Congestive Heart Failure Group Research Articles

Evaluation of hemostatic and fibrinolytic markers in dogs with ascites attributable to right-sided congestive heart failure

To determine whether dogs with ascites secondary to right-sided congestive heart failure (CHF) have bleeding disorders associated with hypofibrinogenemia and discordant plasma fibrin-fibrinogen degradation products (FDPs) and D-dimer assay results (ie, a circulating concentration of FDPs higher than the reference range and a circulating concentration of D-dimer within the reference range). Retrospective case-control study. 80 client-owned dogs. Dogs with ascites secondary to right-sided CHF (group 1; n = 20), unhealthy dogs without cardiac disease (group 2; 40), and dogs with left-sided CHF (group 3; 20) were included in the study. Urine bile acids-to-creatinine concentration ratios were calculated as a marker of liver function. Differences among groups regarding coagulation profile analysis results and prevalence of discordant FDPs and D-dimer assay results were determined. No significant differences were detected among the 3 groups regarding urine bile acids-to-creatinine concentration ratios. Plasma fibrinogen concentration was significantly lower for group 1 versus groups 2 or 3. Prevalence of discordant FDPs and D-dimer assay results was significantly higher for group 1 versus groups 2 or 3. Eighteen group 1 dogs had discordant FDPs and D-dimer assay results. Ten of these dogs had concurrent hypofibrinogenemia, 2 of which had clinical signs of bleeding. Only 10 dogs in groups 2 or 3 had discordant FDPs and D-dimer assay results; none of these dogs had hypofibrinogenemia or clinical signs of bleeding. Dogs with right-sided CHF and ascites may be at increased risk for primary hyperfibrinogenolysis (ie, hypofibrinogenemia and discordant FDPs and D-dimer assay results).

Poor health status and distress in cardiac patients: the role of device therapy vs. underlying heart disease

Implantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influence of living with an ICD vs. congestive heart failure (CHF) on PROs and compared (i) ICD patients without CHF (ICD only), (ii) CHF patients without an ICD (CHF-only), and (iii) CHF patients with an ICD (ICD + CHF). Separate cohorts of ICD and CHF patients (N = 435; 75% men) completed PROs at baseline, 6 and 12 months. Groups differed on physical health status only at baseline (F((2,415)) = 7.15, P = 0.001) and on anxiety at 12 months (F((2,415)) = 4.04, P = 0.01); ICD + CHF patients had the most impaired physical health status but the lowest anxiety level followed by the ICD only and CHF only patients. Congestive heart failure only patients had the most impaired mental health status and reported the highest level of anxiety as compared to the ICD only (P < 0.001) and ICD + CHF groups (P = 0.009), while the two latter groups did not differ. The effect sizes ranged from very small (0.03) to moderate-large (0.69). Groups did not differ in depression scores. Congestive heart failure patients reported worse PROs as compared to ICD patients, although the magnitude of the differences was relatively small. This suggests that the well being of patients is not necessarily negatively influenced by the implantation of an ICD, and that underlying heart disease may have at least an equal if not greater influence on PROs.

Cortical sources of EEG rhythms in congestive heart failure and Alzheimer's disease

IntroductionThe brain needs continuous oxygen supply even in resting-state. Hypoxia enhances resting-state electroencephalographic (EEG) rhythms in the delta range, and reduces those in the alpha range, with a pattern similar to that observed in Alzheimer's disease (AD). Here we tested whether resting-state cortical EEG rhythms in patients with congestive heart failure (CHF), as a model of acute hypoxia, present frequency similarities with AD patients, comparable by cognitive status revealed by the mini mental state examination (MMSE). MethodsEyes-closed EEG data were recorded in 10 CHF patients, 20 AD patients, and 20 healthy elderly subjects (Nold) as controls. LORETA software estimated cortical EEG generators. ResultsCompared to Nold, both AD and CHF groups presented higher delta (2–4Hz) and lower alpha (8–13Hz) temporal sources. The highest delta and lowest alpha sources were observed in CHF subjects. In these subjects, the global amplitude of delta sources correlated with brain natriuretic peptide (BNP) level in the blood, as a marker of disease severity. ConclusionsResting-state delta and alpha rhythms suggest analogies between the effects of acute hypoxia and AD neurodegeneration on the cortical neurons' synchronization. SignificanceAcute ischemic hypoxia could affect the mechanisms of cortical neural synchronization generating resting state EEG rhythms, inducing the “slowing” of EEG rhythms typically observed in AD patients.

