767) (Coleoptera, Pythidae)

The sperm ultrastructure of Pytho depressus (Pythidae) is described in this study. The sperm are short cells, about 85-90 μm long, with an acrosome consisting of three layers, a cylindrical nucleus, which at its base has the initial region of two mitochondrial derivatives. The flagellum has two well-developed triangular accessory bodies, and a 9 + 9+2 axonemal pattern with accessory tubules provided with 16 protofilaments in their wall. The structure and shape of the accessory bodies are diagnostic characters within the superfamily. The sperm morphology of P. depressus can be easily distinguished from those of Ripiphoridae, Meloidae and Tenebrionidae. The P. depressus sperm are organized in cysts as in other species of the group but the sperm are not well aligned and show an antiparallel orientation, a feature also observed in other tenebrionids. The phylogenetic implications of the observed sperm features are discussed in the context of comparative sperm ultrastructure of other insect species.

The sperm ultrastructure of the click beetles (Elateridae) and related groups (Buprestidae and Lampyridae)

In the present study, we describe the sperm morphology of 11 species of Elateriformia (9 elaterids, 1 lampyrid and 1 buprestid) using transmission electron microscopy. All species exhibited sperm that is not usually observed in insects in general. The most highlighted features are the displacement of the nucleus running parallel to the flagellar components, hitherto observed only in coccinellid and carabid beetles, and the presence of thin and dense structures along the nucleus, probably derived from the centriole adjunct, a feature that is so far exclusive to these insects. The other structures are a typical axoneme for insects with 9 + 9 + 2 microtubules, in a position diametrically opposite relative to the nucleus, two slender, symmetrical mitochondrial derivatives and a pair of discrete accessory bodies. This arrangement provides a bilaterally symmetrical flagellum, which favourably influences sperm hydrodynamics, as will be discussed. The occurrence of this unusual structural arrangement in the sperm of species from superfamilies that are phylogenetically as distant as Elateroidea and Buprestoidea support the monophyly of the infraorder Elateriformia, as proposed by some previous molecular studies.

Device therapy guided by implantable loop recorders: predictors of bradyarrhythmic events

Background

Implantable loop recorders (ILR) improved diagnostic yield in unexplained syncope patients (pts). Data on possible predictive factors for bradycardia requiring device implantation in these pts is limited. We aim to identify clinical predictors for device implantation due to a significant bradyarrhythmia in patients who underwent ILR insertion for the study of syncopal/presyncopal (S/pS) events.

Methods

Single-center retrospective study of patients who implanted an ILR for the study of unexplained S/pS episodes between 2013 and 2018. The primary endpoint was a documented bradyarrhythmia requiring device implantation during the follow-up.

Results

A total of 251 pts were included. Mean age was 68±15 years and 53% were female. The majority of pts (220; 88%) had normal ejection fraction. Fifty-two (21%) pts had atrial fibrillation (AF). Regarding basal electrocardiographic characteristics, 34 (14%) pts had 1st degree auriculo-ventricular block (AVB), 31 (12%) pts had left bundle branch block (L-BBB), 22 (9%) pts had R-BBB and 13 (5%) pts had bifascicular block.

During a median follow-up of 20 (IQR 9–34) months, 74 (29%) pts required device implantation because of a significant bradyarrhythmia (92% pacemaker, 4% CRT, 4% ICD). Median duration from ILR until device implantation was 5 (IQR 1–10) months. The indications were sick-sinus-syndrome in 47 (64%) pts, advanced AV block in 23 (31%) pts and symptomatic slow AF in 4 (5%) pts.

Patients who required device implantation were older (73±12 vs 66±15 years, p <0.001), had more hypertension (73% vs 59% p=0.048), a higher prevalence of AF (34% vs 15% p=0.001) and a lower glomerular filtration rate (GFR<60 ml/min: 32% vs 21%, p=0.047). They also had more 1st AVB (22% vs 11%, p=0.026) and intraventricular conduction disturbances (38% vs 25%, p=0.025). There was a trend for a higher device implantation in pts with concomitant 1st AVB and left anterior fascicular block (7% vs 2%, p=0.063)

In a logistic regression model, age >75 years (HR: 1.7; 95% CI: 1.1–2.8) and the presence of AF (HR: 1.8; 95% CI: 1.1–3.0) were independent predictors for device implantation.

