Color M-mode Echocardiography Research Articles

Non-Invasive Assessment of the Intraventricular Pressure Using Novel Color M-Mode Echocardiography in Animal Studies: Current Status and Future Perspectives in Veterinary Medicine.

The assessment of diastolic function has received great interest in order to comprehend its crucial role in the pathophysiology of heart failure and for the early identification of cardiac events. Silent changes in the intraventricular flow (IVF) dynamics occur before the deterioration of the cardiac wall, although they cannot be detected using conventional echocardiography. Collective information on left ventricular (LV) pressures throughout the cardiac cycle has great value when dealing with patients with altered hemodynamics. Accurate pressure measurement inside the ventricle can be obtained by invasive methods to determine the LV diastolic pressures, which reflect the myocardial relaxation and compliance. However, catheterization is only feasible in the laboratory setting and is not suitable for clinical use due to its disadvantages. In contrast, echocardiography is simple, safe, and accessible. Color M-mode echocardiography (CMME) is an advanced cardiac evaluation technique that can measure the intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) based on the Doppler shift of the IVF. Recently, the assessment of IVPD and IVPG has gained growing interest in the cardiovascular literature in both animal and human studies as a non-invasive method for the early diagnosis of cardiac dysfunctions, especially diastolic ones. The usability of IVPD and IVPG has been reported in various surgically induced heart failure or pharmacologically altered cardiac functions in rats, dogs, cats, and goats. This report aims to give an overview of the current studies of CMME-derived IVPD and IVPG in animal studies and its feasibility for clinical application in veterinary practice and to provide the prospects of the technique's ability to improve our understanding.

Effect of trehalose on heart functions in rats model after myocardial infarction: assessment of novel intraventricular pressure and heart rate variability.

Myocardial infarctions remain a leading cause of global deaths. Developing novel drugs to target cardiac remodeling after myocardial injury is challenging. There is an increasing interest in exploring natural cardioprotective agents and non-invasive tools like intraventricular pressure gradients (IVPG) and heart rate variability (HRV) analysis in myocardial infarctions. Trehalose (TRE), a natural disaccharide, shows promise in treating atherosclerosis, myocardial infarction, and neurodegenerative disorders. The objective of this study was to investigate the effectiveness of TRE in improving cardiac functions measured by IVPG and HRV and reducing myocardial remodeling following myocardial infarction in rat model. Rats were divided into three groups: sham, myocardial infarction (MI), and trehalose-treated MI (TRE) groups. The animals in the MI and TRE groups underwent permanent ligation of the left anterior descending artery. The TRE group received 2% trehalose in their drinking water for four weeks after the surgery. At the end of the experiment, heart function was assessed using conventional echocardiography, novel color M-mode echocardiography for IVPG evaluation, and HRV analysis. After euthanasia, gross image scoring, histopathology, immunohistochemistry, and quantitative real-time PCR were performed to evaluate inflammatory reactions, oxidative stress, and apoptosis. The MI group exhibited significantly lower values in multiple IVPG parameters. In contrast, TRE administration showed an ameliorative effect on IVPG changes, with results comparable to the sham group. Additionally, TRE improved HRV parameters, mitigated morphological changes induced by myocardial infarction, reduced histological alterations in wall mass, and suppressed inflammatory reactions within the infarcted heart tissues. Furthermore, TRE demonstrated antioxidant, anti-apoptotic and anti-fibrotic properties. The investigation into the effect of trehalose on a myocardial infarction rat model has yielded promising outcomes, as evidenced by improvements observed through conventional echocardiography, histological analysis, and immunohistochemical analysis. While minor trends were noticed in IVPG and HRV measurements. However, our findings offer valuable insights and demonstrate a correlation between IVPG, HRV, and other traditional markers of echo assessment in the myocardial infarction vs. sham groups. This alignment suggests the potential of IVPG and HRV as additional indicators for future research in this field.

Abstract 13216: Evaluation of Left Ventricular Flow Propagation Velocity From Multi-Dimensional Cardiac Imaging

Introduction: The propagation velocity (Vp) during the left ventricular (LV) early diastole has been proposed as a marker of the diastolic function. However, the measurement of Vp is limited to one-dimensional data from Color M-mode (CMM) echocardiography and does not consider the spatiotemporal variation of Vp. Methods: We introduce a new method to evaluate the LV diastolic flow propagation from multi-dimensional cardiac flow imaging. The proposed method estimates the local and instantaneous flow propagation velocity (V prop ) by fitting the first order wave equation to the velocity gradients with weighted least-squares. The proposed method was validated using the synthetic vortex ring flow data. The method was applied to the LV flow data acquired with two-dimensional phase-contrast magnetic resonance imaging (pc-MRI) and 4D flow MRI. Results: The V prop estimated from multi-dimensional data has about 50% less error than the V prop from one-dimensional data. Fig. 1(a) shows the waveforms of the mitral inflow velocity, the IVPD, and the propagation intensity (I prop ) during the LV diastole of a normal filling patient. During early diastole, the timing of peak flow propagation coincides with the peak intraventricular pressure difference. Fig. 1(b) presents the fields of the blood flow velocity, the V prop , and the relative pressure from the timeframes indicated using the dotted lines in the waveform plots. The flow propagation towards the apex is mainly located at the front of the inflow jet and downstream of the vortex ring formed near mitral valve tips. Conclusions: This study introduces a novel propagation velocity measurement method for multi-dimensional cardiac flow imaging and demonstrated the V prop ’s spatial distribution temporal evolution.

