Nitrogen offset potential in a multiyear farmlet-scale study: Milk and herbage production from grazed perennial ryegrass-white clover swards

The objective of this study was to quantify the farm gate nitrogen (N) offset potential of perennial ryegrass (Lolium perenne L.; PRG) white clover (Trifolium repens L.; WC) swards by comparing the herbage and milk production from dairy farmlets that were simulations of full farming systems. A study was established where 120 cows were randomly assigned to 4 farmlets of 10.9 ha (stocking rate: 2.75 cow/ha), composed of 20 paddocks each. Cows were fed 526 kg of DM of concentrate on average each year. The 4 grazing treatments were PRG-only at 150 or 250 kg of N/ha and PRG-WC at 150 or 250 kg of N/ha. Cows remained in their treatment group for an entire grazing season and were re-randomized as they calved across treatments each year. As cows calved in the spring as standard practice in Ireland, they were rotationally grazed from early February both day and night (weather permitting) to mid-November, to a target postgrazing sward height of 4.0 cm. Mean sward WC content was 18.1% and 15.4% for the 150 and 250 kg of N/ha PRG-WC treatments, respectively over the 3-yr period. When WC was included, lowering the N rate did not reduce pregrazing yield, pregrazing height, or herbage removed, but those factors decreased significantly when WC was absent. Total annual herbage DM production was 13,771, 15,242, 14,721, and 15,667 kg of DM/ha for PRG-only swards receiving 150 or 250 kg of N/ha and PRG-WC swards receiving 150 or 250 kg of N/ha, respectively. In addition, when WC was present, compressed postgrazing sward heights were lower (4.10 vs. 4.21 cm) and herbage allowance (approximately 17 kg/cow feed allocation per cow per day) higher than the high-N control (+ 0.7 kg of DM/cow per day). There was a significant increase in milk production, both per cow and per hectare, when WC was included in PRG swards. Over the 3-yr study, cows grazing PRG-WC had greater milk (+304 kg) and milk solids (+31 kg of fat + protein) yields than cows grazing PRG-only swards. This significant increase in milk production suggests that the inclusion of WC in grazing systems can be effectively used to increase milk production per cow and per hectare and help offset nitrogen use. This result shows the potential to increase farm gate N use efficiency and reduce the N surplus compared with PRG-dominant sward grazing systems receiving 250 kg of N/ha, without negatively affecting milk solids yield or herbage production, thus increasing farm profit by €478/ha.

An evaluation of detailed animal characteristics influencing the lactation production efficiency of spring-calving, pasture-based dairy cattle

Selection for feed efficiency, the ratio of output (e.g., milk yield) to feed intake, has traditionally been limited on commercial dairy farms by the necessity for detailed individual animal intake and performance data within large animal populations. The objective of the experiment was to evaluate the effects of individual animal characteristics (animal breed, genetic potential, milk production, body weight (BW), daily total dry matter intake (TDMI), and energy balance) on a cost-effective production efficiency parameter calculated as the annual fat and protein (milk solids) production per unit of mid-lactation BW (MSperBW_lact). A total of 1,788 individual animal intake records measured at various stages of lactation (early, mid, and late lactation) from 207 Holstein-Friesian and 200 Jersey × Holstein-Friesian cows were used. The derived efficiency traits included daily kilograms of milk solids produced per 100 kg of BW (dMSperBW_int) and daily kilograms of milk solids produced per kilogram of TDMI (dMSperTDMI). The TDMI per 100 kg of BW was also calculated (TDMI/BW_int) at each stage of lactation. Animals were subsequently either ranked as the top 25% (Heff) or bottom 25% (Leff) based on their lactation production efficiency (MSperBW_lact). Dairy cow breed significantly affected animal characteristics over the entire lactation and during specific periods of intake measurements. Jersey crossbred animals produced more milk, based on a lower TDMI, and achieved an increased intake per kilogram of BW. Similarly, Heff produced more milk over longer lactations, weighed less, were older, and achieved a higher TDMI compared with the Leff animals. Both Jersey × Holstein-Friesian and Heff cows achieved superior production efficiency due to lower maintenance energy requirements, and consequentially increased milk solids production per kilogram of BW and per kilogram of TDMI at all stages of lactation. Indeed, within breed, Heff animals weighed 20 kg less and produced 15% more milk solids over the total lactation than Leff. In addition, Heff achieved increased daily milk solids yield (+0.16 kg) and milk solids yield per kilogram of TDMI (+ 0.23 kg/kg DM) during intake measurement periods. Moreover, the strong and consistently positive correlations between MSperBW_lact and detailed production efficiency traits (dMSperBW_int, dMSperTDMI) reported here demonstrate that MSperBW_lact is a robust measure that can be applied within commercial grazing dairy systems to increase the selection intensity for highly efficient animals.

The effect of Holstein-Friesian, Jersey × Holstein-Friesian, and Norwegian Red × (Jersey × Holstein-Friesian) cows on dry matter intake and production efficiencies in pasture-based systems

The objective of this study was to investigate the effect of cow genotype and parity on dry matter intake (DMI) and production efficiencies in pasture-based systems. Three dairy cow genotypes were evaluated over 3 yr; 40 Holstein-Friesian (HF), 40 Jersey × HF (JEX), and 40 Norwegian Red × JEX (3WAY) each year, with each genotype grazed in equal numbers on 1 of 4 grazing treatments in a 2 × 2 factorial arrangement of treatments [diploid or tetraploid perennial ryegrass (Lolium perenne L.) with or without white clover (Trifolium repens L.)]. A total of 208 individual cows were used during the experiment. The effect of parity (lactation 1, 2, and 3+) was also evaluated. Individual DMI was estimated 8 times during the study, 3 times in 2015 and in 2017, and twice in 2016, using the n-alkane technique. Days in milk at each DMI measurement period were 64, 110, and 189, corresponding to spring, summer, and autumn. Measures of milk production efficiency calculated were total DMI/100 kg of body weight (BW), milk solids (kg fat + protein; MSo)/100 kg of BW, solids-corrected milk (SCM)/100 kg of BW, and unité fourragère lait (net energy requirements for lactation equivalent of 1 kg of standard air-dry barley; UFL) available for standard (4.0% fat and 3.1% protein content) milk production after accounting for maintenance. During the DMI measurement periods HF had a greater milk yield (23.2 kg/cow per d) compared with JEX and 3WAY (22.0 and 21.9 kg/cow per d, respectively) but there was no difference in MSo yield. Holstein-Friesian and JEX, and JEX and 3WAY had similar DMI, but HF had greater total DMI than 3WAY (DMI was 17.2, 17.0, and 16.7 kg/cow per d for HF, JEX, and 3WAY, respectively). Jersey × Holstein-Friesian cows were the most efficient for total DMI/100 kg of BW, SCM/100 kg of BW, and MSo/100 kg of BW (3.63, 4.96, and 0.39 kg/kg of BW) compared with HF (3.36, 4.51, and 0.35 kg/kg of BW) and 3WAY (3.45, 4.63, and 0.37 kg/kg of BW), respectively. Unité fourragère lait available for standard milk production after accounting for maintenance was not different among genotypes. As expected, DMI differed significantly among parities with greater parity cows having higher DMI and subsequently higher milk and MSo yield. Although all 3 genotypes achieved high levels of DMI and production efficiency, JEX achieved the highest production efficiency. Some of the efficiency gains (SCM/100 kg of BW, MSo/100 kg of BW, and total DMI/100 kg of BW) achieved with JEX decreased when the third breed (Norwegian Red) was introduced.

