Specific 12-lead ECG criteria have been reported to predict an epicardial site of origin (SoO) of induced ventricular tachycardias (VTs) in left ventricular nonischemic cardiomyopathy.
The purpose of ...this study was to (1) determine the value of ECG criteria to predict an epicardial SoO of clinically documented VTs, (2) analyze the effect of VT cycle length (CL) and antiarrhythmic drugs on the accuracy of ECG criteria, and (3) assess interobserver variability.
In 36 consecutive patients with nonischemic left ventricular cardiomyopathy (age 58 ± 16 years, 75% male) who underwent combined endocardial/epicardial VT ablation, all clinically documented and induced right bundle branch block VTs were analyzed for previously reported ECG criteria to determine the SoO, as defined by ≥11/12 pace-map, concealed entrainment, and/or VT termination during ablation.
In 21 patients with clinically documented (25 mm/s) right bundle branch block VT, none of the ECG criteria differentiated between patients with and those without an epicardial SoO. In induced VTs (100 mm/s), 2 of 4 interval criteria differentiated between an endocardial and epicardial SoO for slow VTs (CL >350 ms) and 2 of 4 criteria in patients on amiodarone, but none for fast VTs (CL ≤350 ms) or patients off amiodarone. The Q wave in lead I was the most accurate criterion for an epicardial SoO (sensitivity 88%, specificity 80%). In both clinically documented and induced VTs, interobserver agreement was poor for pseudodelta wave and moderate for other criteria.
When applied to clinically documented VTs, no ECG criterion could differentiate between patients with and those without an epicardial SoO. Published interval-based ECG criteria do not apply to fast VTs and patients off amiodarone.
Mutations of the TP53 gene have an unfavorable prognosis in Myelodysplastic Syndromes (MDS). The product of the
gene is the p53 protein. Most of the
mutations entail the accumulation of the protein ...in the nucleus of tumor cells. The immunohistochemical (IHC) staining for p53 can be a surrogate suggesting a mutational status and, if overexpressed, seems to be of prognostic value by itself. The best prognostic cut-off value of overexpression is controversial. The aim of this pilot study is to investigate the correct value from a homogenous group of patients with higher IPSS-R risk MDS.
In sixty consecutive patients diagnosed with MDS and categorized as "intermediate," "high" and "very high" IPSS-risk, the bone marrow biopsies performed at diagnosis were retrospectively re-examined for IHC p53 expression. The result of p53 expression was subsequently related to survival.
A worse overall survival was observed both in patients whose IHC p53 expression was ≥5% and ≥ 10% compared to patients with a p53 expression below 5% (p= 0.0063) or 10% (p=0.0038) respectively.
The ICH p53 expression in bone marrow biopsy in higher risk MDS was confirmed to have prognostic value. These results indicate more than 10% expression as the best cut off value.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Data on the use of azacytidine and decitabine as salvage therapy for acute myeloid leukemia are limited. We retrospectively reviewed clinical records of 100 patients treated with hypomethylating ...agents (HMA) as salvage therapy in nine Italian institutions. A total of 24% of patients obtained a response to HMA (CR, PR, or CRi), while 26% showed a stable disease (SD); 50% of patients experienced progressive disease. Median OS was 6.5 months. OS in patients with de novo AML was 6.1 months, while OS in patients with secondary AML (sAML) was 12.3 months (p = 0.037). Median OS after HMA in patients with SD as best response to HMA was similar to median OS in patients with response to HMA (10.6 months vs. 13 months). On multivariate analysis, OS difference between patients who obtained a response versus patients who did not was significant (p = 0.0037). OS difference in sAML was significantly better than in de novo AML (p < 0.00001). HMA showed a remarkable efficacy in terms of response rate and OS in a subgroup of patients (sAMLs), historically characterized by a poor outcome. Therefore, 5Azacitidine and decitabine may represent a good clinical option in a selected patient population with relapsed or refractory AML, unsuitable for allo-HSCT.
