557 Left ventricular diastolic function is a predictor of volumetric response to cardiac resynchronization therapy

Background

Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aims of the study are: 1) to assess diastolic patterns in patients undergoing CRT; 2) to evaluate the role of DF in predicting CRT-response.

Methods

193 patients (age: 67 ± 11 ms, QRS width: 167 ± 21 ms, LVEF 28 ± 8%) were prospectively included in this multicentric study. 2D-standard echocardiography was performed before CRT and at 6-month follow-up (FU). DF was assessed according to recommendations from grade I to III. In case of data in the "grey zone", DF was defined as "indeterminate". A reduction of left ventricular (LV) end-systolic volume >15% at FU identified CRT-responders (CRT-R).

Results

At 6-month FU, 132 patients (68%) were CRT-R. Figure 1 shows DF parameters in the overall population, CRT-R, and CRT-non responders (CRT-NR) before and after CRT. At multivariable analysis, grade I diastolic dysfunction at baseline was a significant independent predictor of CRT response (OR 3.02, p = 0.001) (Table 1). The addition of grade I diastolic dysfunction to a model including clinical (sex, NYHA class, ischemic cardiomyopathy) and echocardiographic parameters (LV size), significantly increase the model power for the prediction of CRT-response (χ2: 29 vs 44, p = 0.001).

Conclusions

Before CRT, DF parameters are significantly altered in CRT-NR with respect to CRT-R. Moreover, CRT-NR experience a significant deterioration of DF after CRT. In our population, grade I diastolic function at baseline was a significant independent predictor of positive response to CRT.

Table 1 Univariable analysis Multivariable analysis Age 1.01 (0.99-1.05) 0.25 Males 0.36 (0.17-0.76) 0.008 0.57 (0.22-1.47) 0.25 CAD 0.21 (0.11-0.40) <0.001 0.31 (0.15-0.65) 0.002 NYHA 0.52 (0.31-0.88) 0.01 0.57 (0.22-1.47) 0.25 QRS 1.01 (0.99-1.02) 0.44 LVEDV 0.99 (0.99-1.00) 0.003 0.98 (0.97-1.01) 0.18 LVESV 0.99 (0.98-0.99) 0.005 1.01 (0.99-1.03) 0.28 LVEF 1.00 (0.97-1.05) 0.63 Grade I DD 4.13 (2.16-7.91) <0.0001 3.02 (1.26-7.23) 0.001 Grade II DD 0.57 (0.40-0.80) 0.001 0.87 (0.35-2.19) 0.79 Grade III DD 0.76 (0.58-1.02) 0.06

Abstract 557 Figure.

Molecular turnover, the H3.3 dilemma and organismal aging (hypothesis)

The H3.3 histone variant has been a subject of increasing interest in the field of chromatin studies due to its two distinguishing features. First, its incorporation into chromatin is replication independent unlike the replication-coupled deposition of its canonical counterparts H3.1/2. Second, H3.3 has been consistently associated with an active state of chromatin. In accordance, this histone variant should be expected to be causally involved in the regulation of gene expression, or more generally, its incorporation should have downstream consequences for the structure and function of chromatin. This, however, leads to an apparent paradox: In cells that slowly replicate in the organism, H3.3 will accumulate with time, opening the way to aberrant effects on heterochromatin. Here, we review the indications that H3.3 is expected both to be incorporated in the heterochromatin of slowly replicating cells and to retain its functional downstream effects. Implications for organismal aging are discussed.

Analysis of interaction partners of H4 histone by a new proteomics approach

We describe a modification of the tandem affinity purification method for purification and analysis of multiprotein complexes, termed here DEF-TAP (for differential elution fractionation after tandem affinity purification). Its essential new feature is the use for last purification step of 6xHis-Ni(++) interaction, which is resistant to a variety of harsh washing conditions, including high ionic strength and the presence of organic solvents. This allows us to use various fractionation schemes before the protease digestion, which is expected to improve the coverage of the analyzed protein mixture and also to provide an additional insight into the structure of the purified macromolecular complex and the nature of protein-protein interactions involved. We illustrate our new approach by analysis of soluble nuclear complexes containing histone H4 purified from HeLa cells. In particular, we observed different fractionation patterns of HAT1 and RbAp46 proteins as compared with RbAp48 protein, all identified as interaction partners of H4 histone. In addition, we report all components of the licensing MCM2-7 complex and the apoptosis-related DAXX protein among the interaction partners of the soluble H4. Finally, we show that HAT1 requires N-terminal tail of H4 for its stable association with this histone.

Gem associates with Ezrin and acts via the Rho-GAP protein Gmip to down-regulate the Rho pathway

Gem is a protein of the Ras superfamily that plays a role in regulating voltage-gated Ca2+ channels and cytoskeletal reorganization. We now report that GTP-bound Gem interacts with the membrane-cytoskeleton linker protein Ezrin in its active state, and that Gem binds to active Ezrin in cells. The coexpression of Gem and Ezrin induces cell elongation accompanied by the disappearance of actin stress fibers and collapse of most focal adhesions. The same morphological effect is elicited when cells expressing Gem alone are stimulated with serum and requires the expression of ERM proteins. We show that endogenous Gem down-regulates the level of active RhoA and actin stress fibers. The effects of Gem downstream of Rho, i.e., ERM phosphorylation as well as disappearance of actin stress fibers and most focal adhesions, require the Rho-GAP partner of Gem, Gmip, a protein that is enriched in membranes under conditions in which Gem induced cell elongation. Our results suggest that Gem binds active Ezrin at the plasma membrane-cytoskeleton interface and acts via the Rho-GAP protein Gmip to down-regulate the processes dependent on the Rho pathway.

Patient-administered sphenopalatine ganglion block

BACKGROUND AND OBJECTIVES

Pain resulting from head and neck cancer can be severe and difficult to manage. Avoiding hospitalization for as long as possible with a reasonable level of comfort requires a number of therapeutic modalities. The usefulness of self-administered sphenopalatine ganglion block was evaluated in a patient with lethal midline granuloma requiring large doses of morphine.

METHODS

A 30-year-old woman with intractable pain from lethal midline granuloma was taught to self-administer 4% lidocaine, 1.5 mL topically into each nostril three times per day.

RESULTS

A 3-month follow-up examination showed substantial pain relief and reduction in morphine requirement. No adverse side effects or complications developed.

CONCLUSIONS

In certain patients, sphenopalatine ganglion block can be effectively self-administered at home to manage chronic pain.