Determinants of the Accuracy of Continuous Glucose Monitoring in Non-Critically Ill Patients with Heart Failure or Severe Hyperglycemia

The accuracy of continuous glucose monitoring (CGM) in non-critically ill hospitalized patients with heart failure or severe hyperglycemia (SH) is unknown. Hospitalized patients with congestive heart failure (CHF) exacerbation (receiving IV or subcutaneous insulin) or SH requiring insulin infusion were compared to outpatients referred for retrospective CGM. Forty-three patients with CHF, 15 patients with SH, and 88 outpatients yielded 470, 164, and 2150 meter-sensor pairs, respectively. Admission glucose differed (188 versus 509 mg/dl in CHF and SH, p < .001) but not the first sensor glucose (p = .35). In continuous glucose error grid analysis, 67-78% of pairs during hypoglycemia were in zones A+B (p = .63), compared with 98-100% in euglycemia (p < .001) and 98%, 92%, and 99% (p = .001) during hyperglycemia for the CHF, SH, and outpatient groups, respectively. Mean absolute relative difference (MARD) was lower in the CHF versus the SH group in glucose strata above 100 mg/dl, but there was no difference between the CHF and outpatient groups. Linear regression models showed that CHF versus outpatient, SH versus CHF, and coefficient of variation were significant predictors of higher MARD. Among subjects with CHF, MARD was not associated with brain natriuretic peptide or change in plasma volume, but it was significantly higher in subjects randomized to IV insulin (p = .04). The results suggest that SH and glycemic variability are more important determinants of CGM accuracy than known CHF status alone in hospitalized patients.

Effect of amiodarone on dispersion of ventricular repolarization in a canine congestive heart failure model

The effects of amiodarone on ventricular electrophysiological parameters, especially the dispersion of ventricular repolarization, were investigated in a canine model of congestive heart failure (CHF). Dogs were randomized to either a control, amiodarone, CHF, or CHF+amiodarone group. Dogs in the CHF and CHF+amiodarone groups underwent 4-5weeks of rapid ventricular pacing; dogs in the control and amiodarone groups underwent sham operation only. Amiodarone (20 mg/kg per day) was administered orally, beginning on postoperative Day 1, in the treatment groups; ventricular electrophysiological variables were evaluated 4-5weeks after rapid pacing or sham operation. In CHF dogs, the transmural dispersion ventricular repolarization time (TDVRT) increased significantly. Amiodarone significantly decreased the TDVRT in CHF dogs. The ventricular fibrillation threshold (VFT) decreased in the CHF group. Amiodarone increased the VFT in CHF dogs. The TDVRT increased in CHF dogs, but amiodarone decreased TDVRT and increased VFT in these dogs. These results suggest a beneficial effect of amiodarone on malignant arrhythmias and may provide the basis for its use in CHF patients.

Canine Model of Cardiorenal Failure

The heart and the kidneys act in tandem to regulate blood pressure, vascular tone, diueresis and to maintain intravascular volume homeostasis. Besides, the kidneys have a neuroendocrine function with interdependent physiological actions regulated by the renin-angiotensin-aldosterone system, sympathetic nervous system, and vasopressin and aterial natriuretic peptide. To investigate these complex pathophysiological mechanisms, a canine model for Congestive Heart Failure (CHF) compromised with Renal Dysfunction (RF) was used, to characterize the hemodynamic and neurohumoral aspects of renal function in 21 dogs. Five dogs were used as controls. Bipolar epicardial pacemaker leads were implanted at the apex of the right ventricle in 8 dogs and the dogs were subjected to ventricular pacing at 250-270 beats/min with an external pacemaker (Nihon Kohden) for a period of 11-21 days. This rapid pacing produced CHF. RF was induced by removal of the right kidney with ligation of the small branches of the left kidney in 8 dogs. Three dogs of each of the CHF and RF groups were used to produce CHF and RF in combination; one dog died due to infection. The glomerular filtration rates of the dogs with RF, CHF and CHF+RF were significantly lower than those of the controls, although among the dogs with RF, CHF and CHF+RF, there were no significant differences. In spite of no differences in blood pressure and renal hemodynamics, the levels of plasma renin activity, norepinephrine and vasopressin of CHF+RF group were significantly higher than those of RF and CHF groups. Taken together, these data suggest that in patients with CHF compromised by RF neurohumoral factors are maximally activated.

