Regression Of Mass Research Articles

Update: Rationale and design of the Sodium Lowering In Dialysate (SoLID) trial: a randomised controlled trial of low versus standard dialysate sodium concentration during hemodialysis for regression of left ventricular mass.

After the publication of our paper Dunlop et al. “Rationale and design of the Sodium Lowering In Dialysate (SoLID) trial: a randomised controlled trial of low versus standard dialysate sodium concentration during hemodialysis for regression of left ventricular mass”, we became aware of further data correlating left ventricular (LV) mass index at baseline and their correpsonding mass at 12 months, using cardiac margnetic resonanace imaging (MRI) in patients on hemodialysis. The original published sample size for the SoLID trial of 118 was a conservative estimate, calculated using analysis of covariance and a within person Pearson’s correlation for LV mass index of 0.75. New data communicated to the SoLID trial group has resulted in re-calcuation of the sample size, based upon a within person Pearson’s correlation of 0.8 but otherwise unchanged assumptions. As a result, the SoLID trial will now recruit 96 participants.

Abstract 4980: Rational design of combination therapies and block of acquired targeted drug resistance

Abstract Recent successes of targeted drugs on end stage cancer patients highlight the value of mutation-based biomarkers with high positive predictive value for drug response predictions. However, the impact of these drugs is often temporary, and the patients progress to acquired resistance. A common mechanism of drug evasion involves feedback mechanisms that increase expression or phosphorylation-driven activation of an alternative oncogenic pathway. The objective of this work was to set up a streamlined methodology for pre-clinical assessment of the novel drug for refractory cancer targeting, with specific focus of personalized medicine, mediated by sequencing, and seek combination therapies that would block the spontaneous drug evasion. We explored the efficacy of the combination approach on a panel of cancer patient derived xenografts in mice, using tumor size, or metabolic imaging as an end point. Each cancer case was subject to target somatic mutation screening, which resulted in a targeted drug recommendation, and then, mouse groups were treated either with sequeincing-based therapy, or with combination of these therapies with blockers of the suspected evasion mechanisms. As a blocker of the evasion mechanism and epithelial to mesenchymal transition, we characterized the utility of a molecule that leads to the destruction of IRS1/2 of the IGF1R pathway. IRS1/2 are altered during EMT and drug resistance, thus blocking them could block drug resistance, and found multiple scenarios, where the combination of this blockage with currently used targeted drugs, such as Erlotinib, Zelboraf, and Gleevec, all increase the attenuation of the cancer growth and progression. Addition of the IRS1/2 destruction to Erlotinib and Zelboraf resistant H&N and melanoma cancers, respectively, lead to regression of the recurrent tumor mass. This combination therapy was further characterized by shRNA-negative screens, and kinome activity profiling, to assess further drug treatments that could be added, and in search for biomarkers that would identify patients likely to respond to the therapeutic combinations, We believe blocking the IGF1R in combination with drugs that inhibit the MAPK and tyrosine kinase receptor pathways may increase the progression free survival and expand the responding population within an array of cancer types, many of which are currently refractory to chemotherapy. Citation Format: Hadas Reuveni, Lana Kuperschmidt, Shani Carmi, Neta Moskovitz, Salomon Stemmer, Izhak Haviv. Rational design of combination therapies and block of acquired targeted drug resistance. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4980. doi:10.1158/1538-7445.AM2015-4980

The Relation Between the Degree of Left Ventricular Mass Regression and Serum Potassium Level Change in Patients With Primary Aldosteronism After Adrenalectomy

BackgroundPrimary aldosteronism (PA) is one of the major etiologies for secondary hypertension featuring more prominent left ventricular hypertrophy. The purpose of the study was to investigate the predictive factors of...

The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients With End-Stage Renal Disease

BackgroundIn-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly utilized form of dialysis intensification, though data on the cardiovascular benefits of this modality are limited. MethodsIn this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis (CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure. ResultsConversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2) g reduction in LVM as compared with continuation on CHD. This result was maintained after adjustment for baseline imbalances between the groups and in ancillary analyses. There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, −1.4-20.9] mm Hg) among INHD recipients with a significant reduction in the number of prescribed antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by 0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based phosphate binder requirements, as compared with those who remained on CHD. ConclusionsCompared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year.

