Myocardial Work Measurement With Functional Capacity Evaluation in Primary Systemic Hypertension Patients: Comparison Between Left Ventricle With and Without Hypertrophy.

OBJECTIVE: Noninvasive measurement of myocardial work (MW) incorporates left ventricular (LV) pressure, and, therefore, allows correction of global longitudinal strain for changing afterload conditions. We sought to investigate MW as a tool to detect early signs of LV dysfunction in primary systemic hypertension patients, particularly with different predictive indices. METHODS AND RESULTS: None left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) patients established were all primary systemic hypertension with preserved ejection fraction. Forty in NLVH and forty in LVH according to left ventricular end-diastolic mass index (LVEDmassI) were prospectively enrolled. The following indices of MW were assessed: global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE). Both global work index (P=0.348) and global constructive work (P=0.225) were increased in NLVH and decreased in LVH, and GWW (P<0.001) was increased significantly in NLVH and increased more in LVH, while GWE (P<0.001) was decreased significantly in NLVH and decreased more in LVH. The clinical utility of GWW (95% CI: 0.802-0.951) and GWE (95% CI: 0.811-0.950) were verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with LVH and control comparisons. In multivariate linear regression analysis, 4-dimenaional LVEDmassI was independently associated with GWE (P=0.018) in systemic hypertension patients. Assessment of intraobserver and interobserver variability in the MW echocardiographic data documented good interclass correlation coefficients (all >0.85). CONCLUSION: GWW and GWE derived from MW are more accurate, sensitive, and reproducible predictors to detect early LV dysfunction in primary systemic hypertension patients, especially in distinguishing the potential functional abnormality of NLVH and LVH, even though the ejection fraction is preserved.

Quantitative Differentiation of Left Atrial Performance in Hypertrophic Cardiomyopathy: Comparison Between Nonobstruction and Occult Obstruction With 4-dimensional Volume-strain.

OBJECTIVE: The objective of this study was to describe the different components of left atrial (LA) dysfunction predictors in nonobstructive and occult obstructive hypertrophy cardiomyopathy (HCM) patients especially with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (D) longitudinal and circumferential strains. METHODS: Twenty-eight nonobstructive HCM patients and 30 occult obstructive HCM patients according to LV outflow tract gradient at rest and after exercise were prospectively enrolled. 4D echocardiographic evaluation was performed in 58 HCM patients, both nonobstructive and occult obstructive, and 38 control subjects. LA reservoir, conduit, contractile functions were performed by 4D volume-strain with volumes and longitudinal, circumferential strains. RESULTS: Optimal correlation coefficients obtained between LV 4D mass (index) and LA 4D longitudinal/circumferential strain (r=-0.860 to 0.518, all P<0.001). Both nonobstructive and occult obstructive HCM patients had increased volumes and significantly decreased longitudinal, circumferential strain values with lower reservoir, conduit, contractile functions than the controls (all P<0.001). Occult obstructive HCM patients presented incremented volumes compared with nonobstructive ones (P<0.001 to 0.003). Lower conduit function and higher contractile function indicated with lower reservoir function revealed by circumferential strain in occult obstructive HCM patients than nonobstructive ones (P<0.001 to 0.017). Interclass correlation coefficients of intraobserver and interobserver in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. CONCLUSIONS: LA volumes were significantly increased and LA reservoir, conduit, and contractile functions were significantly impaired in HCM patients. Furthermore, different performances of LA functional analyses in nonobstruction and occult obstruction patients with 4D volume-strain echocardiography may facilitate the recognition of subtle LA dysfunctional differentiation in HCM patients.

Four-Dimensional Volume-Strain Expression in Asymptomatic Primary Hypertension Patients Presenting with Subclinical Left Atrium-Ventricle Dysfunction.

