Echocardiographic Assessment Of Ventricular Function Research Articles

Comparison of septal vs hisian ventricular synchrony in paediatric patients

Abstract Background Long-term right ventricular stimulation is associated with left ventricular dysfunction and cardiomyopathy, particularly in pediatrics and congenital heart diseases. Research has shown that pacemaker-induced cardiomyopathy can be reversed with stimulation of the Bundle of His in-adult's, however the available information on it's use in pediatrics is scarce. In this study, pacemaker carriers were analyzed over a period of 26 months to set up a protocol for improving the quality of life of patients undergoing this type of procedure. Introduction Cardiac stimulation initially arose with the aim of correcting the hemodynamic instability caused by the low cardiac output resulting from complete atrioventricular block, the next objective sought was to obtain atrioventricular synchrony and with it a more physiological functioning. Stimulation in the Bundle of His and the hisian zone induces a physiologically normal sequence of activation and thus prevents damage associated with the asynchronous pattern. Material and methods We reviewed 21 pediatric patients with pacemakers of stimulation in the Bundle of His and right septal stimulation that had echocardiographic assessment of ventricular function, as well as the assessment of ventricular synchrony. The study period included was from June 2019 to August 2021. Results The total number of patients was 21 of whom 52.4% (11) were carriers of Hisiana stimulation pacemakers, 47.6% (10) with septal pacemakers. Ventricular function was correlated between both groups without obtaining significant relevance. We obtained significant relevance in the evaluation of atrioventricular asynchrony obtaining a P<0.05 (P=0.01), as well as intraventricular synchrony with a P<0. 05 (p=0. 07). Conclusions The site of ventricular stimulation is the major determinant of the presentation or deterioration of asynchrony and ventricular function in the pediatric population. With this study we can conclude that the pacemakers of hisian stimulation are the ones that are closest to cardiac physiological activation and maintain ventricular and intraventricular atrio synchrony for a better ventricular function. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Instituto Mexicano del Seguro Social- Centro Medico Nacional de Occidente - UMAE Pediatria.

Echocardiographic assessment of ventricular function in chronic HCV patients receiving direct antiviral therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hepatitis C virus (HCV) infection is still a major public health burden in many parts of the world (1). Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year (2). Treatment for chronic HCV infection has evolved from interferon (IFN)-based therapy to direct-acting antivirals (DAAs) (3,4). With the development of DAA, treatment of HCV became better-tolerated and highly effective (5,6). Several studies have attempted to explore their cardiac side effects, especially their impact of left ventricular (LV) function; however, these studies were limited by their design and the methods of assessment (7-10). Aim In this prospective study we aimed at evaluating the short effects of DAAs on left ventricular functions using 3D Echocardiography. Methods Patients with HCV infection planned to receive combination therapy of Sofosbuvir 400 mg daily plus Daclatasvir 60 mg daily for 12 weeks were assessed by echocardiography before starting and after 3 months after completion of treatment. Patients with other systemic or cardiac conditions or structural heart disease were excluded. Assessment of LV volume and EF was performed by 3D quantification and global longitudinal strain (GLS). Right ventricle size was assessed by 2D and systolic function was evaluated by TAPSE, S` and FAC. Results In 102 patients who were followed up at 3 months after DAA therapy, We found an increase in increase in both LV end diastolic dimensions and volumes (p∼0.02 & p∼0.045 respectively) as well as end systolic volumes (p∼0.005). There was no significant difference in neither LV systolic function as assessed by EF and GLS (62.25 ± 5.15 vs. 62.35 ± 5.77, p∼0.850, -22.97 ± 2.93 vs. -22.83 ± 2.59, p∼0.546 respectively), nor in diastolic function (p∼0.546). However, subgroup analyses revealed a significant negative correlation between age and GLS (P∼0.022) as well as the number of cardiovascular risk factors (P∼0.039). Hypertension was found to be the only predictor of the decrease in GLS in the regression analysis of risk factors (p∼0.001). There was no significant change in RV size and systolic function at follow up. Conclusions There was no significant change in LV systolic or diastolic function before and after DAA therapy as measured by EF and GLS. Nonetheless, subgroup analysis suggests a drop in GLS in older patients and those with more cardiovascular risk factors. An increase in LV size was also noted while no significant effect was noted with regards to RV size and function.