Diabetes Mellitus Impairs Left Ventricular Mass Regression after Surgical or Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

It is well-documented that persistent myocardial hypertrophy in patients with aortic stenosis is related to suboptimal postoperative outcomes after aortic valve replacement. Although diabetes is known to potentially exacerbate myocardial hypertrophy, it has yet to be examined if it affects postoperative left ventricular mass regression (LVMR). A single-centre, retrospective analysis was performed on 183 consecutive patients who underwent either surgical or transcatheter aortic valve replacement between 2010 and May 2013. Patient demographics, postoperative outcomes and echocardiographic data were obtained preoperatively and a year after surgery. There were 42 diabetic and 141 non-diabetic patients. Preoperative characteristics of diabetic patients were statistically similar to those of non-diabetic patients, except for higher prevalence of hyperlipidaemia (p <0.001) and history of cerebrovascular disorder (p=0.046) in diabetic patients. Median value of postoperative LVMR of all patients was -36.5 g/m(2), and was significantly greater in the non-diabetics compared to the diabetics (-39.1 vs. -22.2 g/m(2), p=0.008). Univariate and multivariate analyses were performed on preoperative variables, and stepwise multiple regression analysis demonstrated that diabetes (standardised partial regression coefficient (SPRC)=-0.187, p=0.018), female gender (SPRC=0.245, p=0.026) and age (SPRC=0.203, p=0.018) were associated with poor postoperative LVMR. Patients with diabetes showed suboptimal postoperative LVMR, and the disease was a prognostic factor that was associated with poor LVMR. These findings suggest that diabetes may predispose the particular group of patients to worse postoperative outcomes.

Metabolic rates of three gazelle species (Nanger soemmerringii, Gazella gazella, Gazella spekei) adapted to arid habitats

The basal metabolic rate of mammals correlates with body mass, but deviations from this regression have been observed and explanations comprise ecological adaptations, reproductive strategies or phylogeny. Certain mammalian groups, adapted to arid environments, show comparatively lower metabolic rates. To expand existing datasets and to investigate metabolic rates in ruminants adapted to arid environments, we conducted respiration measurements with three gazelle species (Gazella spekei, G. gazella and N. soemmerringii, total n=16). After an adaptation period to a diet of fresh lucerne offered ad libitum, subjects were put separately into respiration boxes for 24h where they had free access to food and water. Oxygen consumption and carbon dioxide production were measured with a modular system of gas analyzers and pumps. Mean and resting metabolic rate (RMR) were calculated by accounting for the entire measurement phase or the lowest 20 oxygen measurements, respectively. N. soemmerringii had the lowest relative RMR values and the highest respiratory coefficients compared to the other species. Measured values were compared to expected RMR values calculated based on body mass. Gazella spekei and G. gazella showed higher RMR values than expected, while the RMR of N. soemmerringii was in the range of expected values. Our results indicate that not all mammals adapted to aridity have lower metabolic rates under conditions of unlimited resources and that in these cases other physiological adaptations might be of higher importance. Further extensions of the datasets could allow explaining which deviations of metabolic rate from the body mass regressions result from convergent adaptations.

