Ventricular Diastolic Diameter Research Articles

Enzyme Replacement Therapy Decreases Left Ventricular Mass Index in Patients with Hunter Syndrome?

Although enzyme replacement therapy (ERT) has shown benefit in improving cardiac systolic function in a murine model of cardiomyopathy associated with Hunter syndrome, few studies have analyzed its effect in humans. We evaluated the effect of ERT on patients with Hunter syndrome-related cardiomyopathy. We performed a retrospective analysis of serial transthoracic echocardiograms performed before and over the first 5years after treatment initiation, in 14 patients with Hunter syndrome. An important cardiac remodeling occurred in all patients in this study. There was a significant reduction in left ventricular mass index from 70.88 to 26.75g/m2.7 (p = 0.003), with a trend towards a decrease in relative wall thickness from 0.515 at baseline to 0.370 after 5years of enzyme therapy (p = 0.140). No differences were observed in aortic root diameter, left atrial diameter, left ventricular diastolic and systolic diameters, left ventricular ejection fraction, or myocardial performance index. Our findings demonstrate that ERT contributes to reducing left ventricular mass index in patients with Hunter syndrome.

Echocardiographic evaluation of right heart functions in hemodialysis patients

Amac: Volum yuku degerlendirmesi kronik bobrek yetmezligi (KBY) hastalarinda onemli bir sorundur. Klasik volum degerlendirmesi yontemleri disinda, sag kalp fonksiyonlarinin ekokardiyografik degerlendirmesi ile ilgili yapilmis calisma sayisi kisitlidir. Bu calismada hemodiyaliz (HD) tedavisi alan son donem bobrek yetmezligi hastalarinda sag kalp fonksiyonlarini ekokardiyografik olarak degerlendirmeyi ve volum yuku tayininde kullanilabilirligini amacladik. Yontemler: Bu vaka kontrol calismasina, calisma grubu olarak HD tedavisi alan 49 hasta alindi. Kontrol grubu olarak yas, cinsiyet uyumu saglanmis 46 saglikli birey alindi. Tum katilimcilarin ekokardiyografik olarak degerlendirmesi yapildi. Trikuspit anuler duzlem sistolik hareketi (TAPSE), sistolik pulmoner arter basinci (SPAB), trikuspit E dalga hizi, A dalga hizi, E/A orani, sag ventrikul ejeksiyon fraksiyonu (RVEF) ve sol ventrikul ejeksiyon fraksiyonu (LVEF) olculdu. Bulgular: Sag ventrikul diyastolik capi (sirasiyla 2.55 (0.3) ve 2.30 (0.29), P<0.001) ve SPAP (37.4 (8.3) ve 19 (6.8), P<0.001), calisma grubunda istatistiksel olarak anlamli derecede yuksek bulundu. Calisma grubunda TAPSE (sirasiyla 1.61 (0.35) ve 2.09 (0.27), P<0.001), A orani, (sirasiyla 0.63 (0.27) ve 0.45 (0.26), P<0.001), E / A orani (sirasiyla 0.93 (0.25) ve 1.37 (0.24), P<0.001). Calisma grubunda sag ventrikul E hizi daha dusuktu ancak istatistiksel olarak anlamli degildi (P=0.523). Gruplar arasinda yas, cinsiyet ve vucut kitle indeksi acisindan istatistiksel olarak anlamli fark yoktu. Sonuc: Calismamizda, HD hastalarinda TAPSE’nin dusuk, SBAP’nin ve sag ventrikul diyastolik capinin ise yuksek oldugunu tespit ettik. HD hastalarinda TAPSE ve SPAB'nin, hipervolemiyi degerlendirmede geleneksel yontemlerle birlikte kullanilabilecegini dusunuyoruz. Bu klinik araci kesfetmek icin daha ileri calismalar gereklidir.

Narrower QRS may be enough to respond to cardiac resynchronization therapy in lightweight patients

A prolonged QRS duration (QRSd) is promising for a response to cardiac resynchronization therapy (CRT). The variation in human body sizes may affect the QRSd. We hypothesized that conduction disturbances may exist in Japanese even with a narrow (< 130 ms)-QRS complex; such patients could be CRT candidates. We investigated the relationships between QRSd and sex and body size in Japanese. We retrospectively analyzed the values of 338 patients without heart failure (HF) (controls) and 199 CRT patients: 12-lead electrocardiographically determined QRSd, left ventricular diastolic and systolic diameters (LVDd and LVDs), body surface area (BSA), body mass index (BMI), and LVEF. We investigated the relationships between the QRSd and BSA, BMI, and LVD. The men’s and women’s BSA values were 1.74 m2 and 1.48 m2 in the controls (p < 0.0001), and 1.70 m2 and 1.41 m2 in the CRT patients (p < 0.0001). The men’s and women’s QRSd values were 96.1 ms and 87.4 ms in the controls (p < 0.0001), and 147.8 ms and 143.9 ms in the CRT group (p = 0.4633). In the controls, all body size and LVD variables were positively associated with QRSd. The CRT response rate did not differ significantly among narrow-, mid-, and wide-QRS groups (83.6%, 91.3%, 92.4%). An analysis of the ROC curve provided a QRS cutoff value of 114 ms for CRT responder. The QRSd appears to depend somewhat on body size in patients without HF. The CRT response rate was better than reported values even in patients with a narrow QRSd (< 130 ms). When patients are considered for CRT, a QRSd > 130 ms may not be necessary, and the current JCS guidelines appear to be appropriate.

