[Clinical analysis of 10 patients with Fabry disease].

We aimed to analyze the clinical data of 10 patients (6 male and 4 female) with Fabry disease (FD). The mean age of the patients was (28.80±9.27) years. Seven patients had classical FD and three had delayed onset FD. Among the 10 patients, six had skin involvement and cutaneous angiokeratoma; five had hypohidrosis or anhidrosis; nine had intermittent neuralgia; and three had supraorbital ridge protrusion, forehead bulge, and lip thickening. Five patients had proteinuria, including one with chronic kidney disease stage 3 and one with chronic kidney disease stage 5. Cardiac involvement occurred in three patients, two had myocardial hypertrophy and one had valvular insufficiency. The activity of galactosidase decreased in seven patients (2.80-1.55 µmol·L-1·h-1). Plasma deacetyl-GL-3 was elevated in all 10 patients(3.12-120.00 ng/ml). Three patients underwent renal biopsy, wherein two cases of focal segmental glomerulosclerosis and one of mesangial proliferative glomerulonephritis was found. A large number of myeloid and zebra bodies were found in the podocytes in three patients, including a small number of myeloid and zebra bodies in the renal tubular epithelial cells in one patient with occasional zebra bodies in the renal interstitium. Nine patients had GLA gene mutations. One patient was c.102T>A, a de novo mutation. Four patients were treated with agalsidase α injection (0.2 mg/kg, intravenous infusion every 2 weeks), and their prognosis was good. FD has various clinical manifestations and multi-system involvement, which requires multidisciplinary cooperation. Detection of galactosidase activity, plasma globotriaosylsphingosine, and GLA gene mutation can help for accurate diagnosis.

Assessing hydrological connectivity for natural-artificial catchment with a new framework integrating graph theory and network analysis.

Anthropogenic activities alter the underlying surface conditions and arrangements of landscape features in a drainage basin, interfering with the pollutant (e.g., dissolved nitrogen, phosphorus) transport network configuration and altering the hydrological response. Assessing the impact of anthropogenic activities on hydrological connectivity for natural-artificial catchment is critical to understand the hydrological-driven ecosystem processes, services and biodiversity. However, quantifying this impact at catchment scale remains challenging. In this study, a new framework was proposed to quantify the impact of anthropogenic activities on hydrological connectivity combined with graph theory and network analysis. This framework was exemplified in a natural-artificial catchment of the Yangtze River basin of China. Based on remote sensing and field-investigated data, three transport networks were constructed, including natural transport network (N1), ditch-road transport network (N2), and terrace-dominated transport network (N3), which reflected the different human intervention. The results showed that human intervention improved the connectivity of the nodes and enhanced the complexity of the catchment transport network structure. Anthropogenic activities significantly decreased the hydrological structural connectivity of the catchment. In particular, compared with the N1 network, the critical nodes for hydrological connectivity which were judged by connectivity indexes were reduced by 92.94% and 95.29% in the N2 and N3 network, respectively. Furthermore, the ditch-road construction had a greater impact than terraces in decreasing hydrological structural connectivity at catchment scale. This framework has proven effective in quantifying the hydrological connectivity analysis under different human intervention at the catchment scale and facilitates the improvement of catchment management strategies.

LPS induces pro-inflammatory response in mastitis mice and mammary epithelial cells: Possible involvement of NF-κB signaling and OPN.

BACKGROUND: Lipopolysaccharide (LPS) has pro-inflammatory properties. This study was conducted to determine whether the LPS induced pro-inflammatory response in a model of mastitis and in mouse mammary epithelial cells (MEC). METHODS: To investigate the effects of LPS in vivo, 50 µL of a solution of LPS (20 ng/µL) were infused into the mammary glands of mice. To study the effects of LPS in vitro, MEC were exposed to LPS (20 µg/mL) for 24h. Activation of nuclear factor kB (NF-κB) and myeloperoxidase (MPO) were studied. Production of pro-inflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-alpha], interleukin-1 beta [IL-1 beta]) and expression of osteopontin (OPN) were also evaluated. RESULTS: After LPS administration, route of NF-κB signaling is activated and the activity of MPO is increased. Furthermore, LPS increases the expression of OPN and production of TNF-alpha, IL-6 and IL-1 beta. CONCLUSIONS: Present results demonstrate that LPS induces a pro-inflammatory response in a murine model of mastitis and suggest the involvement of the NF-κB pathway and OPN.

