Abstract Background Takotsubo Cardiomyopathy (TTC) is a transient disorder of ventricular wall dysfunction, mostly induced by physical or emotional stress. TTC may be associated with adverse cardiac ...events. The association of cancer and its clinical impact in TTC patients has not been described yet. Methods In 114 consecutive patients presenting with TTC between January 2003 and September 2015, we studied the frequency of cancer diagnosis, and compared the clinical course and the occurrence of a clinical endpoint of cancer and non-cancer patients during a follow up of 4.2 years. Results Of the 114 patients, 16 (14.0%) had a malignancy already diagnosed at TTC, and further 11 patients received the diagnosis during follow up. Cancer patients had higher frequency of atrial fibrillation and lower hemoglobin levels at admission than patients without cancer. While the occurrence of in-hospital events was comparable, the diagnosis of cancer at TTC event or during follow up was predictive for a higher rate of the composite endpoint. In the Kaplan-Meier analysis, malignant diseases were strongly associated not only with overall mortality but also with worsened time of event-free survival during the long-term outcome. Conclusions Prevalence of malignant diseases is high in TTC patients, and is a risk factor for worse outcome. Screening for malignancies should be recommended in all patients presenting with TTC. Further studies are needed to define the association on molecular levels.
Landslides in the Thompson River valley, British Columbia, Canada, have historically impacted vital transportation infrastructure, the environment and natural resources, cultural heritage features, ...communities, public safety, and the economy. To better understand and manage geohazard risks in Canada’s primary national railway corridor, government agencies, universities, and railway industry partners are focusing research efforts on Ripley Landslide, 7 km south of Ashcroft. Electrical resistivity tomography (ERT) datasets collected in November 2013 (on land) and November 2014 (over water) were successfully combined and inverted into a pseudo-3D model that produced significantly deeper resistivity values than previously available in 2D profiles. The lithology, degree of saturation, porosity, presence of dissolved electrolytes, and temperature all influence electrical resistivity of earth materials in the landslide. Continuous (real-time) ERT monitoring began in November 2017 to characterize the long-term hydrological behavior of geological units in the landslide. Seventy-two electrodes were positioned in two arrays across the slide body and connected to a proactive infrastructure monitoring and evaluation (PRIME) system with internet access. PRIME resistivity results corroborate data from other geophysical techniques and hints at an unusual distribution pattern for surface moisture and groundwater in fractured bedrock and overlying clay-rich sediments containing vertical tension cracks and discrete sub-horizontal planar features interpreted as slide surfaces within pre-sheared zones. A greater understanding of the composition and internal structure of slope failures in the valley is gained at the site from terrain analysis and modeling of multi-dimensional geophysical datasets. This insight helps with the interpretation of multi-year monitoring datasets and will guide future efforts to record landslide activity in the valley, reducing stakeholder risks.
A study of factors impacting landslide displacement rates was conducted on the Ripley Landslide within the Thompson River valley in British Columbia, Canada for the International Programme on ...Landslides’ project #202. Seasonal and multiyear changes in atmospheric factors cause cyclic fluctuation of matric suction in the vadose zone through changes to the in situ water content. The ingress of moisture is shown to contribute to multiyear and seasonal loss of stability causing increasing landslide displacement rates, often disregarded in slope stability calculations. However, the water content in the unsaturated zone is important, especially in semi-arid to arid climates where the water table is low and large portions of the slope are unsaturated. Additional tools for studying long-term variations in climate and seasonal changes in water content are presented. These tools are used to characterize historical climate and compare several factors that have resulted in changing landslide displacement rates and magnitude. Infiltration of precipitation and snowmelt directly contributes to matric suction loss in the head scarp and is exacerbated by the presence of tension cracks. While groundwater levels are often correlated to changing displacement rates, changes in matric suction can also influence the rates of displacement. Climatic trends over subsequent years alter the long-term soil water accumulation which impacts rates of landslide displacement. By accounting for additional strength, or potentially a loss in strength due to increasing water content, it is possible to develop a more complete understanding of the mechanisms of climate change which drive displacement rates in the translational, metastable earthen slides that dominate the Thompson River valley. These mechanisms can be applied to comparable river valleys around the world.
