LS Pattern Research Articles

Abstract 15928: Relative Sparing of Apical Longitudinal Strain for Detection of Cardiac Amyloidosis: Intervendor Variation

Introduction: Relative apical longitudinal strain (RALS) is defined as (average apical LS/(average basal & mid-ventricular LS)). A threshold of 2 has been found to have high sensitivity and specificity for differentiating cardiac amyloidosis (CA) from other causes of left ventricular hypertrophy (LVH). This threshold was developed using General Electric (GE) software, and its reproducibility among different software vendors is unknown. Hypothesis: In patients with CA, regional segmental LS patterns and relative apical longitudinal strain will vary among software vendors. Methods: Speckle-tracking echocardiography was retroactively performed by an experienced technician on two patient cohorts, CA (n=52) and LVH (n=52), using software from two independent vendors: EchoPAC (GE Medical Systems) and TomTEC (TOMTEC Imaging Systems GMBH). For each vendor and patient, strain values for the basal, mid, and apical segments were averaged to obtain three regional LS values which were then used to calculate global longitudinal strain (GLS) and RALS. Results: EchoPAC demonstrated greater average apical LS (-16.5±5.7 vs -13.1±6.6, p<0.001) and RALS (2.1±0.9 vs 1.7±0.7, p<0.001) compared to TomTEC. Bland-Altman analysis yielded a mean bias of -0.4 with limit of agreement 2.2 (p<0.001) in RALS between the two vendors. ROC curve analysis using a RALS cutoff of 2 to differentiate CA from the overall control group showed similarly high specificity (EchoPAC 85%, TomTEC 83%) between vendors but lower sensitivity for TomTEC (23% vs 45%) (Figure 1). LVH subgroup analysis showed similar comparisons. Overall difference in area-under-curve (AUC) was significant (AUC = 0.78 EchoPAC vs AUC = 0.52 TomTEC, p < 0.001). Conclusions: Software measurements of regional LS and thus RALS vary between vendors. Further efforts are needed for intervendor regional strain fidelity. For now, different RALS thresholds to diagnose CA may be needed for various vendors.

1024 Left ventricle myocardial deformation (strain) pattern in severe aortic valve stenosis. AMY-TAVI study

Abstract OnBehalf AMY-TAVI study PURPOSE. To study left ventricular (LV) myocardial deformation in patients with severe symptomatic aortic stenosis (AS), through the analysis of the Regional and Global Longitudinal Strain (GLS), as well as the phenotypic pattern of peak systolic longitudinal strain represented in the bull´s eye. METHODS. A total of 42 patients with severe symptomatic AS were prospectively and consecutively included. Conventional morphological and functional parameters were analyzed, along with LV strain parameters and the strain pattern phenotype using two-dimensional speckle-tracking echocardiography. Indices derived from strain accepted as suggestive of cardiac amyloidosis were calculated (RELAPS: relative apical sparing: defined using the equation (average apical LS/(average basal LS + mid-LS); ­­Eyection Fraction strain ratio (EFSR= LVEF/GLS). Scintigraphy with technetium pyrophosphate99 and blood protein electrophoresis were performed in all patients for the diagnosis / exclusion of cardiac amyloidosis. RESULTS The mean age was 80 ± 7 years, and 52% were women. The mean aortic valvular area was 0.6 ± 0.1 cm2 and the left ventricular ejection fraction (LVEF) was 56 ± 16%. 19 patients (45.2%) presented a pattern of relative apical sparing of LV longitudinal strain (RELAPS> 1); and 16 patients (38%) showed an EFSR> 4.1. Cardiac amyloidosis was excluded in all patients. In the univariate analysis, RELAPS> 1 was significantly associated with higher degree of LV hypertrophy, lower LV end-diastolic volume, and greater myocardial contraction fraction. CONCLUSIONS. In our series, patients with severe symptomatic AS have with high frequency a "relative apical sparing" longitudinal strain pattern and Eyection Fraction Strain Ratio similar to those described in cardiac amyloidosis. Our results suggest that the classic patterns of cardiac amyloidosis are common in patients with severe AS in the absence of said pathology, findings that we believe may have important clinical implications. Abstract 1024 Figure. Peak systolic LS patterns in severe AS

Intraoperative electrical stimulation of language switching in two bilingual patients

BackgroundLanguage switching (LS) is an important phenomena usually observed in some bilingual communities. The ability to switch languages is a very fast, efficient and flexible process, being a fundamental aspect of bilingual efficient language communication. The aim of the present study was to characterize the specific role of non-language specific prefrontal regions in the neural network involved in LS in bilingual patients, during awake brain surgery and using electrical stimulation mapping (ESM). MethodsIn order to identify the neural regions involved in LS we used, a new specific ESM protocol in two patients undergoing awake brain surgery. Besides, functional magnetic resonance imaging (fMRI), neuropsychological testing and the assessment of daily conversational LS patterns post-surgery were used as complementary imaging and behavioral assessments. ResultsThe outcome of the multimodal ESM-fMRI neuroimaging comparison in both patients pointed out to the crucial involvement of the inferior and middle frontal cortices in LS. ConclusionsThe present results add to previous findings highlighting the important role of non-language specific frontal structures in regulating LS. The new protocol developed here might allow neurosurgeons to plan ahead for surgical intervention in multilingual patients to ensure the preservation of regions involved in LS and therefore the prevention of pathological language mixing after intervention.