95 Left Ventricular Mass Regression Occurs very early following Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

<h3>Background</h3> The effect of transcatheter aortic valve replacement (TAVR) on very early left ventricular remodelling has not previously been evaluated. Left ventricular mass (LVM) regression at 30 days (assessed using echocardiography) has been linked to a 50% reduction in re-hospitalisation in the first year following TAVR. We sought to establish using cardiac magnetic resonance (CMR) imaging, the reference standard imaging technique for LVM quantification, whether LVM regression occurs very early following-TAVR. <h3>Methods</h3> 27 patients with symptomatic severe aortic stenosis undergoing TAVR were prospectively enrolled between June 2013 and April 2014. Patients with contraindications to CMR were excluded and all patients provided informed written consent. All patients underwent an identical 1.5T CMR protocol (Intera, Philips) prior to and at a median of 5 days following TAVR (IQR 2 days). Multislice, multi-phase cine imaging was carried out using a standard steady-state free procession pulse sequence in the short axis to cover the entire left ventricle. Quantitative analysis was performed using dedicated computer software (CVI⁴², Circle Cardiovascular Imaging, Alberta, Canada). LVM was calculated by the formula (epicardial volume – endocardial volume) x myocardial density (1.05 g/cm³). <h3>Results</h3> Basic patient, echocardiographic and procedural characteristics can be seen in Table 1. At a median of 5 days following TAVR, mean LVM regressed by 12% from 129.5 +/- 32.5 g to 114.2+/-31 g and indexed LVM (LVMi) reduced from 69.4 ± 15.2 g/m² to 61.3 ± 15.1 g/m²(Figure 1). There was no significant change in indexed left ventricular diastolic volume (96.9 ± 24.5 to 96.8 ± 19.3 ml/m², p = 0.79), LV ejection fraction (54.0 ± 14.6 to 58.4 ± 27.4%, p = 0.49) or indexed left atrial volume (71.5 ± 22.6 to 67.7 ± 22.1 ml/m², p = 0.43). Mean LVM regression was similar between the Medtronic and Boston valve types (14.3 ± 10.4 gVs 16.5 ± 9.9 g, p = 0.58). There was no correlation between Valvulo-arterial impedance (ZVA) and LVM regression (r = 0.02, p = 0.93). There was no difference in mean LVMi regression according to gender (women 8.3 ± 2.8 g/m² Vs men 8.0 ± 5.7 g/m², p = 0.83). TAVR valve size did not appear to impact on early LVM regression. LVMi regression was similar between those with a normal baseline LVM and those with an elevated baseline LVM (defined as 83 g/m² in men and 67 g/m²) in women (7.8 ± 4.8 g Vs 9.0 ± 5.7 g, p = 0.60). 16 patients had evidence of late gadolinium enhancement (LGE) at baseline. There was a trend towards increased LVMi regression in those without LGE at baseline compared with those with LGE (10.1 ± 4.7 g/m²Vs 6.4 ± 4.7 g/m², p = 0.07). <h3>Conclusions</h3> LVM regression begins very early following TAVR and occurs before changes in cavity size or ejection fraction which is likely to be a result of an immediate reduction in wall stress. The type of valve implanted does not appear to influence early LVM regression. <h3>Funding</h3> This study was part funded by the BHF (PG/11/126/29321).

89 Radiofrequency Ablation of the Interventricular Septum to Treat Left Ventricular Outflow Tract Gradients in HOCM: Novel Use of Cartosound Technology to Guide Ablation

Introduction Septal reduction is required for HOCM patients with severe LVOT gradients and symptoms refractory to medications. Myectomy cannot be performed in all due to operative risk and patient choice. Alcohol ablation cannot be performed in 5–15% due to technical difficulties and reliance on septal coronary anatomy. A method of delivering percutaneous damage to the basal septum that is not reliant on coronary anatomy is desirable. Methods 5 patients underwent RF ablation; we describe follow up at 6 months in 4. CARTOsound technology (Intracardiac echocardiography (ICE) merged with the electroanatomic mapping system, CARTO) was used to create a virtual shell of the LV and aorta (Figure 1 (F1), panel A). The precise SAM-septal contact area is ascertained from realtime ICE images and is superimposed onto the CARTO LV shell (pink area, F1, B). This pink area becomes the target for RF energy delivery. Left bundle branch conduction tissue is mapped and superimposed (F1, C). Intravenous heparin is given to keep activated clotting time >250 s. A mean of 31.7 (28–36) minutes of RF energy (50W, 60o) was delivered to the target area using retrograde aortic access and an irrigated 4 mm SmartTouch D-curve ablation catheter (F1, D) Results Peak resting gradient improved from 64.25 (±50.60) to 12.25 (±2.50) mmHg. Valsalva/exercise gradient improved from 93.50 (±30.88) to 23.25 (±8.30) mmHg. SAM improved in all patients. IVSd reduced from 18.25 (±1.89)mm to 16.75 (±2.5)mm. All patients improved NYHA class from 3 to 2. CPEX data was available in 3. Pre-procedural peak VO2 measured 15.48 (±2.27) mL/min/Kg, this improved to 16.53 (±5.16). Total exercise time increased from 558 (±129) to 730 (±63)secs. EQ5D-5L quality of life index value increased from 0.57 (±0.17) to 0.65 (±0.18). Health score improved from 44 (±18.93) to 70 (±3.54). Two patients had CMR post ASA. Scar can be seen upto 8 mm depth at the endocardial surface of the LV target myocardium (Figure 2). Scar measured 6.3 and 2.2 g respectively, representing 2.4 and 1.1% of total LV mass. LV mass prior to ablation measured 259 and 198 g. This reduced to 236 and 160 g, representing a 9 and 19% reduction. Patient 4 died following femoral artery access point bleeding complications. Hypotension was poorly tolerated leading to cardiac arrest. The artery was repaired surgically but deterioration over the subsequent 48 h lead to multi-organ failure. Patient 5 had a paradoxical increase in LVOT gradients post procedure requiring unplanned ITU care. Conclusions Radiofrequency ablation to treat LVOT gradients in HOCM using CARTOsound shows significant promise. The unprecedented accuracy of damage reduces SAM and results in improvements in LVOT gradients, symptoms and quality of life in this preliminary group. A small amount of damage at the correct location can lead to significant LV mass regression. This indicates part of the hypertrophy in HCM is afterload dependent

