BACKGROUNDQuantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.

METHODSTwenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve.

RESULTSAt baseline, significant differences in beta (0.28 +/- 0.12, 0.25 +/- 0.09, 0.22 +/- 0.06, 0.20 +/- 0.07 respectively, P < 0.01) and A x beta (1.37 +/- 0.46, 1.28 +/- 0.47, 1.13 +/- 0.37, 0.91 +/- 0.32, respectively, P < 0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30% - 69% stenosis; 70% - 90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73 +/- 1.28, 5.63 +/- 1.01, 4.96 +/- 0.81, 4.57 +/- 0.62, respectively, P < 0.01), beta (0.67 +/- 0.17, 0.55 +/- 0.19, 0.32 +/- 0.13, 0.25 +/- 0.08, respectively, P < 0.01) and A x beta (3.81 +/- 1.20, 3.11 +/- 1.17, 1.59 +/- 0.82, 1.12 +/- 0.37, respectively, P < 0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20 +/- 0.53, 1.11 +/- 0.16, 0.98 +/- 0.12, 0.99 +/- 0.13, respectively, P < 0.01), beta reserve (2.65 +/- 1.07, 2.32 +/- 0.82, 1.44 +/- 0.40, 1.29 +/- 0.34, respectively, P < 0.01) and A x beta reserve (3.05 +/- 1.63, 2.59 +/- 1.01, 1.42 +/- 0.44, 1.27 +/- 0.34, respectively, P < 0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1 - 5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28 +/- 0.11, 0.22 +/- 0.08, 0.21 +/- 0.05, 0.17 +/- 0.05, 0.19 +/- 0.06, respectively, P < 0.01; A x beta: 1.29 +/- 0.48, 0.98 +/- 0.45, 0.94 +/- 0.29, 0.76 +/- 0.30, 0.92 +/- 0.32, respectively, P < 0.01) and under stress (beta: 0.59 +/- 0.20, 0.35 +/- 0.15, 0.27 +/- 0.08, 0.17 +/- 0.05, 0.20 +/- 0.05, respectively, P < 0.01; A x beta: 3.07 +/- 1.38, 1.62 +/- 0.82, 1.28 +/- 0.40, 0.78 +/- 0.24, 0.93 +/- 0.22, respectively, P < 0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without.

CONCLUSIONSQuantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.

Adult ; Aged ; Contrast Media ; Coronary Angiography ; Coronary Circulation ; Coronary Disease ; diagnostic imaging ; physiopathology ; Dobutamine ; Echocardiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; Reproducibility of Results

Background　Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods　Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results　At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P＜0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P＜0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P＜0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P＜0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P＜0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P＜0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P＜0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P＜0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28±0.11, 0.22±0.08, 0.21±0.05, 0.17±0.05, 0.19±0.06, respectively, P＜0.01; A×beta: 1.29±0.48, 0.98±0.45, 0.94±0.29, 0.76±0.30, 0.92±0.32, respectively, P＜0.01) and under stress (beta: 0.59±0.20, 0.35±0.15, 0.27±0.08, 0.17±0.05, 0.20±0.05, respectively, P＜0.01; A×beta: 3.07±1.38, 1.62±0.82, 1.28±0.40, 0.78±0.24, 0.93±0.22, respectively, P＜0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions　Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation.

BACKGROUNDPrevious studies showed that preservation of microvascular integrity after myocardial ischemia was associated with myocardial viability. Real-time myocardial contrast echocardiography (RT-MCE) is a promising modality for non-invasive evaluation of microcirculation perfusion. Thus, it provides a unique tool to detect myocardial viability. We sought in this study to investigate the role of RT-MCE in predicting left ventricular (LV) functional recovery and remodeling after revascularization in patients with ischemic heart disease.

