Lung ultrasound in patients with suspected HFpEF

Purpose

The aim of the present study was to test correlation of laboratory, echocardiographic and clinical parameters with recently developed scores for HFpEF diagnostics in patients with exertional dyspnea and preserved ejection fraction.

Methods

We performed rest and stress echocardiography, rest and peak exercise B-lines count assessed by 8 zone LUS, cardiopulmonary exercise test and laboratory testing in 47 patients (age 62,6±92 years; 57,4% females) refferred for exertional dyspnea. H2FPEF and HFA-PEFF score was calculated for each patient.

Results

H2FPEF score correlated significantly with rest B-lines count (r=0,350, p=0,016). We observed negative correlation of H2FPEF with peak workload (r=−0,558, p<0,001) and peakVO2 (r=−0,519, p<0,001). HFA-PEFF score correlated with peak workload (r=−0,468, p<0,001) and peakVO2 (r=−0,403, p=0,009). No correlation of B-lines count with HFA-PEFF score was observed. We also observed significant correlation of HFA-PEFF and H2FPEF (r=0,545, p<0,001).

HFpEF was diagnosed in 17 patients according to ESC guidelines. Patients with HFpEF had higher HFA-PEFF score (4,0±1,1 vs 1,9±1,4; p<0,001) and H2FPEF score (4,2±1,8 vs 2,2±1,8; p<0,001) and lower peakVO2 (17,0±4,8 ml/kg/min vs 22,9±5,6 ml/kg/min; p=0,001) and workload (1,3±0,4 W/kg vs 1,8±0,6 W/kg; p=0,002). B-lines count was similar in HFpEF patients and rest of population.

Conclusion

According to our data it seems that recently developed scores HFA-PEFF and H2FPEF would be more useful for HFpEF diagnostics than B-lines scoring.

Funding Acknowledgement

Type of funding source: None

P1490Exercise lung ultrasound in patients with exertional dyspnea: pilot study

Purpose

The aim of the present study was to test the correlation of the exercise lung ultrasound (LUS) and B-lines count with clinical, laboratory and echocardiographic parameters among patients with preserved left ventricle ejection fraction and without signs of congestion reffered for cardiopulmonary exercise test (CPET) for exertional dyspnea.

Methods

The study population consisted of 39 patients (age 63.0±9.3 years; 62% females) with preserved ejection fraction (≥50%) and without signs of congestion reffered for exercise testing. Pulmonary disease and coronary artery disease was ruled out. CPET, rest and stress echocardiography and B-lines count assessed by 8 zone LUS were performed.

Results

Exercise B-lines count was significantly higher than rest B-lines count (3.1±0.5 vs. 1.1±0.2; p<0.001). No correlation was found between B-lines count and peakVO2, workload, NT-proBNP. Among echocardiographic parameters only left atrium diameter correlated weakly (r=0.35; p=0.027) with exercise B-lines count. Difference between rest and exercise B-lines count correlated weakly with VE/VCO2 (r=0.41; p=0.015).

Characteristics of study population <3 B-lines (n=22) ≥3 B-lines (n=17) p Age (years) 62.2±6.2 64.1±12.1 NS Females (n; %) 16 (72.7%) 8 (47.1%) NS DM (n; %) 3 (14%) 1 (6%) NS Arterial hypertension (n; %) 15 (68%) 14 (82%) NS BMI (kg/m2) 29.4±5.7 31.3±3.3 NS NYHA class 1.9±0.5 2.0±0.4 NS HFpEF (n; %) 8 (57.1%) 8 (42.1%) NS NT-proBNP (pg/ml) 240.0±472.8 275.4±323.1 NS E/e' 9.8±2.7 10.4±2.2 NS Left atrial diameter (mm) 36.4±4.7 39.4±4.6 p=0.039 LVEF (%) 62.9±5.6 60.6±4.7 NS PeakVO2 (ml/kg/min) 20.2±5.7 19.5±3.6 NS VE/VCO2 32.3±5.7 35.9±6.2 NS WR (W/kg) 1.7±0.5 1.5±0.3 NS DM = diabetes mellitus; LVEF = left ventricle ejection fraction; WR = workload.

