Tissue Doppler Research Articles

Resistance training improves cardiac function in older women: a randomized controlled trial.

This investigation aimed to determine the effects of 24weeks of resistance training (RT) on cardiac function in older women. Seventy-three physically independent older women were selected for this investigation. Participants were randomized into a training group (TG, n = 38) and a control group (CG, n = 35). The RT program was conducted over 24weeks and consisted of three sessions a week. Participants performed eight exercises for the whole body in three sets of 8-12 repetitions. Tissue Doppler echocardiography was performed, according to current guidelines, before and after 24weeks of the intervention. One-repetition maximum (1-RM) tests were used to assess muscular strength. A group vs. time interaction (P < 0.05) was shown for left ventricular end-diastolic volume (TG = - 8.3% vs. CG = - 0.6%), left ventricular end-systolic volume (TG = - 10.6% vs. CG = + 1.1%), and left atrial volume index (TG = - 9.1% vs. CG = + 3.9%). A main time effect (P < 0.05) was found for left ventricular mass index (TG = + 4.9% vs. CG = - 0.6%), septal thickness (TG = + 3.3% vs. CG = - 1.7%), left ventricular ejection fraction (TG = + 3.7% vs. CG = - 0.5%), E'/E septal (TG = - 4.8% vs. CG = + 0.5%), deceleration time (TG = - 4.1% vs. CG = + 3.9%), E septal (TG = + 4.6% vs. CG = - 0.6%), and E lateral (TG = + 5.2% vs. CG = - 1.1%). These results suggest that 24weeks of RT improves cardiac morphological and functional variables in older women.

Left atrial appendage emptying velocity and left ventricular function as predictors of inotropic support in patients undergoing elective off-pump coronary artery bypass grafting

Abstract Background: Patients undergoing elective off-pump coronary artery bypass grafting (CABG) are at risk of hemodynamic instability, ischemia, arrhythmia, and dysfunction. These events need to be managed by pharmacological supports or relieving of mechanical obstruction (octopus) of the heart to maintain the hemodynamic stability. There is a paucity of data on the effect of left ventricular (LV) dysfunction on left atrial appendage (LAA) emptying velocity. We evaluated the relationship between LV function and LAA emptying velocity and requirement of inotropic support perioperatively. Materials and Methods: In this prospective open-label all-comer study, fifty patients undergoing elective off-pump CABG under general anesthesia, we measured LAA emptying velocity by pulsed wave Doppler and evaluated if it could predict the need for inotropes perioperatively. It is a case series of 50 patients without a comparator arm. We measured pulsed wave Doppler across the mitral valve leaflet and early mitral inflow velocity (Evel) and late mitral inflow velocity, tissue Doppler at the lateral annulus of the mitral valve (e’) and also calculated the ratio of Evel and e’. Need for inotrope in the intraoperative and postoperative period was captured perioperatively. Vasoactive-inotropic score (VIS) was calculated for all the patients. Results: The VIS was significant (P &lt; 0.0001, with odds ratio of 131.6 and confidence interval of 95% (0.9–1). However, there was no significant correlation between ejection fraction (EF) and VIS (P = 0.87). In patients with the need of inotropes, LAA emptying velocity was significantly increased in the postgrafting period as compared to the pregrafting period (75.64 cm/s vs. 57.9 cm/s, P &lt; 0.001). Conclusion: The assessment of LAA emptying velocity value was a useful predictor of the need of inotropic support during off-pump surgery, especially during Obtuse marginal and Ramus grafting. This study paves the need of larger case–control studies to validate the findings.

Effect of Tadalafil on Heart Function in Children with Severe Pulmonary Regurgitation Following Surgical Repair of Tetralogy of Fallot: A Prospective Study

