Decrease In Left Ventricular Systolic Function Research Articles

A young male patient with cardiomyopathy associated with human immunodeficiency virus infection in the era of highly active antiretroviral therapy

Background: Cardiomyopathy in young people, especially those associated with HIV infection, has been reduced since the era of Highly Active Antiretroviral Therapy (HAART). In the era of post-HAART, manifestations of human immunodeficiency virus (HIV)-associated cardiomyopathy with impaired left ventricular (LV) systolic function are approximately about 1-3% of HIV-infected people. In this case, we presented how to diagnose and appropriately manage such a patient. Case Illustration: A 27-year-old male patient who works as a health worker came to the emergency room with complaints of shortness of breath; it worsened in the last 2 weeks. He got vital signs: blood pressure 97/60 mmHg, heart rate 118 bpm, respiratory rate 23 tpm, and oxygen saturation 99 % with oxygen supplementation of 8 lpm. Risk factors in patients such as smoking, family history, hypertension, diabetes mellitus, and dyslipidemia were denied. He was diagnosed with HIV on (antiretroviral therapy) ART 3 years ago with risk factors for free sex without protection. The last CD4 value was 796 cells/ul (normal value 637 – 1485). The echocardiography showed all chamber dilatation, global hypokinetic, and a significant decrease in LV systolic function (LVEF 16%). Laboratory examination showed an increase of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) into 6824 pg/mL (normal value <85.8). It was then treated by optimizing HF therapy continue HIV therapy. Conclusion: In HIV patients who have fallen into heart failure, a proper diagnosis using relevant tools could be a reference for clinicians to make the right decision. Prompt treatment combination of optimal HF therapy and HIV therapy are becoming the keys to the treatment. Keyword: antiretroviral, cardiomyopathy, heart failure, human immunodeficiency virus

A normal and particularly small (

The left atrium (LA) size can change due to cardiac pathologies like heart failure and aging. While the link between LA enlargement and left ventricular (LV) dysfunction is acknowledged, this study aims to assess the negative predictive value of normal LA size concerning the severity of LV systolic function in a large cohort undergoing diagnostic echocardiography. This retrospective cohort study, conducted at the University of California, Irvine Medical Center from 1984 to 1998, aimed to elucidate the negative predictive value of normal LA size measured by M-mode and two-dimensional echocardiography in a large cohort undergoing diagnostic assessment. In the analysis of 22,390 echocardiograms, 55.1% exhibited normal LA size (<40 mm), while 44.9% showed abnormal LA size (≥40 mm). Within the normal LA size group, only 2.4% demonstrated abnormal LV systolic function, with 1.1% mildly depressed, 0.7% moderately depressed, and 0.6% severely depressed LV function. The negative predictive value of normal LA size for abnormal LV systolic function was calculated at 97.5%, rising to 99.3% and 99.4% for moderate or severely decreased LV systolic function, respectively. In patients with small LA size (<35 mm), moderate to severely depressed LV systolic function was observed in only 0.8%, with severe LV systolic dysfunction in 0.3%, yielding an overall prevalence of 1.5% for all systolic dysfunction in the small LA size group. Our findings underscore the clinical significance of normal LA size as a reliable indicator of preserved LV function.

Lifetime evaluation of left ventricular structure and function in male ApoE null mice after gamma and space-type radiation exposure.

The space radiation (IR) environment contains high charge and energy (HZE) nuclei emitted from galactic cosmic rays with the ability to overcome current shielding strategies, posing increased IR-induced cardiovascular disease risks for astronauts on prolonged space missions. Little is known about the effect of 5-ion simplified galactic cosmic ray simulation (simGCRsim) exposure on left ventricular (LV) function. Three-month-old, age-matched male Apolipoprotein E (ApoE) null mice were irradiated with 137Cs gamma (γ; 100, 200, and 400cGy) and simGCRsim (50, 100, 150cGy all at 500 MeV/nucleon (n)). LV function was assessed using transthoracic echocardiography at early/acute (14 and 28days) and late/degenerative (365, 440, and 660days) times post-irradiation. As early as 14 and 28-days post IR, LV systolic function was reduced in both IR groups across all doses. At 14days post-IR, 150cGy simGCRsim-IR mice had decreased diastolic wall strain (DWS), suggesting increased myocardial stiffness. This was also observed later in 100cGy γ-IR mice at 28days. At later stages, a significant decrease in LV systolic function was observed in the 400cGy γ-IR mice. Otherwise, there was no difference in the LV systolic function or structure at the remaining time points across the IR groups. We evaluated the expression of genes involved in hemodynamic stress, cardiac remodeling, inflammation, and calcium handling in LVs harvested 28days post-IR. At 28days post-IR, there is increased expression of Bnp and Ncx in both IR groups at the lowest doses, suggesting impaired function contributes to hemodynamic stress and altered calcium handling. The expression of Gals3 and β-Mhc were increased in simGCRsim and γ-IR mice respectively, suggesting there may be IR-specific cardiac remodeling. IR groups were modeled to calculate the Relative Biological Effectiveness (RBE) and Radiation Effects Ratio (RER). No lower threshold was determined using the observed dose-response curves. These findings do not exclude the possibility of the existence of a lower IR threshold or the presence of IR-induced cardiovascular disease (CVD) when combined with additional space travel stressors, e.g., microgravity.