Follow-up after biventricular repair of the hypoplastic left heart complex

In hypoplastic left heart complex patients, biventricular repair is preferred over staged-single ventricle palliation; however, there are too few studies to support either strategy. Therefore, we retrospectively characterized our patient cohort with hypoplastic left heart complex after biventricular repair to measure left-sided heart structures and assess our treatment strategy. Patients with hypoplastic left heart complex who had biventricular repair between 2004 and 2018 were retrospectively reviewed. Operative results were evaluated and echocardiographic mitral valve (MV) and aortic valve (AoV) dimensions, left ventricular length and left ventricular internal diastolic diameter (LVIDd) were measured preoperatively and during follow-up after 0.5, 1, 3, 5 and 10 years. In 32 patients, the median age at surgery was 10 (interquartile range 5.0) days. The median follow-up was 6.19 (interquartile range 6.04) years. During the 10-year follow-up, the mean Z-scores increased from -2.82 to -1.49 and from -2.29 to 0.62 for MV and AoV, respectively. Analysis of variance results with post hoc paired t-tests showed that growth of left-sided heart structures was accelerated in the first year after repair, but was not equal, with the MV lagging behind the AoV (P = 0.033), resulting in significantly smaller MV Z-scores compared with AoV Z-scores at 10-year follow-up (P < 0.001). There were 2 (6%) early deaths. The major adverse events occurred in 4 (13%) patients. The surgical or catheter-based reintervention was required in 14 (44%) patients. The growth rate of heart structures was most prominent during the first year after biventricular repair with lower growth rate of the MV compared with the AoV.

P5390Adipolin/C1q/Tnf-related protein 12 attenuates adverse cardiac remodeling in a mouse model of myocardial infarction

Abstract Background Ischemic heart disease is one of leading causes of death worldwide. Obesity is closely linked to the development of cardiovascular diseases including ischemic heart disease. Adipose tissue produces various secretory bioactive proteins called as adipokines, and dysregulation of adipokine production contributes to the pathogenesis of obesity-related complications. Previously we identified adipolin, also referred to as C1q/Tnf-related protein12, as an insulin-sensitizing adipokine that is down-regulated in obesity. Here, we investigated the effects of adipolin on cardiac remodeling in a mouse model of myocardial infarction (MI). Method Male adipolin-knockout (APL-KO) and wild-type (WT) mice were subjected to the permanent ligation of the left anterior descending coronary artery to create MI. Echocardiographic and histological analyses were performed to evaluate cardiac function and myocardial remodeling at 4 weeks after MI. Apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Cardiomyocyte cross sectional area was evaluated by Wheat Germ Agglutinin staining. Perivascular fibrosis was assessed by Masson's trichrome staining. Neonatal rat ventricular myocytes were used as cultured cardiac myocytes for in vitro study. Results APL-KO mice exhibited increased ratios of the heart weight/body weight and lung weight/body weight after MI compared with WT mice. APL-KO mice showed increased left ventricular diastolic diameter and decreased fractional shortening after MI compared with WT mice. APL-KO mice had increases in myocardial apoptosis, cardiomyocyte hypertrophy and perivascular fibrosis at the remote zone of infarct hearts as compared with WT mice. Treatment of cultured cardiomyocytes with adipolin protein reduced apoptosis in response to 24 hours of hypoxia. Treatment with adipolin protein also increased the phosphorylation of Akt in cardiomyocytes. Inhibition of PI3 kinase/Akt signaling by LY294002 reversed the anti-apoptotic effects of adipolin in cultured cardiomyocytes. Conclusion Our data indicate that adipolin prevents pathological myocardial remodeling after chronic ischemia, at least in part, by suppressing myocardial apoptosis through an Akt-dependent mechanism.

Silence of lncRNA XIST represses myocardial cell apoptosis in rats with acute myocardial infarction through regulating miR-449.

To study the influences of long non-coding ribonucleic acid (lncRNA) X-inactive specific transcript (XIST) on rats with acute myocardial infarction (AMI), and its regulatory mechanism. A total of 30 Sprague-Dawley rats were randomly assigned into Sham group, Model group, and lncRNA XIST small interfering RNA (XIST siRNA) group. The AMI rat model was prepared through ligating the left anterior descending coronary artery. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular systolic diameter (LVDs), and left ventricular diastolic diameter (LVDd) of rats were determined using a color Doppler ultrasound system. Reverse transcription-polymerase chain reaction was performed to measure the expression levels of lncRNA XIST, microRNA (miR)-449, and Notch1 in rat heart tissues in each group. Pathological morphology of rat heart tissues in each group was observed via hematoxylin-eosin (HE) staining. Cell apoptosis in rat heart tissues was evaluated through terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Compared with those in Sham group, rats in Model group had significantly increased LVEDV, LVESV, LVDs, and LVDd. After transfection with lncRNA XIST siRNA, XIST level in rat heart tissues was remarkably declined in XIST siRNA group compared with that in Model group. According to HE staining results, the pathological injuries in rat heart tissues were greatly improved in XIST siRNA group compared with those in Model group. TUNEL staining results revealed that the apoptosis rate of cells in rat heart tissues in XIST siRNA group was markedly lower than that in Model group. Higher level of miR-449 and lower level of Notch1 were observed in rats of XIST siRNA group than those of Model group. Knockdown of lncRNA XIST can repress the myocardial cell apoptosis in AMI model rats by downregulating miR-449 level.