Background: Tetralogy of Fallot (TOF) is the most prevalent cyanotic congenital heart defect. Pulmonary regurgitation (PR) is a common sequela following most surgical repairs for TOF. Tadalafil might reduce pulmonary vascular resistance after Tetralogy of Fallot total correction (TOFTC). Objectives: This study evaluated the efficacy of tadalafil in reducing PR volume and improving heart function among TOFTC children with severe PR, using transthoracic echocardiography, particularly focusing on changes in N-terminal pro-b-type natriuretic peptide (NT-proBNP). Methods: The present study was conducted on TOFTC patients consecutively between September 2019 and August 2020 at Shiraz University of Medical Sciences, Shiraz, Iran. M-mode and two-dimensional (2D) Doppler echocardiography were performed, and NT-proBNP levels were measured in 20 patients before and one month after tadalafil administration. SPSS version 23.0 was utilized to analyze all results. Results: The patients' ages ranged from 25 to 128 months. The mean age and weight of the patients were 67.9 ± 34.5 months and 21.1 ± 6.9 kg, respectively. Tadalafil administration did not significantly improve Doppler and tissue Doppler parameters; however, it increased the pulmonary valve pressure gradient and velocity-time integral. Additionally, tadalafil had no significant effect on improving NT-proBNP levels. The Spearman correlation test did not show any significant correlation between the pulmonary valve pressure gradient and velocity-time integral with age, weight, and NT-proBNP. Conclusions: Tadalafil increased the pulmonary valve pressure gradient and velocity-time integral in TOFTC patients with severe PR; however, it did not affect NT-proBNP levels or tissue Doppler parameters.

Prediction and Course of Diastolic Dysfunction in COVID-19 Associated Pediatric Multisystem Inflammatory Syndrome

Background: To predict the risk for diastolic dysfunction on admission and assess repetitive cardiac function during the follow-up of individuals diagnosed with multisystem inflammatory syndrome associated with COVID-19 (MIS-C). Methods: This prospective, single-center study comprises patients who were divided into two groups: Mitral E/e'≥8 and mitral E/e' &lt; 8 on the first admission. During follow-up, patients underwent repeated echocardiography (on the first admission and at 1 week, 1 month, and 3 months post-procedure) between December 2020 and June 2022. Results: Among the 92 patients included in this study, 32 are females. Procalcitonin, erythrocyte sedimentation rate, B-type natriuretic peptide (proBNP), ferritin, and interleukin-6 (IL-6) values were found to be significantly higher in the E/e' ≥ 8 groups than that in the mitral valve E/e' 70.3, proBNP of &gt; 278.5, and procalcitonin of &gt; 2.4 was identified as an effective cut-off point in the mitral E/e’(&gt; 8) for patients with MIS-C area under the curve (AUC) = 0.743, 95% confidence interval (CI) = 0.599 - 0.887, P = 0.005, sensitivity: 72%, specificity: 74% for IL-6; AUC = 0.680, 95% CI = 0.535 - 0.825, P = 0.037, sensitivity: 72%, specificity: 60% for proBNP; and AUC = 0.672, 95% CI = 0.528 - 0.816, P = 0.046, sensitivity: 72%, specificity: 60% for procalcitonin). Conclusions: Tissue Doppler imaging findings of diastolic dysfunction seem to be improved until the third month. Tissue Doppler imaging findings of diastolic dysfunction appear to ameliorate until the third month. Mitral valve E/e’&gt; 8 value is significantly associated with IL-6, proBNP, and procalcitonin values in patients with MIS-C. IL-6, proBNP, and procalcitonin values were determined as independent high-risk indicators for left ventricular diastolic dysfunction.

Clinical utility of ambulatory ECG monitoring and 2D-ventricular strain for evaluation of post-COVID-19 ventricular arrhythmia