Myelitis in systemic lupus erythematosus frequently manifests as longitudinal and sometimes occurs at low disease activity.

BACKGROUND: Transverse myelitis (TM) is a relatively infrequent but severe complication in systemic lupus erythematosus (SLE). Owing to its rarity and unfavorable outcome, we investigated its general features on MRI and incidence in the context of lupus activity, to facilitate early recognition and treatment. METHODS: We report a case of a young man with clinically inactive lupus nephritis but who presented with a sudden attack of myelitis. We performed systematic literature search in Medline to study the clinical features of SLE-related TM. RESULTS: From 1960 to April 2013, a total of 72 articles containing 194 cases of lupus myelitis were found. Among acquired articles, 93 patients fulfilled the inclusion criteria. The majority of the cases (88.8%) were female. Longitudinal myelitis was the predominant imaging finding on MRI (71.4%, 45/63). Nearly two-thirds (61/94) of lupus myelitis occurred in association with active lupus, and one-third (33/94) occurred in low disease activity. CONCLUSIONS: Upon literature review, we found myelitis in SLE more frequently manifested as longitudinal on MRI. Although lupus myelitis often presented at an active phase of SLE, one-third of events happened in the presence of low disease activity. Early initiation of effective immunosuppressive therapy facilitated recovery.

Knockdown of the inflammatory factor pentraxin-3 suppresses growth and invasion of lung adenocarcinoma through the AKT and NF-kappa B pathways.

Pentraxin-3 (PTX3), a modulator of tumor-associated inflammation, is known to be positively correlated with tumor grade and severity of malignancies, but the function and molecular underlying mechanisms of PTX3 remain unclear. In the present study, the expression of PTX3 in human lung adenocarcinoma (LAC) was examined by immunohistochemical assay using a tissue microarray procedure. A loss-of-function experiment was performed to explore the effects of lentiviral vector-mediated PTX3 shRNA (Lv-shPTX3) on cell growth and invasive potential in LAC cell lines (A549 and LETPα-2), assessed by MTT and Transwell assays, respectively. We found that the expression of PTX3 protein was significantly increased in LAC tissues compared with that in adjacent non-cancerous tissues (ANCT) (60.42% vs. 29.17%, P=0.004), and positively correlated with lymphatic invasion of the tumor (P=0.006). Furthermore, knockdown of PTX3 suppressed tumor proliferation and invasion of LAC cells, followed by decreased expression of p-AKT, p-NF-kappa B, PCNA, and MMP-9. Taken together, our findings demonstrate that upregulation of PTX3 expression is correlated with tumor metastasis of LAC patients, and knockdown of PTX3 blocks the development of LAC through inhibition of the AKT and NF-kappa B pathways, suggesting that PTX3 may serve as a potential therapeutic target for the treatment of cancer.

Subsurface hydrological connectivity controls nitrate export flux in a hilly catchment.