Effects of uncoupling protein 2 overexpression on myocardial mitochondrial dynamics in sepsis rats

To investigate the effects of uncoupling protein 2 (UCP2) overexpression on mitochondrial dynamics (mitochondrial division and fusion) of sepsis myocardial injury in rats. Forty male Sprague-Dawley (SD) rats were randomly divided into four groups (n = 10): sham operation group (Sham group) using normal saline instead of transfection and simulating cecal ligation and perforation (CLP); CLP group using normal saline instead of transfection, performing CLP to induce sepsis; adeno-associated virus (AAV) group using CLP after myocardial transfection with empty virus; UCP2 overexpression group (UCP2 group) CLP was performed 3 weeks after AAV-UCP2 (1×1015 vg/L, a total of 60 μL) myocardial transfection. The rats in each group were examined by echocardiography at 24 hours after the CLP, and then the rats were sacrificed immediately to harvest myocardial tissue. Myocardial ultrastructural changes were observed under the electron microscope, the expression of regulatory proteins related to myocardial mitochondrial dynamics [optic atrophy 1 (Opa1), dynamin-related protein 1 (Drp1) and fission 1 (Fis1)] were detected by Western Blot, and the level of mitochondrial adenosine triphosphate (ATP) production was detected by chemiluminescence. (1) The echocardiographic results showed that there was no significant difference in left ventricular mass (LVM) and stroke volume (SV). Compared with Sham group, left ventricular diastolic anterior wall thickness (LVAWd), left ventricular systolic anterior wall thickness (LVAWs), left ventricular diastolic posterior wall thickness (LVPWd), left ventricular systolic posterior wall thickness (LVPWs), left ventricular ejection fraction (LVEF) and left ventricular short axis shortening rate (LVFS) were significantly increased in CLP group and AAV group, while left ventricular systolic diameter (LVEDs), left ventricular diastolic diameter (LVEDd), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV) were significantly decreased. Compared with CLP group and AAV group, LVAWs, LVEF, LVFS were significantly decreased in UCP2 group, and LVEDs, LVEDV and LVESV were significantly increased [LVAWs (mm): 3.82±0.42 vs. 4.34±0.30, 4.44±0.12; LVEF: 0.921±0.038 vs. 0.979±0.019, 0.991±0.010; LVFS: (65.33±6.56)% vs. (80.11±8.23)%, (85.31±6.11)%; LVEDs (mm): 1.81±0.36 vs. 0.89±0.54, 0.60±0.17; LVEDV (μL): 137.09±50.05 vs. 89.72±53.04, 85.42±40.99; LVESV (μL): 10.48±4.59 vs. 2.48±3.52, 2.58±2.50, all P < 0.05]. (2) Electron microscope showed that the structure of myocardial fibers in the Sham group was clear and aligned with complete intervertebral disc and mitochondrial structure, no damage to mitochondrial membranes, and tight arrangement of cristae. In CLP group and AAV group, muscle fiber breakage, sarcoplasmic reticulum expansion, severe mitochondrial swelling and even cristage structure disorder were observed. In the UCP2 group, only myocardial fiber edema was observed, and the muscle fiber structure was more complete than that of Sham group and AAV group. The mitochondria were slightly swollen and the cristae were intact. (3) Western Blot showed that there was no significant difference in the expression of Opa1 and Fis1 in the four groups. The expression of Drp1 in CLP group and AAV group were significantly higher than that in Sham group. The expression of Drp1 in UCP2 group was significantly lower than that in CLP group and AAV group (Drp1/β-actin: 1.01±0.03 vs. 1.39±0.03, 1.49±0.03, both P < 0.05). (4) The results of immunofluorescence showed that the ATP content of CLP group and AAV group were significantly lower than that of Sham group; the ATP content of UCP2 group was significantly higher than that of CLP group and AAV group (μmol/L: 1.99±0.15 vs. 1.10±0.17, 1.13±0.19, both P < 0.05). UCP2 overexpression can significantly improve the systemic systolic function of myocardium in sepsis rats, protect myocardial mitochondrial ultrastructure, inhibit mitochondrial division, and improve mitochondrial ATP synthesis.

The influence of dipper vs. non-dipper pattern on left ventricular function and ascending aorta dimensions in hypertensive patients in Angola

Background. The objective of the present study is to evaluate the effect of the dipper vs. non-dipper patterns on left ventricular function and the dimensions of the ascending aorta in hypertensive patients in Angola. Material and methods. This is a descriptive, observational study performed at the Department of Cardiology of Luanda Medical Center. For this purpose, information on demographic data, echocardiographic parameters and 24-hour-ambulatory blood pressure measurement parameters was collected. All patients underwent both echocardiographic study and 24-hour-ambulatory blood pressure measurement. Dipper pattern is considered when there is a decrease in the nocturnal BP in relation to the daytime BP greater than 10%; if this decrease is not observed either in the systolic blood pressure or in the diastolic blood pressure, the patients are considered non-dippers. Results. We enrolled 159 patients, of which 85 (53.46%) were dippers and 74 (46.54%) were non-dippers, and 87 (54.71%) were male. The mean age (SD) was 43.62 (± 10.73) years. The patients with the non-dipper pattern had larger ascending aortic diameters (29.68 ± 4.88 vs. 27.8 ± 5.18, p = 0.001), higher left ventricular diastolic diameters (52.85 ± 9.24 vs. 50.24 ± 4.16, p = 0.027) and greater posterior wall thickness (10.73 ± 1.94 vs. 10.07 ± 1.70, p = 0.024). In addition, the left ventricular diastolic dysfunction (LVDD) (B = 0.103, p = 0.001) and the posterior wall (PW) thickness (B = 0.350, p = 0.001) are significant estimates of non-dipper pattern. Conclusions. The results show that hypertensive patients with non-dipper pattern have more alterations in left ventricular geometry, but not in left ventricular systolic and diastolic function.

