Tissue characterization and myocardium strain by cardiac magnetic resonance imaging in the early detection of anthracycline cardiotoxicity

Background

Cardiotoxicity (CT) remains an important cause of morbidity and mortality in patients with lymphomas treated with anthracyclines. Current strategies for early detection of CT during chemotherapy are not yet fully established.

Purpose

To evaluate the performance of cardiac magnetic resonance with T1 mapping and myocardium strain by feature tracking during chemotherapy in detecting anthracycline CT in patients with lymphoma.

Methods

From June 2017 to March 2019, patients with lymphoma planned to start chemotherapy with anthracyclines were evaluated by a cardiologist to check the eligibility criteria. At baseline (Time 1), at the end of 3° cycle (Time 2) and 30 days after the final cycle (Time 3), patients were evaluated through cardiac biomarkers, electrocardiogram and cardiac magnetic resonance (CMR). Strain, MapT1 and extracellular volume (ECV) were evaluated in all patients. CT was defined as drop of the left ventricular fraction (LVEF) >10% or LVEF decrease below 50%. A p value <0.05 was considered statistically significant.

Result

We included 48 patients, mean age was 45.32 (± 17.84) years-old and 25 (52.1%) were female. The prevalence of hypertension, diabetes and dyslipidemia was 18.8%, 10.4% and 10.4%, respectively. CT was diagnosed in 13 patients (27%). At baseline, there was no difference between cardiotoxicity group (CTG) and no cardiotoxicity group (nCTG) in CMR diastolic volume, systolic volume, nativeT1 map and global longitudinal strain (GLS), respectively (116 [103.6–138.1]ml vs 136.3 [115.7–173.8], p=0.069), (46 [38.0–58.5] ml vs 63.0 [44.5–74.2, p=0.069), (1540.6 [1478.3–1591.1]ms vs 1514.8 [1487.5–1786.3]ms, p=0.568) and (−15.94±2.91% vs −14.84±2.65%, p=0.243). Regarding the others CMR parameters, we showed that comparing CTG patients with nCTG patients at Time 3, systolic volumes were higher (54.8 [45.0–67.0] ml vs 78.51 [53.9–96.3] ml, p=0.007), right ejection fraction was lower (53.41±9.73% vs 46.29±3.93%, p=0.002), LVEF was lower (58.7±5.69% vs 46.67±8.12%, p<0.001) and GLS and radial strain were also reduced (−13.92±1.76% vs −12.44±2.7%, p=0.043) and (22.9 [21.18–27.43]% vs 19.84 [17.12–21.73], p=0.017), respectively. We did not observe any difference between groups in the native T1 map between groups at Time 2 and 3 1537.75 (1493.76–1589.72)ms vs 1601.99 (1501.12–1673.44)ms (p 0.383) and 1538.43 (1479.03–1633.6)ms and 1612.85 (1522.74–1638.34) ms (p=0.289). Similarly, the ECV value was no difference between groups at Time 2 and 3 (25.17 [23.62–32.83]% vs 24.42 [22.75–27.47], p=0.281 and 27.5 [23.59 - 31,9]% vs 27.2 [23.84–28.47]%, p=0.529, respectively).

Conclusions

Cardiotoxicity is a frequent complication in anthracycline treated patients. CMR evaluation, through analysis of volumes, ejection fraction and strain might early identify these patients, allowing prevention strategies to be initiated to improve cardiovascular outcomes.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Fundação de Apoio a pesquisa do estado de São Paulo - FAPESP

Prognostic value of noninvasive combined anatomic/functional assessment by cardiac ct in patients with suspected coronary heart disease

Background

Noninvasive evaluation of patients with stable angina is preferable over invasive testing if it leads to similar patient outcome. The combination of coronary angiography and vasodilator challenge myocardial perfusion imaging by computed tomography allows fast, comprehensive assessment of patients with suspected coronary heart disease.

Purpose

To compare the long-term prognostic value of combined computed tomography angiography (CTA) and myocardial CT perfusion imaging (CTP) with invasive coronary angiography (ICA) and single photon emission tomography (SPECT) in patients with suspected hemodynamically significant coronary heart disease.

Methods

At 16 centres, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC).