Subsurface runoff represents the main pathway of nitrate transport in hilly catchments. The magnitude of nitrate export from a source area is closely related to subsurface hydrological connectivity, which refers to the linkage of separate regions of a catchment via subsurface runoff. However, understanding of how subsurface hydrological connectivity regulates catchment nitrate export remains insufficient. This study conducted high-frequency monitoring of shallow groundwater in a hilly catchment over 17 months. Subsurface hydrological connectivity of the catchment over 38 rainfall events was analyzed by combining topography-based upscaling of shallow groundwater and graph theory. Moreover, cross-correlation analysis was used to evaluate the time-series similarity between subsurface hydrological connectivity and nitrate flux during rainfall events. The results showed that the maximum subsurface hydrological connectivity during 32 out of 38 rainfall events was below 0.5. Although subsurface flow paths (i.e., the pathways of lateral subsurface runoff) exhibited clear dynamic extension and contraction during rainfall events, most areas in the catchment did not establish subsurface hydrological connectivity with the stream. The primary pattern of nitrate export was flushing (44.7%), followed by dilution (34.2%), and chemostatic behavior (21.1%). A threshold relationship between subsurface hydrological connectivity and nitrate flux was identified, with nitrate flux rapidly increasing after the subsurface connectivity strength exceeded 0.121. Moreover, the median value of cross-correlation coefficients reached 0.67, which indicated subsurface hydrological connectivity exerts a strong control on nitrate flux. However, this control effect is not constant and it increases with rainfall amount and intensity as a power function. The results of this study provide comprehensive insights into the subsurface hydrological control of catchment nitrate export.

Chemodiversity of dissolved organic matter exports from subtropical humid catchment driven by hydrological connectivity.

The quantity and quality of dissolved organic matter (DOM) exported from source areas are closely related to hydrological linkage between source areas and streams, that is hydrological connectivity. However, understanding of how hydrological connectivity regulates the export of catchment DOM components remains inadequate. In this study, high-frequency monitoring of groundwater and runoff from subtropical humid catchment was conducted for 20 months, and hydrological connectivity was quantitatively characterized by considering both surface and subsurface hydrological processes. Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) was utilized to investigate the DOM molecular composition. Results showed that over half of the areas in the catchment could not persistently establish hydrological connectivity with the stream during the rainfall. The average proportion of lignin was the highest in DOM components, followed by tannin and proteins. Additionally, both modified aromaticity index and double bond equivalence reached maximums at peak discharge, reflecting terrestrial materials could increase DOM aromaticity and unsaturated degree. Partial least square-structural equation modeling revealed significantly direct effects of rainfall, antecedent conditions, and hydrological connectivity on dissolved organic carbon (DOC) export. Furthermore, nonlinear relationships were observed between hydrological connectivity and DOC, tannin, and condensed aromatics. Specifically, the instantaneous DOC flux increased dramatically when the hydrological connectivity strength exceeded 0.14; tannin and condensed aromatics exhibited a rapid increase with rising connectivity strength, but remained stable at connectivity strength above 0.25. However, hydrological connectivity showed no significant correlation with unstable components (such as lipids, protein, amino sugars, and carbohydrates). These results provide new insights into hydrological controls on the quantity and quality of DOM export and contribute to developing appropriate catchment management strategies for carbon storage.

Interferon-ß efficiently inhibited endothelial progenitor cell-induced tumor angiogenesis.

Neovascularization has a critical role in the growth and metastatic spread of tumors, and involves recruitment of circulating endothelial progenitor cells (EPCs) from bone marrow. In this study, we examined whether EPCs could promote tumor angiogenesis, and found that the tumor growth was enhanced by the administration of EPCs. To test the hypothesis that genetically modified bone marrow-derived EPCs can be effective carriers of therapeutic agents to tumor sites, we conducted human interferon-beta (HuIFN-ß) gene transfection of EPCs with a virus vector in vitro. When HuIFN-ß was applied in the ex vivo culture of EPCs, HuIFN-ß-transduced EPCs achieved efficient killing of the total population of SPC-A1 cells, indicating a bystander effect was elicited by HuIFN-ß-transduced EPCs in vitro. When SCP-A1 cancer cells were coimplanted along with ex vivo cultivated EPCs subcutaneous injection in nude mice, the tumor growth was increased. However, the anti-tumor effect of interferon-beta (IFN-ß) offset the tumor-progressive character of EPCs and the tumor growth, and the vascular density of tumor tissues increased by coimplanted EPCs were decreased upon IFN-ß treatment. In addition, overall expression levels of vascular endothelial growth factor in tumor tissues were decreased upon IFN-ß treatment. Therefore, our results suggest that gene-transfected EPCs could be useful as a tumor-specific drug delivery system.