BackgroundA relatively common complication of COVID -19 infection is arrhythmia. There is limited information about myocardial deformation and heart rate variability (HRV) in symptomatic post COVID patients presented by ventricular arrhythmia.Aim of the studyOur goal was to assess 2D-ventricular strain and heart rate variability indices (evaluated by ambulatory ECG monitoring) in post-COVID-19 patients suffering from ventricular arrhythmia.MethodsThe current observational case–control study performed on 60 patients one month after they had recovered from the COVID-19 infection. Thirty healthy volunteers served as the control group. Each participant had a full medical history review, blood tests, a 12-lead surface electrocardiogram (ECG), 24-h ambulatory ECG monitoring, and an echo-Doppler examination to evaluate the left ventricular (LV) dimensions, tissue Doppler velocities, and 2D-speckle tracking echocardiography (2D-STE) for both the LV and right ventricular (RV) strain.ResultsSymptomatic post-COVID patients with monomorphic premature ventricular contractions (PVCs) showed a substantial impairment of LV/RV systolic and diastolic functions, LV/RV myocardial performance (MPI) with reduced indices of HRV. Patients with higher versus lower ventricular burden had poorer functional status, higher levels of inflammatory biomarkers and reduced parameters of HRV (New York Heart Association (NYHA) class: 2.1 ± 0.9 vs. 1.5 ± 0.6, p < 0.001, C-reactive protein (CRP): 13.3 ± 4.1 vs. 8.3 ± 5.9 mg/L, p < 0.0001, low frequency/high frequency (LF/HF): 3.6 ± 2.4 vs. 2.2 ± 1.2, p < 0.002, the root mean square of the difference between successive normal intervals (rMSSD): 21.8 ± 4.7 vs. 29.3 ± 14.9 ms, p < 0.039 and the standard deviation of the RR interval (SDNN): 69.8 ± 19.1 vs.108.8 ± 37.4 ms, p < 0.0001). The ventricular burden positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.33, p < 0.001), CRP (r = 0.60, p < 0.0001), while it negatively correlated with LV-global longitudinal strain (GLS) (r = -0.38, p < 0.0001), and RV-GLS (r = -0.37, p < 0.0001).ConclusionsPatients with post-COVID symptoms presented by ventricular arrhythmia had poor functional status. Patients with post-COVID symptoms and ventricular arrhythmia had subclinical myocardial damage, evidenced by speckle tracking echocardiography while having apparently preserved LV systolic function. The burden of ventricular arrhythmia in post-COVID patients significantly correlated with increased inflammatory biomarkers and reduced biventricular strain.

Ultrasound evaluation of cardiac and diaphragmatic function at different positions during a spontaneous breathing trial predicting extubation outcomes: a retrospective cohort study

BackgroundThe ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed to predict extubation outcomes. However, few studies focused on the predicting value of E/Ea and DE at different positions during a spontaneous breathing trial (SBT), as well as the effects of △E/Ea and △DE (changes in E/Ea and DE during a SBT).MethodsThis study was a reanalysis of the data of 60 difficult-to-wean patients in a previous study published in 2017. All eligible participants were organized into respiratory failure (RF) group and extubation success (ES) group within 48 h after extubation, or re-intubation (RI) group and non-intubation (NI) group within 1 week after extubation. The risk factors for respiratory failure and re-intubation including E/Ea and △E/Ea, DE and △DE at different positions were analyzed by multivariate logistic regression, respectively. The receiver operating characteristic (ROC) curves of E/Ea (septal, lateral, average) and DE (right, left, average) were compared with each other, respectively.ResultsOf the 60 patients, 29 cases developed respiratory failure within 48 h, and 14 of those cases required re-intubation within 1 week. Multivariate logistic regression showed that E/Ea were all associated with respiratory failure, while only DE (right) and DE (average) after SBT were related to re-intubation. There were no statistic differences among the ROC curves of E/Ea at different positions, nor between the ROC curves of DE. No statistical differences were shown in △E/Ea between RF and ES groups, while △DE (average) was remarkably higher in NI group than that in RI group. However, multivariate logistic regression analysis showed that △DE (average) was not associated with re-intubation.ConclusionsE/Ea at different positions during a SBT could predict postextubation respiratory failure with no statistical differences among them. Likewise, only DE (right) and DE (average) after SBT might predict re-intubation with no statistical differences between each other.

Tissue Doppler ultrasound of arm muscles to assess myotonia in myotonic dystrophies: An exploratory study.

