Cardiac Dimensions Research Articles

Some Anatomical Variations of the Coronary Circulation among Sri Lankan Adults

The coronary circulation has been the centre of focus of many anatomists, pathologists, cardiologists, cardiothoracic surgeons, physiologists and even the general public especially since the introduction of coronary angiography during the 1960's. Though a large number of data regarding the coronary circulation of the Western populations are available, research about coronary circulation of the Sri Lankan population is comparatively rare. This study comprises of data from 150 autopsy specimens of adult Sri Lankans died due to non-cardiac causes. 99.3% had a tricuspid aortic valve while only in 0.7% the aortic valve was bi-cuspid. The incidence of the ectopic origin of the left and the right coronary artery was equal (1.3%), and the posterior sinus was devoid of coronary ostia. A 55.3% of the study population had a single coronary artery ostium for each main coronary artery. The corresponding figure for the left coronary artery was 91.3%. Six percent (06%) of the right coronary ostia were positioned significantly above the sinus while the corresponding figure for the left coronary ostia was higher (17.5%). The average left ventricular wall thickness for males and females were 13mm and 12mm respectively. Significant muscular bridging (in relation to at-least one coronary artery) was found in 19.3% of the study population. The study concludes that variations in the cardiac anatomy are commoner than expected. As per Kitzman chart, cardiac dimensions of the Sri Lankans are somewhat smaller compared to the dimensions of the Western populations.

Sex-dependent effects of genetic upregulation of activated protein C on delayed effects of acute radiation exposure in the mouse heart, small intestine, and skin.

Accidental exposure to ionizing radiation may lead to delayed effects of acute radiation exposure (DEARE) in many organ systems. Activated protein C (APC) is a known mitigator of the acute radiation syndrome. To examine the role of APC in DEARE, we used a transgenic mouse model with 2- to 3-fold increased plasma levels of APC (high in APC, APCHi). Male and female APCHi mice and wild-type littermates were exposed to 9.5 Gy γ-rays with their hind-legs (bone marrow) shielded from radiation to allow long-term survival. At 3 and 6 months after irradiation, cardiac function was measured with ultrasonography. At 3 months, radiation increased cardiac dimensions in APCHi males, while decreases were seen in wild-type females. At this early time point, APCHi mice of both sexes were more susceptible to radiation-induced changes in systolic function compared to wild-types. At 6 months, a decrease in systolic function was mainly seen in male mice of both genotypes. At 6 months, specimens of heart, small intestine and dorsal skin were collected for tissue analysis. Female APCHi mice showed the most severe radiation-induced deposition of cardiac collagens but were protected against a radiation-induced loss of microvascular density. Both male and female APCHi mice were protected against a radiation induced upregulation of toll-like receptor 4 in the heart, but this did not translate into a clear protection against immune cell infiltration. In the small intestine, the APCHi genotype had no effect on an increase in the number of myeloperoxidase positive cells (seen mostly in females) or an increase in the expression of T-cell marker CD2 (males). Lastly, both male and female APCHi mice were protected against radiation-induced epidermal thickening and increase in 3-nitrotyrosine positive keratinocytes. In conclusion, prolonged high levels of APC in a transgenic mouse model had little effects on indicators of DEARE in the heart, small intestine and skin, with some differential effects in male compared to female mice.

The impact of image and performance enhancing drugs on bi-ventricular structure and function in strength-trained athletes and the association to fat-free mass