Echocardiographic Assessment of Ventricular Function in Children with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy

Background: Children with Human Immunodeficiency Virus (HIV) infection could present with varying degrees of cardiac abnormalities, however the effect of Highly Active Antiretroviral Therapy (HAART) has not been extensively studied in them.
 Objectives: To compare the ventricular functions of HIV positive children on HAART with that of HIV negative children using echocardiography.
 Methods: This was a comparative cross sectional descriptive study involving 54 HIV positive children on HAART and 50 HIV negative controls. Using transthoracic echocardiography, trans annular plane systolic excursion (TAPSE), Left ventricular ejection fraction (LVEF), Left ventricular fractionating shortening (LVFS), Left ventricular (LV) mitral inflow velocities, left ventricular mass index (LVMI) and Left ventricular hypertrophy (LVH) were used to assess right ventricular (RV) and left ventricular (LV) function.
 Results: The mean TAPSE for subjects and controls were 26.78±5.92mm and 25.82±3.59mm respectively (t = 1.0, p = 0.32). The prevalence of right ventricular systolic dysfunction using TAPSE was significantly higher among the subjects; 29.63% compared with 8.0% in controls (χ2 = 7.82, p=0.005). There was no significant correlation between TAPSE and CD4 counts (Spearman’s correlation coefficient = 0.15, p = 0.31). The mean left ventricular mass index (LVMI) in subjects was 141.6±45.5g/M2. Forty-one (75.9%) of the subjects had left ventricular hypertrophy (LVMI > 103G/M2) compared with 26.0% (13/50) of the controls and the difference in proportion was significant (Chi-square = 30.49, p<0.001). Left ventricular systolic function was similar in subjects and controls. The prevalence of left ventricular diastolic dysfunction was significantly higher in subjects (15.5%) than in controls (4.0%); {χ2 = 37.89, p<00.1)
 Conclusion: This study shows that children with HIV on HAART regimen have a very high prevalence of ventricular dysfunction compared with normal controls.

Echocardiographic assessment of ventricular function: Conventional and advanced technologies and their clinical applications

Echocardiogram is the first-line and most used noninvasive imaging diagnostic modality and is convenient and reliable in its assessment of ventricular function in pediatrics. Ventricular function is an important physiological parameter representing myocardial performance in response to overall hemodynamic status. Here, we introduce basic principles of conventional echocardiography and advanced echocardiographic technology, including tissue Doppler imaging, 3-dimensional echocardiogram, and speckled tracking echocardiography. Then, we overview clinical applications of these methods in assessing ventricular function in pediatrics, including single ventricle after staged surgical palliation, right ventricular dysfunction in pulmonary hypertension, and ventricular-ventricular interactions in various heart disease. With multimodality approaches, the advantages and limitations of echocardiographic assessment of ventricular function are discussed.

Comprehensive Echocardiographic Assessment of Ventricular Function and Pulmonary Pressure in the Neonatal Omphalocele Population.

Pulmonary hypertension (PH) has been described in the neonatal omphalocele population. This study was aimed to describe cardiac function and PH severity using echocardiography in newborns with giant omphalocele (GO) and with non-GO and determine if right ventricular (RV) dysfunction is associated with mortality. Retrospective, single-center analysis of first echocardiography among neonatal omphalocele patients born between 2004 and 2017 was conducted. Multivariate logistic and univariate Cox's regression was constructed to measure hazard ratio (HR) for death outcome. There were 32 newborns, of whom 18 were GO and 7 died. GO had increased systolic pulmonary arterial to systolic systemic blood pressure ratio (97% [isosystemic] vs. 73% [three-fourths systemic] p = 0.03). RV performance parameters (tricuspid annular plane excursion, HR = 0.40; fractional area change, HR = 0.90; and RV peak global longitudinal strain, HR = 1.39) were associated with mortality. These RV performance parameters remained associated in a multiple logistic regression accounting for gestational age and GO status. The overall population had abnormal eccentricity index and pulmonary artery acceleration time to RV ejection time ratio, two markers of PH. Patients with omphalocele have increased pulmonary pressure, with GO being worse than non-GO. RV dysfunction at initial echocardiography was significantly associated with mortality.