Matched Comparison of Two Different Biological Prostheses for Complete Supra-annular Aortic Valve Replacement

Objective The aim of this retrospective study was to evaluate the hemodynamic performance of the St. Jude Medical Trifecta (SJM Trifecta; St. Jude Medical, St Paul, Minnesota, United States) and the Carpentier-Edwards Perimount Magna Ease (CEPM Ease; Edwards Lifesciences, Irvine, California, United States) bioprostheses early postoperative and at 1 year. Methods From October 2007 to October 2008, a total of 61 consecutive patients underwent aortic valve replacement (AVR) with the CEPM Ease prosthesis. From a prospective cohort of 201 patients (March 2011 to January 2012) who received AVR with the SJM Trifecta valve, a matched group of 51 patients was selected. Matching was conducted 1:1 by ejection fraction, gender, age, and body surface area. A Hegar dilator was used to define the aortic tissue annulus diameter. Data were grouped on the basis of the patient's tissue annulus diameter (≤22 mm; 23-24 mm; ≥25 mm). Results Early postoperative and at 1 year mean pressure gradients (MPGs) in the various groups ranged from 7.2 ± 4.6 to 7.1 ± 2.4 mm Hg and from 10.0 ± 4.3 to 8.0 ± 2.8 mm Hg in the SJM Trifecta group and from 18.0 ± 5.0 to 12.1 ± 3.6 mm Hg and from 17.7 ± 4.5 to 11.8 ± 3.2 mm Hg in the CEPM Ease group, respectively. Likewise, effective orifice areas (EOAs) ranged from 1.7 ± 0.5 to 2.0 ± 0.5 cm(2) and from 1.5 ± 0.3 to 1.7 ± 0.4 cm(2) in the SJM Trifecta group and from 1.3 ± 0.5 to 1.9 ± 0.5 cm(2) and from 1.2 ± 0.3 to 1.8 ± 0.3 cm(2) in the CEPM Ease group, respectively. A marked left ventricular mass (LVM) regression across all annulus sizes was noted in both groups. Severe patient-prosthesis mismatch (PPM) was infrequent overall. Conclusion The SJM Trifecta valve showed lower MPGs early postoperative and at 1 year as well as higher EOA and effective orifice area index early postoperative. No significant differences were detected with regard to LVM regression and PPM.

Regression of left ventricular mass after implantation of the sutureless 3f Enable aortic bioprosthesis.

