Echocardiographic Parameters In Patients Research Articles

Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism.

Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE. Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%. Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5-40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (± 0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591-0.858, p = 0.033). Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism.

Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow-up.

AimTo predict the spontaneous closure of ventricular septal defect (VSD) and assist pediatrician to manage VSD children.MethodsBetween January 2008 and December 2016, 132 children diagnosed with isolated VSD by echocardiography were enrolled. All participating children were followed‐up by echocardiography yearly until the closure of VSD or 6 years old. The clinical indicators and echocardiographic parameters of patients were collected. Statistically significant factors were used to establish a Logistic Regression model for predicting spontaneous closure of VSD. Receiver operating characteristic (ROC) analysis was used to assess the specificity and sensitivity of Logistic Regression model.ResultsSpontaneous closure occurred in 60% of all patients; 57% in perimembranous VSD (p‐VSD) and 64% in muscular VSD (m‐VSD) patients. Initial diagnosis age, defect size, aneurysms tissue of the ventricular membranous septum (ATVMS), pulmonary hypertension (PH), and left ventricular diastolic dimension (LVDD) were statistically significant. Defect size, ATVMS and LVDD were determined by the Logistic Regression model as representative factor. P‐VSD and m‐VSD model had areas under the ROC curves 0.854 and 0.898, respectively.ConclusionWe inferred that defect size, ATVMS and LVDD were characteristic and representative predictors for spontaneous closure of VSD. And we summarized the prognostic factors and recommended a follow‐up criteria to assist the pediatrician managing VSD children.

Prognostic value of transthoracic echocardiography parameters in patients with chronic heart failure: A Tunisian cohort

Heart failure (HF) has a dark prognosis due to the high rate of mortality and re-hospitalization. The aim of our study was to identify among the echocardiographic parameters those predictive of mortality and re-hospitalization in patients with chronic heart failure with reduced ejection fraction after 6 months. We performed a prospective cohort involving 110 patients, hospitalized for HF with ejection fraction (EF) < 40% in our cardiology department, from October 2013 to October 2015. All patients were explored by transthoracic 2D echocardiography associated to a 2D speckle tracking study of the two ventricles. After 6 months of regular follow-up, 19 patients died and 36 patients were hospitalized. In multivariate analysis, six parameters were identified as independent predictor factors of mortality: an EF < 30% (OR = 6, P = 0.01), a global longitudinal strain of the left ventricle (LV GLS) < −10% (OR = 3, P = 0.02), a tricuspid annular plane systolic excursion (TAPSE) < 12 mm (OR = 12, P < 0.001),a right ventricular fractional area change (RV-FAC) < 33% (OR = 8, P < 0.001), a peak of systolic tricuspid annular motion velocity S’ < 10 cm/s (OR = 5, P < 0.01) and a GLS of RV (RV GLS) < −15% (OR = 9, P < 0.001). Independent factors of re-hospitalization were: a RV GLS < −10% (OR = 5.8, P = 0.02), a TAPSE < 12 mm (OR = 6.4, P < 0.001), a RV-FAC < 33% (OR = 7.6, P < 0.001), a peak of S’ < 10 cm/s (OR = 10, P < 0.01), a peak Ea wave velocity < 6.5 cm/s (OR = 8, P < 0.001) and a peak Aa wave velocity < 12.5 cm/s (OR = 3.55, P = 0.01). The evaluation of echocardiographic parameters in patients with chronic heart failure may provide a precise prognosis of this serious disease. This non-invasive exam seems to be extremely valuable and potentially useful for guiding the therapeutic and follow-up strategies in heart failure in order to reduce the problem posed for the global healthcare systems through the increasing rate of mortality and hospitalization caused by this invalid disease.

