P185 Primary cardiac lymphoma: an unexpected finding

BACKGROUND

Primary cardiac malignancies are rare, with a reported incidence of 0.1%. Up to 10% of cardiac tumors are malignant and primary cardiac lymphoma represents (PCL) a very low proportion of them. The wide variety of clinical manifestations and the inespecificity of them, difficults the diagnosis and delays treatment impacting directly in the prognosis of these patients. Here we present a lady with diagnosis of PCL treated in our center.

CASE REPORT

We present a 69 year old female with arterial hypertension and paroxismal atrial fibrilation that attended our clinic in april 2013. She referred severe dyspnoea with daily activities and peripheral oedema for the last three weeks. She also complaint of painful swallowing for bothliquids and solids. Physical exploration was unremarkable and observations where within normal limits. Transthoracic echocardiogram (TTE) was performed which showed an hipoechogenic mass invading the right ventricle, both atria and left ventricle outflow tract. She underwent cardiac MRI which revealed a myocardial isointense mass, with marked signal enhancement in T2 and heterogeneity in late gadolinium enhancement sequences, that was consistent with primary cardiac lymphoma. For histologycal characterization, biopsy of the mass guided with endoscopic ultrasonography was performed, confirming B-cell lymphoma. Positron emmision tomography (PET) scan showed bulky hypercaptant mass invading both atria, superior vena cava and pericardium, with hypercaptant adenopathies in right pulmonary hilum, subcarinal and phrenic chain. Her case was discussed in multidisciplinary team meeting and prompt initiation of treatment under R-CHOP regime was decided. After three cycles, follow up PET was requested, and revealed complete metabolic response. A repeat TTE showed only minimal infiltration of the right atria without ventricular involvement or hemodynamic compromise.

DISCUSSION

The patient we presented, was sent to Cardiology due to heart failure symptoms. Acute heart failure as well as embolisation and life-threatening arrythmias are typical manifestations of PCL. As reported in the literature, our case was a diffuse large B-cell lymphoma, which is the most frequent subtype. Dysphagia, exertional dyspnoea and constitutional symptoms can be present in early stages, as our patient referred. The main strength of this case is based on the quick diagnosis and early treatment. In contrary to what is reported, the overall survival was excellent, and to date the patient is still alive with no signs of relapse. Although TTE sensitivity is 55-60%, it has a key role in the diagnosis, which was supported later on MRI. Right chambers (specially right atria) are more typically involved than the left heart, including right venous drainage. Early systemic chemotherapy can achieve a high response rate and improve survival.

Abstract P185 Figure. Img1

P677 When to look for wtTTR amyloidosis in heart failure: increasing chances of positive gammagraphic study

Introduction

Wild type transtirretin (wtATTR) amyloidosis has become increasingly recognized as a major cause for heart failure (HF). Diagnosis requires complex work up such as DPD scintigraphy (DPDs). Availability of DPDs is limited urging to identify factors to increase its diagnostic rentability.

Methods

Retrospective study of HF patients between 2013 and 2019 with suspected wtATTR and DPDs was performed. Baseline characteristics, biomarkers, EKG findings, TTE parameters (LVEF, LV diastolic function, TAPSE, interventricular septum (IVS), LV mass (LVM), relative LV wall thickness (RWT), indexed LVTD volume and diameter, indexed LA diameter (iAPLAD)) and DPDs results were studied. Two groups were created according to DPDs (SP those with positive results for amyloidosis and SN those with negative results). For statistical SPSS v.21 was used.

Results

37 patients were studied. In our population 54% had positive DPDs for amyloidosis. Among SP patients 50% were classified as grade 2 of Perugini classification meanwhile 50% were grade 3; mean value of heart to contralateral ratio was 2,73 ± 0,8. There were no differences in NYHA classification. Differences among SP and SN patients are reflected in Table 1.

Conclusions

In our population SP was found to have higher biomarkers values and higher IVS, LVM, RWT and iAPLAD with poorer RV function. Further investigation is needed in order to confirm our result and identify prognostic factors.