Effect of ischemic injury characteristics on left ventricular systolic function in patients with acute myocardial infarction

Aim. To study laboratory and magnetic resonance imaging (MRI) characteristics of infarction area depending on left ventricular (LV) global systolic function in patients with acute myocardial infarction (AMI) after revascularization.Material and methods. A total of 78 patients with primary AMI were included. On days 7-10, contrast-enhanced cardiac MRI was performed. Blood brain natriuretic peptide (BNP) was analyzed. Cardiac MRI was used to determine the characteristics of scar tissue, peri-infarct zone (PIZ), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and the global contrast index.Results. According to the MRI, patients were divided into following groups: group 1 — LV ejection fraction (LVEF) ≥50% (n=50), group 2 — LVEF 40-49% (n=21), group 3 — LVEF &lt;40% (n=7).The BNP in groups 1, 2, 3 was 106,8 (37,5; 248), 232,6 (170,1; 337,7) and 548,5±236,4 ng/ml, respectively (p1-3&lt;0,05). The scar tissue mass in groups 1, 2, 3 was 10,3 (2,4; 20,0), 34,7±21,3, 59,4±37,6 g, respectively (p1-2, 3&lt;0,01). PIZ differences were found only between patients with preserved and mildly reduced EF. MVO was diagnosed in 26% of patients with LVEF ≥50%, in 47,6% of patients with LVEF of 40-49% and 85,7% with LVEF &lt;40% (p1-3&lt;0,01). The detection rate of IMH prevailed in the 2nd group (33,3%) compared with the 1st group (12%) (p1-2&lt;0,05). The global contrast index was the lowest in the 1st group (14,7 (8,8; 27,9)%), intermediate in the 2nd group (33,3±12,6%), the highest in the 3th group (54,2±19,5%) (р1-2, 3; 2-3&lt;0,05).Conclusion. The following risk factors for a decrease in LV systolic function in patients with AMI after revascularization were identified: the size of scar tissue, PIZ, MVO and IMH characteristics, global contrast index, BNP level.

Предиктори утримання синусового ритму в пацієнтів із пізньою персистентною фібриляцією передсердь після електричної кардіоверсії під час 6-місячного проспективного спостереження

The aim – to study the predictors of sinus rhythm (SR) maintenance in patients with persistent atrial fibrillation (AF) and duration of AF episode ≥90 days at 6-months follow-up after elective direct current (DC) cardioversion.Materials and methods. The cohort single-center study analyzed clinical and instrumental data from 59 persistent AF patients with duration of its episode ≥90 days (up to 12 months), who underwent an elective DC cardioversion. At 6-months follow-up, patients were subdivided into the groups depending on SR maintenance: 32 (54 %) patients with a maintained SR (G1), and 27 (46 %) patients with a failure to maintain SR (G2).Results. G2, as compared to G1, demonstrated more advanced heart failure (stage C occurred in 74 % and 44 %, respectively [p=0,019]). According to transthoracic echocardiography (TTE) data, G1, as opposed to G2, was characterized by better baseline structure parameters of left heart chambers, particularly the diameter of left atrium (LA), end-diastolic and end-systolic volumes left ventricular (LV) volumes, higher LV systolic function (by LV ejection fraction [EF]), and the majority of the cases without or with mild pulmonary hypertension (PH). Transesophageal echocardiography data suggested the cases of LA spontaneous (echo) contrast and LA appendage flow velocity (LAAFV) ≤ 40 cm/s to be more frequent in G2, in contrast to G1. We revealed the following predictors of SR maintenance after DC cardioversion at 6-months follow-up: higher LV EF (OR 1,07 (95 % CI 1,01–1,13); р=0,021); LAAFV &gt; 40 cm/s (OR 4,33 (95 % CI 1,06–17,78); р=0,042), and less advanced PH (OR 0,24 (95 % CI 0,06–0,93); р=0,038). TTE data from G1 at 6-months follow-up after DC cardioversion suggested the reverse remodeling of both atria (the decrease of LA diameter, LA and right atrium volumes and their indexes). Additionally, G2 demonstrated a worsening in LV systolic function (the rise of LV end-systolic volume and decrease of LV EF), as opposed to G1. Moreover, at 6-months follow-up, G2 patients presented with more advanced severity of PH, as well as mitral and tricuspid regurgitation, in contrast to G1.Conclusions. Better LV systolic function, LAAFV &gt; 40 cm/s and less advanced PH were the predictors of SR maintenance in patients with persistent AF and duration of its episode ≥ 90 days at 6-months follow-up after elective DC cardioversion. The SR maintenance at 6-months follow-up associated with the reverse remodeling of let heart chambers and right atrium. On the contrary, a failure to maintain SR associated with the decrease of LV systolic function, and more advanced PH, mitral and tricuspid regurgitation.