The effect of concentrate supplement type on milk production, nutrient intake, and total-tract nutrient digestion in mid-lactation, spring-calving dairy cows grazing perennial ryegrass (Lolium perenne L.) pasture

The objective of this study was to evaluate the effect of concentrate supplement type on milk production, nutrient intake, and total-tract nutrient digestion in lactating dairy cows grazing mid-season perennial ryegrass (Lolium perenne L.; PRG) pasture. Twelve primiparous (mean ± standard deviation; 95 ± 30 d in milk and 470 ± 43 kg of body weight) and 68 multiparous (99 ± 24 d in milk and 527 ± 64 kg of body weight) lactating dairy cows were blocked based on pre-study milk yield and parity and randomly assigned to 1 of 4 dietary treatments. The 4 dietary treatments were a non-supplemented PRG control (PRG); PRG supplemented with 4.4 kg of dry matter (DM) per cow per day of citrus pulp and 0.067 kg of DM/cow per day of urea (PRG+C); PRG supplemented with 0.8 kg of DM/cow per day of heat-treated soybean meal (PRG+PP); and PRG supplemented with 3.1 kg of DM/cow per day of a combination of heat-treated soybean meal and citrus pulp (PRG+C+PP). The study consisted of a 2-wk adaptation period and a 10-wk period of data collection. Weekly measurements of milk yield, body weight, body condition score, and feeding and rumination time were made. Nutrient intake and total-tract digestibility were measured during wk 6 of the study. A large soil moisture deficit was experienced during the study that probably reduced herbage growth rate and likely altered the chemical composition of the PRG offered when compared with typical mid-season PRG. Total dry matter intake was increased in cows fed PRG+C compared with cows fed PRG and PRG+PP and was similar to cows fed PRG+C+PP (18.0, 15.9, 16.4, and 17.2 ± 0.41 kg of DM/d, respectively). The apparent total-tract neutral detergent fiber digestibility of cows fed the PRG+C diet was lower compared with the PRG and PRG+PP diets and was similar to the PRG+C+PP diet (0.67, 0.70, 0.70, and 0.69 ± 0.01 g/g, respectively). The energy-corrected milk (ECM) yield of cows fed PRG+C+PP was highest (23.7 kg/d), PRG+C was intermediate (22.2 kg/d), and PRG was lowest (20.8 kg/d). Cows fed PRG+PP produced more ECM (22.9 kg/d) compared with cows fed PRG and produced similar ECM compared with cows fed PRG+C and PRG+C+PP diets. The PRG+PP diet increased milk protein yield compared with the PRG diet, tended to increase milk protein yield compared with the PRG+C diet, and was similar to the PRG+C+PP diet. Milk fat concentration and the composition of milk fat were not influenced by treatment. The results demonstrated that, for cows consuming pasture-based diets, increasing metabolizable protein supply allowed higher milk yield as metabolizable protein was more limiting than metabolizable energy. However, due to the large soil moisture deficit experienced during this experiment, caution is recommended when extrapolating these results to cows consuming typical mid-season PRG herbage.

The effect of Lolium perenne L. ploidy and Trifolium repens L. inclusion on dry matter intake and production efficiencies of spring-calving grazing dairy cows

The objective of this study was to investigate the effect of perennial ryegrass (Lolium perenne L.; PRG) ploidy and white clover (Trifolium repens L.) inclusion on milk production, dry matter intake (DMI), and milk production efficiencies. Four separate grazing treatments were evaluated: tetraploid PRG only, diploid PRG only, tetraploid PRG with white clover, and diploid PRG with white clover. Individual DMI was estimated 8 times during the study (3 times in 2015, 2 times in 2016, and 3 times in 2017) using the n-alkane technique. Cows were, on average, 64, 110, and 189 d in milk during the DMI measurement period, corresponding to spring, summer, and autumn, respectively. Measures of milk production efficiency were total DMI/100 kg of body weight (BW), milk solids (kg of fat + protein; MSo)/100 kg of BW, solids-corrected milk/100 kg of BW, and MSo/kg of total DMI. Perennial ryegrass ploidy had no effect on DMI; however, a significant increase in DMI (+0.5 kg/cow per day) was observed from cows grazing PRG-white clover swards compared with PRG-only swards. Sward white clover content influenced DMI as there was no increase in DMI in spring (9% sward white cover content), whereas DMI was greater in summer and autumn for cows grazing PRG-white clover swards (+0.8 kg/cow per day) compared with PRG-only swards (14 and 23% sward white clover content, respectively). The greater DMI of cows grazing PRG-white clover swards led to increased milk (+1.3 kg/cow per day) and MSo (+0.10 kg/cow per day) yields. Cows grazing PRG-white clover swards were also more efficient for total DMI/100 kg of BW, solids-corrected milk/100 kg of BW, and MSo/100 kg of BW compared with cows grazing PRG-only swards due to their similar BW but higher milk and MSo yields. The results highlight the potential of PRG-white clover swards to increase DMI at grazing and to improve milk production efficiency in pasture-based systems.

Microbial composition and omasal flows of bacterial, protozoal, and nonmicrobial amino acids in lactating dairy cows fed fresh perennial ryegrass (Lolium perenne L.) not supplemented or supplemented with rolled barley

The objective of this study was to evaluate the effect of rolled barley supplementation on microbial composition and omasal flows of bacterial, protozoal, and nonmicrobial AA in cows fed fresh perennial ryegrass (Lolium perenne L.; PRG). Ten ruminally cannulated multiparous Holstein cows averaging (mean ± standard deviation) 49 ± 23 d in milk and 513 ± 36 kg of body weight were assigned to 1 of 2 treatments in a switchback design. The treatment diets were PRG only or PRG plus 3.5 kg of dry matter rolled barley (G+RB). The study consisted of three 29-d periods where each period consisted of 21 d of diet adaptation and 8 d of data and sample collection. A double-marker system was used to quantify nutrient flow entering the omasal canal along with ¹⁵N-ammonium sulfate to label and measure the microbial and nonmicrobial omasal flow of AA. Overall, rolled barley supplementation had no effect on the AA composition of the omasal liquid-associated and particle-associated bacteria. Rolled barley supplementation affected the AA concentrations of omasal protozoa; however, the differences were nutritionally minor. Particle-associated bacteria AA flow was increased for all AA, except for Trp and Pro, in cows fed the G+RB diet. Rolled barley supplementation had no effect on protozoal AA flow. On average, protozoa accounted for 23% of the microbial essential AA flow, which ranged from 17 to 28% for Trp and Lys, respectively. The flow of all AA in omasal true digesta increased in cows fed the G+RB diet compared with the PRG-only diet, resulting in a 228 g/d increase in total AA flow in cows fed the G+RB diet. This increase in total AA flow in cows fed the G+RB diet was due to an increase in microbial AA flow. Rolled barley supplementation had no effect on nonmicrobial AA flow. The nonmicrobial AA flow modestly contributed to total AA flow, accounting for 15.6% on average. These results indicated that extensive ruminal degradation of PRG AA occurred (83.5%), and we demonstrated that cows consuming PRG-based diets exhibit a large dependence on microbial AA to support metabolizable AA supply. Rolled barley supplementation can increase the omasal flow of microbial AA in cows consuming PRG-based diets. However, further research is required to elucidate if this increased AA supply can support higher milk yield under such dietary conditions.