AB012. Surgical management of malignant pleural mesothelioma

: The clinical suspicion of mesothelioma should be aroused when a patient presenting with a unilateral pleural effusion and pleural thickening gives a history of asbestos exposure. This maybe as a direct exposure whilst working with the substance or indirectly via environmental exposure. In most a thoracic CT is useful leading to an image guided pleural biopsy (if predominantly pleural thickening) or pleural aspiration (if predominantly effusion) to exclude adenocarcinoma. Effusion control can be achieved together with a definitive histological diagnosis by video assisted thoracoscopy (VATS), which does not necessarily need general anaesthesia. If the lung expands on effusion drainage then talc pleurodesis should be performed after biopsy; if the lung is entrapped then an indwelling pleural catheter should be inserted. If the patient is to proceed to further radical treatment then in general they should have similar cardiorespiratory reserve to withstand a lobectomy for lung cancer. Anaemia, leucocytosis and thrombocythaemia are poor prognostic indicators as is severe weight loss. It may be difficult to measure dynamic and static lung volumes due to the disease itself but differential lung perfusion imaging and echocardiographic assessment of ventricular function are useful, particularly if pneumonectomy is proposed. Since radical surgery should always be considered as part of multimodality therapy then the patient should have adequate renal function. The diagnostic biopsy must be sufficient for the tumour cell type to be identified. In most specialist centres pure sarcomatoid malignant pleural mesothelioma (MPM) precludes radical surgery. For biphasic disease the position is less clear and the proportion of sarcomatoid: epithelioid may be considered. The objective of radical surgery is to achieve macroscopic complete resection (MCR) which means leaving no visible residual tumour or a R2 resection. Therefore, CT is used to exclude T4 disease (in conjunction with MRI) and CTPET may be used to investigate potential peritoneal M1 disease. Tumour thickness and volume on CT and avidity on CTPET may all be used to predict prognosis. As not all nodal stations can be sampled preoperatively then N1 disease is a relative contraindication to resection. Endoscopic ultrasound or mediastinoscopy can be used to exclude contralateral N3 disease. Where indicated by suspicious imaging, contralateral video assisted thoracoscopy or laparoscopy may be needed to exclude M1 disease. Currently we offer radical surgery in patients with N1 disease (providing MCR can be achieved) within the MARS2 trial but we await the results in order to inform future practice. In those with an entrapped lung after drainage a debulking VATS visceral decortication (partial pleurectomy) may be considered. This may improve survival but is intended to improve quality of life by improving dyspnoea and removing the need for drainage. Whilst MCR of the pleura is the objective this may require resection of the lung parenchyma due to visceral pleural invasion. Wedge resection is often performed; lobectomy rarely and pneumonectomy is almost never required. Pleurectomy/decortication (PD) is the ideal outcome but in many cases an extended PD (EPD) is required due to pleural invasion of the muscle of the diaphragm. Every effort should be made to separate the diaphragmatic pleura from muscle but clearance should not be compromised nor should a potentially damaged and dysfunctional muscle be preserved. Total visceral pleurectomy is another potential area where clearance may be compromised as early disease is difficult to dissect from the underlying parenchyma. We advocate total pleurectomy since microscopic invasion may be present in macroscopically normal pleura and intraoperative frozen section analysis is unreliable. A systematic lymph node dissection is always performed to insure accurate staging. Together with the stations dissected in lung cancer, nodes in the internal mammary chain, pericardial, diaphragmatic and posterior intercostal nodes should be sampled. How radical surgery best fits into multimodality therapy remains to be determined. Radical hemithorax irradiation is promoted in the SMART protocol and attempts are being made to develop lung sparing protocols. The timing of systemic chemotherapy is still undetermined. Neoadjuvant chemotherapy does ensure that the patient receives all of the prescribed cycles since the recovery from radical surgery can compromise patient fitness and the ability to tolerate chemotherapy. However, as the response rates are under 50%, there is a risk that tumour progression may lead to unresectability. The use of intrapleural cytotoxic chemotherapy after radical resection has many proponents but is not universally used and lacks high grade supportive evidence. The MARS2 trial in the UK of EPD + chemotherapy vs. chemotherapy alone should complete the recruitment target of 326 patients by early 2020 and therefore report in 2022. Until then we should concentrate on standardizing the surgical technique and how we report intraoperative results and completeness of resection.

