Evolutionary loss of inflammasomes in the Carnivora and implications for the carriage of zoonotic infections

Zoonotic pathogens, such as COVID-19, reside in animal hosts before jumping species to infect humans. The Carnivora, like mink, carry many zoonoses, yet how diversity in host immune genes across species affect pathogen carriage is poorly understood. Here, we describe a progressive evolutionary downregulation of pathogen-sensing inflammasome pathways in Carnivora. This includes the loss of nucleotide-oligomerization domain leucine-rich repeat receptors (NLRs), acquisition of a unique caspase-1/-4 effector fusion protein that processes gasdermin D pore formation without inducing rapid lytic cell death, and the formation of a caspase-8 containing inflammasome that inefficiently processes interleukin-1β. Inflammasomes regulate gut immunity, but the carnivorous diet has antimicrobial properties that could compensate for the loss of these immune pathways. We speculate that the consequences of systemic inflammasome downregulation, however, can impair host sensing of specific pathogens such that they can reside undetected in the Carnivora.

Use of Proteins Identified through a Functional Genomic Screen To Develop a Protein Subunit Vaccine That Provides Significant Protection against Virulent Streptococcus suis in Pigs

Streptococcus suis is a bacterium that is commonly carried in the respiratory tract and that is also one of the most important invasive pathogens of swine, commonly causing meningitis, arthritis, and septicemia. Due to the existence of many serotypes and a wide range of immune evasion capabilities, efficacious vaccines are not readily available. The selection of S. suis protein candidates for inclusion in a vaccine was accomplished by identifying fitness genes through a functional genomics screen and selecting conserved predicted surface-associated proteins. Five candidate proteins were selected for evaluation in a vaccine trial and administered both intranasally and intramuscularly with one of two different adjuvant formulations. Clinical protection was evaluated by subsequent intranasal challenge with virulent S. suis While subunit vaccination with the S. suis proteins induced IgG antibodies to each individual protein and a cellular immune response to the pool of proteins and provided substantial protection from challenge with virulent S. suis, the immune response elicited and the degree of protection were dependent on the parenteral adjuvant given. Subunit vaccination induced IgG reactive against different S. suis serotypes, indicating a potential for cross protection.

Effects of 5 days of head-down bed rest, with and without short-arm centrifugation as countermeasure, on cardiac function in males (BR-AG1 study)

This study examined cardiac remodeling and functional changes induced by 5 days of head-down (−6°) bed rest (HDBR) and the effectiveness of short-arm centrifugation (SAC) in preventing them in males. Twelve healthy men (mean age: 33 ± 7) were enrolled in a crossover design study (BR-AG1, European Space Agency), including one sedentary (CTRL) and two daily SAC countermeasures (SAC1, 30 min continuously; SAC2, 30 min intermittently) groups. Measurements included plasma and blood volume and left ventricular (LV) and atrial (LA) dimensions by transthoracic echocardiography (2- and 3-dimensional) and Doppler inflows. Results showed that 5 days of HDBR had a major impact on both the geometry and cardiac function in males. LV mass and volume decreased by 16 and 14%, respectively; LA volume was reduced by 36%; Doppler flow and tissue Doppler velocities were reduced during early filling by 18 and 12%, respectively; and aortic flow velocity time integral was decreased by 18% with a 3% shortening of LV ejection time. These modifications were presumably due to decreased physiological loading and dehydration, resulting in reduced plasma and blood volume. All these changes were fully reversed 3 days after termination of HDBR. Moreover, SAC was not able to counteract these changes, either when applied continuously or intermittently.

Reference-free transcriptome assembly in non-model animals from next-generation sequencing data

Next-generation sequencing (NGS) technologies offer the opportunity for population genomic study of non-model organisms sampled in the wild. The transcriptome is a convenient and popular target for such purposes. However, designing genetic markers from NGS transcriptome data requires assembling gene-coding sequences out of short reads. This is a complex task owing to gene duplications, genetic polymorphism, alternative splicing and transcription noise. Typical assembling programmes return thousands of predicted contigs, whose connection to the species true gene content is unclear, and from which SNP definition is uneasy. Here, the transcriptomes of five diverse non-model animal species (hare, turtle, ant, oyster and tunicate) were assembled from newly generated 454 and Illumina sequence reads. In two species for which a reference genome is available, a new procedure was introduced to annotate each predicted contig as either a full-length cDNA, fragment, chimera, allele, paralogue, genomic sequence or other, based on the number of, and overlap between, blast hits to the appropriate reference. Analyses showed that (i) the highest quality assemblies are obtained when 454 and Illumina data are combined, (ii) typical de novo assemblies include a majority of irrelevant cDNA predictions and (iii) assemblies can be appropriately cleaned by filtering contigs based on length and coverage. We conclude that robust, reference-free assembly of thousands of genes from transcriptomic NGS data is possible, opening promising perspectives for transcriptome-based population genomics in animals. A Galaxy pipeline implementing our best-performing assembling strategy is provided.