Kaempferol improves carcase characteristics in broiler chickens by regulating ANGPTL3 gene expression.

1. The objective of this study was to examine the beneficial effects of kaempferol, a naturally occurring polyphenol, on carcase characteristics in broiler chickens and the mechanisms involved in this regulation. 2. Broiler chickens were randomly divided into 7 groups: control, carrier control, kaempferol (0·3%), kaempferol (0·6%), hypercholesterolemic (HLD), HLD and kaempferol (0·3%), HLD and kaempferol (0·6%). 3. Seven weeks after treatment, carcase characteristics, lipid levels in the blood and liver, expression of hepatic Angiopoietin-like protein 3 (ANGPTL3) mRNA, and expression of adipose lipoprotein lipase (LPL) protein were determined. 4. Treatment with kaempferol (0·3 or 0·6%) significantly increased plasma high-density lipoprotein cholesterol levels, decreased percentage of abdominal fat, thickness of subcutaneous fat, plasma and hepatic total cholesterol and triglyceride concentrations, muscle malondialdehyde level and down-regulated expression of ANGPTL3 mRNA concomitantly with up-regulated expression of LPL protein in normal and hypercholesterolemic broiler chickens. 5. Kaempferol (0·3 or 0·6%) treatment had no significant effect on the values of percentage of breast muscle, percentage of leg muscle, carcase weight and eviscerated percentage. 6. The results suggest that kaempferol improves carcase characteristics by decreasing expression of ANGPTL3 in broiler chickens.

Hysteresis analysis reveals dissolved carbon concentration - discharge relationships during and between storm events.

The dissolved carbon concentration, which is responsible for aquatic ecosystem productivity and water quality, is tightly coupled with hydrological processes. Excess dissolved carbon may exacerbate eutrophication and hypoxia in aquatic ecosystems and lead to deterioration of water quality. Storm events dominate the dynamics of dissolved carbon concentrations, and this nonlinear behavior exhibits significant time scale dependence. Here, we identified inter- and intra-event variability in the dissolved carbon concentration-discharge (C-Q) relationship in an agriculture-intensive catchment. The driving factors of C-Q hysteresis patterns for dissolved inorganic carbon (DIC) and organic carbon (DOC) were quantified by redundancy analysis combined with hierarchical partitioning. At the inter-event scale, DIC exhibited mainly clockwise hysteresis, indicating an exhaustible, proximal source (e.g., groundwater). However, DOC hysteresis was generally counter-clockwise, indicating distal and plentiful sources (e.g., soil water) in the agricultural catchment. Hierarchical partitioning showed that total rainfall, peak discharge and flood intensity explained 28.38% of the total variation in C-Q hysteresis for DIC and 39.87% for DOC at the inter-event scale. At the intra-event scale, time series analysis of dissolved carbon concentration and discharge indicated the interconversion of supply limitation to transport limitation, which depends on the activation of the specific DIC or DOC source zones. These findings provide significant insights into understanding the dynamics of dissolved carbon during storm periods and are important for targeted watershed management practices aimed at reducing carbon loading to surface waters.

Identifying the molecular targets of Salvia miltiorrhiza (SM) in ox-LDL induced macrophage-derived foam cells based on the integration of metabolomics and network pharmacology.