A standardized imaging protocol improves quality and reduces practice variability in echocardiographic assessment of ventricular function by first-year pediatric cardiology fellows.

Echocardiography education for pediatric cardiology fellows has been a recent focus leading to the implementation of "boot camps." Less is described about continuing education through fellowship and improving image quality. We noticed practice variation in echocardiograms assessing ventricular function performed on nights and weekends. Thus, we implemented a standardized protocol and assessed its impact on imaging and reporting completeness. We created an imaging protocol for the assessment of ventricular function in the acute setting. The protocol included demographic information, a list of images to be obtained, and the methods to quantify ventricular function. The protocol was explained to first-year fellows and distributed on an electronic quick reference card. Echocardiograms independently performed by first-year fellows during their first 4months of on-call time were assessed pre- and postintervention using a standard rubric. Compliance with demographic reporting was high pre- and postintervention, but significantly improved after the standardized protocol (P<0.001). Use of the protocol increased the median number of unique images obtained per echocardiogram from 13 to 17 (out of 23 required views, P<0.001). Particularly improved was the performance of quantitative evaluations of function, including Simpson's method for left ventricular ejection fraction (four chamber: 40% vs 67%, P<0.001; two chamber: 33% vs 67%, P<0.001) and tricuspid annular plane systolic excursion (45% vs 80%, P<0.001). The introduction of a standardized imaging protocol and its distribution to first-year fellows resulted in improvements in echocardiographic reporting completeness and increased the quality of information obtained by providing more quantitative assessments of ventricular function.

Echocardiographic Assessment of Ventricular Function During Exercise in Adolescent Female Patients With Anorexia Nervosa

Patients with anorexia nervosa (AN) have altered physiologic responses to exercise. The aim of this study was to investigate exercise capacity and ventricular function during exercise in adolescent patients with AN. Sixty-six adolescent female patients with AN and 21 adolescent female control subjects who exercised to volitional fatigue on a semisupine ergometer, using an incremental step protocol of 20W every 3min, were retrospectively studied. Heart rate, blood pressure, and echocardiographic Doppler indices were measured at rest and during each stage of exercise. Fractional shortening, rate-corrected mean velocity of circumferential fiber shortening, stress at peak systole, cardiac output, and cardiac index were calculated. Minute ventilation, oxygen consumption, carbon dioxide production, and respiratory exchange ratio were measured using open-circuit spirometry. Patients with AN had significantly lower body mass index (16.7 vs 19.7kg/m2, P<.001), total work (1,126 vs 1,914J/kg, P<.001), and test duration (13.8 vs 20.8min, P<.001) compared with control subjects. Peak minute ventilation, oxygen consumption, and carbon dioxide production were significantly decreased in patients with AN. Heart rate, systolic blood pressure, cardiac index, fractional shortening, and rate-corrected mean velocity of circumferential fiber shortening demonstrated similar patterns of increase with progressive exercise between groups but were decreased at peak exercise in patients with AN. Body mass index percentile, age, peak oxygen consumption, and peak cardiac output were independently associated with exercise duration. Adolescent patients with AN have reduced exercise capacity and peak cardiovascular indices compared with control subjects but normal patterns of cardiovascular response during progressive exercise. Systolic ventricular function is maintained during exercise in adolescents with AN.