Results

Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA/CTP findings compared to ICA/SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: 0.03, 0.36). Abnormal results by combined CTA/CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA/SPECT (95% CI for difference: 0.05, 0.39, CI −1.0, 11.1) (Figure). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI: −4.6, 4.9). When MACE was restricted to death, myocardial infarction, or stroke, AUC for CTA/CTP was 66 vs. 61 by ICA/SPECT (difference 5.1; 95% CI: −7.1, 12.9).

Conclusions

Combined CTA/CTP yield similar 5-year prognostic performance as joined ICA/SPECT assessment in patients presenting with suspected coronary heart disease and thus may represent a fast, non-invasive alternative to the traditional diagnostic approach.

Figure 1. 5-year event-free survival

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Institutes of Health

Effect of skin temperature on the ion reabsorption capacity of sweat glands during exercise in humans

The effect of skin temperature on the ion reabsorption capacity of sweat glands during exercise in humans is unknown. In this study, eight healthy subjects performed a 60-min cycling exercise at a constant intensity (60% VO(2max)) under moderate (25 degrees C) and cool (15 degrees C) ambient temperatures at a constant relative humidity of 40%. The sweating rate (SR), index of sweat ion concentration (ISIC) by using sweat conductivity, esophageal temperature (Tes), mean skin temperature, and heart rate (HR) were measured continuously under both ambient temperatures. The SR and ISIC were significantly lower at the cool ambient temperature versus the moderate temperature. There were no significant differences in the changes in HR and esophageal temperature between these ambient temperature conditions, while the mean skin temperature was significantly lower at the cool ambient temperature by almost 3 degrees C (P < 0.05). The slopes of the relationships between Tes and the SR and ISIC were significantly lower and the thresholds of these relationships were significantly higher at the cool ambient temperature (P < 0.05). The ion reabsorption capacity of the sweat glands was significantly lower (P < 0.05) in a cool environment (0.21 +/- 0.04 vs. 0.52 +/- 0.06 mg/cm(2)/min at 15 and 25 degrees C, respectively) as evaluated using the relationships for SR and ISIC. The results suggest that the ion reabsorption capacity of the sweat glands is influenced by skin temperature during exercise in humans.

Changes in the index of sweat ion concentration with increasing sweat during passive heat stress in humans

To investigate the pattern changes in the index of sweat ion concentration at skin surface with increasing sweat during passive heat stress in humans, we measured conductivity of the perfused water with sweat as the index of sweat ion concentration and sweat rate, continuously at the chest skin surface. Eight healthy subjects (22.4 +/-1.0 years) were passively heated by lower-leg immersion in a hot water bath of 42 degrees C for 50 min in an ambient temperature of 28 degrees C and relative humidity of 50%. The internal temperature (Tor) thresholds of sweat rate and index of sweat ion concentration were almost similar. Concomitant onset for the index of sweat ion concentration and sweat rate occurred but two types of linear regression lines were identified in the relationship between the index of sweat ion concentration and sweat rate at a boundary sweat rate value of 0.30 +/- 0.08 mg cm(-2) min(-1). The slope of the regression line at low levels of sweat (slope 0.02 +/- 0.01 V mg(-1) cm(-2) min(-1)) was significantly gradual compared with that at moderate levels of sweat (slope 0.30 +/- 0.08 V mg(-1) cm(-2) min(-1)) (P<0.05). These results suggest that at low levels of sweat the index of sweat ion concentration responds gradually with respect to sweat rate, which may be due to the ion reabsorption capacity of the sweat duct, and then the index of sweat ion concentration increased steeply with sweat rate.

Investigation of the association between infection with Helicobacter pylori and with TT virus, a novel DNA virus, in patients with gastroduodenal ulcer or ulcer scar

OBJECTIVE

Recently, a novel DNA virus (TT virus; TTV) has been isolated. Enteric transmission is suggested as a route of transmission of TTV, with high prevalence of this virus infection in the general population, and age and geographical distributions of TTV prevalence very similar to those of Helicobacterpylori infection. We analysed an association between TTV and H. pylori infection in patients with gastroduodenal ulcer or ulcer scar.

