Pacing in HCM results in a significant reduction in obstruction, improvement of symptoms and exercise capacity that is progressive and may be achieved after a long period of time. In this series, only 18% of cases needed a more aggressive treatment to relieve residual obstruction and obtain a satisfactory symptomatic status. In conclusion, these results emphasise the need for new controlled studies of pacing with a longer follow-up.
Background: Loop diuretics are beneficial in heart failure in the short term because they eliminate fluid retention, but in the long-term, they could adversely influence prognosis due to activation of neurohumoral mechanisms. Aims: To explore the changes induced by diuretic withdrawal in chronic nonadvanced heart failure. Methods: Diuretics were withdrawn in 26 stabilized heart failure patients with systolic dysfunction (ejection fraction [EF]b45%). Clinical status was evaluated by physical exam, exercise capacity (corridor test) and New York Heart Association (NYHA) class. Biochemical and neurohumoral determinations were performed at baseline and at 3 months. Results: At 3 months, 17 out of 26 patients (65%) were able to tolerate diuretic interruption without a deterioration in exercise capacity or New York Heart Association functional class. Renal function parameters improved (baseline urea 46.2F10.8 to 39.2F10.1 mg/dl at 3 months, p=0.014; creatinine 1.1F0.23 to 0.98F0.2 mg/dl, p=0.013). Glucose metabolism also improved (fasting glucose 151F91 to 122F14 mg/dl, p=0.035). Heart rate and systolic blood pressure did not significantly change, while diastolic blood pressure increased (from 80F10 to 87F13 mm Hg, p=0.006). Neurohumoral determinations showed a decrease in plasma renin activity (4.19F5.96 to 2.88F4.98 ng/ ml, p=0.026), with no changes in aldosterone, arginine-vasopressin, endothelin-1 and norepinephrine. In contrast, atrial natriuretic peptide significantly increased (115F87 to 168F155 pg/ml, p=0.004). Conclusion: Diuretic withdrawal in stabilized heart failure with systolic dysfunction is associated with an improvement in renal function parameters, glucose metabolism and some neurohumoral parameters, such as plasma renin activity; however, atrial natriuretic peptide levels increased.
Background: The American Society of Clinical Oncologists/College of American Pathologists guidelines were updated in January 2020 to account for a range of positivity in Estrogen Receptor expression (ER), with samples with 1-10% immunoreactive tumor cell nuclei being reported as ER low positive (low+). There is limited data on endocrine responsiveness of this group and ER low+ cancers tend to profile and behave more like typical triple negative breast cancers (TNBC). The significance of isolated Progesterone Receptor (PR) expression is still unclear even though it is reported between 1-100%. This project investigated the number of ER low+ breast cancer patients at John Peter Smith Hospital (JPS). JPS has a higher proportion of Black breast cancer patients than SEER. As Black patients are more likely to have TNBC than non-Hispanic white patients (NHW), JPS also has a higher proportion of TNBC. With ER low+ cancers behaving more like TNBC, this research was conducted to see if there were also more ER low+ patients at JPS. Methods: A retrospective study was conducted using data from the institutional registry of the JPS Oncology and Infusion Center in Fort Worth, TX. Eligible patients were diagnosed with invasive breast cancer in 2020. Data from the JPS Department of Pathology and analyzed for ER and PR expression percentage, Her2 status, race, and ethnicity. HR+ was defined as either ER or PR being 10-100%. JPS data was compared to SEER data from 2014-2018. Results: JPS had 119 eligible patients for this study; 36 NHW, 31 Black, and 47 Hispanic. Of these, 6 were ER low+ and 4 of those were Her2-. 2 of the ER low+ patients were Black and 4 Hispanic. There were 96 Her2- patients, with 26 ER-, 4 ER low+, and 66 ER+. Of the overall 35 ER- patients, 34 were also PR- and 1 was PR low+. 4 of the 6 ER low+ were PR- and 2 PR low+. Conclusion: JPS has a higher percentage of ER low+ cases than previous studies conducted, with 2.6% and 1% found in literature review and 5% (95% CI: 1%, 9%) at JPS, but there is no national data to compare to yet. All the ER low+ patients at JPS were Black or Hispanic. This is limited by the number of ER low+ patients. Blacks and especially Hispanics were more likely to be ER- or ER low+ than NHW. They were also more likely to be PR-, with Black patients most likely to be PR low+. Black patients were most likely to be Her2-. For patients that were ER-, there was a strong concordance with PR status, with 1 case where PR was in a higher category and 86% of cases having ER and PR in agreement. Black