SUMMARYOxidation of several substrates by whole or broken organisms of Micrococcus lysodeikticus was arrested following treatment with lysozyme, unless an osmotic stabilizer (sorbitol) were present. Whole organisms, which did not oxidize NADH,, and broken organisms (which oxidized NADH, only slowly) oxidized NADH, readily after lysozyme treatment, though the activity was maintained only in presence of an osmotic stabilizer.Lysozyme treatment similarly allowed whole or broken M . lysodeikticus to oxidize (mammalian) cytochrome c, or to reduce this cytochrome with appropriate electron-donors, e.g. lactate, succinate, or NADH,. Most of these observations held good also for the lysozyme-sensitive Bacillus megaterium, but not for several lysozyme-insensitive organisms (both Gram-positive and Gram-negative).
A second opinion was sought if LV function was assessed as <40%. LV function by cardiac MRI was determined by standard semi-automated endocardial contouring at end diastole and end systole using Siemens Syngovia software. The cut off for severe LV dysfunction was <35% and >55% for normal.Results 12301 TTE and 398 CMR scans were performed in the study period. 120 patients met inclusion criteria with TTE and CMR within 30 days. Reasons for exclusion included missing data (n=2), reversible cause for LV dysfunction (n=1) and poor endocardial definition (n=4) leaving a study population of 113 patients. LVEF by TTE and CMR (figure 1) were strongly correlated (R=0.85, p <0.001). Bland Altman analysis demonstrated a signal of systematic bias with LVEF by CMR 4.4% higher than TTE (mean bias 4.4%, 95% CI -0.3 to 9.0, p = 0.06). Severe LV function on both TTE and CMR were in accordance in 91% of cases. Normal LV function by TTE and CMR was in accordance in 85% of cases. Conclusion These results show good correlation of LVEF by TTE and CMR with the latest generation of scanners with a signal of systematic bias where CMR LVEF reads 4.4% higher than TTE. These results are used locally to guide clinical decision making and form part of on-going quality assurance processes. Further work to improve agreement between modalities is required.
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