Role of the alkylglycerone phosphate synthase in isoproterenol-induced cardiac hypertrophy

Objective To research the effect of alkylation of glycerol phosphate synthase(AGPS) in isoproterenol (ISO) induced rat cardiac hypertrophy. Methods The pathological cardiac hypertrophy rat model was constructed by ISO intraperitoneal injection. Twelve healthy Sprague-Dawley rats (120~150 g) were divided into ISO group and control group randomly. In the ISO group, rats were injected with ISO (3 mg/kg) per day for two consecutive weeks. In the control group, rats were injected with normal saline (3 mg/kg) per day for two consecutive weeks. Changes of left ventricular diastolic diameter, left ventricular posterior wall thickness, left ventricular ejection fraction, left ventricular short-axis shortening rate and left ventricular mass were detected by echocardiography. The cross-sectional area of myocardial cells in rats was measured by hematoxylin-eosin staining. The expression of hypertrophic factors [atrial natriuretic peptide (ANP), myosin light chain-2V (MLC-2V), α-myosin heavy chain (α-MHC)] and AGPS were detected by Western Blot and real-time quantitative PCR (qPCR). Results The results of echocardiography showed that the cardiac hypertrophy rat model was successfully constructed. The results of hematoxylin-eosin staining showed that the myocardial cross-sectional area in the ISO group was significantly larger than that of the control group. The Western Blot and qPCR results indicated that the relative expression of protein and mRNA of hypertrophic factor and AGPS in the ISO group were both up-regulated comparing with that of the control group, and the differences were statistical significance (all P<0.05). Conclusions The rat model of pathological cardiac hypertrophy with up-regulated AGPS expression was successfully constructed providing a theoretical basis for further study on the role of AGPS in pathogenesis of pathological cardiac hypertrophy. Key words: Cardiomyopathy, hypertrophic; Isoproterenol; Alkylglycerone phosphate synthase

Protective effects of berberine against exhaustion exercise induced myocardial injury in rats

Objective: To investigate the effect and possible mechanism of berberine (Ber) on myocardial injury induced by exhaustion exercise (Ee). Methods: Forty healthy male SPF Sprague-Dawley rats were randomly divided into 5 groups using the random unit group design method: control group, Ee group and Ee plus Ber group (low: 50 mg·kg(-1)·d(-1), medium: 100 mg·kg(-1)·d(-1) and high dose: 150 mg·kg(-1)·d(-1), n=8 each). Ber (1.5 ml) or equal volume saline was given per gavage for 14 days. Rats assigned to Ee groups underwent Ee swimming once daily and rats in control group remain sedentary. After 14 days, echocardiographic measurements were performed and left ventricular ejection fraction (LVEF) and fractional shortening (LVFS), left ventricular diastolic diameter (LVIDd) and left ventricular systolic diameter (LVIDs) were obtained. The morphological structure of heart was detected by HE and Masson staining. Serum superoxide dismutase (SOD) and malondialdehyde (MDA) were measured by enzyme-linked immunosorbent assay. Cardiomyocytes apoptosis was detected by TUNEL method. The protein expression of myocardial hypertrophy marker protein B-type natriuretic peptide (BNP) and apoptotic marker protein (Bcl-2, Bax) in rat myocardial tissue was detected by Western blot. Results: (1) Both LVFS and LVEF were significantly lower, and LVIDs and LVIDd were significantly larger in Ee group than those in control group (all P<0.01). The LVFS and LVEF in medium dose of Ber and high-dose Ber groups were significantly higher, and the LVIDs and LVIDd were significantly smaller than those in Ee group (all P<0.01). (2) The results of HE staining showed that the myocardial cells in control group were closely arranged, regular, normal in morphology, clear in structure, and uniform in staining. The myocardial cells of rats in Ee group were disarranged, cell staining was uneven, and vacuoles appeared in the cytoplasm. The disorder of myocardial cell arrangement and unequal staining in the medium dose of Ber were attenuated than in Ee group. The Masson staining results showed that the myocardial cells in control group were closely arranged, regular, normal in shape, clear in structure, and rarely blue-stained (fibrosis). Myocardial cells in rats in Ee group showed obvious fibrosis. The myocardial cell fibrosis in rats with medium dose of Ber was significantly reduced than exercise group. (3) MDA content in myocardial tissue of rats in Ee group was significantly higher than that of control group, and MDA content in myocardial tissue of rats in medium dose of Ber group was significantly lower than in Ee group (P<0.01). The SOD activity of myocardial tissue in rats was significantly lower than that of control group, while that of rats with medium dose of Ber was significantly higher than that of rats in Ee group (P<0.01). (4) TUNEL staining results showed that only a small amount of apoptosis myocardial cells were seen in control group, and a large number of apoptosis myocardial cells were seen in rats in Ee group. However, the number of apoptotic cardiomyocytes in medium dose of Ber was significantly lower than that in Ee group. The AI of rat cardiomyocytes was significantly higher than that of control group (P<0.01), and the AI of rat cardiomyocytes in median dose of Ber group was significantly lower than in Ee group (P<0.01). (5) BNP and Bax protein expression in the myocardial tissues of rats in Ee group were significantly higher than in control group (P<0.01). BNP and Bax protein expression in the myocardial tissues in median dose of Ber group were significantly lower than that of Ee group (P<0.01). The myocardial protein expression level of Bax was significantly higher, and the myocardial protein level of Bcl-2 was significantly lower in Ee group than in control group (both P<0.01), treatment with median dose of Ber could partly reverse above changes (both P<0.01). Conclusion: Ber can attenuate exhaustion exercise induced myocardial injury and remodeling in rats, and the beneficial effects of Ber might possibly be mediated by reducing free radical release and cardiomyocytes apoptosis.

