Annular Velocity Research Articles

Cardiohemodynamic Changes and Cardiac Arrhythmias After Coronavirus Infection

Aim To study changes in cardiohemodynamic alterations of the myocardium and heart rhythm disorders at 3 and 6 months following the coronavirus infection.Material and methods EchoCG, ECG Holter monitoring, and Doppler ultrasonography of hepatolienal blood vessels were performed for 77 patients (mean age, 35.9 years) at 3 and 6 months after coronavirus infection. The patients were divided into the following groups: group 1, with injury of the upper respiratory tract; group 2, with bilateral pneumonia (CТ1, 2), and group 3, with severe pneumonia (CТ3, 4). Statistical analysis was performed with a SPSS Statistics Version 25.0 software package.Results At 6 months after the disease onset, the patients noted an improvement of their general condition. In patients with moderate pneumonia, early peak diastolic velocity (p=0.09), right ventricular isovolumic diastolic time (р=0.09), and pulmonary artery systolic pressure (р=0.005) where decreased, while tricuspid annular peak systolic velocity was, in contrast, increased (р=0.042). Both segmental systolic velocity of the LV mid-inferior segment (р=0.006) and the mitral annular Em / Am ratio were decreased. In patients with severe disease at 6 months, right atrial indexed volume was reduced (р=0.036), tricuspid annular Em / Am was decreased (р=0.046), portal and splenic vein flow velocities were decreased, and inferior vena cava diameter was reduced. Late diastolic transmitral flow velocity was increased (р=0.027), and LV basal inferolateral segmental systolic velocity was decreased (р=0.046). In all groups, the number of patients with heart rhythm disorders was decreased, and parasympathetic autonomic influences prevailed.Conclusion At 6 months after coronavirus infection, practically all patients noted improvement of their general condition; incidence rate of arrhythmia and cases of pericardial effusion were decreased; and autonomic nervous system activity recovered. In patients with moderate and severe disease, morpho-functional parameters of the right heart and the hepatolienal blood flow were normalized, however, occult disorders of LV diastolic function remained, and LV segmental systolic velocity was reduced.

Abstract P550: Genome-Wide Association Analysis Identified Genetic Variants Associated With Cardiac Structure and Function in the Hispanic Community Health Study/Study of Latinos

Introduction: The role of genetic variants on cardiac structure and function among the Hispanic/Latino population is unclear. Hypothesis: We hypothesize that common genetic variants are associated with cardiac structure and function measures in the Hispanic/Latino population. Methods: We performed genome-wide association analyses of nine echo measures among individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), including: left ventricular end-systolic volume (LVESV), LV end-diastolic volume, mean wall thickness, LV mass index, LV ejection fraction (LVEF), stroke volume (SV), septal early mitral annular velocity, ratio of early ventricular filling peak velocity to early mitral annular velocity, and left atrial volume index. We further conducted enrichment analysis to locate candidate gene pathways and performed replication using data from UK BioBank (UKB) and BioBank of Japan (BBJ). Results: We included 4471 Hispanic/Latino participants from two sub-cohorts of HCHS/SOL (mean age 55 and 59, 68% female). Fourteen previously unreported variants at 3 loci were associated with LVEF, SV, or LVESV (p-value < 5х10 -8 , Figure ). Twelve of the 14 variants were associated with LVEF, located on or nearby ncRNA gene LOC105374813 , as well as 1 SNP on gene IPO5 with SV and 1 SNP on gene PGBD5 with LVESV. There were 199 variants that reached suggestive significance (p<5х10 -7 ) for nine measures, with most SNPs had effect directions consistent compared to UKB and BBJ findings. FUMA enrichment analysis showed SNP associated with SV on IPO5 had higher expression in kidney, liver, and heart tissue compared to other tissues. For variants associated with LVEF, eQTL analysis with heart tissue showed that gene RP11-342K6.2 and GCFC2 had chromatin interaction in the region. Conclusions: We identified 14 loci associated with cardiac structure and function among Hispanics/Latinos, providing supporting evidence of genetic contribution to cardiac dysfunction in Hispanic/Latino populations.

