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Background-In patients with severe heart failure and dilated cardiomyopathy, cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function associated with LV reverse remodeling and favorable 1-year survival. However, it is unknown whether LV reverse remodeling translates into a better long-term prognosis and what extent of reverse remodeling is clinically relevant, which were investigated in this study. Methods and Results-Patients (nϭ141) with advanced heart failure (meanϮSD age, 64Ϯ11 years; 73% men) who received CRT were followed up for a mean (ϮSD) of 695Ϯ491 days. The extent of reduction in LV end-systolic volume (LVESV) at 3 to 6 months relative to baseline was examined for its predictive value on long-term clinical outcome. The cutoff value for LV reverse remodeling in predicting mortality was derived from the receiver operating characteristic curve. Then the relation between potential predictors of mortality and heart failure hospitalizations were compared by Kaplan-Meier survival analysis, followed by Cox regression analysis. There were 22 (15.6%) deaths, mostly due to heart failure or sudden cardiac death. The receiver operating characteristic curve found that a reduction in LVESV of Ն9.5% had a sensitivity of 70% and specificity of 70% in predicting all-cause mortality and of 87% and 69%, respectively, for cardiovascular mortality. With this cutoff value, there were 87 (61.7%) responders to reverse remodeling. In Kaplan-Meier survival analysis, responders had significantly lower all-cause morality (6.9% versus 30.6%, log-rank 2 ϭ13.26, Pϭ0.0003), cardiovascular mortality (2.3% versus 24.1%, log-rank 2 ϭ17.1, PϽ0.0001), and heart failure events (11.5% versus 33.3%, log-rank 2 ϭ8.71, Pϭ0.0032) than nonresponders. In the Cox regression analysis model, the change in LVESV was the single most important predictor of all-cause (␤ϭ1.048, 95% confidence intervalϭ1.019 to 1.078, Pϭ0.001) and cardiovascular (␤ϭ1.072, 95% confidence intervalϭ1.033 to 1.112, PϽ0.001) mortality. Clinical parameters were unable to predict any outcome event. Conclusions-A reduction in LVESV of 10% signifies clinically relevant reverse remodeling, which is a strong predictor of lower long-term mortality and heart failure events. This study suggests that assessing volumetric changes after an intervention in patients with heart failure provides information predictive of natural history outcomes. (Circulation. 2005;112:1580-1586.)

Objective: To test the hypothesis that, when measured in the long axis, left ventricular systolic function is abnormal in patients with diastolic heart failure. Design: A case-control study. Setting: University teaching hospital (tertiary referral centre). Patients: 68 patients with heart failure, 29 with a left ventricular ejection fraction (LVEF) of > 0.45 and diastolic dysfunction (diastolic heart failure), 39 with an LVEF of < 0.45 (systolic heart failure), and 105 normal subjects, including 33 age matched controls. Methods: LVEF was measured by cross sectional Simpson's method, and mitral annular amplitudes and velocities by M mode and tissue Doppler echocardiography, respectively, along with mitral Doppler inflow velocities. Results were compared between the three groups. Main outcome measures: Peak systolic mitral annular velocity and amplitude between the different groups. Results: The mitral annular peak mean velocity and amplitude in systole were lower in the patients with diastolic heart failure (mean (SEM), 4.8 (0.2) cm/s) than in the age matched normal controls (6.1 (0.14) cm/s), but higher than those with systolic heart failure (2.8 (0.13) cm/s) (all p < 0.001). Similar changes were seen the mitral annular amplitude during systole. Peak early diastolic velocity and amplitude were also significantly reduced in the group with diastolic heart failure. Left ventricular hypertrophy was evident in over 95% patients in both diastolic and systolic heart failure groups, with a comparable left ventricular mass index. Conclusions: In patients with diastolic heart failure and evidence of left ventricular hypertrophy, there is systolic left ventricular impairment as measured by myocardial Doppler imaging of the longitudinal axis. Thus subtle abnormalities of systolic function are present in patients with heart failure and a normal left ventricular ejection fraction, and there appears to be a continuum of systolic function between those with truly normal, mildly impaired (labelled diastolic heart failure), and obviously abnormal left ventricular systolic function. Isolated diastolic dysfunction is uncommon.H eart failure with a normal left ventricular ejection fraction is usually called "diastolic heart failure" if there are no other obvious causes. In some parts of the world, so called diastolic heart failure may be more common than systolic heart failure in patients presenting with heart failure symptoms. 1 The distinction between the two states is based upon the measurement of left ventricular ejection fraction (LVEF), usually by echocardiography. In patients with a normal or nearly normal LVEF it is assumed that as there is "preserved systolic function" the primary disorder is diastolic. Although LVEF assesses global function, it is a relatively crude measure of left ventricular systolic function. Measurement of the ventricular long axis velocities and amplitude using tissue Doppler and M mode imaging of the mitral annulus is thought to provide a more sensitive index of systolic function than LVEF. 2 Using t...

CP-MT, T1653, HBV DNA levels >or=4 log(10) copies/ml and cirrhosis are independent factors for development of HCC. The risks increased substantially in patients having these factors in combination.

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Using very sensitive HBV DNA and viral resistance assays, continuous entecavir treatment for treatment-naïve CHB patients for 3 years was associated with >90% chance of undetectable HBV DNA and only 1.2% chance of emergence of entecavir-resistant mutations.

Peak myocardial deformation by SRI can differentiate transmural from non-transmural MI, and it allows noninvasive determination of transmurality of the scar after MI and thereby the extent of non-viable myocardium.

HBV pre-S2 deletions were an independent factor associated with the development of HCC. Its oncogenic role may be more important in young patients with HCC.