Novel color M-mode echocardiography for non-invasive assessment of the intraventricular pressure in goats: Feasibility, repeatability, and the effect of sedation.

BackgroundThe intraventricular pressure difference (IVPD) and intraventricular pressure gradients (IVPG), estimated from color M-mode echocardiography (CMME) of the transmitral flow, have been introduced as novel indices for the evaluation of heart functions. Until now, no study demonstrated the feasibility of the CMME approach to measure IVPD and IVPG in any farm animals. The aim of this study was to assess the feasibility and repeatability of CMME-derived IVPD and IVPG variables in goats and explore the effect of sedation on the measured variables.Materials and methodsSixteen male Shiba goats were included in this study and underwent conventional echocardiography. Eight goats were used in the repeatability of IVPD/IVPG variables. Another eight goats were used to evaluate the effect of sedation by xylazine on IVPD/IVPG measurements. CMME between the base and the apex of the left ventricle was carried out. The IVPD and IVPG were analyzed using in-house code software. The IVPD and IVPG were expressed as total, basal, mid-to-apical, mid, and apical segments. Data analysis including the imaging quality score (IQS), repeatability, variability, intraclass correlation coefficient (ICC), as well as the effect size of sedation on the measured variables was calculated.ResultsIVPD and IVPG variables from CMME were feasible in all goats. Low to moderate variability of IVPD and IVPG variables was observed (CV 95% <25%) except for the apical IVPD and apical IVPG. The IVPD/IVPG measurements were repeatable without a significant effect of animal or time on the obtained measurements. The overall ICC was higher than 0.75 in all variables except for the apical segment. Xylazine administration reduced the total, basal, and mid parts of IVPD and IVPG with a large effect size (biserial ranked correlation; rc > 0.8).ConclusionWe reported, for the first time, IVPD and IVPG measurements by CMME in goats. The assessment of IVPD and IVPG by CMME is feasible in goats which can be evaluated in further cardiovascular or pharmacological studies in this species.

Intraventricular pressure gradient: A novel tool to assess the post-infarction chronic congestive heart failure.

Congestive heart failure (CHF), the leading cause of death, is deemed a grave sequel of myocardial infarction (MI). The employment of left ventricular end-diastolic pressure (LVEDP), as a primary indication of CHF, becomes restricted owing to the potential impairment of heart function and caused injury to the aortic valve during its measurement. Echocardiography is the standard technique to detect cardiac dysfunction. However, it exhibits a low capacity to predict the progression of CHF post chronic MI. Being extremely sensitive, noninvasive, and preload-independent, intraventricular pressure gradient (IVPG) was lately introduced to evaluate cardiac function, specifically during cardiomyopathy. Yet, the utility of its use to assess the CHF progression after chronic MI was not investigated. Herein, in the current research, we aimed to study the efficacy of a novel echocardiographic-derived index as IVPG in the assessment of cardiac function in a chronic MI rat model with CHF. Fifty healthy male rats were involved, and MI was surgically induced in 35 of them. Six months post-surgery, all animals were examined using transthoracic conventional and color M-mode echocardiography (CMME) for IVPG. Animals were euthanized the following day after hemodynamics recording. Gross pathological and histological evaluations were performed. J-tree cluster analysis was conducted relying on ten echocardiographic parameters suggestive of CHF. Animals were merged into two main clusters: CHF+ (MI/HF + group, n = 22) and CHF– (n = 28) that was joined from Sham (n = 15), and MI/HF– (n = 13) groups. MI/HF+ group showed the most severe echocardiographic, hemodynamic, anatomic, and histologic alterations. There was no significant change in the total IVPG among various groups. However, the basal IVPG was significantly increased in MI/HF+ group compared to the other groups. The remaining IVPG measures were considerably increased in the MI/HF+ group than in the Sham one. The segmental IVPG measures were significantly correlated with the anatomical, histological, echocardiographic, and hemodynamic findings except for the heart rate. Moreover, they were significant predictors of CHF following a long-standing MI. Conclusively, IVPG obtained from CMME is a substantially promising noninvasive tool with a high ability to detect and predict the progression of CHF following chronic MI compared to conventional echocardiography.