Abstract
Background
The pathophysiology of takotsubo syndrome (TTS) is unclear so far. There is strong association of the occurrence of TTS and malignant diseases. An association between malignant ...diseases and myocardial infarction (MI) was found recently and ascribed to common molecular and lifestyle mechanisms.
Aim
To compare the outcome of patients with MI or TTS and malignant diseases in a matched cohort.
Methods
Patients with TTS or with MI (n = 138 per group) were matched for age and sex and assessed retrospectively and prospectively. Occurrence of malignant diseases and clinical outcome was followed up over 4 years.
Results
At the time of the index event, 8 (5.8%) MI patients and 17 (12.3%) TTS patients were already diagnosed with cancer. During follow up, the rate of patients who developed cancer was significantly higher in the TTS group than in the MI group (log rank P = 0.01). Mortality was higher in the TTS group, but also in the subgroup of TTS patients with cancer (log rank P < 0.05). In the multivariate analysis, male gender, renal impairment and the history of cancer was associated with an increased risk for death.
Conclusions
Patients with TTS have more often malignant diseases than patients with MI. Cancer patients with TTS have a worse clinical outcome. The underlying mechanism is unclear yet, but the results point at TTS being the syndrome of an extracardiac disease rather than a disease of cardiac origin. Longer and closer follow up of patients with TTS and further studies addressing the mechanism of TTS are needed.
Interventional closure of left atrial appendage (LAAC) represents an alternative for stroke prevention in patients with non-valvular atrial fibrillation. Whether LAAC may affect metabolomic pathways ...has not been investigated yet. This study evaluates the impact of LAAC on the metabolism of essential amino acids, kynurenine and creatinine.
Peripheral blood samples of prospectively enrolled patients undergoing successful LAAC were taken before (T0) and 6 months after (T1, mid-term follow-up). Targeted metabolomic profiling was performed using electrospray ionization liquid chromatography–mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements focusing on metabolism of essential amino acids.
44 patients with non-valvular AF (mean CHA2DS2-VASc score 4, mean HAS-BLED score 4) were enrolled. Changes in metabolites of essential amino acids, myocardial contraction and bioenergetic efficacy, such as phenylalanine (percentage change 8.2%, p = 0.006), tryptophan (percentage change 20.3%, p = 0.0006), tyrosine (percentage change 20.2%, p = 0.0001), creatinine (percentage change 7.2%, p > 0.05) and kynurenine (percentage change 8.3%, p = 0.0239) were found at mid-term follow-up.
LAAC may affect the metabolism of essential amino acids and bioenergetic efficacy.
ClinicalTrials.gov Identifier: NCT02985463
•Successful left atrial appendage closure (LAAC) might affect the metabolism of essential amino acids and kynurenine•Pathophysiological alterations due to LAAC include ongoing myocardial contraction, local stretch and device-related neo-endothelization•Changes of these metabolites might reveal the impact of LAAC on bioenergetic efficacy
Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce ...the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.
Background
Left atrial appendage (LAA) closure (LAAC) by implantation of an occlusion device is an established cardiac intervention to reduce risk of stroke while avoiding intake of oral ...anticoagulation medication during atrial fibrillation. Cardiac interventions can alter local or systemic gene and protein expression. Effects of LAAC on systemic metabolism have not been studied yet.
Objectives
We aimed to study the effects of interventional LAAC on systemic metabolism.
Methods
Products of glycolysis, tricarboxylic acid and urea metabolism were analyzed by ESI-LC-MS/MS and MS/MS using the AbsoluteIDQ™ p180 Kit in plasma of 44 patients undergoing successful interventional LAAC at baseline (T0) and after 6 months (T1).
Results
During follow up, plasma concentrations of several parameters of glycolysis and tricarboxylic acid cycle (TCA) and urea metabolism increased (alanine, hexose, proline, sarcosine), while others decreased (aspartate, glycine, SDMA, serine). Multivariate linear regression analysis showed that time after interventional LAAC was an independent predictor for metabolite changes, including the decrease of SDMA (beta −0.19, p < 0.01) and the increase of sarcosine (beta 0.16, p < 0.01).
Conclusions
Successful interventional LAAC affects different pathways of the metabolome, which are probably related to cardiac remodeling. The underlying mechanisms as well as the long term effects have to be studied in the future.
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