Reference-free transcriptome assembly in non-model animals from next-generation sequencing data

Next-generation sequencing (NGS) technologies offer the opportunity for population genomic study of non-model organisms sampled in the wild. The transcriptome is a convenient and popular target for such purposes. However, designing genetic markers from NGS transcriptome data requires assembling gene-coding sequences out of short reads. This is a complex task owing to gene duplications, genetic polymorphism, alternative splicing and transcription noise. Typical assembling programmes return thousands of predicted contigs, whose connection to the species true gene content is unclear, and from which SNP definition is uneasy. Here, the transcriptomes of five diverse non-model animal species (hare, turtle, ant, oyster and tunicate) were assembled from newly generated 454 and Illumina sequence reads. In two species for which a reference genome is available, a new procedure was introduced to annotate each predicted contig as either a full-length cDNA, fragment, chimera, allele, paralogue, genomic sequence or other, based on the number of, and overlap between, blast hits to the appropriate reference. Analyses showed that (i) the highest quality assemblies are obtained when 454 and Illumina data are combined, (ii) typical de novo assemblies include a majority of irrelevant cDNA predictions and (iii) assemblies can be appropriately cleaned by filtering contigs based on length and coverage. We conclude that robust, reference-free assembly of thousands of genes from transcriptomic NGS data is possible, opening promising perspectives for transcriptome-based population genomics in animals. A Galaxy pipeline implementing our best-performing assembling strategy is provided.

Transmission network parameters estimated from HIV sequences for a nationwide epidemic

BACKGROUND

Many studies of sexual behavior have shown that individuals vary greatly in their number of sexual partners over time, but it has proved difficult to obtain parameter estimates relating to the dynamics of human immunodeficiency virus (HIV) transmission except in small-scale contact tracing studies. Recent developments in molecular phylodynamics have provided new routes to obtain these parameter estimates, and current clinical practice provides suitable data for entire infected populations.

METHODS

A phylodynamic analysis was performed on partial pol gene sequences obtained for routine clinical care from 14,560 individuals, representing approximately 60% of the HIV-positive men who have sex with men (MSM) under care in the United Kingdom.

RESULTS

Among individuals linked to others in the data set, 29% are linked to only 1 individual, 41% are linked to 2-10 individuals, and 29% are linked to ≥10 individuals. The right-skewed degree distribution can be approximated by a power law, but the data are best fitted by a Waring distribution for all time depths. For time depths of 5-7 years, the distribution parameter ρ lies within the range that indicates infinite variance.

CONCLUSIONS

The transmission network among UK MSM is characterized by preferential association such that a randomly distributed intervention would not be expected to stop the epidemic.

Next-generation sequencing of transcriptomes: a guide to RNA isolation in nonmodel animals

Next Generation Sequencing technologies (NGS) are rapidly invading many evolutionary and ecological fields, such as phylogenomics, molecular evolution, population genomics and molecular ecology. Among the potential targets of NGS is transcriptome sequencing, a fast and relatively cheap way to generate massive amounts of coding sequence data, offering promising perspectives for the analysis of molecular diversity in the wild. A number of molecular ecology research groups therefore may switch from DNA-based to RNA-based typing in the near future. Sample preparation from natural populations, however, requires specific care and protocols when RNA is the target. Furthermore, NGS sequencing of transcriptome requires high amount of good-quality RNA. Here we present the results of RNA extraction experiments from various samples of 39 animal species caught in the wild. We compared tissue preparation and storage conditions, evaluated and improved standard RNA extraction protocols, and achieved RNA yield and quality suitable for NGS in all cases. We derive general guidelines for the production of ready-to-sequence RNA in nonmodel animals sampled in the field.

Evaluation of alterations on mitral annulus velocities, strain, and strain rates due to abrupt changes in preload elicited by parabolic flight

We tested the hypothesis that in normal subjects, cardiac tissue velocities, strain, and strain rates (SR), measured by Doppler tissue echocardiography (DTE), are preload dependent. To accomplish it, immediately preceding image acquisition, reversible, repeatable, acute nonpharmacological changes in preload were induced by parabolic flight. DTE has been proposed as a new approach to assess left ventricular regional myocardial function by computing tissue velocities, strain, and SR. However, preload dependence of these parameters in normal subjects still remains controversial. DTE images (Philips) were obtained in 10 normal subjects in standing upright position at normogravity (1 G z), hypergravity (1.8 G z), and microgravity (0 G z) with and without −50 mmHg lower body negative pressure (LBNP). Myocardial velocity curves in the basal interventricular septum were reconstituted offline from DTE images, from which peak systolic (S′), early (E′) and late (A′) diastolic velocities, SR, and peak systolic strain (PSε) were measured and averaged over four beats. At 1.8 G z (reduced venous return), S′, E′, and A′ decreased by 21%, 21%, and 26%, respectively, compared with 1-G z values, while at 0 G z (augmented venous return), E′, A′, and PSε increased by 57%, 53%, and 49%, respectively. LBNP reduced E′ and PSε. In conclusion, our results were in agreement with those obtained in animal models, in which preload was changed in a controlled, acute, and reversible manner, and image acquisition was performed immediately following preload modifications. The hypothesis of preload dependence was confirmed for S′, E′, A′, and PSε, while SR appeared to be preload independent, probably reflecting intrinsic myocardial properties.