Abstract 12272: Pericardial Decompression Syndrome Following Low Volume Pericardiocentesis for Malignant Cardiac Tamponade

Introduction: Cardiac tamponade is a life-threatening condition requiring emergent intervention. Pericardial decompression syndrome (PDS) is a rare complication that presents as acute ventricular dysfunction following pericardiocentesis with a mortality rate up to 29%. In this case, we present a patient with PDS who developed cardiogenic shock following pericardiocentesis for cardiac tamponade. Clinical course: A 58-year-old female with no significant cardiac history presented with chest pain and dyspnea. Computed topography revealed a mediastinal mass and large pericardial effusion. Transthoracic echocardiogram (TTE) demonstrated the effusion with tamponade physiology. Left ventricular (LV) systolic function was preserved at this time. A total of 450ml of serosanguinous fluid was removed by pericardiocentesis, with minimal residual volume around the RV and a large effusion remaining around the LV. Repeat TTE 14 hours later revealed severe global hypokinesis and biventricular failure with an LV EF of 15%. The patient was started on inotropic therapy and transferred to our tertiary care center. Continuous diuresis and vasopressor therapy were initiated. Once stable, the patient was taken for pericardial window with further removal of 600ml of fluid. Subsequent TTE demonstrated recovery of LV systolic function to 47%. Discussion: Our patient developed cardiogenic shock secondary to biventricular heart failure following pericardiocentesis. This presentation is concerning for pericardial decompression syndrome. While the exact mechanism of PDS is not known, the current hypothesis postulates that drainage of fluid compressing the RV leads to a sudden increase in venous return. This abrupt change causes septal bowing and decreased LV systolic function. Some sources recommend draining pericardial fluid in smaller quantities; however, PDS may still occur at smaller volumes as was seen in our patient. PDS is a rare but life-threatening complication that requires vigilance post-pericardiocentesis regardless of volume removed.

The role of macrophage migration inhibitory factor in predicting left ventricular remodeling in patients with acute myocardial infarction

Objective — to assess the role of circulating markers of inflammation and macrophage migration inhibitory factor (MIF) in the development of left ventricular (LV) remodeling 6 months after acute ST‑segment elevation myocardial infarction (STEMI).&#x0D; Materials and methods. The study involved 120 patients after STEMI and successful primary percutaneous coronary intervention (PCI). Transthoracic echocardiography with Doppler was performed within 24 — 48 hours after PCI and after 6 months of follow‑up to assess LV remodeling. The levels of MIF and inflammatory markers were measured before and after PCI. All patients were divided into two groups according to the median MIF level &lt; 2501 pg/ml (first group, n = 60) and &gt; 2501 pg/ml (second group, n = 60).&#x0D; Results. Patients with the high levels of circulating MIF had a higher frequency of complications in the hospital and long‑term periods (p = 0.024), including newly diagnosed heart failure or decompensation with hospitalizations. High MIF levels in patients of the second group were accompanied by a significant enlargement of end‑diastolic and end‑systolic LV volumes (p = 0.028; p = 0.031, respectively), the development of secondary mitral regurgitation (p = 0.024) and decreased LV systolic function (p = 0.037). MIF threshold values for predicting remodeling &gt; 2694 pg/ml (sensitivity 69.2 %, specificity 71.4 %, AUC = 0.714; 95 % CI 0.509 — 0.870; p = 0.0375) and LV dysfunction &gt; 2484 pg/ml (sensitivity 90.0 %, specificity 58.0 %, AUC = 0.782; 95 % CI 0.675 — 0.867, p = 0.0003) were determined using ROC analysis. According to the results of univariate and multivariate analysis, levels of MIF (p = 0.028) and soluble suppressor of tumorigenesis‑2 (p = 0.042) were most significant predictors of LV remodeling. A correlation between the levels of MIF and white blood cells count (r = 0.33, p = 0.0001), C‑reactive protein (r = 0.19, p = 0.032), troponin (r = 0.44, p = 0.002) has been established.&#x0D; Conclusions. An early increase of MIF levels is associated with the development of adverse structural and functional changes in left ventricle of patients after acute ST‑segment elevation myocardial infarction.

