Cross-sectional Echocardiography Research Articles

Evaluation of Cardiovascular Status in Hemophilia Patients in Dezful: Echocardiography, Electrocardiography, and Cardiac Risk Factors

Background: Hemophilia is a congenital bleeding disorder with X-linked inheritance that is associated with a deficiency of coagulation factor 8 (hemophilia A) or 9 (hemophilia B). The protective effect of hemophilia is challenging in the prevention of atherothrombotic heart diseases due to the lack of coagulation factors. Objectives: The present study aims to investigate congenital and acquired heart diseases and atherosclerosis risk factors in hemophilia patients. Methods: In the present cross-sectional descriptive study, electrocardiography (ECG) and echocardiography were performed and evaluated on 50 hemophilia patients in Dezful, southwest Iran. Fasting blood sugar, low-density lipoprotein (LDL), cholesterol, plasma high-density lipoprotein (HDL), systemic blood pressure, and body mass index (BMI) were also calculated. The data were analyzed in SPSS software version 21. The results showed 86% with hemophilia A, 12% with hemophilia B, and one patient (2%) with post-pregnancy hemophilia (mean age = 28.12 ± 14.12 years; age range = 6 - 76 years). Results: The most common congenital heart disease was mitral valve prolapse (MVP) with or without mitral regurgitation, consisting of 5 patients (10%); the most common acquired cardiac disorder was diastolic dysfunction grade I, consisting of 5 patients (10 %), and 2 patients (4%) also had systolic pulmonary artery hypertension (pulmonary artery systolic pressure more than 35 mmHg). Bicuspid aortic valve (BAV), atrial septal defect (ASD), and hypertrophic cardiomyopathy (HCM) were observed in one patient each. Ischemic heart disease was observed only in a 76-year-old patient. Examination of the electrocardiogram had no abnormal findings in the rest, except for two patients with HCM and ASD who had ventricular hypertrophy. The most common risk factor was obesity (16%), followed by hypertension (10%) and dyslipidemia (10%), and only 1 (2%) diabetic patient was identified. Patients with risk factors often had more than one risk factor, were over 30 years old, and had a severe form of hemophilia A. Conclusions: In the examination of echocardiography-ECG and risk factors in hemophilia patients, there was no significant abnormality report, while acquired heart diseases and risk factors proportional to age are evident from 30 years of age onwards.

A Study of Cardiovascular Manifestations in Hypothyroidism

Aim and Objective: To study cardiovascular manifestations in hypothyroidism. Materials and Methods: An observational study was carried out in Parul Sevashram Hospital, Vadodara, Gujarat, India. 150 patients, both men, and women, diagnosed with hypothyroidism attending the Parul Sevashram Hospital were recruited from the outpatient and in-patient departments of medicine. Clinical profiles, history, complications, and all required data were collected. All patients were regularly called for follow-up based on their visits. As per the investigator’s discretion, laboratory tests, i.e., thyroid function tests, CBC, electrocardiogram (ECG), and 2D echocardiography were performed as and when required, and medication was prescribed. All physical examinations and all vitals were recorded at every visit till the end of the study. Results: A total of 150 patients were included in this study. Male:female: 57:93; age: 28–76 years. Patients were examined in a prospective manner and results were compared with the control group to evaluate the effect of hypothyroidism, subclinical and overt, on the cardiac status by echocardiography. Variables of heart structure and function were assessed by cross-sectional and Doppler echocardiography. Interventricular septum (IVS) dimensions were significantly raised in moderate subclinical and severe overt hypothyroidism (mean 0.9 +/- 0.03 and 0.9 +/- 0.2 cm). Left ventricular posterior wall (LVPW) thickness was significantly increased only in overt hypothyroidism (mean 1.3 +/- 0.2). However, RVW and LVID showed no definite pattern of change. Pericardial effusion and diastolic dysfunction were seen in 72 cases only in overt hypothyroidism. Diastolic dysfunction with pericardial effusion was found in 74 (49.3%) cases followed by diastolic dysfunction in 49 (32.6%), systolic dysfunction in 15 (10.0 %), and increased interventricular septum spectrum thickness in 12 (8.6%) patients. The majority of the diastolic dysfunction was mild dysfunction associated with females. No cases were found to have severe diastolic dysfunction. Discussion: On the basis of a case history, the clinical and para-clinical manifestations of hypothyroidism are reviewed. Exertion dyspnea without signs of cardiac insufficiency occurs frequently. The minute and stroke volume and heart rate are reduced. The blood pressure may rise (reversible) and hypertension may occur. The function of the left ventricle is reversibly reduced. X-ray of the thorax may reveal massive relatively asymptomatic pleural effusion and cardiomegaly. Pericardial exudate occurs frequently and is demonstrated best by echocardiography. The plasma concentrations of several different enzymes (including creatine kinase (CK), CK-MB, and LDH) may be raised in myxedema. The reason for this is perhaps compromised membrane function in the skeletal muscle cells. Conclusion: Hypothyroidism, both subclinical and overt, is associated with cardiovascular alteration, both structural and functional. IVS and LVPW thickness are markedly affected, and there is an impairment in left ventricular function in diastole. Furthermore, hypothyroidism is more common in females, between the age group of 20–50 years. The majority of the patients have cardiovascular changes such as ECG abnormalities, pericardial effusion, diastolic dysfunction, and diastolic hypertension. We strongly suggest early detection and initiation of hormone replacement therapy can minimize the associated cardiovascular changes. Recommendation: To study inter-and intracellular deposits, infiltrations, and fibrosis in the myocardium and these probably contribute to some of the on-specific, reversible ECG changes (low voltage, flattening/inversion of T waves, sinus bradycardia). To study hypothyroidism present can increase atheroma formation. The patients can be grouped into overt and subclinical hypothyroid.