Exercise training program in patients with NYHA III class systolic heart failure - Parallel comparison to the effects of resynchronization therapy

PurposeThe aim of this study was to assess exercise capacity and echocardiographic parameters in patients with heart failure with reduced ejection fraction (HFrEF) in NYHA III functional class, after cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillator (ICD) implantation followed by 6 months of supervised rehabilitation in ICD patients. Materials and methodsThe study included patients with HFrEF and impaired left ventricle systolic function (LVEF ≤ 35%), divided into two groups: CRT group - patients after CRT-D implantation > six weeks, and ICD-rehab group - patients after ICD implantation > six weeks, followed by 6 months of supervised aerobic interval training and the conditioning exercises. At baseline and after 6 months in all the patients cardiopulmonary exercise tests (CPX) and standard echocardiographic examinations were performed. ResultsThe study included 61 patients (49–77 years) with HFrEF. At baseline, the values of CPX parameters were similar in both groups. After completing training almost all CPX parameters in the ICD-rehab group significantly improved, except for anaerobic threshold (AT). In the CRT group significant improvements were found in 2 parameters: peak oxygen uptake (VO2) and exercise tolerance (metabolic equivalents, METs). Significant reductions in left and right ventricle diameters and an increase in LVEF were observed in both groups after 6 months. ConclusionsSignificant improvement in exercise tolerance capacity and increase of LVEF were observed in similar extent both in heart failure patients with CRT and with ICD undergoing the rehabilitation program. Regular, controlled exercise trainings provided additional, safe and easy to conduct therapeutic option for heart failure patients with no indications for CRT.

Vitamin D deficiency in patients with diastolic dysfunction or heart failure with preserved ejection fraction.

AimsVitamin D deficiency is prevalent in heart failure (HF), but its relevance in early stages of heart failure with preserved ejection fraction (HFpEF) is unknown. We tested the association of 25‐hydroxyvitamin D [25(OH)D] serum levels with mortality, hospitalizations, cardiovascular risk factors, and echocardiographic parameters in patients with asymptomatic diastolic dysfunction (DD) or newly diagnosed HFpEF.Methods and resultsWe measured 25(OH)D serum levels in outpatients with risk factors for DD or history of HF derived from the DIAST‐CHF study. Participants were comprehensively phenotyped including physical examination, echocardiography, and 6 min walk test and were followed up to 5 years. Quality of life was evaluated by the Short Form 36 (SF‐36) questionnaire. We included 787 patients with available 25(OH)D levels. Median 25(OH)D levels were 13.1 ng/mL, mean E/e′ medial was 13.2, and mean left ventricular ejection fraction was 59.1%. Only 9% (n = 73) showed a left ventricular ejection fraction <50%. Fifteen per cent (n = 119) of the recruited participants had symptomatic HFpEF. At baseline, participants with 25(OH)D levels in the lowest tertile (≤10.9 ng/L; n = 263) were older, more often symptomatic (oedema and fatigue, all P ≤ 0.002) and had worse cardiac [higher N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and left atrial volume index, both P ≤ 0.023], renal (lower glomerular filtration rate, P = 0.012), metabolic (higher uric acid levels, P < 0.001), and functional (reduced exercise capacity, 6 min walk distance, and SF‐36 physical functioning score, all P < 0.001) parameters. Increased NT‐proBNP, uric acid, and left atrial volume index and decreased SF‐36 physical functioning scores were independently associated with lower 25(OH)D levels. There was a higher risk for lower 25(OH)D levels in association with HF, DD, and atrial fibrillation (all P ≤ 0.004), which remained significant after adjusting for age. Lower 25(OH)D levels (per 10 ng/mL decrease) tended to be associated with higher 5 year mortality, P = 0.05, hazard ratio (HR) 1.55 [1.00; 2.42]. Furthermore, lower 25(OH)D levels (per 10 ng/mL decrease) were related to an increased rate of cardiovascular hospitalizations, P = 0.023, HR = 1.74 [1.08; 2.80], and remained significant after adjusting for age, P = 0.046, HR = 1.63 [1.01; 2.64], baseline NT‐proBNP, P = 0.048, HR = 1.62 [1.01; 2.61], and other selected baseline characteristics and co‐morbidities, P = 0.043, HR = 3.60 [1.04; 12.43].ConclusionsLower 25(OH)D levels were associated with reduced functional capacity in patients with DD or HFpEF and were significantly predictive for an increased rate of cardiovascular hospitalizations, also after adjusting for age, NT‐proBNP, and selected baseline characteristics and co‐morbidities.

DOES THE CORRECTION OF THE ANXIETY-DEPRESSIVE DISORDERS INFLUENCE ON THE PROCESSES OF THE LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE CORONARY SYNDROME?