Echocardiographic assessment of left ventricular function in ex situ heart perfusion using pump-supported and passive afterload working mode: a pilot study

Ex situ heart perfusion (ESHP) has been developed to decrease cold ischemia time and allow metabolic assessment of donor hearts prior to transplantation. Current clinical ESHP systems preserve the heart in an unloaded condition and only evaluate the cardiac metabolic profile. In this pilot study we performed echocardiographic functional assessment using two alternative systems for left ventricular (LV) loading: pump supported afterload working mode (SAM) and passive afterload working modes (PAM). Six hearts were procured from male Yorkshire pigs. During cold ischemia, hearts were mounted on our custom made ESHP circuit and a 3D-printed enclosure for the performance of echocardiography with a standard TEE probe. Following perfusion with Langherdorf mode of the unloaded heart, the system was switched into different working modes to allow LV loading and functional assessment: pump supported (SAM) and passive (PAM). Echocardiographic assessment of left ventricular function in the donor hearts was performed in vivo and at 1 h of ESHP with SAM, after 4.5 h with PAM and after 5.5 h with SAM. We obtained good quality epicardial echocardiographic images at all time points allowing a comprehensive LV systolic assessment. All indices showed a decrease in LV systolic function throughout the trial with the biggest drop after heart harvesting. We demonstrated the feasibility of echocardiographic functional assessment during ESHP and two different working modes. The expected LV systolic dysfunction consisted of a reduction in EF, FAC, FS, and strain throughout the experiment with the most significant decrease after harvesting.

Cardiac Fibrosis and Changes in Left Ventricle Function in Patients with Chronic Chagas Heart Disease.

ResumoFundamento A cardiopatia chagásica (CC) é uma condição de progressão lenta, cujo principal achado histopatológico é fibrose.Objetivos Avaliar se a fibrose cardíaca aumenta ao longo do tempo e se correlaciona com aumento no tamanho do ventrículo esquerdo (CE) e redução na fração de ejeção (FE) na CC crônica.Métodos Estudo retrospectivo que incluiu 20 indivíduos (50% homens; 60±10 anos) com CC crônica que se submeteram a dois exames de ressonância magnética cardíaca (RMC) com realce tardio com gadolínio em um intervalo mínimo de quatro anos entre os exames. Volume, FE e massa de fibrose do ventrículo esquerdo (VE) foram determinados por RMC. Associações da massa de fibrose na primeira RMC com alterações no volume do VE e FE ventricular esquerda na segunda RMC foram testadas por análise de regressão logística. Valores p<0,05 foram considerados significativos.Resultados Os pacientes foram classificados em: A (n=13; alterações típicas de CC no eletrocardiograma e função sistólica global e segmentar do VE normal) e B1 (n=7; alteração na motilidade da parede do VE e FE ≥45%). O tempo médio entre os dois estudos de RMC foi de 5,4±0,5 anos. Fibrose do VE (em % massa do VE) aumentou de 12,6±7.9% para 18,0±14,1% entre os exames de RMC (p=0,02). A massa de fibrose cardíaca no basal associou-se com uma diminuição > cinco unidades absolutas na FE ventricular esquerda da primeira para a segunda RMC (OR 1,48; IC95% 1,03-2,13; p=0,03). A massa de fibrose do VE foi maior e aumentou entre os dois estudos de RMC no grupo de pacientes que apresentaram diminuição na FE entre os testes.Conclusões Mesmo pacientes em estágios iniciais da CC apresentam um aumento na fibrose do miocárdio ao longo do tempo, e a presença de fibrose do VE no basal está associada a uma diminuição da função sistólica do VE.

Enhanced oxidative stress mediates pathological autophagy and necroptosis in cardiac myocytes in pressure overload induced heart failure in rats.