DIFFERENCES IN THE STABILITY OF THE HEART INTERBEAT RATE DURING WAKE AND SLEEP PERIODS

The Allan (ADEV) and Hadamard (HDEV) deviations are mathematical tools developed in the field of time and frequency metrology to define quantitatively the frequency instabilities of an oscillator; which consist of any unwanted departure from its nominal frequency value over a specified time interval. We use both deviations to analyze the stability of the heart interbeat rate for healthy subjects and patients with congestive heart failure (CHF) during wake and sleep periods. We find that the ADEV and HDEV profiles for the subjects in the CHF group exhibit remarkably different trends between wake and sleep periods, namely, larger dispersion between the results for each member of the group while the results for the healthy subjects show some uniformity across the members of the group. Moreover, we observe that the stability for both groups degrades for low scales during the sleep phase, being more significant for the CHF group. Both ADEV and HDEV statistics reveal that healthy data can be described by more uniform deviation values along several scales, particularly for the wake period, whereas CHF data shows important variations.

Prevalence of Obstructive Sleep Apnea, Associated Risk Factors, and Quality of Life Among Indian Congestive Heart Failure Patients

Stable congestive heart failure (CHF) patients frequently suffer from sleep apnea, which worsens the prognosis of heart failure and affects sleep quality of the patient. The present study was undertaken to assess the prevalence of obstructive sleep apnea (OSA) and associated quality of life (QOL) among CHF patients and to ascertain the relationship of OSA with excessive daytime sleepiness and selected demographic, clinical, and anthropometric characteristics. Fifty CHF patients and 50 healthy controls were conveniently recruited at CHF clinic, cardiothoracic and neurosciences center outpatient department, All India Institute of Medical Sciences, New Delhi, India. Participants were interviewed using Epworth Sleepiness Scale, Modified Berlin Questionnaire, Kansas City Cardiomyopathy Questionnaire, and Quebec Sleep Questionnaire. The present study revealed 18% and 8% prevalence of OSA in the CHF and control groups, respectively. The prevalence of OSA was comparable in males and females. Excessive daytime sleepiness was significantly associated with OSA in CHF patients (P = .02). Clinical severity (New York Heart Association class) and duration of illness were not significantly associated with OSA. Increased body mass index and neck circumference were the significant risk factors responsible for OSA. Quality of life of CHF patients was poor, and OSA had a significantly negative impact on the already compromised QOL in CHF patients as well as in individuals with no CHF. Prevalence of OSA is high in CHF patients as well as in the general population, and it has negative impact on the already compromised QOL of CHF patient; therefore, assessment of the risk of OSA and referral for appropriate treatment should be a part of routine nursing clinical workup. Nursing interventions should also be planned to improve sleep quality of CHF patients.

USING DIFFERENT ENTROPIES TO ANALYZE THE HEART RATE VARIABILITY OF CONGESTIVE HEART FAILURE PATIENTS

The purpose of this paper is to show the influence of congestive heart failure (CHF) on heart by using different entropies to apply on the group of patients with CHF and normal group. Three different entropies are used: approximate entropy (ApEn), multiscale entropy (MSE), and base-scale entropy (BsEn). We use these three entropies to measure the complexity of the heart rate variability (HRV) and also use analysis of variance (ANOVA) to analyze the result of entropies to discuss the feasibility of recognizing CHF patients by utilizing entropies. With the analysis results of different entropies, the influence of CHF on heart has also been clearly demonstrated. The results on the approximate entropy show that the normal young group has a higher approximate entropy value while the CHF group has a lower value. This can be explained as a healthy, strong heart that can change its heart rate freely to adapt the change of the environment or the needs of the human body, therefore the HRV will be more complex. From the ANOVA results of approximate entropy, it can be observed that the F value is larger than 1, but is still small. In other words, the approximate entropy can be used to distinguish the three groups, the effect is, however, not good. It is hard to recognize a CHF patient by using approximate entropy.