Treatment of Growth Hormone Excess is Associated with Improvement in Abnormal Cardiac Phenotypes

IntroductionCardiovascular disease is the leading cause of mortality in patients with growth hormone (GH) hypersecretion, termed acromegaly. The traditional manifestation of GH excess is cardiac hypertrophy, but a dilated phenotype with clinical heart failure exists. Prior studies have suggested that treatment of GH excess may lead to an improvement in early stage dysfunction, but have shown no benefit in dilated cardiomyopathy or advanced disease.HypothesisCorrection of GH excess in acromegaly will result in improvement in both a hypertrophic and dilated (DCM) cardiac phenotype, even in more advanced disease.MethodsA retrospective analysis was performed on all patients diagnosed with and treated for acromegaly at a single institution. Patients with abnormalities on baseline transthoracic echocardiogram were evaluated (n=50). Abnormalities were defined as an elevated left ventricular mass index, elevated left ventricular diastolic diameter, or reduced ejection fraction. Detailed histories were extracted, including age of diagnosis, treatment modality, IGF-1 levels, cardiovascular medications, and clinical outcomes. Where available, we compared pretreatment imaging to most recent findings to quantify changes in cardiac function.ResultsThe study cohort consisted of 21 patients (42%) with dilated cardiomyopathy, 25 patients (50%) with hypertrophic phenotype and 4 patients (8%) with ischemic cardiomyopathy. Hypertension (61%), diabetes mellitus (36%) and obstructive sleep apnea (48%) were the most common comorbidities. Successful treatment of acromegaly resulted in a clinically-relevant improvement in mean LV ejection fraction in the DCM cohort from 38% to 49% (p = 0.05) and mean LV diastolic diameter from 66 to 60 mm (p = 0.20). Additionally, an improvement in LV mass index was seen in the hypertrophic phenotype from 117 to 104 g/m2 (p = 0.05). Heart rate, QRS and QTC intervals were statistically unchanged.ConclusionsContrary to prior research, treatment of human growth hormone excess resulted in an improvement in dilated as well as hypertrophic phenotypes, though not necessarily independent of guideline-directed medical therapy. This highlights the importance of effective treatment of GH excess states in reducing the prevalent cardiovascular morbidity and mortality in patients with acromegaly. Cardiovascular disease is the leading cause of mortality in patients with growth hormone (GH) hypersecretion, termed acromegaly. The traditional manifestation of GH excess is cardiac hypertrophy, but a dilated phenotype with clinical heart failure exists. Prior studies have suggested that treatment of GH excess may lead to an improvement in early stage dysfunction, but have shown no benefit in dilated cardiomyopathy or advanced disease. Correction of GH excess in acromegaly will result in improvement in both a hypertrophic and dilated (DCM) cardiac phenotype, even in more advanced disease. A retrospective analysis was performed on all patients diagnosed with and treated for acromegaly at a single institution. Patients with abnormalities on baseline transthoracic echocardiogram were evaluated (n=50). Abnormalities were defined as an elevated left ventricular mass index, elevated left ventricular diastolic diameter, or reduced ejection fraction. Detailed histories were extracted, including age of diagnosis, treatment modality, IGF-1 levels, cardiovascular medications, and clinical outcomes. Where available, we compared pretreatment imaging to most recent findings to quantify changes in cardiac function. The study cohort consisted of 21 patients (42%) with dilated cardiomyopathy, 25 patients (50%) with hypertrophic phenotype and 4 patients (8%) with ischemic cardiomyopathy. Hypertension (61%), diabetes mellitus (36%) and obstructive sleep apnea (48%) were the most common comorbidities. Successful treatment of acromegaly resulted in a clinically-relevant improvement in mean LV ejection fraction in the DCM cohort from 38% to 49% (p = 0.05) and mean LV diastolic diameter from 66 to 60 mm (p = 0.20). Additionally, an improvement in LV mass index was seen in the hypertrophic phenotype from 117 to 104 g/m2 (p = 0.05). Heart rate, QRS and QTC intervals were statistically unchanged. Contrary to prior research, treatment of human growth hormone excess resulted in an improvement in dilated as well as hypertrophic phenotypes, though not necessarily independent of guideline-directed medical therapy. This highlights the importance of effective treatment of GH excess states in reducing the prevalent cardiovascular morbidity and mortality in patients with acromegaly.

An Asian Perspective on Gender Differences in Clinical Outcomes and Echocardiographic Profiles of Patients With Medically Managed Severe Aortic Stenosis

Gender differences in valvular heart disease are increasingly recognised. A prior study has suggested better surgical outcomes in women with symptomatic aortic stenosis (AS). We investigate gender differences in medically managed severe AS. We studied 347 patients with severe AS (aortic valve area index <0.6 cm2/m2) in terms of baseline clinical background, echocardiographic characteristics, and clinical outcomes. Appropriate univariate and multivariate models were employed, while Kaplan-Meier curves were constructed to compare mortality outcomes. In total, 205 (59%) patients were women. Despite higher incidences of hypertension (75.6% vs 47.3%) and diabetes mellitus (46.5% vs 29.5%) in women, women had improved survival (Kaplan-Meier log-rank = 6.24, p = 0.012). After adjusting for age (hazard ratio [HR], 1.034; 95% confidence interval [CI], 1.014-1.054), hypertension (HR, 1.469; 95% CI, 0.807-2.673), diabetes (HR, 1.219; 95% CI, 0.693-2.145), and indexed aortic valve area (HR 0.145, 95% CI 0.031-0.684) on multivariate analyses, female gender remained independently associated with lower mortality (HR, 0.561; 95%, CI 0.332-0.947). Women tended to have smaller body surface area (BSA), left ventricular (LV) internal diastolic diameter, and smaller LV outflow tract diameter but were similar to men in terms of LV ejection fraction, AS severity, and patterns of LV remodelling. Women appeared to have better outcomes compared to men in medically managed severe AS. These gender differences warrant further study and may affect prognosis, follow-up, and timing of valve surgery.

