Study of a dual-mode array integrated in a multi-element transducer for imaging and therapy of prostate cancer

The development of endocavitary dual-mode probes is essential for the accurate treatment of many deep-seated cancers, which require a high imaging resolution and the capacity to selectively treat focal areas in the region of interest. The MULTIP project is aimed at using state-of-art piezoelectric technologies to design dual-mode ultrasonic probes for cancer-foci treatment and monitoring. In order to allow an efficient surgery planning, the technical study has been accompanied by a volume processing study permitting the design of the ultrasonic imaging/therapy process based on high-resolution–high-quality MRI images. Several prototypes were designed based on a simulation study and implemented: 1) two successive wide-band dual-mode transducer allowing imaging at high-resolution (6 MHz) on a wide field of view, and therapy at 3 MHz with a good transduction efficiency (48% and 70%); 2) a therapy-only transducer matrix adapted to the desired curvature with a high transduction efficiency (70%). Finally, a registration study of MRI volumes on ultrasound volumes has shown that, because of the texture of the ultrasound images, it is more efficient to search at registering the surfaces of the volumes once they have been segmented in each modality, rather than trying to register the two data volumes directly.     

Effect of long-term exposure of mice to 900 MHz GSM radiation on experimental cutaneous candidiasis

Mobile phones communicate with base stations using 900 MHz microwaves. The current study was aimed to survey the effects of long-term 900 MHz microwave exposure of mice on experimentally induced cutaneous candidiasis. Forty inbred, male, BALB/c mice were randomly divided into four groups. Cutaneous lesions with Candida albicans were experimentally induced on the lateral-back skin of the 20 mice. One group of the diseased mice were exposed (6 h per day and 7 d per week) to 900 MHz microwave radiation, while the other groups were not exposed. Two unexposed control groups were also included. The skin lesions were regularly monitored and the live candida cell density was enumerated using the colony-forming unit (CFU) assay. The process was repeated after a one week resting interval. One week later, all mice were challenged through intra tail veins using LD₉₀ dose of C. albicans. Mortality of the mice was recorded and the candida load of the kidney homogenates from died animals was counted. 900 MHz microwave exposed mice had 1.5 day and 3.7 day delays on wound healing in stages two. Live Candida inoculated Wave exposed (LCW) mice also showed higher yeast loads in skin lesions at days 5, 7 and 9 post inoculation. Survival analysis of live candida challenged mice showed the radiation exposed group is prone to death induced by systemic infection and candida enumeration from the kidney homogenates showed radiation exposed animals have had significantly higher yeast load in the tissue. In collection, long-term 900 MHz radiation exposure of mice led to longevity of skin wounds and susceptibility of the animals to systemic challenge and higher incidences of microorganisms in internal tissues.     

Place du scanner dans l’imagerie de l’hyperparathyroïdie primaire

Primary hyperparathyroidism is a biological diagnosis. The reference treatment is surgery. When minimally invasive surgery is considered, it is recommended to perform a cervical ultrasound and a scintigraphic examination to localize the hypertrophied parathyroid glands. The multiphasic scanner (4D CT) is a very effective examination to detect and locate precisely the parathyroid adenomas. The study of densities makes it possible to differentiate the adenoma from the thyroid and the lymph nodes that are the differential diagnoses. Without injection, the adenoma is more hypodense than the thyroid with a threshold set at 75 UH. On the early phase after injection, the adenoma appears very hypervascularized with a density > 114 UH. The ganglion appears hypovascularized with a density < 114 UH. In the late phase, there is a decrease in the density within the adenoma, while density within the ganglion increases. The parathyroid scan is indicated in case of negativity or discordance of the couple ultrasound scintigraphy. It is also strongly recommended, in case of persistence or recurrence of hyperparathyroidism after surgery, as well as to better study a parathyroid ectopy.     