Autonomic Remodeling in the Left Atrium and Pulmonary Veins in Heart Failure

Background— Atrial fibrillation (AF) is commonly associated with congestive heart failure (CHF). The autonomic nervous system is involved in the pathogenesis of both AF and CHF. We examined the role of autonomic remodeling in contributing to AF substrate in CHF. Methods and Results— Electrophysiological mapping was performed in the pulmonary veins and left atrium in 38 rapid ventricular–paced dogs (CHF group) and 39 control dogs under the following conditions: vagal stimulation, isoproterenol infusion, β-adrenergic blockade, acetylcholinesterase (AChE) inhibition (physostigmine), parasympathetic blockade, and double autonomic blockade. Explanted atria were examined for nerve density/distribution, muscarinic receptor and β-adrenergic receptor densities, and AChE activity. In CHF dogs, there was an increase in nerve bundle size, parasympathetic fibers/bundle, and density of sympathetic fibrils and cardiac ganglia, all preferentially in the posterior left atrium/pulmonary veins. Sympathetic hyperinnervation was accompanied by increases in β 1 -adrenergic receptor R density and in sympathetic effect on effective refractory periods and activation direction. β-Adrenergic blockade slowed AF dominant frequency. Parasympathetic remodeling was more complex, resulting in increased AChE activity, unchanged muscarinic receptor density, unchanged parasympathetic effect on activation direction and decreased effect of vagal stimulation on effective refractory period (restored by AChE inhibition). Parasympathetic blockade markedly decreased AF duration. Conclusions— In this heart failure model, autonomic and electrophysiological remodeling occurs, involving the posterior left atrium and pulmonary veins. Despite synaptic compensation, parasympathetic hyperinnervation contributes significantly to AF maintenance. Parasympathetic and/or sympathetic signaling may be possible therapeutic targets for AF in CHF.

Does nocturnal hypoxia relate to acute exacerbation of chronic respiratory failure with right heart failure in late sequelae of pulmonary tuberculosis?

Thirty-eight patients with late sequelae of pulmonary tuberculosis (TB seq.) were studied to clarify whether or not nocturnal oxyhemoglobin desaturation (NOD) could relate to acute exacerbation of chronic respiratory failure (AE). All patients had been untreated with home oxygen therapy, because they were not severely hypoxic. We performed sleep studies, pulmonary function tests and arterial blood gas analysis and investigated past history about AE in each patient. Twelve patients had experienced AE with right heart failure and they were classified as CHF (congestive heart failure) group. The rest was classified as Non-CHF group. These two groups were compared as for each variables examined. There was no difference between the two groups in age, body weight, %VC, FEV1.0%, and awake PaO2. Awake PaCO2 was significantly higher in CHF group. Although no difference was observed in baseline SaO2, the degree of NOD was significantly greater in CHF group when evaluated by lowest SaO2 during sleep and 85% desaturation time (total time spent with SaO2 less than 85%). Moreover, 21 of Non-CHF and 6 of CHF were studied for cardiac parameters using right side cardiac catherization. While the differences of mean pulmonary arterial pressure and cardiac output between the two groups were not significant, pulmonary arteriolar resistance was higher in CHF group. We concluded that NOD in TB seq. had a major role in AE with right heart failure. We speculated that AE might be caused, at least partly, by pulmonary vasopressor response to recurrent NOD.

Serum and pleural fluid N-Terminal-Pro-B-Type natriuretic peptide concentrations in the differential diagnosis of pleural effusions