In cardiac myocytes in vitro, hydrogen peroxide induces autophagic cell death and necroptosis. Oxidative stress, myocyte autophagy and necroptosis coexist in heart failure (HF). In this study, we tested the hypothesis that excessive oxidative stress mediates pathological autophagy and necroptosis in myocytes in pressure overload-induced HF. HF was produced by chronic pressure overload induced by abdominal aortic constriction (AAC) in rats. Rats with AAC or sham operation were randomised to orally receive an antioxidant N-acetylcysteine (NAC) or placebo for 4weeks. Echocardiography was performed for the assessments of left ventricular (LV) structure and function. AAC rats exhibited decreased LV fractional shortening (FS) at 4weeks after surgery. NAC treatment attenuated decreased LV FS in AAC rats. In AAC rats, myocardial level of 8-hydroxydeoxyguanosine assessed by immunohistochemical staining, indicative of oxidative stress, was increased, LC3 II protein, a marker of autophagy, Beclin1 protein and Atg4b, Atg5, Atg7 and Atg12mRNA expression were markedly increased, RIP1, RIP3 and MLKL expression, indicative of necroptosis, was increased, and all of the alterations in AAC rats were prevented by the NAC treatment. NAC treatment also attenuated myocyte cross-sectional area and myocardial fibrosis in AAC rats. In conclusion, NAC treatment prevented the increases in oxidative stress, myocyte autophagy and necroptosis and the decrease in LV systolic function in pressure overload-induced HF. These findings suggest that enhanced oxidative stress mediates pathological autophagy and necroptosis in myocytes, leading to LV systolic dysfunction, and antioxidants may be of value to prevent HF through the inhibition of excessive autophagy and necroptosis.

Quantitative assessment of left ventricular longitudinal function and myocardial deformation in Duchenne muscular dystrophy patients

BackgroundDuchenne muscular dystrophy (DMD) manifests in males mainly by skeletal muscle impairment, but also by cardiac dysfunction. The assessment of the early phases of cardiac involvement using echocardiography is often very difficult to perform in these patients. The aim of the study was to use cardiac magnetic resonance (CMR) strain analysis and mitral annular plane systolic excursion (MAPSE) in the detection of early left ventricular (LV) dysfunction in DMD patients.Methods and resultsIn total, 51 male DMD patients and 18 matched controls were examined by CMR. MAPSE measurement and functional analysis using feature tracking (FT) were performed. Three groups of patients were evaluated: A/ patients with LGE and LV EF < 50% (n = 8), B/ patients with LGE and LVEF ≥ 50% (n = 13), and C/ patients without LGE and LVEF ≥ 50% (n = 30). MAPSE and global LV strains of the 3 DMD groups were compared to controls (n = 18).Groups A and B had significantly reduced values of MAPSE, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in comparison to controls (p < 0.05). The values of MAPSE (11.6 ± 1.9 v 13.7 ± 2.7 mm) and GCS (− 26.2 ± 4.2 v − 30.0 ± 5.1%) were significantly reduced in group C compared to the controls (p < 0.05).ConclusionDMD patients had decreased LV systolic function measured by MAPSE and global LV strain even in the case of normal LV EF and the absence of LGE. FT and MAPSE measurement provide sensitive assessment of early cardiac involvement in DMD patients.

Cardioprotective effect of Trimetazidine in patients with early breast cancer receiving anthracycline-based chemotherapy

Abstract Background Anthracyclines, alone or in combination with other drugs, are among the most effective chemotherapeutic agents to treat breast cancer both in the adjuvant and neoadjuvant settings. Unfortunately, anthracycline-associated dose-dependent cardiotoxicity is a limiting factor in clinical use. Extensive efforts have been devoted to identifying strategies to prevent anthracycline-induced cardiotoxicity. However, most cardioprotective agents have shown little efficacy in clinical trials. We hypothesized that myocardial damage by anthracyclines could be rationally prevented by using trimetazidine (TMZ), previously reported to interfere with anthracycline- and trastuzumab-induced cardiotoxicity. Therefore, we planned a randomized, controlled, open trial to determine whether TMZ may prevent the development of left ventricular (LV) dysfunction in patients receiving standard treatment for breast cancer. Methods The trial included 73 patients (41.2±8.1 years) undergoing surgery for breast cancer, who were scheduled for adjuvant epirubicin-containing chemotherapy and, if indicated, trastuzumab. Patients were randomly allocated in a 1:1 ratio to receive TMZ or baseline therapy only (control group). The main study endpoint was a reduction in the deterioration of left ventricular ejection fraction (LVEF), as evaluated by serial echocardiography performed at randomization and then every 3 months after the start of chemotherapy and for 1 year after its completion. Secondary outcome measures included echocardiographic indices of LV diastolic dysfunction, structural myocardial alterations, as assessed by speckle tracking echocardiography, and changes in cardiac biomarkers (troponin and brain natriuretic peptide). Results We found no significant differences between the two groups regarding baseline clinical and echocardiographic parameters. The two groups reached a similar cumulative dose of doxorubicin. No patient died during the study and no patients withdrew from chemotherapy. Three months after the start of chemotherapy, nonsignificant changes were observed in LVEF, shortening fraction, and LV diameters. No significant changes in cardiac biomarkers were observed in either group. Tissue Doppler imaging detected a significant decrease in myocardial velocities (P=0.001) in the control group, indicating LV diastolic dysfunction. In the same group, speckle tracking imaging revealed a statistically significant alteration in ventricular deformation (P=0.01), which means a decrease in LV systolic function. In the TMZ group, no significant alterations in LV diastolic function were observed. Conclusions Tissue Doppler imaging and speckle tracking imaging are more sensitive than conventional echocardiograms in the early diagnosis of cardiac dysfunction and TMZ seems to have an important role in the prevention of cardiotoxicity. Funding Acknowledgement Type of funding source: None