Cardiac dysfunction and pulmonary systolic hypertension among patients with homozygous VHLR200W mutation (Chuvash polycythemia)

Pulmonary hypertension occurs with chronic high-altitude hypoxia and is exacerbated by iron deficiency. Chuvash polycythemia, due to homozygosity for the R200W mutation in the von Hippel Lindau gene ( VHL ), is characterized in normoxia by elevated levels of hypoxia inducible factors HIF-1 and HIF-2, transcription factors regulating many hypoxia-inducible genes. Three cross-sectional clinical and echocardiography study in Chuvashia, Russian Federation among 120 child and adult VHL R200W homozygotes and 31 VHL- wildtype controls under basal conditions. VHL R200W homozygotes had frequently been treated by phlebotomy and were often iron-deficient based on low ferritin. After adjustment for age, sex, and hemoglobin concentration, the mean ± SD systolic blood pressure tended to be lower in VHL R200W homozygotes compared to controls (112 ± 15.1 vs. 119 ± 17.2 mm Hg; P = .045). In contrast, the echo-determined tricuspid regurgitation velocity (TRV), which reflects right ventricular systolic pressure, was significantly higher in the VHL R200W homozygotes (2.5 ± 0.3 vs. 2.3 ± 0.4 m/s, P = .007). The left ventricular diastolic dimension (4.8 ± 0.5 vs. 4.5 ± 0.6 cm; P = .039) and left atrial diameter (3.4 ± 0.5 vs. 3.2 ± 0.5; P = .045) tended to be larger in the VHL R200W homozygotes, but this was not the case for the mitral valve E/Etdi ratio. Among VHL R200W homozygotes, phlebotomy therapy was associated with lower ferritin, and low ferritin independently predicted higher TRV (standardized beta = −0.29; P = .009). Children and adults with congenital upregulation of HIF-1 and 2 tend to have higher right ventricular systolic pressure as estimated by echocardiography than control subjects. Similar to high-altitude pulmonary hypertension, iron deficiency may contribute to elevated right ventricular systolic pressure in Chuvash polycythemia.

Prevalence and risk of progressive aortic aneurysm and dissection in adults with conotruncal anomalies.

Conotruncal anomalies share common embryogenic defects of the outflow tracts and great arteries, which result in a predisposition to aortic aneurysms. The purpose of this study was to describe the prevalence and risk of progressive aortic aneurysms in adults with conotruncal anomalies. Retrospective study of adults with conotruncal anomalies that underwent cross-sectional imaging 2003-20. Aneurysm was defined as aortic root/mid-ascending aorta >2.1 mm/m2/>1.9 mm/m2, progressive aneurysm as increase by >2 mm, and severe aneurysm as dimension >50 mm. Of 2261 patients (38 ± 12 years; male 58%), 1167 (52%) had an aortic aneurysm, and 205 (14%) had a severe aortic aneurysm. Mean annual increase in aortic root/mid-ascending aorta was 0.3 ± 0.1 mm/0.2 ± 0.1 mm. The 3-, 5-, and 7-year cumulative incidence of the progressive aortic aneurysm was 4%, 7%, and 9%, respectively. The rate of aneurysm growth decreased with age, with no significant growth after age 40 years. There was an excellent correlation between aortic indices from cross-sectional imaging and echocardiography. Of 950 females, 184 had ≥1 pregnancy, and 81 (44%) of the 184 patients had aortic aneurysm prior to pregnancy. There was no aortic dissection or progression of the aortic aneurysm during pregnancy. Overall, there was no aortic dissection during 7984 patient-years of follow-up. Aortic aneurysm was common in patients with conotruncal anomalies. However, the risk of progressive aneurysm or dissection was low. Collectively, these data suggest a benign natural history and perhaps a less frequent need for cross-sectional imaging. Further studies are required to determine the optimal timing for surgical intervention in this population.

