Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices

Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2–4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making. © 2019, Springer Nature B.V

Análise da madeira de Pinus oocarpa parte I: estudo dos constituintes macromoleculares e extrativos voláteis Chemical analysis of Pinus oocarpa wood part I: quantification of macromolecular components and volatile extractives

Neste estudo foram analisados os principais componentes químicos da madeira de Pinus oocarpa, cultivado na região do cerrado. A composição química dessa madeira foi: 59,05% de a-celulose, 21,22% de hemiceluloses A e B, 25,18% de lignina, 2,78% de extrativos em diclorometano, 4,38% de extrativos em etanol:tolueno, 4,31% de extrativos em água quente e 1,26% de cinzas. O conteúdo de celulose foi relativamente elevado, indicando que essa madeira possui grande potencial para produção de pasta de celulose. Investigou-se, também, a composição dos extrativos. Os principais constituintes do extrato diclorometano dessa madeira foram os ácidos diterpênicos, além dos ácidos palmítico e oléico. No óleo essencial, extraído por aparelho de Clevenger, os principais componentes identificados foram aromadendreno, ledano, hexadecanal e ácido oléico.<br>The chemical composition of Pinus oocarpa wood cultivated in the Brazilian cerrado was established. The obtained results were: a-cellulose (59.05%), hemicelluloses A and B (21.22%), lignin (25.18%), dichloromethane extractives (2.78%), ethanol:toluene extractives (4.38%), hot water extractives (4.31%) and ash (1.26%). The cellulose content was high. This result opens perspectives for using Pinus oocarpa wood in pulp and paper industries. Most of the dichloromethane extractives were diterpenic, palmitic and oleic acids. The volatile composition, obtained by means of the Clevenger method followed by GC-MS analysis was constituted mainly by aromadendrene, ledane, hexadecanal and oleic acid