Conclusion

An older age and the presence of AF were independent predictors for device therapy in pts who implanted an ILR for the study of S/pS. These factors may identify a higher risk group and should be considered in the initial workup of these pts.

Funding Acknowledgement

Type of funding source: None

Morphology and histology of the male reproductive system of Collaria oleosa (Distant, 1883) (Heteroptera: Miridae)

Collaria oleosa (Distant, 1883) is a phytophagous bug often observed causing injuries in wheat, barley, and oat crops, besides grass pastures. The male reproductive system of C. oleosa has been studied anatomically and histologically. It consists of a pair of testes, each one with two follicles, one pair of seminal vesicles, two pairs of external accessory glands, and an ejaculatory bulb. The testicular follicles exhibit cysts with spermatogonia, spermatocytes, spermatids, and spermatozoa bundles. The testes are connected to the seminal vesicles by the vas deferens. The seminal vesicles are connected to the ejaculatory bulb and are bound by the accessory glands. In mirids belonging to the Stenodemini tribe, the general morphology of the male reproductive system is similar. However, two follicles per testis may be characteristic of the genus Collaria. The anatomy and histology of the male reproductive system in C. oleosa provides new information and also contributes to the understanding of the systematics of Stenodemini as well as the Miridae family in general.

Sperm ultrastructure of three species of ladybirds (Coleoptera, Coccinellidae)

The sperm of three coccinellid species belonging to the subfamilies Chilocorinae, Coccinellinae and Epilachninae were studied under light and transmission electron microscopy. The basic sperm structure of these ladybirds is common to that of the other previously studied species, especially the acrosome in front of the basal body and not the nucleus, with this latter running parallel with the flagellar components. In the Chilocorinae Platynaspis luteorubra (Platynaspidini) the sperm are of the type 1, as in Scymnini and Coccinellini, since they exhibited a cylindrical basal body with 9 + 0 and then 9 + 2, microtubules continuing further in an initial flagellar portion with the only axoneme devoid of accessory structures. The sperm exhibits a thin nucleus and mitochondrial derivatives. Such uniformity of sperm ultrastructure could be indicative of the occurrence of a close relationship between Platynaspidini and Scymnini as also proposed in the previous studies. Conversely, they differ markedly from the sperm of type 3 observed in the Chilocorini Exochomus quadripustulatus. In the Coccinellini Propylea quatuordecimpunctata the sperm are also of the type 1, but they can be easily differentiated from those of the other Coccinellinae studied so far, because of their very short acrosome without the posterior extension, the relatively thicker mitochondrial derivatives and the cylindrical nucleus. Epilachna clandestina sperm resemble those of E. quadripustulatus but differ from them, because they exhibit an elliptical nucleus which is anteriorly very thin, and the asymmetrical mitochondrial derivatives in the anterior extremity, with the greater one starting at the same level of the basal body, rather than at the nucleus level, as it occurs in E. quadripustulatus. Because of the differences observed in the sperm ultrastructure we propose a new sperm type (Type 4) for E. clandestina. This study on ladybird spermatozoon ultrastructure clearly indicates that the current classifications of coccinellids do not reflect the natural history of this well-known insect family.

P1456 Pacemaker and percutaneous aortic valve endocarditis - a complex decision

CASE REPORT

We describe the case of a 64-year-old man who was referred because of a fever. He had history of hypertension, dyslipidemia, atrial fibrillation, chronic obstructive pulmonary disease and a right lung pneumectomy due to epidermoid lung cancer diagnosed twenty-five years ago. He implanted dual-chamber definite pacemaker ten years ago and had a transcatheter aortic valve implantation (TAVI) in the previous year due to severe aortic stenosis and a high surgical risk.

He was hospitalized 2 months ago because of a respiratory infection. Blood cultures were positive for an Enterococcus faecalis. A transthoracic echocardiogram was performed and had no evidence of vegetations.

After one month, he had recurrence of fever and was again admitted. On physical examination he was hemodynamically stable, with signs of peripheral congestion and no heart murmur on cardiac auscultation. Blood cultures were again positive for Enterococcus faecalis. The transesophageal echocardiogram (TEE) showed a biologic aortic valve with thickened leaflets and small nodular structures suggestive of vegetations. There was a small periprosthetic leak and no obstruction or suspected perivalvular abscesses. There was also a small vegetation with 0,45*0,3 cm in the auricular pacemaker lead. A thoraco-abdomino-pelvic computed tomography scan showed no embolic complications. A diagnosis of pacemaker and TAVI endocarditis was made. The patient started directed antibiotic therapy (ceftriaxone and ampicillin).