Echocardiographic Assessment of Ventricular Function in Young Patients with Asthma.

BackgroundDespite significant advances in understanding the pathophysiology and management of asthma, some of systemic effects of asthma are still not well defined.ObjectivesTo compare heart function, baseline physical activity level, and functional exercise capacity in young patients with mild-to-moderate asthma and healthy controls.MethodsEighteen healthy (12.67 ± 0.39 years) and 20 asthmatics (12.0 ± 0.38 years) patients were enrolled in the study. Echocardiography parameters were evaluated using conventional and tissue Doppler imaging (TDI).ResultsAlthough pulmonary acceleration time (PAT) and pulmonary artery systolic pressure (PASP) were within normal limits, these parameters differed significantly between the control and asthmatic groups. PAT was lower (p < 0.0001) and PASP (p < 0.0002) was higher in the asthma group (114.3 ± 3.70 ms and 25.40 ± 0.54 mmHg) than the control group (135.30 ± 2.28 ms and 22.22 ± 0.40 mmHg). The asthmatic group had significantly lower early diastolic myocardial velocity (E', p = 0.0047) and lower E' to late (E'/A', p = 0.0017) (13.75 ± 0.53 cm/s and 1.70 ± 0.09, respectively) compared with control group (15.71 ± 0.34 cm/s and 2.12 ± 0.08, respectively) at tricuspid valve. In the lateral mitral valve tissue Doppler, the asthmatic group had lower E' compared with control group (p = 0.0466; 13.27 ± 0.43 cm/s and 14.32 ± 0.25 cm/s, respectively), but there was no statistic difference in the E'/A' ratio (p = 0.1161). Right isovolumetric relaxation time was higher (p = 0.0007) in asthmatic (57.15 ± 0.97 ms) than the control group (52.28 ± 0.87 ms), reflecting global myocardial dysfunction. The right and left myocardial performance indexes were significantly higher in the asthmatic (0.43 ± 0.01 and 0.37 ± 0.01, respectively) compared with control group (0.40 ± 0.01 and 0.34 ± 0.01, respectively) (p = 0.0383 and p = 0.0059, respectively). Physical activity level, and distance travelled on the six-minute walk test were similar in both groups.ConclusionChanges in echocardiographic parameters, evaluated by conventional and TDI, were observed in mild-to-moderate asthma patients even with normal functional exercise capacity and baseline physical activity level. Our results suggest that the echocardiogram may be useful for the early detection and evoluation of asthma-induced cardiac changes.

Arginine-vasopressin therapy in hypotensive neonates and infants after cardiac surgery: response is unrelated to baseline ventricular function.

We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine-vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine-vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as "responders" if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine-vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1-26.9), and the median weight was 4.3 kg (3.2-5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the "target" arginine-vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine-vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.

Increased presence of oxidized low-density lipoprotein in the left ventricular blood of subjects with cardiovascular disease.

Oxidized LDL (Ox‐LDL) and oxidative stress have been implicated in both atherosclerosis and congestive heart failure (HF) development. Here, we tested whether Ox‐LDL levels in left ventricular blood (LVB) might differ from those of venous peripheral blood (PB), and whether the level might depend on cardiac function. We also tested whether the LDL molecule is likely to have a longer residence time in the left ventricle of HF subjects with low ejection fraction (EF). The aim of this study was to determine Ox‐LDL levels, paraoxonase 1 (PON1) activity, and cholesterol efflux capacity (CEC) of PB and LVB, and correlate these values with LVEF. Sixty‐one HF patients underwent preoperative transthoracic echocardiographic assessment of ventricular function. LVEFs were determined using Simpson's biplane technique. LVB and PB levels of Ox‐LDL were determined, and PON1 activity and plasma cholesterol efflux capacity were measured. A significant increase in the levels of Ox‐LDL in LVB was noted as compared to levels in PB, even when EF was near normal. However, as ejection fraction decreased, the level of Ox‐LDL in PB approached that of the LVB. PON1 activity and cholesterol efflux studies indicated increased oxidative stress in LVB and a decreased ability to promote cholesterol efflux from lipid‐enriched macrophages. The results suggest that LVB is more oxidatively stressed compared to PB, and therefore LV tissue might be affected differently than peripheral tissues. We recently reported that brain natriuretic peptide (BNP), a marker for HF, is induced by Ox‐LDL, so it is possible localized factors within the LV could profoundly affect markers of HF.