Rumen metabolism, omasal flow of nutrients, and microbial dynamics in lactating dairy cows fed fresh perennial ryegrass (Lolium perenne L.) not supplemented or supplemented with rolled barley grain

The objective of this study was to evaluate the effect of rolled barley grain (RB) supplementation on rumen metabolism, omasal flow of nutrients, and microbial dynamics in lactating dairy cows fed fresh perennial ryegrass (Lolium perenne L.; PRG)-based diets. Ten ruminally cannulated Holstein cows averaging (mean ± standard deviation) 49 ± 23 d in milk and 513 ± 36 kg of body weight were assigned to 1 of 2 treatments in a switchback design. The treatment diets were PRG only (G) or PRG plus 3.5 kg of dry matter RB (G+RB). The study consisted of three 29-d periods where each period consisted of 21 d of diet adaptation and 8 d of data and sample collection. A double marker system was used to quantify nutrient flow entering the omasal canal along with labeled ¹⁵N-ammonium sulfate to measure bacterial, protozoal, and nonmicrobial N flow. Rumen evacuation techniques were used to determine nutrient and microbial pool size, allowing the calculation of fractional rates of digestion and microbial growth. There was no difference in daily milk yield or energy-corrected milk yield between treatments. Milk fat concentration and milk urea N decreased, whereas milk protein concentration increased in cows fed the G+RB diet. During the omasal sampling phase, dry matter intake was higher in cows fed the G+RB diet. Ruminal and total-tract neutral detergent fiber digestibility was lower in G+RB cows; however, no difference was observed in reticulorumen pH. The rumen pool size of fermentable carbohydrate was increased in cows fed the G+RB diet; however, the fractional rate of digestion was decreased. Flow of nonammonia N and bacterial N at the omasal canal increased in cows fed the G+RB diet compared with the G diet. Protozoa N flow was not different between diets; however, protozoa appeared to supply a much larger amount of microbial N and exhibited shorter generation time than previously considered. Feed N ruminal digestibility, corrected for microbial contribution, was similar for both treatments (88.4 and 89.0% for G and G+RB, respectively). In conclusion, RB supplementation did not benefit overall animal performance; however, it reduced ruminal neutral detergent fiber digestibility and increased bacterial N flow. The results demonstrate the large dependence of cows consuming PRG-based diets on microbial N as the main source of nonammonia N supply. Additional quantitative research is required to further describe the supply of nutrients and microbial dynamics in cows consuming PRG-based diets in an effort to determine most limiting nutrients.

An assessment of the production, reproduction, and functional traits of Holstein-Friesian, Jersey × Holstein-Friesian, and Norwegian Red × (Jersey × Holstein-Friesian) cows in pasture-based systems

Pasture-based production systems typically require highly fertile, healthy, and robust genetics, with greater emphasis on milk solids (MSo; kg of fat + protein) production as opposed to milk yield. This study assessed milk production, production efficiency, reproductive performance, body weight (BW), body condition score, and functional traits in 3 different dairy cow genotypes: Holstein-Friesian (HF), Jersey × Holstein-Friesian (JEX), and Norwegian Red × (Jersey × Holstein-Friesian) (3-way). The 3 genotypes were rotationally grazed on 4 different grazing treatments after calving in spring and were stocked at a rate of 2.75 cows/ha. Holstein-Friesian cows produced higher daily and total milk yields compared with JEX and 3-way cows (5,718 vs. 5,476 and 5,365 kg/cow, respectively). However, JEX and 3-way cows had higher milk fat and protein contents (4.86 and 4.75%, respectively, for JEX and 3.87 and 3.88%, respectively, for 3-way) compared with HF (4.52 and 3.72%), resulting in similar MSo yield for JEX and HF (469 and 460 kg/cow) and slightly lower MSo yield for 3-way (453 kg/cow) compared with JEX. As parity increased, milk and MSo yield per cow increased. Reproductive performance was not significantly different between the 3 genotypes, which had similar 24-d submission rates, 6-wk pregnancy rates, and overall pregnancy rates over the 4-yr period. No difference in calving difficulty, incidence of mastitis, or incidence of lameness was observed among the 3 genotypes. Body weight was significantly different among all 3 genotypes, with HF being the heaviest followed by 3-way and JEX (530, 499, and 478 kg, respectively), and 3-way cows had a higher body condition score throughout lactation compared with HF and JEX cows. The differences in BW coupled with similar MSo production resulted in JEX cows having the highest production efficiency (4.58 kg of MSo/kg of metabolic BW), 3-way cows being intermediate (4.30 kg of MSo/kg of metabolic BW), and HF cows having the lowest (4.16 kg of MSo/kg of metabolic BW). In conclusion, HF herds with poor reproductive performance and low milk fat and protein contents are likely to benefit considerably from crossbreeding with Jersey, and all herds are likely to benefit in terms of production efficiency. However, where herd performance, particularly in relation to reproductive performance, is comparable with HF in the current study, crossbreeding with Jersey or Norwegian Red is unlikely to lead to significant improvements in overall herd performance.

White clover incorporation at high nitrogen application levels: results from a 3-year study

Context High nitrogen (N)-fertiliser application levels and high stocking rates have been shown to optimise herbage dry-matter (DM) production in grass-only systems. Conversely, swards including white clover (Trifolium repens L.) are commonly suited to production systems at low N-fertiliser application levels (<150 kg N/ha) and low stocking rates (fewer than two livestock units (LU) per hectare). Despite this, the use of N fertiliser on grass–clover swards has generally increased during the past few decades, particularly in more intensively managed swards under dairy farming. Increasing inorganic N decreases sward white clover content in grass–clover swards, and increasing stocking rate on grass–clover swards can result in damage to white clover plants. However, under high N-application levels, a high stocking rate can also potentially minimise the negative effects of increased grass growth on sward white clover content. Aims The objective of the present study was to investigate the persistency of white clover in an intensive animal-grazing system, under a high N-fertiliser application level (250 kg N/ha) and at a high stocking rate (2.75 LU per hectare) over a 3-year period (2014–2016). Methods The study was a 2 × 2 factorial design, consisting of two perennial ryegrass ploidies (diploid, tetraploid) and two white clover treatments (grass-only, grass–clover). Four sward treatments (diploid-only, tetraploid-only, diploid + clover, tetraploid + clover) were evaluated over a full grazing season at a system scale. Sward measurements were taken at each grazing occasion for 3 years. Key results Over the 3 years, grass–clover swards produced an additional 1468 kg DM/ha when compared with grass-only swards. Sward white clover content decreased by 17% over the three study years. Conclusions This decrease in sward white clover content led to a decrease in contribution to cumulative herbage DM production. Implications Although the present study showed that white clover inclusion can increase herbage DM production at high N-fertiliser application levels, in association with high stocking rates, the initial extra herbage DM production on grass–clover swards decreased each year. Further studies should be undertaken to investigate whether the decline in white clover persistence observed is progressive over a longer time period.

