ABSTRACT
Heart failure has been divided into heart failure with preserved left ventricular (LV) ejection fraction (EF) and heart failure with reduced EF, because the pathophysiologies of the two conditions are different. Cardio-ankle vascular index (CAVI) is a new indicator of arterial stiffness, and the most conspicuous feature of CAVI is its independence of blood pressure at the time of measurement. Arterial stiffness has been considered to increase LV afterload, which requires special care to avoid the onset of heart failure. We compared the correlation of arterial stiffness as assessed by CAVI to LV function in 44 hypertensive patients with preserved EF (EF: 71 ± 7%) and 31 patients with reduced EF (48 ± 8%). All of patients with reduced EF had history of both hypertension and myocardial infarction. Using Doppler echocardiography, LV diastolic and systolic function was evaluated by measuring peak early diastolic mitral annular velocity (e') and global LV peak systolic longitudinal strain (GPSLS), respectively. In patients with preserved EF, CAVI was correlated with e' (r = -0.313, p = 0.038), but not with GPSLS (r = 0.207). By contrast, CAVI was correlated with GPSLS (r = 0.604, p < 0.001) as well as e' (r = -0.393, p = 0.029) in patients with reduced EF. Thus, patients with reduced EF showed a closer correlation of arterial stiffness to LV function compared with patients with preserved EF. Therefore, hypertensive patients with reduced EF require a stricter regimen for treating arterial stiffness than their counterparts with preserved EF.
Subject(s)
Arteries/physiopathology , Stroke Volume/physiology , Vascular Stiffness/physiology , Ventricular Function, Left/physiology , Adult , Aged , Aged, 80 and over , Arteries/diagnostic imaging , Echocardiography , Female , Humans , Linear Models , Male , Middle Aged , Systole/physiology , Young AdultABSTRACT
OBJECTIVE: Immunohistochemistry (IHC) and Fluorescent In Situ Hybridization (FISH) are important technologies to examine the protein expression and gene amplification of human epidermal growth factor receptor type 2/neu (HER-2/neu), respectively, in breast cancer tumors; however, tumor samples are not always available for examination. Therefore, an easy and sensitive examination to detect HER2-overexpressed tumors should be developed. The extracellular domain of HER-2/neu protein (HER2ECD) has been reported to be observed in the serum of many patients with metastatic breast cancer. In this study we assessed the clinical usefulness of serum HER2ECD (sHER2ECD) as a biological marker in breast cancer. METHOD: We measured sHER2ECD levels in 108 patients with breast cancer using the ADVIA Centaur assay system, and conventional tumor markers, i.e. CEA and CA15-3, using enzyme or chemiluminescent immunoassay. The sHER2ECD levels were compared with the levels of tumor markers and clinical characteristics. RESULTS: Patients with primary breast cancer who had four or more lymph nodes involved (n=6) showed significantly higher sHER2ECD values than those with no nodes involved (n=57, p<0.05) and those with 1 to 3 nodes involved (n=15, p<0.01). In the IHC-positive group, the positive rate of sHER2ECD was higher than those of CA15-3 or CEA. In metastatic breast cancer, the combination of sHER2ECD and CA15-3 showed the highest positive rate (81.5%). In all 3 patients with HER2-overexpressed cancer showing a partial response (PR) or complete response (CR) to trastuzumab therapy, sHER2ECD levels declined after treatment (39.9 to 58.7%). CONCLUSION: The sHER2ECD assay by the CLIA method may be useful for the diagnosis and monitoring of metastatic/recurrent breast cancer.
