Identification of patients with nonischemic dilated cardiomyopathy at risk of malignant ventricular arrhythmias: insights from cardiac magnetic resonance feature tracking.

BACKGROUND: Patients with nonischemic dilated cardiomyopathy (NIDCM) are prone to arrhythmias, and the cause of mortality in these patients is either end-organ dysfunction due to pump failure or malignant arrhythmia-related death. However, the identification of patients with NIDCM at risk of malignant ventricular arrhythmias (VAs) is challenging in clinical practice. The aim of this study was to evaluate whether cardiovascular magnetic resonance feature tracking (CMR-FT) could help in the identification of patients with NIDCM at risk of malignant VAs. METHODS: A total of 263 NIDCM patients who underwent CMR, 24-hour Holter electrocardiography (ECG) and inpatient ECG were retrospectively evaluated. The patients with NIDCM were allocated to two subgroups: NIDCM with VAs and NIDCM without VAs. From CMR-FT, the global peak radial strain (GPRS), global longitudinal strain (GPLS), and global peak circumferential strain (GPCS) were calculated from the left ventricle (LV) model. We investigated the possible predictors of NIDCM combined with VAs by univariate and multivariate logistic regression analyses. RESULTS: The percent LGE (15.51 ± 3.30 vs. 9.62 ± 2.18, P < 0.001) was higher in NIDCM patients with VAs than in NIDCM patients without VAs. Furthermore, the NIDCM patients complicated with VAs had significantly lower GPCS than the NIDCM patients without VAs (- 5.38 (- 7.50, - 4.22) vs.-9.22 (- 10.73, - 8.19), P < 0.01). Subgroup analysis based on LGE negativity showed that NIDCM patients complicated with VAs had significantly lower GPRS, GPCS, and GPLS than NIDCM patients without VAs (P < 0.05 for all). Multivariate analysis showed that both GPCS and %LGE were independent predictors of NIDCM combined with VAs. CONCLUSIONS: CMR global strain can be used to identify NIDCM patients complicated with VAs early, specifically when LGE is not present. GPCS < - 13.19% and %LGE > 10.37% are independent predictors of NIDCM combined with VAs.

Left ventricle primary cardiac fibroma in an adult: A case report.

There is a very low prevalence of cardiac fibroma in the adult population. Cardiac fibromas arise from heart fibroblasts, and these tumors are primarily located in the ventricles or in the interventricular septum. Symptomatic tumors are treated by resection. By contrast, asymptomatic tumors require a long-term follow-up or surgical resection as a preventive measure to avoid complications. The present study reports the case of a 43-year-old man, who presented with a cough and shortness of breath for 2 months. Echocardiogram and cardiac magnetic resonance imaging indicated a large mass located in the left ventricular lateral wall. The patient underwent surgical excision of the tumor, and histopathological examination confirmed the mass to be a fibroma. The patient had a good postoperative recovery and was discharged on day 9 post-surgery.

[Predicting Histological Grade of HCC in Rats using Intravoxel Incoherent Motion Imaging].

OBJECTIVE: To predict histological grade of hepatocellular carcinoma (HCC) in Wistar rats using intravoxel incoherent motion imaging (IVIM) with magnetic resonance imaging (MRI). METHODS: Liver lesions of HCC rat models induced by oral diethylnitrosamine (DEN) were scanned by IVIM to obtain apparent diffusion coefficient (ADC) and IVIM parameters,including true diffusion coefficient (D),pseudodiffusion coefficient (D*) and perfusion fraction (f). These HCC lesions were confirmed by Hematoxylin-Eosin (HE) stain and pathologically graded into low (grade Ⅰ+Ⅱ) and high (grade Ⅲ+Ⅳ) using the Edmondson-Steiner method. The ADC and IVIM parameters of the two grade groups were compared: their diagnostic performance were assessed using ROC curves. RESULTS: HCC models were successfully established in 48 rats,containing 50 HCC lesions (28 low-grade and 22 high-grade). The high-grade lesions had lower ADC (P=0.009) and D (P=0.005) values and higher D* (P=0.032) and f (P=0.044) values compared with the low-grade lesions. The largest jonden index appeared in the ROC curves at 0.907 8×10-3 mm2/s of ADC,0.817 6×10-3 mm2/s of D,24.31×10-3 mm2/s of D*,and 14.4% of f,respectively. The area under curves (AUCs) of these parameters ranged from 0.5 to 0.9,showing no significant differences (P>0.05). CONCLUSION: ADC and IVIM parameters have equal and moderate diagnostic values in predicting histologic grade of HCCs, which can be used for estimating pathological grading of HCCs before surgery.

Tumour markers in rheumatoid arthritis-associated interstitial lung disease.

OBJECTIVES: Interstitial lung disease (ILD) is the most common pulmonary extra-articular manifestations of rheumatoid arthritis (RA), but the pathogenesis of RA-ILD is unknown. The purpose of this study was to investigate the tumour markers levels in patients of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to explore the diagnostic value of serum tumour markers for RA-ILD. METHODS: Twenty-eight patients with RA-ILD and 83 patients with RA only were included. Serum levels of tumour markers carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, and CA19-9 were measured. RESULTS: Tumour markers CA15-3, CA125 and CA19-9 were increased in RA-ILD patients compared with RA without ILD patients. Logistic regression analysis revealed that older age (OR=1.06, 95% CI=[1.02-1.11]) and higher CA125 (OR=1.03, 95% CI=[1.01-1.05]) related to the increased risk of RA-ILD. ROC curve analysis showed the relationship between CA125 and RA-ILD was moderate (area under ROC curve (AUC)=0.78, 95% CI=[0.68-0.88]). In addition, CA125 levels above the normal reference (<35 U/ml) raised the risk of RA-ILD (OR=6.00, 95% CI=[2.37-15.16]). CONCLUSIONS: RA patient with older age and elevated tumour markers especially CA125 levels should be evaluated to check whether there is a potential of ILD.

Clinical features of rheumatoid arthritis-associated interstitial lung disease.

Interstitial lung disease (ILD) is the most common extra-articular manifestations of rheumatoid arthritis (RA) in the lung. This study aimed to identify clinical features of RA-associated ILD (RA-ILD). Patients with RA were retrospectively enrolled and sub-classified as RA-ILD or RA without ILD based on high-resolution computed tomography imaging. Pulmonary function testing parameters and levels of RA-related biomarkers, tumour markers, and acute-phase proteins were compared between the two groups. Logistic regression model was used to assess the strength of association between RA-ILD and clinical features of interest. Receiver operating characteristic analysis was performed to assess potential predictive value of clinical features for detecting RA-ILD. Comparison analysis indicated that the percentage of predicted value of total lung capacity, inspiratory capacity, and diffusion capacity of the lung for carbon monoxide (DLCO) were reduced in patients with RA-ILD. Tumour markers CA15-3 and CA125 were increased in patients with RA-ILD. Logistic regression analysis revealed that decreased DLCO was related to the increased likelihood of RA-ILD (OR = 0.94, 95%CI = [0.91, 0.98]). The cut-off point at 52.95 percent of predicted value could sensitively discriminate RA patients with or without ILD. Our study suggested that DLCO value could be a useful tool for detecting ILD in patients with RA.