Stabilization of Early Duchenne Cardiomyopathy With Aldosterone Inhibition: Results of the Multicenter AIDMD Trial

Background Duchenne muscular dystrophy incurs nearly universal dilated cardiomyopathy by the third decade of life, preceded by myocardial damage and impaired left ventricular strain by cardiac magnetic resonance. It has been shown that (1) mineralocorticoid receptor antagonist therapy with spironolactone attenuated damage while maintaining function when given early in a mouse model and (2) low-dose eplerenone stabilized left ventricular strain in boys with Duchenne muscular dystrophy and evident myocardial damage but preserved ejection fraction. We hypothesized that moderate-dose spironolactone versus eplerenone would provide similar cardioprotection in this first head-to-head randomized trial of available mineralocorticoid receptor antagonists, the AIDMD (Aldosterone Inhibition in Duchenne Muscular Dystrophy) trial. Methods and Results This was a multicenter, double-blind, randomized, noninferiority trial. Subjects were randomized to eplerenone, 50 mg, or spironolactone, 50 mg, orally once daily for 12 months. The primary outcome was change in left ventricular systolic strain at 12 months. Among 52 enrolled male subjects, aged 14 (interquartile range, 12-18) years, spironolactone was noninferior to eplerenone (∆strain, 0.4 [interquartile range, -0.4 to 0.6] versus 0.2 [interquartile range, -0.2 to 0.7]; P=0.542). Renal and pulmonary function remained stable in both groups, and no subjects experienced serious hyperkalemia. Infrequent adverse events included gynecomastia in one subject in the spironolactone arm and facial rash in one subject in the eplerenone arm. Conclusions In boys with Duchenne muscular dystrophy and preserved left ventricular ejection fraction, spironolactone added to background therapy is noninferior to eplerenone in preserving contractile function. These findings support early mineralocorticoid receptor antagonist therapy as effective and safe in a genetic disease with high cardiomyopathy risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354352.

Milk production per cow and per hectare of spring-calving dairy cows grazing swards differing in Lolium perenne L. ploidy and Trifolium repens L. composition

Grazed grass is the cheapest feed available for dairy cows in temperate regions; thus, to maximize profits, dairy farmers must optimize the use of this high-quality feed. Previous research has defined the benefits of including white clover (Trifolium repens L.) in grass swards for milk production, usually at reduced nitrogen usage and stocking rate. The aim of this study was to quantify the responses in milk production of dairy cows grazing tetraploid or diploid perennial ryegrass (Lolium perenne L.; PRG) sown with and without white clover but without reducing stocking rate or nitrogen usage. We compared 4 grazing treatments in this study: tetraploid PRG-only swards, diploid PRG-only swards, tetraploid with white clover swards, and diploid with white clover swards. Thirty cows were assigned to each treatment, and swards were rotationally grazed at a farm-level stocking rate of 2.75 cows/ha and a nitrogen fertilizer rate of 250 kg/ha annually. Sward white clover content was 23.6 and 22.6% for tetraploid with white clover swards and diploid with white clover swards, respectively. Milk production did not differ between the 2 ploidies during this 4-yr study, but cows grazing the PRG-white clover treatments had significantly greater milk yields (+596 kg/cow per year) and milk solid yields (+48 kg/cow per year) compared with cows grazing the PRG-only treatments. The PRG-white clover swards also produced 1,205 kg of DM/ha per year more herbage, which was available for conserving and buffer feeding in spring when these swards were less productive than PRG-only swards. Although white clover is generally combined with reduced nitrogen fertilizer use, this study provides evidence that including white clover in either tetraploid or diploid PRG swards, combined with high levels of nitrogen fertilizer, can effectively increase milk production per cow and per hectare.

DNA barcoding and real-time PCR detection of Bactrocera xanthodes (Tephritidae: Diptera) complex

Immature fruit fly stages of the family Tephritidae are commonly intercepted on breadfruit from Pacific countries at the New Zealand border but are unable to be identified to the species level using morphological characters. Subsequent molecular identification showed that they belong to Bactrocera xanthodes, which is part of a species complex that includes Bactrocera paraxanthodes, Bactrocera neoxanthodes and an undescribed species. To establish a more reliable molecular identification system for B. xanthodes, a reference database of DNA barcode sequences for the 5'-fragment of COI gene region was constructed for B. xanthodes from Fiji, Samoa and Tonga. To better understand the species complex, B. neoxanthodes from Vanuatu and B. paraxanthodes from New Caledonia were also barcoded. Using the results of this analysis, real-time TaqMan polymerase chain reaction (PCR) assays for the detection of B. xanthodes complex and for the three individual species of the complex were developed and validated. The assay showed high specificity for the target species, with no cross-reaction observed for closely related organisms. Each of the real-time PCR assays is sensitive, detecting the target sequences at concentrations as low as ten copies µl-1 and can be used as either singleplex or multiplex formats. This real-time PCR assay for B. xanthodes has been successfully applied at the borders in New Zealand, leading to the rapid identification of intercepted Tephritidae eggs and larvae. The developed assays will be useful biosecurity tools for rapid detection of species in the B. xanthodes complex worldwide.

Estimation of myocardial fibrosis in humans with dual energy CT

BACKGROUND

The current clinical standard for in vivo imaging of myocardial fibrosis is contrast-enhanced cardiac magnetic resonance (CMR). We sought to validate a novel non-contrast dual energy computed tomography (DECT) method to estimate myocardial fibrosis in patients undergoing CMR with contrast.

METHODS

All subjects underwent non-contrast, prospectively-triggered cardiac DECT on a single source scanner with interleaved acquisition between tube voltages of 80 and 140 kVp. Monochromatic images were reconstructed at 11 energies spanning 40-140 keV; a region of interest (ROI) was drawn in the mid-inferoseptal segment, recording mean attenuation value in the ROI, at each energy level. Comparison was made to data from single energy (70 keV) image data. Linear discriminant analysis (LDA) was performed to compare the predictive capability of single vs. multi-energy inferoseptal segment CT attenuation on myocardial fibrosis by both visually assessed LGE (absent/present fibrosis) and CMR T1 mapping-derived myocardial extracellular volume fraction (ECV).

RESULTS

The multi-energy CT/LDA approach performed better than a single energy approach to discriminate among LGE-CMR classes of present/absence myocardial fibrosis severity, demonstrating correct classification rates of 89% and 71%, respectively. The multi-energy CT/LDA approach also performed better in correctly discriminating normal from elevated ECV, doing so in 89% of patients vs. correct distinction of normal/elevated ECV in only 70% using the single energy approach.

CONCLUSIONS

Non-contrast cardiac DECT with multi-energy analysis better classifies myocardial fibrosis and extracellular volume compared to what is feasible with non-contrast single energy cardiac CT. These data support further evaluation of this approach to noninvasively assess myocardial fibrosis.

Eplerenone for early cardiomyopathy in Duchenne muscular dystrophy: results of a two-year open-label extension trial

Background

Cardiomyopathy is a leading cause of morbidity and mortality in boys with Duchenne muscular dystrophy (DMD). We recently showed in a 12-month double-blind randomized controlled trial that adding eplerenone to background medical therapy was cardioprotective in this population. The objective of this study was to evaluate the safety and efficacy of longer-term eplerenone therapy in boys with DMD.