Color M-Mode Echocardiography for Non-Invasive Assessment of the Intraventricular Pressure in Dogs Before and After Ductus Arteriosus Occlusion: A Retrospective Study.

BackgroundNovel non-invasive evaluation of the intraventricular pressure differences and gradients (IVPD and IVPG) by color M-mode echocardiography (CMME) is a promising method in diastolic function evaluation. Patent ductus arteriosus (PDA) is a congenital heart defect which is associated with increased preload. The present work provides a clinical trial for the assessment of IVPD and IVPG changes in dogs before and after surgical occlusion of PDA.Materials and MethodsA total of 12 client-owned dogs were enrolled in this study. PDA was confirmed using echocardiography, and all dogs underwent PDA occlusion. Conventional echocardiography and CMME were conducted on each patient on the operation day (Pre-PDA) and 48 h after its occlusion (Post-PDA). The total IVPD and total IVPG, as well as segmental intraventricular pressure (basal, mid-to-apical, mid, and apical) were measured from Euler's equation using specific software (MATLAB). Data were analyzed for variability and for the difference between pre- and post-PDA. The effect of PDA occlusion on the measured variables was calculated using biserial ranked correlation (rc).ResultsThere was a significant reduction in end-diastolic volume, fraction shortening, stroke volume, and mitral inflow velocities (early and late) after PDA closure. CMME was feasible in all dogs, and the CMME indices showed moderate variability, except for the apical segment of IVPD and IVPG. After PDA closure, in comparison with the pre-PDA occlusion, there was a significant reduction in total IVPD (2.285 ± 0.374 vs. 1.748 ± 0.436 mmHg; P = 0.014), basal IVPD (1.177 ± 0.538 vs. 0.696 ± 0.144 mmHg; P = 0.012), total IVPG (1.141 ± 0.246 vs. 0.933 ± 0.208 mmHg; P = 0.032), and basal IVPG (0.578 ± 0.199 vs. 0.377 ± 0.113 mmHg; P = 0.001); meanwhile, mid, mid-to-apical, and apical segments of both IVPD and IVPG showed non-significant difference. The magnitude of PDA occlusion on the measured variables was clinically relevant and associated with a large effect size on total and basal IVPD and IVPG (rc > 0.6).ConclusionThe current clinical study revealed matched response of IVPD and IVPG to the reduced preload rather than left ventricular relaxation. This result is an initial step in the clinical utility of CMME-derived IVPD and IVPG measurements in the diastolic function evaluation in dogs with PDA that warrants further clinical studies.

Changes in Cardiac Function During the Development of Uremic Cardiomyopathy and the Effect of Salvianolic Acid B Administration in a Rat Model.

BackgroundUremic cardiomyopathy (UC), the main cause of death in progressive chronic kidney disease (CKD), is characterized by diastolic dysfunction. Intraventricular pressure gradients (IVPG) derived from color m-mode echocardiography (CMME) and two-dimensional speckle tracking echocardiography (2DSTE) were established as novel echocardiographic approaches for non-invasive and repeatable assessment of cardiac function. Previously, salvianolic acid B (Sal B) showed the potential to alleviate concentric LV hypertrophy in the pressure overload model. The purpose of this study was to evaluate the changes in cardiac function in UC and assess the efficacy of Sal B therapy using IVPG and 2DSTE techniques.Materials and MethodsTwenty-four rats underwent subtotal nephrectomy to produce progressive renal failure and were allocated equally into UC (n = 12) and Sal B-UC (n = 12) groups and monitored for 8 weeks. A sham-operated group was also included in this study (n = 12). Sal B was injected from weeks 4 to 8 in the Sal B-UC group. Conventional echocardiography, 2DSTE, and CMME were performed every 2 weeks post-operation, concomitantly with an evaluation of renal function. Histopathological and immunohistochemistry analyses were carried out to confirm the echocardiography findings.ResultsRenal failure and myocardial dysfunction were confirmed in the UC group from weeks 2 through 8. Eccentric and concentric hypertrophy was observed in the UC group, while the Sal B-UC group showed only eccentric hypertrophy. IVPG analysis did not reveal any significant differences between the groups. Edema, inflammation, fibrosis, and immunohistochemical expression of CD3 infiltration were higher in the UC group compared with sham and Sal B-UC groups.Conclusion2DSTE and IVPG explored the pathophysiology during the development of UC and indicated the incidence of myocardial dysfunction before ventricular morphological changes without intracardiac flow changes. This study confirmed increased ventricular stiffness and fibrosis in UC rats which was potentially treated by Sal B via decreasing edema, inflammation, and fibrosis.

Non-Invasive Detection of Fetal Vascular Endothelial Function in Gestational Diabetes Mellitus.