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Canadian Institute of Health Research Michael Smith Foreign Study Supplement Background Image and performance enhancing drugs (IPED) cause cardiac enlargement and dysfunction. Previous work has not assessed impact of user status (current [CU] vs. past [PU]) or allometric scaling cardiac dimensions for individual differences in fat-free mass (FFM). Purpose To investigate CU and PU of IPED and allometric scaling on LV and RV remodeling in strength-trained athletes. Methods Thirty-four (29 ± 6 years; 82% male) strength-trained athletes were recruited. Fourteen were CU, 9 PU and 11 non-users (NU) of IPEDs. Participants underwent bioelectric impedance body composition analysis, IPED and training questionnaire and 2D echocardiography with strain imaging. All structural data was allometrically scaled to FFM according to the laws of geometric similarity. Results CU and PU had significantly higher FFM compared to NU (82.4 ± 10.1 kg vs. 72.0 ± 6.3 kg vs. 58.2 ± 14.0 kg). Absolute values of all RV and LV size were larger between CU and NU. LV mean wall thickness (MWT) was larger in CU compared to PU but there were no differences between PU and NU. Allometric scaling eliminated all differences with exception of LV mass and LVMWT. LVEF was significantly lower in CU and PU compared to NU (55 ± 3 vs. 57 ± 4 vs. 61 ± 4) whilst LV GLS was lower in CU compared to PU and NU and LV GCS was lower in CU compared to NU but not PU. There was no significant difference between groups for RV functional indices. Conclusion Strength-trained athletes currently using IPEDs have bi-ventricular enlargement as well as reduced LV function. Allometric scaling highlights that increased size is partially associated with a larger FFM, with exception of LVMWT which is independently increased through IPED use. PUs demonstrate reverse structural remodeling whilst functional differences partially remain. CU PU NU RVD1 (mm) 45 ± 5* 43 ± 6 37 ± 6 Scaled RVD1 (mm/kg^0.33) 10.5 ± 0.9 10.4 ± 1.5 9.7 ± 1.0 LVd (mm) 58 ± 7* 55 ± 4 50 ± 4 Scaled LVd (mm/kg^0.33) 13.4 ± 1.2 13.3 ± 0.7 13.1 ± 0.6 MWT (mm) 10 ± 1*” 8 ± 1 8 ± 1 Scaled MWT (mm/kg^0.33) 2.3 ± 0.2*” 2.0 ± 0.1 2.0 ± 0.2 LVEDV (ml) 169 ± 42* 135 ± 28 116 ± 28 Scaled LVEDV (ml/kg) 2.0 ± 0.4 1.9 ± 0.3 2.0 ± 0.2 LV Mass (g) 255 ± 85*” 179 ± 30 137 ± 40 LV mass index (g/kg) 3.1 ± 0.8* 2.5 ± 0.3 2.4 ± 0.4 * CU and NU “ CU and PU ^ PU and NU Abstract Figure. Myocardial strain imaging

Correlation of echocardiographic parameters in prone and supine positions in normal adults using a novel approach.

Transthoracic echocardiography (TTE) in prone position is challenging. Innovative use of transesophageal echocardiography (TEE) probe to perform TTE for such patients has been described; but reproducibility and correlation of the TTE measurements by this technique with those obtained by the standard supine TTE study are still unknown. We enrolled 30 non-COVID-19 individuals, with a mean (SD) age 35 (10.9) years and 11 females, to study the agreement between the transthoracic measurements of the left ventricular (LV), left atrial (LA), aortic dimensions, and ejection fraction (EF) obtained in prone position using an external TEE probe versus the standard supine position using the conventional TTE probe. There were no significant differences between LV end-diastolic and end-systolic diameters, septal wall thickness, posterior wall thickness, and aortic root dimensions in the prone versus the supine positions, while the mean EF (60.3% vs 63.1%, P=.014) and mean LA dimensions (1.8 vs 1.9cm/m2 , P<.001) were significantly lower in the prone position. The mean time of scans was significantly longer in the prone as compared to the supine position (12.5 vs 4.5minutes, P<.001). All supine studies had good quality while in the prone position four studies were of poor quality, and one was nondiagnostic. Assessment of cardiac dimensions and systolic function in the prone position using transthoracic TEE probe was feasible. LV and aortic dimensions agreed well with the standard TTE in supine position; however, LA dimensions and EF were lower in the prone position.

Mitral prolapsing volume is associated with increased cardiac dimensions in patients with mitral annular disjunction.

IntroductionIn patients with mitral annular disjunction (MAD), it can be difficult to assess the severity of mitral regurgitation (MR), as they present with a prolapsing volume (i.e. volume resulting from mitral valve prolapse, blood volume shift) rather than a regurgitant jet. The influence of the mitral prolapsing volume (MPV) on cardiac dimensions is unknown. We hypothesised that the severity of MR is underestimated in these patients. Our aim was to measure MPV and to investigate its influence on cardiac dimensions in patients with MAD.MethodsWe retrospectively included 131 consecutive patients with MAD from our institution’s echocardiographic database. Transthoracic echocardiography was used to assess MPV. Additionally, we established a control group of 617 consecutive patients with degenerative mitral valve disease and performed propensity score matching.ResultsMedian MPV in the MAD group was 12 ml. MPV was an independent predictor for left ventricular end-diastolic (LVEDD) and end-systolic diameter (LVESD) and left atrial volume (all p < 0.001). In patients with large prolapsing volumes (> 15 ml), LVEDD (56 ± 6 mm vs 51 ± 6 mm, p < 0.001), LVESD [38 mm (34–41) vs 34 mm (31–39), p < 0.01] and left atrial volume [105 ml (86–159) vs 101 ml (66–123), p = 0.04] were significantly increased compared to matched patients with degenerative mitral valve disease and similarly assessed severity of MR.ConclusionDue to a volume shift based on the MPV rather than an actual regurgitant jet, MR severity cannot be assessed adequately in MAD patients. Increased MPV induces ventricular and atrial enlargement. These findings warrant future studies to focus on MPV as an additional parameter for assessment of the severity of MR in MAD patients.Supplementary InformationThe online version of this article (10.1007/s12471-021-01575-6) contains supplementary material, which is available to authorized users.

