1
|
De La Torre-Fernandez De Vega J, Valles E, Barberan L, Pancorbo M, Comas M, Garrido A, Hernan I, Vives I, Rivero J, Morales C, Siso C, Cruella M, Balmaña J, Gil-Moreno A, Espinosa Bravo M. Risk factors of complications after nipple-sparing mastectomies in women with breast cancer risk gene mutations (BRCA1, BRCA2, PALB2). Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
2
|
Siso C, Rivero J, Morales C, De la Torre J, Vives I, Rodriguez-Arana A, Miranda I, Rus M, Espinosa-Bravo M. Initial experience with targeted axillary dissection (TAD) guided by ultrasound in early-stage node positive breast cancer patients undergoing upfront surgery. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
3
|
Johannessen Ø, Myhre PL, Claggett B, Lindner M, Lewis EF, Rivero J, Cheng S, Platz E. Left atrial inflow propagation velocity derived by color M-mode Doppler in acute heart failure. Int J Cardiovasc Imaging 2022; 38:2155-2165. [PMID: 37726456 PMCID: PMC10247843 DOI: 10.1007/s10554-022-02614-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
Left atrial (LA) inflow propagation velocity from the pulmonary vein (LAIF-PV) has been proposed as a novel measure of LA reservoir function and is associated with pulmonary capillary wedge pressure in critically ill patients. However, data on LAIF-PV in acute heart failure (AHF) are lacking. We sought to examine the feasibility of measuring LAIF-PV and evaluate clinical and echocardiographic correlates of LAIF-PV in AHF. In a prospective cohort study of adults hospitalized for AHF, we used color M-mode Doppler of the pulmonary veins to obtain LAIF-PV in systole. Among 142 patients with appropriate images and no more than moderate mitral regurgitation, LAIF-PV measures were feasible in 76 patients (54%) aged 71 ± 14 years, including 68% men with left ventricular ejection fraction (LVEF) 38% ± 13. Mean LAIF-PV was 24.2 ± 5.9 cm/s. In multivariable regression analysis adjusted for age, sex, systolic blood pressure, heart rate, body mass index, New York Heart Association class, LA volume and LVEF, the only independent echocardiographic predictors of LAIF-PV were right ventricular (RV) S' [ß 0.46 cm/s per cm/s (95% CI 0.01-0.91), p = 0.045] and tricuspid annular plane systolic excursion (TAPSE) [ß 0.28 cm/s per mm (95% CI 0.02-0.54), p = 0.039]. Notably, LAIF-PV was not significantly correlated with measures of LV function, LA function or E/e'. In conclusion, LAIF-PV was measurable in 54% of patients with AHF, and lower values were associated with measures of impaired RV systolic function but not LV or LA function.
Collapse
Affiliation(s)
- Øyvind Johannessen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Eldrin F Lewis
- Cardiovascular Division, Stanford University, San Francisco, USA
| | - Jose Rivero
- Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| |
Collapse
|
4
|
Brainin P, Claggett B, Lewis EF, Dwyer KH, Merz AA, Silverman MB, Swamy V, Biering-Sørensen T, Rivero J, Cheng S, McMurray JJV, Solomon SD, Platz E. Body mass index and B-lines on lung ultrasonography in chronic and acute heart failure. ESC Heart Fail 2020; 7:1201-1209. [PMID: 32077268 PMCID: PMC7261588 DOI: 10.1002/ehf2.12640] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS Increased body mass index (BMI) is common in heart failure (HF) patients and is associated with lower levels of N-terminal pro-brain natriuretic peptide (NT-proBNP). We evaluated the influence of BMI on lung ultrasonography (LUS) findings indicative of pulmonary congestion (i.e. B-lines) in patients with chronic and acute HF (AHF). METHODS AND RESULTS We analysed ambulatory chronic HF (n = 118) and hospitalized AHF (n = 177) patients (mean age 70 years, 64% men, mean BMI 29 kg/m2 , mean ejection fraction 42%) undergoing echocardiography and LUS in eight chest zones. B-lines and chest wall thickness (skin to pleura) on ultrasound were quantified offline and blinded to clinical findings. NT-proBNP was available in AHF patients (n = 167). In chronic HF, B-line number decreased by 18% per 5 unit increase in BMI [95% confidence interval (CI) -35% to +5%, P = 0.11]. In AHF, the number of B-lines decreased by 12% per 5 unit increase in BMI (95% CI -19% to -5%, P = 0.001), whereas NT-proBNP concentration decreased by 28% per 5 unit increase in BMI (95% CI -40% to -16%, P < 0.001). For AHF, B-line number declined to a lesser degree than NT-proBNP concentration with increasing BMI (P = 0.020), and >6 B-lines were observed in half of AHF patients with severe obesity. There was an inverse relationship between B-line number and chest wall thickness, and this association varied by chest region. CONCLUSIONS Despite an inverse relationship between B-lines and BMI, B-lines declined to a lesser degree than NT-proBNP with increasing BMI. These data suggest that LUS may be useful in patients with HF despite obesity.
Collapse
Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin H Dwyer
- Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Varsha Swamy
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jose Rivero
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Framingham Heart Study, Framingham, Massachusetts
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| |
Collapse
|
5
|
Lindner M, Thomas R, Claggett B, Lewis EF, Groarke J, Merz AA, Silverman MB, Swamy V, Rivero J, Hohenstein C, Solomon SD, McMurray JJ, Steigner ML, Platz E. Quantification of pleural effusions on thoracic ultrasound in acute heart failure. Eur Heart J Acute Cardiovasc Care 2020; 9:513-521. [PMID: 31976745 DOI: 10.1177/2048872620901835] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically. METHODS In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size. RESULTS Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score (P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography (P<0.001), higher NT-pro brain natriuretic peptide values (P=0.001) and a greater number of B-lines on lung ultrasound (P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92-1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11-5.37; P=0.027). CONCLUSION Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.
Collapse
Affiliation(s)
- Moritz Lindner
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Friedrich-Schiller-University Jena, Germany
| | - Richard Thomas
- Department of Radiology, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Brian Claggett
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Eldrin F Lewis
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - John Groarke
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Allison A Merz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Varsha Swamy
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Jose Rivero
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | | | - Scott D Solomon
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - John Jv McMurray
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - Michael L Steigner
- Department of Radiology, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| |
Collapse
|
6
|
García-Sánchez AM, Rivero J, Callejón R, Zurita A, Reguera-Gomez M, Valero MA, Cutillas C. Differentiation of Trichuris species using a morphometric approach. Int J Parasitol Parasites Wildl 2019; 9:218-223. [PMID: 31194117 PMCID: PMC6551462 DOI: 10.1016/j.ijppaw.2019.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 01/23/2023]
Abstract
Trichuris trichiura is a nematode considered as the whipworm present in humans and primates. The systematics of the genus Trichuris is complex. Morphological studies of Trichuris isolated from primates and humans conclude that the species infecting these hosts is the same. Furthermore, numerous molecular studies have been carried out so far to discriminate parasite species from humans and Non-Human Primates using molecular techniques, but these studies were not performed in combination with a parallel morphological study. The hypothesised existence of more species of Trichuris in primates opens the possibility to revise the zoonotic potential and host specificity of T. trichiura and other putative new species of whipworms. In the present work, a study of Trichuris Roederer, 1761 (Nematoda:Trichuridae) parasitizing C. g. kikuyensis, P. ursinus, Macaca sylvanus, Pan troglodytes, and Sus scrofa domestica has been carried out using modern morphometric techniques in order to differentiate populations of Trichuris isolated from four species of captive NHP from different geographical regions, and swine, respectively. The results obtained revealed strong support for geometrical morphometrics as a useful tool to differentiate male Trichuris populations. Therefore, morphometrics in combination with other techniques, such as molecular biology analyses, ought to be applied to further the differentiation of male populations. On the other hand, morphometrics applied to female Trichuris species does not seem to contribute new information as all the measurements combinations of obtained from females always showed similar results. Geometrical morphometrics is an useful tool to differentiate male Trichuris populations. Geometrical morphometrics results are in agreement with the molecular biology analysis applied to the adult male samples that allow the identification of different species of Trichuris. The hypothesised existence of different species of Trichuris in primates opens the possibility to revise the zoonotic potential and host specificity of T. trichiura and other putative new species of whipworms.
Collapse
Affiliation(s)
- A M García-Sánchez
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Professor García González 2, 41012, Seville, Spain
| | - J Rivero
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Professor García González 2, 41012, Seville, Spain
| | - R Callejón
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Professor García González 2, 41012, Seville, Spain
| | - A Zurita
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Professor García González 2, 41012, Seville, Spain
| | - M Reguera-Gomez
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Av. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
| | - M A Valero
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Av. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
| | - C Cutillas
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Professor García González 2, 41012, Seville, Spain
| |
Collapse
|
7
|
Rubio IT, Esgueva A, Espinosa-Bravo M, Rodriguez-Revuelto R, Siso C, Rivero J. Abstract P3-03-15: Patient reported outcomes in women undergoing sentinel lymph node biopsy in the SUNrISE randomized trial evaluating different doses of superparamagnetic iron oxide. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Sentinel lymph node biopsy (SLNB) with 2 mL of superparamagnetic iron oxide (SPIO) tracer has shown to be non-inferior to the standard radioisotope technique in several studies. The SUNrISE randomized trial has shown non inferiority of 1mL vs. 1.5 mL vs. 2 mL dose of SPIO with the standard use of radioisotope 99m Tc. We present patient reported outcomes from this randomized trial.