Ballistocardiography to identify high left atrial pressure in patients with heart failure.

Due to a high prevalence and morbidity rate, heart failure (HF) constitutes an immense economic burden on the global health care system. An increase in left atrial pressure (LAP) precedes the occurrence of any HF symptoms. In this study, we applied a novel non-invasive method of ballistocardiography (BCG) to extract early diastolic ventricular vibration waves [the BCG-B3 index, which corresponds to the third heart sound (S3) at the end of the rapid filling phase of diastole]. This study evaluated the predictive value of the BCG-B3 index for LAP in HF patients. A total of 83 HF patients and 20 patients with underlying diseases were prospectively enrolled, and their cross-sectional BCG and echocardiography (ECHO) data were collected. BCG obtains a signal through a high-precision fiber-optic sensor placed on the patient's back. LAP or pulmonary capillary wedge pressure (PCWP) was estimated by the ratio of mitral inflow peak early diastolic velocity to the early diastolic velocity of the mitral annulus (E/e') or the Nagueh equation (LAP = 1.24 × E/e' + 1.9). To evaluate the diagnostic efficacy of the BCG-B3 index, a receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated. The best cutoff value for the BCG-B3 index was determined by the maximum Youden index. The correlation coefficient between the BCG-B3 index and E/e' ratio was 0.51 (P<0.01). Under an optimal cutoff value of 55.13, the BCG-B3 index showed a positive consistency value of 0.93, a negative consistency value of 0.53, and an overall consistency value of 0.82 for identification of significantly elevated LAP. The BCG-B3 index derived by noninvasive BCG using a built-in fiber-optic sensor has important diagnostic value for identifying significantly elevated LAP in HF patients with high accuracy. BCG examination is not limited by place or the doctor's experience. Therefore, BCG can provide timely assessments for HF patients, enabling early diagnosis and treatment.

Global leadership in paediatric and congenital cardiac care: "Humility in Leadership - an interview with Katarina Hanséus, MD, PhD, President of the Association for European Paediatric and Congenital Cardiology (AEPC)".

Dr. Katarina Hanséus is the focus of our fourth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care". Dr. Hanséus was born in Malmö, Sweden. She attended undergraduate school in her home town in Malmö, Sweden, graduating in 1974. Dr. Hanséus then went on to complete medical school at University of Lund in Lund, Sweden, graduating in 1980, where additionally she completed a Doctoral Dissertation in the evaluation of cardiac function and chamber size in children using Doppler and cross-sectional echocardiography. Under the Swedish Board of National Welfare, Dr. Hanséus completed her authorisation as a paediatrician in 1986, followed by her authorisation as a paediatric cardiologist in 1988, at University of Lund. She was appointed head of Paediatric Cardiology in 2000 at the Children's Heart Center, Skane University Hospital, Lund, Sweden. The programme at Lund serves as one of the two national referral centres for comprehensive paediatric and congenital cardiac care, including paediatric cardiac surgery, in Sweden. From 2006 to 2013, she served as the clinical and administrative head of the Department of Neonatology, Paediatric Surgery, Paediatric Intensive Care, Paediatric Cardiology, and Paediatric Cardiac Surgery, returning as the head of Paediatric Cardiology in 2013, for which she currently holds the position.Dr. Hanséus is a recognised leader in the field of Paediatric Cardiology and has been involved in leadership within the Swedish Pediatric Society, the Swedish Association for Pediatric Cardiology, and the Association for European Paediatric and Congenital Cardiology throughout her career. Within the Association for European Paediatric and Congenital Cardiology, she served as the Secretary General from 2011 to 2016, the President Elect in 2018, and is the current President serving from 2019 until 2022. This article presents our interview with Dr. Hanséus, an interview that covers her experience as a leader in the field of Paediatric Cardiology, including the history and goals of the Association for European Paediatric and Congenital Cardiology, and her role and vision as their current President.

Cardiac adaptations in elite female football- and volleyball-athletes do not impact left ventricular global strain values: a speckle tracking echocardiography study.