The Impact of Maternal Preeclampsia and Hyperglycemia on the Cardiovascular Health of the Offspring: A Systematic Review and Meta-analysis.

The objective of this review was to assess the impact of maternal preeclampsia or hyperglycemia on the body composition and cardiovascular health in the offspring. We conducted a systematic review utilizing PubMed, EBSCO, CINAHLPlus, Cochrane Library, and Web of Science to include all studies assessing the impact of preeclampsia/eclampsia and/or gestational/pregestational diabetes mellitus on the health of the offspring (children <10 years of age). The health measures included anthropometry, cardiac dimensions and function, and vascular function. We performed a meta-analysis using Review Manager software and computed net risk ratio (RR) with 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data. There were 6,376 studies in total, of which 45 were included in the review and 40 in the meta-analysis. The results demonstrated higher birth weight (MD: 0.12 kg; 95% CI: 0.06-0.18) and systolic and diastolic blood pressure (BP; MD: 5.98 mm Hg; 95% CI: 5.64-6.32 and MD: 3.27 mm Hg; 95% CI: 0.65-5.89, respectively) in the offspring of mothers with gestational diabetes compared to controls. In contrast, the offspring of mothers with preeclampsia had lower birth weight (MD: -0.41 kg; 95% CI: -0.7 to -0.11); however, they had increased systolic (MD: 2.2 mm Hg; 95% CI: 1.28-3.12) and diastolic BP (MD: 1.41 mm Hg; 95% CI: 0.3-2.52) compared to controls. There is lack of data to conduct a meta-analysis of cardiac morphology, functional, and vascular imaging parameters. These findings suggest that the in-utero milieu can have a permanent impact on the body composition and vascular health of the offspring. Future work warrants multicenter prospective studies to understand the mechanism and the actual effect of exposure to maternal hyperglycemia and high BP on the cardiovascular health of the offspring and long-term outcomes. · Adverse in-utero exposures may have an impact on cardiovascular risk in children.. · Maternal hyperglycemia/preeclampsia lead to changes in birthweight and BP.. · Limited echocardiographic and vascular imaging data in these cohorts necessitates future work..

Evaluation of Vertebral Heart Score and Cardiac Sphericity in Apparently Normal Dogs

The objectives of this study were to evaluate the relationship between vertebral heart score and cardiac sphericity and to evaluate gender variation in both dimensions in apparently normal Nigeria indigenous dogs. Twelve (six males and six females) apparently normal Nigerian indigenous dogs were selected from dogs in Zaria, Nigeria. Radiographic evaluations involved left lateral views of the thoracic region of the dogs. The vertebral heart size was measured as the sum of the long-axis and short-axis at its greatest diameter then compared with the vertebra bones starting at T4. Cardiac sphericity was obtained by computing the ratio of the long-axis to the short-axis. The mean ± SD for vertebral heart score and cardiac sphericity index in apparently normal Nigerian indigenous dogs were 9.3 ± 0.44 and 0.77 ± 0.06 respectively. Pearson coefficient revealed a significant (p = 0.001) and very strong correlation (p = 0.81) between vertebral heart score and cardiac sphericity index in Nigerian indigenous dogs. There were no gender variations in both dimensions. This study revealed the existence of a strong relationship between vertebral heart score and cardiac sphericity index in dogs in apparently normal Nigerian indigenous dogs, and both dimensions demonstrated no gender variation. Vertebral heart score and cardiac sphericity index in apparently normal Nigerian indigenous dogs are expressed as ideal cardiac dimensions which are suggested to be useful quantitative and objective parameters in the diagnosis of cardiac disorders in dogs.