Material and methods. Patients with stage I breast cancer who underwent breast conservative surgery and sentinel lymph node biopsy were assigned consecutively (1:1:1) to one of the three groups defined by the different SPIO dose, group 1 (1mL), group 2 (1.5 mL) and group 3 (2 mL). Patients filled a questionnaire related to the presence of skin staining, staining intensity ( mild, moderate, intense) and whether the stain worried them. Patient also completed a quality of life (QoL) EORTC C30 questionnaire at 1 month postoperative visit, at 6 months and at 12 months. First analysis from the 1 month postoperative outcomes are reported here. Follow up on the 6 months will be available for the meeting.
Results. One hundred and thirty five patients were included in the trial, 45 in each group. Median age in group 1 was 58 years old, 63 y/o in group 2 and 65 y/o in group 3. (p=0.03) At 1 month follow up, patients in group 1 had less skin tattoo when compared with patients in group 2 and 3 (p= 0.02). There were no significant differences related to skin staining intensity by doses. Seventy percent of patients felt no concern about the tattoo.
On the multivariate analysis including age, SPIO dose, body mass index and breast density, only younger age (p = 0.037), and higher SPIO doses (p= 0.029) were significantly associated with increased skin staining.
There were no statistically significant differences in responses in the QoL questionnaire at 1 month postoperative visit. There were no severe reactions to the procedure or complications in any patient.
Conclusions. SLN with 1mL dose of SPIO has shown non-inferiority in the detection of SLN when compared to 1.5 and 2 mL. Being young and the use of 1.5 and 2 mL increased the risk of developing skin staining. Even though, most of the patients were not concern about the skin staining. Rates of discontinuation of skin discoloration will be assessed at 6 months follow up.
Citation Format: Rubio IT, Esgueva A, Espinosa-Bravo M, Rodriguez-Revuelto R, Siso C, Rivero J. Patient reported outcomes in women undergoing sentinel lymph node biopsy in the SUNrISE randomized trial evaluating different doses of superparamagnetic iron oxide [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-15.
Collapse
Affiliation(s)
- IT Rubio
- Clinica Universidad de Navarra, Madrid, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - A Esgueva
- Clinica Universidad de Navarra, Madrid, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - M Espinosa-Bravo
- Clinica Universidad de Navarra, Madrid, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - R Rodriguez-Revuelto
- Clinica Universidad de Navarra, Madrid, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - C Siso
- Clinica Universidad de Navarra, Madrid, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - J Rivero
- Clinica Universidad de Navarra, Madrid, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain
| |
Collapse
|
8
|
Proplesch M, Merz AA, Claggett BL, Lewis EF, Dwyer KH, Crousillat DR, Lau ES, Silverman MB, Peck J, Rivero J, Cheng S, Platz E. Right atrial structure and function in patients with hypertension and with chronic heart failure. Echocardiography 2018; 35:905-914. [PMID: 29600555 DOI: 10.1111/echo.13876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prior studies have shown that both heart failure (HF) and atrial fibrillation (AF) are factors that impact left atrial function and structure. However, right atrial (RA) function measured as RA emptying fraction (RAEF) on echocardiography has not been analyzed systematically in a chronic HF population. The aim of this study was to assess RA volume index (RAVI) and RAEF in patients with chronic HF and patients with hypertension (HTN) and to relate these findings to other cardiopulmonary ultrasound parameters and 12-month outcomes. METHODS AND RESULTS In this prospective observational study, we identified 119 patients with chronic HF (64 patients without a history of AF [HF without AF], 55 with AF [HF with AF]), and 127 patients with HTN but without important cardiac disease who underwent routine outpatient transthoracic echocardiography. We found that RAEF was impaired in patients with HF without AF compared to patients with HTN (35% ±2 vs 50% ±1, P < .001), whereas RAVI did not differ between these two groups. Lower RAEF was associated with larger RAVI and higher estimated RA pressures but not with a higher degree of pulmonary congestion by lung ultrasound. Both lower RAEF and higher RAVI were associated with an increased risk of 12-month HF hospitalizations or all-cause death (age, sex, and AF adjusted HR: 4.07, 95% CI: 1.69-9.79; P = .002, vs 2.74, 95% CI: 1.15-6.54, P = .023). CONCLUSIONS In an outpatient HF cohort, both lower RAEF and increased RAVI were associated with other markers of impaired cardiac function and 12-month adverse events.
Collapse
Affiliation(s)
- Moritz Proplesch
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brian L Claggett
- Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Eldrin F Lewis
- Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin H Dwyer
- Department of Emergency Medicine, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
| | | | - Emily S Lau
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Montane B Silverman
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Julie Peck
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jose Rivero
- Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Cheng
- Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Dwyer KH, Merz AA, Lewis EF, Claggett BL, Crousillat DR, Lau ES, Silverman MB, Peck J, Rivero J, Cheng S, Platz E. Pulmonary Congestion by Lung Ultrasound in Ambulatory Patients With Heart Failure With Reduced or Preserved Ejection Fraction and Hypertension. J Card Fail 2018; 24:219-226. [PMID: 29499322 DOI: 10.1016/j.cardfail.2018.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/11/2018] [Accepted: 02/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although pulmonary congestion can be quantified in heart failure (HF) by means of lung ultrasonography (LUS), little is known about LUS findings (B-lines) in different HF phenotypes. This prospective cohort study investigated the prevalence and clinical and echocardiographic correlates of B-lines in ambulatory HF patients with preserved (HFpEF) or reduced (HFrEF) ejection fraction compared with hypertensive patients. We related LUS findings to 12-month HF hospitalizations and all-cause mortality. METHODS AND RESULTS We used LUS to examine hypertensive (n = 111), HFpEF (n = 46), and HFrEF (n = 73) patients (median age 66 y, 56% male, 79% white, and median EF 55%) undergoing clinically indicated outpatient echocardiography. B-line number was quantified offline, across 8 chest zones, blinded to clinical and echocardiographic characteristics. The proportion of patients with ≥3 B-lines was lower in hypertensive patients (13.5%) compared with both HFrEF (45.2%, P < .001) and HFpEF (34.8%; P = .05). HF patients with ≥3 B-lines had a higher risk of the composite outcome (age- and sex-adjusted hazard ratio 2.62, 95% confidence interval 1.15-5.96; P = .022). CONCLUSIONS When performed at the time of outpatient echocardiography, LUS findings of pulmonary congestion differ between patients with known HF and those with hypertension, and may be associated with adverse outcomes.
Collapse
Affiliation(s)
- Kristin H Dwyer
- Department of Emergency Medicine, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
| | | | - Eldrin F Lewis
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian L Claggett
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julie Peck
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jose Rivero
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Cheng
- Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elke Platz
- Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
10
|
Shah NR, Cheezum MK, Veeranna V, Horgan SJ, Taqueti VR, Murthy VL, Foster C, Hainer J, Daniels KM, Rivero J, Shah AM, Stone PH, Morrow DA, Steigner ML, Dorbala S, Blankstein R, Di Carli MF. Ranolazine in Symptomatic Diabetic Patients Without Obstructive Coronary Artery Disease: Impact on Microvascular and Diastolic Function. J Am Heart Assoc 2017; 6:JAHA.116.005027. [PMID: 28473401 PMCID: PMC5524071 DOI: 10.1161/jaha.116.005027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Treatments for patients with myocardial ischemia in the absence of angiographic obstructive coronary artery disease are limited. In these patients, particularly those with diabetes mellitus, diffuse coronary atherosclerosis and microvascular dysfunction is a common phenotype and may be accompanied by diastolic dysfunction. Our primary aim was to determine whether ranolazine would quantitatively improve exercise‐stimulated myocardial blood flow and cardiac function in symptomatic diabetic patients without obstructive coronary artery disease. Methods and Results We conducted a double‐blinded crossover trial with 1:1 random allocation to the order of ranolazine and placebo. At baseline and after each 4‐week treatment arm, left ventricular myocardial blood flow and coronary flow reserve (CFR; primary end point) were measured at rest and after supine bicycle exercise using 13N‐ammonia myocardial perfusion positron emission tomography. Resting echocardiography was also performed. Multilevel mixed‐effects linear regression was used to determine treatment effects. Thirty‐five patients met criteria for inclusion. Ranolazine did not significantly alter rest or postexercise left ventricular myocardial blood flow or CFR. However, patients with lower baseline CFR were more likely to experience improvement in CFR with ranolazine (r=−0.401, P=0.02) than with placebo (r=−0.188, P=0.28). In addition, ranolazine was associated with an improvement in E/septal e′ (P=0.001) and E/lateral e′ (P=0.01). Conclusions In symptomatic diabetic patients without obstructive coronary artery disease, ranolazine did not change exercise‐stimulated myocardial blood flow or CFR but did modestly improve diastolic function. Patients with more severe baseline impairment in CFR may derive more benefit from ranolazine. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01754259.
