Ana García-Martín

Contributions to a better comprehension of redox-mediated decolouration and detoxification of azo dyes by a laccase produced by Streptomyces cyaneus CECT 3335

The ability of a laccase (EC 1.10.3.2) produced by Streptomyces cyaneus CECT 3335 to decolourise and detoxify azo dyes was assessed. Results showed that a colour loss of 90% was achieved only in the presence of acetosyringone (0.1mM) acting as a redox mediator for the laccase. Toxicological analysis of the decolourised dyes revealed that there was no direct correlation between decolouration and detoxification; in fact, in the case of the dyes Methyl Orange and Orange II, a significant increase in toxicity was produced after the treatment. In contrast, a significant decrease in toxicity was observed after the decolouration of New Coccine and Chromotrope 2R. Finally, HPLC analysis of the dyes after treatment revealed the complete disappearance of both dyes and mediator and a concomitant appearance of new chromatographic peaks which could be responsible of the residual toxicity detected in some cases.

Accuracy and reproducibility of novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for thanscatheter aortic valve replacement

AIMS A specialized three-dimensional transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced; the system automatically configures a geometric model of the aortic root from the images obtained by 3D-TOE and performs quantitative analysis of these structures. The aim of this study was to compare the measurements of the aortic annulus (AA) obtained by the new model to that obtained by 3D-TOE and multidetector computed tomography (MDCT) in candidates to transcatheter aortic valve implantation (TAVI) and to assess the reproducibility of this new method. METHODS AND RESULTS We included 31 patients who underwent TAVI. The AA diameters and area were evaluated by the manual 3D-TOE method and by the automatic software. We showed an excellent correlation between the measurements obtained by both methods: intra-class correlation coefficient (ICC): 0.731 (0.508-0.862), r: 0.742 for AA diameter and ICC: 0.723 (0.662-0.923), r: 0.723 for the AA area, with no significant differences regardless of the method used. The interobserver variability was superior for the automatic measurements than for the manual ones. In a subgroup of 10 patients, we also found an excellent correlation between the automatic measurements and those obtained by MDCT, ICC: 0.941 (0.761-0.985), r: 0.901 for AA diameter and ICC: 0.853 (0.409-0.964), r: 0.744 for the AA area. CONCLUSION The new automatic 3D-TOE software allows modelling and quantifying the aortic root from 3D-TOE data with high reproducibility. There is good correlation between the automated measurements and other 3D validated techniques. Our results support its use in clinical practice as an alternative to MDCT previous to TAVI.

Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction

The indication for surgery in asymptomatic severe mitral regurgitation (SMR) with preserved left ventricular ejection fraction (LVEF) is controversial. We sought to study 3D myocardial mechanics in this population and test 3D-speckle tracking (3DST) parameters as possible predictors of events. 45 asymptomatic patients with SMR and LVEF >60 % and 20 control individuals without cardiac disease underwent 3DST echocardiography. MR group additionally underwent further clinical monitoring. Dyspnea, LVEF under 60 %, or admissions for heart failure were considered as events. When compared with control group, MR group showed lower percentage of global 3D strain, (35.4 ± 9.1 vs. 43.9 ± 10.6; p = 0.003), lower radial strain, lower area change rate and higher end-diastolic volume. In a follow-up time of 23.2 ± 14.5 months we found 15 events (33.3 %). When comparing the remaining patients with this new-onset HF group we found significant differences in longitudinal strain (−17.9 ± 3.3 vs. −15.8 ± 2.1; p = 0.036), area strain (AS) (−48.6 ± 4.6 vs. −43.7 ± 6.2; p = 0.006), circumferential strain (−35.8 ± 4.7 vs. −31.8 ± 6.1; p = 0.034), 3D LVEF (67.1 ± 4.6 vs. 63.0 ± 7.4; p = 0.034) and E/E′ index (13.5 ± 3.9 vs. 19.3 ± 9.5; p = 0.006). In multivariate Cox regression AS alone was the only independent predictor. A cutoff value of AS greater than −41.6 % reached a hazard ratio of 4.41 (p = 0.004) for prediction of events. In asymptomatic patients with SMR and preserved ejection fraction, 3DST derived AS is a promising tool for predicting the development of heart failure. This finding may be useful for guiding the selection of patients for early mitral valve repair/replacement surgery even if they are asymptomatic.

Four chamber right ventricular longitudinal strain versus right free wall longitudinal strain. Prognostic value in patients with left heart disease

BACKGROUND There is no consensus on which right ventricle (RV) strain parameter should be used in the clinical practice: four chamber RV longitudinal strain (4CH RV-LS) or free wall longitudinal strain (FWLS). The aim of this study was to analyze which RV strain parameter better predicts prognosis in patients with left heart disease. METHODS One hundred and three outpatients with several degrees of functional tricuspid regurgitation severity secondary to left heart disease were prospectively included. 4CH RV-LS and FWLS were assessed using speckle tracking. Left ventricular (LV) systolic function was determined using LV ejection fraction and RV systolic function using tricuspid annular plane systolic excursion (TAPSE). Patients were followed up for 23.1 ± 12.4 months for an endpoint of cardiac hospitalization due to heart failure. RESULTS The cutoff value related to RV dysfunction (TAPSE < 17 mm) was lower, in absolute value, for 4CH RV-LS (4CH RV-LS = -17.3%; FWLS = -19.5%). There were 33 adverse events during the follow-up. Patients with 4CH RV-LS > -17.3% (log rank [LR] = 22.033; p < 0.001); FWLS > -19.5% (LR = 12.2; p < 0.001), TAPSE < 17 mm (LR = 17.4; p < 0.001) and LV systolic dysfunction (LR = 13.3; p < 0.001) had lower event-free survival (Kaplan Meier). In Cox multivariate analysis, 4CH RV-LS > -17.3% (hazard ratio [HR] = 3.593; p < 0.002), TAPSE < 17 (HR = 2.093; p < 0.055) and LV systolic dysfunction (HR = 2.087; p < 0,054) had prognostic value, whereas FWLS did not reach significance. CONCLUSIONS Although both 4CH RV-LS and FWLS have prognostic value, 4CH RV-LS is a better predictor of episodes of heart failure in patients with left heart disease, providing additional information to that obtained by TAPSE.