The case was discussed in Heart Team and because of high surgical risk, medical treatment was decided. The patient completed antibiotic treatment with negative blood cultures and apyrexia. A repeated TEE showed persistence of vegetations, without development of local complications.

It was decided to discharge the patient under palliative suppressive antibiotic treatment with levofloxacin after discussion with the infectious disease doctor. In a follow-up evaluation, he remained clinically stable, without recurrence of fever.

DISCUSSION

As TAVI procedures are performed more frequently, a higher number of late complications are expected. Prosthetic valve endocarditis after TAVI is a complex situation, whose treatment strategy is not well-defined, particularly because these patients are usually of high surgical risk. This case describes a complex clinical picture and highlights the difficulty in decision-making in these situations. Also, it pretends to reinforce the need to discuss in a Heart Team the best treatment options.

P317 Assessment of atrial function in elite soccer players

Introduction

Athlete´s heart is associated with physiological remodelling as a consequence of repetitive cardiac loading. Atrial dilation may occur in athletes, but atrial size is insufficient to provide mechanistic information about the atrium itself and an increase in atrial size is not intrinsically an expression of atrial dysfunction. Two dimensional (2D) LA strain analysis by speckle tracking emerges as a gold standard for evaluation of atrial myocardial function.

Aim

To compare LA function between elite soccer players and sedentary healthy controls through 2D-strain analysis by speckle tracking.

Methods

We included 44 consecutive male professional soccer players and 25 sedentary male healthy controls, matched by age and race. All subjects underwent transthoracic echocardiogram, including evaluation of LA diameter and volume and 2D-strain analysis by speckle tracking. Peak atrial longitudinal strain (PALS) was measured at the end of the reservoir phase and peak atrial contraction strain (PACS) was measured just before the start of the active atrial contractile phase. The average of PALS and PACS was obtained from the 12 LA segments at apical 4 and 2-chamber views. The LA contraction strain index (CSI) (ratio PACS/PALS x100) was also calculated. SPSS 20.0 was used for statistical analysis.

Results

Mean age was similar between athletes and controls (22.3 ± 4.2 vs 25.0 ± 2.4 p = 0.13) as well as body mass index (23.3 ± 5.8 vs 24.6 ± 2.7 Kg/m2, p = 0.24).

Athletes had significantly higher LA volume (29.1 ± 6.9 vs. 21.1 ± 5.5, p < 0.001). No statistical differences were observed in LA diameter between the two groups (18.7 ± 2 vs 18.0 ±1.7, p = 0.163).

Athletes had significantly lower PALS (36.3%±5.8 vs. 44.2%±8.9, p < 0.001), PACS (9.5%±2.8 vs 15.3%±4.8, p < 0.001) and LA CSI (26.3 ± 7.8 vs. 35.0 ± 9.3, p < 0.001) than controls. LA volume was correlated with PALS (p < 0.001 r = 0.99), but not with PACS or CSI (p = 0.089 and p = 0.142, respectively).

Conclusion

This study showed that in top-level athletes LA PALS and PACS are lower and PALS correlates with LA volume, suggesting that LA suffers not only a morphological but also a functional remodelling in response to intensive exercise. This can be mediated by increased LA workload imposed by the increased left ventricular work.

P6579Genetic profile and predictors of positive genetic test in Brugada syndrome

Introduction

Brugada syndrome (BS) is a channelopathy with autosomal dominant transmission, incomplete penetrance and variable expression. There are 18 different gene mutations described in association with this syndrome, however 70% of patients remain without identifiable genetic cause. Genetic testing is appropriated for patients with clinical diagnosis but it is also a very important tool in familiar screening.

Aim

We aim to characterize genetic profile of patients with clinical diagnosis of BS and identify differences between patients with and without causative mutation.