Cardiac adaptations to exercise on an elite level have been well studied. Strain analysis by speckle tracking echocardiography has emerged as a tool for sports cardiologists to assess the nature of hypertrophy in athletes' hearts. In prior studies, strain values generally did not change in physiological adaptations to exercise but were reduced in pathological hypertrophy. However, research in this field has focused almost solely on male athletes. Purpose of the present study is to investigate strain values in the hearts of female elite athletes in football and volleyball. In this cross-sectional study echocardiography was performed on 19 female elite football-players, 16 female elite volleyball-players and 16 physically inactive controls. Conventional echocardiographic data was documented as well as left ventricular longitudinal, radial and circumferential strain values gained by speckle tracking echocardiography. The hearts of the female athletes had a thicker septal wall, a larger overall mass and larger atria than the hearts in the control group. Global longitudinal, radial and circumferential strain values did not differ between the athletes and controls or between sporting disciplines. No correlation between septal wall thickness and global strain values could be documented. Cardiac adaptations to elite level exercise in female volleyball and football players do not influence global strain values. This has been documented for male athletes of several disciplines. The present study adds to the very limited control-group comparisons of left ventricular strain values in elite female athletes. The findings indicate that global strain values can be used when assessing the cardiac health in female athletes.

Impact of echocardiography on parental anxiety in children with innocent murmurs.

Heart murmurs are not uncommon in childhood. Once noted, they may induce appreciable parental anxiety even if the likely diagnosis is that of an innocent murmur. This study aimed to clarify if a confirmatory echocardiogram may increase parental understanding and reduce their anxiety even though the murmur had been diagnosed as being innocent by an experienced paediatric cardiologist. Parents of children referred to a paediatric cardiologist for evaluation of a murmur were asked to complete a State Trait Anxiety Inventory after the cardiologist's clinical diagnosis of an innocent murmur. The questionnaire was repeated after cross-sectional echocardiography to assess if there was a change in the parental understanding regarding their child's murmur and to review their level of anxiety. Over the time available for the study, 62 parents were recruited consecutively wherever possible. Forty-eight (77%) completed both questionnaires. There was a reduction in the state anxiety level following the echocardiogram in parents who exhibited a high (n = 23) or even a low-level trait anxiety (n = 25) (P < 0.05). Enhanced parental understanding of the diagnosis was also demonstrated. Reduced parental anxiety and an increase in their understanding after echocardiography suggested that the procedure may have an important role in the management of innocent murmurs even after the initial reassurance by a paediatric cardiologist.

Epidemiological, clinical and microbiological features of right-sided endocarditis: A Tunisian experience

Right-sided infective endocarditis RSIE is considered as a differential diagnosis of patients with febrile syndrome, respiratory signs and predisposing factors. It concerns mainly patients with a history of intravenous drug use (IVDU) or who have a pacemaker or other intracardiac device. The clinical presentation and treatment are different from those of left-sided endocarditis and the prognosis is more favorable, as many patients can be cured with medical treatment alone. To determine epidemiological, clinical and microbiological characteristics of RSIE in a Tunisian cohort. This was a prospective study which included patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Two hundred forty patients were diagnosed with IE and showed vegetations on cross-sectional echocardiography. In 31 (12.9%) patients, only the right side of the heart was involved: specifically the tricuspid valve alone or associated with pulmonary valves or the right ventricular outflow tract or free wall in 29, and pulmonary valve alone in 2. Fourteen patients (51.6%) had underlying congenital heart disease, 7 had intravascular device whereas the remaining 10 patients (48.4%) did not have any underlying heart disease. The latter group, had isolated right-sided infective endocarditis. The diagnosis can be dramatically delayed, since right-sided murmurs often go undetected, Staphylococcus aureus SA was the most common organism with a high rate mortality. Most of IE are resolved conservatively by antibiotics and surgery is only indicated in particular cases. We conclude that, like western reports, the pattern of right-sided infective endocarditis in Tunisia is almost the same; IVDU was the commonest cause and the SA was the most frequent pathogen.

Predictors of Spontaneous Echo Contrast in Left Heart Chambers in Patients with Dilated Cardiomyopathy: Slowing Down Might not Always Mean Enjoying Life.

