Reproducibility of Echocardiograph‐Derived Multilevel Left Ventricular Apical Twist Mechanics

Left ventricular (LV) twist mechanics are routinely assessed via echocardiography in clinical and research trials investigating the function of obliquely oriented myocardial fibers. However, echocardiograph‐derived measures of LV twist may be compromised by nonstandardized acquisition of the apical image. This study examined the reproducibility of echocardiograph‐derived parameters of apical twist mechanics at multiple levels of the apical myocardium. Two sets of 2D LV parasternal short‐axis images were obtained in 30 healthy subjects (24 men; 19–57 year) via echocardiography. Images were acquired immediately distal to the papillary muscles (apical image 1), immediately above the point of LV cavity obliteration at end systole (apical image 3), and midway between apical image 1 and apical image 3 (apical image 2). Repeat scans were performed within 1 hour, and twist mechanics (rotation and rotation rate) were calculated via frame‐by‐frame tracking of natural acoustic echocardiographic markers (speckle tracking). The magnitude of apical rotation increased progressively toward the apex (apical image 1: 4.2 ± 2.1°, apical image 2: 7.2 ± 3.9°, apical image 3: 11.8 ± 4.6°). apical images 1, 2, and 3 each had moderate to good correlations between repeat scans (ICC: 0.531–0.856). When apical images 1, 2, and 3 were averaged, rotation was 7.7 ± 2.7° and between‐scan correlation was excellent (ICC: 0.910). Similar results were observed for systolic and diastolic rotation rates. Averaging multiple standardized apical images, tending progressively toward the apex, generated the most reproducible rotation indices and may be optimal for the assessment of LV twist mechanics across therapeutic, interventional, and research studies; however, care should be taken given the influence of acquisition level on the magnitude of apical rotation.     

Out-of-the-Blue: Depressive Symptoms are Associated with Deficits in Processing Inferential Expectancy-Violations Using a Novel Cognitive Rigidity Task

Rigid cognition is frequently cited as a plausible maintenance or risk factor for depression. However, most performance-based measures of cognitive rigidity associated with depression offer poor ecological validity, produce mixed findings, and afford little in the way of therapeutic application. In order to establish a more useful and relevant performance-based measure of cognitive rigidity in depression, we developed a novel task that probes a rigidity process using stimuli highly relevant to the level of construal, the thematic content, and the rhetorical mode of depressotypic thinking. The task consists of a set of narrative vignettes that contain an expectancy-violation that is incompatible with an initially-established interpretation. As hypothesized, depressive symptoms were associated with reduced ability to update interpretations. This finding was independent of the valence of the expectancy-violation (i.e., was not merely a negativity bias), and was significant after controlling for basic set-shifting ability, intelligence measures, working memory, and other potential confounds. The novel Contingent Inference Task is a promising approach that may probe a more ecologically and etiologically relevant form of cognitive rigidity in depression than other related performance-based rigidity tasks. This rigidity process may underlie the persistence of biased beliefs in depression, and represent a new therapeutic target.     

Graft-versus-host disease after liver transplantation is associated with bone marrow failure,hemophagocytosis, and DNMT3A mutations

Graft-versus-host disease after liver transplantation (LT-GVHD) is rare, frequently fatal, and associated with bone marrow failure (BMF), cytopenias, and hyperferritinemia. Given hyperferritinemia and cytopenias are present in hemophagocytic lymphohistiocytosis (HLH), and somatic mutations in hematopoietic cells are associated with hyperinflammatory responses (clonal hematopoiesis of indeterminate potential, CHIP), we identified the frequency of hemophagocytosis and CHIP mutations in LT-GVHD. We reviewed bone marrow aspirates and biopsies, quantified blood/marrow chimerism, and performed next-generation sequencing (NGS) with a targeted panel of genes relevant to myeloid malignancies, CHIP, and BMF. In all, 12 marrows were reviewed from 9 LT-GVHD patients. In all, 10 aspirates were evaluable for hemophagocytosis; 7 had adequate DNA for NGS. NGS was also performed on marrow from an LT cohort (n = 6) without GVHD. Nine of 10 aspirates in LT-GVHD patients showed increased hemophagocytosis. Five (71%) of 7 with LT-GVHD had DNMT3A mutations; only 1 of 6 in the non-GVHD LT cohort demonstrated DNMT3A mutation (p = .04). Only 1 LT-GVHD patient survived. BMF with HLH features was associated with poor hematopoietic recovery, and DNMT3A mutations were over-represented, in LT-GVHD patients. Identification of HLH features may guide prognosis and therapeutics. Further studies are needed to clarify the origin and impact of CHIP mutations on the hyperinflammatory state.