Objective evaluation of changes in left ventricular and atrial volumes during parabolic flight using real-time three-dimensional echocardiography

We tested the feasibility of real-time three-dimensional (3D) echocardiographic (RT3DE) imaging to measure left heart volumes at different gravity during parabolic flight and studied the effects of lower body negative pressure (LBNP) as a countermeasure. Weightlessness-related changes in cardiac function have been previously studied during spaceflights using both 2D and 3D echocardiography. Several technical factors, such as inability to provide real-time analysis and the need for laborious endocardial definition, have limited its usefulness. RT3DE imaging overcomes these limitations by acquiring real-time pyramidal data sets encompassing the entire ventricle. RT3DE data sets were obtained (Philips 7500, X3) during breath hold in 16 unmedicated normal subjects in upright standing position at different gravity phases during parabolic flight (normogravity, 1 Gz; hypergravity, 1.8 Gz; microgravity, 0 Gz), with LBNP applied (−50 mmHg) at 0 Gz in selected parabolas. RT3DE imaging during parabolic flight was feasible in 14 of 16 subjects. Data were analyzed (Tomtec) to quantify left ventricular (LV) and atrial (LA) volumes at end diastole and end systole, which significantly decreased at 1.8 Gz and increased at 0 Gz. While ejection fraction did not change with gravity, stroke volume was reduced by 16% at 1.8 Gz and increased by 20% at 0 Gz, but it was not significantly different from 1 Gz values with LBNP. RT3DE during parabolic flight is feasible and provides the basis for accurate quantification of LV and LA volume changes with gravity. As LBNP counteracted the increase of LV and LA volumes caused by changes in venous return, it may be effectively used for preventing cardiac dilatation during 0 Gz.

Improved quantification of left ventricular mass based on endocardial and epicardial surface detection with real time three dimensional echocardiography

OBJECTIVE

To develop a technique for volumetric analysis of real time three dimensional echocardiography (RT3DE) data aimed at quantifying left ventricular (LV) mass and to validate the technique against magnetic resonance (MR) assumed as the reference standard.

DESIGN

RT3DE, which has recently become widely available, provides dynamic pyramidal data structures that encompass the entire heart and allows four dimensional assessment of cardiac anatomy and function. However, analysis techniques for the quantification of LV mass from RT3DE data are fundamentally two dimensional, rely on geometric modelling, and do not fully exploit the volumetric information contained in RT3DE datasets. Twenty one patients underwent two dimensional echocardiography (2DE), RT3DE, and cardiac MR. LV mass was measured from 2DE and MR images by conventional techniques. RT3DE data were analysed to semiautomatically detect endocardial and epicardial LV surfaces by the level set approach. From the detected surfaces, LV mass was computed directly in the three dimensional space as voxel counts.

RESULTS

RT3DE measurement was feasible in 19 of 21 patients and resulted in higher correlation with MR (r = 0.96) than did 2DE (r = 0.79). RT3DE measurements also had a significantly smaller bias (-2.1 g) and tighter limits of agreement (2SD = +/-23 g) with MR than did the 2DE values (bias (2SD) -34.9 (50) g). Additionally, interobserver variability of RT3DE (12.5%) was significantly lower than that of 2DE (24.1%).

CONCLUSIONS

Direct three dimensional model independent LV mass measurement from RT3DE images is feasible in the clinical setting and provides fast and accurate assessment of LV mass, superior to the two dimensional analysis techniques.

Feasibility of real-time 3D echocardiography in weightlessness during parabolic flight

Aim of the study was to test the feasibility of transthoracic real-time 3D (Philips) echocardiography (RT3D) during parabolic flight, to allow direct measurement of heart chambers volumes modifications during the parabola. One RT3D dataset corresponding to one cardiac cycle was acquired at each gravity phase (1 Gz, 1.8 Gz, 0 Gz, 1.8 Gz) during breath-hold in 8 unmedicated normal subjects (41 +/- 8 years old) in standing upright position. Preliminary results, obtained by semi-automatically tracing left ventricular (LV) and left atrial (LA) endocardial contours in multiple views (Tomtec), showed a significant (p<0.05) reduction, compared to 1 Gz, of LV and LA volumes with 1.8 Gz, and a significant increase with 0 Gz. Further analysis will focus on the right heart.

Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study

OBJECTIVE

To assess the feasibility of measuring left atrial (LA) function with acoustic quantification (AQ) and then assess the effects of age and sex on LA reservoir, conduit, and booster pump function.

PATIENTS AND SETTING

165 subjects without cardiovascular disease, 3-79 years old, were enrolled by six tertiary hospital centres.

