Right atrial indexed volume in healthy adult population: reference values for two-dimensional and three-dimensional echocardiographic measurements.

BACKGROUND: Current guidelines do not recommend routine assessment of right atrial volume due to the lack of standardized data. Three-dimensional wall-motion tracking (3D-WMT) is a new technology that allows us to calculate volumes without any geometric assumptions. The aim of this study was to define the indexed reference values for two-dimensional echocardiography (2D-echo) and 3D-WMT in adult healthy population and to assess the intermethod, intra- and interobserver agreement. METHODS: Prospective study. Nonselected healthy subjects were enrolled. Every patient underwent a 2D-echo and a 3D-WMT examination. 2D-echo right atrial volume was obtained by using the area-length method (A-L) from four- and two-chamber view. 3D-echo volumes were assessed by 3D-WMT. Values were indexed by the patient's body surface area. RESULTS: Sixty consecutive healthy subjects were enrolled. Mean age was 57 ± 12-years old and 27 patients (45%) were male. Average indexed right atrial volume obtained by 2D-echo and 3D-echo was 16.76 ± 8.15 mL/m(2) and 19.05 ± 6.87 mL/m(2) , respectively. Univariate linear regression analysis between 2D-echo and 3D-echo right atrial volumes shows a weak correlation between right atrial volume obtained with 2D-echo compared with 3D-WMT (r = 0.29, CI 95% 0.029-0.66, P = 0.033). The agreement analysis shows a similar result (intraclass correlation coefficient [ICC] = 0.28). The intra- and interobserver agreement analysis showed a better agreement when using 3D-WMT. CONCLUSIONS: This is the first study that reports the reference indexed right atrial volume values by means of 2D-echo and 3D-echo in healthy population. 3D-WMT is a feasible and reproducible method to determine right atrial volume.

Area strain: umbrales de normalidad de un nuevo parámetro en sujetos sanos / Area strain: normal values for a new parameter in healthy people

La tecnología ecocardiográfica denominada three-dimensional wall motion tracking es capaz de realizar un seguimiento tridimensional del miocardio y obtener múltiples valores de su deformación, entre los que se encuentra el area strain (AS), que combina el análisis de la deformación longitudinal y circunferencial del ventrículo izquierdo. Nuestro objetivo es describir el valor sistólico máximo normal de referencia de AS en una muestra de sujetos sanos. Se reclutó a 60 sujetos consecutivos, sin enfermedad ni factores de riesgo cardiovascular conocidos, y se les cuantificó el AS del ventrículo izquierdo. El valor promedio de AS fue –38,87 ± 5,89%. Los valores promedio a nivel de los segmentos basales, medio y apicales fueron –38,42 ± 7,58%, –38,74 ± 6,34% y –43,18 ± 12,81% respectivamente. Por lo tanto, nuestros resultados muestran, por primera vez, los valores de referencia de AS en sujetos sanos (AU)

The echocardiographic technology known as three-dimensional wall motion tracking offers three-dimensional images of the myocardium and provides multiple measures of deformation, one of which is known as “area strain” (AS), which combines left ventricular longitudinal and circumferential deformations. Our aim was to describe the normal maximum systolic reference AS value in a sample of healthy subjects. Sixty consecutive subjects without known cardiovascular risk factors or diseases were enrolled, and left ventricular AS was measured. Overall mean AS was –38.87±5.89%. Mean values at the level of the basal, middle, and apical segments were –38.42%±7.58%, –38.74%±6.34%, and −43.18%±12.81%, respectively. Thus, our results show for the first time the reference values for AS in healthy subjects (AU)

[Area strain: normal values for a new parameter in healthy people]. / Area strain: umbrales de normalidad de un nuevo parámetro en sujetos sanos.

The echocardiographic technology known as three-dimensional wall motion tracking offers three-dimensional images of the myocardium and provides multiple measures of deformation, one of which is known as "area strain" (AS), which combines left ventricular longitudinal and circumferential deformations. Our aim was to describe the normal maximum systolic reference AS value in a sample of healthy subjects. Sixty consecutive subjects without known cardiovascular risk factors or diseases were enrolled, and left ventricular AS was measured. Overall mean AS was -38.87 ± 5.89%. Mean values at the level of the basal, middle, and apical segments were -38.42 ± 7.58%, -38.74 ± 6.34%, and -43.18 ± 12.81%, respectively. Thus, our results show for the first time the reference values for AS in healthy subjects.

Adenovirus E1a protein enhances the cytotoxic effects of the herpes thymidine kinase-ganciclovir system.

Cancer gene therapy based on the use of suicide genes, such as the thymidine kinase gene, is not producing satisfactory results. Several approaches have been delineated to enhance the therapeutic responses, including augmentation of the bystander effect, the combination of the herpes simplex virus thymidine kinase-ganciclovir (HSVTK-GCV) system into replication competent adenoviruses and others. Moreover, because usually less than 20% of human malignant cells are in S-phase, the HSVTK-GCV system is not as efficient as expected. To increase the cytotoxic effects of the HSVTK-GCV system, we hypothesized that concomitant expression of E1a protein, which drives cells to proliferation and S-phase, could increase the effects of the HSVTK-GCV system. Several retroviruses were constructed carrying bicistronic sequences of TK and E1a 12S genes under the control of the CMV promoter. The constructions were tested in murine (NIH-3T3, MSC11A5) and human cells (IMR90, HeLa, MDA-MB435). A clear increase of the HSVTK-GCV system killing effect in nonconfluent cells was observed in the cells studied, especially in NIH-3T3, MSC11A5, IMR90, and MDA-MB435 expressing cells. In confluence, the NIH3T3 and IMR90 E1a-TK-expressing cells were also very sensitive and most malignant E1a-TK-expressing cells showed an irreversible G2-M cell cycle arrest. Moreover, the concomitant expression of adenovirus E1a and the HSVTK-GCV system increased the sensitivity to anticancer agents such as cisplatin. These results show that adenovirus E1a protein expression clearly enhances the cytotoxic effects of the HSVTK-GCV system and the response to treatment with cisplatin.

Hipertensión pulmonar grave tratada con bajas dosis de carvedilol en una paciente con infección por el virus de la inmunodeficiencia humana / Severe pulmonary hypertension treated with low dose carvedilol in a patient infected with the human immunodeficiency virus

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