Comparison of accuracy of ultrasonography,progesterone, and pregnancy-associated glycoprotein tests for pregnancy diagnosis in semidomesticated reindeer

The aim of the study was to compare transrectal ultrasound with progesterone (P4) and pregnancy-associated glycoproteins (PAGs) as pregnancy detection methods for semidomesticated reindeer (Rangifer tarandus tarandus) in field conditions. Female reindeer (n = 195) were scanned transrectally by a 7.5-MHz linear array transducer, and blood was sampled either in December 2005 (n = 33), December 2006 (n = 92), or January 2007 (n = 70) during early or mid gestation. Plasma levels of P4 and PAGs were assessed by radioimmunoassay (RIA). Based on calving records, the sensitivity, specificity, predictive values, and the overall accuracy of the three tests were calculated. The overall calving rate calculated from the calving records was 86.2%. The overall accuracy of transrectal ultrasound was 99.5%. The sensitivity and specificity of transrectal ultrasound were 99.4% and 100%, respectively. In the plasma P4 test, the threshold level of 5.0 nmol/L gave the highest overall accuracy (94.9%). The sensitivity of the P4 test decreased from 96.4% to 81.5%, when the threshold level increased from 5.0 nmol/L to 8.0 nmol/L, while the specificity remained at 85.2% over the range of these cutoff values. The overall accuracy of the plasma PAG test decreased from 96.4% to 64.1% when the plasma PAG threshold level increased from 0.5 ng/mL to 3.5 ng/mL, whereas sensitivity decreased from 99.4% to 58.3%. Specificity increased from 77.8% to 100% when the plasma PAG threshold level reached 3.0 ng/mL. Transrectal ultrasound showed higher diagnostic values than those of plasma P4-RIA and PAG-RIA in diagnosing pregnancy of reindeer, with the advantage that diagnoses can be made in real time in field conditions.     

Oestrus cycle characteristics and prediction of ovulation in Catalonian jennies

The Catalonian donkey breed is in danger of extinction, and much needs to be learned about the reproductive features of its females if breeding and conservation programmes are to be successful. This study reports the oestrous behaviour, oestrus cycle characteristics and dynamic ovarian events witnessed during 50 oestrous cycles (involving 106 ovulations) in 10 Catalonian jennies between March 2002 and January 2005. These jennies were teased, palpated transrectally and examined by ultrasound using a 5 MHz linear transducer—daily during oestrus and every other day during dioestrus. Predictors of ovulation were sought among the variables recorded.The most evident signs of oestrus were mouth clapping (the frequent vertical opening and closing of the mouth with ears depressed against the extended neck) and occasional urinating and winking of the vulval lips (homotypical behaviour). Interactions between jennies in oestrus were also recorded, including mounting, herding/chasing, the Flehmen response, and vocalization (heterotypical behaviour).Nine jennies ovulated regularly throughout the year; one had two anovulatory periods (54 and 35 days). The length of the oestrus cycle was 24.90 ± 0.26 days, with oestrus itself lasting 5.64 ± 0.20 days (mean ± S.E.M.) and dioestrus 19.83 ± 0.36 days. The incidence of single, double and triple ovulations was 55.66% (n = 59), 42.45% (n = 45) and 1.89% (n = 2), respectively. No significant difference was seen in the number of ovulations involving the left and right ovaries (52.63% [n = 70] compared to 47.37% [n = 63] respectively; P > 0.05). The mean interval between double ovulation was 1.44 ± 3.98 days. The mean diameter of the preovulatory follicle at day −1 was 44.9 ± 0.5 mm; the mean growth rate over the 5 days before ovulation was 3.7 mm/day.Data on preovulatory changes in oestrous behaviour, follicle size, follicle texture, the echographic appearance of the follicle and uterus, and uterine tone were subjected to stepwise logistic regression analysis to detect predictors of ovulation. The logit function showed the best predictors to be follicle size, follicular texture and oestrous behaviour. Certain combinations of these three variables allow the prediction of ovulation within 24 h with a probability of >75%.     

Évaluation par la TEMP–TDM des lésions classées indéterminées en scintigraphie osseuse chez les patients de cancérologie

