Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure.

Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E'), but LVEF has some major limitations. Systolic annular velocity (S') provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S', E/E' and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S' measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO2 peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S' at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3 cm/s for death and 5.7 cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S' at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO2 peak. Results indicate that measuring S' during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF.

A specific deficit of imitation in autism spectrum disorder.

Imitation is a potentially crucial aspect of social cognitive development. Although deficits in imitation ability have been widely demonstrated in autism spectrum disorder (ASD), the specificity and significance of the findings is unclear, due largely to methodological limitations. We developed a novel assessment of imitation ability, using objective movement parameters (path length and action duration) derived from a touch-sensitive tablet laptop during drawing actions on an identical tablet. By direct comparison of the kinematics of a model's actions with those of the participant who observed them, measures of imitation accuracy were obtained. By replaying the end-point of the movement as a spot on the screen, imitation accuracy was compared against a "ghost control" condition, with no human actor but only the end-point of the movement seen [object movement reenactment (OMR)]. Hence, demands of the control task were closely matched to the experimental task with respect to motor, memory, and attentional abilities. Adolescents with ASD showed poorer accuracy for copying object size and action duration on both the imitation and OMR tasks, but were significantly more impaired for imitation of object size. Our results provide evidence that some of the imitation deficit in ASD is specific to a self-other mapping problem, and cannot be explained by general factors such as memory, spatial reasoning, motor control, or attention, nor related to the social demands of the testing situation.

Prism adaptation improves voluntary but not automatic orienting in neglect.

Prism adaptation has been shown to temporarily ameliorate the symptoms of unilateral neglect. The underlying mechanisms of change are not yet fully understood. In this study, we investigate the influence of this treatment on attentional orienting under conditions of exogenous (peripheral onset) and endogenous (central symbolic) cueing. In one patient with left visual extinction and recovered neglect, and another patient with left visual neglect, visuo-motor adaptation to a rightward prismatic shift of 10 degrees improved leftward orienting of attention following an endogenous but not an exogenous cue; leftward re-orienting of attention was also improved in the endogenous task for the second patient. We suggest that prism adaptation may ameliorate neglect by improving compensatory processes of leftward voluntary orienting, rather than by a fundamental change in attentional bias.