Collapse
Affiliation(s)
- Nishant R Shah
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Cardiovascular Medicine, Department of Medicine, Lifespan Cardiovascular Institute, Brown University Alpert School of Medicine, Providence, RI
| | - Michael K Cheezum
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vikas Veeranna
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stephen J Horgan
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Viviany R Taqueti
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Venkatesh L Murthy
- Divisions of Nuclear Medicine, Cardiothoracic Imaging, and Cardiovascular Medicine, Departments of Medicine and Radiology, University of Michigan, Ann Arbor, MI
| | - Courtney Foster
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jon Hainer
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karla M Daniels
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jose Rivero
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Amil M Shah
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Peter H Stone
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David A Morrow
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael L Steigner
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ron Blankstein
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
11
|
Biering-Sørensen T, Santos M, Rivero J, McCullough SD, West E, Opotowsky AR, Waxman AB, Systrom DM, Shah AM. Left ventricular deformation at rest predicts exercise-induced elevation in pulmonary artery wedge pressure in patients with unexplained dyspnoea. Eur J Heart Fail 2016; 19:101-110. [PMID: 27878925 DOI: 10.1002/ejhf.659] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/01/2016] [Accepted: 08/15/2016] [Indexed: 11/09/2022] Open
Abstract
AIMS Impaired left ventricular (LV) deformation despite preserved LV ejection fraction (LVEF) is common and predicts outcomes in heart failure with preserved LVEF. We hypothesized that impaired LV deformation at rest is a marker of impaired cardiac systolic and diastolic reserve, and aimed to determine whether resting longitudinal (LS) and circumferential strain (CS) are associated with invasively measured haemodynamic response to exercise in patients with dyspnoea and a normal LVEF. METHODS AND RESULTS We studied 85 patients with LVEF ≥50% and free of significant valvular disease who were referred for evaluation of dyspnoea. All patients underwent rest echocardiography followed by right heart catheterization and cardiopulmonary exercise testing with concomitant invasive haemodynamic monitoring. The LS, CS and CS/LS ratio were measured by two-dimensional speckle-tracking echocardiography at rest. Lower absolute LS at rest was associated with greater increase in pulmonary arterial wedge pressure (PAWP) from rest to peak exercise (r = 0.23, P = 0.034). In contrast, higher absolute CS at rest predicted a greater increase in PAWP (r = - 0.27, P = 0.032) and greater stroke volume augmentation with exercise (r = - 0.26, P = 0.021). Higher CS/LS ratio was most predictive of elevation in PAWP with exercise (r = 0.30, P = 0.015). Of the measures of LV systolic and diastolic function assessed, the CS/LS ratio resulted in the highest area under the curve and specificity for the presence of rest- or exercise-induced pulmonary venous hypertension. CONCLUSION Left ventricular deformation at rest predicts exercise-induced rise in PAWP among patients with dyspnoea and a preserved LVEF. A pattern of rest deformation characterized by worse LS and exaggerated CS is most strongly associated with exercise-induced rise in PAWP.
Collapse
Affiliation(s)
- Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Mário Santos
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal
| | - Jose Rivero
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Shane D McCullough
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Erin West
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Alexander R Opotowsky
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David M Systrom
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
12
|
Rivero J, Bosque V, Alicyoy A, Patricia Y, Carugno J. Laparoscopic Apical Support. The Perfect Technique to Minimize Failure. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Rivero J, Bosque V, Alicyoy A, Patricia Y, Carugno J. D50%: A Crystal Clear Vision During Intraoperative Cystoscopy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Alicyoy A, Rivero J, Bosque V, Pilar M, Carugno J. Laparoscopic Salpingostomy by Hydro-Dissection. A Conservative Minimally Invasive Technique for Ectopic Pregnancy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Rivero J, Bosque V, Angulo A, De Pinho J, Jacobo O, Carugno J. Modified Laparoscopic Richardson’s Angle Stitch. A Simple Technique to Prevent Vaginal Cuff Prolapse. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Shah NR, Cheezum M, Veeranna V, Horgan S, Taqueti V, Murthy V, Foster C, Hainer J, Gaber M, Klein J, Daniels K, Rivero J, Shah A, Stone P, Morrow D, Steigner M, Dorbala S, Blankstein R, Carli MD. SHORT-TERM TREATMENT WITH RANOLAZINE IMPROVES LEFT VENTRICULAR FILLING PRESSURES WITHOUT DETECTABLE CHANGES IN MYOCARDIAL BLOOD FLOW IN SYMPTOMATIC DIABETIC PATIENTS WITHOUT OBSTRUCTIVE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31581-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Bianchi G, Carvalho S, Rivero J. Avaliação da progênie de ovelhas Merino Australiano cruzadas com carneiro Dorper ou Southdown. ARQ BRAS MED VET ZOO 2016. [DOI: 10.1590/1678-4162-7706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O presente estudo objetivou avaliar o efeito do genótipo do carneiro (Dorper ou Southdown), do sexo e do tipo de parto sobre características de crescimento de 268 cordeiros filhos de ovelhas Merino Australiano. Até o desmame, todos os animais permaneceram sobre pastagem de trevo-vermelho (Trifolium pratense ), chicória (Cychorium intibus ), trevo-branco (Trifolium repens ), festuca (Festuca arundinacea ) e azevém (Lolium multiflorum ), com carga animal de 10 ovelhas com seus cordeiros/ha. A partir do desmame (29,95±4,94kg de peso vivo e 109,45±7,41 dias de idade), os cordeiros permaneceram sobre a mesma pastagem utilizada durante a lactação, sendo terminados posteriormente sobre um cultivo de soja (Glycine max) , com carga animal de 30 cordeiros/ha. Não foi verificado efeito do genótipo do carneiro (P>0,05) sobre nenhuma das variáveis analisadas. Por outro lado, do nascimento ao desmame e do desmame até o embarque dos cordeiros para abate, os machos (criptorquidas) apresentaram ganhos de peso diário superiores (241 e 212g/dia; 121 e 94g/dia, para machos e fêmeas, respectivamente; P≤0,001), o que proporcionou um peso vivo ao embarque 14,9% superior em relação às fêmeas (40,89 e 35,59kg, para machos e fêmeas, respectivamente; P≤0,001). Os cordeiros de parto simples apresentaram maiores (P≤0,001) pesos vivos e medidas corporais ao nascimento, bem como maior velocidade de crescimento até o desmame (239 e 214g/dia, parto simples e duplo, respectivamente; P≤0,001). Porém, após o desmame, os cordeiros de parto duplo apresentaram maior ganho de peso (98 e 117g/dia) (P≤0,05) e uma superioridade (P≤0,001) em quilogramas de cordeiros desmamados (26,80 e 49,61kg) ou embarcados (33,91 e 64,69kg) por ovelha parida. Independentemente do sexo e do tipo de parto, todos os cordeiros superaram as exigências de peso e condição corporal mínima requerida para comercialização de cordeiros pesados no Uruguai, na metade do tempo que em média ocorre com os genótipos tradicionais.
Collapse
Affiliation(s)
| | | | - J. Rivero
- Universidad de la República, Uruguay
| |
Collapse
|
18
|
Bianchi G, Carvalho S, Rivero J. Matrizes ovinas cruzadas são sempre mais eficientes do que as matrizes puras? ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-4162-7909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Foi estudado o desempenho reprodutivo de 482 ovelhas multíparas (3/4 Texel x 1/4 Corriedale: TXC, 1/2 Romney Marsh x 1/2 Corriedale: RMC, 3/4 Poll Dorset x 1/4 Corriedale: PDC, 1/2 Finnish Landrace x 1/2 Merino Australiano: FLMA e Merino Australiano puras: MA), as características do crescimento de 585 cordeiros provenientes de carneiros Dorper e ovelhas: TXC (n = 68); RMC (n = 64); PDC (n = 68); FLMA (n = 183) e MA (n = 202) e os quilogramas de carne de cordeiros produzidos/kg de ovelha colocadas em cobertura (como indicador de eficiência), pastoreando campo natural e pastagens cultivadas. As ovelhas FLMA e TXC apresentaram as maiores taxas de parição (167,89 e 174,36%, respectivamente) em relação às demais cruzas, as quais não diferiram entre si (121,43 e 125,49%, PDC e RMC, respectivamente; P>0,05), porém foram superiores as MA (88,99%), sendo esse resultado uma consequência da maior quantidade de cordeiros nascidos/ovelha parida, que influenciou mais do que sua maior taxa de fertilidade. O genótipo da ovelha também afetou (P<0,0001) o crescimento dos cordeiros até o momento da sua venda com 41,6 ±6,7kg aos 206±7,25 dias de idade. Os cordeiros filhos das ovelhas TXC, PDC e RMC apresentaram maiores ganhos de peso diário que os filhos de FLMA, e esses maiores do que os MA. No entanto, de todas as cruzas avaliadas, somente a FLMA foi mais eficiente que a MA.