Right ventricular function assessment by 3D echocardiography and 2D speckle-tracking imaging in acute pulmonary embolism

Objective: To assess changes in right ventricular (RV) function parameters determined by three-dimensional (3D) echocardiography and two-dimensional (2D) speckle-tracking echocardiography in patients with acute pulmonary embolism without systemic hypotension, as compare to a control population. Subject and method: Fifty-seven intermediate-high risk pulmonary embolism patients were prospectively studied at the onset of the acute episode and after median follow-up periods of 30 days. A control group of age-and sex-matched subjects were selected. All patients and the controls underwent 2D and 3D transthoracic echocardiography within 24 hours of pulmonary embolism diagnosis and one month after hospital discharge. Tricuspid annular peak systolic velocity (s’), tricuspid annular plane systolic excursion (TAPSE), RV diameter, RV fractional area change (FAC), 3D RV ejection fraction (EF), 2D RV global strain and RV free wall strain were measured. Result: From Dec. 2019 to March 2022, fifty-seven patients with acute intermediate-high risk of early mortality PE were included. Mean age was 56 ± 14 years. Men accounted for 47.4% (27/57). Control group consisted of 34 subjects. Pulmonary embolism patients initially had RV dysfunction as assessed by 2D and 3D parameters: RV diameter: 29.3 ± 4.6mm; TAPSE: 14.6 (9.1-15.7) mm; FAC: 31.5 (30.5-39.9)%; 3DRVEFL 31.9 ± 7.7%; RVGS: -9.8 ± 3%, RVFWS: -8.9 ± 3.3%. At 30-day follow-up: s’, TAPSE, RV diameter, RV FAC were restored compared to the control group, systolic pulmonary artery pressures decreased significantly, right atrial pressure, also decreased significantly at follow-up, contrary to 3DRVEF and RV 2D global strain and free wall strain. Conclusion: After 1 month of anticoagulant therapy in patients with intermediate-high risk pulmonary embolism, RV function has not fully recovered as assessed by 3D RVEF and 2D strain imaging, while the traditional echocardiographic assessment could not detect this incomplete recovery. Further studies are needed to assess the prognostic role and implications of this residual 3DRVEF and 2D RV strain impairment after PE.

Diastolic stress test in assessing functional state of postinfarction myocardium

Taking into account the conflicting literature data and the ambiguity in the interpretation of parameters of diastolic heart function in patients with coronary heart disease, we conducted an analysis of diastolic heart function in patients after myocardial infarction at the outpatient rehabilitation stage. Aim of the study was to investigate the diagnostic information content and the feasibility of diastolic stress testing to assess the functional condition of postinfarction myocardium. Material and methods. 86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with coronary artery stenting ad hoc. The control group consisted of 10 healthy volunteers. Structural and functional examination of the heart was performed at rest and immediately after exercise using stress echocardiography. Results and discussion. Patients after myocardial infarction have a larger indexed volume of the left atrium (30.71 ± 8.88 vs. 20.49 ± 4.04 ml/m2) and an E/e` ratio (8.45 ± 3.27 vs. 6.46 ± 1.42) in comparison with the control group. 38 (62.3 %) patients with normal left ventricular (LV) ejection fraction (EF) had unimpaired LV diastolic function, 19 (31.1 %) and 2 (3.3 %) patients had type 1 and type 2 diastolic dysfunction, respectively, 2 patients (3,3 %) had an indeterminate result. Patients with reduced LV EF have a significantly lower early diastolic mitral annular velocity (e`). The diastolic stress test revealed a significant post-exercise increase in E/e` in only one patient (from 8.92 to 18.37), who also had an initially reduced EF (32 %). The stress test showed no significant changes in diastolic heart parameters after exercise in patients suffering from heart failure with preserved EF, which may indicate relatively good diastolic reserves of the heart. Conclusions. Myocardial infarction is accompanied by the presence of LV diastolic dysfunction in 53,5 % of the patients at the 6th week of the rehabilitation period. The diastolic stress test is accompanied by a rare occurrence of stress-induced diastolic dysfunction (4 %) in patients with reduced LV EF after myocardial infarction.