Parental Acquisition of Echocardiographic Images in Pediatric Heart Transplant Patients Using a Handheld Device: A Pilot Telehealth Study

Pediatric heart transplant patients (PedHtx) require frequent monitoring by echocardiography (echo); however, they often live far from hospitals with pediatric echo services, resulting in urgent/emergent transfers to specialized institutions. Our primary objective was to evaluate the feasibility of parental acquisition of echo images to assess left ventricular (LV) systolic function in PedHtx using a handheld echo device. Secondary objectives included retesting for skill maintenance and in patients with decreased LV systolic function. During a routine clinic visit, parents received 1-hour training with a handheld echo device to acquire images in parasternal short-axis and apical views. Parents recorded images on their children at training completion and 24hours later at home. An independent echocardiographer assessed clinic, training, and home echos for LV systolic function. Fifteen PedHtx (mean age of 12.6years of age; range, 4.1-16.7) were enrolled. All parents could acquire home images adequate for qualitative assessment of LV systolic function with no discrepancy compared with clinical echos. LV ejection fraction (LVEF) could be calculated (5/6 area-length method) in 86% of training and 43% of home echos with <10% difference in LVEF measurements between home and clinic echos. Five parents repeated home echos >12months later. All home echos were adequate for qualitative assessment of LV systolic function (LVEF measurable in two). Additionally, five heart failure patients with decreased LV systolic function (mean age of 8.6years; range 1.9-15.1) were enrolled. All home echos were adequate for qualitative assessment of LV systolic function (LVEF measurable in one). Our results suggest that parental home echo acquisition using a handheld echo device is feasible and adequate for qualitative assessment of LV systolic function in PedHtx. However, quantitative assessment of LV systolic function, especially in patients with dysfunction, and retention of the skill set without additional training are suboptimal.

Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice.

Acute myocardial infarction can lead to acute heart failure and cardiogenic shock. The evaluation of hemodynamics is critical for the evaluation of any potential therapeutic approach directed against acute left ventricular (LV) dysfunction. Current imaging modalities (e.g., echocardiography and magnetic resonance imaging) have several limitations since data on LV pressure cannot directly be measured. LV catheterization in mice undergoing coronary artery occlusion could serve as a novel method for a real-time evaluation of LV function. At the beginning of the procedure, mice were anesthetized followed by endotracheal intubation. For LV catheterization, the right carotid artery was exposed via middle-neck incision. The catheter was introduced and placed into the LV cavity. Left thoracotomy was conducted and the left main coronary artery (LCA) was ligated. To induce reperfusion, the suture was released after 45 min. Pressure-volume data was recorded at all times. Ligation of the LCA caused a decrease in LV systolic function as evidenced by a 30% reduction in stroke volume, LV ejection fraction (EF), and cardiac output. Maximum dP/dt as a parameter for LV contractility was also significantly reduced and diastolic function was severely impaired (minimum dP/dt -40%). Reperfusion over a period of 20 min did not lead to a complete recovery of LV function. Real-time pressure-volume analysis served as a valid procedure for monitoring cardiac function during acute myocardial infarction in mice. Maintaining stable anesthesia and a standardized surgical approach was crucial to ensure valid results. As the early phase of acute myocardial infarction is critical for morbidity and mortality, the delineated method could be beneficial for preclinical evaluation of new strategies for cardioprotection.

Nebivolol effect on doxorubicin-induced cardiotoxicity in breast cancer.