Methods

We included patients followed by the arrhythmology department of our hospital with diagnosis of BS and that have performed genetic test (or patients who were identified through familiar screening and with negative genetic test in the index case). Patients identified through familiar screening with positive genetic test but no spontaneous electrocardiographic pattern, still awaiting pharmacologic provocative test at the time of enrolment – no clinical diagnosis - were excluded. Genetic test was considered positive when we found a pathogenic or probably pathogenic mutation. Mutations in PKP, SLMAP, CACNA, CACNB, SCN10A and CLASP genes considered of uncertain clinical relevance were not included as positive genetic test. We analysed differences between subset of patients with and without causative mutation regarding clinical and electrocardiographic variables. We performed multivariate analysis to find predictors of positive genetic test.

Results

From our 173 patients, 140 met the inclusion criteria and none exclusion criteria so they were enrolled. Patients were 61% male with mean age of 50±15 years old. Mean follow-up was 26±28 months; 24,4% of index cases were positive for causative mutation, 6,8% patients with pathogenic mutation in SCN5A gene and 17,6% with probably pathogenic mutation in SCN5A.

We haven't found significant differences between the 2 groups (negative and positive genetic test) in any clinical variable included. Regarding electrocardiographic variables, patients in whom a mutation was identified had longer PR interval (192±36 vs 170±28, p=0.001), longer QRS (121±19 VS 111±18 p=0.017), particularly when QRS>110ms (p=0,002), and longer QT (398±25 VS 370±45 p=0.015) In multivariate analysis, PR interval (p=0.032) and QRS>110ms (p=0,041) were independent predictors for positive genetic test.

Conclusion

In our BS population, there were no clinical differences between patients with and without causative mutation, also concerning events rate. Patients with positive genetic test have significantly longer PR interval and QRS>110ms than in patients with genetic test negative. Those results can be interpreted in relation to sodium channel disfunction in patients with SCN5A mutation.

The peculiar structure of the flagellar axoneme in Coccinellidae (Insecta-Coleoptera)

The ultrastructure of the complex organisation of the spermatozoa in Harmonia axyridis and Adalia decempunctata (Coccinellidae) was studied, with particular emphasis on the origin of the anterior shifting of the axonemal structure, which becomes parallel to the nucleus in the sperm flagellum. In studying the spermiogenesis, a centriolar remodelling was observed with the long centriole, present in the early spermatids, transformed in the spermatozoa into an exceptionally long and narrowed basal body (about 0.16 × 3.5-4.0 μm long) displaying a 9 + 0 microtubular pattern in the proximal part and a 9 + 2 pattern in the following part; this is a characteristic not observed in any other pterygotan insect. The sperm also have a very long acrosome surrounded by a dense layer of material extending along the whole basal body. These two uncommon features were discussed in the light of sperm movement.

Fine structure of the ladybird spermatozoa (Insecta, Coleoptera, Coccinellidae)

The sperm structure of several ladybird species belonging to different subfamilies of Coccinellidae was studied. Three main sperm types were clearly recognized, and were characterized by differences in acrosomal length, the presence of a dense coat around the acrosome, the length of the basal body, the amount of the centriole adjunct material, and the diameter of the mitochondrial derivatives. However, the whole group shares a pattern of the posterior sperm region uncommon for insects, in which the axoneme and other flagellar components are running parallel with the nucleus. As a general conclusion, this study has revealed an inconsistency between the sperm structure and the systematics of the group, indicating that the generic concepts within the group do not reflect a natural classification, a statement also shared by molecular studies.

Re-description of the sperm morphology of Dalbulus maidis (Hemiptera: Cicadellidae: Deltocephalinae)

The corn leafhopper, Dalbulus maidis, which is one of the most important vectors of maize diseases, had the morphology of its spermatozoa described more than 40 years ago. However, the description is imprecise, requiring certain rectifications. Hence, we re-describe the sperm morphology of this species using light microscopy and transmission electron microscopy. Their spermatozoa measured from 118.1 to 128.5 μm in length, this value being about three times smaller than what was previously described. The head region is formed by a small acrosome and the nucleus. The acrosome is paracrystalline and has the bifurcated base that is docked in two cavities on one side of the anterior region of the nucleus. The nucleus, which is linear and thin, measured from 19.3 to 22.9 μm in length, and exhibited homogeneously compact chromatin. In cross-section, it has a thumbtack shape, except in the anterior and posterior regions, where it is oval. The flagellum consists of an axoneme with 9 + 9 + 2 microtubules, two similar mitochondrial derivatives, two accessory bodies each associated with a small sub-ellipsoidal structure, and a 'center-flagellar material'. In all the spermatozoa observed, the final portion of the flagellum was branched into four filaments. Some of these morphological features are now being re-described, while others have been observed for the first time in the Cicadellidae family, as the center-flagellar material.