Echocardiographic assessment of ventricular function in pediatric patients: a comprehensive guide.

Assessment of ventricular function is an important part of every echocardiographic examination. Specific pediatric guidelines on quantification of ventricular function are available, but technology evolves quickly and it generally takes long before newer techniques are integrated into routine clinical practice and are adopted by the guidelines. In the current overview, we would like to present our experience with integrating newer echocardiographic techniques for assessing ventricular function in children using a comprehensive state-of-the-art echocardiographic functional protocol. This protocol is used for specific patient populations such as pediatric patients with cardiomyopathy, post-transplant patients and oncology patients. We present the practical aspects of the protocols, their rationale and how this can be applied in clinical practice.

Strain Echocardiographic Assessment of Ventricular Function after Percutaneous Pulmonary Valve Implantation

Percutaneous pulmonary valve implantation (PPVI) is an emerging therapy for pulmonary valve dysfunction. Minimal data on the midterm effects of PPVI on ventricular function exist. We describe the effects of PPVI on right and left ventricular (RV, LV) function with speckle tracking echocardiography. Patients who met the inclusion criteria of the Food and Drug Administration Phase 1 Feasibility Clinical Trial PPVI were identified. Patients were studied with echocardiograms at baseline, post-PPVI (day of discharge), 3 months, and at 6 months. Patients were studied by cardiac magnetic resonance at baseline and at 6 months. Longitudinal strain was measured at the basal, mid, and apical portions of the RV, interventricular septum (IVS), and LV. Global RV and LV strain and strain rates were recorded. Paired t-tests were used for analysis. Ten patients were analyzed: nine patients were a variant of tetralogy of Fallot and one patient had complex LV outflow obstruction requiring a Ross and RV-pulmonary atresia conduit. Mean age was 24.4 ± 7.6 years. Indication for PPVI was pulmonary regurgitation in six patients, stenosis in two patients, and stenosis/regurgitation in two patients. After PPVI, both RV systolic pressure and RV to pulmonary artery pressure gradient significantly decreased. Cardiac magnetic resonance RV end-diastolic volume significantly decreased. IVS-mid, IVS-apical, and LV-global strain significantly increased and RV-basal decreased immediately after PPVI. Global RV a' strain rate significantly increased immediately after PPVI. However, RV, IVS, and LV strain/strain rate values between baseline and the 6 month echocardiographic study were either similar or significantly decreased. Despite improvement in RV hemodynamics, there was a decrease or no improvement in RV and LV function as measured by strain echocardiographic values at midterm follow-up. Larger studies with longer follow-up are needed to determine if these results remain consistent.

Abstract 302: Presence of Oxidized Low-Density Lipoprotein in the Left Ventricular Blood of Subjects with Cardiovascular Diseases