Myotonia is a key symptom of myotonic dystrophies (DM), and its quantification is challenging. This exploratory study evaluated the utility of tissue Doppler ultrasound (TDU) to assess myotonia in DM. Twelve DM patients (seven type-1 DM [DM1] and five type-2 DM [DM2]) and 20 age-matched healthy subjects were included in this cross-sectional study. After measuring cross-sectional areas of the flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC) muscles in a resting state, muscle contraction/relaxation time, time to peak tissue velocity, peak tissue velocity and velocity gradients of these muscles were measured via TDU while performing forced fist unclenching after fist closure. Additionally, grip strength, Medical Research Council Sum score and patient-reported myotonia severity scores were assessed. DM1 and DM2 patients had a lower grip strength than healthy subjects (p = .0001/p = .002). Patient-reported myotonia did not differ between DM1 and DM2 patients. DM1 patients revealed FDS and EDC atrophy compared to DM2 patients and healthy subjects (p = .003/p = .004). TDU revealed prolonged muscle contraction and relaxation times in both DM subtypes, with prolonged time to reach FDS peak relaxation velocity and altered peak FDS relaxation velocity only in DM1 patients (p = .03/p = .003). Peak FDS relaxation velocity correlated inversely with C(C)TG repeat numbers in DM patients. Sensitivity of TDU parameters to detect myotonic dystrophy varied between 50% and 75%, with a specificity of 95%. Our exploratory study suggests that TDU could serve as a novel tool to quantify myotonia in DM patients, but larger follow-up studies are warranted to validate its diagnostic accuracy.

A prospective analysis of the correlation between ultrasonic B-lines, cardiac tissue doppler signals and left ventricular end-diastolic pressure in patients with severe aortic stenosis

BackgroundThe development of heart failure is a turning point in the natural course of aortic stenosis (AS). Pulmonary oedema and elevated left ventricular pressure (LVP) are cardinal features of heart failure. Evaluating pulmonary oedema by lung ultrasound involves taking the upper hand with a bedside noninvasive tool that may reflect LVP.AimWe sought to assess the correlation between sonographic pulmonary congestion, invasive LV pre-A pressure, and echocardiographic LV end-diastolic pressure (LVEDP) in symptomatic AS patients receiving transcatheter aortic valve replacement.MethodsForty-eight consecutive patients with severe AS and planned transcatheter aortic valve implantation (TAVI) were enrolled. LVEDP was estimated to be normal or elevated using the ASE/EACVI algorithm and transmitral Doppler indices, the E/A ratio, the E/e′, and the left atrial volume index. Invasive LV pre-A pressure was used as a reference, with > 12 mm Hg defined as elevated.ResultsForty-eight patients (25 women (52%), mean age 75 years, standard deviation (SD) ± 7.7 years) were enrolled in the study. We detected severe B-lines (≥ 30) in 13 (27%) patients and moderate B-lines (15–30) in 33 (68.6%) patients. The number of B-lines increased significantly with the severity of New York Heart Association (NYHA) functional classes (Fig. 1). The B-line count was 14 ± 13 in NYHA class I patients, 20 ± 20 in class II patients, and 44 ± 35 in class III patients (p < 0.05, rho = 0.384). The number of B-lines was correlated with the E/E’ ratio (R = 0.664, p < 0.0001) and the proBNP level (R = 0. 882, p < 0.008). We found no significant correlation with the LVEDP or LVEF. The LVEDP correlated well with the E/E’ ratio (R = 0.491, p < 0.001) but not at all with E/A, DT, or LAVI. All patients had an elevated LVEDP > 12, with a mean pressure of 26 mmHg, a minimum of 13 mmHg, and a maximum of 45 mmHg, with an SD of 7.85.ConclusionAssessing lung ultrasonic B-lines is a straightforward and practical approach to identifying pulmonary oedema in AS patients. The number of B-lines correlated with the E/E’ ratio and the functional status of patients but did not correlate with invasive LVEDP or LVEF. All patients had elevated LVEDP that correlated with E/E’.

Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function.

The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.

Association between cardiac time intervals and incident heart failure after acute coronary syndrome