INTERVENTIONS

Continuous LA AQ area data were acquired and signal averaged to form composite waveforms which were analysed off-line.

MAIN OUTCOME MEASURES

Parameters of LA performance according to age and sex.

RESULTS

Signal averaged LA waveforms were sufficiently stable and detailed to allow automated analysis in all cases. An age related increase in LA area was noted. LA reservoir function did not vary with age or sex. All parameters of LA passive and active emptying revealed a significant age dependency. Overall, the passive emptying phase accounted for 66% of total LA emptying ranging from 76% in the youngest to 44% in the oldest decade. LA contraction accounted for 34% of atrial emptying in all subjects combined with the older subjects being more dependent on atrial booster pump function. When adjusted for atrial size, there were no sex related differences in LA function.

CONCLUSIONS

LA reservoir, conduit, and booster pump function can be assessed with automated analysis of signal averaged LA area waveforms. As LA performance varies with age, establishment of normal values should enhance the evaluation of pathologic states in which LA function is important.

Normal values of regional left ventricular endocardial motion: multicenter color kinesis study

Our goal was to establish normal values for quantitative color kinesis indexes of left ventricular (LV) wall motion over a wide range of ages, which are required for objective diagnosis of regional systolic and diastolic dysfunction. Color-encoded images were obtained in 194 normal subjects (95 males, 99 females, age 2 mo to 79 yr) in four standard views. Quantitative indexes of magnitude and timing of systolic and diastolic function were studied for age- and gender-related differences. Normal limits of all ejection and filling indexes were in a narrow range (< or =25% of the mean), with no major gender-related differences. Despite invariable ejection fractions, both peak filling and ejection rates decreased with age (30 and 20%, correspondingly) with a concomitant increase in mean filling and ejection times, resulting in five- and twofold increases in the late to early filling and ejection ratios, correspondingly. Diastolic asynchrony increased with age (from 4.7 +/- 2.0 to 6.4 +/- 3.2 from the 2nd to 7th decade). The normal values of color kinesis indexes should allow objective detection of regional LV systolic and diastolic dysfunction.

Electronic transmission of digital echocardiographic studies: effects of MPEG compression

The acquisition, storage and retrieval of digital echocardiographic studies greatly facilitates image review and quantitation and permits the transmission of studies electronically. However, the considerable size of digital echocardiographic data files makes transmission over existing networks slow and impractical. Reduction in the size of these data files can be accomplished with digital image compression. We sought to evaluate the effects of MPEG-1 compression on the transfer time of digital echocardiographic studies over currently available network connections. Ninety consecutive routine clinical echocardiographic studies were randomly compressed at one of three compression ratios 60:1, 80:1, or 120:1 and sent to a receiving terminal using simulated transmission rates. Compression of digital echocardiographic studies at these ratios which, have been shown to maintain diagnostic image quality, reduced the size of digital echocardiographic studies to less than 1% of their original sizes which allowed transmission of echocardiographic studies over networks using 3ISDN or T1 lines with minimal waiting time.

Power Doppler imaging as a basis for automated endocardial border detection during left ventricular contrast enhancement

Echocardiographic evaluation of left ventricular (LV) systolic function relies on endocardial visualization, which can be improved when necessary using contrast enhancement. However, there is no method to automatically detect the endocardial boundary from contrast-enhanced images. We hypothesized that this could be achieved using harmonic power Doppler imaging. Twenty-two patients were studied in two protocols: (1) 11 patients with poorly visualized endocardium (> 3 contiguous segments not visualized) and (2) 11 consecutive patients referred for dobutamine stress echocardiography who were studied at rest and at peak dobutamine infusion. Patients were imaged in the apical four-chamber view using harmonic power Doppler mode (HP SONOS 5500) during LV contrast enhancement (Optison or Definity DMP115). Digital images were analyzed using custom software designed to automatically extract the endocardial boundary from power Doppler color overlays. LV cavity area was automatically measured frame-by-frame throughout the cardiac cycle, and fractional area change calculated and compared with those obtained by manually tracing the endocardial boundary in end-systolic and end-diastolic gray scale images. Successful border detection and tracking throughout the cardiac cycle was possible in 9 of 11 patients with poor endocardial definition and in 10 of 11 unselected patients undergoing dobutamine stress testing. Fractional area change obtained from power Doppler images correlated well with manually traced area changes (r = 0.82 and r = 0.97, in protocols 1 and 2, respectively). Harmonic power Doppler imaging with contrast may provide a simple method for semi-automated border detection and thus facilitate the objective evaluation of LV function both at rest and under conditions of stress testing. This methodology may prove to be particularly useful in patients with poorly visualized endocardium.