Introduction:Spontaneous echo contrast(SEC) is usually detected in heart chambers as a result of reduced flow velocity in the cavity. The clinical importance of SEC lies in its association with embolic events. The aim of our study was to determine the frequency of SEC in left heart chambers in sinus rhythm patients with dilated cardiomyopathy and predictors for its emergence.Materials and Methods:This was a prospective cross-sectional transesophageal echocardiography study conducted in 101 sinus rhythm patients with dilated heart and mild-to-moderate systolic dysfunction.Results:Moderate-degree SEC was found in the left ventricle(LV) in around 9% of patients, in the left atrium(LA) in 12% and in left atrial appendage(LAA) in 40%. Multiple regression analysis showed that lower heart rate(95% confidence interval[CI]: 0.845–0.978; P = 0.011) and larger LV end-systolic diameter(LVESD)(95% CI: 1.034–1.394; P = 0.017) were independent predictors for LV SEC presence. Lower LV ejection fraction(LVEF) (95% CI: [−0.079]–[−0.037]; P = 0.0001) was the only independent predictor for SEC in the LA. Whereas, independent predictors for SEC in LAA were lower heart rate(95% CI:[−0.030]–[−0.003]; P = 0.018), greater LA indexed diameter (95% CI: 0.016–0.116; P = 0.010), and higher value of C-reactive protein(CRP)(95% CI: 0.0026–0.031; P = 0.027).Conclusions:SEC in left heart chambers is a frequent finding in patients with dilated cardiomyopathy in sinus rhythm. Lower heart rate and LVEF, larger LVESD and LA, as well as higher CRP, predict the presence of SEC in left heart chambers. Lower heart rate might be an essential predictor for SEC presence and severity in these patients.

AIUM Practice Parameter for the Performance of Fetal Echocardiography.

AIUM Practice Parameter for the Performance of Fetal Echocardiography.

Cardiac manifestations and gene mutations of patients with RASopathies in Taiwan

RASopathies are developmental diseases caused by mutations in rat sarcoma-mitogen-activated protein kinase pathway genes. These disorders, such as Noonan syndrome (NS) and NS-related disorders (NSRD), including cardio-facio-cutaneous (CFC) syndrome, Costello syndrome (CS), and NS with multiple lentigines (NSML; also known as LEOPARD syndrome), have a similar systemic phenotype. A wide spectrum of congenital heart disease and hypertrophic cardiomyopathy (HCMP) can exhibit major associated characteristics. A retrospective study was conducted at the Mackay Memorial Hospital, National Taiwan University Hospital, Buddhist Tzu-Chi General Hospital, Chang-Gung Memorial Hospital, Taichung Veterans General Hospital, and Chung Shan Medical University Hospital from January 2007 to December 2018. We reviewed the clinical records of 76 patients with a confirmed molecular diagnosis of RASopathies, including NS, CS, CFC syndrome, and NSML. We evaluated the demographic data and medical records with clinical phenotypes of cardiac structural anomalies using cross-sectional and color Doppler echocardiography, electrocardiographic findings, and follow-up data. A total of 47 (61.8%) patients had cardiac abnormalities. The prevalence of cardiac lesions according to each syndrome was 62.7, 50.0, 60.0, and 66.7% in patients with NS, CFC syndrome, CS, and NSML, respectively. An atrial septal defect was usually combined with other cardiac abnormalities, such as pulmonary stenosis (PS), HCMP, ventricular septal defect, or patent ductus arteriosus. Patients with NS most commonly showed PS. In patients with NSRD and cardiac abnormalities, HCMP (29.4%) was the most commonly observed cardiac lesion. PTPN11 was also the most frequently detected mutation in patients with NS and NSRD. Cardiac abnormalities were the most common symptoms observed in patients with RASopathies at the time of their first hospital visit. Performing precise analyses of genotype-cardiac phenotype correlations in a larger cohort will help us accurately diagnose RASopathy as soon as possible.

Change of coronary artery indices according to coronary dominance pattern in early childhood.

Purpose Coronary arterial lesion assessment in children can be difficult, depending on the coronary dominance pattern. Although it is easier to determine coronary dominance with echocardiography in children than in adults, it is still difficult. This study aimed to examine the coronary dominance pattern according to the objective coronary artery (CA) indices.Methods The CA diameter, aortic valve annulus, and abdominal aorta of 69 children without any cardiovascular disease were measured with cross-sectional echocardiography at Chungnam National University Hospital. To evaluate the coronary dominance pattern, echocardiography was primarily used; additionally, coronary computed tomographic angiography or coronary angiography (CAG). Coronary dominance was determined according to the status of the CA that gives rise to the posterior descending artery.Results The mean age was 4.02±2.78 years, and the mean body surface area (BSA) was 0.70±0.22 m2 . Right dominance was present in 78% and left in 22% of the subjects. In those with left dominance, the CA to aortic valve annulus diameter ratio was 0.125±0.021 in the right coronary artery (RCA) and 0.255±0.032 in the left coronary artery (LCA). In those with right dominance, the corresponding ratio was 0.168±0.028 in the RCA and 0.216±0.030 in the LCA (P<0.05). Significant differences were also found in the diametric ratios of the CA to BSA and abdominal aorta (P<0.05).Conclusion The CA indices showed significant difference according to the coronary dominance pattern in early childhood. It is possible to indirectly determine the coronary dominance pattern with the CA indices in children using echocardiography. The accuracy of coronary artery lesion diagnosis can be improved by taking coronary dominance into account.