BackgroundCardiac time intervals are sensitive markers of myocardial dysfunction that predispose to heart failure (HF). We aimed to investigate the association between cardiac time intervals and HF in patients with acute coronary syndrome (ACS).MethodsThis study included 386 ACS patients treated with percutaneous coronary intervention (PCI). Patients underwent an echocardiography examination a median of two days after PCI. Cardiac time intervals including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and systolic ejection time (ET), and myocardial performance index (MPI) were obtained by tissue Doppler echocardiography. The outcome was incident HF.ResultsDuring follow-up (median 4.3, IQR:1.0-6.7 years), 140 (36%) developed HF. In unadjusted analyses, IVRT was not associated with HF (HR 1.02 (0.95–1.10), p = 0.61, per 10ms increase), and neither was IVCT (HR 0.07 (0.95–1.22), p = 0.26, per 10ms increase). Increasing MPI was associated with a higher risk of HF (HR 1.20 (1.08–1.34), P = 0.001, per 0.1 increase), and so was decreasing ET (HR 1.13 (1.07–1.18), P < 0.001 per 10ms decrease). After multivariable adjustment for cardiovascular risk factors, MPI (HR 1.13 (1.01–1.27), P = 0.034) and ET (HR 1.09 (1.01–1.17), P = 0.025) remained significantly associated with incident HF. LVEF modified the association between ET and HF (p for interaction = 0.002), such that ET was associated with HF in patients with LVEF ≥ 36% (HR = 1.15 (1.06–1.24), P = 0.001, per 10ms decrease).ConclusionIn patients admitted with ACS, shortened ET and higher MPI were independently associated with an increased risk of incident HF. Additionally, ET was associated with incident HF in patients with LVEF above 36%.Graphical

Abstract Mo111: Comparison of Pre-Clinical Models of Heart Failure with Preserved Ejection Fraction Using Multimodal Approaches

There are various pre-clinical models of heart failure with preserved ejection fraction (HFpEF) designed to model different clinical phenotypes of HFpEF. However, detailed assessment and head to head comparison of diastolic function by invasive and non-invasive techniques in these models is lacking. Our goal was to comprehensively evaluate cardiac structure and function in three HFpEF mouse models – deoxycortisterone acetate (DOCA)-salt, Nω-nitro-l-arginine methyl ester high fat diet (LNAME+HFD), and aged female mice fed HFD with angiotensin infusion (Ang+HFD) – using both non-invasive and invasive methods. We employed pulse wave and tissue Doppler echocardiography, cardiac magnetic resonance imaging (CMR), and left ventricular (LV) catheterization in the commonly used C57BL/6J mouse, enabling direct comparisons between models. Cardiac hypertrophy was assessed by heart weight (HW) to tibia length (TL) ratio. The Mann-Whitney test was used for statistical testing within each model. We found that on echocardiography, all models demonstrated diastolic dysfunction with significant differences (p &lt; 0.05) or trends for significance (p &lt; 0.1) on tissue doppler peak mitral annular velocity during early filling (e’), ratio of peak early mitral flow velocity (E) to e’ (E/e’), ratio of peak early mitral flow velocity (E) to e’ (E/e’), isovolumetric relaxation time (IVRT), and E pressure half time (E PHT). CMR was notable for findings of reduced right ventricular ejection function in the LNAME+HFD group (36.1±2.7% vs 49.8±1.4% in chow controls, p&lt;0.01). On invasive hemodynamics, only DOCA-salt had a higher LV diastolic time constant (t, 11.7±1.4 vs 6.9±0.8 ms in sham controls, p=0.02) and only Ang+HFD had a higher minimum rate of pressure change in the ventricle (dP/dt min , -3506±342 vs -5268±227 in chow fed, vehicle infusion controls, p&lt;0.01). No model showed a difference in LV end diastolic pressure. For cardiac hypertrophy, we found that both DOCA-salt (8.1±0.2 vs 10.3±0.5, p&lt;0.01) and Ang+HFD (9.2±0.3 vs 11.5±0.4, p&lt;0.01) models demonstrated increased HW to TL ratio, while LNAME+HFD did not. These results highlight differences in cardiac structure and function in HFpEF mouse models and the need for multi-modal assessment in pre-clinical studies.