ObjectivesEndothelial dysfunction in the fetuses of women with gestational diabetes mellitus (GDM) is associated with their subsequent cardiovascular events. Prenatal assessment of endothelial function in fetuses exposed to intrauterine hyperglycemic environment remains challenging. The aim of this study was to assess the fetal vascular endothelial function in GDM patients using color M-mode derived aortic propagation velocity (APV) and evaluate the correlation of APV with endothelial function biomarkers.MethodsThis observational cross-sectional study included 31 gestational diabetic mothers and 30 healthy pregnant mothers from August 2019 to January 2020. Clinical data were compared between the groups. Fetal APV was measured using color M-mode echocardiography at late gestation. Concentrations of endothelial biomarkers including von Willebrand Factor (vWF), vascular endothelial-cadherin and endothelin-1 in umbilical cord serum were assessed. Measurements between diabetic group and controls were compared.ResultsvWF was the only endothelial functional marker that differed between the two groups. Fetuses in the GDM group had significantly lower APV levels and higher vWF levels compared with the healthy controls (P < 0.05). There was a moderate but significant correlation between APV and vWF (r =−0.58, P < 0.001). There were no associations between APV and ventricular wall thickness or umbilical artery pulsatility index.ConclusionsColor M-mode propagation velocity of aorta is a non-invasive, practical method that correlates well with GDM and fetal endothelial function. This novel metric could contribute to recognizing early vascular functional alterations and hence represents a potential strategy for early risk factor surveillance and risk modification.

Effect of Loading Changes on the Intraventricular Pressure Measured by Color M-Mode Echocardiography in Rats.

Evaluation of diastolic function is a pivotal challenge due to limitations of the conventional echocardiography, especially when the heart rate is rapid as in rats. Currently, by using color M-mode echocardiography (CMME), intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG) in early diastole can be generated and are available as echocardiographic indices. These indices are expected to be useful for the early diagnosis of heart failure (HF), especially diastolic dysfunction. There have not been any studies demonstrating changes in IVPD and IVPG in response to changes in loading conditions in rats. Therefore, the present study aims to evaluate CMME-derived IVPD and IVPG changes in rats under various loading conditions. Twenty rats were included, divided into two groups for two different experiments, and underwent jugular vein catheterization under inhalational anesthetics. Conventional echocardiography, CMME, and 2D speckle tracking echocardiography were measured at the baseline (BL), after intravenous infusion of milrinone (MIL, n = 10), and after the infusion of hydroxyethyl starch (HES, n = 10). Left ventricular IVPD and IVPG were calculated from color M-mode images and categorized into total, basal, mid-to-apical, mid, and apical parts, and the percentage of the corresponding part was calculated. In comparison to the BL, the ejection fraction, mid-to-apical IVPG, mid IVPG, and apical IVPD were significantly increased after MIL administration (p < 0.05); meanwhile, the end-diastolic volume, E-wave velocity, total IVPD, and basal IVPD were significantly increased with the administration of HES (p < 0.05). The increase in mid-to-apical IVPD, mid IVPD, and apical IVPD indicated increased relaxation. A significant increase in basal IVPD reflected volume overloading by HES. CMME-derived IVPD and IVPG are useful tools for the evaluation of various loading conditions in rats. The approach used in this study provides a model for continuous data acquisition in chronic cardiac disease models without drug testing.

The Utility of Intraventricular Pressure Gradient for Early Detection of Chemotherapy-Induced Subclinical Cardiac Dysfunction in Dogs.

Simple SummaryCardiotoxicity is a serious side effect of doxorubicin in cancer patients due to the risk of development of heart failure. Early detection of doxorubicin-induced cardiomyopa-thy (DXR-ICM) has become a major objective to reduce heart failure in cancer patients. Echocar-diography is the gold standard method to diagnose cardiac diseases when cardiac dysfunction is prominent; however, it still cannot predict or early diagnose heart failure before functional de-cline. The intraventricular blood flow is characterized by intraventricular pressure gradients (IVPG) that created due to the suction of blood by the ventricles. Currently, advanced imaging techniques allow non-invasive assessment of IVPG from color M-mode echocardiography (CMME) after image processing for the clinical setting. Studies revealed that IVPG indices are promising for the early diagnosis of cardiac dysfunction. In this study, we aimed to investigate the usefulness of IVPG to detect cardiac function changes after DXR administration in dogs. Early detection of doxorubicin (DXR)-induced cardiomyopathy (DXR-ICM) is crucial to improve cancer patient outcomes and survival. In recent years, the intraventricular pressure gradient (IVPG) has been a breakthrough as a sensitive index to assess cardiac function. This study aimed to evaluate the usefulness of IVPG for the early detection of chemotherapy-related cardiac dysfunction. For this purpose, six dogs underwent conventional, speckle tracking, and color M-mode echocardiography concomitantly with pressure-and-volume analysis by conductance catheter. The cardiac function measurements were assessed before DXR administration (baseline, Pre), at the end of treatment protocol (Post), and at 1.5 years follow-up (Post2). The result showed a significant reduction in the left ventricular end-systolic pressure-volume (Emax: 4.4 ± 0.7, 6.1 ± 1.6 vs. 8.4 ± 0.8 mmHg/mL), total-IVPG (0.59 ± 0.12, 0.62 ± 0.15 vs. 0.86 ± 0.12 mmHg), and mid-IVPG (0.28 ± 0.12, 0.31 ± 0.11 vs. 0.48 ± 0.08 mmHg), respectively in Post2 and Post compared with the baseline (p < 0.05). Mid-to-apical IVPG was also reduced in Post2 compared with the baseline (0.29 ± 0.13 vs. 0.51 ± 0.11). Meanwhile, the fraction shortening, ejection fraction, and longitudinal strain revealed no change between groups. Total and mid-IVPG were significantly correlated with Emax (R = 0.49; p < 0.05, both) but only mid-IVPG was a predictor for Emax (R2 = 0.238, p = 0.040). In conclusion, this study revealed that impairment of contractility was the initial changes observed with DXR-ICM in dogs and only IVPG could noninvasively detect subclinical alterations in cardiac function. Color M-mode echocardiography-derived IVPG could be a potential marker for the early detection of doxorubicin cardiomyopathy.