METHODS

In 181 patients with a gastroduodenal ulcer or ulcer scar (102 with a gastric lesion, 60 with a duodenal lesion, and 19 with both sites involved), specimens were cultured for H. pylori and TTV infection was sought in serum by a polymerase chain reaction.

RESULTS

H. pylori infection was demonstrated in 152 patients (84.0%) and TTV was detected in 168 patients (92.8%). Patients with TTV were significantly older than those without TTV (P = 0.0001), while no age difference was observed between patients with and without H. pylori infection. No difference was apparent in the prevalence of TTV infection between patients with and without H. pylori infection, and vice versa.

CONCLUSIONS

We found no association between TTV infection and H. pylori infection in patients with peptic ulcer diseases, which is consistent with a lack of association between TTV infection and peptic ulcer. However, larger studies including surveys of the general population will be required to analyse the overall association between TTV and H. pylori.

Primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma with polypoid appearance. Polypoid gastric MALT lymphoma: A clinicopathologic study of eight cases

In the current study, we report eight cases with primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma endoscopically characterized by polypoid lesions in order to highlight their clinicopathologic significance. Four patients were male, their ages ranging from 40 to 78 years old. The resected specimens revealed a histology of low-grade MALT lymphoma characterized by dense lymphocytic infiltration predominantly in the submucosa and a relatively monotonous proliferation of centrocyte-like cells with reactive follicles and infrequent lymphoepithelial lesions. The tumor cells were of CD5-, CD10-, CD20+, BCL2+ and cycline D1- phenotype, and showed a monoclonal rearrangement of immunoglobulin heavy chain genes in the five of six cases examined. Interestingly, Helicobacter pylori (H. pylori) was detected in three (37.5%) of the eight patients, which was significantly lower than previous reports. Two of the H. pylori-positive cases initially underwent H. pylori eradication, but showed no change in their lymphomas after the cure of H. pylori infection. The clinicopathologic findings of the present cases appeared to closely resemble those of colorectal MALT lymphoma with a polypoid appearance and few association of H. pylori infection in their pathogenesis. These gastric polypoid cases may merit separate consideration because of the therapeutic problems they pose.

Effect of an insulin sensitizer, pioglitazone, on hypertension in fructose-drinking rats

To determine whether insulin resistance is responsible for the development of hypertension, we examined whether blood pressure changes in an insulin-resistant animal that was given a fructose solution as their drinking water. Wistar Kyoto rats that drank a 10% fructose solution for 10 weeks showed significant increases not only in plasma triglyceride and insulin levels but also in systolic blood pressure. The decrease in blood glucose in response to the intraperitoneal injection of insulin (0.2-1.0 U/kg) was slight in these fructose-drinking rats. To confirm whether insulin resistance contributes to the observed hypertension, we examined the effect of pioglitazone, an insulin sensitizer, on blood pressure in rats given a 10% fructose solution. When pioglitazone was administered to the rats at a dose of 10 mg/kg/day for 4 weeks from 12 weeks of age, plasma triglyceride and insulin levels and systolic blood pressure decreased, and blood glucose reduction in response to insulin was normalized. These results suggest that insulin resistance is responsible for the development of hypertension in fructose-drinking rats.

Autocrine transformation by fibroblast growth factor 9 (FGF-9) and its possible participation in human oncogenesis

Transfection of human fibroblast growth factor 9 (FGF-9) cDNA into mouse BALB/c 3T3 clone A31 cells led to morphological transformation of the cells and foci formation 4 weeks later. Isolated transformants had a higher saturation density than parental A31 cells, could grow in soft agar, and secreted FGF-9 into the culture supernatant. The introduction of FGF-9 N33 cDNA, which encodes a truncated protein that has 33 N-terminal amino acids deleted and has the same mitogenic potency as FGF-9, failed to lead to foci formation. Although FGF-9 is a secretory protein, it does not have a typical secretory signal sequence, and the secreted protein retains the full sequence coded in the cDNA except for the initiating methionine. The produced FGF-9 N33 was not secreted and remained within the cell. It is possible that FGF-9 has an uncleavable signal sequence within the first 33 N-terminal amino acids. All of the phenotypes acquired by transformation could be arrested by treatment with a neutralizing anti-human FGF-9 monoclonal antibody (MAb) 150-59. Additionally, transformants formed tumors in nude mice. Injection of MAb 150-59 suppressed tumor formation in nude mice and caused existing tumors to regress. Our results suggest that the cellular transformation mediated by FG F-9 is produced by autocrine stimulation. We have detected FGF-9 production in the human tumor cell lines glioma NMC-G1, from which FGF-9 was originally purified, and stomach carcinoma AZ-521. The growth of NMC-G1 was not affected by MAb 150-59, but that of AZ-521 was arrested by MAb 150-59 in the presence of heparin. Moreover, the growth of the AZ-521 cell tumor in nude mice could be partially arrested by antibody treatment. The possibility of a participation of FGF-9 in the formation of human tumors is suggested.