Effect of age, heart rate and tricuspid regurgitation on the Doppler echocardiographic evaluation of right ventricular diastolic function

Pulsed-wave Doppler analysis of tricuspid inflow and hepatic venous flow allows the determination of multiple parameters of right-ventricular (RV) diastolic function. This study sought to evaluate the influence of heart rate, age and tricuspid regurgitation on Doppler parameters of RV diastolic performance. We studied 80 subjects (20 normal and 60 with RV pathology) with Doppler recordings of the tricuspid inflow and hepatic vein. All tricuspid Doppler parameters were dependent on heart rate, age or regurgitation severity as were the hepatic vein S wave, S/D ratio and systolic filling fraction. The atrial reversal velocity in the hepatic vein Doppler tracing was not affected by age, heart rate or regurgitation. In addition, the inspiratory increase in this parameter was significantly elevated in RV pathologic states. This study demonstrates that most Doppler echocardiographic parameters of RV diastolic performance are dependent on age, tricuspid regurgitation or heart rate.

The role of echocardiographic harmonic imaging and contrast enhancement for improvement of endocardial border delineation

Despite advances in imaging technology, many myocardial segments remain poorly visualized with echocardiography; however, both contrast enhancement and harmonic imaging have shown promise for improving endocardial definition. Fifty subjects with technically limited echocardiograms were studied with fundamental and harmonic imaging as well as during echocardiographic contrast injection. Overall endocardial visualization scores improved with both techniques compared with fundamental imaging. Harmonic imaging improved endocardial visualization in 43% of all segments and in 57% of segments nonvisualized with fundamental imaging. The benefit of harmonic imaging was seen in all segments. Contrast echocardiography had similar overall improvements in visualization (42% of all segments, 67% of segments nonvisualized with fundamental imaging) but was not helpful in all regions. Harmonic imaging outperformed contrast in 9 of 22 segments, whereas contrast was superior in 4 of 22. In a subgroup of patients with very poor images, contrast enhancement was superior, with a greater increase in overall score and a higher salvage rate than harmonic (68% vs 40%).

Effects of MPEG compression on the quality and diagnostic accuracy of digital echocardiography studies

The advantages of digital echocardiography studies include ease of retrieval, review, comparison, duplication, and quantitation as well as the potential for moving studies over networks. However, the large amounts of data associated with digital echocardiography studies have posed new problems. Reduction of the amount of data can be accomplished with image compression, in particular MPEG-1 (Moving Pictures Expert Group), which is designed for dynamic image sequences. However the effects of different levels of compression on the quality and diagnostic content of echocardiographic images need to be established. Digital sequences of single cardiac cycles were acquired in 40 consecutive patients, MPEG-1-compressed at different effective ratios (60:1, 80:1, 120:1, 200:1, 300:1, 370:1, 500:1), reviewed, and scored for endocardial visualization. The overall visualization scores and percentages of nonvisualized segments in the compressed images were not different from the uncompressed images up to a compression ratio of 200:1. Differential effects of compression were noted on a segmental basis and also varied with baseline image quality. The ability to correctly identify regional wall motion abnormalities did not decrease until compression ratios of 1:200 or higher were used. Digital echocardiography loops, MPEG-1-compressed at an effective ratio of 200:1, demonstrate no degradation in endocardial visualization quality or diagnostic content. Compression at this ratio has the potential to reduce the storage size of digital echocardiography studies to less than 1% of their current size.

Identification of cardiac masses and abnormal blood flow patterns with harmonic power Doppler contrast echocardiography

Power Doppler is an ultrasound technique that color-encodes the change in amplitude of the ultrasound signal, which reflects changes in the position of scatterers between ultrasound pulses. Power Doppler can be used with echocardiographic contrast agents in a harmonic imaging mode to opacify a cardiac chamber. The opacification of a cardiac chamber can aid in visualizing the silhouette of intracardiac masses and displaying blood flow patterns. Four cases are presented that demonstrate the use of harmonic power Doppler to aid in the identification of a left ventricular apical thrombus, a left atrial thrombus, and a left ventricular pseudoaneurysm.

Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images

OBJECTIVES

To test the feasibility of objective and automated evaluation of echocardiographic stress tests, we studied the ability of segmental analysis of color kinesis (CK) images to detect dobutamine-induced wall motion abnormalities and compared this technique with inexperienced reviewers of conventional gray-scale images.

BACKGROUND

Conventional interpretation of stress echocardiographic studies is subjective and experience dependent.

METHODS

CK images were obtained in 89 of 104 consecutive patients undergoing clinical dobutamine stress studies and were analyzed using custom software to calculate regional fractional area change in 22 segments in four standard views. Each patient's data obtained at rest was used as a control for automated detection of dobutamine-induced wall motion abnormalities. Independently, studies were reviewed without CK overlays by two inexperienced readers who classified each segment's response to dobutamine. A consensus reading of two experienced reviewers was used as the gold standard for comparisons. In a subgroup of 16 patients, these consensus readings and CK detection of wall motion abnormalities were compared with coronary angiography.