Left ventricular hypertrophy in aortic stenosis is considered a compensatory response for the maintenance of systolic function but a risk factor for cardiac morbidity and death. We investigated the degree of left ventricular mass regression after implantation of the sutureless Medtronic 3f Enable Aortic Bioprosthesis. We studied 19 patients who, from May 2010 through July 2011, underwent isolated aortic valve replacement with the 3f Enable bioprosthetic valve, with clinical and echocardiographic follow-up at 6 months. The mean age was 77.1 ± 5.1 years (range, 68-86 yr); 14 patients were women (73.7%); and the mean logistic EuroSCORE was 15.4% ± 11.8%. Echocardiography was performed preoperatively, at discharge, and at 6 months' follow-up. The left ventricular mass was calculated by means of the Devereux formula and indexed to body surface area. The left ventricular mass index decreased from 146.1 ± 47.6 g/m(2) at baseline to 118.1 ± 39.8 g/m(2) at follow-up (P=0.003). The left ventricular ejection fraction did not change significantly. The mean transaortic gradient decreased from 57.3 ± 14.2 mmHg at baseline to 12.3 ± 4.6 mmHg at discharge and 12.2 ± 5.3 mmHg at follow-up (P <0.001), and these decreases were accompanied by substantial clinical improvement. No moderate or severe paravalvular leakage was present at discharge or at follow-up. In isolated aortic stenosis, aortic valve replacement with the 3f Enable bioprosthesis results in significant regression of left ventricular mass at 6 months' follow-up. However, this regression needs to be verified by long-term echocardiographic follow-up.

A prospective, double-blind, randomized controlled trial of the angiotensin-converting enzyme inhibitor Ramipril In Aortic Stenosis (RIAS trial).

AimsAngiotensin-converting enzyme (ACE) inhibitors improve left ventricular (LV) remodelling and outcome in heart failure and hypertensive heart disease. They may be similarly beneficial in patients with aortic stenosis (AS), but historical safety concerns have limited their use, and no prospective clinical trials exist.Methods and resultsWe conducted a prospective, randomized, double-blind, placebo-controlled trial in 100 patients with moderate or severe asymptomatic AS to examine the physiological effects of ramipril, particularly LV mass (LVM) regression. Subjects were randomized to ramipril 10 mg daily (n = 50) or placebo (n = 50) for 1 year, and underwent cardiac magnetic resonance, echocardiography, and exercise testing at 0, 6, and 12 months, with follow-up data available in 77 patients. There was a modest but progressive reduction in LVM (the primary end point) in the ramipril group vs. the placebo group (mean change −3.9 vs. +4.5 g, respectively, P = 0.0057). There were also trends towards improvements in myocardial physiology: the ramipril group showed preserved tissue Doppler systolic velocity compared with placebo (+0.0 vs. −0.5 cm/s, P = 0.04), and a slower rate of progression of the AS (valve area 0.0 cm2 in the ramipril group vs. −0.2 cm2 in the placebo arm, P = 0.067). There were no significant differences in major adverse cardiac events.ConclusionACE inhibition leads to a modest, but progressive reduction in LVM in asymptomatic patients with moderate–severe AS compared with placebo, with trends towards improvements in myocardial physiology and slower progression of valvular stenosis. A larger clinical outcome trial to confirm these findings and explore their clinical relevance is required.

Left ventricular mass regression after two alternative sutureless aortic bioprostheses.

Left ventricular (LV) hypertrophy in aortic stenosis (AS) constitutes a risk factor for cardiac morbidity and mortality. The aim of this study was to investigate the degree of LV mass regression after aortic valve replacement (AVR) with two alternative sutureless self-expanding strategies: Perceval S (Sorin Group, Saluggia, Italy) (P) and 3f Enable (Medtronic, ATS Medical, Minneapolis, MN USA) (E) aortic bioprostheses. Between March 2010 and December 2011, 129 patients with symptomatic AS underwent AVR with the Perceval S or 3f Enable bioprostheses in two cardiac surgery departments (Massa, Italy; Nuremberg, Germany). We analyzed 45 patients in group P and 19 in group E undergoing isolated AVR with a 6-month follow-up. The LV mass was calculated using the Devereux formula and was indexed to body surface area. Baseline patient characteristics showed no significant differences between the two groups. There were no in-hospital deaths. Two patients in group P died at follow-up versus zero in group E (P = 0.49). Mean LV mass index decreased from 146.6 (78) g/m at baseline to 123.3 (63) g/m at follow-up (P < 0.001) in group P and from 146.1 (47.6) g/m to 118.1 (39.8) g/m (P = 0.003) in group E, with no significant difference between the two groups (P = 0.315). This effect was accompanied by significant clinical improvement. In isolated AS, AVR with sutureless bioprostheses is associated with a significant regression in LV mass at 6-month follow-up. No significant differences were present between the two alternative sutureless strategies. However, regression needs an evaluation with long-term echocardiographic examinations.