Construction of a sensitive enzyme immunoassay for human fibroblast growth factor 9

Hybridomas secreting monoclonal antibodies (MAbs) against human fibroblast growth factor 9 (FGF-9) were established using recombinant human (rh) FGF-9 N33 as the immunogen. Among these, MAb 150-59 demonstrated a potent neutralizing activity against FGF-9. It arrested the FGF-9-induced growth of BALB/c 3T3 A31 cells at an equimolar dose of the factor. It also abrogated the in vivo thrombopoietic activity of FGF-9. Mitogenic activity of several other FGF family members such as FGF-1, FGF-2, and FGF-4 was not neutralized by this MAb. A sensitive sandwich enzyme immunoassay for FGF-9 was developed employing MAbs 150-59 and 13-3. The detection limit of this system was 3 pg/well. In this assay system, FGF-1 and FGF-2 were not cross-reactive up to 1 microgram/well. Using this system, the distribution of FGF-9 in rat organs was examined. FGF-9 could be detected only in the extract of rat cerebellum. Also, we detected a high amount of FGF-9 in the culture supernatant of certain cell lines originated from human tumor. These findings suggest that this enzyme immunoassay system may be used to clarify biological meaning of FGF-9.

[Lymphocyte subset change during cancer chemotherapy on patients with gastrointestinal, lung and hematopoietic malignancies]

Lymphocyte subsets measured by Ortho-mune on OKT 3, OKT 4A, OKT 8, OKT 10, OKT 11, OKM1, OKB 7, OKB 2 and OKDR were observed before and after chemotherapy on patients with gastrointestinal, lung and hematopoietic malignancies. Almost all patients showed decreased T-cell function expressed by OKT 11 or OKT 3 and suppressor, helper T-cell function expressed by OKT 8 and OKT 4A. In some patients improvement of T-cell function were observed with clinical response and in such cases life span seemed to be longer as expected, and it is supposed that during cancer chemotherapy improvement of T-cell function expressed by OKT series may be important prognostic factors.

A network of influences on adolescent drug involvement: neighborhood, school, peer, and family

The interrelationship of neighborhood, school, peer, and family factors and adolescent drug involvement was investigated. Data were collected separately from 518 adolescents and their mothers when the children were between 9 and 18 years of age and again two years later. Neighborhood and school effects were not directly related to adolescent drug use. Neighborhood effects were mediated through the domains of school, peer, and family; school effects were mediated through the peer domain. Family and peer variables had a direct impact on adolescent drug involvement. Risk factors in the adolescents' peer environment can be ameliorated by protective factors in their school environment. Implications for the prevention of drug use are discussed.

Onset of adolescent drinking: a longitudinal study of intrapersonal and interpersonal antecedents

This study investigated several models for exploring the interrelationships of domains of personality, peer, and family factors and their effect on initiation into alcohol use. Three hundred eighteen black and white high school students were administered questionnaires when they were in the ninth and tenth grades (T1) and again two years later when the students were in the eleventh and twelfth grades (T2). Only those students who had never used alcohol at T1 were included in this study. The results supported an independent model: Each of the domains of T1 personality, peer, and family factors, with control on the other domains, had a direct effect on T2 initiation into alcohol use. The interactions of peer variables with personality and family variables were examined. The findings indicated that risk factors stemming from the peer group were ameliorated by protective personality and family factors.