Point of care transthoracic echocardiography for the prediction of post – spinal anesthesia hypotension in elderly patients with cardiac diseases and left ventricular dysfunction

In elderly patients with cardiac diseases, changes in cardiovascular physiology diminish cardiovascular reserve and predispose to hemodynamic instability after spinal anesthesia; hence, such patients could be at risk of postoperative complications. Additionally, transthoracic echocardiography (TTE) is used in clinical practice to evaluate cardiovascular hemodynamics. Therefore, we hypothesized that echocardiographic measurements could display significant diagnostic power in the prediction of post - spinal anesthesia hypotension in elderly patients with cardiac diseases and reduced left ventricular ejection fraction (LV-EF). Therefore, sixty-one elderly orthopedic-trauma patients were recruited. Prior to spinal anesthesia a TTE examination was performed. The LV-EF, the stroke volume index (SVI), the peripheral vascular resistance (PVR), the LV filling pressures (E/Em ratio), the right ventricular function [tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV) and fractional area change (FAC)], as well as inferior vena cava (IVC) measurements, such as IVCCI (collapsibility index of the IVC) and dIVCmax (maximum diameter of IVC)-to-IVCCI ratio were assessed. Twenty-six out of sixty-one patients manifested hypotension. Preoperative dIVCmax-to-IVCCI ratio demonstrated the greatest performance amongst echocardiographic indices in predicting post - spinal anesthesia hypotension. The dIVCmax-to-IVCCI ratio < 48 had significantly higher diagnostic power than IVCCI > 0.28, FAC > 42, E/Em ratio < 9 and SVI < 32 (receiver operator characteristic curve analysis). The gray zone for the dIVCmax-to-IVCCI ratio (40–49) showed the lowest number of inconclusive measurements among echocardiographic variables. The preoperative dIVCmax-to-IVCCI ratio could be a reliable echocardiographic index to predict post - spinal anesthesia hypotension in elderly patients with left ventricular dysfunction.

Numerical study of temperature and pressure effects of a yield-power law fluid flow on frictional pressure losses for laminar and turbulent regimes

The effective determination of pressure losses depends on accurate knowledge of the drilling fluid rheology. As the fluid circulates deeper around the wellbore, its rheological behavior undergoes significant alterations due to the variations in downhole conditions encountered. The present study investigates the effects of the rheological properties of Yield-power law fluid at various pressures and temperatures on annular pressure losses and velocity profiles. Simulations were performed using Computational Fluid Dynamics to examine the fluid flow in turbulent and laminar regimes. Comparison between numerical, experimental and slot approximation model results showed a good agreement. Results indicated that pressure losses have reduced in both regimes with increasing temperature, at a constant pressure. However the pressure has the opposite effect at a constant temperature. For a drilling fluid flow velocity of 1 m/s, the elevation of temperature from 25 °C to 90 °C, decreases the pressure drop gradient by (31% to 48%) at low and high- pressure conditions respectively. Whereas, the influence of increasing pressure on pressure losses is more apparent at 25 °C. Earlier transition from laminar to turbulent is observed with temperature rise. Therefore, the temperature effect on pressure losses in the turbulent region; is shown for different Generalized Reynolds numbers.

Reverse Circulation Displacement of Miscible Fluids for Primary Cementing

AbstractPrimary cementing is the well construction operation where drilling fluid is displaced from the annular space behind the casing string, and replaced by a cement slurry. The annular cement sheath is a critical barrier element that should provide zonal isolation along the well and prevent uncontrolled flow of formation fluids to the environment. We present a combined experimental and computational study of reverse circulation displacement of the annulus, corresponding to operations where cementing fluids are pumped down the annulus from the surface. We focus on iso-viscous displacements in a vertical and concentric annulus, and vary the density hierarchy among the fluids to study both stable and density-unstable displacement conditions. While the interface between the two fluids is advected according to the laminar annular velocity profile for density-stable and iso-dense displacements, considerable secondary flows and fluid mixing is observed for density-unstable cases. Increasing the imposed velocity from the top is seen to provide a certain stabilizing effect by suppressing backflow of the lighter fluid and reduce the magnitude of azimuthal fluctuations. Computational results are in qualitative agreement with the experiments, and support the categorization of the displacement flows as either inertial or diffusive, in accordance with previous work on buoyant pipe displacements.

Echocardiographic parameters in French Bulldogs, Pugs and Boston Terriers with brachycephalic obstructive airways syndrome