Aim:to study the dynamic of echocardiographic parameters in patients with acute coronary syndrome associated with anxiety and depressive disorders during the therapy by innovative Russian drug containing release-active antibodies to the brain-specific protein S-100 (Tenoten) in-hospital and during six months of treatment.Material and Methods. 54 patients with acute coronary syndrome associated with anxiety and depressive disorders were randomized into 2 groups: patients of group 1 were administered with anti-anxiety medicament Tenoten, 6 tablets per day in addition to the therapy for acute coronary syndrome; group 2 received placebo. All patients underwent echocardiography at inpatient and outpatient stages six months after randomization.Results. Clinically significant anxiety and subclinical depression were detected in patients of both study groups. The intake of anti-anxiety drug Tenoten for six months contributed to anxiety reduction, myocardial contractility improvement, and a decrease in the left ventricular volume indices. Negative changes were observed in comparison group: a decrease in the left ventricular ejection fraction, increase in volume indices, and decline in the left ventricular relaxation.Conclusion. Administration of Tenoten at a dose of six tablets per day to patients with acute coronary syndrome in combination with affective disorders resulted not only in improvement of a mental status, but it also contributed to suppression of the left ventricular remodeling processes.

The association of inflammatory markers and echocardiographic parameters in Behçet’s disease

Background: The main objective of the current study is to find out if any association exists between specific inflammatory markers such as homocysteine (Hcy) and pentraxin-3 (PTX-3) and cardiac involvement determined by means of echocardiographic parameters in patients with Behçet disease (BD).Methods: From January 2011 to January 2012, a total of 62 Behçet’s patients were enrolled in the study. Thirty-two healthy subjects constituted the control group. The diagnosis of BD was made as proposed by International Study Group of BD.Results: The mean PTX-3, Hcy, and C-reactive protein levels were significantly higher in patients with BD compared to the control group. The electromechanical delay (EMD) times were found to be prolonged in patients with BD. Also, the aortic stiffness index (SI) and elastic modulus (Ep) were significantly higher, while the aortic dispensibility was significantly lower in patients with BD. The left atrial volume, left atrial volume index, E/A ratio, E/E’ septal, IRight-EMD, PA’-ML, PA’-MS, PA’-TL, SI, and Ep were correlated with PTX-3 levels. In addition, the E/A, PA’-ML, PA’-MS, SI, and Ep displayed correlation with Hcy levels in patients having BD.Conclusion: Elevated levels of PTX-3 and Hcy were found to be correlated with cardiac involvement determined by means of echocardiographic parameters in patients with BD.

Echocardiographic parameters of patients in the intensive care unit undergoing continuous renal replacement therapy.

Main objectivesEchocardiographic parameters have been used to predict outcomes for specific intensive care unit (ICU) populations. We sought to define echocardiographic parameters for ICU patients receiving continuous renal replacement therapy (CRRT).Design, setting, participants, and measurementsThis is a historical cohort study of consecutive ICU patients at Mayo Clinic (Rochester, Minnesota) who received CRRT from December 9, 2006, through November 13, 2015. Only patients with an echocardiographic examination within 7 days of CRRT initiation were considered.ResultsThe study included 1,276 patients. Decreased left ventricular ejection fraction (LVEF; ≤45%) was noted in 361/1,120 (32%) and increased right ventricular systolic pressure (RVSP; ≥40 mm Hg) was noted in 529/798 (66%). Right ventricular systolic dysfunction was observed in 320/820 (39%). The most common valvular abnormality was tricuspid regurgitation (244/1,276 [19%]). Stratification of these parameters by ICU type (medical, surgical, cardiothoracic, cardiac) showed that most echocardiographic abnormalities were significantly more prevalent among cardiac ICU patients: LVEF ≤45% (67/105 [64%]), RVSP ≥40 mm Hg (63/79 [80%]) and tricuspid regurgitation (50/130 [38%]). We compared patients with acute kidney injury (AKI) vs end-stage renal disease and showed that decreased LVEF (284/921 [31%] vs 78/201 [39%]), was significantly less prevalent among patients with AKI, but increased RVSP was more prevalent (445/651 [68%] vs 84/147 [57%]) with AKI.ConclusionsICU patients who required CRRT had increased prevalence of pulmonary hypertension and right and left ventricular systolic dysfunction. Prediction of adverse outcomes with echocardiographic parameters in this patient population can lead to identification of modifiable risk factors.