RESULTS

The consensus reading detected ischemic response to dobutamine in 43 of 1958 segments in 23 of 89 patients. Automated detection of stress-induced wall motion abnormalities correlated more closely with the standard technique than the inexperienced reviewers (sensitivity 0.76 vs. 0.55, specificity 0.98 vs. 0.94 and accuracy 0.97 vs. 0.92). When compared with coronary angiography in a subgroup of patients, analysis of CK images differentiated between normal and abnormal wall motion more accurately than expert readers of gray-scale images (accuracy of 0.93 vs. 0.82).

CONCLUSIONS

Analysis of CK images allows fast, objective and automated evaluation of regional wall motion, sensitive enough for clinical dobutamine stress data and more accurate than inexperienced readers. This method may result in a valuable adjunct to conventional visual interpretation of dobutamine stress echocardiography.

Quantitative assessment of regional right ventricular function with color kinesis

We used color kinesis, a recent echocardiographic technique that provides regional information on the magnitude and timing of endocardial wall motion, to quantitatively assess regional right ventricular (RV) systolic and diastolic properties in 76 subjects who were divided into five groups, as follows: normal (n = 20), heart failure (n = 15), pressure/volume overload (n = 14), pressure overload (n = 12), and RV hypertrophy (n = 15). Quantitative segmental analysis of color kinesis images was used to obtain regional fractional area change (RFAC), which was displayed in the form of stacked histograms to determine patterns of endocardial wall motion. Time curves of integrated RFAC were used to objectively identify asynchrony of diastolic endocardial motion. When compared with normal subjects, patients with pressure overload or heart failure exhibited significantly decreased endocardial motion along the RV free wall. In the presence of mixed pressure/volume overload, the markedly increased ventricular septal motion compensated for decreased RV free wall motion. Diastolic endocardial wall motion was delayed in 17 of 72 segments (24%) in patients with RV pressure overload, and in 31 of 90 segments (34%) in patients with RV hypertrophy. Asynchrony of diastolic endocardial wall motion was greater in the latter group than in normal subjects (16% versus 10%: p < 0.01). Segmental analysis of color kinesis images allows quantitative assessment of regional RV systolic and diastolic properties.

Calcified right atrial mass in a woman receiving long-term intravenous phosphate therapy

Right atrial masses are easily seen by 2-dimensional echocardiography and may represent primary tumors, secondary tumor invasion of the right atrium, tricuspid valve vegetations, or atrial thrombi. Calcification of right atrial masses is uncommon but easily identified by 2-dimensional echocardiography because of the high echogenicity of calcium deposits. We describe a patient with a heavily calcified right atrial thrombus caused by an indwelling central venous catheter and long-term intravenous phosphate infusion.

Age dependency of left atrial and left ventricular acoustic quantification waveforms for the evaluation of diastolic performance in left ventricular hypertrophy

We evaluated diastolic performance in 50 normal subjects and 50 patients with concentric left ventricular (LV) hypertrophy. Age-dependent normal values were determined for LV and left atrial (LA) acoustic quantification parameters. Pulsed wave Doppler echocardiography was also performed on all subjects. Patients with LV hypertrophy had higher peak velocities of atrial contraction and atrial contributions to filling. The acoustic quantification waveforms revealed lower rapid filling percentage of total filling and lower peak rapid filling rates. The LA acoustic quantification analysis confirmed the dependence on active atrial emptying in the patients with LV hypertrophy. There were significant correlations with age for most of the LV and LA acoustic quantification parameters. Acoustic quantification provided confirmatory results in subjects with an abnormal relaxation or restrictive Doppler pattern. In subjects with a normal Doppler pattern, the acoustic quantification was of added diagnostic value, identifying abnormalities in 77% to 80% of the patients.

Use of color kinesis for evaluation of left ventricular filling in patients with dilated cardiomyopathy and mitral regurgitation

OBJECTIVES

We tested the feasibility of using analysis of color kinesis images to objectively assess global and regional left ventricular (LV) diastolic function in patients with dilated cardiomyopathy (DCM). In addition, the ability of this technique to track drug-induced changes on LV diastolic properties was studied.

BACKGROUND

Diastolic dysfunction contributes to symptomatology in patients with DCM. The assessment of LV diastolic function using conventional Doppler echocardiography is indirect and is confounded by multiple variables. Moreover, the noninvasive evaluation of regional diastolic properties is difficult. In contrast, color kinesis directly tracks and color-encodes regional diastolic endocardial motion.

METHODS

We studied 24 patients with DCM and mitral regurgitation (MR) and 24 age-matched normal subjects. Transmitral and pulmonary vein flow velocities were measured using pulsed Doppler echocardiography. Diastolic color kinesis images were used to calculate indexes of magnitude and timing of global and regional diastolic function. Diastolic asynchrony was evaluated in different subgroups of patients with DCM. The effects of drug infusions (nitroprusside and dobutamine) were also studied.

RESULTS

Color kinesis indexes of global diastolic function showed significant differences between patients with DCM and normal subjects. Compared with Doppler indexes, color kinesis was less confounded by MR and was capable of differentiating between drug-induced lusitropic and vasodilator effects. Diastolic asynchrony was increased in patients with DCM and severe MR.