Results

Eleven subjects (phase 1 baseline median [range] age: 13 [7 – 25] years) from the original 12-month trial at a single participating center were enrolled. Importantly, those who entered the extension study who had been on eplerenone previously were significantly older than those who had originally been on placebo (median age 10.5 vs. 18.0 years, p = 0.045). During an additional 24-month open-label extension study, all boys received eplerenone 25 mg orally once daily to treat preclinical DMD cardiomyopathy, defined as evident myocardial damage by late gadolinium enhancement cardiac magnetic resonance (LGE) with preserved ejection fraction (EF). The threshold for potassium level, the primary safety measure, was not exceeded in any non-hemolyzed blood sample. Over 24 months, left ventricular (LV) systolic strain, a more sensitive marker whose more negative values indicate greater contractility significantly improved (median change -4.4%, IQR -5.8 to -0.9%) in younger subjects whereas older subjects’ strain remained stable without significant worsening or improvement (median change 0.2%, IQR -1.1 to 4.3%). EF and extent of myocardial damage by LGE remained stable in both groups over 2 years.

Conclusions

Eplerenone offers effective and safe cardioprotection for boys with DMD, particularly when started at a younger age. Eplerenone is a useful clinical therapeutic option, particularly if treatment is initiated earlier in life when cardiac damage is minimal.

Trial registration

http://ClinicalTrials.gov identifier NCT01521546. Registered 26 January 2012.

The effect of stocking rate on soil solution nitrate concentrations beneath a free-draining dairy production system in Ireland

Economically viable and productive farming systems are required to meet the growing worldwide need for agricultural produce while at the same time reducing environmental impact. Within grazing systems of animal production, increasing concern exists as to the effect of intensive farming on potential N losses to ground and surface waters, which demands an appraisal of N flows within complete grass-based dairy farming systems. A 3-yr (2011 to 2013) whole-farm system study was conducted on a free-draining soil type that is highly susceptible to N loss under temperate maritime conditions. Soil solution concentrations of N from 3 spring-calving, grass-based systems designed to represent 3 alternative whole-farm stocking rate (SR) treatments in a post-milk quota situation in the European Union were compared: low (2.51 cows/ha), medium (2.92 cows/ha), and high SR (3.28 cows/ha). Each SR had its own farmlet containing 18 paddocks and 23 cows. Nitrogen loss from each treatment was measured using ceramic cups installed to a depth of 1m to sample the soil water. The annual and monthly average nitrate, nitrite, ammonia, and total N concentrations in soil solution collected were analyzed for each year using a repeated measures analysis. Subsequently, and based on the biological data collated from each farm system treatment within each year, the efficiency of N use was evaluated using an N balance model. Based on similar N inputs, increasing SR resulted in increased grazing efficiency and milk production per hectare. Stocking rate had no significant effect on soil solution concentrations of nitrate, nitrite, ammonia, or total N (26.0, 0.2, 2.4, and 32.3 mg/L, respectively). An N balance model evaluation of each treatment incorporating input and output data indicated that the increased grass utilization and milk production per hectare at higher SR resulted in a reduction in N surplus and increased N use efficiency. The results highlight the possibility for the sustainable intensification of grass-based dairy systems and suggest that, at the same level of N inputs, increasing SR has little effect on N loss in pastoral systems with limited imported feed. These results suggest that greater emphasis should be attributed to increased grass production and utilization under grazing to further improve the environmental impact of grazing systems.

Iron, inflammation and atherosclerosis risk in men vs. perimenopausal women

OBJECTIVE

Age at first atherosclerotic event is typically older for women vs. men; monthly iron loss has been postulated to contribute to this advantage. We investigated the relationship between an MRI-based arterial wall biomarker and the serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) in perimenopausal women vs. men.

METHODS AND RESULTS

Women without evident atherosclerotic disease were prospectively enrolled and observed over 24 months of menopause transition, indicated by hormone levels and reduction in median number of menstrual cycles from 4 [3-6] per year to 0 [0-1] per year (P < 0.01). Higher hsCRP predicted shorter carotid artery wall T2* in women entering the menopause transition (r = -0.3139, P = 0.0014); this relationship weakened after 24 months of perimenopause in women (r = -0.1718, P = 0.0859) and was not significant in a cohort of men matched for age and cardiovascular risk category (r = -0.0310, P = 0.8362). Serum ferritin increased from baseline to 24-month follow-up during women's menopause transition (37 [20-79] to 67 [36-97] ng/mL, P < 0.01), but still remained lower compared to men (111 [45-220] ng/mL, P < 0.01). Circulating ferritin levels correlated with arterial wall T2* values in women at baseline (r = -0.3163, P = 0.0013) but not in women after 24 months (r = -0.0730, P = 0.4684) of menopause transition nor in men (r = 0.0862, P = 0.5644).

CONCLUSIONS

An arterial wall iron-based imaging biomarker reflects degree of systemic inflammation in younger women, whereas this relationship is lost as women transition through menopause to become more similar to men. Iron homeostasis and inflammation in the arterial wall microenvironment warrants further investigation as a potential early target for interventions that mitigate atherosclerosis risk.

Eplerenone for early cardiomyopathy in Duchenne muscular dystrophy: a randomised, double-blind, placebo-controlled trial

BACKGROUND

Cardiomyopathy is a leading cause of death in patients with Duchenne muscular dystrophy and myocardial damage precedes decline in left ventricular systolic function. We tested the efficacy of eplerenone on top of background therapy in patients with Duchenne muscular dystrophy with early myocardial disease.

METHODS

In this randomised, double-blind, placebo-controlled trial, boys from three centres in the USA aged 7 years or older with Duchenne muscular dystrophy, myocardial damage by late gadolinium enhancement cardiac MRI and preserved ejection fraction received either eplerenone 25 mg or placebo orally, every other day for the first month and once daily thereafter, in addition to background clinician-directed therapy with either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Computer-generated randomisation was done centrally using block sizes of four and six, and only the study statistician and the investigational pharmacy had the preset randomisation assignments. The primary outcome was change in left ventricular circumferential strain (Ecc) at 12 months, a measure of contractile dysfunction. Safety was established through serial serum potassium levels and measurement of cystatin C, a non-creatinine measure of kidney function. This trial is registered with ClinicalTrials.gov, number NCT01521546.

FINDINGS

Between Jan 26, 2012, and July 3, 2013, 188 boys were screened and 42 were enrolled. 20 were randomly assigned to receive eplerenone and 22 to receive placebo, of whom 20 in the eplerenone group and 20 in the placebo group completed baseline, 6-month, and 12-month visits. After 12 months, decline in left ventricular circumferential strain was less in those who received eplerenone than in those who received placebo (median ΔEcc 1·0 [IQR 0·3-2·2] vs 2·2 [1·3-3·1]; p=0·020). Cystatin C concentrations remained normal in both groups, and all non-haemolysed blood samples showed normal potassium concentrations. One 23-year-old patient in the placebo group died of fat embolism, and another patient in the placebo group withdrew from the trial to address long-standing digestive issues. All other adverse events were mild: short-lived headaches coincident with seasonal allergies occurred in one patient given eplerenone, flushing occurred in one patient given placebo, and anxiety occurred in another patient given placebo.