The aim of the present study was to investigate the contribution of the single photon emission computed tomography/computed tomography (SPECT/CT) in cancer patients and to evaluate its ability to correctly classify indeterminate lesions on planar bone scintigraphy (PBS).MethodsFrom November 2006 to August 2007, all patients with confirmed malignancy, whose PBS showed indeterminate lesions, underwent without delay a SPECT/CT. The study included 120 patients (67 men, 53 women), with a mean age of 69 ± 12 years (range 42–96 years). The patients with obvious metastases, important pains or who did not accept the examination were excluded from the study. The location of the lesions was described either as precise, probable or indeterminate. The lesions were classified either as definitely malignant, definitely benign or indeterminate.ResultsBreast, prostate, lung and kidney neoplasms represented approximately 80% of all cancers. The PBS highlighted 267 lesions of location either as precise (n = 29), probable (n = 129) or indeterminate (n = 109), classified either as definitely malignant (n = 28), definitely benign (n = 27) or indeterminate (n = 212). The SPECT/CT revealed 440 lesions, of location either as precise (n = 353), likely (n = 39) or indeterminate (n = 48), classified either as definitely malignant (n = 84), definitely benign (n = 305) or indeterminate (n = 51). Thoracic and lumbar spine and pelvis were the locations of 79% of the scintigraphic lesions and of 88% of the osseous metastases. SPECT/CT modified the final report of 80 patients, by excluding from metastases (n = 2), by showing metastases (n = 23) and by showing the benign character of indeterminate lesions (n = 55). Moreover, 69 patients out of 120 (> 57%) had an evolution confirmed with 35 true positives, 31 true negatives, one false negative and two patients with indeterminate lesions on SPECT/CT, without osseous metastasis.ConclusionThe assessment of the indeterminate scintigraphic lesions of oncologic patients benefits from the SPECT/CT. The lesion-based analysis showed that the SPECT/CT detected more lesions (+64%) and correctly classified 88% of the detected lesions. The patient-based analysis highlighted that SPECT/CT modified the final report for more than 66% of the patients. The follow-up showed that SPECT/CT correctly classified for more than 95% of the patients.     

Asynchronisme cardiaque chez le sujet à QRS fin. Étude par échocardiographie Doppler tissulaire

ObjectiveTo assess the prevalence of different types of cardiac dyssynchrony by pulsed Doppler ultrasound and Doppler tissue in patients with narrow QRS with or without left ventricular systolic dysfunction.MethodologyProspective, cross-sectional survey at the Institute of Cardiology of Abidjan, from January to April 2012, in subjects with narrow QRS. Group 1: patients with dilated cardiomyopathy with severe left ventricular dysfunction (left ventricular end diastolic diameter greater than 60 mm and/or 30 mm/m² and ejection fraction less than 35% NYHA stage IV). Group 2: normal subjects with normal echocardiography. All patients underwent an evaluation including tissue Doppler search for different types of dyssynchrony (atrioventricular, interventricular and left intraventricular).ResultsPatients in group 1 were significantly older (51.5 ± 15.8 vs. 35.8 ± 7.8, P = 0.03), with larger left ventricular diameters and significantly higher pulmonary systolic pressure. The prevalence of different types of dyssynchrony in group 1 were: atrioventricular dyssynchrony 43.7%, interventricular dyssynchrony 37.5%, left ventricular dyssynchrony 65.6%. Group 2: atrioventricular dyssynchrony 0%, interventricular dyssynchrony 0%, left ventricular dyssynchrony 35%.ConclusionA large proportion of patients with left ventricular systolic dysfunction and narrow QRS have cardiac dyssynchrony and left ventricular dyssynchrony can be found in healthy patients. This raises the problem of the specificity of Doppler ultrasound criteria using cardiac tissue Doppler to assess cardiac dyssynchrony.     

Modélisation des flux cérébraux par une analogie électrique : validation par vélocimétrie IRM

The cine Phase-Contrast Magnetic Resonance (PCMR) sequence is the only noninvasive technique for the study of cerebrospinal fluid (CSF) oscillations. It can provide CSF and blood flow measurements throughout the cardiac cycle. To study cerebral hydro-hemodynamic, models have been developed; nevertheless the majority of these models did not take into account the CSF oscillations. The objective of this study was to establish reference values for cerebral hydro-hemodynamic and propose a new electrical model of the brain dynamics.Material and methodsCSF and blood flows were measured in 19 control subjects by PCMR imaging. Dynamic flow images were analyzed on dedicated software to reconstruct the flow curves during the cardiac cycle. An electrical analogue was realized. The inputs of the model were fed by PCMR arterial and venous flows to simulate CSF oscillations. The simulated CSF oscillations were compared to the measured CSF oscillations to validate the model.ResultsThe key parameters of the CSF and blood flow curves were obtained, e.g. total cerebral blood flow was 688 ± 115 mL/min, ventricular CSF oscillatory volume was 0.05 ± 0.02 mL/cardiac cycle, and the subarachnoid CSF oscillatory volume was 0.55 ± 0.15 mL/cardiac cycle. A close agreement was found between measured and simulated cerebral CSF oscillations.ConclusionThis study established the main values characterizing cerebral hydrodynamics in a control population. It provided a better understanding of the mechanisms of intracranial volumes regulation during the cardiac cycle. Our results are now used in clinical practice and the model proposed is effective to study cerebral hydro-hemodynamic.     

