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Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

  • Yubo Guo;Xiao Li;Yajuan Gao;Kaini Shen;Lu Lin;Jian Wang;Jian Cao;Zhuoli Zhang;Ke Wan;Xi Yang Zhou;Yucheng Chen;Long Jiang Zhang;Jian Li;Yining Wang
    • Korean Journal of Radiology
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    • v.25 no.5
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    • pp.426-437
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    • 2024
  • Objective: Cardiac magnetic resonance (CMR) is a diagnostic tool that provides precise and reproducible information about cardiac structure, function, and tissue characterization, aiding in the monitoring of chemotherapy response in patients with light-chain cardiac amyloidosis (AL-CA). This study aimed to evaluate the feasibility of CMR in monitoring responses to chemotherapy in patients with AL-CA. Materials and Methods: In this prospective study, we enrolled 111 patients with AL-CA (50.5% male; median age, 54 [interquartile range, 49-63] years). Patients underwent longitudinal monitoring using biomarkers and CMR imaging. At follow-up after chemotherapy, patients were categorized into superior and inferior response groups based on their hematological and cardiac laboratory responses to chemotherapy. Changes in CMR findings across therapies and differences between response groups were analyzed. Results: Following chemotherapy (before vs. after), there were significant increases in myocardial T2 (43.6 ± 3.5 ms vs. 44.6 ± 4.1 ms; P = 0.008), recovery in right ventricular (RV) longitudinal strain (median of -9.6% vs. -11.7%; P = 0.031), and decrease in RV extracellular volume fraction (ECV) (median of 53.9% vs. 51.6%; P = 0.048). These changes were more pronounced in the superior-response group. Patients with superior cardiac laboratory response showed significantly greater reductions in RV ECV (-2.9% [interquartile range, -8.7%-1.1%] vs. 1.7% [-5.5%-7.1%]; P = 0.017) and left ventricular ECV (-2.0% [-6.0%-1.3%] vs. 2.0% [-3.0%-5.0%]; P = 0.01) compared with those with inferior response. Conclusion: Cardiac amyloid deposition can regress following chemotherapy in patients with AL-CA, particularly showing more prominent regression, possibly earlier, in the RV. CMR emerges as an effective tool for monitoring associated tissue characteristics and ventricular functional recovery in patients with AL-CA undergoing chemotherapy, thereby supporting its utility in treatment response assessment.

Evaluation of Parameters of Gas Exchange During Partial Liquid Ventilation in Normal Rabbit Lung (토끼의 정상 폐 모델에서 부분액체환기 시 가스교환에 영향을 주는 인자들에 대한 연구)

  • An, Chang-Hyeok;Koh, Young-Min;Park, Chong-Wung;Suh, Gee-Young;Koh, Won-Jung;Lim, Sung-Yong;Kim, Cheol-Hong;Ahn, Young-Mee;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.1
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    • pp.14-23
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    • 2002
  • Background: The opitmal ventilator setting during partial liquid ventilation(PLV) is controversial. This study investigated the effects of various gas exchange parameters during PLV in normal rabbit lungs in order to aid in the development of an optimal ventilator setting during PLV. Methods: Seven New-Zealand white rabbits were ventilated in pressure-controlled mode with the following settings; tidal volume($V_T$) 8 mL/kg, positive end-expiratory pressure(PEEP) 4 $cmH_2O$, inspiratory-to-expiratory ratio(I:E ratio) 1:2, fraction of inspired oxygen($F_TO_2$) 1.0. The respiration rate(RR) was adjusted to keep $PaCO_2$ between 35~45 mmHg. The ventilator settings were changed every 30 min in the following sequence : (1) Baseline, as the basal ventilator setting, (2) Inverse ratio, I:E ratio 2:1, (3) high PEEP, adjust PEEP to achieve the same mean inspiratory pressure (MIP) as in the inverse ratio, (4) High $V_T$, $V_T$ 15 mL/kg, (5) high RR, the same minute ventilation (MV) as in the High $V_T$. Subsequently, the same protocol was repeated after instilling 18 mL/kg of perfluorodecalin for PLV. The parameters of gas exchange, lung mechanics, and hemodynamics were examined. Results: (1) The gas ventilation(GV) group showed no significant changes in the $PaO_2$ at all phases. The $PaCO_2$ was lower and the pH was higher at the high $V_T$ and high RR phases(p<0.05). No significant changes in the lung mechanics and hemodynamics parameters were observed. (2) The baseline $PaO_2$ for the PLV was $312{\pm}$ mmHg. This was significantly lower when decreased compared to the baseline $PaO_2$ for GV which was $504{\pm}81$ mmHg(p=0.001). During PLV, the $PaO_2$, was significantly higher at the high PEEP($452{\pm}38$ mmHg) and high $V_T$ ($461{\pm}53$ mmHg) phases compared with the baseline phase. However, it did not change significantly during the inverse I:E ratio or the high RR phases. (3) The $PaCO_2$ was significantly lower at high $V_T$ and RR phases for both the GV and PLV. During the PLV, $PaCO_2$ were significantly higher compared to the GV (p<0.05). (4) There were no important or significant changes in of baseline and high RR phases lung mechanics and hemodynamics parameters during the PLV. Conclusion: During PLV in the normal lung, adequate $V_T$ and PEEP are important for optimal oxygenation.