Collapse
Affiliation(s)
| | | | - J. Rivero
- Universidad de la República, Uruguay
| |
Collapse
|
19
|
Santos M, Rivero J, McCullough SD, West E, Opotowsky AR, Waxman AB, Systrom DM, Shah AM. E/e' Ratio in Patients With Unexplained Dyspnea: Lack of Accuracy in Estimating Left Ventricular Filling Pressure. Circ Heart Fail 2015; 8:749-56. [PMID: 26067855 DOI: 10.1161/circheartfailure.115.002161] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated left ventricular filling pressure is a cardinal feature of heart failure with preserved ejection fraction. Mitral E/e' ratio has been proposed as a noninvasive measure of left ventricular filling pressure. We studied the accuracy of E/e' to estimate and track changes of left ventricular filling pressure in patients with unexplained dyspnea. METHODS AND RESULTS We performed supine and upright transthoracic echocardiography in 118 patients with unexplained dyspnea who underwent right heart catheterization. Supine E/e' ratio modestly but significantly correlated with supine pulmonary arterial wedge pressure (PAWP; r=0.36; P<0.001) and demonstrated poor agreement with PAWP values (Bland-Altman limits of agreement of -8.3 to 8.3 mm Hg; range, 6.5-21.2 mm Hg). Similarly, E/e' ratio cut off of 13 performed poorly in identifying patients with elevated left ventricular filling pressure (sensitivity 6%, specificity 90%). The receiver-operating characteristic area of E/e' was 0.65 (95% confidencce interval, 0.50-0.79). With change from the supine to upright position, PAWP decreased (-5±4 mm Hg; P<0.001) as did both E wave (-17±15 cm/s; P<0.001) and e' (-2.7±2.7 cm/s; P<0.001) velocities, whereas E/e' remained stable (+0.2±2.6; P=0.57). Positional change in PAWP correlated modestly with change in E-wave (r=0.37; P<0.001) velocity. There was no appreciable relationship between change in PAWP and change in average E/e' (r=-0.04; P=0.77) and in half the patients the change in PAWP and E/e' were directionally opposite. CONCLUSIONS In patients with unexplained dyspnea, E/e' ratio neither accurately estimates PAWP nor identifies patients with elevated PAWP consistent with heart failure with preserved ejection fraction. Positional changes in E/e' ratio do not reflect changes in PAWP.
Collapse
Affiliation(s)
- Mário Santos
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Jose Rivero
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Shane D McCullough
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Erin West
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Alexander R Opotowsky
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Aaron B Waxman
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - David M Systrom
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.)
| | - Amil M Shah
- From the Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.); Divisions of Cardiovascular Medicine (J.R., S.D.M., E.W., A.R.O., A.M.S.) and Pulmonary and Critical Care Medicine (A.B.W., D.M.S.), Brigham and Women's Hospital, Boston, MA; and Department of Cardiology, Boston Children's Hospital, MA (A.R.O.).
| |
Collapse
|
20
|
Platz E, Pivetta E, Merz AA, Peck J, Rivero J, Cheng S. Impact of device selection and clip duration on lung ultrasound assessment in patients with heart failure. Am J Emerg Med 2015; 33:1552-6. [PMID: 26123928 DOI: 10.1016/j.ajem.2015.06.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/22/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Pulmonary edema is a common sign of heart failure and can be quantified by counting vertical artifacts (B-lines) on lung ultrasound (LUS). The primary aim of this study was to compare a pocket size ultrasound device to high-end ultrasound systems on the measured number of B-lines. We also compared the impact of different-length ultrasound clips on the measured number of B-lines. METHODS AND RESULTS We studied 21 hospitalized patients with heart failure (81% men; median age, 73; 71% Caucasian) who underwent concurrent 8- and 4-zone LUS using both a pocket ultrasound device and a high-end ultrasound system. For the 4-zone scanning method, the median B line number was 2 (interquartile range, 1-4) for the pocket device and 3 (1-5) for the high-end system (P = .67). For the 8-zone method, the median B-line number was 4 (2-7) for the pocket device and 5 (3-7) for the high-end system (P = .18). A higher number of B-lines was identified on the 4- vs 2-second LUS clips (P < .001 for 4 zones, P = .001 for 8 zones), and on the 6- vs 4-second LUS clips (P=0.057 for 4 zones, P=0.018 for 8 zones). CONCLUSIONS Our findings suggest significant differences based on LUS clip duration rather than the type of ultrasound device used, with respect to the number of B-lines detectable in patients with heart failure. These factors should be considered in the design and reporting of LUS studies and in longitudinal assessments of heart failure patients.
Collapse
Affiliation(s)
- Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Emanuele Pivetta
- Department of Medical Sciences, Division of Emergency Medicine and Cancer Epidemiology Unit, "Città della Salute e della Scienza di Torino", Hospital and the University of Turin, Turin, Italy
| | - Allison A Merz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Julie Peck
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jose Rivero
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Susan Cheng
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
21
|
Santos M, Rivero J, Mccullough S, Opotowsky A, Waxman A, Systrom D, Shah A, Santoro C, Esposito R, Schiano Lomoriello V, Raia R, De Palma D, Ippolito R, Ierano P, Arpino G, De Simone G, Galderisi M, Cameli M, Lisi M, Di Tommaso C, Solari M, Focardi M, Maccherini M, Henein M, Galderisi M, Mondillo S, Simova I, Katova T, Galderisi M, Pauncheva B, Vrettos A, Dawson D, Grigoratos C, Papapolychroniou C, Nihoyannopoulos P, Voilliot D, Huttin O, Vaugrenard T, Venner C, Sadoul N, Aliot E, Juilliere Y, Selton-Suty C, Hamdi I, Mahfoudhi H, Ben Mansour N, Dahmani R, Lahidheb D, Fehri W, Haouala H, Erken Pamukcu H, Gerede D, Sorgun M, Akbostanci C, Turhan S, Erol U, Voilliot D, Magne J, Dulgheru R, Kou S, Henri C, Caballero L, De Sousa C, Sprynger M, Pierard L, Lancellotti P, Panelo ML, Rodriguez-Fernandez A, Escriba-Bori S, Krol W, Konopka M, Burkhard K, Jedrzejewska I, Pokrywka A, Klusiewicz A, Chwalbinska J, Dluzniewski M, Braksator W, Elmissiri A, Eid M, Sayed I, Awadalla H, Schiano-Lomoriello V, Esposito R, Santoro C, Lo Iudice F, De Simone G, Galderisi M, Ibrahimi P, Jashari F, Johansson E, Gronlund C, Bajraktari G, Wester P, Henein M, Potluri R, Aziz A, Hooper J, Mummadi S, Uppal H, Asghar O, Chandran S, Surkova EA, Tereshina OV, Shchukin UV, Rubanenko AO, Medvedeva EA, Hamdi I, Mahfoudhi H, Ben Mansour N, Dahmani R, Lahidheb D, Fehri W, Haouala H, Krapf L, Nguyen V, Cimadevilla C, Himbert D, Brochet E, Iung B, Vahanian A, Messika-Zeitoun D, Van De Heyning CM, Magne J, Pierard L, Bruyere P, Davin L, De Maeyer C, Paelinck B, Vrints C, Lancellotti P, Bertrand P, Groenendaels Y, Vertessen V, Mullens W, Pettinari M, Gutermann H, Dion R, Verhaert D, Vandervoort P, Guven S, Sen T, Tufekcioglu O, Gucuk E, Uygur B, Kahraman E, Valuckiene Z, Jurkevicius R, Pranevicius R, Marcinkeviciene J, Zaliaduonyte-Peksiene D, Stoskute N, Zaliunas R. Club 35 Poster session 2: Thursday 4 December 2014, 08:30-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Platz E, Hempel D, Pivetta E, Rivero J, Solomon SD. Reply. Echocardiography 2014; 31:408-9. [DOI: 10.1111/echo.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elke Platz
- Brigham and Womens Hospital; Boston Massachusetts
| | - Dorothea Hempel
- University Medical Center of the Johannes Gutenberg University Mainz; Mainz Germany
| | - Emanuele Pivetta
- University of Turin and Città della Salute e della Scienza Hospital; Turin Italy
| | - Jose Rivero
- Brigham and Womens Hospital; Boston Massachusetts
| | | |
Collapse
|
23
|
Gupta DK, Skali H, Rivero J, Campbell P, Griffin L, Smith C, Foster C, Claggett B, Glynn RJ, Couper G, Givertz MM, Mehra MR, Di Carli M, Solomon SD, Pfeffer MA. Assessment of myocardial viability and left ventricular function in patients supported by a left ventricular assist device. J Heart Lung Transplant 2014; 33:372-81. [PMID: 24582837 DOI: 10.1016/j.healun.2014.01.866] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronically supported left ventricular assist device (LVAD) patients may be candidates for novel therapies aimed at promoting reverse remodeling and myocardial recovery. However, the effect of hemodynamic unloading with a LVAD on myocardial viability and LV function in chronically supported LVAD patients has not been fully characterized. We aimed to develop a non-invasive imaging protocol to serially quantify native cardiac structure, function, and myocardial viability while at reduced LVAD support. METHODS Clinically stable (n = 18) ambulatory patients (83% men, median age, 61 years) supported by a HeartMate II (Thoratec, Pleasanton, CA) LVAD (median durations of heart failure 4.6 years and LVAD support 7 months) were evaluated by echocardiography and technetium-99m ((99m)Tc)-sestamibi single photon emission computed tomography (SPECT) imaging at baseline and after an interval of 2 to 3 months. Echocardiographic measures of LV size and function, including speckle tracking-derived circumferential strain, were compared between ambulatory and reduced LVAD support at baseline and between baseline and follow-up at reduced LVAD support. The extent of myocardial viability by SPECT was compared between baseline and follow-up at reduced LVAD support. RESULTS With reduction in LVAD speeds (6,600 rpm; interquartile range: 6,200, 7,400 rpm), LV size increased, LV systolic function remained stable, and filling pressures nominally worsened. After a median 2.1 months, cardiac structure, function, and the extent of viable myocardium, globally and regionally, was unchanged on repeat imaging while at reduced LVAD speed. CONCLUSIONS In clinically stable chronically supported LVAD patients, intrinsic cardiac structure, function, and myocardial viability did not significantly change over the pre-specified time frame. Echocardiographic circumferential strain and (99m)Tc-sestamibi SPECT myocardial viability imaging may provide useful non-invasive end points for the assessment of cardiac structure and function, particularly for phase II studies of novel therapies aimed at promoting reverse remodeling and myocardial recovery in LVAD patients.