INTERPRETATION

In boys with Duchenne muscular dystrophy and preserved ejection fraction, addition of eplerenone to background ACEI or ARB therapy attenuates the progressive decline in left ventricular systolic function. Early use of available drugs warrants consideration in this population at high risk of cardiac death, but further studies are needed to determine the effect of combination cardioprotective therapy on event-free survival in Duchenne muscular dystrophy.

FUNDING

BallouSkies, Parent Project for Muscular Dystrophy, US National Center for Advancing Translational Sciences, and US National Institutes of Health.

Abstract P2-11-07: Endothelial progenitor cells as novel markers of anthracycline induced cardiac injury

Background: Anthracyclines including doxorubicin (DOX) cause myocardial damage that manifests as either subclinical decrements of left ventricular ejection function (LVEF) or overt cardiomyopathy. LVEF changes and cardiac risk factors are insufficient predictors of future DOX cardiotoxicity. Bone marrow derived endothelial progenitor cells (EPCs) are mobilized and are homed to sites of myocardial injury to help with repair of damaged myocardium. We hypothesized that EPC levels would be indicative of early DOX cardiotoxicity. Hence, we prospectively collected serial blood samples to evaluate functional EPCs, Troponin I (Ti) and B-natriuretic peptide (BNP), in patients (pts) receiving DOX-based chemotherapy.

Methods: Eligible pts were initiating adjuvant DOX for early stage breast cancer. Pts underwent cardiac magnetic resonance (CMR), Ti, BNP, and EPC at baseline, after 1 cycle of DOX, and after completion of DOX. CD133+ progenitor cells were isolated from the peripheral blood mononuclear cells (PBMC) using AutoMACS (automated magnetic cell sorting, Miltenyi Biotech). In vitro colony forming unit (CFU) assay was performed for isolated CD133+ progenitor cells on MethoCult (Stemcell Technology). After 8 days of culture, EPC colonies were counted using a two-step image analysis algorithm. Repeated measures analysis of variance modeled changes in cardiac markers over time. Logistic regression was used to correlate variables with abnormal Ti.

Results: Forty two women were enrolled. The average age was 52 years (range 33–68) and stage distribution was I (14%), II (58%) and III (28%). All but one patient received peg-fligrastim after DOX. Thirty six pts had EPC/cardiac biomarkers and twenty nine pts had CMRs at all three time points. LVEF decreased 1.6% following completion of DOX (95% CI: −3.8 to 0.6, p = 0.16). There was a non-linear trend in EPCs over time (p = 0.05), with an initial increase followed by a decrease, with average values of 59 (95% CI: 50–70), 65 (95% CI: 55–75), and 50 (95% CI: 40–60), respectively, across the three time points. By the end of treatment, 54% (95% CI: 0.37–0.71) of women had abnormal troponins (median: 0.03, range: 0.02 to 0.17). Variables associated with abnormal troponins included lower baseline EPCs (p = 0.095), older age (p = 0.075) and initial increase in BNP post cycle 1 (p &lt; 0.03). In a multivariable model, age (p = 0.04) and BNP (p = 0.04) were independent prognostic factors for abnormal troponins, where the odds of abnormal troponins was 65% higher for every 5-year increase in age (OR = 1.65, 95% CI: 1.02–2.66) and 58% higher for every 1.5-fold increase in BNP (OR = 1.58, 95% CI: 1.01–2.46). Baseline EPC did not remain in the final model with p = 0.12.

Conclusions: DOX was well-tolerated with no significant changes in LVEF as measured by serials CMRs. Older age and increased BNP were independent prognostic factors for rise in Ti. We observed an initial increase of EPCs with DOX exposure followed by a decrease after the end of treatment. Although not statistically significant, lower EPCs at baseline, corresponding to lower cardiac reserve, were correlated with abnormal Ti. This is the first study reporting an intriguing association of EPCs with traditional cardiac biomarkers during DOX chemotherapy. Funded by R21 CA143787-02.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-07.

Validation of mid-infrared spectrometry in milk for predicting body energy status in Holstein-Friesian cows

Cow energy balance is known to be associated with cow health and fertility; therefore, routine access to data on energy balance can be useful in both management and breeding decisions to improve cow performance. The objective of this study was to determine if individual cow milk mid-infrared spectra (MIR) could be useful to predict cow energy balance across contrasting production systems. Direct energy balance was calculated as the differential between energy intake and energy output in milk and maintenance (maintenance was predicted using body weight). Body energy content was calculated from (change in) body weight and body condition score. Following editing, 2,992 morning, 2,742 midday, and 2,989 evening milk MIR records from 564 lactations on 337 Scottish cows, managed in a confinement system on 1 of 2 diets, were available. An additional 844 morning and 820 evening milk spectral records from 338 lactations on 244 Irish cows offered a predominantly grazed grass diet were also available. Equations were developed to predict body energy status using the milk spectral data and milk yield as predictor variables. Several different approaches were used to test the robustness of the equations calibrated in one data set and validated in another. The analyses clearly showed that the variation in the validation data set must be represented in the calibration data set. The accuracy (i.e., square root of the coefficient of multiple determinations) of predicting, from MIR, direct energy balance, body energy content, and energy intake was 0.47 to 0.69, 0.51 to 0.56, and 0.76 to 0.80, respectively. This highlights the ability of milk MIR to predict body energy balance, energy content, and energy intake with reasonable accuracy. Very high accuracy, however, was not expected, given the likely random errors in the calculation of these energy status traits using field data.

Cardiovascular magnetic resonance of cardiomyopathy in limb girdle muscular dystrophy 2B and 2I

BACKGROUND

Limb girdle muscular dystrophies (LGMD) are inclusive of 7 autosomal dominant and 14 autosomal recessive disorders featuring progressive muscle weakness and atrophy. Studies of cardiac function have not yet been well-defined in deficiencies of dysferlin (LGMD2B) and fukutin related protein (LGMD2I). In this study of patients with these two forms of limb girdle muscular dystrophy, cardiovascular magnetic resonance (CMR) was used to more specifically define markers of cardiomyopathy including systolic dysfunction, myocardial fibrosis, and diastolic dysfunction.

METHODS

Consecutive patients with genetically-proven LGMD types 2I (n = 7) and 2B (n = 9) and 8 control subjects were enrolled. All subjects underwent cardiac magnetic resonance (CMR) on a standard 1.5 Tesla clinical scanner with cine imaging for left ventricular (LV) volume and ejection fraction (EF) measurement, vector velocity analysis of cine data to calculate myocardial strain, and late post-gadolinium enhancement imaging (LGE) to assess for myocardial fibrosis.

RESULTS

Sixteen LGMD patients (7 LGMD2I, 9 LGMD2B), and 8 control subjects completed CMR. All but one patient had normal LV size and systolic function; one (type 2I) had severe dilated cardiomyopathy. Of 15 LGMD patients with normal systolic function, LGE imaging revealed focal myocardial fibrosis in 7 (47%). Peak systolic circumferential strain rates were similar in patients vs. controls: εendo was -23.8 ± 8.5vs. -23.9 ± 4.2%, εepi was -11.5 ± 1.7% vs. -10.1 ± 4.2% (p = NS for all). Five of 7 LGE-positive patients had grade I diastolic dysfunction [2I (n = 2), 2B (n = 3)]. that was not present in any LGE-negative patients or controls.

