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1.  A new baseline scoring system may help to predict response to cardiac resynchronization therapy 
Introduction
The PROSPECT trial reported no single echocardiographic measurement of dyssynchrony is recommended to improve patient selection for cardiac resynchronization therapy (CRT).
Material and methods
In 100 consecutive patients who received CRT, we analyzed 27 ECG and echocardiographic variables to predict a positive response to CRT defined as a left ventricular (LV) end systolic volume decrease of ≥ 15% after CRT.
Results
Right ventricular (RV) pacing-induced left bundle branch block (LBBB), time difference between LV ejection measured by tissue Doppler and pulsed wave Doppler (TTDI-PW), and wall motion score index (WMSI) were significantly associated with positive CRT response by multivariate regression. We assigned 1 point for RV pacing-induced LBBB, 1 point for WMSI ≤ 1.59, and 2 points for TTDI-PW > 50 ms. Overall mean response score was 1.79 ±1.39. Cutoff point for response score to predict positive response to CRT was > 2 by receiver operating characteristic (ROC) analysis. Area under ROC curve was 0.97 (p = 0.0001). Cardiac resynchronization therapy responders in patients with response score > 2 and ≤ 2 were 36/38 (95%) and 7/62 (11%, p < 0.001), respectively. After age and gender adjustment, the response score was related to CRT response (OR = 45.4, p < 0.0001).
Conclusions
A response score generated from clinical, ECG and echocardiographic variables may be a useful predictor for CRT response. However, this needs to be validated.
doi:10.5114/aoms.2011.24132
PMCID: PMC3258780  PMID: 22291798
cardiac resynchronization therapy; wall motion score index
2.  Predicting lymph node status in patients with early gastric carcinoma using double contrast-enhanced ultrasonography 
Introduction
Double contrast-enhanced ultrasonography (DCUS) is a new method we used in predicting lymph node metastasis (LNM) in patients with early gastric cancer.
Material and methods
Seventy-six patients with early gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined using DCUS preoperatively. Group N1 included 15 patients with LNM and group N0 61 patients without LNM.
Results
In group N1, 13 patients (87%) had marked hyperenhancement during early arterial phase using DCUS, and 2 patients (13%) were unmarked as hyperenhancement. In group N0, 24 patients (39%) had marked hyperenhancement during early arterial phase using DCUS, and 37 patients (61%) had unmarked hyperenhancement. The sensitivity and specificity of marked hyperenhancement in predicting LNM in patients with early gastric cancer was 86.7% and 60.7% respectively, and the Youden’s index was 0.474. The κ value of this method was 0.89.
Conclusions
Double contrast-enhanced ultrasonography is a new valuable method to evaluate LNM at an early stage of gastric cancer and prognosis of early gastric cancer preoperatively.
doi:10.5114/aoms.2011.23412
PMCID: PMC3258739  PMID: 22295029
early gastric cancer; lymph node metastasis; contrast-enhanced ultrasonography
3.  Double contrast-enhanced ultrasonography evaluation of preoperative Lauren classification of advanced gastric carcinoma 
Introduction
The clinical value of double contrast-enhanced ultrasonography (DCUS) in determining the Lauren classification of advanced gastric carcinoma needed investigation.
Material and methods
Fifty-eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination in which an oral contrast agent was combined with an intravenous agent, and the findings were compared with the postoperative pathological findings using haematoxylin-eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining.
Results
Of 58 patients, 34 (59%) were the intestinal type and 24 (41%) the diffuse type on pathological examination of resected specimens. Among intestinal type patients, 30 (88%) showed homogeneous vascular enhancement and 4 (12%) heterogeneous enhancement with the “sandwich” pattern in 2 patients (50%) and “barrier” pattern in 2 patients (50%). In the diffuse type, 22 of 24 patients (92%) enhanced heterogeneously, with stippled and peripheral enhancement in 9 (41%), the “sandwich” pattern in 8 (36%) and “barrier” pattern in 5 (23%). Two of 24 patients (8%) with the diffuse type enhanced homogeneously. The proportion of heterogeneous enhancement was significantly different between the 2 subtypes of tumour (p = 0.0001). The sensitivity and specificity of heterogeneous enhancement in diagnosing the diffuse type of advanced gastric cancer were 92% and 88%, respectively. Youden’s index was 0.8.
Conclusions
Double contrast-enhanced ultrasonography is a new and useful method to determine Lauren classification in patients with gastric carcinoma.
doi:10.5114/aoms.2011.22080
PMCID: PMC3258721  PMID: 22291769
ultrasonography; microbubbles; contrast; gastric carcinoma; Lauren classification
4.  Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography 
Introduction
We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA).
Material and methods
We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70% narrowing).
Results
HRCA was present in 45 of 187 patients (24%). AA severity was grade I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p< 0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ≤ 2 died (p= 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p= 0.002).
Conclusions
AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality.
doi:10.5114/aoms.2011.20605
PMCID: PMC3258703  PMID: 22291734
high-risk coronary anatomy; transesophageal echocardiography; thoracic aortic atheroma; coronary angiography
5.  Evaluation of left ventricular dyssynchrony using combined pulsed wave and tissue Doppler imaging 
Introduction
The combination of pulsed wave (PW) and tissue Doppler imaging (TDI) has been proposed as a new method to assess left ventricular (LV) mechanical dyssynchrony (LVMD), but results have not been validated. We investigated the correlation of a combination of PW and TDI with a positive response to cardiac resynchronization therapy (CRT).
Material and methods
We studied 108 consecutive patients who received CRT. Patients with atrial fibrillation were excluded. The time difference (TPW-TDI) between onset of QRS to the end of LV ejection by PW (TPW) and onset of QRS to the end of the systolic wave in LV basal segments with greatest delay by TDI (TTDI) was measured before CRT and during short-term and long-term follow-up.
Results
The TPW-TDI interval before CRT was 74 ±48 ms. Intra-observer variabilities for TPW and TTDI were 1.5 ±0.24% and 1 ±0.17%. Inter-observer variabilities for TPW and TTDI were 1 ±0.36% and 1 ±0.64%, respectively. TPW-TDI > 50 ms was defined as the cutoff value for diagnosis of LVMD by receiver operating curve (ROC) analysis. During follow-up of 15 ±11 months, the sensitivity and specificity of TPPW-TDI to predict a positive response to CRT were 98% and 82%, respectively. The area under the ROC curve was 0.92. There was a significant agreement between LVMD determined by TPW-TDI and the positive response to CRT (κ=0.80).
Conclusions
Left vertricular dyssynchrony detected by the method combining PW and TDI demonstrated a high reproducibility, sensitivity, specificity and agreement with a positive response to CRT.
doi:10.5114/aoms.2010.14462
PMCID: PMC3284065  PMID: 22371794
cardiac resynchronization therapy; left ventricular mechanical dyssynchrony

Results 1-5 (5)