Currently, new biomarkers like N-Terminal-Pro-B-Type natriuretic peptide (NT-proBNP) have been used in the differential diagnosis of pleural effusions. In our study, we aimed to investigate the diagnostic value of NT-proBNP, especially in cardiac originated pleural effusions. Forty-five patients with pleural effusions were included in the study. NT-proBNP levels and biochemical markers involved in the Light's criteria were analyzed in pleural fluid and serums of the patients. Pleural fluid culture, AFB smear, cytology were performed where they were indicated according to the clinical evaluation. In patients, to whom cardiac pathology was considered to be; cardiological evaluation and echocardiography were also done. Thirty-eight pleural effusions were exudative and, 7 were transudative according to the Light's criteria. Final diagnosis were malignant effusion in 13, infection (tuberculosis/pneumonia) in 10, congestive heart failure in 21, and other conditions related with pleural effusion in 1 of the patients. Median (25th to 75th percentiles) NT-proBNP levels of serum and pleural fluid due to congestive heart failure (CHF) were 4747 pg/mL (931-15754) and 4827 pg/mL (1290-12.430) while median NT-proBNP levels of serum and pleural fluid related with non-cardiac reasons were 183 pg/mL (138-444) and 245 pg/mL (187-556) respectively. NT-proBNP levels of serum and pleural fluid were significantly high in CHF (p< 0.001 for both). When four groups were compared serum and pleural fluid NT-proBNP levels were highest in the CHF group which was followed by malignancy, infection and others (p< 0.001 for both). Fourteen of 21 patients who were accepted to have congestive heart failure as the final diagnosis by a cardiological evaluation had an exudative pleural fluid according to the Light's criteria. Serum and pleural fluid NT-proBNP levels were higher in transudates and this reached statistically significance for pleural fluid (p= 0.009). We suggest that measurement of pleural fluid NT-proBNP is a smart approach and pleural fluid NT-proBNP can reflect cardiac origin of effusions better than serum NT-proBNP and Light's criteria.

Can troponin T levels be useful in the diagnosis of rheumatic carditis?

Objective:Acute rheumatic fever (ARF) is an endemic disease observed in children of developing countries. The purpose of this study was to test if it was possible to identify myocardial involvement in cases with rheumatic carditis by the measurement of serum cardiac TnT.Methods:30 patients diagnosed as ARF underwent echocardiography and their cardiac troponin T (cTnT) serum levels were measured. Patients were divided into group 1: Arthritis alone, group 2: carditis, and group 3 carditis with congestive heart failure (CHF).Results:cTnT serum levels were normal in all except one patient with in group 3. Two patients in carditis (group 2) and three patients in CHF (group 3) had dilation in left ventricular end diastolic diameter.Conclusions:Normal cTnT levels in our patient group suggests that inflammation rather than myocardial necrosis is predominant in ARF carditis.

Change of Thyroid Hormone and its Meaning in Patients with Chronic Heart Failure

Objective To investigate the clinical significance between congestive heart failure (CHF) and serum thyroxine. Methods 50 patients with CHF (7 cases of grade Ⅱ heart function,grade Ⅲ 19 cases,grade Ⅳ 24)and 30 normal persons wre selected. The serum triiodothyronine( T3 ), four-triiodothyronine( T4 ), free triiodothyronine (FT3), free triiodothyronine (FT4), thyroid stimulating hormone TSH were determined by radioimmunoassay. Results The T3, FT3 contens ( 1.95 ± 0.55) nmol/L, (2.20 ± 0.39 ) pmol/L in CHF group were lower than the control group (2.4 ± 0.50) nmol/L, ( 5.89 ± 0. 45 ) pmol/L ( t = 2. 415,2. 325, P < 0.05 ); The T3, FT3 contens ( 2.19 ± 0. 53 )nmol/L,(3.69 ± 0.57)pmol/L after treatment were significantly higher than that before treatment (t =2. 375,2. 405, P < 0.05 ); The T3, FT3 contens in cardiac function with stage Ⅳ ( 1.76 ± 0.7) nmol/L, ( 1.99 ± 0. 45 ) pmol/L were significantly lower than the control group( t = 2.245,2. 375, P < 0.05 ); Serum TT3, TT4 and cardiac function was negatively correlated ( r = -0.933, -0.383, all P < 0.05 ) , serum FT3, FT4,TSH and cardiac function were not correlated. Conclusion The changes of serum thyroid level could be used as an index of the severity of heart failure. Key words: Heart failure,Congestive; Thyroid hormone; Cardiac function

Increment of monthly mean predialysis heart rate reflects early cardiac overload in hemodialysis patients with normal cardiac function

The aim of our study was to examine the association of heart rate (HR) with the onset of congestive heart failure (CHF), and to compare the predictive value of HR with that of the serum level of human atrial natriuretic peptide (hANP) and the cardiothoracic ratio (CTR). Thirty-eight patients on chronic hemodialysis (HD) aged 68 ± 11 years (61% men, 41% with diabetes) who had normal cardiac function were enrolled in this study. Among them, 6 patients had suffered CHF. Baseline characteristics and HR, hANP and CTR were compared between the 2 groups. At baseline, the monthly mean pre-HR (before HD), CTR and hANP values were higher in CHF patients compared with non-CHF patients. In the CHF group, the monthly mean pre-HR increased progressively beginning 10 months before the onset of CHF, which was earlier than the increments of hANP and CTR. A significant difference between the CHF and non-CHF groups was observed earlier for monthly mean pre-HR (4 months before CHF) and ANP (4 months before CHF) than for CTR (2 months before CHF). The increment of monthly mean pre-HR may reflect the early phase of cardiac overload, and is of equal significance to hANP. Further large-scale prospective studies are required to confirm these results.