METHODSThirty-one patients with ischemic heart disease and resting regional LV dysfunction were included. LV volume, global and regional function were evaluated by echocardiography before and 6 - 9 months after revascularization. RT-MCE was performed before revascularization using low mechanical index power modulation imaging. Myocardial contrast opacification of dysfunctional segments was scored on a 3-point scale and mean contrast score in dysfunctional segments was calculated. Patients were divided into 2 groups according to mean contrast score in dysfunctional segments: group A, patients with mean contrast score = 0.5 (n = 19); group B, patients with mean contrast score < 0.5 (n = 12).

RESULTSWall motion improvement was found to be 94.5%, 45.5% and 16.1% respectively (P < 0.01) in homogenous, patchy and absent contrast opacification segments. At baseline, there was no significant difference in LV volume and global function between the two groups. After revascularization, group B had significantly larger LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV), lower LV ejection fraction (LVEF) and higher wall motion score index (WMSI) than those of group A (all P < 0.05). Revascularization was followed by significant improvement of LV volume and recovery of global LV function in group A (all P < 0.01); however, in group B, after revascularization, deterioration of LVEDV (P < 0.05) was observed, moreover LVESV, WMSI and LVEF did not change significantly.

CONCLUSIONSThe maintenance of myocardial microcirculation detected by RT-MCE can predict functional recovery and LV remodeling after revascularization in patients with ischemic heart disease, which might be helpful in clinical decision-making and risk stratification.

Adult ; Echocardiography ; methods ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; diagnostic imaging ; pathology ; physiopathology ; Myocardial Revascularization ; methods ; Myocardium ; pathology ; Recovery of Function ; Stroke Volume ; Time Factors ; Ventricular Function, Left ; Ventricular Remodeling

BACKGROUNDGranulocyte colony-stimulating factor (G-CSF) seems to improve cardiac function and perfusion when used systemically through mobilization of stem cells into peripheral blood, but results of previous clinical trials remain controversial. This study was designed to investigate safety and efficacy of subcutaneous injection of G-CSF on left ventricular function in patients with impaired left ventricular function after ST-segment elevation myocardial infarction (STEMI).

METHODSThirty-three patients (22 men; age, (68.5 +/- 6.1) years) with STEMI and with comorbidity of leukopenia were included after successful primary percutaneous coronary intervention within 12 hours after symptom onset. Patients were randomized into G-CSF group who received G-CSF (10 microg/kg of body weight, daily) for continuous 7 days and control group. Results of blood analyses, echocardiography and angiography were documented as well as possibly occurred adverse events.

RESULTSNo severe adverse events occurred in both groups. Mean segmental wall thickening in infract segments increased significantly at 6-month follow up compared with baseline in both groups, but the longitudinal variation between two groups had no significant difference (P > 0.05). The same change could also be found in longitudinal variation of wall motion score index of infarct segments (P > 0.05). At 6-month follow-up, left ventricular end-diastolic volume of both groups increased to a greater extent, but there were no significant differences between the two groups when comparing the longitudinal variations (P > 0.05). In both groups, left ventricular ejection fraction measured by echocardiography ameliorated significantly at 6-month follow-up (P < 0.05), but difference of the longitudinal variation between two groups was not significant (P > 0.05). When pay attention to left ventricular ejection fraction measured by angiocardiography, difference of the longitudinal variation between groups was significant (P = 0.046). Early diastolic mitral flow velocity deceleration time changed significantly at 6- month follow-up in both groups (P = 0.05).

CONCLUSIONSMobilization of stem cells by G-CSF after reperfusion of infarct myocardium is safe and seems to offer a pragmatic strategy for recovery of myocardial global function.

Aged ; Angiocardiography ; Coronary Angiography ; Echocardiography ; Female ; Granulocyte Colony-Stimulating Factor ; adverse effects ; pharmacology ; therapeutic use ; Humans ; Leukopenia ; drug therapy ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; therapy ; Ventricular Function, Left ; drug effects

OBJECTIVETo evaluate the value of quantitative real-time myocardial contrast echocardiography (RT-MCE) combined with low dose dobutamine stress test in the detection of coronary artery disease (CAD), and to assess the contribution of collateral blood flow (CBF) to myocardial perfusion.