Which echocardiographic parameter is a better marker of volume status in hemodialysis patients?

Aim: Bio-impedance analysis (BIA) is a preferred method for estimating the volume status. However, it cannot be utilized in daily practice. Since the assessment of the volume status is important and challenging for hemodialysis (HD) patients, the aim of study was to determine the volume status in chronic HD patients using echocardiographic parameters and assess its correlation with BIA.Methods: In this cross-sectional analysis, echocardiography and BIA were performed on 30 chronic HD patients 30 min before and 30 min after dialysis. All the cases of dialysis were performed in the middle of the week. This study also assessed the correlation between echocardiographic parameters and BIA parameters.Results: There were significant differences between ECW, TBW, and TBW% (TBW/W) before and after HD. Significant differences were observed between echocardiographic parameters of IVCD, IVCDimin, IVCDimax before and after the HD. LVEDD, LVESD, LA area, mitral valve inflow, E/E′, and IVRT, were improved after dialysis, too. There was a significant correlation between IVCDimin as an index of volume status, ECW% and TBW% before HD and IVCDimin change after dialysis had a significant correlation with %ECW change after dialysis. Comparison between hypertensive and non-hypertensive groups indicated IVCDimin was significantly lower in non-hypertensive group after dialysis.Conclusion: Our results showed a correlation between IVCDimin and BIA parameters before HD. So, it seems that IVCDimin can be a good parameter for determining the volume status of HD patients. However, further studies, with larger sample size and with a prospective study design, are required to confirm these results.

Posture and Gender Differentially Affect Heart Rate Variability of Symptomatic Mitral Valve Prolapse and Normal Adults.

Heart rate variability (HRV) has been shown to be a useful measure of autonomic activity in healthy and mitral valve prolapsed (MVP) subjects. However, the effects of posture and gender on HRV in symptomatic MVP and normal adults had not been elucidated in Taiwan. A total of 118 MVP patients (7 males, 39 ± 7 years old; and 111 females, 42 ± 13 years old) and 148 healthy control (54 males, 28 ± 4 years old; and 94 females, 26 ± 6 years old) were investigated. The diagnosis of MVP was confirmed by cross-sectional echocardiography. A locally developed Taiwanese machine was used to record the HRV parameters for MVP and control groups in three stationary positions. Thereafter, the HRV time-domain parameters, and the frequency-domain parameters derived from fast Fourier transform or autoregressive methods were analyzed. The MVP group showed a decrease in time domain parameters and obtunded postural effects on frequency domain parameters moreso than the control group. Though the parasympathetic tone was dominant in female (higher RMSSD, nHF and lower nLF vs. male), the sympathetic outflow was higher in MVP female (lower SDNN, NN50 and higher nLF vs. normal female). While the parasympathetic activity was lower in male, sympathetic outflow was dominant in MVP male (lower nHF and higher nLF vs. normal male). Both MVP female and male subjects had elevated levels of sympathetic outflow. The obtunded postural effects on frequency domain measures testified to the autonomic dysregulation of MVP subjects.

An integrated index for automated detection of infarcted myocardium from cross-sectional echocardiograms using texton-based features (Part 1)

