The value of left ventricular global longitudinal strain assessed by three-dimensional strain imaging in the early detection of anthracyclinemediated cardiotoxicity.

INTRODUCTION: Anthracyclines are important anticancer drugs, but their use is limited by acute and chronic cardiotoxicity. Current approaches to surveillance are often inadequate to detect myocardial disease. Strain imaging might detect earlier myocardial dysfunction. Speckle analysis of three-dimensional (3D) echocardiography improves information about left ventricular (LV) segmental and global deformation by avoiding the loss of speckles seen in monoplane bidimensional-strain analysis. We assessed whether early 3D-strain analysis could predict later anthracycline-induced cardiotoxicity. METHODS: Echocardiography, troponin T (TnT) and N-terminal pro-brain natriuretic peptide were used to evaluate 59 patients (age 51 ± 10 years) before, and at 12 and 36 weeks after anthracycline treatment. LV global longitudinal strain (3DGLS), global radial strain (3DGRS) and global circumferential strain (3DGCS) were determined using 3D-strain imaging before and after 12 weeks of chemotherapy. Percentage changes from baseline to 12 weeks after initiation of chemotherapy () were calculated for all parameters analysed. RESULTS: During the follow-up period, eight patients (13.5%) developed cardiotoxicity. At 12 weeks after the initiation of chemotherapy, isovolumic relaxation time, 3DGLS, 3DGCS and 3DGRS had deteriorated and troponin was elevated (all p<0.05), before any decrease in LV ejection fraction. Cumulative anthracycline dose at 12 weeks, LVEF, 3DGLS and TnT were predictors of the later development of cardiotoxicity on univariate logistic regression. By multiple logistic regression, 3DGLS emerged as the only independent predictor of later cardiotoxicity (Odds ratio 1.09, p=0.04). CONCLUSIONS: Anthracycline therapy induced early deterioration of 3DGLS, 3DGCS and 3DGRS. 3DGLS seems to be a good predictor of the future development of anthracycline-induced cardiotoxicity.

Genes and genetic variations involved in the development of hypertension: focusing on a Greek patient cohort.

INTRODUCTION: Essential hypertension (HTN) is a multifactorial disease involving environmental, genetic and other factors. Over the past years, genetic studies of essential HTN have increased dramatically but the molecular mechanisms involved are still unknown. As part of a research program coordinated by Boston university (USA), we studied the role of various genes and single nucleotide polymorphisms (SNPs) in the inheritance or the onset of HTN in African-American, Caucasian-American and Greek families. METHODS: Among 128 Greek families with a history of HTN, we studied 1474 people. Of the total examined, 273 men and 286 women were hypertensive. Based on 410 DNA samples from the hypertensive subjects, different SNPs were examined. An overall meta-analysis of the results from the Greek families, as well as a comparison with the 2 other groups (African-Americans and Caucasian-Americans), was performed. RESULTS: We report SNPs that are associated with the inheritance of HTN and are located either at the promoters of N-methyltransferase and catalase genes, or within the coding region of NEDD4L ubiquitin ligase gene, or SNPs in mitochondrial DNA of hypertensive probands. Furthermore, we clarified the role of hereditary predisposition in the development of HTN, showing that the presence of maternal HTN was significantly higher in African-Americans and Greeks compared to Caucasian-Americans (81.7%, 84.8%, and 65%), while the paternal HTN showed no such difference (50%, 48.3% and 44.9%), respectively. CONCLUSIONS: Although genetic factors that were correlated with HTN were identified, it was not possible to identify a single gene that should be targeted for the treatment of HTN. Nevertheless, the important role of the maternal hereditary predisposition to HTN in the Greek patients and the responsible genetic factors involved should be further examined.

Neoclassical facial canons in young adults.

BACKGROUND: Facial proportional analysis is commonly used in the preoperative planning as well as in consultation for aesthetic and reconstructive operations. Neoclassical canons, introduced by Ancient Greeks, have been used to describe the facial morphological features for many years. In this paper, the validity of 7 neoclassical canons was tested in young adult Greeks. The frequency and kind of variations were noted. MATERIALS AND METHODS: Direct anthropometric landmarks, obtained from 163 volunteer subjects, were used to test the neoclassical canons of the Greek face. These measurements produced 7 neoclassical canons: the 3-section facial profile canon (tr-n=n-sn=sn-gn), the naso-aural proportion canon (n-sn=sa-sba), the naso-aural inclination canon, the orbital canon (en-en=ex-en), the orbitonasal canon (en-en=al-al), the naso-oral canon (ch-ch=1+1/2 al-al), and the nasofacial canon (al-al=1/4 zy-zy). Results were compared with North American Caucasians published in a previous study. RESULTS: A significant difference was found between genders in the orbital proportion canon, the orbitonasal canon, and the nasofacial and the naso-oral proportion canon. The difference between the 2 races was demonstrated in the orbitonasal proportion canon, the naso-aural inclination canon, and the dominant variation of the naso-oral proportion canon. The mean frequency of all valid canons was greater in White Americans than in Greeks but similar among Greek genders. CONCLUSIONS: In the majority of Greeks, the neoclassical canons were not valid. In absence of valid proportion indices, this study offers surgeons guidance in assessing facial characteristics of Greek patients in preparation for corrective surgery and evaluation of postoperative results.