Evidence of a procentriole during spermiogenesis in the coccinellid insect Adalia decempunctata (L): An ultrastructural study

We studied spermatogenesis and spermiogenesis in Adalia decempunctata (L), a beetle of the Coccinellidae family. The spermatocyte exhibits two centrioles which elongate to form a pair of primary cilia. A novel structure, appearing in cross sections as a dense droplet, is observed near the long centriole during spermiogenesis, and is soon accompanied by a procentriole (PCL). PCL structure consists of singlet microtubules, a central tubule and an incomplete cartwheel. The PCL persists until the end of spermiogenesis, when it vanishes together with the dense droplet. The sperm has an exceptionally long basal body and the nucleus is disposed parallel to the flagellar components, a peculiar trait shared by other species of the coccinellid group. The presence of a procentriole suggested by the use of antibodies is discussed.

RELEVANCE OF WHOLE BODY VIBRATION EXERCISE IN SPORT: A SHORT REVIEW WITH SOCCER, DIVER AND COMBAT SPORT

Background:

Whole body vibration exercise (WBVE) has been used as a safe and accessible exercise and important reviews have been published about the use of this exercise to manage diseases and to improve physical conditions of athletes The aim of this paper is to highlight the relevance of WBVE to soccer players, divers and combat athletes.

Material and methods:

This study was made through a systematic review of publications involving WBVE and the selected sports in two databases (Pubmed and PEDRo).

Results:

It were identified 10 studies involving WBVE and sports (6 of soccer, 2 of diving and 2 of sport combat) with 156 subjects (80 soccer players, 32 divers and 44 combat athletes), with age from 17 to 44 years old.

Conclusion:

The use of WBVE has proven to be a safe and useful strategy to improve the physical conditions of players of different sports. These findings may have clinical relevance and should be considered as a strategy to be used to try improve the physical conditions of players.

Testicular, spermatogenesis and sperm morphology in Martarega bentoi (Heteroptera: Notonectidae)

The testicular, spermatogenesis and sperm morphology of the backswimmer Martarega bentoi was described using light and transmission electron microscopy. In this species, a pair of testes, two deferent ducts, two different pairs of accessory glands, and an ejaculatory duct form the male reproductive system. Each testis consists of two testicular follicles, which are arranged side by side in snail shape. The follicles are filled with cysts at different stages of spermatogenesis, but in the same cyst the germ cells (up to 64) are in the same stage. At the end of spermatogenesis, the sperm cells are very long, with the flagellum measuring approximately 2500 μm in length, the nucleus only 19 μm, and the acrosome, with two distinct regions, 300 μm. The flagellum is composed of an axoneme, with a 9 + 9 + 2 microtubular pattern, and 2 asymmetric mitochondrial derivatives (MDs). These have the anterior ends inserted into two cavities at the nucleus base, exhibit two paracrystalline inclusions, and have bridges linking them to the axoneme. Few spermatozoa per cyst, asymmetry in size and shape of the MDs, as well as their insertion at the nuclear base are characteristics considered derived, and that differentiate the sperm of M. bentoi from those of the Nepomorpha, Belostomatidae and Nepidae.

Sperm morphology of the leafhopper Diaphorina citri Kuwayama (Hemiptera: Sternorrhyncha: Psylloidea: Liviidae)

In this study, by using light and electron microscopy, we describe the sperm morphology of the leafhopper Diaphorina citri, a serious pest of citrus throughout the world. In this species the sperm measures 538.49±8.75μm in length, and as observed in psylloids, the sperm, when manipulated, opens into two filaments, one of which is attached to the nuclear base and the other becomes free. Along the flagellum, and only of it, there are lateral projections, about 2μm in length. Furthermore, at the end of the flagellum three appendages, with approximately 7μm in length, are observed. The head region is formed by the nucleus with compact chromatin, and, parallel to it, a structure of median electron density that extends about 25μm in length ahead of the nuclear tip. The flagellum consists of an axoneme with a 9+9+2 microtubule arrangement, two mitochondrial derivatives, and two accessory bodies each with two regions of different electron density. The presence of lateral projections is a characteristic observed in other Sternorrhyncha. As seen previously, the sperm opening in two filaments, when manipulated, was observed only in Psylloidea, and the presence of the three appendices at the end of the flagellum distinguishes D. citri from the other Psylloidea species studied.