RENOVASCULAR HYPERTENSION-INDUCED CARDIAC CHANGES IN A RAT MODEL: FEASIBILITY OF CONVENTIONAL AND RECENT ECHOCARDIOGRAPHY

Objective: Renovascular hypertension (RH) is a major cause of secondary hypertension, and hypertension eventually led to cardiac remodeling in patients. Hypertension leads to concentric left ventricle hypertrophy, while hypervolemia originated from renal failure leads to eccentric hypertrophy. Both mechanisms occur in RH which results in complex cardiac remodeling. Uraemic cardiomyopathy results from RH is characterized by diastolic dysfunction, but traditional echocardiography was limited in evaluating the diastolic function due to unknown hemodynamic and morphologic status. Recently, non-invasive intraventricular pressure gradient (IVPG), a preload-independent diastolic function parameter, was established and showed higher sensitivity to evaluate diastolic dysfunctions, particularly during cardiomyopathy. However, no previous studies highlighted the feasibility of the IVPG in the diagnosis of RH. Design and method: Twelve rats were received subtotal nephrectomy in 1 week to produce progressive renal failure as the RH group. The other twelve rats were sham-operated as a control group. Conventional and color M-mode echocardiography was performed for isoflurane-anesthetized rats at 2nd, 4th, 6th, and 8th weeks post-operation. IVPG was evaluated based on the Euler equation. Results: Hypertension, polyuria and hypervolemia were observed in RH group from the 2nd, 4th, and 8th week, respectively. Marked left ventricle hypertrophy was evidenced at 6th (1.32 ± 0.28 vs 1.09 ± 0.09, p = 0.016) and 8th-week post-operation (1.34 ± 0.28 vs 1.16 ± 0.09, p = 0.014) that was more prominent in the posterior papillary muscle. Peak mitral E velocity in RH rats was higher than control at the 8th week (106.35 ± 16.04 vs 91.23 ± 10.82, p = 0.031). In contrast, tissue Doppler index, total IVPG, basal IVPG, and mid-to-apical IVPG showed no difference between groups throughout the experiment. Conclusions: Hypervolemia and RH lead to unclassified geometry in RH-associated cardiac remodeling. Blood pressure change precedes the change of preload during the development of RH cardiac remodeling.

Intraventricular pressure gradients change during the development of left ventricular hypertrophy: Effect of salvianolic acid B and beta-blocker.

Intraventricular pressure gradient is regarded as a non-invasive indicator of diastolic function. Salvianolic acid B (Sal-B), a traditional Asian medicine, revealed its usefulness in myocardial infarction models; however, the hemodynamic effect of salvianolic acid B is still unknown. The present study aimed to investigate the intraventricular pressure gradient changes during the development of left ventricular hypertrophy with or without salvianolic acid B and a beta-blocker. In total, 48 rats were divided into four groups; Sham, Non-treatment, salvianolic acid B, and Carvedilol. Aortic coarctation-induced left ventricular hypertrophy was done in three groups and the treatment was started from the third to the sixth week. Blood pressure, conventional echocardiography, and color M-mode echocardiography for measurement of intraventricular pressure gradient were carried out for six consecutive weeks. At 4.5 weeks, the LV mass was elevated in the coarctation groups but the blood pressure was significantly lower in salvianolic acid B and Carvedilol groups (P < 0.05). In the Non-treatment group, the total intraventricular pressure gradient was increased at 4.5 and 6 weeks (2.60 and 2.65, respectively). Meanwhile, the basal intraventricular pressure gradient was elevated at 3 and 6 weeks (1.67 and 1.75) compared with the Sham group. Salvianolic acid B and Carvedilol significantly reduced the basal intraventricular pressure gradient at six weeks compared with the Non-treatment group (1.52 and 1.51 vs 1.75, respectively). Salvianolic acid B and Carvedilol promote cardiac function by decreasing the elevated basal intraventricular pressure gradient. The current preclinical results revealed the efficacy of salvianolic acid B as a potential therapy for left ventricular hypertrophy because of the non-blood pressure lowering effect.