METHODSTwenty-six hospitalized patients referred for coronary angiography and subsequent revascularization underwent routine echocardiography, RT-MCE at baseline and after low dose dobutamine administration. The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve by using the QLab software.

RESULTSAt baseline, both beta and A x beta (but not A) were decreased with the increase of severity of coronary stenosis (P < 0.01). Under dobutamine stress, A, beta and A x beta values were decreased with the increase of severity of coronary stenosis (P < 0.01), Graded decreasing in the reserves of A, beta and A x beta were observed with increasing coronary stenosis severity (P < 0.01). Furthermore, significant differences in beta, A x beta, and WMS were observed between segments with CBF and those without.

CONCLUSIONQuantitative RT-MCE in conjunction with dobutamine stress can be used as a sensitive measure to identify and stratify CAD as well as to assess the contribution of collateral blood flow.

Adult ; Aged ; Collateral Circulation ; Contrast Media ; Coronary Circulation ; Coronary Disease ; diagnostic imaging ; physiopathology ; Echocardiography, Stress ; methods ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the value of the HCT-CI score in chemotherapy risk assessment and prognosis of elderly patients with acute myeloid leukemia (AML).

METHODSThe clinical data of 116 AML patients older than 60 years in the department of Hematology, Henan Provincial People's Hospital from January 2000 to December 2010 were analyzed retrospectively. All patients received cytarabine-based regimens, including protocol DA, MA, IA, AA or CAG, followed by cytarabine-based postremission treatment. (1) Comorbidities were evaluated by using HCT-CI score, the early death rates and median survival time were compared among these different groups. (2) These prognostic factors were analyzed by univariate and multivariate analyses.

RESULTS(1) All 116 cases were followed-up. The patient cohort was divided into those with HCT-CI scores of 0, 1 or 2, or ≥ 3. Early death rates were 3.7%, 12.1% and 23.21% in above three groups, respectively (P < 0.01). Overall survival were 345, 225 and 113 days, respectively (P < 0.01). (2) HCT-CI score ≥ 3 (P < 0.01), antecedent MDS history (P = 0.035), high-risk karyotype (P = 0.018), white blood cells at diagnosis ≥ 100×10(9)/L (P = 0.041) were independent adverse prognostic factors with multivariate analysis.

CONCLUSION(1) The HCT-CI score can objectively assess elderly AML patients with comorbidities and predict chemotherapy risk in older patients receiving AML induction therapy. (2) Antecedent MDS history, high-risk karyotype, high white blood cell, and HCT-CI score ≥ 3 are independent adverse prognostic factors of elderly AML patients.

Aged ; Aged, 80 and over ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Leukemia, Myeloid, Acute ; diagnosis ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Treatment Outcome