The identification of network targets is one of the core issues used to reveal the molecular mechanism of traditional Chinese medicine (TCM) and is also the grand challenge of modernization of TCM. In this study, a protein-protein interaction (PPI) network was constructed based on the integration of network pharmacology and metabolomics, which was used as an effective approach to elucidate the relationship between disease pathway proteins and the targets of active small-molecule compounds. The intermolecular transfer process of the drug effect of active compounds in Salvia miltiorrhiza (SM) was revealed and visualized using the PPI network. Our study indicates that PTGS2 was the most important disease protein regulated by the active compounds in SM. Furthermore, the drug targets that can be linked to PTGS2 were regarded as direct targets and the direct targets of the active compounds were identified, respectively. Western blot and co-immuno precipitation (Co-IP) were used to verify the results of the network analysis and reveal the intermolecular transfer process of the effect of Tan IIA. Biological validation revealed that Tan IIA-EDN1-PTGS2-anandamide was a major intervention way of Tan IIA on early atherosclerosis (AS). This work provides a new perspective for the discovery of drug targets and the specific approaches regulated by the active compounds in SM on disease pathway proteins, which is beneficial for understanding the mechanism of action of bioactive compounds and expanding their clinical applications.

Symptomatic first-degree atrioventricular block in a young woman after taking a fat burner supplement.

A 22-year-old woman collapsed at home and was brought to the accident and emergency department. History revealed that she was fit and taken T5 capsule the night before the collapse. There was no history of similar collapses or seizure. Examination revealed blood pressure (BP) of 104/69 mmHg and a heart rate (HR) of 70 bpm. Chest, cardiovascular, and neurology examination were unremarkable. However, on standing, her HR increased to 120 bpm, and her BP dropped to 62/40 mmHg. Blood Na, K, Ca, Mg, phosphate, creatinine, complete blood count, T4 cortisol, and thyroid-stimulating hormone (TSH) were normal. The electrocardiogram (ECG) on the ambulance revealed sinus rhythm with normal morphology but a significant first-degree atrioventricular block with a PR interval of 280-300 ms. The patient was treated for orthostatic hypotension with intravenous fluids. Her symptoms gradually improved. The repeat ECG taken 24 h after admission showed reduced PR interval to 230ms. The patient was followed up in the clinic after 1 week with normal ECG with a PR interval of 200 ms and a normal echocardiogram. The findings are discussed.

Capillary liquid chromatography-microcoil 1H nuclear magnetic resonance spectroscopy and liquid chromatography-ion trap mass spectrometry for on-line structure elucidation of isoflavones in Radix astragali.

Miniaturization and hyphenation of chromatographic separation techniques to nuclear magnetic resonance spectroscopy is being increasingly demanded in the field of biomedical, drug metabolite and natural product analysis. Herein, capillary liquid chromatography was coupled on-line to microcoil 1H nuclear magnetic resonance spectroscopy (capLC-NMR) equipped with a 1.5 microL solenoidal probe for structure elucidation of isoflavones in Radix astragali. The extract was screened by HPLC-UV-MS as the preliminary step and four major peaks were identified tentatively by ion trap mass spectrometry molecular weights and characteristic fragments. Then, stopped-flow capLC-UV-NMR was performed using 33 microg extract injected on-column. The four peaks were parked manually in the micro probe one by one and corresponding 1H NMR spectra were recorded with good resolutions under the applied capLC-NMR conditions (120 and 220 ng injected on-column for peaks 2 and 4, respectively). All aromatic regions of 1H NMR spectra correlated well to the characteristic signals of isoflavone aglycone protons. And the signal corresponding to the anomeric proton of the glucopyranoside of isoflavone glycoside was also obtained for peak 1. Therefore, these four peaks are determined as calycosin-7-O-beta-D-glucopyranoside (1), ononin (2), calycosin (3) and formononetin (4) unambiguously. The capLC-NMR results indicate that this hyphenated technique could be used for the determination of a great variety of natural products from small sample amounts, e.g., only 5 g R. astragali in this study.

Effects of intravenous milrinone on left ventricular function in ischemic and idiopathic dilated cardiomyopathy.