Chinese Veterinary Medicine B307 Promotes Cardiac Performance and Skeletal Muscle Contraction via Enhancing Intracellular Calcium Levels and Neural Electrical Activity in Animal and Cell Models

The study mainly investigated the effects of Chinese veterinary medicine B307 in cardiac and motor functions in animal models of pigeons and mice. Related cellular mechanisms were also studied in the neuroblastoma cell model of SH-SY5Y. Cardiac functions of pigeons and mice were examined by using moorFLPI Laser color Doppler imager and M-mode echocardiography, and motor functions were examined by using muscle electrical stimulation and force recording in the isolated breast muscle. Intracellular calcium levels and electrical activity of SH-SY5Y cells were examined by using Fura 2-AM fluorescence and MED64 system separately. Our results in vivo found that those pigeons under oral B307 treatment obviously enhanced subcutaneous microcirculation and contractile force and prolonged fatigue time in their breast muscles. Those mice under oral B307 treatment obviously elevated ejection fraction and cardiac output in their hearts. Our results in vitro showed that those SH-SY5Y cells under B307 treatment obviously increased intracellular calcium mobilization and electrical activities. These results revealed that improvement of cardiac and motor functions under B307 treatments may be caused by increasing electrical activities and intracellular calcium levels in neuromuscular cells and a similar mechanism may also occur in muscle cells. Thus, we suggested that B307 can be a functional Chinese veterinary medicine for flying pigeons.

Progression of left ventricular diastolic function in the neonate and early childhood from transmitral color M-mode filling analysis

We implemented sophisticated color M-mode analysis to assess age-dependent progression of left ventricular (LV) diastolic function. Normal infants were prospectively enrolled for serial echocardiograms at 1 week, 1 month, 6 months, 1 year, and 2 years. From color M-mode scans, propagation velocity (VP), strength of filling (VS), and intraventricular pressure difference (IVPD) in 3 segments along apex-to-mitral valve scan line were measured. Age-wise comparisons of diastolic filling from 121 echocardiograms in 31 infants showed VP (cm/s), VS (cm2/s), and E-wave IVPD (mmHg) at 1 week to be 66.2 ± 11.9, 75.3 ± 19.9, and 1.5 ± 0.4, respectively, while VP, VS, and E-wave IVPD at 1 month were 80.3 ± 14.4, 101.2 ± 28.3, and 2.42 ± 1.1, respectively. There were significant differences in VP and segmental IVPD between first week and first month (p < 0.005) and IVPD between the age groups (p < 0.001). Comprehensive analysis of transmitral color M-mode data is feasible in infants, enabling calculation of pressure drop between the LV base and apex and strength of propagation from two distinct slopes. Profound changes very early followed by relatively constant filling mechanics in later infancy indicate significant LV maturation occurring during the first month of life. We implemented sophisticated analytic methods for color M-mode echocardiography in infants to assess age- and dimension-dependent changes in left ventricular diastolic function. Comprehensive characterization of transmitral color M-mode flow was feasible, enabling calculation of pressure drop between left ventricular base and apex and strength of propagation. Left ventricular diastolic filling function has predictable maturational progression, with significant differences in the intraventricular pressure between infants from birth to 2 years. This study forms the basis for future studies to examine alteration of early diastolic filling in congenital heart disease.

Aortic propagation velocity does not correlate with classical aortic stiffness parameters in healthy individuals.

Objective:Aortic stiffness is an important cardiovascular risk marker, which can be determined using different noninvasive techniques. Aortic propagation velocity (APV) has recently been established as a novel echocardiographic parameter of aortic stiffness. This study aimed to investigate the association between APV and the classical echocardiography-derived aortic stiffness parameters, aortic distensibility (AD) and aortic strain (AS), in a group of otherwise healthy individuals.Methods:In total, 97 consecutive healthy subjects were recruited in this observational study. APV was measured using color M-mode echocardiography from the suprasternal window in the descending aorta. AS and AD were calculated using clinical blood pressure and the M-mode echocardiography-derived aortic diameters. Correlation analyses were performed between cardiovascular risk factors related to increased aortic stiffness (age, obesity, and blood pressure) and measured stiffness parameters (APV, AS, and AD). Correlation analyses were also performed among the measured stiffness parameters.Results:Good correlation of age, blood pressure, and BMI with AS and AD was observed. One-on-one correlation of age, blood pressure, and BMI with APV was not observed. No correlation was observed between APV and AS (r=–0.05, p=0.6) or between APV and AD (r=–0.17, p=0.8).Conclusion:Although APV has been proposed as a novel and practical echocardiographic parameter of aortic stiffness, especially in patients with coronary artery disease, correlations between classical stiffness parameters (AS and AD) and APV were absent in healthy individuals at low–intermediate risk. The clinical and research applicability of APV should be further evaluated.