Can the development of atrial fibrillation in patients with ischemic heart failure with low ejection fraction be predicted?

OBJECTIVE:Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF).METHODS:Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared.RESULTS:PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E’, pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI: 1.08–1.42; p=0.001). ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95%: 0.724–0.927; p<0.001].CONCLUSION:The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF.

Evaluation of Echocardiographic Parameters in Patients with White Coat and Masked Hypertension Detected by Ambulatory Blood Pressure Monitoring

The aim of this study was to assess the echocardiographic changes in patients who have masked hypertension (MH) and white coat hypertension (WCH) depending on monitoring of blood pressure by ambulatory method. This study was conductedon (66) subjects in a private clinic in Al-Hilla city; the subjects underwent a (24 hours) ABPM in addition to atransthoracic echocardiography. Based on the readings of ABP measurements, average and maximum (24 hours) diastolic and systolic blood pressures (BP) were analyzed during mean nighttime (from 10 p.m. to 6 a.m.) and during mean daytime (from 6 a.m. to 10 p.m.). The echocardiographic parameters included the measurement of left atrial size, left atrial diameter (LAD), posterior cardiac wall thickness (PWT), anterior cardiac wall thickness (AWT), E/A ratio, left ventricular end-diastolic diameter (LVEDD), and isovolumic relaxation time (IVRT). The percentage of patients having WCH was higher than MH 41: 66 (62%) vs. (38%) (25: 66). Regarding WCH, there were few patients had personal history of hypertension 5 (12%) and most of them had family history of hypertension 36 (88%), while in case of MH, all patients had negative personal history of hypertension and most of them had negative family history 21 (84%) of hypertension.

Relationship of Serum Soluble Klotho Levels and Echocardiographic Parameters in Patients on Maintenance Hemodialysis

Background: Cardiovascular disease is the leading cause of morbidity and mortality in maintenance hemodialysis (MHD) patients. Uremic cardiomyopathy, characterized by myocardial hypertrophy and fibrosis, has a significant contribution to these adverse cardiac outcomes. The protective effect of soluble Klotho (s-Klotho) on myocardial damage was demonstrated in in vitro and animal experiments. However, data from MHD patients is limited. The present study was designed to identify potential correlations between echocardiographic parameters and serum s-Klotho levels in MHD patients. Methods: This is a cross-sectional study involving 105 MHD patients from the Dialysis Center of Capital Medical University affiliated Beijing Friendship Hospital between March and October 2014. The general information for each patient was recorded. Fasting blood samples were collected prior to hemodialysis during the mid-week session in all patients. The echocardiogram and left lateral lumbar spine radiograph were performed after the same mid-week session. The dialysis records for each session within 3 months before the blood tests were documented. According to the quartiles of s-Klotho levels, patients were divided into four groups (Group 1–4). The demographic and clinical characteristics, echocardiographic parameters, and abdominal aortic calcification scores among the groups were compared. Results: The enrolled 105 patients were predominantly male (54.3%) with an average age of 59.9 ± 11.2 years. Previous hemodialysis durations were 76 (42–133) months. Sixteen (15.2%) patients had diabetes mellitus. Mean serum s-Klotho level was 411.83 ± 152.95 pg/mL, and the 25th percentile, 50th percentile, and 75th percentile values of serum s-Klotho levels were 298.9, 412, and 498.2 pg/mL, respectively. Individuals in the bottom quartile of s-Klotho levels (Group 1) had significantly increased interventricular septal thickness (IVST) compared to those in the other three quartiles of s-Klotho levels (Group 1: 1.12 ± 0.16 cm; vs. Group 2: 1.12 ± 0.16 cm, p = 0.008; vs. Group 3: 0.94 ± 0.13 cm, p < 0.001; vs. Group 4: 1.03 ± 0.1 5 cm, p = 0.022). There were significant differences in the ratios of IVST and posterior wall thickness (PWT) between patients of Group 1 and Group 3 (1.12 ± 0.1 2 vs. 1.00 ± 0.1 4, p = 0.004). No significant differences were found for other parameters among the groups. The univariate correlation analyses showed that gender (r = –0.211, p = 0.030), Kt/V urea (r = –0.240, p = 0.014), hypersensitive C reactive protein (hs-CRP) (r = 0.196, p = 0.045), and serum s-Klotho levels (r = –0.260, p = 0.007) significantly correlated with IVST. Ultimately, only hs-CRP and serum s-Klotho levels were entered into a multiple regression model. Conclusions: The present study showed that patients with lower circulating s-Klotho levels were more often associated with larger IVST and greater ratios of IVST and PWT. There was an independent association between s-Klotho and IVST, and lower s-Klotho levels seem to be a potential risk factor of uremic cardiomyopathy in MHD patients.