Cross-sectional view echocardiography is an efficient non-invasive diagnostic tool for characterizing Myocardial Infarction (MI) and stages of expansion leading to heart failure. An automated computer-aided technique of cross-sectional echocardiography feature assessment can aid clinicians in early and more reliable detection of MI patients before subsequent catastrophic post-MI medical conditions. Therefore, this paper proposes a novel Myocardial Infarction Index (MII) to discriminate infarcted and normal myocardium using features extracted from apical cross-sectional views of echocardiograms. The cross-sectional view of normal and MI echocardiography images are represented as textons using Maximum Responses (MR8) filter banks. Fractal Dimension (FD), Higher-Order Statistics (HOS), Hu’s moments, Gabor Transform features, Fuzzy Entropy (FEnt), Energy, Local binary Pattern (LBP), Renyi’s Entropy (REnt), Shannon’s Entropy (ShEnt), and Kapur’s Entropy (KEnt) features are extracted from textons. These features are ranked using t-test and fuzzy Max-Relevancy and Min-Redundancy (mRMR) ranking methods. Then, combinations of highly ranked features are used in the formulation and development of an integrated MII. This calculated novel MII is used to accurately and quickly detect infarcted myocardium by using one numerical value. Also, the highly ranked features are subjected to classification using different classifiers for the characterization of normal and MI LV ultrasound images using a minimum number of features. Our current technique is able to characterize MI with an average accuracy of 94.37%, sensitivity of 91.25% and specificity of 97.50% with 8 apical four chambers view features extracted from only single frame per patient making this a more reliable and accurate classification.

Insights gained from three-dimensional imaging modalities for closure of ventricular septal defects.

Ventricular septal defects (VSDs) are the commonest group of congenital heart lesions, accounting for ≈30% of congenital heart defects in liveborn infants.1 Defects in the ventricular septum are classified according to their position when the ventricular septum is viewed from the right ventricle and these may vary in their location, size, and number.2,3 VSDs can occur as isolated lesions or as part of more complex disease, for example, transposition of the great arteries or double outlet right ventricle, where the location and size of such defects assume great importance in planning the optimal mode of surgical repair.4 In most cases, surgical closure remains the mainstay treatment for VSDs, but selected lesions may be amenable to catheter closure.5,6 Cross-sectional echocardiography is the most commonly used noninvasive diagnostic method to delineate the position of a VSD before surgery.7 Multiple sonographic cuts and cross-sectional sweeps of the region of interest are used to build a virtual reconstruction of the three-dimensional (3D) anatomy in the mind of the echocardiographer. However, for the surgeon who deals solely with 3D images there can remain an element of uncertainty when called to operate on the patient. The number, size, location of VSDs, and their relationship to adjacent structures are central for selecting whether the defects might be best closed via the tricuspid valve, via the semilunar valves, or via a ventriculotomy or whether these might not be readily approachable and a palliative pulmonary artery banding is desirable.8,9 In this review, we present key 3D echocardiographic projections and examples of different types of VSDs where the images have a direct effect on the approach taken to VSD closure. Comparison of 3D echocardiography (3DE) with other 3D imaging modalities is also described. Images are presented in an …

Abstract 357: Intra-placental gene transfer of Insulin Like Growth Factor 1 Reprograms Altered Myocardial Gene Expression In Growth Restricted Mouse Model with Cardiac Dysfunction

Background: Intrauterine growth restriction (IUGR), defined as birth weight &lt;10% for gestational age, is a risk factor for adult onset cardiovascular disease. We demonstrated that Intraplacental gene transfer of adenoviral insulin growth factor1 (Ad IGF1) rescues IUGR induced cardiac dysfunction in a surgical IUGR mouse model. The underlying molecular mechanism is unknown. We hypothesize that Ad IGF1 reprograms altered gene expression involved in collagen deposition in myocardium (Col1A1, CTGF, SRF, OPN, TGFβ) Method: Laparotomy was performed on pregnant C57 mice at embryonic day 18 and pups were divided into 3 groups. Control: Sham operated; IUGR: by ligation of a uterine artery branch; IUGR+IGF1: injection of Ad IGF1 after ligation. Pups were delivered and followed up with cross-sectional (2D) and Doppler transthoracic echocardiography until 36 week. Hearts were collected and RNA extracted for gene expression analysis by qPCR at 36 week. Data were analyzed using ANOVA Result: At week 36, IUGR mice showed significantly reduced EF (41 ± 6 vs 53 ± 7 vs 57 ± 9) compared to SHAM &amp; IUGR+IGF1 (Fig A). IUGR showed significantly increased LVID;d (3.8 ± 0.3 vs 3.1± 0.49 vs 2.9 ± 0.4) as compared to SHAM &amp; IUGR+IGF1 (Fig B). IUGR hearts demonstrated significantly increased CTGF (1.7± 0.6 vs 0.9 ± 0.3 vs 0.8 ± 0.2), and Col1A1 (2.4 ± 0.2 vs. 1.6 ± 0.4 vs 1.4 ± 0.5), as compared to SHAM &amp; IUGR+IGF1(Fig C). No differences were detected in the other genes Conclusion: AdIGF1 gene transfer rescues IUGR induced cardiac dysfunction and reprograms myocardial gene expression of CTGF&amp;COL1A1. These changes may represent a potential epigenetic regulation that reprograms the fetus and attenuates the risk of adult onset CVD

Treatment of children with protein - losing enteropathy after fontan and other complex congenital heart disease procedures in condition with limited human and technical resources.

