Real Time Three‐Dimensional Echocardiography for Quantification of Ventricular Volumes,Mass, and Function in Children with Congenital and Acquired Heart Diseases

Quantitative measurement of left ventricular (LV) volumes, mass, and function is one of the most common and important indications for echocardiography. These measurements are among the most powerful tools for diagnosis and prognosis of congenital and acquired heart diseases and for assessment of medical, percutaneous, and surgical interventions. Awareness is also growing of the importance of right ventricular (RV) volume, mass, and function in many cardiopulmonary diseases. Furthermore, there are challenges and opportunities to measure the volume, mass, and function of complex chambers such as the left atrium, right atrium, and the univentricular heart. As echocardiography continues to be the imaging modality of choice for these measurements, the strengths and limitations of M‐mode, two‐dimensional (2D), and recently three‐dimensional (3D) echocardiographic (3DE) methodologies for accurate and reproducible measurement of these indices have been extensively investigated for congenital and acquired heart diseases. Evidence suggests that 3DE provides improved accuracy and reproducibility over 2D methods for measurement of LV volume and function calculation in adults and in children. Data have accumulated on the utility of 3DE for measuring chamber volumes and function for the RV and for the single ventricle, which may become more widely used in clinical and research arenas in the future. Finally, new advanced modes of analysis such as 3D strain and synchrony analysis by 3DE are promising methodologies that warrant further investigation.     

基于网络药理学及实验验证探究芪苈强心胶囊治疗射血分数保留型心衰的作用机制

目的 基于网络药理学及实验验证探讨芪苈强心胶囊治疗射血分数保留型心衰（heart failure with preserved ejection fraction,HFpEF）的作用机制。方法 将44个明确鉴定的芪苈强心胶囊体内代谢物检识有效成分，利用Swisstargetprediction、pharmmapper平台预测化合物靶点，OMIM、DisGenet、GenCard数据库中检索HFpEF疾病靶点；取交集靶点，利用String数据库和Cytoscape 3.7.2软件进行蛋白质-蛋白质相互作用（protein-protein interaction,PPI）和拓扑分析；Metescape平台对共同靶点进行基因本体（gene ontology,GO）功能富集分析及京都基因与基因组百科全书（Kyoto encyclopedia of genes and genomes,KEGG）通路富集分析。构建醋酸脱氧皮质酮（deoxycorticosterone acetate,DOCA）盐敏感型HFpEF大鼠模型，给予沙库巴曲缬沙坦或芪苈强心胶囊进行干预，给药8周后，利用小动物超声成像系统...     

Atrial Functional Mitral Regurgitation: JACC Review Topic of the Week

Unlike secondary mitral regurgitation (MR) in the setting of left ventricular (LV) disease, the occurrence of functional MR in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) has remained largely unspoken. LV size and systolic function are typically normal, whereas isolated mitral annular dilation and inadequate leaflet adaptation are considered mechanistic culprits. Moreover, the role of left atrial and annular dynamics in provoking MR is often underappreciated. Because of this peculiar pathophysiology, atrial functional MR benefits from a different approach compared with secondary MR. Although both AF and HFpEF—two closely related disease epidemics of the 21st century—are held responsible, current guidelines do not emphasize the need to differentiate atrial functional MR from (ventricular) secondary MR. This review summarizes the prevalence and prognostic importance of atrial functional MR, providing mechanistic insights compared with those of secondary MR and suggesting potential therapeutic targets.     

Sustained clinical improvement of Parkinson’s disease in two patients with facially-transplanted adipose-derived stromal vascular fraction cells

Cell-based therapy has been studied as an alternative for Parkinson's Disease (PD), with different routes of administration. The superficial fascia and facial muscles possess a rich blood supply, while venous and lymphatic access via the orbit and the cribriform plate provide a route to cerebral circulation. We here document positive clinical effects in two patients with PD treated with autologous adipose-derived stromal vascular fraction (SVF) cell preparation, implanted into the face and nasal cavity. Two patients with PD were transplanted with 60 million total nucleated cells in processed SVF into the facial muscles and nose. Serial evaluations were carried out up to 5 years (patient 1) and 1 year (patient 2), using the PDQ-39, the UPDRS, and serial videos. Video scoring was reviewed in a blinded fashion. Both patients reported qualitative improvement in motor and nonmotor symptoms following injection. Quantitatively, PDQ-39 scores decreased in all categories for both. On-medication UPDRS motor scores decreased in both (20 to 4 in patient 1, 18 to 3 in patient 2) despite taking the same or less medication (LEDD 350 to 350 in patient 1, LEDD 1175 to 400 in pt2). Both subjects had off-medication UPDRS scores similar to their pretreatment on-medication scores (20 to 14 in patient 1, 18 to 23 in patient 2). These preliminary findings describe local facial and nasal injections of SVF preparation followed by prolonged clinical benefit in two patients. Despite an unknown mechanism of action, this potential therapy warrants careful verification and investigation.