CONCLUSIONS

LGMD2I and LGMD2B generally result in mild structural and functional cardiac abnormalities, though severe dilated cardiomyopathy may occur. Long-term studies are warranted to evaluate the prognostic significance of subclinical fibrosis detected by CMR in these patients.

Design and Rationale for the Study of Changes in Iron and Atherosclerosis Risk in Perimenopause

This study seeks to investigate changes in iron homeostasis and carotid arteries in women at risk of atherosclerosis, addressing a relatively unexplored hypothesis explaining why women have a 5-10 year lag in initial atherosclerotic events. Recent evidence points to hepcidin, the key regulator of macrophage iron uptake and release, as a potential mediator of risk. Furthermore, iron catalyzes the generation of free radicals that oxidize cholesterol stimulating atheroma formation. Magnetic resonance imaging (MRI) is ideally suited to study iron because of iron's local effects on magnetic susceptibility that can be quantified using a relaxation parameter called T2* ('T2-star'), as well as the ability to noninvasively characterize and quantify atherosclerotic plaque with MRI. This work outlines the rationale and study design to provide critical evidence related to the iron hypothesis, such that novel diagnostics and therapeutics to attenuate risk may be derived from a better understanding of iron's role in atherosclerosis.

Impaired myocardial perfusion reserve and fibrosis in Friedreich ataxia: a mitochondrial cardiomyopathy with metabolic syndrome

AIMS

Cardiomyopathy produces significant mortality in patients with Friedreich ataxia (FA), a genetic disorder that produces intra-mitochondrial iron accumulation. We sought to test the hypothesis that abnormal myocardial perfusion reserve and fibrosis represent early manifestations of cardiomyopathy.

METHODS AND RESULTS

Twenty-six patients with genetically proven FA ages 36 ± 12 years without cardiomyopathy and eight controls underwent cardiac magnetic resonance with adenosine. Precontrast imaging for myocardial iron estimation was performed. Myocardial perfusion reserve index (MPRI) was quantified using the normalized upslope of myocardial enhancement during vasodilator stress vs. rest. Left ventricular (LV) mass and volumes were computed from short-axis cine images. Serologies included lipids, and platelets were isolated for iron quantification using inductively coupled plasma mass spectrometry. Left ventricular ejection fraction and mass averaged 64.1 ± 8.3% and 62.7 ± 16.7 g/m², respectively, indicating preserved systolic function and absence of significant hypertrophy. Myocardial perfusion reserve index quantification revealed significantly lower endocardial-to-epicardial perfusion reserve in patients vs. controls (0.80 ± 0.18 vs. 1.22 ± 0.36, P = 0.01). Lower MPRI was predicted by increased number of metabolic syndrome (met-S) features (P < 0.01). Worse concentric remodelling occurred with increased GAA repeat length (r = 0.64, P < 0.001). Peripheral platelet iron measurement showed no distinction between patients and controls (5.4 ± 8.5 × 10⁻⁷ vs. 5.5 ± 2.9 × 10⁻⁷ ng/platelet, P = 0.88), nor did myocardial T2* measures.

CONCLUSIONS

Patients with FA have abnormal myocardial perfusion reserve that parallels met-S severity. Impaired perfusion reserve and fibrosis occur in the absence of significant hypertrophy and prior to clinical heart failure, providing potential therapeutic targets for stage B cardiomyopathy in FA and related myocardial diseases.

Real-time cine and myocardial perfusion with treadmill exercise stress cardiovascular magnetic resonance in patients referred for stress SPECT

BACKGROUND

To date, stress cardiovascular magnetic resonance (CMR) has relied on pharmacologic agents, and therefore lacked the physiologic information available only with exercise stress.

METHODS

43 patients age 25 to 81 years underwent a treadmill stress test incorporating both Tc99m SPECT and CMR. After rest Tc99m SPECT imaging, patients underwent resting cine CMR. Patients then underwent in-room exercise stress using a partially modified treadmill. 12-lead ECG monitoring was performed throughout. At peak stress, Tc99m was injected and patients rapidly returned to their prior position in the magnet for post-exercise cine and perfusion imaging. The patient table was pulled out of the magnet for recovery monitoring. The patient was sent back into the magnet for recovery cine and resting perfusion followed by delayed post-gadolinium imaging. Post-CMR, patients went to the adjacent SPECT lab to complete stress nuclear imaging. Each modality's images were reviewed blinded to the other's results.

RESULTS

Patients completed on average 9.3 +/- 2.4 min of the Bruce protocol. Stress cine CMR was completed in 68 +/- 14 sec following termination of exercise, and stress perfusion CMR was completed in 88 +/- 8 sec. Agreement between SPECT and CMR was moderate (kappa = 0.58). Accuracy in eight patients who underwent coronary angiography was 7/8 for CMR and 5/8 for SPECT (p = 0.625). Follow-up at 6 months indicated freedom from cardiovascular events in 29/29 CMR-negative and 33/34 SPECT-negative patients.

CONCLUSIONS

Exercise stress CMR including wall motion and perfusion is feasible in patients with suspected ischemic heart disease. Larger clinical trials are warranted based on the promising results of this pilot study to allow comparative effectiveness studies of this stress imaging system vs. other stress imaging modalities.

In vivo atherosclerotic plaque characterization using magnetic susceptibility distinguishes symptom-producing plaques

OBJECTIVES

We investigated the role of iron deposition in atherosclerotic plaque instability using a novel approach of in vivo plaque characterization by a noninvasive, noncontrast magnetic resonance-based T2* measurement. This approach was validated using ex vivo plaque analyses to establish that T2* accurately reflects intraplaque iron composition.

BACKGROUND

Iron catalyzes free radical production, a key step for lipid peroxidation and atherosclerosis development. The parameter T2* measures tissue magnetic susceptibility, which historically has been used to quantify hepatic and myocardial iron. The T2* measurement has not been used for in vivo plaque characterization in patients with atherosclerosis.

METHODS

Thirty-nine patients referred for carotid endarterectomy were prospectively enrolled to undergo preoperative carotid magnetic resonance imaging (MRI) and postoperative analysis of the explanted plaque. Clinical history of any symptoms attributable to each carotid lesion was recorded. We could not complete MRI in 4 subjects because of their claustrophobia, and 3 patients scanned before the institution of a neck stabilizer had motion artifact, precluding quantification.

RESULTS

Symptomatic patients had significantly lower plaque T2* values (20.0 +/- 1.8 ms) compared with asymptomatic patients (34.4 +/- 2.7 ms, p < 0.001). Analytical methods demonstrated similar total iron (138.6 +/- 36.5 microg/g vs. 165.8 +/- 48.3 microg/g, p = NS) but less low molecular weight Fe(III) (7.3 +/- 3.8 microg/g vs. 17.7 +/- 4.0 microg/g, p < 0.05) in the explanted plaques of symptomatic versus asymptomatic patients, respectively, which is consistent with a shift in iron from Fe(III) to greater amounts of T2*-shortening forms of iron. Mass spectroscopy also showed significantly lower calcium (37.5 +/- 10.8 mg/g vs. 123.6 +/- 19.3 mg/g, p < 0.01) and greater copper (3.2 +/- 0.5 microg/g vs. 1.7 +/- 0.1 microg/g, p < 0.01) in plaques from symptomatic patients.