Studies on the Physical Properties of Major Tree Barks Grown in Korea -Genus Pinus, Populus and Quercus- (한국산(韓國産) 주요(主要) 수종(樹種) 수피(樹皮)의 이학적(理學的) 성질(性質)에 관(關)한 연구(硏究) -소나무속(屬), 사시나무속(屬), 참나무속(屬)을 중심(中心)으로-)

  • Lee, Hwa Hyoung
    • Journal of Korean Society of Forest Science
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    • v.33 no.1
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    • pp.33-58
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    • 1977
  • A bark comprises about 10 to 20 percents of a typical log by volume, and is generally considered as an unwanted residue rather than a potentially valuable resourses. As the world has been confronted with decreasing forest resources, natural resources pressure dictate that a bark should be a raw material instead of a waste. The utilization of the largely wasted bark of genus Pinus, Quercus, and Populus grown in Korea can be enhanced by learning its physical and mechanical properties. However, the study of tree bark grown in Korea have never been undertaken. In the present paper, an investigative study is carried out on the bark of three genus, eleven species representing not only the major bark trees but major species currently grown in Korea. For each species 20 trees were selected, at Suweon and Kwang-neung areas, on the same basis of the diameter class at the proper harvesting age. One $200cm^2$ segment of bark was obtained from each tree at brest height. Physical properties of bark studied are: bark density, moisture content of green bark (inner-, outer-, and total-bark), fiber saturation point, hysteresis loop, shrinkage, water absorption, specific heat, heat of wetting, thermal conductivity, thermal diffusivity, heat of combustion, and differential thermal analysis. The mechanical properties are studied on bending and compression strength (radial, longitudinal, and tangential). The results may be summarized as follows: 1. The oven-dry specific gravities differ between wood and bark, further more even for a given bark sample, the difference is obersved between inner and outer bark. 2. The oven-dry specific gravity of bark is higher than that of wood. This fact is attributed to the anatomical structure whose characters are manifested by higher content of sieve fiber and sclereids. 3. Except Pinus koraiensis, the oven-dry specific gravity of inner bark is higher than that of outer bark, which results from higher shrinkage of inner bark. 4. The moisture content of bark increases with direct proportion to the composition ratio of sieve components and decreases with higher percent of sclerenchyma and periderm tissues. 5. The possibility of determining fiber saturation point is suggested by the measuring the heat of wetting. With the proposed method, the fiber saturation point of Pinus densiflora lies between 26 and 28%, that of Quercus accutissima ranges from 24 to 28%. These results need be further examined by other methods. 6. Contrary to the behavior of wood, the bark shrinkage is the highest in radial direction and the lowest in longitudinal direction. Quercus serrata and Q. variabilis do not fall in this category. 7. Bark shows the same specific heat as wood, but the heat of wetting of bark is higher than that of wood. In heat conductivity, bark is lower than wood. From the measures of oven-dry specific gravity (${\rho}d$) and moisture fraction specific gravity (${\rho}m$) is devised the following regression equation upon which heat conductivity can be calculated. The calculated heat conductivity of bark is between $0.8{\times}10^{-4}$ and $1.6{\times}10^{-4}cal/cm-sec-deg$. $$K=4.631+11.408{\rho}d+7.628{\rho}m$$ 8. The bark heat diffusivity varies from $8.03{\times}10^{-4}$ to $4.46{\times}10^{-4}cm^2/sec$. From differential thermal analysis, wood shows a higher thermogram than bark under ignition point, but the tendency is reversed above ignition point. 9. The modulus of rupture for static bending strength of bark is proportional to the density of bark which in turn gives the following regression equation. M=243.78X-12.02 The compressive strength of bark is the highest in radial direction, contrary to the behavior of wood, and the compressive strength of longitudinal direction follows the tangential one in decreasing order.

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