BackgroundIn this prospective study, we hypothesized that dogs with signs of brachycephalic obstructive airway syndrome (BOAS) would show differences in left and right heart echocardiographic parameters compared with brachycephalic dogs without signs of BOAS and non-brachycephalic dogs.ResultsWe included 57 brachycephalic (30 French Bulldogs 15 Pugs, and 12 Boston Terriers) and 10 non-brachycephalic control dogs.Brachycephalic dogs had significantly higher ratios of the left atrium to aorta and mitral early wave velocity to early diastolic septal annular velocity; smaller left ventricular (LV) diastolic internal diameter index; and lower tricuspid annular plane systolic excursion index, late diastolic annular velocity of the LV free wall, peak systolic septal annular velocity, late diastolic septal annular velocitiy, and right ventricular global strain than non-brachycephalic dogs. French Bulldogs with signs of BOAS had a smaller diameter of the left atrium index and right ventricular systolic area index; higher caudal vena cava at inspiration index; and lower caudal vena cava collapsibility index, late diastolic annular velocity of the LV free wall, and peak systolic annular velocity of the interventricular septum than non-brachycephalic dogs.ConclusionsThe differences in echocardiographic parameters between brachycephalic and non-brachycephalic dogs, brachycephalic dogs with signs of BOAS and non-brachycephalic dogs, and brachycephalic dogs with and without signs of BOAS indicate higher right heart diastolic pressures affecting right heart function in brachycephalic dogs and those with signs of BOAS. Most changes in cardiac morphology and function can be attributed to anatomic changes in brachycephalic dogs alone and not to the symptomatic stage.

Tricuspid annular dynamics, not diameter, predicts tricuspid regurgitation after mitral valve surgery: Results from a prospective randomized trial

ObjectiveCurrent guidelines advise using prophylactic tricuspid valve annuloplasty during mitral valve surgery, especially in the presence of annular diameter enlargement. However, several retrospective studies and a prospective randomized study from our department could not confirm that diameter enlargement is predictive of late regurgitation. We examined whether 2- and 3-dimensional echocardiographic and clinical characteristics could identify patients who will develop moderate or severe recurrent tricuspid regurgitation. MethodsPatients with less than severe functional tricuspid regurgitation (FTR) were randomized not to receive tricuspid annuloplasty, and 11 of 53 of them were excluded from the study because 3-dimensional echocardiographic analysis was not possible. Cox regression was used to estimate the model-based probability of moderate or severe FTR (vena contracta ≥3 mm) or progression of TR and FTR regression using valve dimensions (annulus area, diameter perimeter, nonplanar angle, and sphericity index), dynamics (annulus contraction, annulus displacement, and displacement velocity), and clinical parameters as possible predictors. ResultsAt a median follow-up of 3.8 years (range, 3-5.6 years), 17 patients had moderate or severe FTR or progression, and 13 had FTR regression. Our models identified annular displacement velocity as a significant predictor for FTR recurrence and nonplanar angle as a significant predictor for FTR regression. ConclusionsAnnular dynamics, not the dimension, predict recurrence and regression of FTR. Annular contraction should be systematically investigated as a possible surrogate of right ventricle function to prophylactically treat the tricuspid valve.

Down syndrome patients with normal hearts: are they really normal?

Even though congenital heart disease is a common finding in down syndrome (DS) patients, some of them have anatomically normal hearts. However, the term "normal" might not be suitable, as these patients usually suffer from functional cardiac dysfunction. Several research highlighted that despite the absence of anatomical heart defects, subtle cardiac function derangements are present in DS patients. We aim to assess cardiac functions by Two-dimensional echocardiography and tissue Doppler imaging (TDI) in pediatric DS patients who have anatomically normal hearts. One hundred seventy-two patients with karyotyping confirmed DS with anatomically normal hearts and 165 healthy normal control children were enrolled in the current study. Their cardiac functions were assessed using both 2-dimensional echocardiography and TDI. Both patients and controls had structurally and anatomically normal hearts. In DS patients, the right side of the heart showed a significant reduction in both systolic and diastolic functions. Systolic dysfunction was evident by significantly decreased levels of Tricuspid annular plane systolic excursion and systolic wave by TDI. Diastolic dysfunction of the right ventricle was evident by prolonged deceleration time by conventional echocardiography and a significant decrease in annular tissue doppler velocity during early diastole/late diastole ratio by TDI. The E/De ratio was significantly increased. Even with anatomically normal hearts, DS patients should undergo cardiac function assessment by echocardiography & TDI. TDI is superior to conventional echocardiography in detecting subtle cardiac dysfunction especially left ventricular diastolic dysfunction in DS patients. TDI showed a significant decrease in the early/atrial ratio of mitral valve annulus and prolongation of left ventricle isometric relaxation time in DS children. Also, the left ventricle E/De ratio was prolonged denoting elevated filling pressures and diastolic dysfunction. This indicates that the TDI has higher sensitivity to detect diastolic dysfunction than conventional Echocardiography. Biventricular TDI-derived myocardial performance index was found to be significantly increased in DS children.

