Differentiating cardiac amyloidosis and hypertrophic cardiomyopathy by use of three-dimensional speckle tracking echocardiography.

INTRODUCTION: Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) are important differential diagnosis of left ventricular hypertrophy. The aim of this study was to investigate if three-dimensional (3D) speckle tracking-derived functional parameters enabled differentiation of CA and HCM by a disease-specific pattern. METHODS: Twelve patients with CA and 12 patients with HCM were included. CA and HCM were diagnosed by contrast-enhanced cardiovascular magnetic resonance (CMR). Three-dimensional speckle tracking echocardiography with wall motion analysis was performed for strain (radial [RS(%)], longitudinal [LS (-%)], and circumferential [CS (-%)]), rotation (ROT [degree]), and twist (TWT [degree]). Intergroup comparison included normalized values from 49 healthy volunteers. RESULTS: Averaged RS, LS, CS, ROT, and TWT were investigated at basal, midventricular, and apical levels. With some exceptions, 3D speckle tracking function parameters were mostly lower in the HCM and minimal in the CA group as compared to controls. Comparing CA and HCM, basal RS was significantly reduced in patients with amyloidosis (7.5 ± 19.7 vs. 22.3 ± 22.7; P < 0.0001), furthermore the "physiological" gradient of basoapically decreasing RS, which was reduced, but still preserved in HCM, showed a clear "inverse pattern" in patients with amyloidosis, comprising a gradual increase from base to apex. Correlation analysis of 3D speckle tracking function and CMR late gadolinium enhancement (LGE) revealed high inverse correlation of RS and LGE in CA (r =-0.82) and only mild correlation in HCM, followed by CS as second best parameter. An increasing/decreasing basoapical RS gradient yielded a sensitivity of 83% versus the CMR-derived diagnosis "CA" and "HCM." CONCLUSIONS: Three-dimensional speckle tracking echocardiography demonstrated significant differences in CA and HCM. The basoapical RS gradient displayed oppositional characteristics in CA and HCM, suggesting a "function-pattern-based" differentiation of amyloidosis and HCM.

An Insight into Professional Identity Formation: Qualitative Analyses of Two Reflection Interventions During the Dissection Course.

The professional behavior of future doctors is increasingly important in medical education. One of the first subjects in the curriculum to address this issue is gross anatomy. The Tuebingen Medical Faculty implemented a learning portfolio and a seminar on medical professionalism during the dissection course. The aims of this research project are to get an overview of how students form a professional identity in the dissection course and to compare the content of both their oral and written reflections on the course. A qualitative analysis was conducted of the oral and written reflections on the dissection laboratory experience. This study was conducted during winter term 2013/2014 with a cohort of 163 participants in the regular dissection course. Written reflection texts (from n = 96 students) and audio recordings from four oral reflection seminar discussions (with n = 11 students) were transcribed and deductively categorized with Mayring's qualitative content analysis method. Both qualitative analyses show that students reflected on many topics relevant to professional development, including empathy, respect, altruism, compassion, teamwork, and self-regulation. Quantitative analysis reveals that students who attended the oral reflection wrote significantly more in their written reflection than students who did not. There is, however, no difference in the reflection categories. Reflection content from students corresponds with categories derived from existing competency frameworks. Both the seminar (oral reflections) and the learning portfolio (written reflections) present excellent opportunities to foster professional development during anatomy education; the key is using them in conjunction with the dissection course.