QT Dispersion Changes after Transcatheter Aortic Valve Implantation in Patients with Aortic Stenosis.

ObjectiveThe aim of this study was to evaluate the QT dispersion and echocardiographic parameters in patients before and after transcatheter aortic valve implantation (TAVI).MethodsOne hundred and fifty-two patients with severe aortic valve stenosis (AS) were included in our study. Ninety five patients who underwent aortic valve replacement with TAVI were included in the TAVI group and 57 patients, who refused TAVI, were included in the medical treatment group. The QT interval and echocardiographic parameters of all patients were assessed before and after the procedure (first and sixth months and first year). The QT intervals were taken from the onset of the QRS to the end of the T wave.ResultsAll patients had severe AS. The average mean aortic valve gradient was 46.1±12. Left ventricular internal diastolic diameter (LVIDD) and interventricular septum diastolic thickness (IVSDT) did not change significantly after TAVI (P>0.05). QT dispersion, corrected QT dispersion, and mean aortic valve gradient changed significantly six months after TAVI (P<0.05). Compared to the medical treatment group, QT dispersion and corrected QT dispersion were significantly decreased at the sixth month in the TAVI group. The incidence of malignant arrhythmias was smaller in the TAVI group than in the medical treatment group. The mortality rate was lower at the first-year follow-up in the TAVI group than in the medical treatment group.ConclusionIncreased QT dispersion is associated with severe symptomatic AS. After TAVI, QT dispersion reduces.

Prognostic role of echocardiography in patients with chronic renal failure on hemodialysis

BackgroundCardiovascular diseases (CVD) account for approximately 50% of all deaths in patients undergoing hemodialysis and account for approximately one third of their hospital admissions(1). Structural and functional alterations detected by echocardiography are important steps for the characterization of individuals with higher cardiovascular risk(2,3). Thus, we aimed to study the prognostic value of echocardiographic parameters in patients with CKD undergoing hemodialysis. Patients and methodsThis study include 61 patients (17 females) with age ranged from 21 to 72 years. All of them were on continuous regular hemodialysis 3 times per week for 3months at least. All patients underwent thorough history taking, full clinical examination, 12 lead ECG, and beside echocardiography. Then all patients underwent regular follow up for 6 months, the end points were the occurrence of fatal or non-fatal cardiovascular events. Our results6 patients developed cardiovascular morbidity; 4 unstable angina and 2 CHF beside 4 cardiovascular mortality one due to aortic dissection, one due to cerebral hemorrhage, one due to MI and one due to SCD.We had two groups, non-complicated group1 and complicated group2. By comparison between both groups we found that:-Left ventricular mass index (LVMI) ≥136 gm/m2 had 86% sensitivity and 85% specificity for the development of cardiovascular morbidity and mortality.-Age ≥49 years had 86% sensitivity and 64% specificity in predicting development of cardiovascular morbidity and mortality. ConclusionLVMI and age are the only predictors of cardiovascular morbidity and mortality in patients under hemodialysis with an odds ratio of 34.4 and 7.8 respectively

THE ROLE OF POLYMORPHIC VARIANTS OF NO-SYNTHASE, RECEPTOR ENDOTHELIN-1 AND NADPH-OXIDASE IN THE DEVELOPMENT OF HEART FAILURE RESULTED FROM CHEMOTHERAPY-INDUCED CARDIOTOXICITY