Color doppler correlates of pulmonary artery hypertension

Mild systolic reduction in pulmonary artery flow is an echocardiographic sign of pulmonary artery hypertension. However, at times, it is difficult to appreciate and further grade it into mild, moderate, or severe. We regularly performed color Doppler and color M-mode echocardiography of pulmonary flow and observed that it is easier to interpret and grade the findings. Findings correlate with pulmonary artery pressure evaluated by tricuspid regurgitation jet. Four representative examples are presented.

PP.01.15

Objective: Pseudonormal and restrictive diastolic pattern of mitral inflow were associated with dilatation and cardiac mortality in first year after acute myocardial infarction (AMI). Arterial hypertension before the acute coronary event is known to be a factor linked to an increased enddiastolic pressure. Purpose of the study was to find a correlation between echocardiographic parameters of filling pressure at discharge and pattern of mitral inflow at one year after AMI in hypertensive patients. Design and method: A number of 98 hypertensive patients (56 males and 42 females), admitted with acute myocardial infarction with ST-segment elevation were evaluated during the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurement of: left atrium volume index (LAVi), left ventricular mass index (LVMi) using transthoracic echocardiography; cut off levels for left ventricular hypertrophy (LVH) were LVMi>115 g/m2 in males and>95 g/m2 in females; mitral inflow, pulmonary venous inflow measurement using Doppler echocardiography, tissue Doppler echocardiography at lateral and medial corner of mitral annulus, color Mmode echocardiography. E/E’ average ratio, E/vp ratio and ar-A duration were calculated. After one year the pattern of mitral inflow was evaluated using transthoracic Doppler echocardiography. All patients received fibrinolytic therapy. LVEF measured by Simpson method was less than 45%. Results: 1. Mean values of parameters of filling pressure in hypertensive patients with LVH and without reperfusion were: VASi:35,04, p = 0,00007, E/E’:14,81, p = 0,03992, E/vp:1,99, p = 0,00197, ar-A:28,79, p = 0,00726. 2. Using chi squared (CS), odd ratio (OR) and relative risk (RR) significant correlations were found between mitral pattern and: VASi>32 ml/m2 CS:6,512834; E/E’>14, CS:10,179653, E/vp < 1,5, CS:10,637642, ar-A>30ms, CS:40,105. Conclusions: 1. The highest mean values of echocardiographic parameters of increased filling pressure at discharge after an acute myocardial infarction were found in hypertensive patients with LVH and without reperfusion. 2. A correlation was found between these increased mean values at discharge and mitral inflow after one year suggesting a worse evolution in these patients.

High-temporal velocity-encoded MRI for the assessment of left ventricular inflow propagation velocity: head-to-head comparison with Color M-mode echocardiography

High-temporal velocity-encoded MRI for the assessment of left ventricular inflow propagation velocity: head-to-head comparison with Color M-mode echocardiography

Left Atrial and Left Ventricular Diastolic Function in Chronic Chagas Disease

Left atrial (LA) and left ventricular (LV) diastolic function analysis can yield new strategies to recognize early cardiac involvement and prognostic indicators in Chagas disease. Patients with Chagas disease with the indeterminate (n= 69) or with the cardiac form (32 with changes limited to electrocardiography [stage A], 25 with changes in LV systolic function but no heart failure [HF; stage B], and 26 with HF) underwent evaluation of LV diastolic function (mitral inflow, pulmonary vein flow, color M-mode echocardiography, and tissue Doppler analysis), and LA function by three-dimensional echocardiography and strain analysis and were prospectively followed for the occurrence of clinical events. Echocardiograms were also obtained from 32 controls. LV diastolic dysfunction was gradually more prevalent and severe across groups from patients with the indeterminate form of Chagas disease to patients with HF. Tissue Doppler was the best tool to demonstrate the worsening of LV diastolic function across the groups (E' velocity: controls, 12.6 ± 2.3 cm/sec; patients with the indeterminate form, 12.1 ± 3.1 cm/sec; stage A, 10.3 ± 2.9 cm/sec; stage B, 8.3 ± 2.8cm/sec; patients with HF, 5.6 ± 1.9; P < .0001). Although maximum LA volume was increased only in patients with HF, minimum LA volume (controls, 8 ± 2 mL/m(2); patients with the indeterminate form, 8 ± 2 mL/m(2); stage A, 9 ± 3 mL/m(2); stage B, 11 ± 4 mL/m(2); patients with HF, 27 ± 17 mL/m(2); P < .0001) and precontraction LA volume (controls, 11 ± 3 mL/m(2); patients with the indeterminate form, 12 ± 3 mL/m(2); stage A, 13 ± 4mL/m(2); stage B, 16 ± 5 mL/m(2); patients with HF, 32 ± 19 mL/m(2); P < .0001) were increased in all cardiac form groups. LA conductive function was depressed in all cardiac form groups, while LA contractile function was depressed only in patients with HF. Cox proportional-hazards regression analysis revealed that end-systolic LV diameter (hazard ratio, 1.6; 95% confidence interval, 0.9-2.8; P= .09), E' velocity (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8; P= .001), and peak negative global LA strain (hazard ratio, 1.21; 95% confidence interval, 1.02-1.4; P= .03), were independent predictors of clinical events. LV diastolic dysfunction was found in all forms of chronic Chagas disease, including those without LV systolic dysfunction. LV diastolic dysfunction may contribute to changes in LA volume and conductive function found in early stages of the cardiac form. Both LV diastolic function and LA contractile function were independent predictors of clinical events.