The value of a new speckle tracking index including left ventricular global longitudinal strain and torsion in patients with dilated cardiomyopathy.

INTRODUCTION: Torsional and longitudinal deformations are essential components of left ventricular (LV) performance. We believe that a precise assessment of LV function must take into account both LV torsion (LVtor) and global longitudinal strain (LVε). Therefore, we investigated with speckle tracking echocardiography the value of a new parameter, LVtor × LVε, for assessing LV function in dilated cardiomyopathy (DCM) and validated it against N-terminal pro-brain natriuretic peptide (NTproBNP). METHODS: Echocardiography was performed simultaneously with NTproBNP determination in 55 consecutive patients with DCM in sinus rhythm. The ratio of early diastolic transmitral velocity to early mitral annular diastolic velocity (E/E') was measured. LVtor was defined as the ratio between LV twist (LVtw) and LV enddiastolic longitudinal length. LVtw (net difference between rotation angles at base and apex) was obtained from parasternal apical and basal short-axis planes. LVε was obtained by averaging longitudinal peak systolic strain of all 17 LV-segments (from apical planes). RESULTS: Log-transformed NTproBNP correlated significantly with LVε (r=0.56, p<0.001), E/E' (r=0.52, p<0.001), LVtor (r=-0.41, p=0.003), LVtw (r=-0.38, p=0.004) and LV ejection fraction (r=-0.37, p=0.005). LVtor × LVε had the strongest correlation with log-NTproBNP (r=0.71, p<0.001). LVtor × LVε was a better predictor of NTproBNP levels >900 pg/ml (sensitivity 73%, specificity 82%) than LVε, E/E', LVtw, LVtor and LV ejection fraction (each p<0.05). CONCLUSIONS: This study demonstrates that in patients with DCM in sinus rhythm, the evaluation of LV function can be accurately accomplished by using a new speckle tracking index, LVtor × LVε.

The relationship between the time interval difference of isovolumic relaxation (T[IVRT-IVRTa]) and serum levels of N-terminal pro-brain natriuretic peptide in patients with intermediate E/Ea ratio.

INTRODUCTION: The ratio of early diastolic transmitral velocity to early mitral annular diastolic velocity (E/Ea) can be used to group patients according to filling pressures. However this relationship has not been validated in the intermediate group (E/Ea = 8-15). The time difference between the onset of E and Ea also correlates with left ventricular (LV) filling pressures. The purpose of our study was to evaluate the correlation between the time interval difference of isovolumic relaxation (T[IVRT-IVRTa]) and N-terminal pro-brain natriuretic peptide (NTpro-BNP) in patients with an intermediate E/Ea ratio. METHODS: Echocardiography was performed simultaneously with NTpro-BNP measurement in 60 consecutive patients who had an intermediate E/Ea and were in sinus rhythm. Ea and the isovolumic relaxation time (IVRTa) at the septal and lateral sites of the mitral annulus were measured using pulsed tissue Doppler and the average was utilised. Pulsed Doppler was used to measure E and IVRT. E/Ea and IVRT-IVRTa (T[IVRT-IVRTa]) were calculated. RESULTS: We demonstrated significant correlations between T[IVRT-IVRTa] and NTpro-BNP (r = -0.72, p<0.001), maximal systolic velocity of the mitral annulus (Sa: r = -0.50, p < 0.001), pulmonary artery systolic pressure (r = 0.42, p = 0.002), IVRTa (r = -0.27, p = 0.03), LV ejection fraction (LVEF: r = -0.26, p = 0.04), IVRT (r = -0.24, p = 0.04). We were unable to demonstrate significant relationships between NTpro-BNP and E deceleration time, left atrial diameter/area/volume, Ea or E. By a multiple linear regression analysis, including T[IVRT-IVRTa], IVRT, IVRTa, E/Ea, LVEF, pulmonary artery systolic pressure and Sa as potential determinants, TIVRT-IVRTa (= -0.57, p < 0.001) was shown to be the best independent predictor of NTpro-BNP (r 2 = 0.68, p < 0.001). CONCLUSIONS: T[IVRT-IVRTa] correlates strongly with NTpro-BNP levels in patients with intermediate E/Ea, and could be used as a simple echocardiographic index, with reasonable accuracy.