Rest and peak exercise B-lines count

Conclusion

We observed weak but significant correlation between exercise B-lines count and left atrium diameter. However we didn't observe significant difference between HFpEF patients and rest of study population in B-lines count. Limitation of our observation is small study population.

Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction

BACKGROUND

Identifying the cause of nasal obstruction is critical before surgical intervention. Structural nasal obstruction, due to nasal valve stenosis, is unlikely to benefit from simple septoplasty and turbinate reduction. This study assesses changes in nasal peak inspiratory flow (NPIF) as a tool for discriminating decongestable versus structural obstruction.

METHODOLOGY

Cross-sectional study of patients undergoing nasal airflow assessment was performed. Rhinomanometry, nasal obstruction visual analogue scores (VAS) and NPIF were performed pre- and post-decongestion. Population groups were defined with decongestable or structural obstruction by relative post-decongestion changes in airways resistance and symptoms.

RESULTS

Fifty two patients were assessed, 24 with decongestable, 28 with structural obstruction. Pre- and post-decongestion NPIF were similar between groups. Absolute and percentage NPIF change were larger with decongestable versus structural obstruction. Sensitivity and specificity for predicting decongestable obstruction were 75.0% and 60.7% for NPIF increase >20 L/min; 75.0% and 64.3% for NPIF increase >20%. The respective positive predictive values were 62.1% and 64.3%.

CONCLUSION

NPIF increase after decongestion is larger with decongestable than structural nasal obstruction. NPIF alone cannot discriminate the two conditions and does not replace more formal assessment.

Identifying genes for neuron survival and axon outgrowth in Hirudo medicinalis

We have studied the molecular basis of nervous system repair in invertebrate (Hirudo medicinalis) nerve cells. Unlike in mammals, neurons in invertebrates survive injury and regrow processes to restore the connections that they held before the damage occurred. To identify genes whose expression is regulated after injury, we have used subtractive probes, constructed from regenerating and non-regenerating ganglia from the leech Hirudo medicinalis, to screen cDNA libraries made from whole leech CNS or from identified microdissected neurons. We have identified genes of known or predicted function as well as novel genes. Known genes up-regulated within hours of injury and that are widely expressed in invertebrate and mammalian cells include thioredoxin and tubulin. Other known genes, e.g. Cysteine Rich Intestinal Protein (CRIP), have previously been identified in mammalian cells though not in regenerating adult neurons. Two regulated genes identified, myohemerythrin and the novel protein ReN3 are exclusively expressed in invertebrates. Thus our approach has enabled us to identify genes, present in a neuron of known function, that are up- and down-regulated within hours of axotomy, and that may underpin the intrinsic ability of invertebrate neurons to survive damage and initiate regrowth programmes.

Radiation hybrid map, physical map, and low-pass genomic sequence of the canine prcd region on CFA9 and comparative mapping with the syntenic region on human chromosome 17

Progressive rod-cone degeneration (prcd) is a canine retinal disease that maps to the centromeric end of CFA9 in a region of synteny with the distal part of HSA17q. As such, prcd has been postulated as the only animal model of RP17, a human retinitis pigmentosa locus that maps to 17q22. In an effort to establish more detailed regions of synteny between dog CFA9 and the HSA17q-ter region, we created a robust gene-enriched CFA9-RH08(3000) map with 34 gene-based markers and 12 microsatellites, with the highest resolution and number of markers for the centromeric end of CFA9. Furthermore, we built an approximately 1.5-Mb physical map containing both GRB2 and GALK1, genes so far identified by meiotic linkage analysis as being closest to the prcd locus, and generated about 1.2 Mb low-pass (3.2x) canine sequence. Canine to human comparative sequence analysis identified 49 transcripts that had been previously mapped to the HSA17q25 region. The generated low-pass canine sequence was annotated with a working draft of human sequence from HSA17q25, and we used this scaffold to order and orient the canine sequence against human. This order and orientation are preliminary, as high-throughput genomic sequencing of HSA17q-ter has not been fully completed.