The sperm ultrastructure and spermiogenesis of Tribolium castaneum (Coleoptera: Tenebrionidae) with evidence of cyst degeneration

Previous studies on the spermatogenesis of tenebrionid beetles showed the unusual formation of two antiparallel sperm bundles per cyst. In this work we reported this feature also in Tribolium castaneum using light and transmission electron microscopy. The sperm structure of T. castaneum, similar to other tenebrionids, consists of a three-layered acrosome, an elongated nucleus and a flagellum with a 9+9+2 axoneme, two accessory bodies and two asymmetric mitochondrial derivatives. The presence of two antiparallel sperm bundles per cyst also in Meloidae and Rhipiphoridae suggests that it is a strong trait synapomorphic for Tenebrionoidea. The huge degeneration of whole sperm cells in several cysts of testes during spermiogenesis is also described.

The sperm ultrastructure of Stictoleptura cordigera (Füssli, 1775) (Insecta, Coleoptera, Cerambycidae)

The spermatozoa of the longhorn beetles Stictoleptura cordigera were ultrastructurally described in this paper. They have an apical bilayered acrosome, an elongated nucleus, a centriole with star-shape links, two asymmetric mitochondrial derivatives partially crystallized and a 9+9+2 flagellar axoneme with accessory tubules provided with 16 protofilaments in their wall. A centriole adjunct is present and gives rise to two thick laminae as accessory bodies, also asymmetrical, to which two relatively small puff-like structures of different size are connected. These features were previously found in the sperm of the cerambycid Morimus asper. The strict similarity of the cerambycid sperm characters with those of curculionoids indicates a clear phylogenetic relationship between Chrysomeloidea and Curculionoidea.

Sperm morphology and phylogeny of lagriids (Coleoptera, Tenebrionidae)

The systematics of tenebrionids remain unclear, principally at the subfamily level, as is the case of the Lagriinae. Considering that sperm morphology has contributed to the various insect group phylogenies, in this work we describe the structure and ultrastructure of these cells in Lagria villosa. Sperm in this species exhibit a strong morphological similarity to those of Tenebrio molitor and Tribolium castaneum, the only two species of Tenebrionidae with previously described sperm. In tenebrionids, the flagellar components offer good diagnostic characters, e.g. the symmetry of mitochondrial derivatives in L. villosa differentiates sperm of this species from those of Te. molitor and Tr. castaneum. However, the lateral association of the nucleus with flagellar components, the form of accessory bodies, and the presence of material connecting the axoneme to the accessory bodies and mitochondrial derivatives indicate that the three species form a sister group. Therefore, the sperm morphology of L. villosa support lagriid beetles as a subfamily (Lagriinae) of Tenebrionidae.

Testicular and spermatogenic characteristics of Lagria villosa (Tenebrionidae: Lagriinae) with taxonomic inferences

In the present study testicular and spermatogenetic aspects were described for Lagria villosa using light and scanning electron microscopy. In this species, spermiogenesis results in the formation of sperm bundles with spermatozoa arranged in an antiparallel manner, a characteristic observed only in Tenebrionidae. L. villosa, however, has about 60 follicles per testis and up to 1200 spermatozoa per cyst, in contrast to other tenebrionids that exhibit only six follicles in each testis and up to 512 spermatozoa per cyst. Therefore, the antiparallel arrangement of the spermatozoa in the bundle give support to previous works classifying the lagriids in a subfamily (Lagriinae) of Tenebrionidae. Just as the number of spermatozoa per cyst and follicles per testis suggest that they constitute, in fact, a distinct branch of this family.

