Fabian Schmitz

Advanced speckle tracking echocardiography allowing a three-myocardial layer-specific analysis of deformation parameters.

AIMS Different layers of myocardium may contribute differently to myocardial deformation. Speckle tracking based on high resolution two-dimensional (2D) echocardiography has been used to define myocardial deformation parameters of whole left ventricular (LV) segments. This study evaluated with a Novell analysis modality allowing layer-specific analysis of deformation if there are differences in myocardial deformation between different layers of myocardium. METHODS AND RESULTS In 30 normal subjects and 20 patients with impaired myocardial function 2D parasternal short-axis echocardiographic views of the LV were acquired at the basal, mid-papillary, and apical levels. Using a Novell automatic frame-to-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound, Haifa, Israel), circumferential strain (CS) and strain rate of the endocardial, mid-myocardial and epicardial layer was calculated for each LV segment in an 18-segment model. Wall motion for each segment was defined as normokinetic, hypokinetic, and akinetic based on 2D echocardiographic images. Peak systolic CS could be analysed in 837 segments (93%). In the normal subjects peak systolic CS was greatest in the endocardial layer, lower in the mid-myocardial layer, and lowest in the epicardial layer (38.1+/-9.0%, 28.9+/-9.3%, and 24.0+/-9.4%, respectively, P<0.001). In the patients with impaired LV function 151 segments were hypokinetic and 92 segments akinetic by visual analysis. In all myocardial layers peak systolic CS and strain rate decreased with decreasing segmental function. CONCLUSION Decreasing myocardial deformation from endocardial to epicardial layers can be demonstrated with the use of an advanced analysis system allowing definition of deformation parameters for three myocardial layers. Myocardial deformation is reduced in all layers of segments with impaired wall motion.

The interleukin-6 promoter polymorphism is associated with elevated leukocyte, lymphocyte, and monocyte counts and reduced physical fitness in young healthy smokers.

Smoking and interleukin-6 are important factors in driving inflammation. This study assessed the relationship between smoking, interleukin-6 genotype, physical fitness, and peripheral blood count in healthy young men. For this interleukin-6 promoter polymorphism −174 genotype-phenotype association study 1,929 healthy German male aviators recruited at the central German Air Force Institute of Aviation Medicine were stratified by smoking habits. Cardiovascular fitness was expressed as maximal physical working capacity (PWCmax) in watts per kilogram body weight as assessed by maximal exercise testing by cycle ergometry up to physical exhaustion. Smokers had higher leukocyte and lymphocyte counts than nonsmokers and lower PWCmax. In the overall study population the C allele of the interleukin-6 polymorphism was weakly associated with elevated leukocytes and lymphocytes; in nonsmokers the interleukin-6 polymorphism was not associated with altered phenotypes, but in smokers the interleukin-6 C allele was associated with higher leukocytes, lymphocytes, and monocytes and with lower PWCmax. Smoking is thus associated with elevated leukocytes and lymphocytes and with reduced physical fitness. Gene carriers with the interleukin-6 C allele may suffer particularly from cigarette smoking.

Calcium Metabolism in Adults With Severe Aortic Valve Stenosis and Preserved Renal Function

Data suggest a link of aortic stenosis (AS) with calcium and bone metabolism. To further investigate this, the following parameters were analyzed in 38 patients with severe AS and in 38 age- and gender-matched controls, without obstructive coronary artery disease and with preserved renal function: calcium, phosphate, 1,25(OH(2))-vitamin D(3), intact parathyroid hormone (iPTH), and osteoprotegerin. Patients with AS had significantly higher serum levels of calcium (2.63 +/- 0.28 vs 2.48 +/- 0.23 mmol/L, p <0.01) and phosphate (1.56 +/- 0.33 vs 1.38 +/- 0.26 mmol/L, p <0.01) and increased calcium-phosphorus products (4.16 +/- 1.13 vs 3.44 +/- 0.89 mmol/L(2), p = 0.003). Notably, the iPTH concentration in the AS group was lower, and significantly more patients in the AS group had levels less than the study median of 60 ng/L. Osteoprotegerin was elevated in patients with AS, confirming reports in other populations (9.94 +/- 5.96 vs 6.73 +/- 4.28 pmol/L, p = 0.009). The relations of several parameters to iPTH were also altered (AS vs controls): calcium and iPTH, 0.071 +/- 0.034 versus 0.046 +/- 0.023, p <0.0001; phosphate and iPTH, 0.042 +/- 0.020 versus 0.025 +/- 0.013, p <0.0001; vitamin D and iPTH, 0.99 +/- 0.61 versus 0.63 +/- 0.46, p = 0.006; and osteoprotegerin and iPTH, 0.24 +/- 0.15 versus 0.12 +/- 0.09, p <0.0001. In conclusion, these data support a hypothesis connecting (severe) AS to altered calcium and bone homeostasis.

Relationship of Five Inflammatory Gene Polymorphisms with Morbidity and Mortality in 533 Patients Admitted to an ICU

BackgroundThe aim of this study was to analyze the association of polymorphisms of five candidate genes with the outcome of consecutive patients admitted to a medical ICU.Materials and MethodsThe study population was prospectively recruited. Inclusion criteria were admission to the ICU and written informed consent by the patients or their relatives. A total of 533 patients were recruited. The morbidity was assessed by SAPS II Score. Outcome data of in hospital mortality and length of ICU and hospital stay were obtained. Genotyping for genetic polymorphisms (CRP 1059, IL1B −511, CTGF −477, CCR2 64VI, IL6 −174) were performed by allele-specific fluorogenic oligonucleotide probes (TaqMan analysis).ResultsAll of the investigated polymorphisms were not associated with an altered outcome. There was no difference in morbidity and ICU or in-hospital mortality (neither in cross tabs analysis nor in Kaplan Meier or Cox regression analysis including age, gender and diagnosis as covariates) between the different genotypes.ConclusionsGenotyping of the investigated polymorphism for risk stratification of patients admitted to ICU does not seem to be appropriated.