Patients who do not fulfill criteria for hypertrophic cardiomyopathy but have unexplained giant T-wave inversion: a cardiovascular magnetic resonance mid-term follow-up study.

BACKGROUND: Patients who have unexplained giant T-wave inversions but do not meet criteria for hypertrophic cardiomyopathy (HCM) (left ventricular (LV) wall thickness < 1.5 cm) demonstrate LV apical morphological features that differ from healthy subjects. Currently, it remains unknown how the abnormal LV apical morphology in this patient population changes over time. The purpose of this study was to investigate LV morphological and functional changes in these patients using a mid-term cardiovascular magnetic resonance (CMR) exam. METHODS: Seventy-one patients with unexplained giant T-wave inversion who did not fulfill HCM criteria were studied. The mean interval time of the follow-up CMR was 24.4 ± 8.3 months. The LV wall thickness was measured in each LV segment according to the American Heart Association 17-segmented model. The apical angle (ApA) was also measured. A receiver operating curve (ROC) was used to identify the predictive values of the CMR variables. RESULTS: Of 71 patients, 16 (22.5%) progressed to typical apical HCM, while 55 (77.5%) did not progress to HCM criteria. The mean apical wall thickness was significantly different between the two groups at both baseline and follow-up, with the apical HCM group having greater wall thickness at both time points (all p < 0.001). There was a significant difference between the two groups in the change of ApA (- 1.5 ± 2.7°/yr vs. - 0.7 ± 2.0°/yr, p < 0.001) over time. The combination of mean apical wall thickness and ApA proved to be the best predictor for fulfilling criteria for apical HCM with a threshold value of 8.1 mm and 90° (sensitivity 93.8%, specificity 85.5%). CONCLUSIONS: CMR metrics identify predictors for progression to HCM in patients with unexplained giant T-wave inversion.

[Effect of water extract from traditional Chinese medicines Rehmannia glutinosa, Scrophularia ningpoensis, Asparagus cochinchinensis and Ophiopogon japonicas on contents of CYP450 and activities of CYP3A, CYP2E1 and CYP1A2 in rat].

OBJECTIVE: To study the effects of the water extract of Rehmannia glutionsa, Scrophularia ningpoensis, Asparagus cochinchinensis and Ophiopogon japonicas, which are the drug from Tianwang Buxin Wan from nourishing vin, on the content of cytohrome P450 (CYP450) in rat and the activities of CYP3A, CYP2E1 and CYP1A2 to investigate the role of CYP450 in the biotransformation of Tianwang Buxin Wan. METHOD: The rats were killed after administrated with extracts once daily for consecutive 7 days, the livers were removed rapidly and weighed, liver microsomes were prepared with ultra-centrifuge method, the contents of liver microsomal CYP450, cytochrome b5 (Cytb5) and the activities of CYP3A were examined by ultraviolet spectrophotometry, the activities of CYP2E1 and CYP1A2 were determined by high performance liquid chromatography (HPLC). RESULT: All groups had no difference in the levels of liver indexe compared with normal sodium group. The water extract of R. glutionsa obviously decreased the contents of P450 (P < 0.01) and increased the activity of CYP3A (P < 0.01) and CYP1A2 (P <0.05). The water extract of S. ningpoensis decreased the contents of P450 (P < 0.05) and significantly increased CYP3A and CYP1A2 activities (P < 0.01). A. cochinchinensis increased content of Cytb5 (P < 0.05) in rat and increased the activity of CYP2E1 (P < 0.05) and CYP1A2 (P < 0.01). O. japonicas had no significant difference on the contents of CYP450 and Cytb5 while increased the activities of CYP3A (P < 0.05), CYP2E1 (P < 0.05) and CYP1A2 (P < 0.01). CONCLUSION: R. glutionsa and S. ningpoensis could decrease the content of CYP450 enzyme in rat liver and induct the activities of CYP3A and CYP1A2. A. cochinchinensis could induct the activities of CYP2E1 and CYP1A2. O. japonicus could induction the activities of CYP3A, CYP2E1 and CYP1A2 in Tianwang Buxin Wan. By inhibiting CYP450 activity to decrease the metabolism of other drugs, the effect of other functional groups in the compatibility of Tianwang Buxin Wan can be enhanced, and a theoretical basis on studying the compatible mechanism can be provided.

MRI Characteristics, Prevalence, and Outcomes of Hypertrophic Cardiomyopathy with Restrictive Phenotype.

PURPOSE: To investigate the MRI characteristics, prevalence, and outcomes of hypertrophic cardiomyopathy (HCM) with restrictive phenotype. MATERIALS AND METHODS: A total of 2592 consecutive patients with HCM were evaluated to identify individuals who fulfilled the diagnostic criteria of restrictive phenotype. Thirty-four patients with HCM (mean age, 41 years ± 16 [standard deviation]; range, 21-62 years, 16 men) with restrictive phenotype were retrospectively identified. Thirty-four patients with HCM with the same age and sex distributions were randomly selected as a control group. Kaplan-Meier survival curves were compared using log-rank statistics for survival analysis. RESULTS: The anteroposterior diameters of the left and right atria were 55 mm ± 5 and 61 mm ± 9, respectively, which were larger than those of the control group (P < .001). The maximum wall thickness in the restrictive group was lower than that in the control group (16 mm ± 2 vs 19 mm ± 3, P < .001). No significant difference was found in late gadolinium enhancement fraction between the restricted phenotype and the control group (15% ± 8 vs 13% ± 7, P = .376). The 5-year event-free survival from any cause of death and cardiac transplantation was 81% in the restrictive group, compared with 94% in the control group (log-rank P = .018). CONCLUSION: Restrictive phenotype is a rare subtype of HCM and is associated with severe clinical symptoms and poor prognosis. The MRI features of this phenotype include mild to moderate left ventricular hypertrophy, markedly enlarged atria, moderate myocardial fibrosis, and pericardial effusion.© RSNA, 2020.

Clay mineralogy indicates a mildly warm and humid living environment for the Miocene hominoid from the Zhaotong Basin, Yunnan, China.

Global and regional environmental changes have influenced the evolutionary processes of hominoid primates, particularly during the Miocene. Recently, a new Lufengpithecus cf. lufengensis hominoid fossil with a late Miocene age of ~6.2 Ma was discovered in the Shuitangba (STB) section of the Zhaotong Basin in Yunnan on the southeast margin of the Tibetan Plateau. To understand the relationship between paleoclimate and hominoid evolution, we have studied sedimentary, clay mineralogy and geochemical proxies for the late Miocene STB section (~16 m thick; ca. 6.7-6.0 Ma). Our results show that Lufengpithecus cf. lufengensis lived in a mildly warm and humid climate in a lacustrine or swamp environment. Comparing mid to late Miocene records from hominoid sites in Yunnan, Siwalik in Pakistan, and tropical Africa we find that ecological shifts from forest to grassland in Siwalik are much later than in tropical Africa, consistent with the disappearance of hominoid fossils. However, no significant vegetation changes are found in Yunnan during the late Miocene, which we suggest is the result of uplift of the Tibetan plateau combined with the Asian monsoon geographically and climatically isolating these regions. The resultant warm and humid conditions in southeastern China offered an important refuge for Miocene hominoids.