Effect of agroclavine on NK activity in vivo under normal and stress conditions in rats

Agroclavine is a natural, clavine type of ergot alkaloid with D1 dopamine and a-adrenoceptor agonistic properties. We showed previously that in vitro agroclavine enhances natural killer (NK) cell activity, increases interleukin-2 and interferon-gamma production and prolongs the survival time of tumor-bearing mice. The aim of this study was 1) to test the effect of agroclavine on NK activity in vivo, and 2) to assess the potential toxicity of high doses of agroclavine on cardiac and liver functions using creatine kinase MB (CKMB) and alanine aminotransferase (ALT) as biochemical markers in normal and stressed animals. The effect of stress was studied because we examined promising anticancer properties of agroclavine and malignant diseases are supposed to be a potent stressful event for patients. In our experiments 3-month-old male rats of the Wistar-Kyoto strain were used. Agroclavine was injected intraperitoneally (0.5 mg/kg or 0.05 mg/kg) 30 min before stress (four hours' restraint and immersion in 23 degrees C water). The animals were killed 30 min after stress, blood was collected and the spleen was removed. Non-stressed animals treated with agroclavine were killed 5 h after the drug administration. The results confirmed our previous in vitro results and showed that also in vivo agroclavine increases NK cell activity under non-stress conditions. Agroclavine only slightly increased CKMB and had no influence on ALT in non-stressed animals. These promising results are limited by the fact that agroclavine (0.5 mg/kg) diminished NK cell activity and significantly increased ALT and CKMB under stress conditions.

Human BAC ends quality assessment and sequence analyses

End sequences from bacterial artificial chromosomes (BACs) provide highly specific sequence markers in large-scale sequencing projects. To date, we have generated >300,000 end sequences from >186,000 human BAC clones with an average read length of >460 bp for a total of 141 Mb covering approximately 4.7% of the genome. Over 60% of the clones have BAC end sequences (BESs) from both ends representing more than fivefold coverage of the human genome by the paired-end clones. Our quality assessments and sequence analyses indicate that BESs from human BAC libraries developed at The California Institute of Technology (CalTech) and Roswell Park Cancer Institute have similar properties. The analyses have highlighted differences in insert size for different segments of the CalTech library. Problems with the fidelity of tracking of sequence data back to physical clones have been observed in some subsets of the overall BES dataset. The annotation results of BESs for the contents of available genomic sequences, sequence tagged sites, expressed sequence tags, protein encoding regions, and repeats indicate that this resource will be valuable in many areas of genome research.

Transcriptional regulation of the proton-translocating ATPase (atpIBEFHAGDC) operon of Escherichia coli: control by cell growth rate

The F0F1 proton-translocating ATPase complex of Escherichia coli, encoded by the atpIBEFHAGDC operon, catalyzes the synthesis of ATP from ADP and Pi during aerobic and anaerobic growth when respiratory substrates are present. It can also catalyze the reverse reaction to hydrolyze ATP during nonrespiratory conditions (i.e., during fermentation of simple sugars) in order to maintain a electrochemical proton gradient across the cytoplasmic membrane. To examine how the atp genes are expressed under different conditions of cell culture, atpI-lacZ operon fusions were constructed and analyzed in single copy on the bacterial chromosome or on low-copy-number plasmids. Expression varied over a relatively narrow range (about threefold) regardless of the complexity of the cell growth medium, the availability of different electron acceptors or carbon compounds, or the pH of the culture medium. In contrast to prior proposals, atp operon expression was shown to occur from a single promoter located immediately before atpI rather than from within it. The results of continuous-culture experiments suggest that the cell growth rate rather than the type of carbon compound used for growth is the major variable in controlling atp gene expression. Together, these studies establish that synthesis of the F0F1 ATPase is not greatly varied by modulating atp operon transcription.