CONCLUSIONS

In vivo measurement of intraplaque T2* using MRI is feasible and distinguishes symptom-producing from non-symptom-producing plaques in patients with carotid artery atherosclerosis. Symptom-producing plaques demonstrated characteristic changes in iron forms by ex vivo analysis, supporting the dynamic presence of iron in the microenvironment of atherosclerotic plaque.

Continuous positive airway pressure therapy reduces right ventricular volume in patients with obstructive sleep apnea: a cardiovascular magnetic resonance study

STUDY OBJECTIVES

There are few data on the effects of continuous positive airway pressure (CPAP) therapy on the structural and functional characteristics of the right heart in patients with obstructive sleep apnea (OSA). We sought to leverage the advantages of cardiac magnetic resonance imaging (CMR) and hypothesized that CPAP treatment would improve right ventricular (RV) function in a group of patients with OSA who were free of other comorbid conditions.

METHODS

Patients with severe (apnea-hypopnea index > or = 30/h) untreated OSAwere prospectively enrolled. CMR included 3-dimensional measurement of biventricular size and function, and rest/stress myocardial perfusion and was performed at baseline and after 3 months of CPAP therapy.

RESULTS

Fifteen patients with mild to moderate desaturation were enrolled; 2 could not undergo CMR due to claustrophobia and obesity. There were significant decreases in the Epworth Sleepiness Scale score (p < 0.0001) and RV end-systolic and RV end-diastolic volumes (p < 0.05) with CPAP. There was a trend toward improvement in RV ejection fraction, but the improvement did not reach statistical significance. Other measures such as left ventricular volumes, left ventricular ejection fraction, myocardial perfusion reserve index, and thickness of the interventricular septum and ventricular free wall did not change significantly.

CONCLUSIONS

This preliminary study found that CPAP treatment decreases RV volumes in patients with severe OSA who are otherwise healthy. CMR offers a novel technique to determine the effects of CPAP on ventricular structure and function in patients with OSA. A randomized controlled study is needed to confirm the results of our study.

Assessment, treatment, and relapse prevention: male hypoactive sexual desire disorder

There is a dearth of conceptual, clinical, and empirical work in the area of male hypoactive sexual desire disorder. Instead, the sexual medicine approach has focused on erectile dysfunction and premature ejaculation. This conceptual/clinical article focuses on a couple, integrative, psychobiosocial approach to understand, assess, treat, and relapse prevention of this very important problem. The hope is to generate conceptual, clinical, and research interest in this largely ignored dysfunction.

Dobutamine stress cardiac magnetic resonance imaging to detect myocardial ischemia in women

This study sought to evaluate dobutamine stress cardiac magnetic resonance imaging (DCMRI) in women with abnormal stress nuclear testing results. Women with findings on stress nuclear exams, including electrocardiography and/or perfusion, thought to require further evaluation with invasive coronary angiography were prospectively enrolled. Multiplane cine imaging was obtained at rest and at each stage of inotropic stress with atropine as needed to achieve target heart rate. DCMRI results were compared with stress nuclear and invasive cardiac catheterization results. Of 23 patients enrolled successfully, 22 completed DCMRI examination without complications. In all cases, DCMRI imaging demonstrated appropriate stress response with no ischemia despite abnormalities on stress nuclear testing. In the 18 patients who also underwent invasive coronary angiography, no significant obstructive disease was identified. DCMRI may be a useful alternative to stress nuclear examination in women; larger studies are warranted to determine its potential to more accurately predict obstructive coronary artery disease.

Mid-myocardial fibrosis by cardiac magnetic resonance in patients with lamin A/C cardiomyopathy: possible substrate for diastolic dysfunction

AIMS

We sought to identify patterns of myocardial fibrosis in vivo in patients with lamin cardiomyopathy, and to determine its functional significance.

METHODS AND RESULTS

Eleven patients sharing the identical mutation in LMNA without contraindication to magnetic resonance were identified from a 1016-member pedigree. Eight autopsy hearts from deceased relatives were reviewed. Patients and age-matched controls underwent cardiac magnetic resonance that included measures of cardiac function and late gadolinium enhancement (LGE). LGE-CMR identified midmyocardial fibrosis of the basal interventricular septum in 5 of 11 LMNA patients that was identical to that seen in 6 autopsy specimens of related genotype-positive family members; this was not present in any of 11 controls. LGE-CMR was positive in the 5 oldest patients in the cohort, age 46 +/- 6 years compared to 24 +/- 10 years for LGE-negative subjects (p = 0.003). Systolic function was abnormal in 2 subjects, both with myocardial fibrosis. LGE-positivity distinguished patients with diastolic dysfunction by mitral inflow velocities from those with normal diastolic function; these patients also had significant left atrial enlargement compared to controls (p < 0.05).

CONCLUSIONS

LGE-CMR can identify myocardial fibrosis under genetic control in vivo in patients with heritable cardiomyopathy similar in distribution to that observed at autopsy. Mid-myocardial fibrosis may form the substrate for diastolic dysfunction in these patients.

Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance

BACKGROUND

Cardiac magnetic resonance (CMR) accurately quantifies right ventricular (RV) and left ventricular (LV) volumes and function. Limited availability of CMR and increasing use of MR-incompatible cardiovascular devices underscore the potential utility of cardiac computed tomography (CT) for ventricular quantification. This study quantified biventricular size and systolic function with multi-detector row CT compared with CMR imaging.

METHODS

Twenty-six subjects prospectively underwent CT and CMR examinations on a 16-detector CT and 1.5 T MR scanner, respectively; claustrophobia in one and nongated CT imaging in another precluded complete imaging in 2 subjects. Contiguous multiphase short-axis images were generated from axial CT data, and steady-state free precession cine MR produced contiguous short-axis cines. Semiautomated software generated ventricular borders to calculate volume, mass, and ejection fraction (EF) from both sets of images. Blinded observers completed quantification and wall motion analyses of 23 CMR and CT data sets independently.

RESULTS

All measures of LV size and function by cardiac CT correlated well with CMR over a wide range of LV function (LVEF 30%-72% by CMR), including end-diastolic volume (r = 0.97), end-systolic volume (r = 0.97), EF (r = 0.97), and mass (r = 0.95). Of 24 cases, 6 had inadequate contrast opacification of the RV precluding RV segmentation. In the remaining 18 CMR-CT data pairs, RVEF showed moderate agreement (r = 0.86), and RV volumes correlated well (r = 0.97 and 0.94 for RV end-diastolic volume and RV end-systolic volume, respectively). Ten percent of LV segments visualized by CT were inadequate for wall motion assessment due to motion artifact or inadequate contrast between myocardium and endocardium. For segments adequately visualized by both techniques, the mean kappa statistic was 0.88 (range 0.78-1.0), consistent with good agreement.

CONCLUSION

Cardiac CT accurately quantifies LV size and function; RV quantification with cardiac CT requires optimized contrast opacification of the RV.