Uncommon formation of two antiparallel sperm bundles per cyst in tenebrionid beetles (Coleoptera)

Several species of Tenebrionidae are stored-grain pests. Since they belong to a specious family, the systematics of these beetles is still in doubt. In insects, spermatogenesis and the spermatozoa exhibit great diversity, and are therefore commonly used in phylogenetic and taxonomic analyses. During the spermatogenetic process in these organisms, the cells originating from a single spermatogonium develop synchronically in groups referred to as cysts. At the end of this process, there is usually only one sperm bundle per cyst, with all the cells in the same orientation. This paper details the spermiogenesis of the tenebrionid beetles Tenebrio molitor, Zophobas confusa, Tribolium castaneum and Palembus dermestoides using whole mount and histological sections of the cysts. In these species, spermatogenesis is similar to that which occurs in most insects. However, during spermiogenesis, the nuclei of the spermatids migrate to two opposite regions at the periphery of the cyst, leading to the uncommon formation of two bundles of spermatozoa per cyst. This feature is possibly an apomorphy for Tenebrionidae.

PP145. Hypertensive disorders of pregnancy: A two year study (2008-2009)

INTRODUCTION

The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. According to the group studies of NHPBEB 2000 four entities are defined: Chronic Hypertension (CH) previous to pregnancy, Gestational Hypertension (GH), Preeclampsia/Eclampsia (PE/E) and superimposed Preeclampisa/Eclampsia in Chronic Hypertension (PE/E CH). All this entities have different outcomes and require adequate follow-up and specific attitude.

OBJECTIVES

Review all cases of hypertensive disorders in a two-year period, its incidences, and related maternal and fetal complications.

METHODS

In a retrospective study, from January 2008 to December 2009, all files related with hypertensive disorders, seen in our department, were reviewed. The statistic analysis was based on Excel 2007.

RESULTS

The global incidence of hypertensive disorders was 3.8% (309 cases), with each entity with an incidence of: 40% in CH, 40% GH, 25% PE/E and 7% PE/E CH. In terms of demographic characteristics the majority of the population were caucasian (46%) and black (40%), the mean age was of 31years (minimum of 12-maximum of 47), and mainly previous Chronic Hypertension and endocrinologic disorders as co-morbidities (Diabetes Mellitus, obesity and thyroid pathology). The fetal/maternal complications were mainly preterm delivery (26.2%), with a low percentage of Abruptio Placentae (1%). Maternal complications were analysed in terms of ICU admissions of 7%, cardiovascular/renal disorders of 1% and maternal bleeding 1%. No maternal death was described. Fetal outcomes were also studied, specifically in terms of birth weight, with an average of 2794 (500-5480g), apgar index in 1st and 5th minute below seven in respectively, 14% and 3.5%.

CONCLUSION

The incidence of maternal complications in our analysis was lower than described in literature. The incidence of preterm delivery was similar to that reported in other studies, mostly due to late pre-terms (>32w).

PP100. Pre-eclampsia: Risk factors and outcomes - A two-year study

INTRODUCTION

Pre-eclampsia (PE) is a hypertensive disorder responsible for major morbidity and mortality in both mother and fetus. There are some risk factors associated with this entity, but it remains very difficult to predict.

OBJECTIVES

Study the incidence of PE and the related risk factors, as well as the maternal and fetal outcome.

METHODS

We reviewed the clinical records of pregnant women admitted to Prof. Fernando Fonseca's Hospital from January 2008 to December 2009, with the diagnosis of pre-eclampsia. The statistic analysis was based on Excel 2007.

RESULTS

There were 90 cases of PE, among the 308 hypertensive disorders reviewed, with an incidence of 1,1% in overall population of pregnant women. Risk factors with higher association were Chronic Hypertension before pregnancy (24,4%), maternal age above 35 years old (16,67%), maternal age under 20 years old (14,44%), and previous episode of pre-eclampsia (8,89%). Major maternal complications that determined Intensive Care Unit admission were recorded in 17 cases (18,89%), with 3 HELLP syndromes (Hemolysis, elevated liver enzymes, and low platelets)(3,33%). No maternal death was recorded. Preterm delivery (PTD) was seen in 61,1%, 32% before 34weeks and 6,67% before 28weeks. There were 19 cases of 1st minute Apgar Index below 7 and 5 cases of 5th minute Apgar Index below 7. There was one in utero death and two interruptions of pregnancy below 24 weeks due to serious PE. Three twin pregnancies.

CONCLUSIONS

PE is a form of hypertensive pregnancy disorder, with a risk of recurrence in subsequent pregnancies. It has a catastrophic potential, mainly associated to PTD, and also with significant morbidity to the pregnant women, reflected in the incidence of admissions to ICU, HELLP syndrome and end-organ failure. In our study we confirmed the adverse outcomes related to this entity, and the risk factors associated.