M-mode echocardiography and Doppler were used to assess the effects of phosphodiesterase inhibition on subendocardial function in dilated cardiomyopathy, and in particular, to study interactions with both systolic and diastolic left ventricular function. Twelve adult patients with dilated cardiomyopathy were studied (6 ischemic in origin and 6 idiopathic), 7 of whom were being considered for cardiac transplantation. Cardiac index increased without significant change in heart rate or blood pressure. Longitudinal mitral ring motion, which had been uniformly reduced, increased markedly after intravenous milrinone. Left ventricular cavity size decreased, and shortening fraction, posterior wall thickness, and rates of posterior wall thickening and thinning increased markedly. Left atrial pressure decreased, and isovolumic relaxation time increased. However, the peak velocity and duration of the transmitral E wave increased, with no change in the A wave. Improved longitudinal (subendocardial) function was reflected by improved posterior wall dynamics, and early filling, possibly by augmentation of restoring forces. Thus, severely reduced subendocardial function in dilated cardiomyopathy is potentially reversible, with marked effects on systolic and diastolic function. These previously unrecognized actions of milrinone provide further evidence to justify its short-term use in supporting the severely depressed myocardium.

Determination and identification of isoflavonoids in Radix astragali by matrix solid-phase dispersion extraction and high-performance liquid chromatography with photodiode array and mass spectrometric detection.

The isoflavonoids in Radix astragali were determined and identified by HPLC-photodiode array detection-MS after extraction employing matrix solid-phase dispersion (MSPD). As a new sample preparation method for R. astragali, the MSPD procedure was optimized, validated and compared with conventional methods including ultrasonic and Soxhlet extraction. The amounts of two major components in this herb, formononetin (6) and ononin (2), were determined based on their authentic standards. Four major isoflavonoids, formononetin (6), ononin (2), calycosin (5) and its glycoside (1), and three minor isoflavonoids, (6aR,11aR)-3-hydroxy-9, 10-dimethoxypterocarpan (7), its glycoside (3), and (3R)-7,2'-dihydroxy-3',4'-dimethoxyisoflavone-7-O-beta-D-glycoside (4), were identified based on their characteristic two-band UV spectra and [M + H], [aglycone + H]+ and [A1 + H]+ ions, etc. The combined MSPD and HPLC-DAD-MS method was suitable for quantitative and qualitative determination of the isoflavonoids in R. astragali.

Effects of intermittent left bundle branch block on left ventricular diastolic function: a case report.

We investigated systolic and diastolic left ventricular function in a patient with an echocardiographically normal left ventricle and rate dependent left bundle branch block. Abnormal activation was associated with asynchronous left ventricular wall motion and secondary changes in filling pattern. The latter were similar to those seen in severe left ventricular disease. When the activation pattern reverted to normal, all of these abnormalities regressed. This case provides further evidence that abnormal activation can, on its own, cause left ventricular diastolic as well as systolic dysfunction.

Absent septal q wave on electrocardiogram: a forgotten marker of myocardial disease.

Though absence of the septal q wave on a standard ECG was recognised by Willem Einthoven, this abnormality has received little attention. Nevertheless it is common in patients with coronary artery disease, and strongly associated with fibrosis of the septum with or without infarction. Furthermore, the associated disturbance of ventricular activation has clear mechanical consequences, impairing both systolic and diastolic left ventricular performance. Its structural, functional, and possible prognostic significance combined with ease of its detection all suggest that the cardiographic sign of absence of the septal q wave should be more widely recognised as a noninvasive marker of ventricular disease.

Natural history of abnormal conduction and its relation to prognosis in patients with dilated cardiomyopathy.