Improvement of Diastolic Function in Patients With Congestive Heart Failure After Cardiac Resynchronization Therapy by Echocardiography

Brief Description of the Purpose of the StudyThe aims were to evaluate the diastolic function in CHF after CRT by conventional echocardiography or Doppler tissue imaging (TDI) and supply information for clinical therapy.Methods31 patients with CHF were divided into responders (Group R) and non-responders (Group R) according standard of a decline in LV end-systolic volume ≥10% 6 months after CRT. All the patients received echo examination 1-3 days before CRT and 6 month after CRT. Color M-mode echocardiography indices included Vp, E/Vp. TDI indices included the peak velocity in early diastole (e) at 4 sites of mitral annulus, E/e, time to peak velocity in systole (Ts), Ts-SD and maximum difference of Ts (Ts-Dif) among 12 segments.Main ResultsCompared with before CRT, Ts-SD and Ts-Dif significantly shortened in Group R; Vp increased significantly, E/e at each 4 site and mean value at 4 sites of mitral annulus, E/Vp decreased significantly; but there were no significant difference in Group N. There were significant positive correlation between mean value at 4 sites of E/e, E/Vp and Ts-SD in Group R.Importance of the ConclusionsThe diastolic function in responders to CRT improved, which was associated with the decreased LV filling pressure and improved LV relaxation. Brief Description of the Purpose of the StudyThe aims were to evaluate the diastolic function in CHF after CRT by conventional echocardiography or Doppler tissue imaging (TDI) and supply information for clinical therapy. The aims were to evaluate the diastolic function in CHF after CRT by conventional echocardiography or Doppler tissue imaging (TDI) and supply information for clinical therapy. Methods31 patients with CHF were divided into responders (Group R) and non-responders (Group R) according standard of a decline in LV end-systolic volume ≥10% 6 months after CRT. All the patients received echo examination 1-3 days before CRT and 6 month after CRT. Color M-mode echocardiography indices included Vp, E/Vp. TDI indices included the peak velocity in early diastole (e) at 4 sites of mitral annulus, E/e, time to peak velocity in systole (Ts), Ts-SD and maximum difference of Ts (Ts-Dif) among 12 segments. 31 patients with CHF were divided into responders (Group R) and non-responders (Group R) according standard of a decline in LV end-systolic volume ≥10% 6 months after CRT. All the patients received echo examination 1-3 days before CRT and 6 month after CRT. Color M-mode echocardiography indices included Vp, E/Vp. TDI indices included the peak velocity in early diastole (e) at 4 sites of mitral annulus, E/e, time to peak velocity in systole (Ts), Ts-SD and maximum difference of Ts (Ts-Dif) among 12 segments. Main ResultsCompared with before CRT, Ts-SD and Ts-Dif significantly shortened in Group R; Vp increased significantly, E/e at each 4 site and mean value at 4 sites of mitral annulus, E/Vp decreased significantly; but there were no significant difference in Group N. There were significant positive correlation between mean value at 4 sites of E/e, E/Vp and Ts-SD in Group R. Compared with before CRT, Ts-SD and Ts-Dif significantly shortened in Group R; Vp increased significantly, E/e at each 4 site and mean value at 4 sites of mitral annulus, E/Vp decreased significantly; but there were no significant difference in Group N. There were significant positive correlation between mean value at 4 sites of E/e, E/Vp and Ts-SD in Group R. Importance of the ConclusionsThe diastolic function in responders to CRT improved, which was associated with the decreased LV filling pressure and improved LV relaxation. The diastolic function in responders to CRT improved, which was associated with the decreased LV filling pressure and improved LV relaxation.