Aim. To study the clinical and genetic aspects of the influence of polymorphic variants of the genes of endothelial NO-synthase (NOS3), the receptor of endothelin-1 type A (EDNRA) and NADPH-oxidase on the development of cardiotoxic remodeling of the left ventricle and heart failure during anthracycline-based regimens for patients with breast cancer.Methods. 176 women with breast cancer receiving anthracycline antibiotics as part of multiple drug chemotherapy regimens were examined. According to the results of the examination, 12 months after the end of multiple drug chemotherapy, all the patients with the main disease in remission were divided into 2 groups: patients with cardiac remodeling caused by cardiotoxicity (Group 1 = 52) and those with preserved heart function (Group 2 = 124). All patients underwent echocardiographic assessment before chemotherapy, during the treatment regimen with anthracyclines and after the therapy. Genetic material (buccal cells) was collected from all patients for the subsequent typing of alleles of genes NOS3 (rs1799983), EDNRA (rs5335) and NADPH-oxidase (rs4673).Results. Analysis of echocardiographic parameters in patients 12 months after the completion of multiple drug chemotherapy in comparison with those before treatment showed a statistically significant difference between end-systolic and end-diastolic dimensions, as well as a significant reduction in the left ventricular ejection fraction in the group of women who developed cardiotoxicity with anthracycline cardiotoxicity. An association between the development of cardiotoxic lesions with the presence of mutant allele of NOS3 rs1799983 and NADPH-oxidase rs4673 genes has been determined. The presence of the T/T genotype of the NOS3 rs1799983 gene was associated with myocardial damage during multiple drug chemotherapy, along with the T/T genotype of the NADPHoxidase gene rs4673. Importantly, the genotype G/G of the gene NOS3 rs1799983 was more frequently determined in Group 2, suggesting its protective effect against cardiotoxic myocardial damage.Conclusion. The development of the strategy aimed at preventing or reducing the risk of cardiovascular complications in the treatment of cancer is a crucial problem. Genetic typing is an effective measure to predict the increased risk of cardiotoxic effects of anthracyclines.

Correlations Between Biochemical Profile and Echocardiographic Parameters in Patients with Cirrhosis of the Liver Without Previous Cardiovascular Abnormalities

The role of cardiac imaging in the management of non-cardiovascular diseases has been continuously increased. Most studies suggest the utility of echocardiography examination in the evaluation of left ventricular function in cirrhotic patients, being well-known that cirrhosis of the liver is associated with cardiovascular abnormalities which include especially left ventricle diastolic dysfunction and left ventricular hypertrophy. Cardiac dysfunction contributes to morbidity and mortality associated with liver transplantation. The aim of this study was to emphasize the role of echocardiography in assessing left ventricular systolic and diastolic function in cirrhotic patients in order to establish a correlation between echocardiography parameters and biochemical variables in patients with end-stage cirrhosis. The study was conducted as a cross-sectional analysis over a two-year period (2016-2018). 41 patients with cirrhotic liver from the departments of Gastroenterology and Cardiology from St Spiridon Emergency Hospital of Ia�i were included in the study, after a written informed consent was obtained. Patients with any previous cardiovascular (CV) abnormalities, other causes of pulmonary hypertension and endocrinopathies were excluded from the study. Using transthoracic echocardiography left ventricle dimensions and wall thickness (left ventricle posterior wall thickness + interventricular septum thickness) and also diastolic function (E wave, A wave, E/A ratio, deceleration time of E wave) and systolic function (ejection fraction) were determined along with biochemical variables. In conclusion, no significant association was obtained between echocardiographic changes and biochemical profile in patients with cirrhosis of liver.

Left Ventricular Systolic Dysfunction in Patients With Type-A Aortic Dissection Is Associated With 30-Day Mortality

The aim of this study was to analyze preoperative and postoperative echocardiographic parameters in patients with type-A acute aortic dissection (ATAAD) and to analyze whether impaired preoperative left ventricular function was associated with short- and long-term survival. To enable multivariable analysis, established risk factors of ATAAD were analyzed as well. Retrospective single-center study. The German Heart Center Berlin. The retrospective data of 512 patients with ATAAD who were treated between 2006 and 2014 were analyzed. None. Preoperative versus postoperative left ventricular ejection fraction (LVEF), right ventricular ejection fraction, left ventricular end-diastolic diameter, and right ventricular end-diastolic diameter were not significantly different, and the mean values were within the reference ranges. Because of the surgical intervention, incidences and severities of aortic regurgitation and pericardial effusion decreased. In multivariable logistic analysis, the authors identified age (odds ratio [OR] 1.04, p < 0.001), preoperative LVEF ≤35% (OR 2.20, p = 0.003), any ischemia (Penn non-Aa) (OR 2.15, p < 0.001), and longer cardiopulmonary bypass time (OR 1.04, p < 0.001) as independent predictors of 30-day mortality. Cardiopulmonary resuscitation, tamponade, or shock, and pre-existing cardiac disease, were not predictors of death. After surgery, aortic insufficiency and pericardial effusion decreased, whereas cardiac functional parameters did not change. Severe LV dysfunction was identified as a new independent predictor of 30-day mortality.