PurposeThe aim of this study was to assess whether nebivolol treatment could have beneficial effects in the prevention of anthracyclines-induced cardiotoxicity.Patients and methodsOur prospective study included 60 women, mean age 52.6±13 years, with HER2 negative breast cancer, scheduled to undergo treatment with doxorubicin. The patients were randomly divided into two groups: the treatment group (n=30) which received nebivolol 5 mg once daily for the duration of chemotherapy and the control group (n=30) without treatment with nebivolol. Cytostatic treatment was performed with doxorubicin 70 mg/m2 administered intravenously every 21 days for six cycles. The average cumulative dose of doxorubicin was 520±8 mg/m2. Echocardiography was performed immediately before and after six cycles of doxorubicin therapy.ResultsWe found no significant differences between the two groups regarding baseline clinical and echocardiographic parameters. The two groups reached a similar cumulative dose of doxorubicin. No patient died during the study. None of the patients withdrew from chemotherapy. After six cycles of doxorubicin therapy, the left ventricular (LV) ejection fraction, shortening fraction, and LV diameters changed, but not significantly. Tissue Doppler imaging (TDI) detected in the control group a significant decrease of myocardial velocities, indicating a LV diastolic dysfunction. In the same group, speckle tracking imaging (STI) revealed a statistically significant alteration of the ventricular deformation, which means a decrease in LV systolic function. In the nebivolol treatment group, no significant alterations in the LV systolic and diastolic function were observed.ConclusionThe results of this study show the benefit of new echocardiographic imaging methods such as TDI and STI in the screening of early cardiac dysfunction induced by cytostatic treatment. Nebivolol treatment prevented the occurrence of anthracyclines-induced cardiomyopathy in the short term. In order to confirm these preliminary results, larger studies with a longer follow-up period are required.

Acute echocardiographic effects of sotalol on ventricular systolic function in dogs with ventricular arrhythmias.

BackgroundSotalol is a commonly used antiarrhythmic drug that may alter ventricular function.ObjectiveTo determine the effect of sotalol on echocardiographic indices of ventricular systolic function in dogs with ventricular arrhythmias.AnimalsThirty‐five client‐owned dogs with ventricular arrhythmias.MethodsDogs with ventricular arrhythmias (n = 27) had an echocardiogram and 5‐minute ECG performed at baseline and 2‐4 hours post‐sotalol (2‐2.5 mg/kg PO once). Eight additional dogs underwent the same protocol but did not receive sotalol (within‐day variability controls). Left ventricular (LV) internal dimension at end‐systole normalized to bodyweight (LVIDs_N), LV ejection fraction (LV EF), LV shortening area, LV fractional shortening, tricuspid annular plane systolic excursion (TAPSE), and right ventricular systolic myocardial velocity were evaluated as indices of systolic function.ResultsAll indices except TAPSE had mild decreases in systolic function post‐sotalol (all P ≤ .0007) compared with baseline but only the percent change in LVIDs_N and LV EF were significantly (P ≤ .0079) different from the percent change of the same indices in control dogs. Sinus heart rate, ventricular premature complexes/5‐minutes, and arrhythmia grade also were decreased post‐sotalol (all P ≤ .01) compared with baseline when assessed by a 5‐minutes ECG. No dog experienced an adverse event post‐sotalol, including dogs with systolic dysfunction or atrial enlargement.Conclusions and Clinical ImportanceA single dose of sotalol may cause a mild decrease in LV systolic function in dogs with ventricular arrhythmias. Sotalol appears to be well tolerated, even in dogs with atrial enlargement or systolic dysfunction.

Analysis of left ventricular systolic function in patients with isolated ventricular noncompaction by cardiac MRI

Objective To compare cardiac magnetic resonance imaging (MRI) features between patients with normal and decreased left ventricular (LV) systolic function in isolated ventricular noncompaction (IVNC) and to analyze the related factors of LV systolic function. Methods In a retrospective blinded study, 62 IVNC patients were divided into two subgroups: those with normal LV systolic function [LV ejection fraction (LVEF) ≥55%) ] and those with decreased LV systolic function (LVEF< 55%). A total of 30 healthy volunteers were enrolled as controls. The LVEF, LV volume, number of non-compacted segments, ratio of non-compacted to compacted myocardium (NC/C ratio) , and delayed enhancement were assessed using cardiac MRI. One-way analysis of variance, independent t test and χ2 test were used. The correlation between LVEF and the number of non-compacted segments or NC/C ratio were calculated with Spearman and Pearson correlation analysis. Results The LVEF of patients with normal LVEF [ (58.8±3.8) %] and patients with decreased LVEF [ (31.1±11.1) %] were less than that of control group [ (66.1±6.0) %], which demonstrated significant differences (F=140.789, P 0.05). The patients with decreased LVEF had significantly greater LV volume compared with patients with normal LVEF and control group (P<0.05). The number of non-compacted segments in patients with decreased LVEF (7.5±1.0) was more than that of the patients with normal LVEF (5.6± 1.0) , and the NC/C ratio in patients with decreased LVEF (4.4±0.9) was higher than that of patients with normal LVEF (3.4±0.7) , which demonstrated significant differences (t=7.248, 4.472, P<0.01). There was significant difference in the rate of delayed enhancement between patients with decreased LVEF (18/42) and patients with normal LVEF (1/20) (χ2=9.136, P<0.01). The non-compacted segments were more common in apex, apical and mid lateral segments in two IVNC groups, and there were no involvement of basal septal, mid septal and mid inferior segments. Some basal segments were involved in patients with decreased LVEF, while there were no basal segments involved in patients with normal LVEF. The number of non-compacted segments and NC/C ratio were correlated negatively with LVEF (r=- 0.690, - 0.591, respectively,P<0.01). Conclusions The dilation, remodeling and myocardial delayed enhancement of LV in IVNC patients can lead to decreased LV systolic function. In addition, the extent and severity of non-compacted myocardium in IVNC patients are correlated negatively with LVEF. Key words: Cardiomypathies; Ventricular dysfunction, left; Magnetic resonance imaging

Role of echocardiography in clinical hypertension.