To investigate the natural history of disturbances in ventricular activation, atrioventricular conduction, and ventricular cavity size, we retrospectively studied 58 patients from a total of 296 patients with dilated cardiomyopathy seen within 4 years. A total of 309 computerised electrocardiograms (ECGs) and 135 M-mode echocardiograms were analysed. In the majority of the patients, PR interval, QRS duration and QT interval prolonged progressively, though heart rate changed little. Their increase was much more striking in patients who died (n = 10) or had a pacemaker inserted (n = 9), compared to that in the clinically stable patients, though at entry all these values, as well as age and left ventricular cavity size, were similar. There were no significant differences between patients who died and those with a pacemaker inserted, except for QRS axis, which had shifted rightwards in 8 out of 10 who died, but only in 3 of 9 who subsequently had a pacemaker inserted and 14 of the 29 stable patients. A QRS duration over 160 ms was found in 8 out of the 10 patients who died, 6 of 9 who had a pacemaker and only in 5 out of the 39 stable patients (P < 0.001). The sum of PR interval and QRS duration over 375 ms was not found in any stable patient but was present in 6 of the 7 patients who were in sinus rhythm and died (P < 0.001). Left ventricular cavity size also increased with time, but did not correlate significantly with ECG progression, nor did it identify patients who subsequently died. Thus, a combination of increasing PR interval and QRS duration, particularly along with rightwards shift of QRS axis, appears to be a marker of high risk in patients with dilated cardiomyopathy.

Re-evaluation of normal splitting of the second heart sound in patients with classical left bundle branch block.

To study the mechanism of normal splitting of the second heart sound in patients with classical left bundle branch block, we investigated 43 such patients and 15 normal controls, using electro-, phono- and echo-cardiography and comparing the relative timing of mechanical activity in the two ventricles. The splitting of the second heart sound is reversed in only two-thirds of the patients and normal in remaining one-third. Comparing patients with and without reversed splitting, there are no significant differences in left ventricular cavity size, heart rate, pre-ejection period and the distribution of age, gender, or aetiology. QRS duration is longer (P < 0.01) in patients with reversed splitting. Diastolic events of the left ventricle do not differ between groups. The onset of the left ventricular free wall motion is delayed compared with normal by a similar extent in the two groups. In patients with normal splitting, the onset of the right ventricular wall motion is also delayed, both with respect to normal and to those with reversed splitting to an extent similar to that seen in classical right bundle branch block. Normal splitting of the second heart sound associated with an electrocardiographic pattern of left bundle branch block therefore suggests bilateral block. This combination can be documented from the precise timing of the movement of the two ventricles by M-mode echocardiography and identified by simple auscultation.

Absent right precordial R waves are associated with reduced left ventricular function and poor prognosis in patients with aortic stenosis.

Right precordial Q waves can be present in patients with aortic stenosis as well as in those with anterior myocardial infarction. In order to evaluate the relationship of right precordial Q waves to left ventricular function and prognosis in patients with aortic stenosis, we studied 49 such patients with no history of myocardial infarction, by means of ECG, clinical history and echocardiography. 15 (31%) patients had Q waves in both V1 and V2 and 34 (69%) did not. There were no differences in age (77+/-9.0 years vs. 78+/-9.7), follow-up time (15+/-9.0 months vs. 18+/-10), gender (female:male 8:7 vs. 15:19), aortic valve gradient on Doppler (70.0+/-20 mmHg vs. 71+/-20) and left ventricular mass (360+/-118 g vs. 320+/-80) between the two groups (all P=NS). Left ventricular shortening fraction (22+/-9.0% vs. 28+/-8.5, P<0.05), ejection fraction (51+/-15% vs. 62+/-12, P<0.01) and circumferential fibre shortening (0.8+/-0.3 circ/s vs. 1.0+/-0.3, P<0.0s) were all significantly reduced in patients with right precordial Q waves compared to those without. During a mean follow-up of 1.5 years, 9 out of 15 (60%) patients with right precordial Q waves died compared with only 5 out of 34 (15%) patients with a normal QRS pattern died (P<0.01). In summary, a right precordial QS ECG pattern is present in nearly 1/3 patients with aortic stenosis and is associated with impaired left ventricular systolic function and adverse prognosis.