Abstract Mo124: New Rho-kinase Inhibitor Reduces Diastolic Dysfunction induced by Estrogen Depletion in Spontaneously Hypertensive Rats

Heart failure with preserved ejection fraction (HFpEF) observed in women with estrogen depletion is a consequence of the reduction of cardioprotection and endothelial dysfunction. Rho-kinase (ROCK) signaling pathway plays a role in cardiac dysfunction consequent to female aging. This work investigated the effects of a new synthetic ROCK inhibitor (iROCK) after oral administration in spontaneously hypertensive rats (SHR) submitted to oophorectomy (OVX). Experimental protocols were approved Animal Care and Use Committee at Universidade Federal do Rio de Janeiro. Under ketamine (80 mg/kg, i.p.) and xylazine (15 mg/kg, i.p.) anesthesia, female SHR submitted to OVX had cardiac function assessed after 8 weeks and compared to SHR-Sham. Eight weeks after OVX, SHR were randomly divided in groups, which were orally treated with either vehicle (DMSO) or iROCK (10 mg/kg) during 2 weeks. Novel iROCK displays potent inhibitory activity for ROCK1 and ROCK2 isoforms, with IC50 of 1.3 μM and 1.7 μM, respectively. At the end of treatment, hemodynamic parameters were evaluated using echocardiography and LV catheterization. Cardiac tissues collected for determining the expression of mitogen-activated protein kinases p38MAPK and extracellular signal-regulated kinase (ERK-1/2) using Western blot technique. After 8 weeks of estrogen depletion, SHR displayed HFpEF because ejection fraction (EF) was 85.2 ± 0.9%, while a reduction in EF from 83.0 ± 2.7 to 64.9 ± 0.9% was only detected after 12 weeks of OVX. Altered filling pressure confirmed the diastolic dysfunction after OVX, because the ratio of rapid mitral flow (E) to rapid wave of mitral annulus tissue Doppler (e') increased from 12.1 ± 1.3 in SHR-Sham to 19.3 ± 0.5. LV end diastolic pressure (LVEDP) increased from 13.4 ± 1.3 to 21.1 ± 4.9 in SHR after 8 weeks post-OVX. Oral administration of iROCK (10 mg/kg) reduced both E/e’ to 16.2 ± 0.5 and LVEDP to 6.4 ± 0.7 mmHg. OVX in SHR increased cardiac p38 MAPK and ERK-1/2 contents by 2.3 and 1.3 fold from SHR-Sham values. In contrast, iROCK reduced p38 overexpression but not altered ERK-1/2 content. Since pro-inflammatory cytokines and oxidative stress activate p38, the recovery of its expression after treatment, indicates that iROCK could reduce the inflammatory component of HF. In conclusion, the new iROCK recovered LV diastolic function induced by estrogen depletion in SHR, through the reduction of myocardial inflammation.

High-Resolution Tissue Doppler and Strain Imaging for Adult Zebrafish Myocardial Tissue Through Ultrafast High-Frequency Ultrasound Vector Doppler Estimation.

Zebrafish has been considered as an essential small-animal model for investigating the mechanism of heart regeneration. Due to the small size of zebrafish heart, high-frequency ultrasound (HFUS) imaging is often required for in vivo evaluations of its dynamic functions. Although commercial HFUS systems are available for myocardial velocity and strain measurement, only the outer myocardial region can be quantified due to the complex structure of zebrafish heart. In this study, a high-resolution 2-D myocardial tissue Doppler and strain imaging based on ultrafast HFUS imaging was developed for zebrafish heart imaging during heart regeneration. The cardiac flow region was first extracted to recognize the myocardial region, and the myocardial velocity and strain were then determined through vector Doppler estimation. Adult AB-line zebrafish was used for in vivo experiments, and cryoinjury was induced in the apical region of the heart. Both the myocardial velocity and strain of the whole ventricle after cryoinjury were directly visualized over 28 days. Myocardial velocity (during later diastolic motion) and strain, respectively, were significantly decreased (anterior wall: -2.0 mm/s and -3.3%; apical region: -2.0 mm/s and -4.5%; and posterior wall (PW): -1.7 mm/s and -4.3%) at the first three days after cryoinjury, which indicates weak myocardial beating due to heart injury. However, these all returned to the baseline values at 14 days after cryoinjury. All of the experimental results indicate that the proposed method is a useful tool for heart regeneration studies in adult zebrafish. In particular, it allows for the noninvasive evaluation of regional dynamic heart function.

E/e' Ratio as a Predictor of In-Hospital Complications and Clinical Outcomes of Acute Myocardial Infarction.