Hypertension is a major and correctable cardiovascular risk factor. The correct diagnosis of hypertension and precise assessment of cardiovascular risk are essential to give proper treatment in patients with hypertension. Although echocardiography is the second-line study in the evaluation of hypertensive patients, it gives many clues suggesting bad prognosis associated with hypertension, including increased left ventricular (LV) mass, decreased LV systolic function, impaired LV diastolic function, and increased left atrial size and decreased function. Along with conventional echocardiographic methods, tissue Doppler imaging, three-dimensional echocardiography, and strain echocardiography are newer echocardiographic modalities in the evaluation of hypertensive patients in the current echocardiographic laboratories. Understanding conventional and newer echocardiographic parameters is important in the diagnosis and assessment of cardiovascular risk in hypertensive patients.

Decreased left ventricular (LV) function is associated with hip-fractures

BackgroundSeveral risk factors for falls and hip-fractures have been recognized, but controversy still exists toward the importance of structural cardiac abnormalities as a potentially modifiable risk factor for recurrent falls. Aim of this study was to determine the association between echocardiographic abnormalities and hip-fractures. MethodsDesign case–control study within consecutive patients undergoing hip-surgery in an academic hospital. Cases: patients with traumatic hip-fractures. Controls: patients undergoing planned hip surgery (non-traumatic). Inclusion criteria: age≥50 years, presence of pre-operative echocardiogram. Exclusion criteria: high energy trauma, pathological and/or previous hip-fracture. Outcome: echocardiographic abnormalities (ventricular function, atrial enlargement, valve stenosis and/or regurgitation, pulmonary hypertension (pulmonary artery pressure (PAP) ≥35mmHg)). Multivariate logistic regression was performed to calculate odds ratios (OR) and to correct for confounders. ResultsWe included 197 patients (141 cases). Mean age was 77 years (SD), 65% female. After adjustment for potential confounders, decreased LV systolic function was associated with hip-fractures (OR 3.2 [95%CI 1.1–9.1]). Increasing severity of LV dysfunction was also associated with hip-fractures (p for trend=0.012). DiscussionIn conclusion, patients with traumatic hip-fracture had greater risk of decreased LV function than patients who underwent planned hip-surgery. Possibly, decreased LV function is an underestimated risk factor for injurious falls.

Outcomes in Atrial Fibrillation Patients With and Without Left Ventricular Hypertrophy When Treated With a Lenient Rate-Control or Rhythm-Control Strategy

Although left ventricular (LV) hypertrophy has been proposed as a factor predisposing to atrial fibrillation (AF), its relevance to prognosis and selection of therapeutic strategies is unclear. We identified 2,105 patients with echocardiographic data on LV mass enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. LV hypertrophy was defined as increased LV mass, stratified by American Society of Echocardiography criteria. The primary end point was all-cause mortality, secondary end point was as per AFFIRM trial definition, and tertiary end point was cardiovascular hospitalizations. We compared "strict" versus "lenient" rate control in patients with increased LV mass, and studied association of heart failure (HF) with preserved and decreased systolic function in patients with increased LV mass. Over 6 years, 332 deaths (15.7%) were reported. Adjusted hazard ratio (HR) of severely increased LV mass for all-cause mortality was 1.34 (95% confidence interval [CI] 1.01 to 1.79, p=0.045) for the overall population and 1.61 (95% CI 1.09 to 2.37, p=0.016) for the rhythm-control arm. Increased LV mass was a predictor of cardiovascular hospitalizations in the lenient rate-control group (HR 1.72, 95% CI 1.05 to 2.82, p=0.03) but not in the strict rate-control group. Severely increased LV mass was predictive of cardiovascular hospitalizations in patients with HF with preserved (HR 1.8, 95% CI 1.0 to 3.2, p=0.03) and decreased LV systolic function (HR 2.4, 95% CI 1.1 to 5.2, p=0.02). Thus, LV hypertrophy is a significant independent predictor of mortality in patients with AF, especially those managed with rhythm control. In patients with LV hypertrophy, strict rate control may be associated with better outcomes than lenient rate control. LV hypertrophy portends higher cardiovascular morbidity in patients with AF and HF.