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Background Echocardiographic parameters to predict pulmonary capillary wedge pressure (PCWP) in mitral regurgitation (MR) are not yet elucidated. We reported that PCWP could be accurately estimated by novel KT index which is defined as log 10 [left atrial (LA) emptying function (EF)/LA volume]. We examined the usefulness of the KT index as a predictor of PCWP in primary and secondary MR with sinus rhythm and also MR with atrial fibrillation. Methods LA dimension, strain, volume, EF, and E / e ′ were measured in moderate to severe MR with sinus rhythm ( n = 58, age: 67 ± 8 years) and MR with atrial fibrillation ( n = 24, age: 69 ± 11 years) just before catheterization and in normal subjects ( n = 26, age: 67 ± 11 years) using speckle tracking echocardiography. MR with sinus rhythm was divided into primary MR ( n = 27) and secondary MR ( n = 31). The estimated PCWP (ePCWP) was calculated as 10.8–12.4 × KT index. Results There was a correlation between PCWP and LA dimension, E / e ′, minimum LA volume index, active LAEF, total LAEF, or LA strain ( r = 0.32, r = 0.31, r = 0.55, r = −0.61, r = −0.51, and r = −0.50, respectively, p < 0.05). The better correlation was found between PCWP and ePCWP in MR including both primary and secondary MR and also MR with atrial fibrillation ( r = 0.70, r = 0.67, and r = 0.58, respectively, p < 0.01). Multiple regression analysis revealed that ePCWP was an independent predictor of PCWP in MR. The ePCWP demonstrated good diagnostic accuracy (area under the curve of 0.86) and sensitivity (81%) and specificity (71%) to predict elevated PCWP >15 mmHg using a cut-off of 16 mmHg. Conclusion The ePCWP was the reliable echocardiographic parameter to predict PCWP in primary and secondary MR and might also be useful in MR with atrial fibrillation. The ePCWP may have an incremental value in a clinical setting. [ABSTRACT FROM AUTHOR]

Background We hypothesized that a development of a novel index based on the combination of left atrial volume (LAV) and left atrial (LA) function evaluated by the time–LA volume curve using speckle tracking echocardiography (STE) would be accurate and useful to estimate pulmonary capillary wedge pressure (PCWP). Our goal was to develop a novel index of PCWP based on a combination of LAV and LA function using STE. Methods A cross-validation study was performed with the patients divided into a training study to define the novel index ( n = 50) and a testing study to validate the index ( n = 196). PCWP was measured by right heart catheterization, and phasic LAV and emptying function (EF) were measured by STE. Results Simple linear regression analysis in the training study revealed that the novel index that best estimated PCWP was the kinetics-tracking index [KT index = log 10 (active LAEF/minimum LAV index)]. Multiple regression analysis revealed that the KT index was the most reliable predictor of PCWP. It had the strongest correlation with PCWP ( r = −0.86, p < 0.001) among all echocardiographic parameters. In the testing study, PCWP estimated by the KT index was also strongly correlated with measured PCWP ( r = 0.92, p < 0.001). These correlations were also strong in the patients with reduced left ventricular ejection fraction (<50%), chronic heart failure, and chronic atrial fibrillation ( r = 0.92, r = 0.91, r = 0.79, p < 0.001, respectively). Conclusions A novel index (KT index) using a combination of LAV and LA function was a powerful and useful predictor of PCWP and may be valuable in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Left atrial appendage (LAA) thrombus increases the risk of thromboembolism in atrial fibrillation (AF), and LAA contractile function like emptying fraction (EF) should have physiological importance in thrombus formation. The aim of this study was to validate a velocity vector imaging (VVI) method for quantification of the LAA function and to elucidate echocardiographic parameters that are related to the presence of LAA thrombus in patients with nonvalvular AF. Methods: We measured left atrial (LA) dimension and LAEF by VVI using transthoracic echocardiography, and LAA emptying velocity, spontaneous echo contrast (SEC), and LAAEF by W l using transesophageal echocardiography (TEE) in 142 consecutive patients with nonvalvular AF. The patients were divided into two groups according to the presence (n = 38) or absence (n = 104) of LAA thrombus. Results: There was a good correlation between the VVI method and manual-tracing method for LAAEF and LAEF of patients with AF (r = 0.97, r = 0.96, respectively, p< 0.001). LAAEF in AF with thrombus was significantly reduced compared with AF without thrombus (16.9 ±3.1% and 29.0±9.7%, p<0.001). In multivariate logistic regression analysis, LAAEF, SEC, and prior stroke were independent determinants of LAA thrombus. Using 20% of LAAEF as a cutoff value, the sensitivity was 92% and specificity was 88% for LAA thrombus. Conclusion: The Wl method was reliable in the measurement of LAAEF and LAEF compared with the manual-tracing method. LAAEF assessed by the VVI method using TEE was related to the presence of LAA thrombus. [ABSTRACT FROM AUTHOR]

Abstract: The effect of a strong, lipophilic statin (pitavastatin) on the thoracic aorta has not yet been elucidated. The purpose of the present study was to evaluate the effects of pitavastatin (P) therapy on plaque components and morphology in the thoracic aorta by transesophageal echocardiography (TEE) and clarify the impact of the therapy on media and intima in patients with hypercholesterolemia. Sixty-four media and 64 intima of the thoracic aorta were investigated in 32 patients with hypercholesterolemia. The corrected integrated backscatter (c-IBS) values in the thoracic aortic wall and intima-media thickness (IMT) at the same site were measured before and after P therapy or diet (D) for 7 mo. Moreover, c-IBS values in media were measured in 168 patients without hypercholesterolemia to estimate age-dependent changes. C-IBS values in media were correlated with age (r = 0.84, p < 0.001). C-IBS and IMT of media in the P group significantly decreased from −17.8 ± 2.4 to −20.1 ± 3.7 dB and from 1.7 ± 0.3 to 1.5 ± 0.3 mm, respectively (p < 0.001), whereas those in the D group significantly increased from −18.3 ± 2.0 to −16.7 ± 2.1 dB and from 1.6 ± 0.3 to 1.7 ± 0.2 mm, respectively (p < 0.001). IMT in intima in the P group significantly decreased from 3.7 ± 0.4 to 3.3 ± 0.4 mm (p < 0.001). C-IBS in intima in the P group significantly increased from −10.2 ± 2.2 to −6.9 ± 1.7 dB, which indicated plaque stabilization. Pitavastatin improved the atherosis measured by IMT and sclerosis measured by c-IBS values in the media and induced stabilization and regression of plaques in the intima of the thoracic aorta. (E-mail: masanori@ya2.so-net.ne.jp) [Copyright &y& Elsevier]

We show here that a zinc finger transcriptional repressor, Slug, which is aberrantly upregulated by the E2A-HLF oncoprotein in pro-B cell acute leukemia, functions as an antiapoptotic factor in normal hematopoietic progenitor cells. Slug−/− mice were much more radiosensitive than wild-type mice, dying earlier and showing accentuated decreases in peripheral blood cell counts, as well as abundant microhemorrhages and widely disseminated bacterial microabscesses throughout the body. Slug expression was detected in diverse subsets of hematopoietic progenitors, but not in more differentiated B and T lymphoid cells, and there was a significant increase in apoptotic (TUNEL-positive) bone marrow progenitor cells in irradiated Slug−/− mice compared to wild-type controls. These results implicate Slug in a novel survival pathway that protects hematopoietic progenitors from apoptosis after DNA damage. [ABSTRACT FROM AUTHOR]