Human mesenchymal stem cells derived from amniotic membrane attenuate isoproterenol (ISO)-induced myocardial injury by targeting apoptosis.

Background: Currently, stem cell therapy has been proposed as an efficient strategy to prevent or treat myocardial injuries. The current study was conducted to examine cardioprotective effects of human mesenchymal stem cells derived from amniotic membrane (hAMSCs) against isoproterenol (ISO)-induced myocardial injury and explore its potential mechanisms. Methods: The hAMSCs were injected intramyocardially in male Wistar rats 28 days after last injection of ISO (170 mg/kg body weight for 4 consecutive days). The echocardiography was performed to confirm induction of myocardial damage and cardiac function 28 days after last injection of ISO and 4 weeks hAMSCs transplantation after HF induction. The expression of apoptotic markers such as Bcl-2, Bax and P53 was evaluated using Western blotting assay. Masson’s trichrome staining was used to determine fibrosis. The cytoarchitecture of myocardial wall and morphology of cells were investigated using hematoxylin and eosin (H&E) staining. Results: As compared to ISO group, hAMSCs transplantation after heart failure (HF) induction significantly blunted the increasing of cardiac dimensions and restored ejection fraction (EF) and fractional shortening (FS) parameters (p<0.05). Moreover, hAMSCs transplantation after HF induction increased the expression of antiapoptotic markers such as Bcl-2 and decreased the expression of pro-apoptotic markers such as P53 and Bax (p<0.05). As compared to ISO group, hAMSCs transplantation after HF induction markedly reduced interstitial myocardial fibrosis and contributed to maintain of normal cytoarchitecture of myocardial wall and morphology of cells. Conclusion: Collectively, the results of current study suggest that transplantation of hAMSCs confers cardioprotection by targeting ISO‐induced mitochondria‐dependent (intrinsic) pathway of apoptosis.

“A CROSS SECTIONAL, DESCRIPTIVE STUDY ON SYSTEMIC ILLNESSES AND CARDIAC FUNCTION ABNORMALITIES IN CHILDREN”

Background:There are wide number of diseases of almost every system in the body which can affect heart in a number of different ways including increasing demands on the heart ,ventricular dysfunction ,rhythm abnormalities ,valve abnormalities ,pulmonary pressures and lot more.Cardiac involvement in systemic diseases is usually silent or oligosymptomatic and includes different pathophysiological mechanisms such as myocardial inflammation, infarction ,subendocardial vasculitis,valvular disease and different patterns of fibrosis. Objective : To study association between systemic illnesses (hematological, endocrinal , renal) and cardiac function abnormalities as ventricular function,cardiac dimensions ,pulmonary artery pressure and pericardial effusion,for early diagnosis and treatment to decrease morbidity and mortality in patient with systemic illness. Design/Method:It was a cross sectional,descriptive study The present study was conducted in the Department of Pediatrics, LLRM Medical College,Meerut,Uttar Pradesh over a period of 1 year (June 2019-June 2020) Results: Cardiac findings in all three groups show ECG abnormalities and echocardiographic changes compared to general population. ECG abnormalities were prolonged PR interval and sinus tachycardia while echocardiographic changes mainly left ventricular(LV) dilatation and hypertrophy ,increased cardiac output ,ventricular dysfunction and pulmonary arterial hypertension(PAH),were noted in a significant proportion of patients. Conclusion:Systemic illnesses affect cardiac parameters in various ways including prolonged PR interval,cardiac dilatation,chamber hypertrophy ,high cardiac output,high cardiac index ,PAH and ventricular dysfunction.

Assessment of myocardial deformation with CMR: a comparison with ultrasound speckle tracking.