Left ventricular mass regression may occur very early following transcatheter aortic valve implantation for severe aortic stenosis

Background The effect of transcatheter aortic valve implantation (TAVR) on left ventricular remodelling early following valve implantation has not previously been evaluated using cardiac magnetic resonance (CMR). Early left ventricular mass (LVM) regression (assessed using echocardiography) has been linked to a 50% reduction in rehospitalisation in the first year following TAVR. We sought to establish using CMR, the reference standard non-invasive imaging technique for LVM quantification, whether LVM regression occurs early post-TAVR.

Metabolic vs. hedonic obesity: a conceptual distinction and its clinical implications.

SummaryBody weight is determined via both metabolic and hedonic mechanisms. Metabolic regulation of body weight centres around the ‘body weight set point’, which is programmed by energy balance circuitry in the hypothalamus and other specific brain regions. The metabolic body weight set point has a genetic basis, but exposure to an obesogenic environment may elicit allostatic responses and upward drift of the set point, leading to a higher maintained body weight. However, an elevated steady‐state body weight may also be achieved without an alteration of the metabolic set point, via sustained hedonic over‐eating, which is governed by the reward system of the brain and can override homeostatic metabolic signals. While hedonic signals are potent influences in determining food intake, metabolic regulation involves the active control of both food intake and energy expenditure. When overweight is due to elevation of the metabolic set point (‘metabolic obesity’), energy expenditure theoretically falls onto the standard energy–mass regression line. In contrast, when a steady‐state weight is above the metabolic set point due to hedonic over‐eating (‘hedonic obesity’), a persistent compensatory increase in energy expenditure per unit metabolic mass may be demonstrable. Recognition of the two types of obesity may lead to more effective treatment and prevention of obesity.

0316: Assessment of left ventricular mass regression after implantation of a new generation of sutureless aortic bioprosthesis

The development of left ventricular (LV) concentric hypertrophy in the natural course of aortic stenosis is known as an independent prognostic factor of morbidity and mortality. The regression of LV mass after aortic valve replacement leads to an improvement of functional capacity and long-term outcome. To assess the degree of LV mass regression at one month after implantation of Edwards INTUITY. Single arm, prospective study, from July 2012 to March 2014. Echocardiography was performed preoperatively, at discharge and at one-month follow up. Inclusion criteria: 1/ Severe symptomatic aortic stenosis 2/ tricuspid aortic valve.Endpoints:1/ In hospital mortality 2/ Evolution of LVEF, IVSd and LVPWd 3/ Evolution of LV mass index 4/ Evolution of mean gradient and iEOA 5/Incidence of periprosthetic regurgitation (PPR) 72 patients, age = 77.4±6.6, BMI = 31.2±4.2, Euroscore II= 3.4±3.4, LVEF = 63.4±10.2%, Aortic valve area = 0.5±0.2 cm2, Mean gradient = 56.7±19.3mmHg, Stroke volume = 49.9±11.6 ml/m2, full sternotomy in all, associated CABG in 23 patients (33%), Cross clamping time = 48.7±22.3. 1/ In-hospital mortality: 1.4%. 2/ Evolution of LV parameters: LVEF(%) remains stable (61.6±8.9 versus 61.8±7.5, p=0.08), IVSd(mm) and LVPWd (mm) significantly decreased ((13.5±2 vs 14.9±1.7, p<0.001) and (12.5±1.5 vs 15.3±1.4, p< 0.001)). 3/ Evolution of LV mass index: LV mass index ( mg/m2) significantly decreased at one month FU(124.4±26.7 vs 167±45.1, p<0.001) 4/ Evolution of mean gradient and iEOA: Mean gradient (mmHg): 12.3±7.10 vs 56.7±19.3, p< 0.001 iEOA(cm2/m2): 1±0.4 vs 0.5±0.2, p<0.001 5/ Incidence of PPR No moderate or severe paravalvular leakage was observed at discharge and at follow-up. Edwards’s Intuity bioprosthesis provides favorable preliminary results and is associated with significant regression of LV mass during the first month after aortic valve replacement.Midterm results should be evaluated.