Collapse
Affiliation(s)
- Deepak K Gupta
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hicham Skali
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jose Rivero
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patricia Campbell
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Leslie Griffin
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen Smith
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Courtney Foster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, Massachusetts
| | - Brian Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert J Glynn
- Department of Biostatistics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory Couper
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mandeep R Mehra
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcelo Di Carli
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, Massachusetts
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc A Pfeffer
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
24
|
Platz E, Hempel D, Pivetta E, Rivero J, Solomon SD. Echocardiographic and Lung Ultrasound Characteristics in Ambulatory Patients with Dyspnea or Prior Heart Failure. Echocardiography 2013; 31:133-9. [DOI: 10.1111/echo.12346] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Elke Platz
- Department of Emergency Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Dorothea Hempel
- Department of Medicine II; University Medical Center of the Johannes Gutenberg University; Mainz Germany
| | - Emanuele Pivetta
- Department of Emergency Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Jose Rivero
- Cardiovascular Division; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Scott D. Solomon
- Cardiovascular Division; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| |
Collapse
|
25
|
Lakdawala NK, Thune JJ, Colan SD, Cirino AL, Farrohi F, Rivero J, McDonough B, Sparks E, Orav EJ, Seidman JG, Seidman CE, Ho CY. Subtle abnormalities in contractile function are an early manifestation of sarcomere mutations in dilated cardiomyopathy. ACTA ACUST UNITED AC 2012; 5:503-10. [PMID: 22949430 DOI: 10.1161/circgenetics.112.962761] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sarcomere mutations cause both dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM); however, the steps leading from mutation to disease are not well described. By studying mutation carriers before a clinical diagnosis develops, we characterize the early manifestations of sarcomere mutations in DCM and investigate how these manifestations differ from sarcomere mutations associated with HCM. METHODS AND RESULTS Sixty-two genotyped individuals in families with sarcomeric DCM underwent clinical evaluation including strain echocardiography. The group included 12 subclinical DCM mutation carriers with normal cardiac dimensions and left ventricular ejection fraction (LVEF ≥55%), 21 overt DCM subjects, and 29 related mutation (-) normal controls. Results were compared with a previously characterized cohort of 60 subclinical HCM subjects (sarcomere mutation carriers without left ventricular hypertrophy). Systolic myocardial tissue velocity, longitudinal, circumferential, and radial strain, and longitudinal and radial strain rate were reduced by 10%-23% in subclinical DCM mutation carriers compared with controls (P<0.001 for all comparisons), after adjusting for age and family relations. No significant differences in diastolic parameters were identified comparing the subclinical and control cohorts. The opposite pattern of contractile abnormalities with reduced diastolic but preserved systolic function was seen in subclinical HCM. CONCLUSIONS Subtle abnormalities in systolic function are present in subclinical DCM mutation carriers, despite normal left ventricular size and ejection fraction. In contrast, impaired relaxation and preserved systolic function appear to be the predominant early manifestations of sarcomere mutations that lead to HCM. These findings support the theory that the mutation's intrinsic impact on sarcomere function influences whether a dilated or hypertrophic phenotype develops.
Collapse
Affiliation(s)
- Neal K Lakdawala
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Araújo MG, Taboada JM, Solís DM, Rivero J, Landesa L, Obelleiro F. Comparison of surface integral equation formulations for electromagnetic analysis of plasmonic nanoscatterers. Opt Express 2012; 20:9161-9171. [PMID: 22513627 DOI: 10.1364/oe.20.009161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The performance of most widespread surface integral equation (SIE) formulations with the method of moments (MoM) are studied in the context of plasmonic materials. Although not yet widespread in optics, SIE-MoM approaches bring important advantages for the rigorous analysis of penetrable plasmonic bodies. Criteria such as accuracy in near and far field calculations, iterative convergence and reliability are addressed to assess the suitability of these formulations in the field of plasmonics.
Collapse
Affiliation(s)
- M G Araújo
- Department of Teoría do Sinal e Comunicacións, E.E. Telecomunicación, Universidade de Vigo, 36310 Vigo, Spain.
| | | | | | | | | | | |
Collapse
|
27
|
Araújo MG, Taboada JM, Rivero J, Solís DM, Obelleiro F. Solution of large-scale plasmonic problems with the multilevel fast multipole algorithm. Opt Lett 2012; 37:416-418. [PMID: 22297371 DOI: 10.1364/ol.37.000416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A surface integral equation together with the multilevel fast multipole algorithm is successfully applied to fast and accurate resolution of plasmonic problems involving a large number of unknowns. The absorption, scattering, and extinction efficiencies of several plasmonic gold spheres of increasing size are efficiently obtained solving the electric and magnetic current combined-field integral equation. The numerical predictions are compared with reference analytic results to demonstrate the accuracy, suitability, and capabilities of this approach when dealing with large-scale plasmonic problems.
Collapse
Affiliation(s)
- M G Araújo
- EE Telecomunicación, Universidade de Vigo, Vigo, Spain.
| | | | | | | | | |
Collapse
|
28
|
Rivero J, Taboada JM, Landesa L, Obelleiro F, García-Tuñón I. Surface integral equation formulation for the analysis of left-handed metamaterials. Opt Express 2010; 18:15876-15886. [PMID: 20720970 DOI: 10.1364/oe.18.015876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A surface integral equation (SIE) formulation is applied to the analysis of electromagnetic problems involving three-dimensional (3D) piecewise homogenized left-handed metamaterials (LHM). The resulting integral equations are discretized by the well-known method of moments (MoM) and solved via an iterative process. The unknowns are defined only on the interfaces between different media, avoiding the discretization of volumes and surrounding space, which entails a drastic reduction in the number of unknowns arising in the numerical discretization of the equations. Besides, the SIE-MoM formulation inherently includes the radiation condition at infinity, so it is not necessary to artificially include termination absorbing boundary conditions. Some 3D numerical examples are presented to confirm the validity and versatility of this approach on dealing with LHM, also providing some intuitive verifications of the singular properties of these amazing materials.
Collapse
Affiliation(s)
- J Rivero
- Department of Tecnologías de los computadores y de las comunicaciones, Escuela Politecnica, Universidad de Extremadura, 10071 Cáceres, Spain
| | | | | | | | | |
Collapse
|
29
|
Bermudez G. V, Gonzalez M, Ruíz J, Rivero J, Herrera F. Characterization of Venezuelan field strains of EEEV by RT-PCR and SSCP. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
30
|
Rivero J, Sotelo R, Stoessel JR, Oswaldo C, Monish A. V44 Laparo-endoscopic single site (LESS) simple hysterectomy. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
31
|
Ho CY, Carlsen C, Thune JJ, Havndrup O, Bundgaard H, Farrohi F, Rivero J, Cirino AL, Andersen PS, Christiansen M, Maron BJ, Orav EJ, Køber L. Echocardiographic strain imaging to assess early and late consequences of sarcomere mutations in hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2009; 2:314-21. [PMID: 20031602 DOI: 10.1161/circgenetics.109.862128] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Genetic testing identifies sarcomere mutation carriers (G+) before clinical diagnosis of hypertrophic cardiomyopathy (HCM), allowing characterization of initial disease manifestations. Previous studies demonstrated that impaired relaxation develops before left ventricular hypertrophy (LVH). The precise impact of sarcomere mutations on systolic function in early and late disease is unclear. METHODS AND RESULTS Comprehensive echocardiography with strain imaging was performed on 146 genotyped individuals with mutations in 5 sarcomere genes. Contractile parameters were compared in 68 preclinical (G+/LVH-), 40 overt (G+/LVH+) subjects with HCM, and 38 mutation (-) normal control relatives. All subjects had normal left ventricular ejection fraction. In preclinical HCM, global and regional peak systolic strain (epsilon(sys)) and longitudinal systolic strain rate were not significantly different from controls, but early diastolic mitral annular velocity (Ea) was reduced by 13%. In overt HCM, there was a significant 27% and 14% decrease in global longitudinal epsilon(sys) and systolic strain rate, respectively, compared with both preclinical HCM and controls (P<0.013 for all comparisons), and a 33% reduction in Ea. CONCLUSIONS Sarcomere mutations have disparate initial effects on diastolic and systolic functions. Preclinical HCM is characterized by impaired relaxation but preserved systolic strain. In contrast, both diastolic and longitudinal systolic abnormalities are present in overt disease despite normal ejection fraction. We propose that diastolic dysfunction is an early consequence of sarcomere mutations, whereas systolic dysfunction results from mutations combined with subsequent pathological remodeling. Identifying mechanistic pathways triggered by these mutations may begin to reshape the clinical paradigm for treatment, based on early diagnosis and disease prevention.