The use of bioimpedance in the detection/screening of tongue cancer

Oral cancers are the 11th most common malignancy reported worldwide, accounting for 3% of all newly diagnosed cancer cases, and one with high mortality ratios among all malignancies. The objectives of this study were therefore to study the electrical properties of cancerous tongue tissue and normal tongue tissue, as well as to investigate a new approach for low-cost, noninvasive, and real-time screening of oral cancer. Twelve tongue cancer patients and twelve healthy subjects participated in this study. A disposable probe with four silver electrodes was used to measure the electrical properties of patient's and healthy subject's tongue tissues at six different frequencies, which were 20 Hz, 50 kHz, 1.3 MHz, 2.5 MHz, 3.7 MHz and 5 MHz. The amplitude of the applied voltage was limited to 200 mV. Four measurement parameters of impedance, phase angle, real part of impedance, and imaginary part of impedance of tongue were assessed to see if significant difference in values obtained in patient's and healthy subject's tongue tissues existed. Intraclass correlation coefficient showed that all measurements had good reliability and validity (ICC > 0.95 for all measurements). Significant differences were found at 20 Hz (p < 0.05–0.001 for the four measurement parameters) and 50 kHz (p < 0.001 for the four measurement parameters) between patient's and healthy subject's tongue tissues. In conclusion, bioimpedance at a particular frequency is a potentially promising technique for tongue cancer screening.     

Computational assessment of model-based wave separation using a database of virtual subjects

The quantification of arterial wave reflection is an important area of interest in arterial pulse wave analysis. It can be achieved by wave separation analysis (WSA) if both the aortic pressure waveform and the aortic flow waveform are known. For better applicability, several mathematical models have been established to estimate aortic flow solely based on pressure waveforms. The aim of this study is to investigate and verify the model-based wave separation of the ARCSolver method on virtual pulse wave measurements.The study is based on an open access virtual database generated via simulations. Seven cardiac and arterial parameters were varied within physiological healthy ranges, leading to a total of 3325 virtual healthy subjects. For assessing the model-based ARCSolver method computationally, this method was used to perform WSA based on the aortic root pressure waveforms of the virtual patients. As a reference, the values of WSA using both the pressure and flow waveforms provided by the virtual database were taken.The investigated parameters showed a good overall agreement between the model-based method and the reference. Mean differences and standard deviations were −0.05 ± 0.02 AU for characteristic impedance, −3.93 ± 1.79 mmHg for forward pressure amplitude, 1.37 ± 1.56 mmHg for backward pressure amplitude and 12.42 ± 4.88% for reflection magnitude.The results indicate that the mathematical blood flow model of the ARCSolver method is a feasible surrogate for a measured flow waveform and provides a reasonable way to assess arterial wave reflection non-invasively in healthy subjects.     

Real-time assessment of flow reversal in an eccentric arterial stenotic model

Plaque rupture is the leading cause of acute coronary syndromes and stroke. Plaque formation, otherwise known as stenosis, preferentially occurs in the regions of arterial bifurcation or curvatures. To date, real-time assessment of stenosis-induced flow reversal remains a clinical challenge. By interfacing microelectromechanical system (MEMS) thermal sensors with the high frequency pulsed wave (PW) Doppler ultrasound, we proposed to assess flow reversal in the presence of an eccentric stenosis. We developed a 3-D stenotic model (inner diameter of 6 mm, an eccentric stenosis with a height of 2.75 mm, and width of 21 mm) simulating a superficial arterial vessel. We demonstrated that heat transfer from the sensing element (2×80 μm²) to the flow field peaked as a function of flow rates at the throat of the stenosis along the center/midline of arterial model, and dropped downstream from the stenosis, where flow reversal was detected by the high frequency ultrasound device at 45 MHz. Computational fluid dynamics (CFD) codes are in agreement with the ultrasound-acquired flow profiles upstream, downstream, and at the throat of the stenosis. Hence, we characterized regions of eccentric stenosis in terms of changes in heat transfer along the midline of vessel and identified points of flow reversal with high spatial and temporal resolution.     

