ABSTRACT
BACKGROUND: Measurement of left ventricular outflow tract (LVOT) diameter and area for estimation of aortic valve area (AVA) using transthoracic echocardiography (TTE) and the continuity equation assumes circular LVOT. The use of direct planimetric measurement of LVOT area by gated-CT can theoretically improve accuracy of AVA calculation. PURPOSE: We aim to assess reproducibility of LVOT echo measurement and its correlation and agreement with Gated CT measurements. In the subgroup with aortic stenosis (AS) we secondarily assessed the potential change in AS severity using LVOT area by CT instead of TTE in the continuity equation. METHODS: We retrospectively studied 93 patients, 43 of whom with severe AS. LVOT Area was measured with 2D TTE by 2 expert echocardiographers and gated-CT by 2 expert radiologists; inter-reader agreement and inter-method (Echo vs gated CT) agreement and correlation were measured. Finally we used the measurement of CT scan in the continuity equation instead of TTE measurement to assess potential reclassification of AS severity. RESULTS: Mean age was 78±11. Table shows inter-reader and inter-method agreement and correlation.The correlation between 2 echocardiophers for LVOT measurements was good (rho = 0,77) although not perfect. Out of 43 severe AS, defined as AVA<1 cm2 using TTE in the continuity equation, 18 were reclassified by gated-CT LVOT measurements into moderate AS. This was due to gated-CT LVOT area resulting on average 1.4 cm2 larger than LVOT area by TTE. CONCLUSION: LVOT is elliptical and TTE tends to underestimate LVOT area and AVA due to the measurement of the shorter diameter of this ellipse. CT scan can provide more geometrically accurate measurement and requires different cut-offs compared with traditional TTE AVA measurement. By the way, in the current study the LVOT area by CT was on average 38% larger of the LVOT area measured by TTE. Such correcting factor (increase TTE LVOT area by 38%) should apparently be used to assess anatomical true planimetric area to be compared with gated-CT LVOT.summary tableTTE Inter-reader correlation LVOT area (Spearman rho)0.77TTE reader A vs CT 3-chamber equivalent correlation (Spearman rho)0.49TTE reader B vs CT 3-chamber equivalent correlation (Spearman rho)0.38TTE reader A area vs CT planimetric area correlation (Spearman rho)0.41TTE reader B area vs CT planimetric area correlation (Spearman rho)0.31Mean LVOT Area by TTE reader A3,60SD 0,6038%Mean LVOT Area by CT scan4,99SD 0,98 Abstract P981 Figure.summary table.Abstract P981 Figure.
Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Image Interpretation, Computer-Assisted , Tomography, X-Ray Computed/methods , Ventricular Outflow Obstruction/diagnostic imaging , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Case-Control Studies , Female , Humans , Male , Observer Variation , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , Ventricular Outflow Obstruction/physiopathologyABSTRACT
OBJECTIVE: The aim of this study was to determine the sex-dependent differences in the response of key parameters involved in thermogenesis and control of body weight in brown adipose tissue (BAT) and white adipose tissue (WAT) in postcafeteria-fed rats, a model of dietary obesity. RESEARCH METHODS AND PROCEDURES: BAT and WAT were obtained from male and female control and postcafeteria-fed Wistar rats. Postcafeteria-fed rats were initially fed with cafeteria diet from day 10 of life until day 110 (cafeteria period) and with standard chow diet from then until day 180 of life (postcafeteria period). Body mass and energy intake were evaluated. Biometric parameters were analyzed in interscapular BAT (IBAT). Levels of uncoupling protein 1 (UCP1), alpha(2)-adrenergic receptor (AR), and beta(3)-AR proteins and UCP1, UCP2, UCP3, beta(3)-AR, and leptin mRNAs, in IBAT or WAT, were studied by Western blot and Northern blot analyses, respectively. RESULTS: Rats attained 59% (females) and 39% (males) increase in body weight at the end of the cafeteria period. During the postcafeteria period, the rats showed a loss of body weight, which was higher in females. Postcafeteria-fed female rats also presented higher activation of thermogenic parameters in IBAT, including UCP1, UCP2, and UCP3 mRNAs. Female control rats showed lower levels of both alpha 2 and beta(3)-ARs in BAT compared with male rats, but these levels in postcafeteria-fed female and male rats were the same, because males tended to down-regulate them. Levels of leptin mRNA in response to the postcafeteria state depended on gender and the specific WAT depot studied. DISCUSSION: It is suggested that in postcafeteria-fed female rats, BAT thermogenic capacity becomes more efficiently activated than in males. Female rats also showed a bigger weight loss. The parallel regulation of the levels of UCP2 and UCP3 mRNAs, with respect to UCP1 mRNA, with higher activation in female postcafeteria-fed rats, suggests a possible role of both UCP2 and UCP3 in the regulation of energy expenditure and in the control of body weight. The distinct responses to overweight of alpha 2 and beta(3)-ARs--which were sex dependent--and leptin mRNA--which depended on both sex and WAT depot--also support the different response of thermogenesis-related parameters between overweight males and females.
Subject(s)
Adipose Tissue/metabolism , Carrier Proteins/metabolism , Leptin/genetics , Membrane Proteins/metabolism , Obesity/metabolism , Adipose Tissue, Brown , Animals , Body Temperature Regulation , Diet , Female , Gene Expression Regulation , Ion Channels , Leptin/metabolism , Male , Mitochondrial Proteins , RNA, Messenger/analysis , Rats , Rats, Wistar , Receptors, Adrenergic, alpha-2/metabolism , Receptors, Adrenergic, beta-3/metabolism , Sex Factors , Thermogenesis , Uncoupling Protein 1Subject(s)
Arteriosclerosis/prevention & control , Carotid Artery Diseases/prevention & control , Femoral Artery , Hyperlipidemias/drug therapy , Hypolipidemic Agents/therapeutic use , Leg/blood supply , Angiography , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/etiology , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Coronary Angiography , Female , Femoral Artery/diagnostic imaging , Follow-Up Studies , Humans , Hyperlipidemias/complications , Intermittent Claudication/drug therapy , Intermittent Claudication/etiology , Intermittent Claudication/prevention & control , Male , Prospective Studies , Randomized Controlled Trials as Topic , Risk Factors , Time Factors , UltrasonographyABSTRACT
The presence of the tumor in women with breast cancer provokes a profile of biochemical change characterized by hypoglycemia, hyperuremia and high levels of free fatty acids and ketone bodies in plasma. The total circulating levels of amino acids and lactate are slightly higher in patients with breast cancer. Moreover, alterations in the circulating levels of free and total fatty acids are associated with enhanced levels of total free fatty acids and significantly lower levels of esterified arachidonic acid. This profile may indicate a state of moderate catabolic activation in breast cancer patients and may also be associated with a slight mobilization of proteins and fatty acids by some of the peripheral tissues in order to cover the needs of the host and the tumor. However, the alteration in the distribution of different fatty acids (saturated, mono-unsaturated and poly-unsaturated) and the different behaviour of the free and esterified fractions may be the result of a greater release of only specific fatty acids by tumor or other host tissues, rather than a higher release of the whole spectrum of free fatty acids. Thus, it is proposed that some of the alterations may be directly related to localized tumor activity.