Myocardial deformation integrated with cardiac dimensions provides a comprehensive assessment of cardiac function, which has proven useful to differentiate cardiac pathology from physiological adaptation to situations such as chronic intensive training. Feature tracking (FT) can measure myocardial deformation from cardiac magnetic resonance (CMR) cine sequences; however, its accuracy is not yet fully validated. Our aim was to compare the accuracy and reproducibility of FT with speckle tracking echocardiography (STE) in highly trained endurance athletes. Ninety-three endurance athletes (> 12-h training/week during the last 5 years, 52% male, 35 ± 5.1 years old) and 72 age-matched controls underwent resting CMR and transthoracic echocardiography to assess biventricular exercise-induced remodeling and biventricular global longitudinal strain (GLS) by CMR-FT and STE. Strain values were significantly lower when assessed by CMR-FT compared to STE (p < 0.001), with good reproducibility for the left ventricle (bias = 3.94%, limit of agreement [LOA] = ± 4.27 %) but wider variability for right ventricle strain. Strain values by both techniques proportionally decreased with increasing ventricular volumes, potentially depicting the functional biventricular reserve that characterizes athletes' hearts. Biventricular longitudinal strain values were lower when assessed by FT as compared to STE. Both methods were statistically comparable when measuring LV strain but not RV strain. These differences might be justified by the lower in-plane spatial and temporal resolution of FT, which is particularly relevant for the complex anatomy of the RV. • Strain values were significantly lower when assessed by FT as compared to STE, which was expected due to the lower in-plane spatial and temporal resolution of FT versus STE. • Both methods were statistically comparable when measuring LV strain but not for RV strain analysis. • Characterizing the normal ranges and reproducibility of strain metrics by FT is an important step toward its clinical applicability, since it can be assessed offline and applied to routinely acquired cine CMR images.

Prevalence and characteristics of ventricular septal defects in a non-racehorse equine population (2008-2019).

BackgroundVentricular septal defects (VSDs) are the most common congenital cardiac defect in horses.ObjectivesTo identify prevalence, age, breed, and sex distribution of VSD and to describe associated clinical and ultrasonographic findings.AnimalsHospital‐based population of 21 136 horses presented to the equine internal medicine department.MethodsMedical records over a 12‐year period were reviewed for VSD confirmed by ultrasonography. Age, breed, sex, sport discipline, murmur, clinical signs, outcome, VSD type, VSD size, shunt velocity, cardiac dimensions, concomitant cardiac anomalies, and valvular regurgitations were recorded.ResultsFrom 1894 horses that underwent echocardiography, 54 had a VSD: 42 as an isolated lesion and 12 as part of complex congenital heart disease (CHD). Median age was 5 years (range, 0‐26) and 1 year (range, 0‐8), respectively. Warmbloods and males were overrepresented. In the isolated VSD group, only 15% had associated clinical signs and most horses had a perimembranous VSD (pmVSD; 36/42). Horses with a pmVSD and clinical signs showed a significantly lower maximal shunt velocity (3.77 vs 5.20 m/s; P < .001), higher VSD/Aortic root (Ao) diameter (0.52 vs 0.38; P = .05), higher left atrium/Ao diameter (1.94 vs 1.22; P < .001), and higher pulmonary artery/Ao diameter (1.15 vs 0.88; P = .005) compared to horses without clinical signs. All horses with complex CHD had clinical signs and abnormal cardiac dimensions.Conclusion and Clinical ImportanceMost isolated VSD were diagnosed only at a later age and were not associated with clinical signs. Horses with complex CHD were more likely to have or develop clinical signs at younger age.

Left ventricular longitudinal strain and strain rate measurements in paediatric patients in long-term treatment for Chagas disease.

Previous echocardiographic studies failed to show residual alterations of heart function in paediatric patients that have received treatment for Chagas disease. While the echocardiogram is the fundamental front-line tool for evaluating heart function, the appearance of new techniques allows a more detailed analysis. We aimed to evaluate systolic and diastolic function with new techniques in a paediatric population with Chagas disease several years after treatment completion. Echocardiograms were obtained from 84 Chagas disease patients (48 female) and 27 healthy controls. All patients had received treatment concluding on average 10 years prior to the study. The prospective analysis considered cardiac dimensions and cardiac function using two-dimensional, M-mode, Doppler and tissue Doppler imaging with emphasis on measuring longitudinal strain in the left ventricle by speckle tracking. Ejection fraction was measured with three-dimensional echocardiography. Patients had an age of 14.2 ± 5.7 years (6-33) at the time of evaluation. Global and segmental motility of the left ventricle was normal in all patients. Ejection fraction was 59.2 ± 6.5 and 57.4 ± 6.5% (p = 0.31) in patients and controls respectively. Left ventricular global longitudinal systolic strain was -19 ± 2.4% in patients and -19 ± 3.6% (p = 0.91) in controls. No significant differences were found in remaining systolic and diastolic function measurements. Paediatric patients that have received treatment for Chagas disease, evaluated with either conventional techniques or new tools, do not show significant long-term alterations of ventricular function.

Fetal cardiac dimensions in congenital diaphragmatic hernia: relationship with gestational age and postnatal outcomes.