Elevated circulating inflammatory markers in female patients with cardiac syndrome X

Background. The pathophysiological mechanism in cardiac syndrome X has been suggested as impairment in normal endothelial function of the coronary microvasculature, resulting in inadequate flow reserve. However, despite the extensive studies, the precise mechanisms in cardiac syndrome X remain unclear. Purpose. The present study was, therefore, to investigate whether inflammatory cells and markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) might be involved in the pathogenesis of cardiac syndrome X. Methods. Thirty-six female patients with cardiac syndrome X and 30 sex-matched normal controls were prospectively enrolled in this study. Blood samples were drawn for measuring white blood and monocyte cells, inflammatory markers such as CRP and IL-6, and data were compared between patients with cardiac syndrome X and normal controls. Results. The data showed that increased numbers of white blood and monocyte cells were found in patients with cardiac syndrome X compared with normal controls (white blood cells: 7072 ± 1146/mm³ vs. 6138 ± 1079/mm³; monocyte cells: 612 ± 186/mm³ vs. 539 ± 190/mm³ p < 0.05, respectively). Moreover, patients with cardiac syndrome X were detected to have significantly higher plasma CRP and IL-6 levels in comparison with patients with normal controls (CRP: 0.48 ± 0.26 mg/L vs. 0.22 ± 0.15 mg/L; IL-6: 13.4 ± 1.2 pg/dl vs. 6.2 ± 0.6 pg/dl, p < 0.01, respectively). The multivariate analysis showed that CRP was the independent variable most strongly associated with cardiac syndrome X. Conclusions. Our data suggested that low-grade, chronic inflammation might contribute to the development of cardiac syndrome X manifested by increased plasma levels of inflammatory cells and inflammatory markers.     

High-field MR spectroscopy in the multiparametric MRI evaluation of breast lesions

IntroductionThe aim of this work was to assess the role of 3T-MR spectroscopy (MRS) in the multi-parametric MRI evaluation of breast lesions, using a pattern-recognition based classification method.Methods291 patients (301 lesions, median 2.3 cm³) were enrolled in the study (age 18–85 y, mean 54.2 y). T1-TSE (TR/TE = 400/10 ms) and T2-STIR imaging (TR/TE = 5000/60 ms), dynamic-contrast-enhanced MRI (DCE-MRI), apparent diffusion coefficient (ADC) (b = 0–800 s/mm²), and single-voxel MRS (10 × 10 × 10 mm³, PRESS, TR/TE = 3000 ms/135 ms) were performed by means of a 3T scanner. MRS results were accepted if the FWHM of the water peak was ⩽45 Hz. Total choline (tCho) was considered detected if the signal-to-noise ratio (SNR) of the 3.2 ppm peak was ⩾2. A classifier-based analysis (support-vector-machines, SVM) was performed with 4-dimensional vectors including type of margin, DCE-MRI kinetic curve type, ADC mean value, and tCho SNR. A comparison with 3-dimensional vectors (without tCho SNR) was used to assess MRS impact on sensitivity, specificity, and positive-negative predictive values (PPV-NPV) for malignancy.Results228 lesions (180 malignant/48 benign) showed acceptable spectral quality. Comparison of classification results with histopathological examination of surgical specimens showed sensitivity = 93.7%, specificity = 84.9%, PPV = 95.2%, NPV = 81.5% without the inclusion of MRS in the SVM analysis. When MRS was included, the figures increased to 95.1%, 90.7%, 97.2%, and 85.0%, respectively.ConclusionsInclusion of 3T-MRS in the multi-parametric MRI evaluation of breast lesions improved the performance of the SVM-based classifier, showing a possible role of high-field MR spectroscopy in the differential diagnosis between benign and malignant breast lesions. Further research is however needed to confirm this initial evidence.     

Ultrasound assisted lipase catalysed synthesis of isoamyl butyrate

The present work illustrates the incorporation of ultrasound and its improved impact in the lipase catalysed esterification. Synthesis of isoamyl butyrate from isoamyl alcohol and butyric acid using immobilised Novozym 435, has been carried out in the presence of ultrasound. The optimisation of various parameters affecting the synthesis of ester in presence of ultrasound was done. The systematic experimentation involves change of one working parameter at one time while keeping the others constant. For the maximum conversion, optimum parameters such as the ultrasound of 25 kHz frequency with power of 70 W, at the temperature of 60 °C with stirring speed of 80 rpm, mole ratio of alcohol:acid followed as 2:1, use of molecular sieves weighing 2 g, with immobilised enzyme loading of 2% (m/v) and duty cycle of 83%, were obtained. The optimum parameters collectively, gave 96% conversion of the product in 3 h as compared with 10 h in absence of ultrasound. The immobilised biocatalyst, Novozym 435 has an added benefit of reusability till 7 repetitive cycles. Besides, the synthesis is executed in the solvent free system that contributes the production of flavour in greener way.     

