T1 mapping of the remote non-infarct myocardium for predicting adverse left ventricular remodeling following STEMI

Background

Adverse Left Ventricular (LV) remodeling (ALVR) following ST-segment Elevation Myocardial Infarction (STEMI) is the result of numerous mechanical, neurohormonal, micro and macrovascular factors, and remains a major clinical problem. Cardiac Magnetic Resonance (CMR) is a multimodality technique that provides comprehensive functional and tissue characterization of infarcted and non-infarcted myocardium. Whether changes in the extracellular matrix in the remote myocardium in patients following a STEMI are associated with adverse LV remodeling has been a topic of debate.

Aim

We explored the additive value of native T1 variation (ΔnT1) and derived-extracellular volume (ECV) fraction in the remote non-infarcted myocardium as predictors of adverse LV remodeling following STEMI.

Methods

A total of 99 subjects (83% male) with their first mechanically reperfused STEMI underwent CMR within 2 weeks and at 6 months, including T1 mapping prior and 15 to 20 minutes following a bolus of gadolinium (0.2 mmol/kg), with a MOLLI sequence. ECV and nT1 values were computed by averaging co-registered ROIs in three distinct segments in the remote non-infarcted myocardium.

Results

Baseline nT1 but not ECV correlated with infarct size (r=0.349, P<0.001 and r=0.162, P=0.096 respectively). In addition, ΔnT1 but not ΔECV correlated with an increase in LV end-diastolic volume index (LVEDVi) (r=0.268, P<0.01 and r=0.113, P=0.285).

ALVR, defined as Δ>20% inLVEDVi, occurred in 21 cases, despite optimal medical therapy. Subjects with ALVR showed greater ΔnT1 (13.2±44.1 vs −5.2±30.2 ms, P<0.05) but no significant differences in ΔECV (1.27±2.77 vs 0.72±2.45%, P=0.401). Also, subjects with ALVR were more likely hypertensive (67 vs 33%, P<0.05), had more segments with microvascular obstruction (2.1±2.2 vs 0.8±1.7, P<0.01) and lower baseline EF (39.8±8.8 vs 44.6±9.6%, P<0.05). Infarct size was not significantly larger in ALVR subjects (20.7±13.4 vs 17.5±13.0% LV mass, P=0.322). A multivariate analysis including all these factors, showed the extent of microvascular obstruction (ExpoB: 1.35 [1.05–1.73], P=0.019) and remote ΔnT1 (ExpoB: 1.02 [1.00–1.03], P=0.026) to be the independent predictors of ALVR.

Conclusions

The nT1 variation in remote non-infarcted myocardium and the extent of microvascular obstruction are superior to ECV changes and infarct size in predicting ALVR following STEMI.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Maratό TV3 2015 30 31 32. Fondos FEDER

P1010Association between left atrial fibrosis detected by cardiac magnetic resonance and endocardial electroanatomic mapping in the evaluation of the electrophysiological substrate in atrial fibrillation

Background

Atrial fibrillation (AF) is related to left atrial fibrosis, but its identification by late magnetic resonance imaging (LGE) with gadolinium (LGE) persists in controversy due to heterogeneous results in its correlation with the electroatomic map (EAM) and the difficulty of perform histological studies in humans.

Purpose

We try to examine the point-by-point association between high density EAM and LGE-MRI using an automatic and reproducible method.

Methods

A LGE-MRI was performed in 16 patients prior to ablation. Three different areas were established depending on the intensity of normalized enhancement for each patient according to their blood group with the image intensity ratio (IIR) (healthy <1.20, border area (BZ) ≥1.20 <1.32 and scar ≥1.32). The high density electroanatomic maps of the left atrium (LA) were projected onto the MRI, obtaining an automatic correlation point by point.

Results

The study obtained significant differences (p < 0.001) between voltage (mV) and CV (mm/ms) among healthy, BZ and scar areas, as well a significant inverse correlation (p < 0.001) between voltage and IIR (R=-0.39). It obtained too a significant correlation between CV and IIR (R=-0.24), but this showed a greater correlation in those patients who have the least dilated LA (p = 0.02).

Conclusions

LGE-MRI and EAM showed good correlation in delineating potential pathologic substrate in AF, but left atrium dilation could reduce the performance of the CMR in this task. Conduction velocity could be more sensitive than voltage and LGE-MRI to detect incipient substrate in AF.