and Hispanic patients account for 80% of TNBC at JPS. JPS has a significantly higher proportion of TNBC cases compared to SEER, with 21% (95% CI: 14%; 28%) of cases being TNBC and an additional 3.4% that are ER low+ and Her2-, therefore possibly behaving like TNBC. It is necessary to further investigate the significance of ER low+ and PR low+ expression, and for more research to be done on breast cancer in minority patients who are underrepresented in clinical trials but are more likely to have TNBC, which is aggressive and has poor survival rates. Percentage of Each Status by RaceER-ER low+ER+PR-PR low+PR+Her2-Her2+TNBCNon-Hispanic White22.2%(8)0%(0)77.8%(28)30.6%(11)5.6%(2)63.9%(23)77.8%(28)22.2%(8)20%(5)Black29%(9)6.5%(2)64.5%(20)41.9%(13)16.1%(5)41.9%(13)87.1%(27)9.7%(3)24%(6)Hispanic31.9%(15)8.5%(4)59.6%(28)51.1%(24)6.4%(3)42.6%(20)80.9%(38)19.1%(9)48%(12)Other50%(3)0%(0)33.3%(2)66.7% (4)0%(0)16.7%(1)66.7%(4)16.7% (1)8%(2)Overall29.4%(35)5%(6)64.7%(77)42.9%(51)8.4%(10)47.9 %(57)80.7%(96)17.6%(21)(25)*One patient was Black Hispanic and was included in both rows as ER+ PR- Her2- Comparison of Subtypes between JPS and SEERHR+ Her2-ER low+ PR- Her2-ER-PR low+ Her2 -HR-Her2- (TNBC)HR+ Her2+ER low+ PR- Her2+HR- Her2+UnknownJPS Cases by Subtype 202055.5% (66)3.4%(4)0.8%(1)21%(25)9.2%(11)1.7%(2)6.7%(8)1.7%(2)SEER Cases by Subtype 2014-201868%(included in HR+ Her2-)(included in HR+ Her2-)10%10%(included in HR+ Her2+)4%7% Citation Format: Callie Angell, Jolonda Bullock, Anna Diaz, Riyaz Basha, Kalyani Narra. Prevalence of low estrogen receptor and low progesterone receptor positivity at an urban safety net hospital [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-16.
It has been shown that in patients with essential hypertension and cardiac hypertrophy Tissue Doppler Imaging (TDI) is able to detect impairment of diastolic function more accurately than pulsed transmitralic Doppler (TD). The aim of this study was to assess if, in hypertensive patients without cardiac hypertrophy, there are differences in diastolic function evaluated by using TDI or TD. We studied 17 patients (46±9 years, 11 male) with never treated essential hypertension. Echocardiographic evaluation was used to assess the following parameters: concentric remodelling (CR) pattern, defined as a normal left ventricular mass index with a relative wall thickness >0.45; global diastolic dysfunction (GDD), detected by correcting for age the TD flow early to atrial (E/A) ratio values; regional diastolic dysfunction (RDD) evaluated by TDI, with the sample volume positioned within the basal septum and defined according to the age-corrected tissue E/A ratio values. CR was found in 12 patients (70%); among these, 4 showed both GDD and RDD, while 5 patients showed only RDD. In the absence of CR, no patient showed either GDD or RDD. At Fisher test analysis, RDD was significantly associated with the presence of CR (p=0.019), whereas no significant association was found between CR and GDD. TDI showed a higher sensitivity in detecting diastolic dysfunction than TD (75% vs 33%) and a higher negative predictive value (63% vs 38%); both TDI and TD had a specificity and positive predictive value of 100%. In conclusion, in hypertensive patients with cardiac remodeling an abnormal regional diastolic function can be observed more frequently than a global diastolic dysfunction, thus suggesting that TDI is able to detect early impairment of diastolic function more accurately than pulsed transmitralic Doppler even in the absence of cardiac hypertrophy. 511Arterial distensibility and ambulatory blood pressure as determinant of left ventricular hypertrophy and intima-media thickeness in elderly subjects. Morbidity and mortality in hypertension are primary related to arterial damages that may affect several organs.The aim of this study was to evaluate the ambulatory blood pressure measurement (ABPM) and pulse wave velocity analysis (PWV) in 3 groups composed by elderly subjects, being selected as "normotensive" (Group I, n=24,72,04±6,02years); "isolated systolic hipertensive" (Group II, n=32, 72,34±4,55years); and "systolic-diastolic hipertensive" (Group III, n=33, 71,42±5,72years), in an effort to identify, among the assessed variables, those that could be correlated to the determination of the target organ damage (TOD) defined as left ventricular hypertrophy (LVH) and intima-media thickness of the left and/or right common carotid artery (IMT-CCA).The variables analyzed involved: the ABPM measures; the IMT-CCA measures, by means of carotid ultrasonography; the left ventricular mass and left ventricular mass index measures, by means of echocardiography; and the PWV measures. The distribution of age, gender and anthropometrical rates showe...
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