CONCLUSIONS

Quantitative analysis of global and regional LV diastolic function in patients with DCM using color kinesis is feasible.

Quantitative evaluation of global and regional left ventricular diastolic function with color kinesis

BACKGROUND

Diastolic wall motion asynchrony is a major determinant of impaired left ventricular (LV) filling in patients with concentric hypertrophy and coronary artery disease. We evaluated the ability of Color Kinesis, a new echocardiographic technique that color-encodes endocardial motion, to quantitatively assess global and regional LV filling properties.

METHODS AND RESULTS

Color Kinesis images and mitral and pulmonary vein flow Doppler data were acquired in 29 patients with LV hypertrophy and 29 age-matched control subjects. In addition, Color Kinesis data were correlated to coronary angiographic findings in 15 patients with suspected coronary artery disease. Segmental analysis of Color Kinesis images was used to obtain time histograms of regional diastolic fractional area change, wherein early and late peaks (peaks 1 and 2) reflected rapid LV filling and atrial contraction, respectively. Regional mean LV filling time and filling curves were used to objectively identify diastolic endocardial motion asynchrony in patients with LV hypertrophy and coronary artery disease. None of the mitral and pulmonary vein Doppler indices differentiated patients with normalized mitral Doppler profile (n=13) from control subjects, whereas reduced peak1/peak2 ratio and prolonged mean filling time indicated augmented contribution of atrial contraction toward LV filling (P<.05). In 22 of 25 patients with LV hypertrophy and preserved systolic function and in all patients with coronary artery disease, delayed diastolic endocardial motion was observed in at least one segment.

CONCLUSIONS

Analysis of Color Kinesis images provides objective assessment of global and regional LV filling properties and allows identification of both diastolic dysfunction in patients with normalized Doppler indices and wall motion asynchrony.

Doppler echocardiographic reference values for healthy rhesus monkeys under ketamine hydrochloride sedation

Cardiac ultrasound is a noninvasive technique that is commonly used to serially evaluate cardiac structure and function. Recent advances in Doppler-Echocardiography enable the ultrasonographer to perform a sophisticated noninvasive assessment of cardiovascular physiology. The Rhesus monkey is a frequently used non-human primate animal model of human cardiovascular disease because this species closely models human anatomy and physiology. However, while this species is frequently used in cardiovascular research, standardized echocardiographic values generated from large numbers of normal Rhesus are not available. In the present study, we performed cardiac ultrasound imaging on 28 healthy Rhesus monkeys to obtain normal reference values of cardiovascular structure and function in this species. Nomograms were generated from these data by plotting parameters of cardiovascular geometry and function with body weight. These normal reference data were compared to previously reported values obtained from prior studies that used noninvasive, invasive, and morphometric techniques.

Segmental analysis of color kinesis images: new method for quantification of the magnitude and timing of endocardial motion during left ventricular systole and diastole

BACKGROUND

We describe a method for objective assessment of left ventricular (LV) endocardial wall motion based on Color Kinesis, a new echocardiographic technique that color-encodes pixel transitions between blood and myocardial tissue.

METHODS AND RESULTS

We developed a software that analyzes Color Kinesis images and provides quantitative indices of magnitude and timing of regional endocardial motion. Images obtained in 12 normal subjects were used to evaluate the variability in each index. Esmolol, dobutamine, and atropine were used to track variations in LV function in 14 subjects. Objective evaluation of wall motion was tested in 20 patients undergoing dobutamine stress testing. Regional fractional area change, displacement, and radial shortening were displayed as histograms and time curves. Global function was assessed by calculating magnitude and timing of peak ejection or filling rates and mean time of ejection or filling. Patterns of endocardial motion were consistent between normal subjects. Fractional area change and peak ejection rate decreased with esmolol and increased with dobutamine. Time to peak ejection and mean time of contraction were prolonged with esmolol and shortened with dobutamine. Using atropine, we proved that our findings with dobutamine were not secondary to its chronotropic effects. Dobutamine induced regional wall motion abnormalities in 10 patients in 38 segments diagnosed conventionally. Segmental analysis detected abnormalities in 36 of these 38 segments and in an additional 5 of 322 segments.

CONCLUSIONS

Analysis of Color Kinesis images allows fast, objective, and automated evaluation of regional wall motion sensitively enough to evaluate clinical dobutamine stress data. This method has significant potential in the diagnosis of myocardial ischemia.

Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function

OBJECTIVES

Peripartum cardiomyopathy is a rare complication of pregnancy. Thirty percent of patients with this disorder are reported to recover baseline ventricular function within 6 months of delivery, but the ability of these ventricles to respond to hemodynamic stress is unknown. The aim of this investigation was to quantitatively assess the contractile reserve of patients with a history of peripartum cardiomyopathy and recovered left ventricular function.

