Clinical Evaluation of Heart Failure: Agreement among Tests

<div><p>Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available.</p></div

Characteristics of Study Population (n = 56).

<p>Characteristics of Study Population (n = 56).</p

Selected Graphs of Correlations Between Tests of LV Function.

<p>Graphs represent Pearson’s correlations, with p-values and correlation coefficients (r) listed. EF, Ejection Fraction; ETT, Exercise Treadmill Test; LV, Left Ventricular.</p

Linear Regressions Among Markers of Heart Function.

<p>Linear Regressions Among Markers of Heart Function.</p

Mean Values of Key Measures of LV Function (n = 56).

<p>Mean Values of Key Measures of LV Function (n = 56).</p

Change in flavin oxidoreductase activity of the purified MelF (blue bars) and WCL (red bars) in presence of inhibitors as compared to control (enzyme activity in the absence of inhibitors).

<p>Values were mean ± SD of two replicates. Among 20 inhibitors tested, 16 showed significant inhibition (P < 0.05) in enzyme activity in comparison to control; while inhibitors ^#,* revealed no inhibitory effect (P > 0.05).</p

Determination of cytotoxicity of the inhibitors by MTT cytotoxicity assay.

<p>Survival of HeLa cells in the presence of 1X and 5X MIC concentrations of inhibitors. INH was taken as a positive control. The experiments were done in duplicate and the data was represented as mean ± SD.</p

Remesas y economía familiar en El Salvador, Guatemala y Nicaragua

Incluye Bibliografía. Versión preliminar al documento LC/MEX/L.154.Presenta una visión comparativa de los resultados de los estudios sobre la dinámica de las remesas internacionales y propone líneas de acción para fomentar el uso productivo de las remesas con fines sociales

Post-docking interactions between targeted site residues of MelF protein with compounds.

<p>The protein is depicted in transparent surface view, whereas FMN (green sticks for carbon atoms) and compounds [black sticks for carbon atoms; (A) # 5175552 (B) # 5255825 (C) # 5255829 (D) # 6492687 (E) # 6513745 (F) # 9125618] within the binding pocket. The interacting amino acids are also shown as sticks (grey color for carbon atoms). Rests of the atoms are colored as per convention.</p

Expression and purification of MelF protein using pMAL-c5x vector.

<p>(A) SDS-PAGE showing over-expressed MBP-tagged MelF protein for WCL (lane 1) and whole bacterial suspension (lane 2). (B) Western blot analysis for WCL (lane 1) and whole bacterial suspension (lane 2) for over-expressed MBP-tagged MelF Protein; M represents protein marker.</p