Left ventricular remodeling after transcatheter aortic valve implantation: one-year follow-up study.

The impact of transcatheter aortic valve implantation (TAVI) on left ventricular (LV) mass regression is not well defined. We aimed to measure LV mass regression, changes in LV volumes and dimensions, as well as mitral valve function after TAVI. Eighty patients who underwent TAVI between 2008 and 2010 were studied. Echocardiographic findings before procedure and at 6- and 12-month follow-up were analyzed. Aortic valve area increased from 0.71 (0.27) cm before procedure to 1.89 (0.64) cm at 12 months (P < 0.001), which was associated with reduction in peak [80.79 (23) vs 16.9 (6.5) mm Hg, P < 0.001] and mean [47.65 (14.2) vs 8.77 (3.29) mm Hg, P < 0.001] gradients. At 1 year, there was a change in LV end-systolic volume [46.12 (36.6) to 48.96 (4.05) mL, P = 0.042] and LV mass [202.4 (92.2) to 183.6 (98.2) g, P = 0.04]. Left ventricular mass index regressed from 130.7 (28.9) to 122.1 (28.9) g/m (P = 0.01). Maximum wall thickness decreased from 1.28 (0.18) to 1.25 (0.17) cm (P < 0.001). There was no significant change in LV ejection fraction, LV end-systolic and end-diastolic diameters, as well as mitral valve regurgitation. Transcatheter aortic valve implantation is associated with significant regression of LV hypertrophy at 1 year. However, this regression was not associated with changes in LV systolic and diastolic functions, size, or changes in mitral valve regurgitation.

Síndrome de la vena cava superior como forma de inicio de carcinoma microcítico de pulmón en un varón de 51 años

The case is presented of a 51 year-old man, a smoker of 3 packs of cigarettes per day for 30 years. Father was a smoker, dying of pulmonary neoplasia, and the mother died from Alzheimer disease.He came to clinic due to having swelling in the neck, sub-maxillary, and parotid region, as well as oropharyngeal discomfort with swelling, pharyngeal-tonsil hyperaemia, and right supraclavicular lymph nodes.The laboratory results showed a large increase in white cells (25,000).A large image of an upper right parahilar tumour was observed in the chest X-ray.He was referred to hospital, where he was studied with a thoraco-abdominal CT scan, fibre-optic bronchoscopy, and Doppler ultrasound. He was diagnosed with disseminated small-cell pulmonary carcinoma with superior vena cava obstruction.Chemotherapy and radiotherapy was indicated. The initial response was good, with clinical improvement and regression of pulmonary mass observed in the chest X-ray.

0343: Obstructive cardiac tumor in Hodgkin’s lymphoma: course of cardiac involvement under emergency chemotherapy

Cardiac involvement in Hodgkin’s disease (HD) is one of the least investigated subjects in cardiac oncology. Emergency chemotherapy is a rare necessity in Hodgkin’s disease, but life-threatening cardiac involvement is possible, compromising hemodynamic stability. We report a case of Hodgkin’s lymphoma which presented with acute obstructive left heart failure. It is about a 37 years old patient treated in 2000 for HD, type3, stage IVB medullar by chemotherapy (4MOPP+ABVD) followed by radiotherapy, and judged in complete remission. Few months ago, the patient presents a cardiac relapse, echocardiography revealed an enormous left atrial mass inducing a subtotal mitral obstruction confirmed by the tomodensitomety. After a multidisciplinary concertation we used the CEOP protocol (cyclophosphamide 650 mg/m 2 , etoposid100 mg/m 2 , oncovin 1,4 mg/m 2 , prednisone, 40 mg/m 2 ) associated to the conventional heart failure treatement. Under chemotherapy the evolution was favourable with amelioration of symptoms strengthen by regression of cardiac mass gradually in the weekly echocardiography checking after 4 cures. HD is not a steroid-sensitive disease, no single drug is rapidly efficient, and no recommendation is available in the literature regarding urgent cytoreduction. Therefore, if a decision for emergency chemotherapy is made, an aggressive combination may be recommended. In addition, newer agents resulting in improved cancer therapy outcomes might alter the prevalence and location of metastatic deposits to include more unusual disease sites, including intracardiac locations. Lymphomatous involvement of the heart, previously a rarity, is now being reported with greater frequency. The increased incidence might be partly a result of increased clinical awareness, improved imaging techniques. Adaptative chemotherapy can successfully improve the long term outcome of these patients.