Clinical Study on Congestive Heart Failure patients with Sleep Apnea Syndrome

Objective To investigate the effect of sleep apnea syndrome(SAS) on the cardiac function of congestive heart failure(CHF) patients, and the clinical significance of leptin and tumor necrosis factor a (TNF-a) in serum. Methods 22 patients with congestive heart failure only (CHF group)and 18 patients with congestive heart failure and sleep apnea syndrome(CHF + SAS group)were examined with the Polysomnogram (PSG) , their serum were tested on the levels of leptin(by radio-immunoassay) ,TNF-a and sTNFR1 (by ELISA method). Results ①The AHI(apnea hypopnea index)and the TSaO2 ＜90％ (the time of SpO2 ＜90％ in total sleeping time) in CHF + SAS group are significantly higher than those in CHF group(P ＜0. 01). ②The level of Leptin,TNF-a and sTNFR1 in CHF + SAS group are significantly higher than those in CHF group(P＜0. 01).Conclusion The sleep apnea syndrome cause the blood oxygen desaturation at night, it makes the patients with congestive heart failure getting worse. Leptin and TNF-a might involve in this disease development. Key words: Congestive heart failure(CHF); Sleep apnea syndrome(SAS); Leptin; Tumor necrosis factor(TNF)

Prognostic Significance of Strain Doppler Imaging in Light-Chain Amyloidosis

To clarify the prognostic value of strain and strain rate imaging in light-chain (AL) amyloidosis. Myocardial strain and strain rate Doppler imaging are objective measurements that may detect regional subtle myocardial functional abnormalities in patients with amyloidosis. We prospectively examined 119 consecutive, untreated patients with biopsy-proven AL amyloidosis. The mean values of tissue velocity, strain, and strain rate were calculated from the basal, mid, and apical left ventricular (LV) multiple walls in apical 2- and 4-chamber views. The prognostic value of these parameters was compared with standard 2-dimensional echocardiographic and Doppler measurements of transmitral and pulmonary venous flow. Seventy patients had cardiac involvement defined as the mean value of LV wall thickness greater than 12 mm. Thirty-two patients (27%) (including 22 proven cardiac deaths) died during a mean follow-up period of 285 +/- 136 days. No echocardiographic or Doppler features differentiated patients with cardiac involvement without congestive heart failure (CHF) from noncardiac amyloid group other than the pre-defined wall thickness and LV end-diastolic and end-systolic diameters. On the other hand, strain rate and strain imaging clearly detected differences of longitudinal LV myocardial deformation among 3 groups (noncardiac involvement group, cardiac amyloidosis without CHF group, and cardiac amyloidosis with CHF group). Univariate analysis showed that strain rate, strain, and tissue velocity values were statistically significant predictors of outcome at most of the sites. Multivariate analysis showed that the mean LV basal strain was the only independent predictor of both cardiac and overall deaths. Among patients with AL amyloidosis, the mean basal strain, a measure of longitudinal LV function, was a powerful predictor of clinical outcome and was superior to standard 2-dimensional echocardiographic, Doppler flow measurements, and simple tissue velocity indexes.

