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Background: Assessment of left ventricular (LV) diastolic function is part of routine echocardiographic examinations. Accuracy of the 2016 ASE/EACVI algorithm to detect LV diastolic dysfunction in patients with a normal LV ejection fraction (LVEF) has been examined but simultaneous measurements of LV pressures and echocardiographic parameters of diastolic function are sparse. Methods: The accuracy of multiple echo parameters of diastolic dynamics and the 2016 guidelines were assessed by simultaneous transthoracic echocardiography and LV pressure recordings in 120 patients (derivation cohort) and 60 patients (validation cohort) with suspected coronary artery disease and normal LVEF. Receiver‐operating characteristic (ROC) curves defined optimal cut points for each echocardiographic parameter. A new algorithm was proposed to estimate LV diastolic pressures using 5 parameters based on ROC data: tricuspid regurgitation velocity >280cm/s, average e' <9 cm/s, average E/e' ratio >13, velocity of pulmonary vein A‐wave reversal >32 cm/s, and left atrial volume index >32 mL/m2. Performances of the 2016 guidelines and a proposed algorithm were examined for detecting a LV pre‐A >12 and LV end‐diastolic pressure (LVEDP) >15 mm Hg. Results: In the derivation cohort, the 2016 algorithm identified an elevated LVEDP >15 mm Hg with an accuracy of 74.2% (63.8–82.9); the modified algorithm improved accuracy to 86.0% (77.6–92.1), P <.05. In the validation cohort, the proposed algorithm improved sensitivities with accuracies remaining like the 2016 algorithm. Conclusions: LV diastolic pressures in patients with normal LVEF were reliably assessed by the 2016 guidelines. The proposed algorithm improved sensitivities and may improve the accuracies for detecting abnormal LV filling pressures. [ABSTRACT FROM AUTHOR]

Background: Ischemia‐reperfusion injury (IRI) frequently follows successful PCI for STEMI and is recognized by multiple modalities. Multilayer speckle tracking echocardiography (STE) has the potential of detecting myocardial dysfunction in different myocardial layers. Our objective was to describe the changes in layer‐specific myocardial function over the 24 hours after successful PCI for ST‐elevation myocardial infarction (STEMI). Methods: Patients (n = 120) with STEMI and no prior myocardial infarction underwent echocardiography prior to PCI, immediately after and at 3‐ and 24‐hours post‐PCI. Worsening focal dysfunction (WFD) was defined as an immediate reduction, compared to the pre‐PCI value, in the amplitude of endo‐myocardial longitudinal strain (endo‐MLS) within the infarction territory. Results: Patients with WFD (52%) had further reductions in endo‐MLS, mid‐MLS, and epi‐MLS in the infarction region immediately post‐PCI; at 3 hours strain began to improve and continued to improve at 24 hours. Reductions of endo‐MLS strain were more evident than those of global, mid‐MLS, and epi‐MLS. This same pattern was seen in each of the ischemic territories of the anterior descending, circumflex, and right coronary arteries. Immediate improvement in endo‐MLS following PCI was seen in 48% of patients. The time from symptom onset to balloon time was markedly longer in those with WFD (P <.0001). Conclusions: Multilayer SPE is a sensitive method that identifies serial alterations in focal myocardial function following successful PCI for STEMI. Layer‐specific reductions in endo‐MLS appeared more evident than decreases in global LV strain. Prolonged total ischemic time prior to PCI was directly related to the incidence of WFD. [ABSTRACT FROM AUTHOR]

Background A satisfactory biopsy determines the state-of-the-art management of lung cancer in this era of personalized medicine. This study aimed to investigate the suitability and efficacy of computed tomography ( CT)-guided core needle biopsy in clinical management. Methods A cohort of 353 patients with clinically suspected lung cancer was enrolled in the study. Patient factors and biopsy variables were recorded. Epidermal growth factor receptor ( EGFR) gene mutations and echinoderm microtubule-associated protein-like 4 ( EML4)-anaplastic lymphoma kinase ( ALK) rearrangement were detected in tumor specimens. Adequacy of biopsic obtainment for clinical trial screening and tissue bank establishment were reviewed. Results Overall diagnostic accuracy of malignancy achieved 98.5%. The median biopsy time of the cohort was 20 minutes. In patients with non-small cell lung cancer ( NSCLC), 99.3% (287/289) were diagnosed as specific histologic subtypes, and two patients (0.7%) were determined as NSCLC not otherwise specified ( NOS). EGFR mutations were analyzed in 81.7% (236/289) of patients with NSCLC, and 98.7% (233/236) showed conclusive results. EML4- ALK gene fusion was tested in 43.9% (127/289) of NSCLC patients, and 98.4% (125/127) showed conclusive results: 6.4% (8/125) of those had gene fusion. Ninety-six NSCLC patients participated in clinical trial screening and provided mandatory tumor slides for molecular profiling. Pathological evaluation was fulfilled in 90 patients (93.8%); 99.4% (320/322) of patients with malignancy provided extra tissue for the establishment of a tumor bank. Conclusions CT-guided core needle biopsy provided optimal clinical management in this era of translational medicine. The biopsic modality should be prioritized in selected lung cancer patients. [ABSTRACT FROM AUTHOR]