The preliminary study on cardiac structure and function in Chinese patients with primary hyperparathyroidism.

Recent evidences show that primary hyperparathyroidism (PHPT) patients have a high prevalence of cardiovascular diseases. However, the reported changes in cardiac status are inconsistent in previous studies. The present work evaluated the cardiac structure and function in PHPT patients by echocardiography. PHPT patients and age- and sex-matched healthy controls were enrolled in this case-control study. Biochemical parameters were retrospectively collected from PHPT patients. Cardiac function and structure were assessed in all subjects using echocardiography. A total of 153 PHPT patients and 51 age- and sex-matched healthy controls were enrolled in this study. The mean serum calcium and parathyroid hormone (PTH) levels in PHPT patients were 2.84 ± 0.28mmol/L and 206.9 (130.0, 447.5) pg/ml, respectively. Left ventricular ejection fraction (LVEF) and early to late mitral annular velocity (E/A) were significantly lower in PHPT patients than in healthy controls (68.2 ± 6.0 vs. 70.7 ± 16.7%, 1.0 ± 0.5 vs. 1.4 ± 0.5, respectively, p both < 0.05). The left ventricular mass index (LVMI) and the relative wall thickness (RWT) were not significantly different between the two groups. However, the difference in LVEF between PHPT patients without hypertension and diabetes and the control groups disappeared. The majority of PHPT patients had normal cardiac geometry; however, a proportion of them exhibited concentric remodeling (normal LVMI, RWT≥0.42). Serum calcium, corrected calcium, ionized calcium and PTH were inversely related to E/A, whereas serum phosphorus and 24-hour urine calcium were positively related to E/A. Furthermore, biochemical parameters were not correlated with LVEF. These findings demonstrate that PHPT patients exhibit diastolic cardiac dysfunction reflected by decreased E/A, as well as possible cardiac structural abnormalities. The serum calcium, phosphorus, and parathyroid hormone levels may influence cardiac structure and function.

Dantrolene improves diastolic property of left ventricle in mineralcorticoid-induced hypertensive rats.

Diastolic dysfunction is getting important issue in this era of “heart failure pandemic”. However, there are few options of treatment toward such condition. In this study, we examined whether dantrolene, which is known to stabilize ryanodine receptors, can suppress cardiac hypertrophy and improve HFpEF using a mineral corticoid-induced hypertension rat model. Male Sprague-Dawley rat (8 weeks old) received a uninephrectomy (UNX), a subcutaneous pellet of DOCA (200 mg) implantation and 0.9% NaCl water (UNX+DOCA-salt). UNX and control pellet serves as control (UNX control). Effect of oral administration of 100 mg/kg/day dantrolene in the UNX+DOCA-salt rats were examined (UNX+DOCA-salt+DAN). UNX+DOCA-salt treatment resulted in mild hypertension. Oral dantrolene treated UNX+DOCA-salt rats did not affect blood pressure. Increased lung weight and heart weight in UNX+DOCA-salt were significantly decreased in UNX+DOCA-salt+DAN. Echocardiography revealed almost same fractional shortening of three groups. LV wall thickness was increased and mitral annular early relaxation velocity was decreased in UNX+DOCA-salt compared with UNX control; however, both were significantly improved in UNX+DOCA-salt+DAN. Increased LV fractional fibrosis in UNX+DOCA-salt was significantly improved in UNX+DOCA-salt+DAN. Static compliance of LV was significantly decreased in UNX+DOCA-salt; however, it was significantly improved in UNX+DOCA-salt+DAN. Cardiomyocytes were isolated from heart and then the size of cardiomyocytes, cell shortening, and Ca2+ spark frequency (CaSF) were examined. Increased cell size in UNX+DOCA-salt was significantly decreased in UNX+DOCA-salt+DAN. Increased 80 % recovery time of cell shortening in UNX+DOCA-salt was significantly improved in UNX+DOCA-salt+DAN. SpF in UNX+DOCA-salt was significantly increased, but remained to be normal in UNX+DOCA-salt+DAN. In conclusion, dantrolene improve diastolic property of left ventricle in both terms of myocardial stiffness and relaxation. It could be a new option of treatment for HFpEF.

Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death

Background Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Methods and Results A total of 330 patients without left ventricular systolic dysfunction (ejection fraction ≥50%) and significant epicardial coronary stenosis (fractional flow reserve >0.80) were analyzed. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e' velocity, tricuspid regurgitation velocity, and left atrial volume index). Overt CMD was defined as coronary flow reserve <2.0 and index of microcirculatory resistance ≥25 U. The primary end point was cardiovascular death or admission for heart failure during 5 years of follow-up. In patients without left ventricular systolic dysfunction and significant epicardial coronary stenosis, prevalence of cardiac diastolic dysfunction and overt CMD was 25.5% and 11.2%, respectively. Overt CMD was independently associated with cardiac diastolic dysfunction (adjusted odds ratio, 3.440 [95% CI, 1.599-7.401]; P=0.002). Patients with cardiac diastolic dysfunction showed significantly higher risk of the primary outcome than those without (adjusted hazard ratio [HR], 2.996 [95% CI, 1.888-4.755]; P<0.001). Patients with overt CMD also showed significantly higher risk of the primary outcome than those without (adjusted HR, 2.939 [95% CI, 1.642-5.261]; P<0.001). Presence of overt CMD was associated with significantly increased risk of cardiovascular death among the patients with cardiac diastolic dysfunction (43.8% versus 14.5%; P=0.006) but not in patients without cardiac diastolic dysfunction (interaction P<0.001). Inclusion of overt CMD into the model with cardiac diastolic dysfunction significantly improved predictive ability for cardiovascular death or heart failure admission (conconrdance index, 0.719 versus 0.737; P for comparison=0.034). Conclusions There was significant association between the presence of cardiac diastolic dysfunction and overt CMD. Both cardiac diastolic dysfunction and overt CMD were associated with increased risk of cardiovascular death or admission for heart failure. Integration of overt CMD into cardiac diastolic dysfunction showed improvement of the risk stratification in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Registration DIAST-CMD (Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function) registry; Unique identifier: NCT05058833.

The predictive value of revised diastolic dysfunction in outcomes of liver transplantation: A propensity score matching analysis.

Diastolic dysfunction (DD), one of the earliest signs of cirrhotic cardiomyopathy (CCM), is included in the revised 2019 CCM criteria. Nonetheless, relevant research regarding the effects of revised DD on post-liver transplantation (LT) outcomes remains limited. This retrospective study enrolled patients who underwent LT for decompensated cirrhosis, from January 2018 to March 2021. Patients were divided into DD and non-DD groups. Clinical data were collected. Patients were followed up with, for at least 1 year post-LT; cardiovascular adverse events (AEs) and survival status were recorded. Risk factors were identified using 1:2 propensity score matching (PSM), after adjusting for confounding factors. The caliper value was set to 0.02. Of 231 patients, 153 were diagnosed with DD (male, 81.8%; mean age, 51.5 ± 9.5 years). Nineteen patients with DD died within 1 year, post-LT. After PSM, 97 and 60 patients were diagnosed with and without DD, respectively. Patients with DD had longer intensive care unit (ICU) stays, higher perioperative cardiovascular AEs, and higher mortality rates than those without DD. In a multivariate analysis, interventricular septum (IVS), left atrial volume index (LAVI), and potassium levels were independent prognostic factors of perioperative cardiovascular AEs, while a decreased early diastolic mitral annular tissue velocity (e'), increased neutrophil-to-lymphocyte ratio (NLR) and tumor markers were predictors of mortality within 1 year post-LT after PSM (P < 0.05). Cardiac DD may contribute to perioperative cardiovascular AEs and mortality post-LT. Clinicians should be aware of decompensated cirrhosis in patients with DD.

Significance of standard and speckle-tracking echocardiography for early diagnosis of asymptomatic left ventricular dysfunction in type 2 diabetes