The impact of intermittent pneumatic compression devices on deep venous flow velocity in patients with congestive heart failure

Intermittent pneumatic compression (IPC) has been used to prevent deep venous thrombosis (DVT), but the effects of IPC on the hemodynamics of popliteal and soleal veins, especially in patients with congestive heart failure (CHF) have not been evaluated. The aim of this study was to evaluate the effects of IPC on the flow velocity of deep veins in the lower extremities and to compare the efficacy of two different types of IPC in deep venous flow enhancement in patients with CHF. Flow velocities of popliteal and soleal veins were recorded in 19 patients with CHF and in 19 control subjects using a high-resolution linear probe. Peak and mean flow velocities were measured (1) at rest, (2) with sequential foot and calf IPC (SFC-IPC) which consists of an electrically driven air compressor and four air chambers, and (3) with impulse foot IPC (IF-IPC) which consists of a pneumatic impulse generator operated at an applied pressure of 130 mmHg. In the resting condition, popliteal venous flow velocity in the CHF group was attenuated (12.8+/-4.7 cm/s vs. 21.1+/-13.5 cm/s; p<0.05). Both SFC-IPC and IF-IPC increased venous velocity, but the increase with IF-IPC in CHF patients was lower than that in control subjects. In the soleal veins, after applying SFC-IPC, the peak and mean velocity in CHF increased to the same extent as in the control group. IF-IPC increased soleal venous velocity in control subjects, but there was no increase in CHF patients. Two-dimensional Doppler scanning revealed a significant increase in the mean and peak velocities in the soleal and popliteal veins with SFC-IPC but not with IF-IPC in patients with CHF. These results indicate that SFC-IPC could have favorable effects in preventing DVT in patients with CHF.

Antioxidant treatment attenuates pulmonary arterial hypertension-induced heart failure

ROS have been implicated in the development of pathological ventricular hypertrophy and the ensuing contractile dysfunction. Using the rat monocrotaline (MCT) model of pulmonary arterial hypertension (PAH), we recently reported oxidative stress in the failing right ventricle (RV) with no such stress in the left ventricle of the same hearts. We used the antioxidant EUK-134 to assess the role of ROS in the pathological remodeling and dysfunction of the RV. PAH was induced by an injection of MCT (80 mg/kg, day 0), treatment with EUK-134 (25 mg/kg, once every 2 days) of control and MCT-injected animals [congestive heart failure (CHF) group] was started on day 10, and animals were analyzed on day 22. EUK-134 treatment of the CHF group attenuated cardiomyocyte hypertrophy and associated changes in mRNA expression (myosin heavy chain-beta and deiodinase type 3). It also reduced RV oxidative stress and proapoptotic signaling and prevented interstitial fibrosis. Cardiac MRI showed that ROS scavenging did not affect the 37% increase in end-diastolic volume of the RV in the CHF relative to the control group, but the threefold increase in end-systolic volume was reduced by 42% in the EUK-134-treated CHF group. The improved systolic function was confirmed using echocardiography by an assessment of tricuspid annular plane systolic excursion. These data indicate an important role of ROS in RV cardiomyocyte hypertrophy and contractile dysfunction due to PAH and show the potential of EUK-class antioxidants as complementary therapeutics in the treatment of RV dysfunction in PAH.

Evaluation of right ventricular systolic function by measurement of tricuspid annular displacement with speckle tracking imaging

Objective To explore the value of peak systolic displacement of tricuspid annulus(TAD)in evaluation of right ventricular systolic function by speckle tracking imaging(STI).Methods The study population consisted of 24 healthy subjects(control group)and 16 patients with congestive heart failure(CHF).The apical four-chamber view was obtained and imput to Qlab 6.0 workstation. The TAD at the right ventricular free wall (TADla)and the midpoint of tricuspid annulus(TADmid)were measured and calculated automatically.Right ventricular ejection fraction(RVEF)was measured by real-time three-dimensional echocardiography.The correlation of displacement parameters with RVEF was analyzed.Results In all 40 subjects, the mean value of TADla was(19.3±5.9)mm with s range from 7.8 to 28.4 mm while the mean value of TADmid was(15.3±4.6)mm with a ranging from 7.2 to 22.2 mm.The parameters in CHF group were significantly lower than those of the control group(P<0.01).TADla and TADmid showed an excellent correlation with RVEF(r=0.87 and 0.91 respectively,P<0.01).The cut-off value of TADla for RVEF<45%was 17.2 mm with a sensitivity of 89%and a specificity of 93% while the cut-off value of TADmid for RVEF<45% was 13.1 mm with a sensitivity of 96%and a specificity of 1 00%.Conclusions TAD by STI showed an excellent correlation with RVEF, and it may be a new promising method for routine evaluation of right ventricular systolic function. Key words: Echocardiography; Ventricular function,right; Tricuspid annular displacement; Speckle tracking imaging