Voltage and conduction velocity values Area /IIR Velocity (mm/ms) Voltage (mV) I / <.20 1.036(0.913-1.158) 1.593(1.489-1.696) 2 / ≥1.20 and <1.32 0.722(0.590-0.850) 0.792 (0.649-0,935) 3 / ≥1.32 0.623(0.473-0,733) 0.444(0.245-0.642) Voltage and conduction velocity values in the three areas of the LGE-RMN.

Abstract Figure. Correlation among voltage, VC and LA

Abstract OT2-07-06: Phase Ib study to assess the safety, tolerability, and clinical activity of gedatolisib in combination with palbociclib and either letrozole or fulvestrant in women with metastatic or locally advanced/recurrent breast cancer (B2151009)

Background:Hormone receptor positive (HR+) disease is the most common subset of advanced breast cancer (BC). The majority of women with HR+ metastatic BC (MBC) develop resistance to endocrine therapy (ET), with a median survival of 2-3 years. A new strategy to treat HR+ MBC involves the combination of ET and a cyclin-dependent kinase 4/6 inhibitor (CDKi 4/6), which has demonstrated improved progression-free survival (PFS) in both first-and later-line MBC. Preclinical evidence in PI3K-mutant cell-line xenografts demonstrated that combinations of PI3K and CDK4/6i reduced intrinsic and adaptive resistance to ET, leading to tumor regression (Vara, 2004; Pfizer data). Inhibition of the PI3K/mTOR pathway by gedatolisib (G) may provide a new therapy to overcome ET resistance. These findings support developing the triplet combination of G with the CDKi 4/6 palbociclib (P)+letrozole (L) or fulvestrant (F) for the treatment of patients (pts) with ER+/HER2- BC.

Methods: This ongoing study in women with ER+/HER2- MBC, in first- and later-line settings, includes a dose-escalation (DE) to evaluate dose-limiting toxicities (DLTs, primary endpoint [pEP]) and determine the maximum tolerated dose and recommended phase 2 dose (RP2D) for a triplet regimen of G+P+L or G+P+F. The escalation rules follow the modified toxicity probability interval method (G doses: 180 and 215 mg IV weekly). Treatment assignment to the triplet is based on investigator decision and bone-only disease is permitted. After RP2D determination for each triplet, a 3-arm expansion for early signs of efficacy (ESOE) will investigate objective response rate (ORR) compared to historical controls [pEP] of Arm A) G+P+L in first-line, B) G+P+F in pts with no prior CDKi 4/6 in second-line and C) G+P+F in pts who have received prior CDKi 4/6. Pts receive G+P (125 mg oral daily for 21 days [D] on and 7 D off) + L (2.5 mg oral daily) or F (500 mg IM on D1, 15 of cycle [C] 1; D1 of C2 and then 500 mg IM on D1 of all 28-D cycles). Secondary endpoints include safety, tumor response (DE), PFS (ESOE), pharmacokinetics (PK), and biomarker correlations associated with the PI3K/mTOR pathway.

Results: 27 pts received G (180 mg/week) in combination with P+L (L cohort, n=12) or P+F (F cohort, n=15). Median prior therapies were: L cohort: 1 (range: 0-4); F cohort: 2 (range 1-5). The 3 most common, drug-related adverse events (%) were in L cohort: nausea (75), neutropenia (67), and stomatitis (67); F cohort: stomatitis (67), nausea (60), and neutropenia (53). C1 DLTs were: L cohort: grade (gr) 3 neutropenia (n=1); F cohort: gr 3 stomatitis (n=1). Preliminary rates of stable disease/partial response were: L cohort: 33%/16%; F cohort: 40%/13%. PK parameters and next-generation sequencing of PI3K-related mutations are pending.

Conclusions: G can be combined with P+L or P+F with manageable toxicity and promising preliminary antitumor activity, even in heavily pretreated pts. Dose escalation, followed by expansion for ESOE, is ongoing.

This study is sponsored by Pfizer. Editorial support was provided by Engage Scientific Solutions and was funded by Pfizer.