Objective: To explore the clinical characteristics and prognostic factors of the patients with non-Hodgkin's Lymphoma (NHL) complicated with HBV infection, so as to provide a basis for clinical accurate diagnosis and prognosis evaluation. Methods: The data of 313 newly diagnosed NHL patients from August 2012 to July 2016 were collected. The HBV serological markers were detected by ELISA, and HBV DNA was quantified by full automatic microparticle chemiluminescence immunoassay (≥1×10(5) copies/ml as high copy group, 1×10(3)-<1×10(5) copies/ml as low copy group). The relationship between HBV infection and prognosis was analyzed combined with the clinical features of the patients, and the HBV detection rate was compared with that of the common population (from the national HBV sero epidemiological data). Results: ①The positive rate of HBsAg in NHL patients was 12.5% (39/313), which was higher than 7.2% in the general population (χ(2)=14.596, P<0.001). HBV infection in the past (HBsAg negative but HBcAb positive) in 114 cases (36.4%), the incidence was slightly higher than that in the general population (34.1%). ②Compared HBsAg positive group with the negative group, the proportion of B cell type (87.2% vs 70.3%, P=0.027), Ann Arbor stage Ⅲ-Ⅳ(69.2% vs 34.6%, P<0.001), IPI score 3-5 (74.4% vs 50%, P=0.004), LDH level (79.5% vs 47.8%, P<0.001) and liver involvement (45.5% vs 31.7%, P=0.006) were all higher. The difference was statistically significant. ③Compared the HBV infected group (114 cases) with the non-infected group (160 cases), the difference had statistical significance in the proportion of Ann Arbor stage Ⅲ-Ⅳ (P=0.023) and IPI score 3-5 scores P=0.035). ④Compared HBV DNA positive group (30 cases) with negative group (71 cases), Ann Arbor stage Ⅲ-Ⅳ (P=0.011), IPI score 3-5 score (P=0.030), LDH level (P=0.025) and liver involvement (P<0.001) in the proportion of patients had statistical significance. The positive patients were divided into HBV DNA high and low copy groups with 1×10(5) copies of /ml as the boundary. The results showed that there was no statistical difference between the two groups (P>0.05). Conclusions: The HBV infection rate of NHL patients is significantly higher than that of the general population, and HBV infection is more closely related to B cell type NHL. Patients with HBV infection and HBV DNA positive had late Ann Arbor stage, high IPI score, high LDH level and liver involvement, and the prognosis is poor.
Hepatitis B ; Hepatitis B Antibodies ; Hepatitis B Surface Antigens ; Humans ; Lymphoma, Non-Hodgkin ; Prognosis

Bortezomib/therapeutic use* ; CD56 Antigen ; Humans ; Multiple Myeloma ; Prognosis ; Proto-Oncogene Proteins c-kit

Objective: To explore the expression of CD45 in newly diagnosed multiple myeloma (MM) and its relationship with clinical efficacy and prognosis. Methods: This study retrospectively analyzed expression and distribution of CD45 in 130 cases of newly diagnosed MM, comparing clinical efficacy and prognosis in CD45(+)/CD45(-) groups. Results: ①The CD45(+) group was 33 cases (25.38%) , and CD45(-) group was 97 cases (74.62%) . ②The objective remission rate (ORR) of CD45(+) and CD45(-)group was 33.33% and 64.95%, respectively. The difference was statistically significant (P=0.002) . For patients in Bortezomib regimen, the ORR of CD45(+) and CD45(-) group was 35.71% and 66.25%, respectively. The difference was statistically significant (P=0.005) . ③The median progress free survival (PFS) of CD45(+) group and CD45(-) group was 29.8 (95%CI 10.0-59.0) months vs 34.5 (95%CI 6.0-69.0) months (χ(2)=14.59, P<0.001) and the median overall survival (OS) was 32.5 (95%CI 10.0-68.0) months vs 37.6 (95%CI 6.0-78.0) months (χ(2)=11.42, P=0.001) , respectively. Among the patients in bortezomib regimen, The median PFS and median OS of CD45 (+) group and CD45(-) group were 30.3 (95%CI 10.0-59.0) months vs 36.3 (95%CI 6.0-69.0) months (χ(2)=14.75, P=0.001) and 34.0 (95%CI 10.0-68.0) months vs 39.5 (95%CI 6.0-78.0) months (χ(2)=10.62, P=0.001) . ④Cox risk regression model analysis showed that serum creatinine≥176.8 μmol/L (HR=5.078, 95%CI 1.744-14.723, P=0.001) , CD45 positive (HR=14.504, 95%CI 0.168-0.42, P=0.001) , LDH≥220 IU/L (HR=1.308, 95%CI 1.16-2.417, P=0.015) were independent risk prognostic factors. Conclusion: CD45 expression is a risk prognostic factor of MM patients. Bortezomib did not improve the poor prognosis of CD45(+) MM patients.
Antineoplastic Combined Chemotherapy Protocols ; Disease-Free Survival ; Humans ; Leukocyte Common Antigens/metabolism* ; Multiple Myeloma/diagnosis* ; Prognosis ; Retrospective Studies