Effect of imatinib mesylate and rapamycin on the preformed intimal hyperplasia in rat carotid injury model.

PurposeIntimal hyperplasia (IH) is the main cause of restenosis or occlusion after vascular procedures. Imatinib mesylate and rapamycin are known to prevent IH. The purpose of this study was to evaluate the effect of these drugs on the regression of preformed IH in rat carotid injury model.MethodsIH was established in rat carotid arteries using a balloon catheter. The drug effects were assessed in vitro on proliferation, migration, and apoptosis of vascular smooth muscle cells (VSMC) in the neointima. And in vivo studies were carried out in 4 groups: imatinib, rapamycin, combined, and no medication. After 2-week oral medication, morphometric analysis evaluated the number and density of neointimal cells, intima-to-media (I/M) ratio and cross-sectional area. Cell proliferation, apoptosis, and collagen changes were also investigated by immunohistochemical staining (IHCS).ResultsImatinib and rapamycin significantly inhibited VSMC proliferation and migration, and promoted apoptosis in vitro. In morphometric analysis, the number and density of neointimal cells decreased significantly in all medication groups compared with control group (P < 0.01). However, there was no significant difference in neointimal cross-sectional area and I/M ratio among groups. In IHCS, imatinib and rapamycin inhibited neointimal cell proliferation significantly. However, there was no significant change in cell apoptosis and collagen composition.ConclusionCombined treatment of with imatinib and rapamycin induced reduction of cell mass in preformed intimal hyperplasia, but failed to induce regression of intimal mass in this short-term medication study. Further studies will be needed with additional strategies of inducing lysis of the extracellular matrix.

Hemodynamic Performance and Durability of Mosaic Bioprostheses for Aortic Valve Replacement, up to 13 Years.

This study evaluated the mid to long-term durability and hemodynamics of the small-size Mosaic bioprosthesis, a third-generation stented porcine bioprosthesis, for aortic valve replacement (AVR). From 2000 to 2012, 207 patients (117 women; age, 74±8 years; body surface area, 1.48±0.25 m(2)) underwent AVR with a Mosaic bioprosthesis. The mean follow-up period was 3.5±2.7 years (maximum, 12.4 years) and the follow-up rate was 93.7%. A 19-, 21-, 23-, 25-, and 27-mm prosthesis was used in 103, 53, 35, 13, and 3 patients, respectively. The measured effective orifice area was 1.17±0.25, 1.29±0.19, 1.39±0.24, and 1.69 cm(2)for the 19-25 mm prostheses, and the mean transvalvular pressure gradient was 19.4±6.0, 18.5±5.8, 16.5±7.3, and 13.2±2.9 mmHg, respectively. The left ventricular mass regression was significant (P<0.05) with rates of 74.6±18.8%, 75.5±30.2%, 68.1±30.5%, 55.9±12.9%, and 49.2%, respectively. The 30-day mortality rate was 1.9% and the 5- and 10-year actuarial survival rates were 86.0% and 73.7%, respectively. Valve-related comorbidities occurred in 3 patients (structural valve deterioration [SVD] in 1 after 7.2 years, and prosthetic valve endocarditis in 2). Freedom from SVD at 10-year was 96.7%. The mid to long-term performance of the small Mosaic bioprosthesis was satisfactory, with excellent hemodynamics and few valve-related adverse events.