Predictors of Increased Left Ventricular Filling Pressure in Dialysis Patients with Preserved Left Ventricular Ejection Fraction

Aim

To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) filling pressure in dialysis patients with preserved LV ejection fraction.

Methods

This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/E’≤10.16).

Results

Compared with patients with low filling pressure, the group of patients with high filling pressure included a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m³, P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), higher E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’:8.6 ± 1.5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence interval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients.

Conclusions

In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure.Cardiovascular disorders are the main cause of mortality and morbidity in patients with end-stage renal failure who are in regular hemodialysis programs (1,2). The left ventricular (LV) hypertrophy is a common finding in these patients. It reflects a physiological response to pressure and volume overload (3) and positively correlates with cardiovascular mortality (4). LV hypertrophy is frequently associated with LV dilatation and reduced systolic function (5). An increased incidence of atherosclerotic cardiovascular events in these patients has also been reported (6). Systolic dysfunction and LV hypertrophy have been identified as the best predictors of outcome in dialysis patients (4,7,8). However, the conventional systolic dysfunction appears in the late stages of the chronic renal failure (9).In contrast to conventional echocardiography, tissue Doppler imaging of the myocardial velocities overcomes the load dependence of diastolic parameters (10). The ratio of transmitral early diastolic velocity (E) to early myocardial velocity (E’) (E/E’ ratio) has been shown to be an accurate method of the LV filling pressure estimation (8) and the best predictor of LV diastolic filling in various cardiac pathologies (11,12), thereby serving as one of the best predictors of outcome in heart failure patients (13-15) and patients with end-stage renal disease (16).The aims of this study were to investigate the left and right ventricular function in patients with end-stage renal disease and preserved LV ejection fraction and to assess the predictors of increased LV filling pressure in these patients.     

Category-specific activations during word generation reflect experiential sensorimotor modalities

According to the sensorimotor theory of lexicosemantic organization, semantic representations are neurally distributed and anatomically linked to category-specific sensory areas. Previous functional neuroimaging studies have demonstrated category specificity in lexicosemantic representations. However, little evidence is available from word generation paradigms, which provide access to semantic representations while minimizing confounds resulting from low-level perceptual features of stimulus presentation. In this study, 13 healthy young adults underwent fMRI scanning while performing a word generation task, generating exemplars to nine different semantic categories. Each semantic category was assigned to one of three superordinate category types, based upon sensorimotor modalities (visual, motor, somatosensory) presumed to predominate in lexical acquisition. For word generation overall, robust activation was seen in left inferior frontal cortex. Analyses by sensorimotor modality categories yielded activations in brain regions related to perceptual and motor processing: Visual categories activated extrastriate cortex, motor categories activated the intraparietal sulcus and posterior middle temporal cortex, and somatosensory categories activated postcentral and inferior parietal regions. Our results are consistent with the sensorimotor theory, according to which lexicosemantic representations are distributed across brain regions participating in sensorimotor processing associated with the experiential components of lexicosemantic acquisition.     

Phytochemical composition,anti-inflammatory activity and cytotoxic effects of essential oils from three Pinus spp.

Context: Inflammation and cell differentiation lead to a number of severe diseases. In the recent years, various studies focused on the anti-inflammatory and anticancer activity of essential oils (EOs) of numerous plants, including different Pinus species.

Objective: The phytochemical composition, anti-inflammatory and cytotoxic activity of EOs from needles and twigs of Pinus heldreichii Christ (Pinaceae) and P. peuce Griseb., and from needles, twigs and cones of P. mugo Turra were determined.

Materials and methods: For separation and identification of the EOs, gas chromatography/flame ion detector (GC/FID) and GC/mass spectrometry were performed. The amount of secreted IL-6 in a lipopolysaccharide (LPS)-stimulated macrophage model was quantified (concentration of oils: 0.0001–0.2%, 3?h incubation). Cytotoxicity on the cancer cell lines HeLa, CaCo-2 and MCF-7 were determined using a MTT (Thiazolyl Blue Tetrazolium Bromide) assay (concentration of oils: 0.001–0.1%, 24?h incubation).

Results: The most prominent members in the oils include: δ-3-carene, α-pinene and linalool-acetate (P. mugo); α-pinene, β-phellandrene and β-pinene (P. peuce); limonene, α-pinene and (E)-caryophyllene (P. heldreichii). EOs showed significant cytotoxic effects on cancer cell lines (IC₅₀ 0.007 to >0.1%), with a reduction in cell viability with up to 90% at a concentration of 0.1%, and anti-inflammatory activity (IC₅₀ 0.0008–0.02%) with a reduction of IL-6 secretion with up to 60% at a concentration of 0.01%.

Discussion and conclusion: The EOs of needles and twigs from P. peuce and P. heldreichii as well as of needles, twigs and cones of P. mugo can be considered as promising agents for anticancer and anti-inflammatory drugs.     

Co‐causation of reduced newborn size by maternal undernutrition,infections, and inflammation

More than 20 million babies are born with low birthweight annually. Small newborns have an increased risk for mortality, growth failure, and other adverse outcomes. Numerous antenatal risk factors for small newborn size have been identified, but individual interventions addressing them have not markedly improved the health outcomes of interest. We tested a hypothesis that in low‐income settings, newborn size is influenced jointly by multiple maternal exposures and characterized pathways associating these exposures with newborn size. This was a prospective cohort study of pregnant women and their offspring nested in an intervention trial in rural Malawi. We collected information on maternal and placental characteristics and used regression analyses, structural equation modelling, and random forest models to build pathway maps for direct and indirect associations between these characteristics and newborn weight‐for‐age Z‐score and length‐for‐age Z‐score. We used multiple imputation to infer values for any missing data. Among 1,179 pregnant women and their babies, newborn weight‐for‐age Z‐score was directly predicted by maternal primiparity, body mass index, and plasma alpha‐1‐acid glycoprotein concentration before 20 weeks of gestation, gestational weight gain, duration of pregnancy, placental weight, and newborn length‐for‐age Z‐score (p < .05). The latter 5 variables were interconnected and were predicted by several more distal determinants. In low‐income conditions like rural Malawi, maternal infections, inflammation, nutrition, and certain constitutional factors jointly influence newborn size. Because of this complex network, comprehensive interventions that concurrently address multiple adverse exposures are more likely to increase mean newborn size than focused interventions targeting only maternal nutrition or specific infections.     

A silent trio: Giant descending aortic aneurysm combined with coarctation and persistent left brachiocephalic truncus

We report a case of an undiagnosed descending aortic aneurysm, combined with coarctation and persistent left brachiocephalic truncus in a 59‐year‐old male. It highlights the necessity for aortic imaging, when facing a poorly controlled hypertension.