The Relation between the Tibetan Winter Snow and the Asian Summer Monsoon and Rainfall: An Observational Investigation

Abstract Utilizing winter (November–March) accumulated snow depth data at 60 stations over the Tibetan Plateau (TP) for the period 1960–98, three typical patterns of the TP snow anomaly's spatial distribution were objectively classified by means of empirical orthogonal function (EOF) analysis. They are characterized by light snow over the entire Tibet region (LS pattern), by an eastern Tibet heavy snow (ETHS pattern), and by a southwestern Tibet heavy snow (SWTHS pattern), respectively. The possible relations between various patterns of the Tibet winter snow anomaly and subsequent summer monsoon and rainfall over south, southeast, and east Asia are investigated using composite analysis. In ETHS and SWTHS years, the south and southeast Asian summer monsoon becomes weak and there is less summer rainfall over south and southeast Asia than in normal years. In LS years, the anomalies of the subsequent summer monsoon and rainfall are opposite to those in ETHS and SWTHS years. The physical mechanism is, in part,...

喉頭・下咽頭癌手術の皮切法の分類と選択性

The skin incision of 67 laryngeal and hypopharyngeal cancer patients who were treated surgicaly were analyzed and grouped on the basis of three unilateral basic patterns and bilateral lpatterns with various modifications. The basic patterns consisted of parallel P-shaped, L-shaped, and inverted L-shaped designs. Modifications included Pm, Lm, Ls, and inverted Lm. Bilateral patterns were symmetrical and identified by preceding the single basic patterns with the term bilateral. The bilateral L-shaped pattern was most useful and reliable in laryngeal and hypopharyngeal cancer operations. The bilateral Ls pattern was suitable for simple total laryngectomy, with or without radiotherapy. When cervical lymph node metastasis appears, neck dissection could be done by the unilateral, or, bilateral Lm type skin incision. The P pattern or bilateral P pattern were applied when neck dissection had to be done before resection of the primary lesion. The inverted L, or, bilateral inverted L pattern could be used in a limited number of patients. The selection of skin incisions must be designed in accordance with the viability of the skin flap, in order to reduce skin flap complications.

Arousal and stress response across the menstrual cycle in women with three perimenstrual symptom patterns

The purpose of this study was to compare arousal levels and stress response across menstrual cycle phases in women with three perimenstrual symptom patterns. Women with low symptom severity (LS, N = 28), were compared with those with a premenstrual syndrome (PMS, N = 15) and premenstrual magnification (PMM, N = 19) pattern across postmenses and premenses phases. Each woman was assessed during relaxation and in response to mental task and symptom imaging stressors during a postmenses and premenses day. Results of baseline skin conductance (SCL), electromyogram (EMG), and finger temperature (T) demonstrated arousal premenses in women with the PMS pattern, but not in women with the LS pattern. In addition, women with the PMS pattern experienced increased EMG and SCL response to stressors premenses. Women with the PMM pattern experienced a rise in finger temperature premenses, opposite the pattern of the women with LS or PMS. These results support development of symptom management strategies to reduce arousal and modulate stress response for women with PMS who seek help for their symptoms. In addition, the difference in arousal and stress response observed in women with PMS and PMM support development of different symptom management strategies for these two groups of women.

Changes in light scattering from poly(ethylene terephthalate) and nylon 6 films upon stretching in relation to the deformation mechanism

AbstractUnoriented T‐die flat films of nylon 6 and PET films annealed at 90°C were stretched in water at 80°C. Amorphous PET films were stretched in water at 65–75°C. Changes in the light scattering patterns from these samples upon stretching were investigated. One of the observed LS patterns from the stretched samples is the Hv eight‐leaf pattern consisting of four lobes and streaks. In the nylon 6 and heat‐treated PET showing this pattern, spherulitic patterns can be seen in polarization microscopy. The microscopic spherulitic superstructure may possibly be the factor responsible for producing the lobe‐and‐streak pattern. On the other hand, many microscopic eight‐leaf patterns can be observed in amorphous unannealed PET showing the lobe‐and‐streak pattern. These microscopic patterns are due to retardation at stress concentrations around impurities and nuclei. The superstructure giving these microscopic patterns must be the origin of the lobe‐and‐streak pattern from unannealed PET. Another scattering pattern, the Vv cruciform pattern, was observed in both stretched nylon 6 and unannealed PET. This pattern is due to an orientation change across the slip lines observed under a polarizing microscope. It is noted (1) that the appearance of the slip lines in PET coincides with the occurrence of oriented crystallization on stretching, (2) that the lobe‐and‐streak pattern from PET in which orientation crystallization has taken place is fairly stable to heat treatment and does not disappear until just before melting, and (3) that the superstructures produced at low stretching seem to be deformed on further stretching, in accordance with affine deformation theory.