To serially assess fetal cardiac dimensions in congenital diaphragmatic hernia (CDH) and their relation to disease severity. Retrospective analysis of CDH cases and matched controls. Mitral (MVd) and tricuspid (TVd) valve diameters, left (LV) and right (RV) ventricular length and area, Z-scores, were serially assessed at 24-26, 30-32, and 35-37 weeks gestational age (GA). In CDH cases MVd, MVd Z-score, and LV area were significantly reduced at 24-26 and 35-37 weeks GA. TVd, TVd Z-score, and RV area were significantly reduced at 24-26 weeks. RV area Z-score increased with advancing GA. MVd and MVd Z-score were significantly lower at 24-26 weeks GA in CDH who had a combined outcome of death and/or ECMO. LV hypoplasia in CDH is characterized by reduced MVd from 24 weeks GA. MVd, and the ratio of mitral and tricuspid valve diameters at later gestations, may be potential predictors of disease severity.

Fate of preoperative moderate mitral regurgitation following left ventricular assist device implantation.

We examined for improvements in preoperative moderate mitral regurgitation following continuous-flow left ventricular assist device (cfLVAD) implantation. From 2006 to 2020, 190 patients with moderate MR underwent cfVLAD implant without concomitant mitral valve (MV) surgery. Cardiac dimensions and contractility, as well as valve function, were assessed with an echocardiogram (echo) pre-cfLVAD, and at approximately 1 month post-cfLVAD. Outcomes were determined by retrospective chart review. Median echo follow-up was 0.94 (0.53, 1.38) months. Residual significant moderate or greater MR was present in 30/190 (15.8%) on follow-up. Patients with significant residual MR had larger preoperative left ventricular internal diameters in diastole (74.4 ± 8.7 vs. 71.1.0 ± 9.1 mm, p = .034). Significant residual MR was associated with higher preoperative mean pulmonary artery pressures (OR = 1.055, p = .035) and pulmonary capillary wedge pressures (OR = 1.060, p = .034). Significant residual MR on echo was not associated with any survival difference (p = .325). The 1, 5, and 10 year survival were 89.9%, 55.2%, and 34.2%, respectively. For patients with moderate MR undergoing LVAD implantation, the likelihood of significant residual MR is low and mitral intervention in this population is not recommended. However, select patients with larger preoperative left heart dimensions and pulmonary vascular pressures may be at risk for persistent residual MR.

Beneficial Roles of Cellulose Patch-Mediated Cell Therapy in Myocardial Infarction: A Preclinical Study.

Biological scaffolds have become an attractive approach for repairing the infarcted myocardium and have been shown to facilitate constructive remodeling in injured tissues. This study aimed to investigate the possible utilization of bacterial cellulose (BC) membrane patches containing cocultured cells to limit myocardial postinfarction pathology. Myocardial infarction (MI) was induced by ligating the left anterior descending coronary artery in 45 Wistar rats, and patches with or without cells were attached to the hearts. After one week, the animals underwent echocardiography to assess for ejection fraction and left ventricular end-diastolic and end-systolic volumes. Following patch formation, the cocultured cells retained viability of >90% over 14 days in culture. The patch was applied to the myocardial surface of the infarcted area after staying 14 days in culture. Interestingly, the BC membrane without cellular treatment showed higher preservation of cardiac dimensions; however, we did not observe improvement in the left ventricular ejection fraction of this group compared to coculture-treated membranes. Our results demonstrated an important role for BC in supporting cells known to produce cardioprotective soluble factors and may thus provide effective future therapeutic outcomes for patients suffering from ischemic heart disease.

Use of Lung Ultrasound with Tissue Doppler Echocardiography to Follow up Cardiovascular State of Haemodialysis Patient

Background: Chronic hypervolemia is the main cause of cardiovascular complications in haemodialysis patients. Objectives: We aimed to study the effect of lung ultrasound-guided dry weight reduction strategy on the cardiovascular state of hypertensive haemodialysis patients. Patients and Methods: We carried out a single-blind two-arm randomized trial on 50 hypertensive haemodialysis patients in Qena University Hospital dialysis centre over 8 weeks from 1/11/2020 to 1/1/2021. Patients were divided into usual care group (control arm) and active group(study arm). In study group, dry weight reduction was assessed weekly by lung ultrasonography guided by the total number of B-lines, before the midweek session ofhaemodialysis. In the controlgroup, dry weight probing was done according to clinical criteria. To assess outcomes,we compared the clinical and echocardiographic improvement in both groups including full clinical assessment, etc at baseline and at the study end. Results: In study group, dry weight wassignificantly reduced in comparison with the control group (−0.41 ± 0.32 vs. 0.04 ± 0.09 kg; P < 0.001), resulting in a statistically significant reduction in systolic and diastolic blood pressures (P < 0.001). Furthermore, a statistically significant reduction in echocardiographic indices of cardiac chambers dimensions occurred in study group,in addition to improvement of the diastolic function of both ventricles. Conclusion: Ultrafiltration based on assessment of fluid status using lung ultrasound dry weight reduction is better than that based on conventional method regarding both clinical and echocardiographic parameters.