Hypothesis: Oxidized low density lipoprotein (Ox-LDL) has properties that profoundly affect cardiovascular function. We hypothesized that Ox-LDL is likely to be formed in the left ventricular blood (LVB) when the heart is subjected to ischemic conditions and the ejection fraction (EF) is low. We speculated whether “stagnation” of LDL in the LV could result in increased formation of Ox-LDL. Objective: We studied whether there is an increased level of Ox-LDL in the LVB as opposed to peripheral blood (PB), and whether its presence correlated with the EF. Also we examined whether a higher level of Ox-LDL negatively correlated with the activity of paraoxonase 1 (PON 1). Methods: Following the Institutional Review Board (IRB) approval, 62 HF patients were enrolled in the study. All patients underwent pre-operative transthoracic echocardiographic assessment of ventricular function. Left ventricular ejection fractions were determined using the Simpsons bi-plane technique. 2ml of LVB and 5ml of PB samples were taken before coronary artery bypass surgery, or a surgery with replacement of mitral, aortic or tricuspid valve. Blood level of Ox-LDL was determined by ELISA (Mercodia), and PON 1 activity was determined by the rate of conversion of its substrate p-nitrophenyl acetate into p-nitrophenol. Results: The result showed significant increase in Ox-LDL in LVB as compared to PB (p=0.032) in HF subjects even when EF was near normal. There was no significant increase in subjects with lower EF. In contrast, Ox-LDL levels increased in the PB of subjects with lower EF and reached those of LVB. We also noticed that there was a statistically significant negative correlation between EF and Ox-LDL levels in both LVB and PB (p &lt; 0.05). The activity of PON1, an antioxidant enzyme that protects LDL from oxidation showed decreased levels both in LV blood as well as in PB with decreased EF. It was observed that there was a statistically significant difference in PON1 levels between LV and PB of subjects having EF&gt;60% (p = 0.03). Conclusions: In conclusion the results suggest that there might be oxidative stress associated with LVB even when the EF is not compromised. In contrast, the increase in PB Ox-LDL with poor EF might suggest that the low blood flow to peripheral tissues and end organs also might contribute to increased oxidative stress. The results also might suggest that persistent oxidative stress could have affected the clearance mechanisms of Ox-LDL.

Serial Echocardiographic Assessment of Ventricular Function using Tissue Doppler Imaging in Very Low Birthweight Infants within First 7 Days of Life

Background and aims: We aimed to evaluate early changes of ventricular function in very low birthweight(VLBW) infants using tissue Doppler imaging(TDI) echocardiography.

Tissue velocities, strain, and strain rate for echocardiographic assessment of ventricular function in congenital heart disease

During the last decade tissue Doppler and myocardial deformation imaging has been introduced to quantify myocardial function in patients with congenital heart disease. These methods could have potential benefits for patients where the anatomy makes it difficult to quantify ventricular function using M-mode or two-dimensional volumetric techniques. In this overview, the potential benefits as well as limitations of the techniques are discussed. Looking directly into the myocardium renders the techniques geometry-independent, allowing the quantification of right ventricular as well as univentricular systolic function. The limitations include the influence of variable loading conditions as well as different methodological problems.

Editorial: Doppler Echocardiographic Assessment of Ventricular Function—Time to Move to the Right?

Editorial: Doppler Echocardiographic Assessment of Ventricular Function—Time to Move to the Right?

A comparative echocardiographic assessment of ventricular function in five species of sharks

A comparative echocardiographic study was carried out on five shark species that differ in heart morphology and in aspects of their behavior and natural history. The study contrasted the ventricular function in the highly active mako shark (heart type IV) and four other sharks (heart type III) that differ in activity levels (i.e. the sedentary horn and swell sharks vs. the moderately active blue and smooth-hound sharks). All five species exhibited biphasic ventricular filling characterized by an early (conduit) and late (atrial systole) phase. In the mako shark, early filling was dominant as indicated by a higher early flow peak velocity, a greater early:late velocity ratio, and a greater early velocity time integral. In contrast, the late filling phase was the more important filling agent in the other species. Indices of systolic function such as ventricular ejection fraction and ventricular fractional shortening also reflect a more efficient cardiac pumping capacity in mako shark relative to the other four sharks. The comparative echocardiographic assessment of in vivo ventricular function integrates structural and functional features with shark activity level to arrive at a new perspective blending the occurrence of biphasic filling with functional concepts based on heart morphological typology and changing views regarding the role of factors such as central filling pressure and pericardial pressure on end-diastolic ventricular volume.