BackgroundProtein-losing enteropathy (PLE) is a disorder characterized by abnormal and often profound enteric protein loss. It’s relatively uncommon complication of Fontan and other complex congenital heart disease (CCHD) procedures. Because of the complexity and rarity of this disease process, the pathogenesis and pathophysiology of protein-losing enteropathy remain poorly understood, and attempts at treatment seldom yield long-term success.Aim of presentationis to describe single centre experience in diagnosis, evaluation, management and treatment of children with protein-losing enteropathy after Fontan and other CCHD procedures in the current era and in centre with limited human and technical resources, follows with a comprehensive review of protein-losing enteropathy publications, and concludes with suggestions for prevention and treatment.Material and methodologyRetrospectively we analyzed patients with CCHD and protein-losing enteropathy in our institution, starting from January 2000 to December 2012. The including criteria were age between two and 17 years, to have a complex congenital heart disease and available complete documentation of cardiac surgery under cardiopulmonary bypass.ResultsOf all patients we evaluated 18 cases with protein-losing enteropathy, aged 6 to 19 years (mean 14±9); there were three children who had undergone screening procedure for D-transposition, one Tetralogy of Fallot, and remaining 14 patients had undergone Fontan procedures; (anatomic diagnosis are: six with tricuspid atresia, seven with d-transposition, double outlet right ventricle and pulmonary atresia and two with hypoplastic left heart syndrome). The diagnosis of protein-losing enteropathy was made at median age of 5.6 years, ranging from 13 months to 15 years. Diagnosis was made using alpha 1-antitrypsin as a gold marker in stool. By physical examination in 14 patients edema was found, in three ascites, and six patients had pleural effusion. Laboratory findings at the time of diagnosis are: abnormal enteric protein loss was documented at the time of diagnosis in all 18 patients. At the time of diagnosis all patients receiving some form of anticoagulation, 17 patients receiving other medication: 17 – diuretics and ACE inhibitors, 12 digoxin, 9 antiarrhytmics. Cross-sectional echocardiography was performed for all patients and different abnormalities were registered. In 14 patients also magnetic resonance was performed. Therapeutic approach was based on the non-specific medication (diet, diuretics, digoxin, ACE inhibitors, and anticoagulants), heparin and corticosteroids therapy. Long-term response to this type of therapy was registered in three patients. Nine patients underwent treatment with heparin and corticosteroids and no one experienced long term benefit. Despite of needs for catheter therapy or surgical intervention in our study, in the absent of technical and human resources now any one had underwent those procedures. Six patients has been transferred abroad and in five of them surgical intervention was perform.ConclusionProtein-losing enteropathy remains a devastating complication of Fontan procedure and despite in advantages in surgical and medical therapy there is no evidence that protein-losing enteropathy is less common in the current area.

Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis

Coronary artery fistulas (CAF) are rare, and are most often diagnosed by echocardiography or by coronary angiography. The incidence of this disease is very low, with a more frequent occurrence of fistulas originating in the right coronary artery. There is a higher incidence of CAF to right heart chambers, with CAF to the left ventricle (LV) being rare. Treatment can be surgical or percutaneous [1]. This report describes a case of CAF to the right ventricle (RV) resulting in severe pulmonary hypertension, in a patient with end-stage renal disease (ESRD) on hemodialysis and rheumatoid arthritis [2]. The patient had a history of hypertension for over 30 years [3]. Computed tomographic pulmonary angiography ruled out pulmonary embolism, but it suggested a coronary fistula to the RV cavity. A 61-year-old woman was referred for cardiac evaluation for chest pain and worsening dyspnea. The patient was on maintenance hemodialysis for the prior 2 years owing to ESRD. Clinical examination revealed tachycardia, crackles at both bases with no wheezes, rhonchi, or other adventitious sounds, a blood pressure of 160/70 mmHg. The patient had a radio-cephalic fistula constructed at the left wrist between the radial artery and the cephalic vein, using end-to-end anastomosis. An electrocardiogram showed evidence of a right bundle branch block, and signs of ventricular overload. Cross-sectional echocardiography with Doppler interrogation revealed a left ventricular ejection fraction of 55 %, and there was evidence of diastolic dysfunction, without important calcification or regurgitation of the valves.