Collapse
Affiliation(s)
- Carolyn Y Ho
- Cardiovascular Division, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Clavo B, Robaina F, Ruiz A, Lloret M, Macias D, Rivero J, Pinar B, Quintero S, Cuyas JM, Hernandez MA. Predictive factors in advanced head and neck cancer treated by radio-chemotherapy and hypoxia modification. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6085 Background: Anemia and tumor hypoxia are known factors for resistance to radio-chemotherapy (RT-CT). In a previous report we have suggested that spinal cord stimulation (SCS) can modify tumor oxygenation and regional blood flow in head and neck cancer (HNC). The aim of the present prospective study was to test the predictive value of pO2 measurement in HNC treated by RT-CT and hypoxia modification using SCS. Methods: Twelve male patients with advanced HNC were analyzed. Stage IVb-IVa: 8–4; mean age 58 + 7.6 years (46–70). Scheduled therapy was hyperfractionated RT (120 cGy/fraction, two fractions/day, total dose 81.6 Gy) from a Co- 60 source, and tegafur 800 mg/day. SCS devices were placed before RT-CT under local anesthesia. During treatment, SCS was connected from 20–30 min before to 20–30 min after each radiotherapy session. Before treatment, they were assessed: Hemoglobin levels and tumor oxygenation pre-SCS and pos-SCS (measured by a polarographic probe system ‘pO2 Histograph‘), expressed as median-pO2, and the fraction of pO2 values less than 5 mmHg (HF5) and less than 2.5 mmHg (HF2.5). Correlations were assessed using Pearson and Spearman tests, and actuarial survival using Kaplan-Meier estimates and Log-rank test. Results: Hemoglobin levels were correlated with oxygenation pre-SCS and pos-SCS: median-pO2 (p=0.005 and p=0.011), HF5 (p=0.048 and p=0.005) respectively. Anemia was associated with more advanced stage (IVb vs IVa, p=0.022), higher HF5 pos-SCS (p=0.028) and lower disease-free survival (p=0.019). The HF2.5 pos-SCS was adversely correlated with the 2 years actuarial: disease-free survival (p=0.027), cause-specific survival (p=0.008) and overall survival (p=0.008). HF2.5 was also correlated with hematocrit (p=0.044). Conclusions: Low hemoglobin levels and anemia are associated with more hypoxic and more advanced tumors. Pre-treatment tumor hypoxia (assessed by the fraction of pO2 values less than 2.5 mmHg during-SCS) is a strong predictive factor for survival in advanced HNC. Patients with highly hypoxic tumors should be selected for more aggressive treatments. Partially supported by: Grant ‘FUNCIS: PI 31–98‘. Scientific supervision was carried out by GICOR. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- B. Clavo
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - F. Robaina
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - A. Ruiz
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - M. Lloret
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - D. Macias
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - J. Rivero
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - B. Pinar
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - S. Quintero
- Dr. Negrin University Hospital, Las Palmas, Spain
| | - J. M. Cuyas
- Dr. Negrin University Hospital, Las Palmas, Spain
| | | |
Collapse
|
33
|
Clavo B, Robaina F, Catalá L, Pérez JL, Lloret M, Caramés MA, Morera J, López L, Suárez G, Macías D, Rivero J, Hernández MA. Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours. Ann Oncol 2004; 15:802-7. [PMID: 15111351 DOI: 10.1093/annonc/mdh189] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tumour ischaemia leads to decreased delivery of oxygen, chemotherapy and radiosensitisers. Hypoxia in head and neck (H&N) tumours is an important adverse prognostic factor. Spinal cord stimulation (SCS) is a well-established neurosurgical technique in the treatment of several ischaemic syndromes. This prospective study evaluated the effect of cervical-SCS on common carotid artery (CCA) blood flow and tumour oxygenation in patients with advanced H&N cancer. PATIENTS AND METHODS Sixteen patients with advanced H&N tumours were enrolled. Cervical-SCS devices were inserted subcutaneously prior to commencement of scheduled chemoradiotherapy. Pre- and post-SCS measurements were as follows: (i) tumour oxygenation (mmHg) using polarographic probes; (ii) blood flow quantification (ml/min) and diastolic and systolic velocimetry (cm/s) in the CCA using colour Doppler. RESULTS After SCS, median tumour oxygenation increased in two-thirds of patients (34%; P = 0.023), all patients had improved CCA blood flow (50%; P <0.001) and almost all patients showed an increased CCA diastolic velocity (26%; P = 0.003) and systolic velocity (20%; P = 0.011). CONCLUSIONS Cervical-SCS increased tumour oxygenation and CCA blood flow, and could enhance the loco-regional delivery of oxygen, radiosensitising and chemotherapeutic drugs. Cervical-SCS as adjuvant in chemoradiotherapy of these tumours warrants further investigation.
Collapse
Affiliation(s)
- B Clavo
- Department of Radiation Oncology Research Unit, Dr Negrín Hospital, C/Barranco la Ballena s/n, 35020 Las Palmas, Canary Islands, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hernández M, Rodríguez I, Pozo L, Rivero J. Chimeric synthetic peptides from the nucleocapsid p24 protein of human immunodeficiency virus type-1. Biochem Biophys Res Commun 2001; 282:1-3. [PMID: 11263961 DOI: 10.1006/bbrc.2001.4541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two chimeric synthetic peptides incorporating antigenic sequences from N-terminal (peptide C14) (134-163) and C-terminal (peptide C15) (335-364) of the p24 protein of human immunodefiency virus (HIV- 1), were synthesized. Peptides C14-GG-C15 and C15-GG-C14 represented sequences from the p24 protein in both possible orders, separated by two glycine residues as arm spacers. These peptides were evaluated as antigen in an Ultramicroenzyme-linked immunosorbent assay (UMELISA) using sera of HIV-1-infected individuals (n = 16) with different titers of antibodies and the specificity was evaluated with healthy blood donors (n = 20). The results were compared to plates coated with monomeric peptides C14 and C15. The chimeric peptide C14-GG-C15 was the most antigenic. Those results may be related to the peptide structure, the sequence order in the chimeric peptide, and epitope accessibility to the antibodies. This chimeric peptide would be very useful for HIV-1 diagnostics.
Collapse
Affiliation(s)
- M Hernández
- Department of Peptide Synthesis, Immunoassay Center, Havana, Cuba.
| | | | | | | |
Collapse
|
35
|
Rodríguez L, Collado-Mesa F, Aragón U, Díaz B, Rivero J. Hepatitis B virus exposure in human immunodeficiency virus seropositive Cuban patients. Mem Inst Oswaldo Cruz 2000; 95:243-5. [PMID: 10733747 DOI: 10.1590/s0074-02762000000200019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In order to estimate the prevalence of serological markers of exposure to Hepatitis B Virus (HBV), 295 subjects were selected at random from the National Registry of human immunodeficiency virus positive subjects. Evidence of exposure to HBV was defined as: testing Hepatitis B surface antigen (HBsAg) and anti-Hepatitis B core antigen (anti-HBc) positive or anti-HBc positive only. Overall, 133 (45.5%) were positive for anti-HBc and 15 (5.1%) resulted positive to HBsAg. Significant statistical association was found between male sex and exposure to HBV (p<0.01). Homosexual or bisexual behavior was found to be strongly associated to HBV exposure (p<0.001). In conclusion, the prevalence of HBV serological markers is higher in Cuban HIV positive subjects compared to the Cuban general population.