A large amount of research is currently being conducted on wine pH because of its effect on the formation of turbidity in unfined white wines. The haze-forming tendency and the protein profile of an ...Italian white wine (Erbaluce di Caluso D.O.C.G.), as affected by pH ranging from 3.00 to 3.60, a common pH range in wine, were analysed. The results indicated increased heat stability of the wine at lower pH, which was revealed by a lack of haze formation even above 70°C. The pH increase was accompanied by a progressive shift in the haze formation temperature from 50–60°C to 70–80°C. The electrophoretic protein pattern of the wine was characterised, and proteins derived from both yeast and grape tissues were identified. The statistical analysis of band intensities revealed that the solubility of five yeast and grape protein bands was modified by the pH shift. Most of the proteins involved were determined to be glycosylated, a feature that has been speculated to have an influence on the differential solubility of wine proteins in response to pH.
•pH-driven changes in the protein profile of an Italian white wine were characterised.•The SDS-PAGE band abundance was quantified to detect significant changes.•All of the protein bands were identified by mass spectrometry.•A shift in white wine pH has an influence on its haze-forming tendency.•The solubility of specific protein fractions is influenced by wine pH.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Progressive activation delay after premature stimulation has been associated with ventricular fibrillation in nonischemic cardiomyopathy (NICM).
The objectives of this study were (1) to investigate ...prolongation of the paced QRS duration (QRSd) after premature stimulation as a marker of activation delay in NICM, (2) to assess its relation to induced ventricular arrhythmias, and (3) to analyze its underlying substrate by late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) and endomyocardial biopsy.
Patients with NICM were prospectively enrolled in the Leiden Nonischemic Cardiomyopathy Study and underwent a comprehensive evaluation including LGE-CMR, electrophysiology study, and endomyocardial biopsy. Patients without structural heart disease served as controls for electrophysiology study.
Forty patients with NICM were included (mean age 57 ± 14 years; 33 men 83%; left ventricular ejection fraction 30% ± 13%). After the 400-ms drive train and progressively premature stimulation, the maximum increase in QRSd was larger in patients with NICM than in controls (35 ± 18 ms vs. 23 ± 12 ms; P = .005) and the coupling interval window with QRSd prolongation was wider (47 ± 23 ms vs. 31 ± 14 ms; P = .005). The maximum paced QRSd exceeded the ventricular effective refractory period, allowing for pacing before the offset of the QRS complex in 20 of 39 patients with NICM vs. 1 of 20 controls (P < .001). In patients with NICM, QRSd prolongation was associated with the inducibility of polymorphic ventricular tachycardia (16 of 39 patients) and was related to long, thick strands of fibrosis in biopsies, but not to focal enhancement on LGE-CMR.
QRSd is a simple parameter used to quantify activation delay after premature stimulation, and its prolongation is associated with the inducibility of polymorphic ventricular tachycardia and with the pattern of myocardial fibrosis in biopsies.
This study sought to determine whether ablation of hidden substrate unmasked by right ventricular extrastimulation (RVE) improves ablation outcome of post-myocardial infarction (MI) ventricular ...tachycardia (VT).
In patients with small or nontransmural scars after MI, part of the VT substrate may be functional and, in addition, masked by high-voltage far-field signals arising from adjacent normal myocardium.
In 60 consecutive patients, systematic analysis of electrograms recorded from the presumed infarct area was performed during sinus rhythm, RV pacing at 500 ms, and during a short-coupled RV extrastimulus. Sites showing low-voltage, near-field potentials with evoked conduction delay in response to RVE were targeted.
In 37 (62%) patients, ablation target sites located in areas with normal voltage during sinus rhythm were unmasked by RVE (hidden substrate group). These patients had better left ventricular function (36 ± 11% vs. 26 ± 12%; p = 0.003), smaller electroanatomical scars (<1.5 mV), and smaller dense scars (<0.5 mV) (median 59 and 14 cm2 vs. 82 and 44 cm2; p = 0.044 and p = 0.003) than did those in whom no hidden substrate was identified (overt substrate group). During a median follow-up of 16 months, 13 (22%) patients had VT recurrence. Patients with hidden substrate had a lower incidence of VT recurrence (12-month VT-free survival 89% vs. 50% in patients with overt substrate; p = 0.005). Compared with a historical cohort of 90 post-MI patients matched for left ventricular function and electroanatomical scar area, in whom no RVE was performed, patients in the hidden substrate group had a higher 1-year VT-free survival (89% vs. 73%; p = 0.039).
Hidden substrate ablation unmasked by RVE improves ablation outcome in post-MI patients with small or nontransmural scars.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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