Aim. To study the relationship between echocardiographic parameters of left ventricular (LV) function and carbohydrate metabolism indicators, as well as to evaluate value of speckle-tracking echocardiography (STE) in the early diagnosis of subclinical LV dysfunction in type 2 diabetes (T2D) in individuals without clinical manifestations of cardiovascular disease (CVD).Material and methods. The study included 120 people of both sexes aged 45 to 75 years. Patients were divided into three following groups: 1 — with T2D (n=53), 2 — with prediabetes (n=20), 3 — control, without carbohydrate metabolism disorders (n=47). All participants underwent transthoracic two-dimensional echocardiography with an assessment of standard systolic and diastolic parameters, as well as quantitative STE indicators. In addition, all participants underwent laboratory diagnostics of carbohydrate metabolism disorders, which included the determination of blood fasting glucose, glycated hemoglobin (HbA1c), insulin, and C-peptide, as well as insulin resistance index estimation.Results. In patients with T2D, in comparison with the control group, diastolic function parameters were significantly different as follows: a lower value of early to late diastolic transmitral flow velocity (E/A) ratio, the ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e'), mitral annular velocity (e') and higher isovolumic relaxation time (IVRT), as well as early diastolic flow deceleration time (DT). According to multivariate analysis, not only T2D, but also prediabetes was an independent predictor of diastolic dysfunction. The Simpson's LV ejection fraction was preserved in all study participants. In patients with T2D, in comparison with the control, according to STE, a decrease in global longitudinal strain (GLS), an increase in apical rotation, and also LV twist were revealed. In a multivariate regression analysis, the HbA1c level had an inverse relationship with GLS and was an independent predictor of its decrease, and the T2D duration was a significant predictor of twisting changes, apical and basal rotation. At the same time, GLS and LV twist had a high sensitivity in determining the decrease in E/A, e'/a', e', as well as the increase in IVRT.Conclusion. In patients with T2D without CVD manifestations, sub-clinical signs of diastolic dysfunction were revealed, such as delayed LV relaxation; systolic dysfunction with preserved ejection fraction was manifested by a decrease in GLS, as well as an increase in apical rotation and LV twisting, identified by STE. The severity of asymptomatic LV systolic-diastolic dysfunction was associated with the severity of glucose metabolism disorders and T2D duration.

Experimental Analysis of the Annular Velocity of a Capsule When Starting at Different Positions of a Horizontal Bend Pipe

The study of the annular slit flow field is important for energy consumption, transport efficiency, and the force on the capsule for hydraulic capsule transportation. A combination of physical experiments and theoretical analysis was used to study the annular flow field around a capsule that was set in motion at different positions of a horizontal bend pipe. We study the flow velocity distribution of the gap flow field at different bend positions of the capsule by changing the position of the capsule at the bend. We found that the distribution of the flow field remained similar for different starting positions of the capsule, but the flow velocity increased suddenly and dramatically at the inflow section of the ring gap. We recorded different velocity distributions of the annular gap on the concave and convex sides of the pipe; on the convex side, the streamline of the gap was smooth, and the change in velocity was relatively small. The flow velocity of the slit flow varied more notably on the concave side of the pipe, and there was a greater fluctuation in the flow velocity distribution. Because the effects of the capsule and the pipe on water flow were not the same, we found large fluctuations in gap flow velocity at different measuring points on the concave side. Gap flow velocity was most influenced by axial flow velocity. We found that the axial flow velocity was about one order of magnitude greater than the radial flow velocity or circumferential flow velocity. In this paper, we analyze the changes in the ring gap flow field of the capsule at different bending positions and analyze the reasons for the flow field changes and the flow velocity distribution law. This is of great significance to the study of the transport efficiency and energy consumption of the capsule. The results of this paper complement the study of capsule initiation at different positions in the bend and provide a reference point in terms of transport efficiency, energy consumption, and capsule stress. The results of this study promote the development of hydraulic capsule transportation.

Complementary Value of Tissue Doppler Imaging in Dobutamine Stress Echocardiography: A Prospective Cohort Study

