Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic ...dysfunction. Specifically, diastolic dysfunction has been correlated with the prognosis in liver cirrhotis patients independently of the disease severity. Left atrial reservoir strain (LASr) is a novel index which is inversely correlated with left ventricular end-diastolic pressure, but has not been adequately studied in cirrhotic patients.
Purpose
To investigate the correlations between LASr and diastolic function or disease severity in cirrhotic patients.
Methods
Echocardiographic analysis of 51 consecutive cirrhotic patients was performed and images were analyzed off-line. LASr was calculated semi-automatically using dedicated software and was feasible in 49 patients. Clinical and biochemical examination was used to assess severity of liver disease by calculating MELD-Na score.
Results
Mean age was 58.0± 8.6 years, 37 (75.5%) were males, mean MELD-Na score was 15.6 ±7.5 and mean LASr was 39.7 ±12.5. LASr correlated with age (r=-0.415, p = 0.003), LAVI (r=-0.329, p = 0.022), e’ (r = 0.476, p = 0.001), E/e (r=-0.401, p = 0.004) and GLS (r=-0.388, p = 0.006), but not with ejection fraction, stroke volume or MELD-Na score. MELD-Na score correlated with ejection fraction (r = 0.316, p = 0.029), stroke volume (r = 0.549, p < 0.001), left atrial volume index (r = 0.575, p < 0.001), GLS (r = 0.521, p < 0.001), right atrial end systolic area (r = 0.368, p = 0.011) and right ventricular diameter (r = 0.541, p < 0.001) reflecting high cardiac output state in patients with advanced cirrhosis. LASr was significantly lower in patients with E/e’ >14 (22.5 ± 13.6) when compared to patients with E/e’ 8-14 (37.3± 10.6, p = 0.039) and E/e’<8 (44.7± 12.0, p = 0.003). The two latter groups also differed significantly (p = 0.034). LASr correlation with E/e’ was the only statistically significant correlation in a multiple regression model including left ventricular end diastolic volume, ejection fraction and left atrial volume (B=-1.371, P = 0.023). Correlation of LASr with MELD-Na score remained non-significant.
Conclusion
LASr correlates inversely with E/e’ ratio in liver cirrhotic patients, but does not correlate with load dependent echocardiographic parameters and disease severity. Hence in this special population, LASr may be an earlier and more specific index of diastolic dysfunction than traditional echocardiographic indices. Further studies are needed to examine the prognostic significance of LASr in cirrhotic patients.
Abstract
Introduction
Non-alcoholic steatohepatitis (NASH) in patients with metabolic syndrome is a common cause of cirrhosis and has been associated with increased cardiovascular mortality. In ...patients with liver cirrhosis systolic or diastolic dysfunction can be observed and is independent of the cirrhosis etiology. Only few studies using newer echocardiography indices such as Global Longitudinal Strain (GLS) have been published in cirrhotic patients.
Purpose
To evaluate GLS in patients with NASH cirrhosis when compared to other etiologies.
Methods
A total of consecutive 36 cirrhotic patients aged 18-70 were included in our study. Standard speckle-tracking software was used for offline analysis of standard apical views and GLS was calculated. Stroke Volume Index (SVI) was calculated with the Simpson method and a standard 2D, Doppler and Tissue Doppler examination was performed in all patients.
Results
Median age of the study population was 58 (IQR 50-64) years, 78% were male and 17% had ascites. Cirrhosis was considered decompensated in 21 (58%) of patients. The 28%, 42% and 19% had NASH-associated, alcoholic and viral etiology of cirrhosis, respectively. Median ejection fraction (EF) was 60% (IQR: 57%; 65%) and GLS was -21.1% (-19.7%; -23.1%) in the total population. Absolute value of GLS was lower in patients with NASH cirrhosis compared to other etiologies (p = 0.009) (figure 1). EF, SVI, left atrial volume index (LAVI), E/e’ ratio and mitral annular velocity (e’) did not differ significantly between those with NASH associated cirrhosis and the rest. GLS values were significantly correlated with EF (r=-0.588, p = 0.002), SVI (r=-0.469, p = 0.016) and BNP levels (r=-0.571, p = 0.007), but not with age, left ventricular end diastolic volume, left atrial volume index, E/e’, mitral annular velocity and blood pressure. According to a multivariable linear regression model, NASH etiology B = 2.1 (0.6; 3.7), p = 0.008) and EF (per 10% increase) B=-1.7 (-3.3; -0.2), p = 0.03) were the only independent factors associated with GLS values in cirrhotic patients.
Conclusions
GLS values are within normal limits in cirrhotic patients but seem to be affected in patients with NASH associated cirrhosis. Further studies are needed to assess the prognostic implications of this finding.
Abstract P1768 Figure 1
A search for a long-lived, heavy neutral lepton ( N ) in 139 fb −1 of √s=13 TeV pp collision data collected by the ATLAS detector at the Large Hadron Collider is reported. The N is produced via W→ ...Nμ or W→ Ne and decays into two charged leptons and a neutrino, forming a displaced vertex. The N mass is used to discriminate between signal and background. No signal is observed, and limits are set on the squared mixing parameters of the N with the left-handed neutrino states for the N mass range 3 GeV< m N <15 GeV. For the first time, limits are given for both single-flavor and multiflavor mixing scenarios motivated by neutrino flavor oscillation results for both the normal and inverted neutrino-mass hierarchies.
A measurement of the top quark pair-production cross section in the lepton+jets decay channel is presented. It is based on 4.6 fb−1 of √s=7 TeV pp collision data collected during 2011 by the ATLAS ...experiment at the CERN Large Hadron Collider. A three-class, multidimensional event classifier based on support vector machines is used to differentiate t¯t events from backgrounds. The t¯t production cross section is found to be σt¯t=168.5±0.7(stat) +6.2−5.9(syst) +3.4−3.2(lumi) pb. The result is consistent with the Standard Model prediction based on QCD calculations at next-to-next-to-leading order.
A full-size prototype of a Micromegas precision tracking chamber for the upgrade of the ATLAS detector at the LHC Collider has been built between October 2015 and April 2016. This paper describes in ...detail the procedures followed in the construction of the components of the chamber in various INFN laboratories and the final assembly in the Laboratori Nazionali di Frascati (LNF). In addition, the results of the chamber exposure to a particle beam at SPS/H8 at CERN in June 2016 are presented. The performances obtained in the construction and the results of the test beam are compared with the requirements set in order to sustain the high radiation levels expected during the data-taking of the LHC in the next years.
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