Liver stiffness obtained by ElastPQ ultrasound shear wave elastography independently determines mean right atrial pressure.

We aimed to investigate the relationship between right atrial pressure (RAP) and liver stiffness (LS) determined by liver elastography (LE) during cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and conventional pacemaker (PM) implantation in patients without HF. 60 patients with HF who underwent CRT and 60 patients without HF who underwent PM were enrolled. Routine echocardiography and laboratory examinations were performed. Systolic, diastolic, and mean RAP measurements were performed inversely during PM implantation and LS measurement with ElastPQ technique. Systolic, diastolic, and mean RAP, left ventricular (LV) systolic-diastolic, right ventricular (RV) diastolic and left atrial diameters, tricuspid regurgitation pressure gradient, and RV-myocardial performance index (MPI) values were significantly higher in patients with HF (p < 0.05 each-one). LV ejection fraction and tricuspid annular plane systolic excursion values were significantly lower in patients with HF group (p < 0.05 each-one). LS values and inspiratory (Ins) and expiratory inferior vena cava (IVC) diameters were significantly higher in the patients with HF (p < 0.05 each-one). Mean RAP was found to be closely related to LS value, Ins-IVC diameter, RV-MPI, and NT-proBNP levels. LS value and Ins-IVC diameter were found to determine patients with mean RAP > 5mmHg and > 10mmHg. When the cut-off value of LS was taken as 7kPa, it was found that the mean RAP > 10mmHg with 89.6% sensitivity and 87.5% specificity. The non-invasive LS value determined by LE independently determines the mean RAP in patients with and without HF. According to our study results, > 7kPa value for LS determined in liver US may be predictive for increased mean RAP.

Age, Sex and Body Weight Related Echocardiographic Parameters of Clinically Healthy New Zealand White Rabbits

Background: Echocardiography provides useful additional information on cardiac dimensions including heart wall and dimension of the ventricles, atria and conditions. Rabbits have been diagnosed with cardiac diseases, and an understanding of the animals’ cardiac chamber dimensions is vital in assessing the diseases’ severity and prognoses. Changes in cardiac dimensions due to age related and body weight were determined at different animals. The increased incidence of congenital cardiovascular anomalies makes it essential to establish the diagnosis at an early age. The aims of this study 1) establish normal values for the commonly used two-dimensional (2D) M-mode parameters using pre anaesthetics and 2) evaluate the effects of age, sex, and body weight on echocardiographic parameters in clinically healthy New Zealand rabbits.Materials, Methods &amp; Results: In this study we used 49 New Zealand white rabbits (25 male, 24 female) all reared under the same conditions. A general physical and clinical examination including complete blood count was performed for each animal. Body surface area was calculated as BSA= 0.00718 × Height 0.725 × Weight 0.425. Rabbits were sedated with midazolam before echocardiographic examination was performed. Echocardiographic examination was performed using a DC 6-Vet® (Mindray, PRC) ultrasonographic device equipped with a micro-convex 8 MHz probe. Right parasternal short-axis view, B-mode and two-dimensional guided M-mode parameters were measured. Echocardiographic measurements were performed using leading-edge-to-leading-edge conventions outlined by the American Society of Echocardiography. Statistical analyses were employed using the SPSS 19.0 program. Sex had no significant effect on the measured echocardiographic parameters except in the case of interventricular septum thickness in diastole values of the three-month-old rabbits. The increase in the left ventricular systolic and diastolic diameters, E- point to septal separation, diastolic aortic root parameters for the three, six, and nine-month-old groups indicated persistent anatomic heart enlargement. However, it was also discovered that the fractional shortening percentage of the left ventricle and diastolic diameters of left atrium:aortic root were unrelated to age and weight.Discussion: New Zealand rabbits are an important model for cardiovascular research, mainly as they are small and relatively inexpensive however large enough to allow anatomical and physiological experiments. Different ages and sizes of New Zealand rabbits showed no significant difference in fractional shortening despite heart enlargement. The ejection fraciton, which can be calculated from the left ventricular dimensions via M-mode echocardiography, is another parameter of cardiac function. Our echocardiograph calculated the ejection fraction automatically using the Teicholz formula. It was further observed that three-month-old rabbits ejection fraction of the left ventricle was higher than that of the six and nine-month-old rabbits. This might indicate the necessity of periodical analysis of echocardiographic parameters. Transthoracic echocardiography can be considered an applicable method for cardiovascular research using a growing rabbit animal model after appropriate adjustments for age, sex and body size. These findings give a better understanding of the functional changes investigated by echocardiography in rabbits and will be helpful when evaluating echocardiographic data in small experimental animals.