Table 1: Results Total (37) PS (20) PN (17) p value Age (Y) 78 ± 7,9 80 ± 6,5 75,29 ± 8,7 0,05 Gender (male) (%) 30 (8) 19 (95) 11(64) 0,11 Carpal tunnel sdr (%) 3(8) 3 (15) 0 (0) 0,09 Systolic blood pressure (x ± sd) 127 ± 21 118 ± 18 138,5 ± 19 <0,01 ProBNP (x ± sd) 3596 ± 4002 4615 ± 4538 1761 ± 1927 <0,05 Troponin T (x ± sd) 132 ± 360 66,4 ± 35 43 ± 39 0,09 Pseudoinfarction pattern (%) 26 (70) 17 (85) 9 (52) <0,05 IVS (mm) (x ± sd) 14,6 ± 4,5 16,6 ± 5,3 13 ± 3 <0,01 LVM (g/m2) (x ± sd) 142,5 ± 68 180 ± 80 111 ± 32 <0,01 RWT (x ± sd) 0,68 ± 0,42 0,8 ± 0,24 0,56 ± 0,5 <0,01 LVEF (%) (x ± sd) 57,4 ± 11 54 ± 12 60 ± 10 0,12 iAPLAD (mm/m2) (x ± sd) 25,4 ± 6 28,7 ± 6 22,7 ± 4,3 <0,01 TAPSE (mm) (x ± sd) 18,6 ± 5 16,1 ± 4 20,6 ± 5 <0,05 IVS = interventricular septum; LVM = left ventricular mass; RWT = relative wall thickness; iAPLAD= indexed anteroposterior left atrium diameter.

P4800Estimated effect of NOACs compared to Vitamin K Antagonists in real-world atrial fibrillation patients: Data from FANTASIA Registry

Background

Despite of the effectiveness and safety profile of Non-vitamin K Antagonists Oral Anticoagulants (NOACs) even in real-world (RW) Atrial Fibrillation (AF) patients, Vitamin K Antagonists (VKAs) have remained widely used in clinical practice worldwide but the comparison with acenocoumarol therapy in RW is unknown.

Purpose

To estimate the potential absolute benefit in clinical adverse events if the AF patients anticoagulated with VKA therapy had been treated with NOACs.

Methods

We analyzed anticoagulated AF patients who were prospectively recruited into the multicentre FANTASIIA registry. Patients were treated with VKAs for at least 6 months prior to inclusion. The estimation of clinical adverse events avoided was calculated applying absolute risk reductions, relative risk reductions and hazard ratios from the meta-analysis of RW use of NOACs relative to VKAs.

Results

We analyzed 1,470 patients under VKA therapy (mean age 74.1±9.5 years; 56.4% male). Stroke rate with acenocoumarol treatment was 0.88%/year. The estimated rates for stroke using NOACs would be 0.80%/year for Dabigatran 150 mg; 0.76%/year for Rivaroxaban and 0.74%/year for Apixaban instead of VKA. No significant differences were observed between the different NOACs and VKA in stroke rate. Major bleeding with acenocoumarol was 3.40%/year. The estimated rates for major bleeding using NOACs would be 2.75%/year for Dabigatran 150 mg; 3.37%/year for Rivaroxaban and 2.18%/year for Apixaban instead of VKA. Apixaban was the only NOAC that showed a significant estimated reduction rates (p=0.046). Finally, the all-cause mortality rate with acenocoumarol was 4.69%/year. The estimated rates of all-cause mortality using NOACs would be 3.28%/year for Dabigatran 150mg; 4.88%/year for Rivaroxaban and 2.67%/year for Apixaban. Dabigatran and Apixaban showed significant estimated reduction rates with the highest reduction with Apixaban (Table).

Annual Rate reduction of adverse events

Conclusion

The absolute estimated effect of NOACs in the AF patients anticoagulated with VKA showed a significant reduction in adverse clinical events. Apixaban performed the highest estimated reduction in major bleeding and all-cause mortality in comparison with acenocoumarol.

Differential effects of pregnancy on contractile behavior of rat fast and slow skeletal muscles

BACKGROUND

The effect of pregnancy on skeletal muscle still has not been clearly established. The aim of the present study was to investigate the effect of pregnancy on muscle weight and contractile properties of soleus and plantaris muscles.