Assessment of myocardial deformation with CMR: a comparison with ultrasound speckle tracking in a cohort of highly trained endurance athletes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Plan Nacional I.D., Del Programa Estatal de Fomento De La Investigación Científica y Técnica de Excelencia, Subprograma De Generación Del Conocimiento, Ministerio de Economía y Competitividad 2013. Background Myocardial deformation integrated with cardiac dimensions provides a comprehensive assessment of the ventricular remodelling patterns induced by cumulative effects of intensive exercise. Feature tracking(FT) can measure myocardial deformation from cardiac magnetic resonance(CMR) cine sequences; however, its accuracy is still scarcely validated. Purpose Our aim was to compare FT’s accuracy and reproducibility to speckle tracking echocardiography (STE) in highly trained endurance athletes (EAs). Methods 93 EAs (&amp;gt;12 hours training/week during the last 5 years, 52% male, 35 ± 5.1 years) and 72 age-matched controls underwent a resting CMR and a transthoracic echocardiography to assess biventricular exercise-induced remodelling and biventricular global longitudinal strain (GLS) by CMR-FT and STE. Results High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and mildly reduced systolic function of both ventricles (p &amp;lt; 0,05). Strain values (both by CMR-FT and STE) proportionally decreased with increasing ventricular volumes potentially depicting the increased volume and functional biventricular reserve that characterize EAs heart. Strain values were lower when assessed by CMR-FT as compared to STE (p &amp;lt; 0.001), with good reproducibility for the LV (bias = 3.94%, LOA= ± 4.27%) but wider variability for RV strains (Figure 2). Conclusions Biventricular longitudinal strain values were lower when assessed by FT compared to STE. Both methods were comparable when measuring LV strain but not RV strain. These differences might be justified by FT’s lower in-plane spatial and temporal resolution, which is particularly relevant for the complex anatomy of the RV. Abstract Figure. Fig 1. Bland-Altman plots; FT vs STE.

Hemodialysis: effects of preload reduction on novel echocardiographic parameters of left ventricular function

Abstract Funding Acknowledgements Type of funding sources: None. Background Echocardiography has been widely used to study cardiac function in patients with end-stage renal disease on hemodialysis (HD), but cardiac function assessment by measuring cardiac dimensions and their rate of change is load dependent, therefore it is influenced by volume depletion. Effects of acute volume reduction on left (LV) and right ventricular (RV) function are still not well understood. Some studies investigated myocardial mechanics after dialysis using speckle tracking echocardiography (STE) but their relative load-dependency makes STE indices unable to account for changes in pre- and afterload. Myocardial work (MW) incorporates both deformation and load into its analysis and is an emerging tool to study LV myocardial function. There are no data about the effects of hemodialysis on LV MW. Purpose This study aimed to evaluate acute changes of novel echocardiographic indices of both LV and RV function after a HD session. Methods Patients with end-stage renal disease undergoing HD were prospectively enrolled. A transthoracic echo, including STE calculation of LV global longitudinal strain (GLS) and free wall RV strain, was performed before and after hemodialysis. Parameters of MW such as global work index (GWI), global constructive work (GCW), global work efficiency (GWE) and global wasted work (GWW) were quantified using a commercially available software package. Results 27 patients were enrolled, mean baseline parameters were: LV end-diastolic volume 136 ± 38 mL, LV ejection fraction (LVEF) 56.9 ± 7.5%, LV GLS -17.1 ± 4.1%, RV free wall strain -26.9 ± 5.6%, GWI 2117 ± 602 mmHg%, GCW 2299 ± 633 mmHg%, GWW 137 ± 88 mmHg, GWE 93 ± 3.6%, systolic arterial pressure 145 ± 26 mmHg and diastolic pressure 80 ± 16mmHg. After hemodialysis we observed a significative reduction in LV GLS (p = 0.04), RV strain (p = 0.002), GWI (p = 0.002, Figure I) and GCW (p = 0.004). No significative changes in LVEF and blood pressure were observed. Comparing patients using a LVEF cut-off of 55% (19 patients with LVEF≥55%, 8 patients &amp;lt;55%) we observed a significative reduction of LV GLS (p = 0.004), GWI (p &amp;lt; 0.001), GCW (p &amp;lt; 0.001) only in patients with LVEF ≥55% while RV strain and LV volume showed a reduction in both groups. We observed no significative differences in extracted volumes between the groups (2.6 vs 2.1 liters,p = 0.3). Patients with normal LVEF showed a significative negative variation (D) of LVEF (-1 vs 3%), GWI (-551 vs 38 mmHg%) and GCW (-522 vs 11 mmHg%). Correlations were found between DGWI and extracted volume (r= 0.46, p = 0.01), basal GWI and both DLVEF (r= 0.39, p = 0.04) and DLV GLS (r= 0,42, p = 0.02), basal LV GLS and DLVEF (r= 0.5, p &amp;lt; 0.01). Conclusions Our preliminary data show that, immediately after the HD session, there is a reduction in biventricular STE-derived systolic parameters. Patients with normal LV systolic function are more sensitive to acute volume changes and entity of volume depletion seems to be correlated with MW reduction. Abstract Figure.