Assessment of cardiac and vessel functions in childhood psoriasis

Background/aim Psoriasis is a chronic inflammatory disease. The effect of psoriasis on the cardiovascular system has not been studied in children before. We studied ventricular strain and vascular functions to assess early cardiovascular effects of psoriasis during childhood. Materials and methods The study population consisted of 20 psoriatic and 20 age- and sex-matched control subjects. Two-dimensional echocardiography images, longitudinal and global strain, and carotid and brachial ultrasound studies were performed. Results The mean age of psoriatic children was 14 ± 0.89 years and that of the controls was 14.05 ± 0.88. There were significant increases in terms of interventricular septum diastolic and left ventricular posterior wall diastolic diameter and decreases in mitral E, mitral A, and E/A values between groups. Tissue Doppler imaging revealed significant differences between groups in terms of lateral annulus E’, A’, E’/A, isovolumetric contraction time, and ejection time. Aortic stiffness was significantly higher and global circumferential strain and longitudinal strain were significantly lower in the psoriasis group. Carotid intima media thickness and flow-mediated dilatation did not differ significantly between the groups. Conclusion Cardiac left ventricular and arterial functions are affected in psoriatic children and may be an alarming sign of atherosclerotic heart disease in the long term. Early detection of these changes may be helpful for eliminating other risk factors.

Feasibility of RA-LV pacing in patients with symptomatic left bundle branch block: a pilot study.

Several studies have reported the adverse effects of right ventricular apical pacing. Permanent His bundle pacing is proved to be the most physiological. But it can be technically difficult sometimes. One recent large multicenter randomized trial showed that pacing from left ventricular apex or mid-lateral wall has the greatest potential to prevent pacing-induced reduction of cardiac pump function (by maintaining left ventricular mechanical synchrony) and, therefore, can be considered as physiological site. In our study, we have wanted to see the outcome of left ventricular pacing through coronary sinus branch with active fixation bipolar lead as a routine pacing technique in patients with symptomatic left bundle branch block. In our study we have recruited 27patients for left ventricular pacing through coronary sinus branch (as done in cardiac resynchronization therapy) with active fixation bipolar lead and 33 patients for right ventricular apical pacing (control) and compared left ventricular pacing with right ventricular apical pacing in patients with history of syncope with left bundle branch block in baseline electrocardiography who presented with atrio-ventricular block or prolonged HV interval (≥ 70ms) on electrophysiology study in term of procedure and fluoroscopy time and short-term lead performance and left ventricular function. The results of our study showed that left ventricular pacing through a tributary of coronary sinus is associated with shortened QRS duration (21.10 ± 3.92ms) and better LV function (higher left ventricular ejection fraction 64.00 ± 3.03 vs. 59.73 ± 6.73 and lower left ventricular diastolic internal diameter 4.58 ± 0.32 vs. 5.23 ± 0.40cm) in comparison to right ventricular apical pacing. However, the total procedure time and fluoroscopy time was significantly higher (73.75 ± 11.02 vs. 63.32 ± 6.06min and 7.08 ± 1.48 vs. 5.02 ± 1.39min, respectively) in left ventricular pacing group. The results of this study indicate that transvenous left ventricular epicardial pacing may be an option for physiological pacing in patients with symptomatic left bundle branch block.

Sleeve Gastrectomy in Obese Zucker Rats Restores Cardiac Function and Geometry Toward a Lean Phenotype Independent of Weight Loss

Bariatric surgery, including sleeve gastrectomy (SG), significantly improves cardiac geometry and function in patients with heart failure. In this study, we used the obese Zucker rat as an animal model of heart failure with preserved ejection fraction (HFpEF) to test the hypothesis that a SG will improve cardiac function independent of weight loss. Obese, male Zucker rats underwent SG, pair-fed sham, or ad-lib sham surgery. Lean Zucker rats also underwent ad-lib sham surgery. Echocardiograms were performed preoperatively and at 6 weeks postoperatively. Obese SG and obese pair-fed sham rats had similar body weights postoperatively. Obese SG and lean, ad-lib, sham rats had a significant increase in postoperative stroke volume, and left ventricular internal diameter in diastole and systole. SG preserved systolic function and significantly improved isovolumetric relaxation time (13.9 ± 2.4 to 11.1 ± 2.1 ms, P = .02) independent of weight loss. SG has a beneficial impact on both systolic and diastolic cardiac function in obese Zucker rats toward a lean phenotype independent of weight loss and caloric restriction. These findings may represent a weight-loss independent mechanism generated from the gastrointestinal tract that has the potential to improve diastolic dysfunction independent of obesity status and translate to patients with HFpEF.

Use of 2-dimensional speckle-tracking echocardiography to assess left ventricular systolic function in dogs with systemic inflammatory response syndrome.

BackgroundEarly identification of systolic dysfunction in dogs with systemic inflammatory response syndrome (SIRS) potentially could improve the outcome and decrease mortality.ObjectiveTo compare 2‐dimensional speckle tracking (2D‐STE) with 2‐dimensional (2D) and M‐mode echocardiography in the evaluation of systolic function in SIRS dogs.AnimalsSeventeen SIRS and 17 healthy dogs.MethodsProspective observational case‐control study. Each dog underwent physical examination, conventional echocardiography, 2D‐STE, and C‐reactive protein measurement.ResultsDogs with SIRS had lower 2D‐STE ejection fraction (X4D‐EF; 44 ± 8 versus 53 ± 8; P = .003), endocardial global longitudinal strain (ENDO‐G‐Long‐St; −14.6 ± 3.2 versus −18.5 ± 4.1; P = .003), and normalized left ventricular diameter in diastole (1.38 ± 0.25 versus 1.54 ± 0.17; P = .04) and systole (0.85 ± 0.18 versus 0.97 ± 0.11; P = .03) as compared to healthy dogs. Simpson method of disks (SMOD) right parasternal EF (55 ± 9 versus 60 ± 6; P = .07) and end systolic volume index (ESVI; 23 ± 10 versus 21 ± 6; P = .61), SMOD left apical EF (59 ± 9 versus 59 ± 6; P = .87) and ESVI (20 ± 8 versus 22 ± 6; P = .25), fractional shortening (FS; 34 ± 5 versus 33 ± 4; P = .39), M‐mode EF (64 ± 7 versus 62 ± 5; P = .35), and ESVI (23 ± 11 versus 30 ± 9; P = .06) were not significantly different between SIRS and control group, respectively.Conclusion and Clinical ImportanceSpeckle tracking X4D‐EF and ENDO‐G‐Long‐St are more sensitive than 2D and M‐Mode FS, EF, and ESVI in detecting systolic impairment in dogs with SIRS.