Collapse
Affiliation(s)
- L Rodríguez
- Laboratorio de Referencia para Hepatitis Virales, Departamento de Virología, Instituto Pedro Kourí, Habana, 601, Cuba.
| | | | | | | | | |
Collapse
|
36
|
de Lemos JA, Delacretaz E, Piana RN, Smith T, Rivero J, Simon DI, Friedman PL. Images in cardiovascular medicine. Ebstein's anomaly associated with an anomalous coronary artery, 2 myocardial bridges, and a mahaim fiber. Circulation 1999; 100:1757-9. [PMID: 10525497 DOI: 10.1161/01.cir.100.16.1757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J A de Lemos
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Campos ME, López Campos D, Pérez Piñero B, Rivero J, López-Aguado D. [Facial nerve anomaly. A morphohistological study. Apropos a case]. Acta Otorrinolaringol Esp 1999; 50:481-4. [PMID: 10502703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A malformation of the facial nerve in the temporal bone of an otherwise normal adult is reported. The abnormality consisted in the facial nerve obstructing the oval window in the second part of its intrapetrosal section.
Collapse
Affiliation(s)
- M E Campos
- Servicio de ORL, Facultad de Medicina, La Laguna, Tenerife, 38320, España
| | | | | | | | | |
Collapse
|
38
|
García Alvarez CD, Campos Bañales ME, López Campos D, Rivero J, Pérez Piñero B, López Aguado D. [Polyps, nodules, and Reinke edema. An epidemiological and histopathological study]. Acta Otorrinolaringol Esp 1999; 50:443-7. [PMID: 10502695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A retrospective epidemiological and histopathological review was made of 258 patients. Forty had laryngeal polyps, 35 vocal fold nodules, and 41 Reinke edema. One hundred forty-two records were excluded for lack of epidemiological or histopathological data. No dysplastic changes were observed in nodules or polyps. One patient with edema had mild dysplasia. The epidemiological data showed that voice abuse or misuse was the main factor in patients with vocal fold nodules; smoking was the main factor in polyps and edema.
Collapse
Affiliation(s)
- C D García Alvarez
- Cátedra ORL, Hospital Universitario de Canarias, La Laguna, Tenerife, 38320, España
| | | | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- B Pérez
- Department of Otolaryngology, University Hospital of Canarias, La Laguna, Tenerife, Spain
| | | | | | | |
Collapse
|
40
|
Rohde LE, Lee RT, Rivero J, Jamacochian M, Arroyo LH, Briggs W, Rifai N, Libby P, Creager MA, Ridker PM. Circulating cell adhesion molecules are correlated with ultrasound-based assessment of carotid atherosclerosis. Arterioscler Thromb Vasc Biol 1998; 18:1765-70. [PMID: 9812916 DOI: 10.1161/01.atv.18.11.1765] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although cellular adhesion molecules (CAMs) are hypothesized to play an important role in atherogenesis, the relationship between CAMs and systemic atherosclerosis is uncertain. Among 92 outpatients (48 men; mean+/-SD age, 65+/-9 years), we evaluated the association of soluble vascular CAM-1 (sVCAM-1) and intercellular adhesion molecule-1 (sICAM-1) with carotid intimal-medial thickness (IMT), an index of early atherosclerosis. All subjects underwent a 2-dimensional ultrasound examination of both carotid arteries at the distal common carotid arteries and bifurcation. sVCAM-1 and sICAM-1 levels measured by enzyme-linked immunosorbent assay were significantly correlated with mean IMT of the common carotid artery (r=0.34 and r=0.30, respectively; P<0.01) and carotid bifurcation (r=0.31 and r=0.26, respectively; P<0.05), whereas sVCAM-1 was also positively associated with maximal carotid IMT (r=0.35, P<0.01). Adjustment for age attenuated the association between sVCAM-1 and common (r=0.16, P=0.13) and bifurcation (r=0.18, P=0.07) carotid IMT but had minimal effect on the associations between sICAM-1 and carotid measurements (r=0.32, P<0.01; r=0.23, P<0.05; for common and bifurcation IMT, respectively). Age-adjusted sICAM-1 levels increased in a stepwise fashion across common carotid IMT tertiles (253+/-27 versus 275+/-24 versus 384+/-26 pg/mL for the lowest, intermediate, and highest IMT tertiles, respectively; P<0.01). A similar trend was also found between sVCAM-1 levels and common carotid IMT tertiles (625+/-60 versus 650+/-53 versus 714+/-58 pg/mL; P<0.15). These associations were minimally affected in analyses adjusting for hypertension, diabetes, smoking, low and high density lipoprotein cholesterol, lipoprotein(a), and homocysteine, or in a subgroup analysis limited to those with no prior history of atherothrombotic disease. These data demonstrate a positive association between serum CAMs with carotid IMT and further support the hypothesis that systemic inflammation may have a role in atherosclerotic lesion development.
Collapse
Affiliation(s)
- L E Rohde
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Gil A, Carrizosa F, Herrero A, Martin J, González J, Jareño A, Rivero J. Influence of mechanical ventilation on blood lactate in patients with acute respiratory failure. Intensive Care Med 1998; 24:924-30. [PMID: 9803328 DOI: 10.1007/s001340050691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To determine whether mechanical ventilation (MV) may affect blood lactate concentration in patients with acute respiratory failure. DESIGN Prospective observational study with follow-up to hospital discharge. SETTING A 17-bed medical and coronary intensive care unit in a 650-bed general hospital. PATIENTS 55 adult patients mechanically ventilated for acute respiratory failure between May 1996 and April 1997 were recruited. MEASUREMENTS AND RESULTS Arterial blood samples for determination of plasma lactate and blood gas analysis were taken just before tracheal intubation on spontaneous breathing, and 20 and 60 min after the initiation of controlled MV. Cuff systemic arterial pressure was measured before tracheal intubation and every 10 min during the first h of MV. Hyperlactatemia (arterial blood lactate > or = 2 mmol/l) was present in 21 of the 55 patients studied. After 20 min of MV, there was a decrease in blood lactate from 4.74 +/- 1.78 to 3.07 +/- 1.69 mmol/l (p < 0.01); 40 min later there was a further decrease to 2.63 +/- 1.35 mmol/l (p < 0.05). The decrease in blood lactate was also observed in those patients who after starting MV developed systemic arterial hypotension (p < 0.01). In patients with a normal lactate concentration at the entry to the study, lactate remained the same after 60 min on MV (NS). CONCLUSIONS Controlled MV decreases substantially the severity of hyperlactatemia in patients with acute respiratory failure, and any adverse circulatory effects of MV do not alter this beneficial outcome.
Collapse
Affiliation(s)
- A Gil
- Intensive Care Unit, Hospital of Jerez, C(a) Circunvalacion sn, Jerez de la Frontera, Spain.
| | | | | | | | | | | | | |
Collapse
|
42
|
Resik S, Santana E, Rivero J, Pérez AB, Kourí V, Larralde O. [Follow-up serological study of herpes simplex and cytomegalovirus in Cuban patients infected with human immunodeficiency virus (HIV)]. Rev Cubana Med Trop 1998; 49:113-9. [PMID: 9685973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The evolution serological response against the herpes simplex virus and citomegalovirus in HIV infected patients grouped into different stages of the disease was studied. Fluctuations in the TPG of antibodies were observed in these values in a cyclical way through time. There was a greater significant difference among the TPG of antibodies against HSV in the group of asymptomatic patients compared with AIDS patients and with those who died. There is a marked decrease in the TPG of antibodies against HSV and CMV approximately one year before the death of patients.
Collapse
Affiliation(s)
- S Resik
- Instituto de Medicina Tropical Pedro Kourí
| | | | | | | | | | | |
Collapse
|
43
|
Miguez J, Laferté J, Tejero Y, González G, Otero AJ, Rivero J, Duarte C. Evaluation of the serologic response against two consensus V3 loop peptides from human immunodeficiency virus-1 in Cuban patients. Int J Infect Dis 1998; 2:221-5. [PMID: 9763506 DOI: 10.1016/s1201-9712(98)90057-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES A retrospective study was conducted to evaluate the antibody response of Cuban patients infected with human immunodeficiency virus (HIV)-1 against two consensus peptides from the third variable domain (V3) loop of glycoprotein gp120. METHODS The study included sera from 10 individuals at different stages of disease. Two 15-meric synthetic peptides designed from a consensus sequence, belonging to group B or C of HIV-1, were used to determine antibody titers and avidity indexes in an indirect enzyme-linked immunoassay. RESULTS A high reactivity against both peptides was detected, with 80% of the sera reacting with at least one of the peptides. The antibody titers and avidity indexes did not correlate with disease progression. Additionally, for one of the patients from whom the virus had been isolated, a higher avidity index was found against the homologous peptide. CONCLUSIONS This study showed high reactivity against two consensus peptides from the V3 loop of gp120 among patients with HIV. Large scale studies are needed to determine whether the titers or avidity of anti-V3 antibodies, at the early stages of infection, are predictive of disease progression. Both peptides are candidates for inclusion in experimental vaccines.