The effect of glucagon-like peptide-2 on arterial blood flow and cardiac parameters

BackgroundGlucagon-like peptide-2 (GLP-2) is known to increase mesenteric blood flow. The aim of the study was to evaluate the effect of GLP-2 on blood flow in different vascular sites, and dynamic changes in cardiac parameters.Methods10 healthy volunteers were given 450 nmol subcutaneous (SC) GLP-2 or isotonic saline (5 subjects) in a single blinded manner. During the following 90 min, blood flow in the superior mesenteric artery (SMA), celiac artery (CA), renal artery (RA), common carotid artery (CCA) was measured using Doppler ultrasound (US), and cardiovascular variables were measured by impedance cardiography and finger plethysmography. Plasma GLP-2 was measured at times 0, 30 and 60 min.ResultsCompared to the placebo group, GLP-2 elicited a 27% decrease in the resistance index (RI) and a 269.4% increase in Time Averaged Maximal Velocity (TAMV) in the SMA (P < 0.01). CA, RA and CCA: There were no significant changes in RI or TAMV in the GLP-2 or placebo group, and no change in CA diameter.Cardiac parameters: GLP-2 increased cardiac output (CO), stroke volume (SV) and heart rate (HR) compared to baseline (respectively: 15.3, 4.81 and 8.2% (P < 0.001, P < 0.01 and P < 0.01)). The CO, SV and HR changes were not significantly different from the placebo group.Mean plasma GLP-2 serum levels in the placebo group at times 0, 30 and 60 min were 22.8, 23.4 and 23.2 pmol/l. In the GLP-2 group 20.3, 1273 and 1725 pmol/l.ConclusionSC GLP-2 increased SMA blood flow, as previously shown, but elicited no changes in other vascular sites. CO and HR increased significantly, presumably due to the increased mesenteric blood flow.     

Optimization of 18F-Choline PET/CT acquisition in prostate cancer: Preliminary results concerning the length of the acquisition

ObjectiveFCH-PET/CT protocol for prostate cancer assessment consists of an early and late acquisition. Concerning the early acquisition, this study compares contrast-to-noise ratio of tumoral lesions between 5 and 10 minutes post-injection in order to shorten the time of this early acquisition.Materials and methodsPatients with proven prostate cancer referred for initial staging or recurrence were prospectively included. Patients underwent 10 minutes of pelvic dynamic acquisition for the early phase and late phase was performed at 60 minutes post-injection. Contrast-to-noise of lesions at 5 and 10 min post-injection were compared.ResultsForty-nine patients with 77 lesions were analyzed. No significant difference of prostatic lesions contrast-to-noise ratio was found between 5 min and 10 min post-injection (median contrast-to-noise ratio was respectively 38 and 42, P = 0.128).ConclusionThese results could have an impact on clinical practice with FCH-PET/CT early acquisition shortened to 5 min post-injection for patients with prostate cancer.     

The predictive value of plasma catestatin for all-cause and cardiac deaths in chronic heart failure patients

Catestatin (CST) is a proteolytic fragment of Chromogranin A with a broad spectrum of activities in the cardiovascular system. The level of plasma CST increases in chronic heart failure patients, but its potential relationship to patient prognosis is unknown. In this study, we measured plasma CST levels in 202 chronic heart failure patients and followed them for a median of 52.5 months. The plasma CST level was higher in patients with all-cause death and cardiac death than in survivors. According to univariate COX regression, higher plasma CST levels predicted increased risk of all-cause and cardiac death. After adjustment for other confounding factors, plasma CST was an independent risk factor for both outcomes, and the hazard ratios (HRs) were 1.84 (95% CI: 1.02–3.32, p = 0.042) and 2.41 (95% CI: 1.26–4.62, p = 0.008) for all-cause death and cardiac death, respectively. The new risk-predictive model considering CST was superior to the previous model for both outcomes by ANOVA and likelihood ratio tests (p = 0.040 and p = 0.008, respectively). Concurrent increases in plasma BNP (B-type natriuretic peptide) and CST levels predicted the highest risk for both all-cause and cardiac deaths [HR = 5.18 (95% CI: 1.94–13.87, p = 0.001) and HR = 9.19 (95% CI: 2.75–30.78, p < 0.001), respectively]. Large-scale studies are needed to further assess the value of plasma CST in predicting heart failure prognosis.