Left Ventricular Assist Device Implantation in Patients with Preoperative Severe Mitral Regurgitation.

We examined cardiac features associated with residual mitral regurgitation (MR) following continuous-flow left ventricular assist device (cfLVAD) implant. From 2003 to 2017, 134 patients with severe MR underwent cfVLAD implant without mitral valve (MV) intervention. Echocardiographic (echo) assessment occurred pre-cfLVAD, early post-cfLVAD, and at last available echo. Ventricular and atrial volumes were calculated from established formulas and normalized to be predicted. Cluster analysis based on preoperative normalized left ventricular and atrial volumes, and MV height identified grades 1, 2, and 3 with progressively larger cardiac chamber sizes. Median early echo follow-up was 0.92 (0.55, 1.45) months and the last follow-up was 15.12 (5.28, 38.28) months. Mitral regurgitation improved early after cfLVAD by 2.10 ± 1.16 grades (p < 0.01). Mitral regurgitation severity at the last echocardiogram positively correlated with the preoperative left ventricular volume (p = 0.014, R = 0.212), left atrial volume (p = 0.007, R = 0.233), MV anteroposterior height (p = 0.032, R = 0.185), and MV mediolateral diameter (p = 0.043, R = 0.175). Morphologically, smaller grade 1 hearts were correlated with MR resolution at the late follow-up (p = 0.023). Late right ventricular failure (RVF) at the last clinical follow-up was less in grade 1 (4/48 [8.3%]) compared with grades 2 and 3 (26/86 [30.2%]), p = 0.004). Grade 1 cardiac dimensions correlates with improvement in severe MR and had less late RVF.

Association of Sleep Quality With Greater Left Ventricular Mass in Children Aged 9 to 11 Years.

Research has consistently found associations between sleep characteristics and cardiovascular disease risk in children, adolescents, and adults. Although primarily investigated in clinical samples (e.g., in those with sleep disorders), greater left ventricular mass is associated with poor sleep quality in nonclinical adult populations as well; however, this has not been evaluated in children or adolescents. Our study aim was to consider the relationship between objectively measured sleep characteristics and left ventricular mass in children. We assessed sleep and cardiac structure in a biracial sample of 9- to 11-year-old children (n = 176; 41% White, 59% Black; 50% female). Sleep was assessed with actigraphy for five nights. Cardiac dimensions were assessed using echocardiography. After adjusting for covariates, we found that poor sleep quality was associated with significantly greater left ventricular mass (β = 0.13, t(167) = 2.14, p = .034, Cohen d = 0.16, for activity during sleep; β = 0.15, t(167) = 2.43, p = .016, Cohen d = 0.18, for sleep fragmentation). Other cardiac dimensions (namely, relative wall thickness and right ventricular dimension) were also significantly associated with sleep characteristics. Notably, associations did not differ as a function of sex or race. The present findings are novel and unique because no prior reports have systematically documented the association between poor sleep quality with potentially detrimental cardiac remodeling in a nonclinical sample of children. However, the novelty and importance of these findings require additional research for confirmation.