Citation Format: Forero A, Han HS, Dees EC, Wesolowski R, Bardia A, Kabos P, Kern KA, Perea R, Pierce KJ, Houk B, Rugo HS. Phase Ib study to assess the safety, tolerability, and clinical activity of gedatolisib in combination with palbociclib and either letrozole or fulvestrant in women with metastatic or locally advanced/recurrent breast cancer (B2151009) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-07-06.

Dielectric relaxation in concentrated nonaqueous colloidal suspensions

In this work we report on the permittivity of suspensions of elongated goethite particles in silicone oils of different viscosities. In spite of the low conductivity of the systems, the electrode polarization is significant. To correct this phenomenon, the procedure chosen is the one called logarithmic derivative of the real part of the permittivity, and it proves to efficiently reduce the effect of electrodes to the extent that the spectra of pure liquids are flat in the accessible frequency range (20 Hz-1 MHz). In our suspensions, we observe the presence of a dielectric relaxation for frequencies in the range 4-40 kHz. In principle, such relaxations might be ascribed to the Maxwell-Wagner (MW) polarization. However, it is found that both the characteristic frequency and the relaxation amplitude of the suspensions increase with volume fraction, something unexpected for an MW relaxation. Such discrepancy can be explained by considering the Frenkel-Trukhan model, which reproduces the Maxwell-Wagner results in conditions of thin electrical double layers (which it is not our case). An excellent agreement is found between our data and the model predictions, using only the particle surface charge as a parameter.

Impact of colonoscopy screening on individuals at high risk of hereditary nonpolyposis colorectal cancer (HNPCC)

384

Background: Colonoscopy screening reduces the incidence of, and mortality from, colorectal cancer (CRC) in individuals with HNPCC. The aim of this study was to determine the impact of colonoscopic follow-up in individuals at high risk of HNPCC, in terms of detection of precursor lesions (adenomas) or cancer.

Methods: Between 2005-2008, 163 individuals with HNPCC were advised to undergo regular follow-up colonoscopy. Compliance and results of the scans were evaluated annually and were verified with medical documentation.

Results: Of the 125 individuals who underwent at least one colonoscopy during the follow-up period of colonoscopy screening, in 33 subjects (26%) at least one colonic adenoma was detected. The median number of adenomas detected per colonoscopy in individuals with polyps was 2. The number of colonoscopies with polyps did not differ between women and men. However, the number of polyps removed by colonoscopy and the total number of polyps removed during the follow-up period was significantly higher in men (p = 0.005, p = 0.05 bilateral, respectively). 5 individuals (4%) were diagnosed with CRC, one of whom had two synchronous tumors. Of these, four individuals had properly followed the screening recommendations with the recommended frequency. In the case where two synchronous tumors were detected, it was the first colonoscopy screening that had been performed on the individual. None had had cancer previously, they were healthy relatives of an index case. All except one belonged to families that fulfilled the Amsterdam criteria I / II. All the tumors were diagnosed at an early stage, except two, which exhibited positive nodes.

Conclusions: Colonoscopy screening is effective in diagnosing colorectal adenomas and cancer in individuals with HNPCC. Men with HNPCC have a greater number of colorectal adenomas. Screening allows the detection of colorectal cancer at an early stages. Funded by a young researcher's grant from the Spanish Society of Medical Oncology 2006.

No significant financial relationships to disclose.

[Photopheresis: an alternative therapeutic approach in corticoresistant erosive oral lichen planus]

BACKGROUND

The immunomodulatory effect of extracorporeal photochemotherapy (photopheresis) coupled with its efficacy in lymphocytic skin diseases provides a rationale for its use for erosive lichen planus. We report two cases of chronic oral erosive and corticoresistant lichen planus successfully treated with photopheresis.

PATIENTS AND METHODS

Case 1. A 61-years-old man had erosive oral lichen planus for four years. Oral steroids were contra-indicated due to iatrogenic pancreatitis. After nine photopheresis sessions, subjective improvement occurred and the oral lesions were stabilized. Case 2. A 17-years-old woman presented corticodependent oral and genital erosive lichen planus and cutaneous lesions. After seven sessions of photopheresis, the patient was able to eat again and the pain decreased. After 20 sessions, the cutaneous lichen planus disappeared and complete remission of the mucous lesions was obtained without corticotherapy.

DISCUSSION

These two cases, together with 23 other cases reported elsewhere, strongly suggested the value of photopheresis in the treatment of erosive lichen planus. However, relapses after treatment withdrawal appear extremely frequent.