Collapse
Affiliation(s)
- J Miguez
- Instituto de Medicina Tropical Pedro Kourí, Ciudad Havana, Cuba
| | | | | | | | | | | | | |
Collapse
|
44
|
Llorente MD, Olsen EJ, Leyva O, Silverman MA, Lewis JE, Rivero J. Use of antipsychotic drugs in nursing homes: current compliance with OBRA regulations. J Am Geriatr Soc 1998; 46:198-201. [PMID: 9475449 DOI: 10.1111/j.1532-5415.1998.tb02539.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the degree and patterns of compliance with the Omnibus Budget Reconciliation Act (OBRA) regulations regarding the use of antipsychotic drugs in nursing homes. DESIGN Retrospective chart review of all resident records. PARTICIPANTS Eight nursing homes: five community, two county-owned, and one university-affiliated Veterans Administration facility. MEASUREMENTS A structured assessment instrument to track compliance with each aspect of the OBRA regulations regarding antipsychotic drug use. RESULTS A total of 1573 nursing home residents' pharmacy records were reviewed between August 1994 and March 1996. Two hundred seventy-nine residents were actively taking antipsychotic medications (prevalence = 17.7%). Mean compliance greater than 70% was found for (1) appropriate diagnostic indication (mean = 70.9%), (2) dosage within recommended limits (mean = 90.1%), and 3) documented appropriate target symptoms (mean = 90.4%). Dosages were more likely to exceed limits in those patients with histories of major mental illness, particularly schizophrenia. CONCLUSIONS Nursing homes were better able to comply with those guidelines that are most specific. Educational interventions now need to focus on behavioral interventions, monitoring of adverse effects, and efficacy. These data are useful in establishing threshold levels of performance and can be used by nursing homes for continuous quality improvement. OBRA continues to impact neuroleptic drug prescribing practices in nursing homes significantly.
Collapse
Affiliation(s)
- M D Llorente
- University of Miami School of Medicine, Florida, USA
| | | | | | | | | | | |
Collapse
|
45
|
Benítez J, Palenzuela D, Rivero J, Gavilondo JV. A recombinant protein based immunoassay for the combined detection of antibodies to HIV-1, HIV-2 and HTLV-I. J Virol Methods 1998; 70:85-91. [PMID: 9506816 DOI: 10.1016/s0166-0934(97)00173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to develop and evaluate a combined assay for the detection of antibodies to HIV-1, HIV-2 and HTLV-I (human T-cell leukemia virus type I). A mixture of recombinant proteins and synthetic peptides was fixed to the surface of microELISA wells and a protein A peroxidase conjugate was used as tracer. The combined assay was compared to specific HIV-1/2 and HTLV-I commercial ELISAs. The sensitivity was studied with a panel of 158 HIV-1, 82 HIV-2 and 48 HTLV-I positive sera, all of which were reactive in the combined assay. The analytical sensitivity was studied with a panel of serially diluted sera and was similar to that obtained for the specific ELISAs. The specificity of the test was 99.78% against a panel of 466 negative sera collected from voluntary donors that included HBsAg, HCV, and VDRL positive sera. The false positive serum was borderline in the HTLV-I specific ELISA. The new combined ELISA can be used as an efficient initial screening assay, avoiding the cost of individual tests for HIV and HTLV.
Collapse
Affiliation(s)
- J Benítez
- Immunotechnology and Diagnostics Division, Center for Genetic Engineering and Biotechnology, Havana, Cuba.
| | | | | | | |
Collapse
|
46
|
Rohde L, Lee R, Briggs W, Rivero J, Jamacochian M, Nass N, Libby P, Creager M, Ridker P. Soluble vascular cell adhesion molecule-1 (sVCAM-1) and intercellular adhesion molecule-1 (sICAM-1) correlates with carotid thickness. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
47
|
Rivero J, Fraga M, Cancio I, Cuervo J, López-Saura P. Long-term treatment with recombinant interferon alpha-2b prolongs survival of asymptomatic HIV-infected individuals. Biotherapy 1997; 10:107-13. [PMID: 9373732 DOI: 10.1007/bf02678537] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVE Early long-term treatment with recombinant interferon (IFN) alpha-2b delayed disease progression in asymptomatic Human Immunodeficiency Virus (HIV) carriers in a randomized trial that lasted from October 1987 to February 1992 (14). The aim of the work reported in this paper was to observe if there was also an effect on survival when the same patients were followed-up further. DESIGN AND INTERVENTIONS IFN alpha-2b was given 3 x 10(6) IU, 3 times weekly. The control group did not receive any treatment. The main end-point for this evaluation was death due to any cause. The deadline was August 1995. POPULATION Subjects were anti-HIV-1 seropositive, Western blot-confirmed, asymptomatic (CDC group II), or with generalized lymphadenopathies (CDC group III). The groups had 79 (control) and 83 (IFN) patients. MAIN RESULTS Mean survival was longer in the IFN group (95% CI: 127-152 vs. 101-120 months since infection or 80-90 vs. 70-82 months since the start of treatment). Survival rates were higher in IFN-treated individuals (61-77% vs. 24-54% at 10 years of infection or 53-69% vs. 34-52% at 7 years of treatment or follow-up). It was also confirmed that disease progression is significantly slower in IFN-treated patients. There were 23.4 vs. 3.2% long-term survivors in the IFN and control groups, respectively (p = 0.005). IFN-treated patients had fewer AIDS-related malignancies (5 vs. 11), mainly Kaposi's sarcomas (1 vs. 5). This difference was not statistically significant, but clinically interesting. There was no difference in survival if measured since the onset of AIDS. CONCLUSION IFN alpha treatment given from the early stages of infection, but not after the appearance of AIDS symptoms, can prolong survival.
Collapse
Affiliation(s)
- J Rivero
- Sanatorio Santiago de las Vegas, La Habana, Cuba
| | | | | | | | | |
Collapse
|
48
|
Palenzuela DO, Benítez J, Rivero J, Serrano R, Ganzó O. Single point dilution method for the quantitative analysis of antibodies to the gag24 protein of HIV-1. J Immunol Methods 1997; 208:43-8. [PMID: 9433459 DOI: 10.1016/s0022-1759(97)00126-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the present work a concept proposed in 1992 by Dopotka and Giesendorf was applied to the quantitative analysis of antibodies to the p24 protein of HIV-1 in infected asymptomatic individuals and AIDS patients. Two approaches were analyzed, a linear model OD = b0 + b1.log(titer) and a nonlinear log(titer) = alpha.OD beta, similar to the Dopotka-Giesendorf's model. The above two proposed models adequately fit the dependence of the optical density values at a single point dilution, and titers achieved by the end point dilution method (EPDM). Nevertheless, the nonlinear model better fits the experimental data, according to residuals analysis. Classical EPDM was compared with the new single point dilution method (SPDM) using both models. The best correlation between titers calculated using both models and titers achieved by EPDM was obtained with the nonlinear model. The correlation coefficients for the nonlinear and linear models were r = 0.85 and r = 0.77, respectively. A new correction factor was introduced into the nonlinear model and this reduced the day-to-day variation of titer values. In general, SPDM saves time, reagents and is more precise and sensitive to changes in antibody levels, and therefore has a higher resolution than EPDM.
Collapse
Affiliation(s)
- D O Palenzuela
- División de Immunotecnología y Diagnóstico, Centro de Ingeniería Genética y Biotecnología, La Habana, Cuba.
| | | | | | | | | |
Collapse
|
49
|
Abstract
The cytotoxicity of a low mol. wt fraction (LMWF) obtained from Aloe vera gel was determined by two different assays. Firstly, exposure of monolayers of chicken fibroblasts to LMWF induced disruption of intercellular junctions and detachment of individual cells from the bottom of the flask, with formation of cell-free gaps in the monolayer. Secondly, LMWF inhibited the production of reactive oxygen species by human polymorphonuclear leukocytes stimulated by zymosan, as followed by luminol-dependent chemiluminescence. The toxic activity of LMWF was compared to that of sodium dodecyl sulfate (a well-known toxic substance), aloe-emodin and aloin (an anthraquinone and its precursor present in Aloe vera cortex) using the chemilumescence assay, and was found to be of similar potency to these toxic substances on a weight-to-weight basis. These results confirm that Aloe vera gel contains toxic low mol. wt compounds, and every effort must be made to limit the amount of these toxins in the commercially prepared Aloe vera gel products.
Collapse
Affiliation(s)
- H Avila
- Centro de Investigaciones Biomédicas (BIOMED), Facultad de Ciencias de la Salud, Universidad de Carabobo, Maracay, Venezuela
| | | | | | | |
Collapse
|
50
|
Abstract
Fifty human temporal bones from necropsies were used to study the frequency of canal dehiscences in detail along the course of the facial nerve. Specifically, the study focused on bony dehiscences in the fallopian canal and vascular communications between the facial nerve and the surrounding bone. High frequency of dehiscences at the oval window (60%) and in the pyramidal segment (54%) were found. These dehiscence rates are in agreement with published reports. A 20% rate of dehiscences at the most anterior segment of the tympanic segment was noted and a non-reported high rate (20%) of multiple dehiscences along the course of the fallopian canal in the same temporal bone in specimens of newborns and young children. The significance of these findings in terms of clinical implications is discussed.
Collapse
Affiliation(s)
- B Perez
- Department of Otolaryngology, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | | | | | | | | |
Collapse
|