Introduction Acute myocardial infarction (AMI) is the leading cause of death worldwide. E/e' ratio can predict complications and mortality in the long term, but information on its effectiveness in in-hospital settings is limited. Identifying high-risk patients effectively is crucial for early management, which may improve overall clinical outcomes. This study evaluated the predictive value of the E/e' ratio of in-hospital complications and clinical outcomes of AMI. Methods Patients presenting with AMI to Batumi Referral Hospital, Georgia, between December 2023 and May 2024, were examined in this study. During the first 24 hours of hospitalization, all patients underwent two-dimensional echocardiograms. Early diastolic filling velocity (E) was measured by pulsed wave Doppler, and early mitral annulus velocity (e') was measured by tissue Doppler. Based on the ratio of the two measures, patients were divided into three groups: E/e'<8, E/e' 8-14, and E/e'>14. Results A total of 113 patients (92 males and 21 females) were included in the study. The average age of the patients was 62 years (SD = 11.71). Overall, 27 (23.8%) patients were diagnosed with ST-elevation myocardial infarction (STEMI) and 86 (76.2%) patients with non-ST-elevation myocardial infarction (NSTEMI). The E/e' ratio was normal (less than 8) in 39 (34.5%) patients (group A), increased to 8-14 in 46 (40.7%) (group B), and greater than 14 in 28 (24.8%) (group C). The percentage of deaths in group B was higher than that in group A (2.2% vs 0%), and in group C, it was significantly higher than that in group B (17.9% vs 2.2%) (p<0.05). The percentage of heart failure developed during hospitalization was higher in group B compared to group A (54.3% vs 2.6%), and it was significantly higher in group C compared to group B (67.9% vs 54.3%) (p<0.05). The percentage of arrhythmias developed during hospitalization was higher in group B compared to group A (13.0% VS 2.6%), and in group C, was significantly higher compared to group B (35.7% VS 13.0%) (p<0.05). The percentage of cardiogenic shock in group B was higher than that in group A (4.3% VS 0%), and in group C, it was significantly higher than group B (25.0% VS 4.3%) (p<0.05). No significant association was found between E/e' ratio and recurrent angina, nor was there a significant association between all-cause deterioration during hospitalization (p>0.05). Conclusions Both slightly and significantly elevated E/e' ratios are predictors of in-hospital complications and may be used to identify individuals at high risk of negative health outcomes.

Role of Inter Atrial and Left Atrial Desynchrony Assessed by Tissue Doppler Imaging in Predicting Atrial Fibrillation in Patient with ST-Elevation Myocardial Infarction

Role of Inter Atrial and Left Atrial Desynchrony Assessed by Tissue Doppler Imaging in Predicting Atrial Fibrillation in Patient with ST-Elevation Myocardial Infarction

Effect of Hypertension on the Left Atrium Using Tissue Doppler Imaging Echocardiography

Effect of Hypertension on the Left Atrium Using Tissue Doppler Imaging Echocardiography

Left Atrial Coupling Index Predicts Heart Failure in Patients with End Stage Renal Disease.

Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a' wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments.

Normal M-mode, Pulsed Wave and Tissue Doppler Echocardiographic Studies in Healthy Working Police Dogs

Background: Physical activity alters the cardiovascular system of dogs depending on the exercise characteristics and the animal’s physical conditioning. Little is known about the cardiovascular changes in working police dogs. This study evaluated the cardiovascular responses of working Labradors to regular exercise and various workload. Methods: Twelve working Labradors of Tamil Nadu police department that were regularly trained and exercised 30 minutes morning and evening and twelve normal household pet Labradors brought for regular checkup to Madras Veterinary College Teaching hospital were taken for the study. All the animals were subjected to physical, clinical, hematobiochemical, electrocardiographic examinations and cardiac auscultation before performing echocardiography. Those animals which showed normal recordings in all the above tests were further subjected to M-mode, Pulsed wave and Tissue Doppler echocardiography. In this study, the resting heart rate values of working groups were lesser than that of normal pet dogs. Result: The results of echocardiography showed significant increase in Interventricular septal diameter during diastole, left atrial diameter, aortic artery diameter and the left atrium to aortic diameter ratio without impairing systolic and diastolic cardiac functions in working dogs. The present study indicated that there were few changes in the echocardiographic parameters which might be a response to physiological adaptation and regular exercise.