Introduction: In patients with Coronary Artery Diseases (CAD), the presence of viable myocardium predicts the recovery of Left Ventricular (LV) systolic function after revascularisation. The identification of myocardial viability during dobutamine stress echocardiography is subjective and with observer bias. Tissue Doppler Imaging (TDI) echocardiography has opened new possibilities for non-invasive quantification of myocardial function by directly interrogating myocardial velocity with high temporal and spatial resolution. Aim: To determine the baseline regional myocardial and mitral annular Maximum Systolic Velocities (MSV) in patients with LV dysfunction and to compare the MSV values in viable and nonviable myocardium. Materials and Methods: In this prospective Cohort study, TDI of regional and annular LV myocardial velocities was performed at the baseline (at rest) in 352 patients with CAD and LV dysfunction who were referred for Dobutamine stress Echocardiography. Viability assessment by 2 Dimensional (2D) methods was done simultaneously using routine Dobutamine stress protocol. Patients were grouped in two groups based on the presence or absence of viability with 2D stress echocardiography. TDI velocities were compared in the two groups of patients with and without myocardial viability. Measurements of regional wall thickness, Ejection Fraction(EF) and Wall Motion Score Index (WMSI) were done to assess the regional and global LV function in these patients. Those patients who underwent revascularisation were subsequently assessed for functional recovery by 2D and TDI echocardiography before discharge from the hospital. Analyses were conducted using Statistical Package for Social Sciences(SPSS) version 16.0. Results: Among 352 patients studied (124 females and 228 males), mean age 58 years (range 36 to 75 years). A total of 243 patients (69%) with viable myocardium as per 2D echocardiography had higher cut-off Baseline Regional Maximum Systolic Velocity (BRMSV) &gt;0.03 m/s and baseline mitral annular systolic velocity &gt;0.06 m/s with high sensitivity and specificity compared to patients with severe contractile dysfunction and non-viable myocardium. Conclusion: Tissue doppler parameters like regional myocardial systolic and mitral annular velocities have shown significantly higher cut-off values in those patients with ischaemic and viable myocardium compared to non-viable myocardium.

Perirenal Fat and Kidney Function Deterioration in Patients With Acute Decompensated Heart Failure.

The thick perirenal fat pad can induce high intracapsular pressure and cause compression of the renal vasculature and resultant congestive nephropathy. The current study investigated the association of perirenal fat thickness with kidney dysfunction in patients with acute decompensated heart failure (ADHF). Data from 266 patients hospitalized with ADHF were analyzed. Patients were divided into two groups according to the glomerular filtration rate (GFR) at admission (preserved kidney function [GFR ≥60 mL/min/1.73 m2] and reduced kidney function [GFR <60 mL/min/1.73 m2] groups). Right and left posterior perirenal fat thicknesses were measured using computed tomography, and their average values were calculated. Associated factors with reduced kidney function was assessed by logistic regression model, presenting with odds ratio (OR) and confidence interval (CI). Increasing age (OR, 1.08; 95% CI, 1.04-1.12; p<0.001), diabetes mellitus (OR, 2.46; 95% CI, 1.18-5.12; p<0.017), increased log N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR, 1.82; 95% CI, 1.32-2.52; p<0.001), and increased average perirenal fat thickness (OR, 1.11; 95% CI, 1.06-1.16; p<0.001) were independently associated with reduced kidney function. In the subgroup analyses, patients over 70 years old, the ratio of mitral-to-mitral annular velocity >15, elevated log NT-proBNP had a significantly higher association with increased perirenal fat thickness with reduced kidney function. Thick perirenal fat pads were independently associated with kidney function deterioration in patients hospitalized with ADHF.

Role and Clinical Importance of Progressive Changes in Echocardiographic Parameters in Predicting Outcomes in Patients With Hypertrophic Cardiomyopathy.

The prognostic utility of follow-up transthoracic echocardiography (FU-TTE) in patients with hypertrophic cardiomyopathy (HCM) is unclear, specifically in terms of whether changes in echocardiographic parameters in routine FU-TTE parameters are associated with cardiovascular outcomes. From 2010 to 2017, 162 patients with HCM were retrospectively enrolled in this study. Using echocardiography, HCM was diagnosed based on morphological criteria. Patients with other diseases that cause cardiac hypertrophy were excluded. TTE parameters at baseline and FU were analyzed. FU-TTE was designated as the last recorded value in patients who did not develop any cardiovascular event or the latest exam before event development. Clinical outcomes were acute heart failure, cardiac death, arrhythmia, ischemic stroke, and cardiogenic syncope. Median interval between the baseline TTE and FU-TTE was 3.3 years. Median clinical FU duration was 4.7 years. Septal trans-mitral velocity/mitral annular tissue Doppler velocity (E/e'), tricuspid regurgitation velocity, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) at baseline were recorded. LVEF, LAVI, and E/e' values were associated with poor outcomes. However, no delta values predicted HCM-related cardiovascular outcomes. Logistic regression models incorporating changes in TTE parameters had no significant findings. Baseline LAVI was the best predictor of a poor prognosis. In survival analysis, an already enlarged or increased size LAVI was associated with poorer clinical outcomes. Changes in echocardiographic parameters extracted from TTE did not assist in predicting clinical outcomes. Cross-sectionally evaluated TTE parameters were superior to changes in TTE parameters between baseline and FU at predicting cardiovascular events.

Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging.

The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.