Prognostic implications of global myocardial mechanics in hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking. Relations to left ventricular hypertrophy and fibrosis

BACKGROUND Interstitial fibrosis, myocardial fiber disarray and non-uniform shortening are common histological features of hypertrophic cardiomyopathy (HCM). The degree of LV hypertrophy and fibrosis are postulated to contribute to the impairment of myocardial shortening. Cardiovascular magnetic resonance myocardial (CMR) feature tracking (CMR-FT) has emerged as a robust method that provides quantitative measurements of myocardial deformation. Our aim was first to evaluate LV strain parameters in HCM by CMR-FT and their dependence on both functional parameters and late gadolinium enhancement (LGE); and secondly we sought to determine their association with major cardiovascular outcomes. METHODS AND RESULTS 74 patients with HCM and 75 controls subjects underwent a CMR study including LGE imaging. Global peak longitudinal, circumferential and radial systolic strain values (GLS, GCS, GRS) were measured by CMR-FT. A primary endpoint of all-cause mortality and secondary combined endpoint of hospital admission related to heart failure, lethal ventricular arrhythmias or cardiovascular death were defined. Patients with HCM showed attenuation of all LV strain values (p<0.001). Multivariate analysis showed that both LV hypertrophy and %of LGE were independent predictors of attenuated LV strains. All systolic LV strain parameters were impaired in patients with primary and secondary endpoints (follow up time: 25.6±9.9months, p<0.05 and p<0.01 respectively). Abnormal GLS, GCS and GRS were significantly associated with primary and secondary endpoints. CONCLUSION Both LV hypertrophy and fibrosis contribute to the impairment of LV myocardial mechanics in HCM. In this population, reduced LV strain is associated with poor cardiac outcomes, particularly cardiovascular mortality and HF.

Fusion between cardiac venous coronary computed tomography and three-dimensional speckle-tracking for selecting the appropriate vein for resynchronization therapy.

A 78-year-old man with dyspnoea [New York Heart Association (NYHA) class III] and left bundle branch block underwent 2D echocardiography showing akinetic inferior wall and dyssynchrony. Left ventricular ejection fraction (EF) was 35%. 3D speckle-tracking (3DST) echocardiography images were acquired. Invasive coronary angiography was performed and showed occlusion of the right …

‘Tri-leaflet mitral valve morphology’: a new phenotypic expression in hypertrophic cardiomyopathy?

A 74-year-old female with obstructive hypertrophic cardiomyopathy (OHC) was referred for a transesophageal echocardiography (TEE) to evaluate a cystic structure. In 3D-TEE view ( Panel A ; see Supplementary data online, Video S1 ), mitral valve showed three equidistant commissures (yellow arrow: cystic image). In 2D-TEE transgastric view ( Panel B ; see Supplementary data online, Video S2 ), three …

New Quantitative Model of Aortic Valve in PreTAVI Patients

Application of percutaneous techniques is a major advance in the field of structural cardiology that has been extended to a large number of diseases that were previously treated surgically or had no available treatment. Advancing these techniques requires a precise knowledge of cardiovascular anatomy, and the various imaging methods have become an indispensable tool in their development. To this end, a new specialized software has emerged, which can automatically configure—with minor manual changes—a geometric model of the aortic root from images obtained by 3-dimensional transesophageal echocardiography and perform quantitative analysis of these structures (Auto Valve Analysis, Siemens, California, United States). We present a case in which this new program was used for the preprocedure evaluation of transcatheter aortic valve implantation (TAVI). Aortic annulus measurement was 22 25 mm by 3-dimensional transesophageal echocardiography (Figure 1), 20 24 mm by computed tomography, (Figure 2), and 25 mm (Figure 3) with the new software. Ultimately, a 26-mm Edwards-SAPIEN XT aortic valve was successfully implanted. The ability to predict the outcome of TAVI with image-based geometric models is one of the possibilities offered by this new software. Automatic handling of the images, with acquisition of a larger number of measurements than those evaluable manually, as well as the shorter time period needed and greater reproducibility, are some of the advantages of this software over the techniques available to date, such as echocardiography and computed tomography. 3D Quantification

Specific modeling and quantification of the aortic valve. Response.

relevant because they show that the level of risk in the population with atrial fibrillation is very similar to that of the populations included in clinical trials with new oral anticoagulants. In addition, an increasing body of evidence suggests that thromboembolic risk, as measured with these scales in the population without a diagnosis of atrial fibrillation, is associated with the onset of events.