STUDY DESIGN

Baseline left ventricular contractility was assessed by use of the load and heart rate-independent relationship between end-systolic stress and rate-corrected velocity of fiber shortening. Data were acquired from "recovered" patients (10.5 +/- 11.6 months after delivery) and compared with data from matched nonpregnant controls with use of two-dimensionally targeted M-mode echocardiography and calibrated subclavian pulse tracings that were recorded over a wide range of afterloads (end-systolic stress) generated by methoxamine (1 mg/min) infusion. Contractile reserve was assessed by a dobutamine challenge (5 micrograms/kg/min) and quantified as the vertical deviation of the dobutamine end-systolic stress minus the corrected velocity of fiber shortening data point from the baseline contractility line.

RESULTS

Patients with peripartum cardiomyopathy and matched controls had normal baseline heart rates, blood pressures, ventricular dimensions, and left ventricular function. Contractile reserve, however, was reduced in patients with recovered peripartum cardiomyopathy (0.30 +/- 0.12 vs 0.17 +/- 0.04 circ/sec, p < 0.03).

CONCLUSIONS

Women with a history of peripartum cardiomyopathy who have regained normal resting left ventricular size and performance have decreased contractile reserve revealed by the use of a dobutamine challenge test. Ventricles of these women may respond suboptimally to hemodynamic stress in spite of evidence of recovery by routine echocardiographic evaluation.

Feasibility of aortic diameter measurement by multiplane transesophageal echocardiography for preoperative selection and preparation of homograft aortic valves

BACKGROUND

Preoperative knowledge of the aortic annular diameter could enable the preoperative selection and preparation of an appropriately sized homograft aortic valve.

OBJECTIVE

The aims of this study were to prospectively determine whether the combined use of transthoracic and multiplane transesophageal echocardiography allows accurate preoperative aortic annular measurements for the selection and preparation of adequately sized homograft aortic valves and to retrospectively evaluate the influence of the echocardiographic approach (transthoracic vs transesophageal) and the reader's level of experience on the accuracy of these measurements.

METHODS

Aortic annular measurements were performed before the operation by an experienced reader who used a combination of transthoracic and multiplane transesophageal images of 25 patients (mean age 52 +/- 13 years) referred for homograft aortic valve replacement. Measurements were also performed retrospectively by three additional readers with different levels of training in echocardiography. These readers acquired aortic annular diameters from prerecorded tapes and obtained measurements from each echocardiographic modality independently. All values were compared with the surgical measurement obtained with a ring valve sizer.

RESULTS

With the combined echocardiographic approach, excellent agreement was found between preoperative echocardiographic and surgical measurements (mean difference +/- 2 standard deviations = 0.2 +/- 1.4 mm). All echocardiographic data were found to be within 2 mm of the surgical measurement. These measurements were used to select and prepare the aortic homograft valve before insertion. The accuracy of annular measurements appeared to increase in parallel to the level of experience. The aortic annular measurements obtained retrospectively by a second experienced reader were more accurate with the use of transesophageal than with transthoracic echocardiography (p < 0.01). In contrast, the echocardiographic modality had no influence on the accuracy of measurements of less experienced readers (p > 0.2).

CONCLUSIONS

Preoperative measurement of the aortic annular diameter by transthoracic and multiplane transesophageal echocardiography is accurate and clinically feasible. Preoperative knowledge of the aortic annular diameter may be used to select and prepare the aortic homograft, improving valve availability and reducing ischemic time.

Echocardiographic quantification of regional left ventricular wall motion with color kinesis

BACKGROUND

Color kinesis is a new technology for the echocardiographic assessment of left ventricular wall motion based on acoustic quantification. This technique automatically detects endocardial motion in real time by using integrated backscatter data to identify pixel transitions from blood to tissue during systole on a frame-by-frame basis. In this study, we evaluated the feasibility and accuracy of quantitative segmental analysis of color kinesis images to provide objective evaluation of regional systolic endocardial motion.

METHODS AND RESULTS

Two-dimensional echocardiograms were obtained in the short-axis and apical four-chamber views in 20 normal subjects and 40 patients with regional wall motion abnormalities. End-systolic color overlays superimposed on the gray scale images were obtained with color kinesis to color encode left ventricular endocardial motion throughout systole on a frame-by-frame basis. These color-encoded images were divided into segments by use of custom software. In each segment, pixels of different colors were counted and displayed as stacked histograms reflecting the magnitude and timing of regional endocardial excursion. In normal subjects, histograms were found to be highly consistent and reproducible. The patterns of contraction obtained in normal subjects were used as a reference for the objective automated interpretation of regional wall motion abnormalities, defined as deviations from this pattern. The variability in the echocardiographic interpretation of wall motion between two experienced readers was similar to the diagnostic variability between the consensus of the two readers and the automated interpretation.

CONCLUSIONS

Color kinesis is a promising new tool that may be used clinically to improve the qualitative and quantitative evaluation of spatial and temporal aspects of global and regional wall motion. In this initial study, segmental analysis of color kinesis images provided accurate, automated, and quantitative diagnosis of regional wall motion abnormalities.