Comparison of usefulness between exercise capacity and echocardiographic indexes of left ventricular function in cardiac amyloidosis

In patients with primary systemic amyloidosis (AL), the echocardiographic assessment of ventricular function alone does not always correspond to patients’ symptoms and functional status. Peak oxygen uptake and anaerobic threshold (AT), in contrast, constitute 2 objective, reliable and reproducible indicators of functional status in patients with circulatory failure. Thirty-two consecutive patients (mean age 50 ±13 years) with histologic evidence of systemic primary AL were studied (29 AL, 3 hereditary). There were 16 with echocardiographic features of cardiac infiltration (group I) and 16 without (group II). Twenty age- and gender-matched healthy subjects were also studied for comparison. Of the 32 patients, 12 were in New York Heart Association functional class I, 9 were in class II, and 11 were in class III. Each subject underwent 2-dimensional and Doppler echocardiography and cardiopulmonary exercise testing using a modified Bruce protocol. Left atrial (LA), left ventricular (LV) dimensions, wall thickness, and LV fractional shortening, as well as transmitral flow velocities and their E/A ratio were measured. Peak oxygen consumption (VO 2max [ml/kg/min]), AT (ml/kg/min), and exercise duration (seconds) were also measured. VO 2max and AT were lower in patients with AL than in controls (20.8 ± 7.0 vs 35.0 ± 8.5, p <0.001 and 13.1 ± 3.7 vs 27.0 ± 4.2, p <0.001, respectively). As a group, symptomatic patients had lower VO 2max, AT, and exercise duration than those without symptoms (17.1 ± 3.6 vs 27.0 ± 6.9, p = 0.0001, 11.1 ± 2.1 vs 16.2 ± 3.6, p = 0.0001, and 489 ± 235 vs 843 ± 197, p = 0.0001, respectively), whereas LV dimensions only showed a small difference (p = 0.03). VO 2max, AT, and exercise duration of patients in functional class I were higher than those in functional classes II and III (p = 0.01, p <0.05, and p = 0.007, respectively). Asymptomatic patients had lower VO 2max, AT, and exercise duration than controls (p <0.0001). VO 2max, AT, and exercise duration were poorly related to LA diameter, LV dimensions, fractional shortening, wall thickness, peak velocities of E and A waveforms, and E/A ratio. Patients with VO 2max >15 ml/kg/min had a better survival than patients with VO 2max <15 ml/kg/min. Thus, in patients with primary systemic AL, cardiorespiratory exercise testing is the preferred way of assessing functional capacity. Echocardiographic Doppler indexes at rest are not predictive of a patient’s symptoms and exercise capacity. Furthermore, VO 2max is a strong independent predictor of survival in these patients.

Simplified single patch technique for the repair of atrioventricular septal defect

Objective: Because of the complexity of traditional 1- and 2-patch techniques for the repair of complete atrioventricular septal defect, we modified our repair technique to avoid the use of any ventricular septal patch material. We report our prospective experience with this simplified 1-patch technique. Method: Forty-seven consecutive patients between May 1995 and August 1998 underwent repair with the use of this technique without modification. Repair was done in all patients by direct suturing of the common atrioventricular valve leaflets to the crest of the ventricular septum. No division of valve leaflets was necessary. A single pericardial patch was used to close the defect in the atrial septal component. Follow-up included electrocardiography and echocardiographic assessment of ventricular function, atrioventricular valve function, and adequacy of the left ventricular outflow tract. Results: There were 2 deaths (4%), only 1 cardiac related, in the series. There were 17 male patients and 30 female patients. Mean age at repair was 5.6 months (median, 3.4 months). Associated lesions were repaired in 19 patients (40%). Mean follow-up was 1.85 years (median, 1.9 years). There was no heart block. There were no significant residual ventricular septal defects detected and no left ventricular outflow tract obstruction seen on echocardiography in any patient to date. Mitral valve status after operation was assessed as no incompetence in 13 patients (28%), minimal in 19 patients (40%), mild in 12 patients (26%), and moderate in 3 patients (6%). Conclusion: The repair of complete atrioventricular septal defect by direct suturing of the atrioventricular valve leaflets to the crest of the ventricular septum with a single-patch technique greatly simplifies the repair and does not lead to left ventricular outflow tract obstruction nor interfere with valve function. (J Thorac Cardiovasc Surg 1999;118:642-7)