[Detection of Brucella melitensis by BACTEC 9050 system]

OBJECTIVES

To evaluate BACTEC 9050 system capacity for detection of bacteremia due to Brucella spp.

MATERIAL AND METHODS

16 febrile patients were studied during an epidemic infection for Brucella spp. Suspicious of brucellosis was serologically confirmed with Rose Bengal test and agglutination tube test. Only one blood culture was processed per patient. Ten millilitres of blood were inoculated in a Bactec Plus aerobic/F bottle and incubated in BACTEC 9050 automatic system. The bottles were kept in incubation during 21 days, and they were subcultured when the machine detected its growth; if not, a blind subculture was performed after 21 days.

RESULTS

13 of 16 patients showed bacteriemia (81.2%): 11 patients were detected by BACTEC 9050 system and 2 patients by blind subculture after 21 days. A positive result appeared in 149.8 hours (6.2 days) as a mean. Earlier detections were seen in 83 hours (3.4 days) and the latest ones at 245 hours (10.2 days). The aetiology agent of the epidemic infection was Brucella mellitensis biotype 1. We found significative differences comparing the BACTEC 9050 with BACTEC 9120/9240 systems (p<0.03).

CONCLUSIONS

Incubation protocols of 5 days are not useful for BACTEC 9050 system in the case brucellosis suspicious. Protocols of 7 would detect only 69.2% of the cases.

Scaling Behavior of the Rheological Properties of Montmorillonite Suspensions: Correlation between Interparticle Interaction and Degree of Flocculation

In this work we investigate some aspects of the rheological behavior of sodium montmorillonite (NaMt) suspensions in the pH range 3 to 9, of NaCl concentrations between 10(-3) and 10(-1) M, and of solid concentrations between 5 and 11% w/v. Three kinds of experiments were performed: steady-state viscometry, oscillatory test, and creep recovery. The physical quantities of interest were the yield stress sigma(y) of the suspensions, the elastic rigidity modulus G', and the instantaneous elastic compliance. Furthermore, G' was obtained from oscillatory tests in three different experiments: determination of the viscoelastic linear region, oscillograms, and the gelation process. All quantities were found to scale with the concentration of solids, C, according to a power law of the form Y=k(y)C(n). The exponents n were found to change from approximately 3 to approximately 6 when the pH was increased from 3 to 9 (at constant ionic strength 10(-2) M), although values as high as 10 were estimated when the NaCl concentration was reduced to 1 mM. Such values of n correlate well with the characteristics of the edge-to-face (E-F), edge-to-edge (E-E), and face-to-face (F-F) interparticle interactions. The minimum values of n correspond to maximum E-F attractions, whereas the largest n are associated with strong F-F repulsions. Copyright 2001 Academic Press.

[The epidemiology of Q fever in the northern area of Huelva, Spain]

OBJECTIVE

The aim of the present study is to know the prevalence, incidence and clinical presentation of the acute Q fever in the north of the Huelva district.

METHODOLOGY

a) Prevalence: 1,654 serum were randomly collected from the health district and distributed by their origin, age and sex. The methodology used was the indirect immunofluorescence, Coxiella burnetii phase II as antigen. Were regarded as positives those serum whose titles were equal or higher to 80; b) Incidence: prospective study of every case treated in hospital during 1996-1997 plus every referred patient from the different "Health Centers". An acute case of Q fever was established as a feverish syndrome of more than 2 days plus a title equal or higher to 320 against C. burnetti phase II antigen, and c) Clinical data: all the patients were clerked and similar form was filled up including the following items: pneumonia, hepatitis, headache, persistent fever, etc.

RESULTS

a) Prevalence: it was 5.08%, more frequent in men than in women; b) Incidence: 21 new cases over two years, an incidence of 12.70 cases per 100,000 population, and c)

CLINICAL PRESENTATION

feverish syndrome plus hepatitis in 100% of the cases, just two pneumonia were recorded and in 4 cases the clinical picture was associated to immunological symptoms with persistent fever.

CONCLUSION

A discrepancy between incidence and prevalence has been pointed out which makes us think that the majority of the Q fever cases in this area debut as a self restricted feverish syndrome which does not require specialized treatment.