Contribution of genes involved in fibrogenesis to myocardial echocardiographic parameters in patients with atherosclerosis

Contribution of genes involved in fibrogenesis to myocardial echocardiographic parameters in patients with atherosclerosis

P3759Expression analysis of microRNAs (133b and 138) and correlation with echocardiographic parameters in patients with alcoholic cardiomyopathy

P3759Expression analysis of microRNAs (133b and 138) and correlation with echocardiographic parameters in patients with alcoholic cardiomyopathy

The effect of tadalafil on functional capacity and echocardiographic parameters in patients with repaired Tetralogy of Fallot.

BACKGROUNDTetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases (CHD) in children. Various surgical procedures including palliative shunts and TOF total correction (TFTC) were done with some complications, of which, the most common is pulmonary valve regurgitation (PR). Tadalafil is a phosphodiesterase 5 inhibitor which reduces pulmonary vascular resistance, and improves right ventricular function and vascular endothelium, and may have some beneficial effects after TFTC.METHODSWe studied 18 patients with TOF and PR, with some impaired right ventricular function after TFTC. Tadalafil tablets at a dose of 1 mg per kg (maximum 40 mg) per day as a single dose was administered orally for 8 weeks. In all patients, before and after taking tadalafil, functional class assessment, electrocardiography (ECG) changes, some echocardiographic and endothelial function parameters [flow-mediated dilation (FMD) and intima-media thickness (IMT) of carotid artery], and exercise test were determined.RESULTSThe patient's mean age was 10.11 ± 4.03 years, and the mean age of operation was 2.52 ± 1.12 years. The effect of tadalafil on different echocardiographic parameters and also on tricuspid valve regurgitation (TR) and PR severity and gradient was not significant. Moreover, it had no effects on QRS duration. Tadalafil had a significant effect on improving FMD and exercise test (P = 0.01). The effect of tadalafil on echocardiographic parameters, carotid artery IMT, and ECG parameters was not significant (P > 0.05). Tadalafil was tolerated well, and the most common side effects were headache and myalgia.CONCLUSIONThis study showed that tadalafil is a safe and well-tolerated drug. It might improve exercise performance, endothelial function, and functional class, and possibly could allow patients a longer period of well-being and could possibly delay the need for pulmonary valve replacement (PVR).

The impact of pericardial approach and myocardial protection onto postoperative right ventricle function reduction

BackgroundThe reduction of RV function after cardiac surgery is a well-known phenomenon. It could persist up-to one year after the operation and often leads to an incomplete recovery at follow-up echocardiographic control. The aim of the present study is to analyze the impact of different modalities of pericardial incision (lateral versus anterior) and of myocardial protection protocols (Buckberg versus Custodiol) onto postoperative RV dynamic by relating two- and three-dimensional echocardiographic parameters in patients undergoing mitral valve repair through minimally invasive or traditional surgery approach.MethodsWe have analyzed 44 consecutive patients with severe degenerative mitral regurgitation who underwent mitral reparation with different surgical approach and cardioplegia type: Group 1 (17 pts): sternotomy with Buckberg cardioplegia protocol; Group 2 (10 pts): sternotomy with Custodiol cardioplegia; Group 3 (17 pts): mini-invasive surgery with Custodiol cardioplegia. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post-surgery to evaluate RV function by tricuspid annular plane systolic excursion (TAPSE).ResultsAll patients underwent successful and uneventful. A postoperative TAPSE reduction was found in all groups. However, mini-invasive patients experienced a significant reduced variation versus traditional surgery.ConclusionsMini-invasive mitral repair, with lateral incision of pericardium, reduces postoperative TAPSE fall, while cardioplegia protocol fails to have an impact onto longitudinal RV function. In our study, the RV seems to experience a clinically irrelevant geometrical modification too, whose entity appears to be less evident in case of lateral pericardial approach. These results could strengthen the use of minimally invasive approach also to preserve RV function.