Early cardiac mechanics abnormalities in patients with mitochondrial diseases

BackgroundEvidence about early cardiac mechanics abnormalities in patients with mitochondrial diseases (MDs) before overt cardiomyopathy is limited. MethodsIn this prospective study, we performed a comparative analysis of conventional and speckle tracking echocardiographic parameters between patients with genetically identified MDs and no overt cardiomyopathy vs controls matched for age, sex and cardiovascular risk factors. The Newcastle mitochondrial disease adult scale (NMDAS) was calculated, using a threshold of > 21 as indicator of high disease severity. ResultsWe enrolled 24 MDs patients (50 % males, mean age 47.2 ± 14.3 years), the most prevalent mutation was the MT-TL1 m.3243A>G (37.5 %). In MDs patients all dimensional echocardiographic parameters were similar to controls. Conversely, albeit normal, Tissue Doppler septal systolic (p = 0.002) and early diastolic velocities (p = 0.016) were significantly lower and E/e’ ratio was higher (p = 0.032) in MDs. Moreover, LV-GLS was significantly reduced in MDs as compared to their counterparties (20.2 ± 1.6 vs 22.6 ± 1.5, p < 0.001). Similarly, LA reservoir and conduit strain were significantly lower in MDs (31.7 ± 7.0 vs 35.9 ± 6.6, p = 0.038; 19.7 ± 5.6 vs 23.1 ± 6.0, p = 0.049 respectively), while LA contractile strain was similar between the two groups. Lower values of LV-GLS were observed in patients with NMDAS > 21 vs patients with NMDAS ≤ 21 (19.0 ± 1.2 vs 21.0 ± 1.3, p = 0.001). ConclusionsIn patients with MDs and no overt cardiomyopathy Tissue Doppler and speckle tracking analysis unveil worse LV systolic and diastolic function indices as compared to controls. Reduced LV-GLS values were found especially in those with worse disease burden.

Prognostic impact of beta-blocker use by N-terminal pro-brain natriuretic peptide level in acute heart failure patients.

Both patients with heart failure (HF) with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF) present with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) and have multiple comorbidities; consequently, the prognostic effect of NT-proBNP according to beta-blocker (BB) use is unknown. This retrospective study evaluated patients admitted for acute HF between January 2012 and December 2017 at Ulsan University Hospital. Clinical, echocardiographic, laboratory and drug prescription data, including BB data, were collected from the hospital database. Information on mortality was collected by reviewing medical records or using national death data. Of the 472 patients evaluated, 216 (45.8%) and 256 (54.2%) patients were and were not prescribed BB at discharge, respectively. A total of 224 (47.5%) patients died within a median follow-up duration of 44months. The Kaplan-Meier analysis showed reduced all-cause mortality with BB in HFrEF (ejection fraction≤40%) but not in HFpEF (ejection fraction>40%). In the multivariate Cox regression analysis, transmitral to tissue Doppler imaging, early diastolic velocity ratio (E/E'), NT-proBNP and BB use were independent predictors of all-cause mortality in HFrEF. Meanwhile, haemoglobin and NT-proBNP levels were independent predictors of HFpEF. The NT-proBNP cut-off value for determining all-cause mortality was set to 4800pg/mL. Among HFrEF patients with NT-proBNP<4800pg/mL, the survival rate was higher for patients with BB use than those with no BB use (log-rank P<0.001). However, in the HFpEF group, the survival rate associated with BB use did not differ according to the NT-proBNP levels. Both HFrEF and HFpEF patients with NT-proBNP levels of ≥4800pg/mL presented with multiple comorbidities, including lower body mass index and haemoglobin levels and higher creatinine levels, NT-proBNP levels and E/E'. In patients with acute HF, BB use is associated with reduced all-cause mortality in those with HFrEF but not in those with HFpEF. HFrEF patients with NT-proBNP levels of <4800pg/mL treated with BB have a higher survival rate than those not treated with BB. However, this benefit is not seen in HFrEF patients with NT-proBNP levels of ≥4800pg/mL or in all HFpEF patients, regardless of the NT-proBNP level. NT-proBNP levels are elevated in multiple comorbid conditions, and these comorbidities may contribute to the attenuated effects of BB on all-cause mortality.