OBJECTIVE: The purpose of this study was to evaluate the different components of left atrial (LA) dysfunction predictors in asymptomatic primary systemic hypertension patients with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (4D) longitudinal and circumferential strain values. METHODS AND RESULTS: Patients with no left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) are all asymptomatic regarding primary blood hypertension. Thirty NLVH patients and 30 LVH patients according to LV mass index and 40 controls analyzed by 4D echocardiography were prospectively enrolled. LA volumes and longitudinal and circumferential strains were measured using 4D volume-strain echocardiography with a Vivid E95 Version 203 instrument. Correlation analysis indicated a significant relation between LV 4D mass index and LA 4D longitudinal/circumferential strain (r = -0.446 to 0.381, p = 0.000-0.042). LVH patients had a reduced LA emptying fraction compared with NLVH patients and control subjects (p < 0.01). NLVH patients had an impaired LA conduit function and increased contractile function compared with the control group (p < 0.01). LVH patients had increased LA volumes and significantly decreased reservoir, conduit and contractile functions compared with the controls (p < 0.01). LVH patients had increased LA volumes and decreased reservoir and contractile functions compared with NLVH patients (p < 0.01). The clinical utility of LA 4D volume-strain measurement was verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with NLVH, LVH and control group comparisons. Interclass correlation coefficients of interobserver and intraobserver assessments in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. CONCLUSIONS: LVH patients showed increased LA volumes and decreased LA emptying fractions. LA reservoir, conduit and contractile functions were significantly impaired in LVH patients. Decreased LA conduit function and increased contractile function were revealed in NLVH patients. LA volumetric and functional analyses with 4D volume-strain echocardiography may facilitate the recognition of subtle LA and LV dysfunctions in asymptomatic systemic hypertension patients.

[ANAMMOX Reactor with Two Kinds of Inoculated Sludge: Start-up and Kinetics Characteristics].

Two different mixed sludges (aerobic nitrifying sludge and ANAMMOX-denitrification sludge:R1, and anaerobic digestion flocculent sludge and ANAMMOX-denitrification sludge:R2), were used as inocula in two UBF reactors to enrich Anammox bacteria. Both kinds of mixed sludge set up the Anammox process successfully. It took 36 days for R1, while R2 required 53 days. Nitrogen removal rates of R1 and R2 were high during the whole operation. During the stable operation stage, the removal rates of NH4+-N, NO2--N, and TN were about 99.92%, 96.64%, and 81.87% for R1; and 97.54%, 94.91%, and 80.98% for R2. Illumina High-throughput Sequencing revealed Candidatus Kuenenia was in the top six taxa in the two reactors with 3.22% relative abundance in R1 and 2.35% in R2 after the successful start-up. Simulation results indicated that the Modified Stover-Kincannon model and the second-order model were appropriate models. It was deduced that the N-removal potential of R1 was a little greater than that of R2 after comparing the projected maximum substrate removal rate Umax of the two reactors.

[Nitrogen Removal Characteristics and Diversity of Microbial Community in ANAMMOX Reactor].

The volume loading of upflow blanket filter increased from 0.52 kg·(m3·d)-1to 2.75 kg·(m3·d)-1 by improving the influent NH4+-N and NO2--N concentrations. The removal efficiency of NH4+-N, NO2--N and TN increased from 76.18%, 53.47%, 55.66% to 94.04%, 86.97%, 82.96% respectively. Meanwhile, the microbial community of UBF ANAMMOX reactor was analyzed by Illumina high-throughput sequencing during the initial and later operational process. The results indicated that the denitrifying bacteria coexisted in the reactor. The percentages of Planctomycetes, Proteobacteria and Nitrospirae in the sludge were 27.9%-39.9%, 1.1%-26.4% and 0.035%-0.188%, respectively. The proportions of Planctomycetes and Proteobacteria increased from 1.1%, 27.9% in the enrichment stage to 26.4%, 39.9% in the stable operation stage respectively. In addition, Planctomycetes increased significantly. The proportion of Brocadiacea reached 24.57%. Therefore, Brocadiacea became the dominant bacteria in the phylum Planctomycete, which contained Candidatus brocadia. The alpha diversity index and relative abundance of clustering figure indicated that the diversity of microbial community decreased gradually and the structure of microbial community changed obviously.