Combination of ST2 and B-type natriuretic peptide in diabetic patients with acute heart failure: relation with ventricular stiffness and outcome.

Diabetes is a common disease in heart failure and its prevalence ranges from 10 to 30%. ST-2 is a novel biomarker of myocardial fibrosis and remodelling in heart failure and may be involved in the inflammatory process of diabetes mellitus. In this study, we sought: to evaluate levels of ST-2 and B-type natriuretic peptide (BNP) in groups with acute heart failure with and without diabetes; to analyse the prognostic impact of ST-2 over a 6-month follow-up period. We performed an echocardiographic examination and measured ST-2 and BNP within 24 h of hospital admission. Patients were classified as heart failure with reduced ejection fraction {HFrEF [left ventricular ejection fraction (LVEF) <50%]} or heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%). We defined diastolic function according to recent guidelines, and we calculated left ventricular stiffness was assessed by the ratio between E/e' (index of left ventricular filling pressure) and left ventricular diastolic diameter (LVEDD) (index of left ventricular volume). The sum of death and rehospitalization due to cardiovascular causes was considered in the composite outcome. Of 121 patients enrolled, 58 experienced diabetes and 63 had normal glucose levels. Sixty patients showed HFrEF and 61 HFpEF. Among patients with diabetes, we observed significantly increased levels of serum ST-2 with respect to patients without diabetes [89 (29-147) 72 ± 42 vs. 48 (29-80) 59 ± 33 ng/ml; P = 0.04]. No differences were found between the two groups in terms of BNP levels, risk factors, renal function and echocardiographic measurements. Conversely, BNP was significantly higher in HFrEF with respect to HFpEF [786 (344-1390) vs. 423 (195-796) pg/ml; P = 0.004]. A significant correlation between ST-2 and BNP in diabetic patients (r = 0.50; P < 0.001) compared with nondiabetic patients (r = 0.40; P = 0.001) was found. ST-2 showed a numerically greater correlation with left ventricular stiffness in patients with diabetes (r = 0.56; P < 0.001) than patients without (r = 0.29; P = 0.04). Moreover, in all patients, ST-2 demonstrated a significant correlation with glycated glycosylated haemoglobin HbA1c (r = 0.40; P < 0.001). Univariate analysis demonstrated that both ST-2 more than 54 ng/ml and BNP more than 567 pg/ml were related to adverse events occurrence within 6 months [hazard ratio (HR): 3.64 (1.90-6.94), P < 0.001; HR: 2.21 (1.20-4.07), P = 0.01, respectively]. After adjustment for potential confounding factors, the multivariable analysis showed that only ST-2 levels greater than 54 ng/ml were associated with poor prognosis [HR: 3.56 (1.66-7.62); P = 0.001]. ST-2 confirmed its prognostic power independently of diabetes and LVEF. Patients with diabetes showed higher levels of ST-2. However, the mechanism related to ST-2 increase needs to be better understood, although increased left ventricle stiffness and filling pressure seem to be the most important causative factors. www.clinicaltrial.gov Diur-HF Trial (Trial ID: NCT01441245).

Normogram of right ventricular echocardiographic dimensions in a cohort of normal term neonates in Ibadan

Introduction: The study of the right ventricle is a relatively young field, particularly in the newborn. This study assessed the right ventricular echocardiographic dimensions in a cohort of normal term neonates in Ibadan. Materials and Methods: This was a longitudinal cohort study involving 120 term neonates with normal maternal cardio topographic (CTG) parameters, physical findings, and oxygen saturation. The right ventricular dimensions were measured at birth and then weekly till age 28 days. The measurements obtained in millimeters were as follows: the main pulmonary artery, right ventricular anterior wall thickness, right ventricular diameter in diastole, interventricular septum thickness in diastole, and interventricular septal thickness in systole. Echocardiographic assessment was done with the Sonosite Titan mobile ultrasound machine with 5.0MHz transducer; measurements were made according to the American Society of Echocardiography recommendations. Results: A total of 120 normal term newborns were studied, of which 60 males and 60 females. The mean weight varied from 3.16 to 4.02 kg, the length varied from 48.25 to 54.38 cm, whereas the body surface area varied from 0.036/m2 to 0.037/m2. The mean values and their respective standard deviations relative to the echocardiographic measurements are presented and right ventricular normograms derived from echo parameters and weight using 95% confidence interval. Conclusions: This study has focused on right ventricular echocardiographic dimensions in normal newborn using a longitudinal cohort of newborn evaluated using CTG and pulse oximetry monitoring, thus demonstrating true normal zero probability of recruiting asphyxiated babies. The parameters thus can be used for evaluating Nigerian newborns pending the availability of results from larger multicenter studies.