Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging: A Multicenter Study

ObjectivesThis study sought to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived mitral annular plane systolic excursion (MAPSE) in a large multicenter population of patients with hypertension.BackgroundIn patients with hypertension, cardiac abnormalities are powerful predictors of adverse outcomes. Long-axis mitral annular movement plays a fundamental role in cardiac mechanics and is an early marker for a number of pathological processes. Given the adverse consequences of cardiac involvement in hypertension, the authors hypothesized that lateral MAPSE may provide incremental prognostic information in these patients.MethodsConsecutive patients with hypertension and a clinical indication for CMR at 4 U.S. medical centers were included in this study (n = 1,735). Lateral MAPSE was measured in the 4-chamber cine view. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models.ResultsOver a median follow-up period of 5.1 years, 235 patients died. By Kaplan-Meier analysis, risk of death was significantly higher in patients with a lateral MAPSE < median (10 mm) (log-rank; p < 0.0001). Lateral MAPSE was associated with risk of death after adjustment for clinical and imaging risk factors (hazard ratio [HR]: 1.402-per-millimeter decrease; p < 0.001). Addition of lateral MAPSE in this model resulted in significant improvement in the C-statistic (0.735 to 0.815; p < 0.0001). Continuous net reclassification improvement was 0.739 (95% confidence interval: 0.601 to 0.902). Lateral MAPSE remained significantly associated with death even after adjustment for feature tracking global longitudinal strain (HR: 1.192-per-millimeter decrease; p < 0.001). Lateral MAPSE was independently associated with death among the subgroups of patients with preserved ejection fraction (HR = 1.339; p < 0.001) and in those without history of myocardial infarction (HR: 1.390; p < 0.001).ConclusionsCMR-derived lateral MAPSE is a powerful, independent predictor of mortality in patients with hypertension and a clinical indication for CMR, incremental to common clinical and CMR risk factors. These findings may suggest a role for CMR-derived lateral MAPSE in identifying hypertensive patients at highest risk of death.     

Angiographic profile and outcomes in persistent non-valvular atrial fibrillation: A study from tertiary care center in North India

BackgroundThe relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established, yet it is often missed. There is evidence of myocardial ischemia on stress imaging in AF patients in the absence of obstructive CAD. In this prospective cohort, we studied the angiographic profiles of non-valvular AF patients.MethodsThe study was a nonrandomized, prospective, single-center observational study of consecutive patients of persistent non-valvular AF. Patients symptomatic for AF despite optimal medical therapy for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with prior history of CAD were excluded.ResultsA total of 70 patients were followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49) years. Hypertension was the commonest comorbidity seen in 74% patients. Obstructive CAD was present in 32 (46%) patients, non-obstructive (<50% stenosis) CAD in 17 (24%) patients and normal coronaries in 21 (30%) patients. Overall 49 (70%) patients had evidence of CAD. Amongst patients without obstructive CAD, slow flow was seen in 16 (42%) patients. Lower baseline ejection fraction, lower haemoglobin & albumin levels and higher creatinine levels was associated with increased mortality. In patients without obstructive CAD, hospitalizations for fast ventricular rate were significantly increased in those having slow flow on CAG (p = 0.005).ConclusionsMajority (70%) of our patients had evidence of atherosclerotic CAD on CAG. A large proportion of patients without obstructive CAD had slow flow on CAG.     

阻塞性睡眠呼吸暂停综合征患者的血浆同型半胱氨酸与左室几何构型的相关性临床研究

目的 探讨血浆同型半胱氨酸(Hcy)对阻塞性睡眠呼吸暂停综合征(OSAS)患者左室几何构型改变的影响。方法 选取经多导睡眠呼吸仪(PSG)监测呼吸暂停指数(AHI)≥5次/h确诊为OSAS的患者192例,次日晨行血压、血糖、血脂、血浆同型半胱氨酸水平测定及超声心动图检查,同时选取性别、年龄匹配,血糖、血脂、胸片、心电图和PSG等检查均正常的健康人30例作为对照组。依据左室质量指数(LVMI)和相对室壁厚度(RWT)将OSAS患者按左室几何构型分为四组：正常构型组(NG)、向心性重构组(CR)、向心性肥厚组(CH)、离心性肥厚组(EH)。比较对照组与OSAS四组血浆Hcy水平的差异,对血浆Hcy与其他参数进行单因素相关性分析,并进一步进行多因素逐步回归分析。 结果 ①与对照组相比,CR组、CH组、EH组血浆Hcy水平升高,差异具有统计学意义(P<0.05)；与NG、CR组相比,CH组、EH组血浆Hcy水平升高,差异具有统计学意义(P<0.05)；与EH组相比,CH组血浆Hcy水平升高,差异无统计学意义(P>0.05)；②单因素相关性分析血浆Hcy与BMI、SBP、腹围、AHI、血糖、LVMI、异常左室几何构型呈正相关,与Em/Am、LVEF呈负相关,而与性别、年龄、DBP、颈围、臀围、T90、MSaO2、LSaO2、RWT无相关性 ；③多因素逐步线性回归进一步分析得出血浆Hcy与AHI、LVMI、异常左室几何构型独立相关。结论 OSAS不同左室几何构型患者的血浆Hcy表达水平不同,血浆Hcy水平是OSAS患者左室几何构型(CH、EH)改变的主要影响因素之一。     

Formation and Function of Liquid-Like Viral Factories in Negative-Sense Single-Stranded RNA Virus Infections

Liquid–liquid phase separation (LLPS) represents a major physiochemical principle to organize intracellular membrane-less structures. Studies with non-segmented negative-sense (NNS) RNA viruses have uncovered a key role of LLPS in the formation of viral inclusion bodies (IBs), sites of viral protein concentration in the cytoplasm of infected cells. These studies further reveal the structural and functional complexity of viral IB factories and provide a foundation for their future research. Herein, we review the literature leading to the discovery of LLPS-driven formation of IBs in NNS RNA virus-infected cells and the identification of viral scaffold components involved, and then outline important questions and challenges for IB assembly and disassembly. We discuss the functional implications of LLPS in the life cycle of NNS RNA viruses and host responses to infection. Finally, we speculate on the potential mechanisms underlying IB maturation, a phenomenon relevant to many human diseases.