METHODS

The female Sprague-Dawley rats were divided into two groups: nonpregnant (NP, 250 ± 4 g, n = 8) and late-pregnant (LP, 305 ± 13 g, n = 8). The right plantaris and soleus muscles were liberated from the surrounding tissues. Each muscle was placed on setup to mechanical recording with electric stimulation. In the optimum length of each muscle were recorded single twitches, tetani and fatigue.

RESULTS

The weight and cross-sectional area of soleus and plantaris muscles from pregnant rats was increased respect to nonpregnant rats. The maximal twitch tension decreased in both muscles during pregnancy respect to nonpregnant group. The soleus muscle of LP group developed lesser tetanic tension than NP group. However, the plantaris muscle showed a different behavior: to lower frequencies (5-30 Hz) the NP group developed greater tetanic tension than LP group, and for higher frequencies (40-100 Hz), the LP group developed greater tetanic tension than NP group. Finally, the soleus muscle was more resistance to fatigue than plantaris muscle in pregnant rats.

CONCLUSION

The fast and slow skeletal muscles show a differential contractile response during pregnancy, in tetanic tension and fatigue (Fig. 4, Ref. 48).

Molecular networks perturbed in a developmental animal model of brain injury

Methylazoxymethanol (MAM) is widely used as a developmental neurotoxin and exposure to its glucoside (i.e., cycasin) is associated with the prototypical neurological disorder western Pacific ALS/PDC. However, the specific molecular targets that play a key role in MAM-induced brain injury remain unclear. To reveal potential molecular networks targeted by MAM in the developing nervous system, we examined characteristic phenotypic changes (DNA damage, cytoarchitecture) induced by MAM and their correlation with gene expression differences using microarray assays (27,648 genes). Three day-old postnatal C57BL/6 mice (PND3) received a single injection of MAM and the cerebellum and cerebral cortex of PND4, 8, 15, and 22 mice were analyzed. DNA damage was detected in both the cerebellum (N7-mGua, TUNEL labeling) and cerebral cortex (N7-mGua) of PND4 mice, but progressive disruption of the cytoarchitecture was restricted to the cerebellum. A majority (>75%) of the genes affected (cerebellum 636 genes, cortex 1080 genes) by MAM were developmentally regulated, with a predominant response early (PND4) in the cerebellum and delayed (PND8 and 15) in the cerebral cortex. The genes and pathways (e.g., proteasome) affected by MAM in the cerebellum are distinct from cortex. The genes perturbed in the cerebellum reflect critical cellular processes such as development (17%), cell cycle (7%), protein metabolism (12%), and transcriptional regulation (9%) that could contribute to the observed cytoarchitectural disruption of the cerebellum. This study demonstrates for the first time that specific genes and molecular networks are affected by MAM during CNS development. Further investigation of these targets will help to understand how disruption of these developmental programs could contribute to chronic brain injury or neurodegenerative disease.

Work characteristics and pesticide exposures among migrant agricultural families: a community-based research approach

There are few data on pesticide exposures of migrant Latino farmworker children, and access to this vulnerable population is often difficult. In this paper we describe a community-based approach to implement culturally appropriate research methods with a migrant Latino farmworker community in Oregon. Assessments were conducted in 96 farmworker homes and 24 grower homes in two agricultural communities in Oregon. Measurements included surveys of pesticide use and work protection practices and analyses of home-dust samples for pesticide residues of major organophosphates used in area crops. Results indicate that migrant farmworker housing is diverse, and the amounts and types of pesticide residues found in homes differ. Azinphos-methyl (AZM) was the pesticide residue found most often in both farmworker and grower homes. The median level of AZM in farmworker homes was 1.45 ppm compared to 1.64 ppm in the entry area of grower homes. The median level of AZM in the play areas of grower homes was 0.71 ppm. The levels of AZM in migrant farmworker homes were most associated with the distance from fields and the number of agricultural workers in the home. Although the levels of AZM in growers and farmworker homes were comparable in certain areas, potential for disproportionate exposures occur in areas of the homes where children are most likely to play. The relationship between home resident density, levels of pesticide residues, and play behaviors of children merit further attention.

