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Chen L, Oon Y, Rawlings C, Sabeng K, Adam S, Lasep H, Pang I, Ling H, Chandan D, Tan C, Koh K, Cham Y, Said A, Fong A, Ong T. Semi-automated left ventricular endocardial detection versus hand-tracing in the measurement of left ventricular volumes and ejection fraction in daily clinical practice. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The common method of assessing left ventricle (LV) volumes and ejection fraction (EF) is hand-tracing Biplane Simpson method. Alternatively, ultrasound vendors offer different semi-automated LV endocardial border detection software with anatomical intelligence to assess LV volumes and EF. By using speckle-tracking technique, this software tracks the LV endocardium throughout the cardiac cycle and computes the LV volumes in every image frame using the disk summation method from which a volume-curve is generated, and the EF is calculated using the maximum and minimum volumes obtained. Data on the performance of this method in comparison with the hand-tracing Biplane Simpson method in daily clinical practice is scarce.
Purpose
To determine the accuracy of LV volumes and EF using semi-automated LV endocardial detection tracing, and to compare the reproducibility of this method with the hand-tracing Biplane Simpson method, among operators with varying level of experience in echocardiography.
Methods
This was a single center retrospective observational study, conducted in year 2020. 127 patients, aged >18 years, who underwent clinically indicated transthoracic echocardiography were recruited. The echocardiographic images were analyzed independently in a blinded fashion by 3 operators – a sonographer, a fellow-in-training and a cardiologist specialized in echocardiography. The LV volumes and EF were first measured using hand-tracing Biplane Simpson method, then repeated using semi-automated tracing at a different time and the operator were blinded to the initial hand-tracing measurements.
Results
The mean age of patients was 50±16 years, 35.4% were male, mean body surface area was 1.62±0.18m2, 92.1% were in sinus rhythm, and 61.4% had good acoustic window. Table 1 shows the LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF, measured using different method, by the 3 operators. There were excellent correlation and agreement between semi-automated tracing measurements and hand-tracing measurements of LV EDV (r=0.985, LOA [mean ± 1.96 SD] 16.9 ml, ICC 0.991), ESV (r=0.990, LOA 12.7 ml, ICC 0.994) and EF (r=0.962, LOA 7.43%, ICC 0.967) by experienced cardiologist. The limit of agreement (LOA) between cardiologist and sonographer for semi-automated tracing measurement of LV EDV, ESV and EF were 29.13 ml, 19.74 ml and 9.25% respectively, which was comparable with that of hand-tracing measurement. The agreement between cardiologist and fellow-in-training for semi-automated tracing measurement of LV volumes and EF was slightly better than hand-tracing method, with a LOA of 25.60 ml, 17.48 ml and 7.08%, for EDV, ESV and EF respectively (Table 2).
Conclusion
In daily clinical practice, measurement of LV volumes and EF using semi-automated LV endocardial tracing method is accurate and demonstrates comparable reproducibility with hand-tracing Biplane Simpson method among operators with different level of experience in echocardiography.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L.S Chen
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - Y.Y Oon
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - C Rawlings
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - K Sabeng
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - S Adam
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - H Lasep
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - I.X Pang
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - H.S Ling
- University Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Malaysia
| | - D.B Chandan
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - C.T Tan
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - K.T Koh
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - Y.L Cham
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - A Said
- University Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Malaysia
| | - A.Y.Y Fong
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - T.K Ong
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
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Chung L, Onyango D, Guo Z, Jia P, Dai H, Liu S, Zhou M, Lin W, Pang I, Li H, Yuan YC, Huang Q, Zheng L, Lopes J, Nicolas A, Chai W, Raz D, Reckamp KL, Shen B. The FEN1 E359K germline mutation disrupts the FEN1-WRN interaction and FEN1 GEN activity, causing aneuploidy-associated cancers. Oncogene 2014; 34:902-11. [PMID: 24608430 PMCID: PMC4160428 DOI: 10.1038/onc.2014.19] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/18/2013] [Accepted: 12/20/2013] [Indexed: 02/02/2023]
Abstract
Polymorphisms and somatic mutations in Flap Endonuclease 1 (FEN1), an essential enzyme involved in DNA replication and repair, can lead to functional deficiencies of the FEN1 protein and a predisposition to cancer. We identified a FEN1 germline mutation which changed residue E359 to K in a patient whose family had a history of breast cancer. We determined that the E359K mutation, which is in the protein-protein domain of FEN1, abolished the interaction of FEN1 with Werner Syndrome protein (WRN), an interaction which is critical for resolving stalled DNA replication forks. Furthermore, although the flap endonuclease activity of FEN1 E359K was unaffected, it failed to resolve bubble structures, which requires the FEN1 gap dependent endonuclease (GEN) activity. To determine the etiological significance of E359K, we established a mouse model containing this mutation. E359K mouse embryonic fibroblasts (MEF) were more sensitive to DNA cross-linking agents that cause replication forks to stall. Cytological analysis suggested that the FEN1-WRN interaction was also required to for telomere stability; mutant cell lines had fragile telomeres, increased numbers of spontaneous chromosomal anomalies and higher frequencies of transformation. Moreover, the incidence of cancer was significantly higher in mice homozygous for FEN1 E359K than in wild-type mice, suggesting that the FEN1 E359K mutation is oncogenic.
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Affiliation(s)
- L Chung
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - D Onyango
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Z Guo
- 1] Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA [2] Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - P Jia
- WWAMI Medical Education Program, School of Molecular Biosciences, Washington State University, Spokane, WA, USA
| | - H Dai
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - S Liu
- 1] Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA [2] College of Life Science, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - M Zhou
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - W Lin
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - I Pang
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - H Li
- Department of Molecular Medicine, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Y-C Yuan
- Department of Molecular Medicine, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Q Huang
- Department of Pathology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - L Zheng
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - J Lopes
- 1] Section de Recherche, Institut Curie, CNRS UMR3244, Paris, France [2] Muséum National d'Histoire Naturelle, USM 503, INSERM U565, UMR7196, Paris, France
| | - A Nicolas
- Section de Recherche, Institut Curie, CNRS UMR3244, Paris, France
| | - W Chai
- WWAMI Medical Education Program, School of Molecular Biosciences, Washington State University, Spokane, WA, USA
| | - D Raz
- Department of Surgery, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - K L Reckamp
- Department of Medical Oncology and Therapeutics Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - B Shen
- Department of Radiation Biology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
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