Assessing the effects of low boron diets on embryonic and fetal development in rodents using in vitro and in vivo model systems

To date, boron (B) essentiality has not been conclusively shown in mammals. This article summarizes the results of a series of in vitro and in vivo experiments designed to investigate the role of B in mammalian reproduction. In the first study, rat dams were fed either a low (0.04 microg B/g) or an adequate (2.00 microg B/g) B diet for 6 wk before breeding and through pregnancy; reproductive outcome was monitored on gestation day 20. Although low dietary B significantly lowered maternal blood, liver, and bone B concentrations, it had no marked effects on fetal growth or development. The goal of the second study was to assess the effects of B on the in vitro development of rat postimplantation embryos. Day 10 embryos collected from dams fed either the low or adequate B diets for at least 12 wk were cultured in serum collected from male rats exposed to one of the two dietary B treatments. Dams fed the low B diet had a significantly reduced number of implantation sites compared to dams fed the B-adequate diet. However, embryonic growth in vitro was not affected by B treatment. The aim of study 3 was to define the limits of boric acid (BA) toxicity on mouse preimplantation development in vitro. Two-cell mouse embryos were cultured in media containing graded levels of BA (from 6 to 10,000 microM). Impaired embryonic differentiation and proliferation were observed only when embryos were exposed to high levels of BA (>2000 microM), reflecting a very low level of toxicity of BA on early mouse embryonic development. Study 4 tested the effects of low (0.04 microg B/g) and adequate (2.00 microg B/g) dietary B on the in vitro development of mouse preimplantation embryos. Two-cell embryos obtained from the dams were cultured in vitro for 72 h. Maternal exposure to the low B diet for 10, 12, and 16 wk was associated with a reduction in blastocyst formation, a reduction in blastocyst cell number, and an increased number of degenerates. Collectively, these studies support the concept that B deficiency impairs early embryonic development in rodents.

Prevalence of diabetes mellitus in the population aged 40-69 years in Galicia, northwest Spain

A cross-sectional study of the prevalence and distribution of diabetes among 40- to 69-year olds in Galicia (NW Spain) is presented. A (R)Reflotron system was used to measure the capillary fasting glucaemia in 1275 subjects randomly chosen from the electoral roll, who also answered a short questionnaire and were weighed and measured. The prevalence of diabetes was 7.5% regardless of sex or habitat (urban or rural), and increased significantly with age. These data are in keeping with the scant available information from other parts of Spain and the world in general. The lack of difference between urban and rural habitats was unexpected in view of previously reported dietary differences between both areas.

Liquid Chromatographic Method for Determination of Oxythioquinox in Technical and Formulated Products: Collaborative Study

A liquid chromatographic method for determination of oxythioquinox (Morestan®) in oxythioquinox technical and formulated products has been developed and collaboratively studied in 14 laboratories. Samples are dissolved in chloroform containing n-valerophenone as an internal standard, diluted with acetonitrile, and analyzed by reverse phase chromatography. Collaborators analyzed blind duplicate samples of oxythioquinox technical and 25 WP. Coefficients of variation were 1.06 and 1.72% for the technical and 25 WP samples, respectively. The method has been adopted official first action.

[Long bone growth changes in thymectomized rats in the pre-puberal stage (author's transl)]

The authors studied the relationship between thymus and growth of long bones in rats in the pre-puberal stage. 150 rats of both sexes were divided in 3 groups: thymectomized, sham-thymectomized and controls. The animals were sacrificed 15 days after surgery, the femurs were collected and measured, in length and breadth. Thymectomized animals have a bone growth significantly lesser in length and breadth when compared to the sham-thymectomized animals. The latter ones also presented a lesser bone growth when compared to the controls. The average body weight was also significantly lesser in thymectomized rats than in controls, the same happening with the shamthymectomized rats. It is suggested that the thymus probably presents some kind of relation with the hypothalamus through a positive feed-back, simulating secretion of substances that would act on the adenohypophysis rising the secretion of growth hormone and the thymus playing a role in maintaining the serum levels of growth hormone and thyroxine necessary for the growth and development of bones.