End-diastolic Index Research Articles

Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

Background and objectiveMitral regurgitation (MR) after myocardial infarction (MI) carries adverse prognosis. The objective of this study was to assess the impact of functional MR on adverse in-hospital outcomes in acute MI. Materials and methodsA total of 569 patients with first ever acute MI were divided into three groups: no MR, mild MR (regurgitant orifice area <0.2cm2) and moderate-severe MR group (regurgitant orifice area more or equal >0.2cm2). Clinical profile and in-hospital outcomes were compared among the groups. ResultsPatients with increasing grade of MR were elder (P<0.001), more likely to be female (P=0.003), have atrial fibrillation (P<0.001), higher peak C-reactive protein values (P=0.001), multivessel coronary artery disease (P<0.001), and less likely to have dyslipidemia (P=0.029). Ejection fraction, age, atrial fibrillation and left ventricular end diastolic diameter index were independent predictors of moderate and severe MR (P<0.001). In hospital cardiac death and decompensated heart failure was more prevalent in moderate-severe MR group. ConclusionsModerate and severe MR in acute MI is related to age, atrial fibrillation, increased left ventricular diastolic dimensions and decreased ejection fraction. Moderate and severe, but not mild MR is an important clinical contributor to in-hospital cardiac death.

Duplex Color Doppler Evaluation of Retinal Arterial Blood Flow in Type 2 Diabetic Subjects without Retinopathy

Background: Diabetic retinopathy is a vascular disorder affecting the microvasculature of retina. It is caused by changes in the blood vessels of retina. If untreated, it may lead to blindness which is usually preventable if retinopathy is diagnosed early and treated promptly. In ophthalmology, color Doppler imaging is a new method that enables us to assess the orbital vasculature. It allows for simultaneous two dimensional anatomical and Doppler evaluations of hemodynamic characteristics of retinal artery. Objective: To observe the difference between Doppler flow velocity indices (peak systolic velocity, end diastolic velocity and resistive index) of retinal artery in type 2 diabetic subjects without retinopathy and those of normal controls. Materials and Methods: This case-control study was carried out in the department of Radiology and Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) in collaboration with Ophthalmology Outpatient Department, BIRDEM, Dhaka from July 2011 to June 2013. Eighty diabetic patients without retinopathy aged 27–68 years were enrolled as cases and age and sex matched 80 healthy subjects were selected as controls. Type 1 diabetic patients, type 2 diabetics with retinopathy, hypertensive and dyslipidemic subjects were excluded from the study. All the selected subjects underwent duplex Doppler ultrasonography of both eyes using 5 to 7.5 MHZ linear phase transducer. Duplex color Doppler findings including spectral analysis (PSV, EDV and RI) were recorded. Unpaired t test was done to compare blood flow velocity indices of retinal artery in type 2 diabetic patients without retinopathy and that of healthy control subjects. p value &lt;0.05 was considered as significant. Results: Majority (42.5% and 47.5%) of subjects were in 4th decade of life in both groups with predominance of males. The mean duration of diabetes was 4.56 ± 2.1 years. Mean peak systolic velocity (PSV) in 80 diabetic patients without retinopathy was 10.70 ± 1.50 cm/sec ranging 5.30–16.10 cm/sec and that of 80 healthy subjects was 11.27 ± 0.98 cm/sec ranging 9.0–13.10 cm/sec. Mean end diastolic velocity (EDV) in 80 diabetic patients without retinopathy was 2.58 ± 0.67 cm/sec ranging 1.00 –5.10 cm/sec and that of 80 healthy subjects was 4.11 ± 2.7 cm/sec ranging 3.00–4.60 cm/sec. Mean resistive index (RI) in 80 diabetic patients without retinopathy was 0.75 ± 0.04 ranging 0.66–0.81 and that of 80 healthy subjects was 0.64 ± 0.02 ranging 0.60–0.70. Mean difference of retinal arterial RI of diabetic subjects without retinopathy and healthy control eyes was statistically significant (p&lt;0.001). Conclusion: From the present study it can be concluded that, there is statistically significant difference between retinal arterial RI of type 2 diabetic patients without retinopathy and that of healthy control adult subjects. DOI: http://dx.doi.org/10.3329/jemc.v4i3.20948 J Enam Med Col 2014; 4(3): 168-173

Parameters Characterizing Age-Dependent Retrobulbar Circulation in Healthy Subjects Measured by Color Doppler Ultrasonography

Purpose: The aim of this study was to analyze age-related effects influencing retrobulbar blood flow parameters.Materials and Methods: The study enrolled healthy volunteers (162 eyes) with a mean age of 49.64 years (SD ± 17.50). Participants were divided into 5 groups (G1–G5) based on 12-year age spans (means from 25.41 to 73.87 years). Peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV), pulsatility index (PI) and resistive index (RI) of the ophthalmic (OA), central retinal (CRA) and posterior ciliary arteries (PCAs) were measured by color Doppler ultrasonography (CDU). In addition, systemic blood pressure (BP), ocular perfusion pressure (OPP) and intraocular pressure (IOP) were evaluated. Statistical analysis was performed using the Shapiro–Wilk, Levene’s, Spjotvoll–Stoline and analysis of variance tests (p ≤ 0.05 was considered statistically significant).Results: In the oldest group, significantly lower PSV, EDV in the CRA and PCAs as well as MV in the CRA were confirmed. Significantly increased RI in the OA, CRA and PCAs in regard to age was recorded.Conclusions: CDU has considerable potential for evaluating hemodynamic changes in the retrobulbar circulation in relation to age. Age laboratory standards for a specific CDU device should be established for further analyses of blood flow in ocular diseases of vascular origin.

Detection of Hepatic Hemodynamics in Normal Rhesus Monkeys Using High-Frequency Ultrasound

The rhesus monkey liver disease model provides useful information for hepatic research, as studies of hepatic hemodynamics in humans are rare. A 3-9 MHz high-frequency linear transducer (iU22, Philips Medical Systems, Royal Philips Electronics, The Netherlands) was used to obtain ultrasonograms of the livers of 28 normal rhesus monkeys (16 males, 12 females). Diameters of the portal vein and proper hepatic artery; maximum velocity of the portal vein; and peak-systolic and end-diastolic velocity and resistive index of the proper hepatic artery were also assessed. The portal vein and proper hepatic artery were 0.584 ± 0.123 and 0.151 ± 0.052 cm in diameter, respectively. The maximum velocity of the portal vein was 40.2 ± 13.7 cm/s. Peak systolic velocity and resistive index of the proper hepatic artery were 72.2 ± 25.4 cm/s and 0.67 ± 0.10, respectively. We found that high-frequency Doppler ultrasonography can be used to obtain clear portal vein and proper hepatic artery ultrasonograms and to measure the hemodynamic parameters of the portal vein and proper hepatic artery in rhesus monkeys. It is thus an effective method for studying changes in hepatic hemodynamics and has interesting technical and therapeutic implications. Our results provide useful information and establish normal reference values for future studies of adult healthy rhesus monkeys.

Comparing a novel automatic 3D method for LGE-CMR quantification of scar size with established methods

Current methods for the estimation of infarct size by late-enhanced cardiac magnetic imaging are based upon 2D analysis that first determines the size of the infarction in each slice, and thereafter adds the infarct sizes from each slice to generate a volume. We present a novel, automatic 3D method that estimates infarct size by a simultaneous analysis of all pixels from all slices. In a population of 54 patients with ischemic scars, the infarct size estimated by the automatic 3D method was compared with four established 2D methods. The new 3D method defined scar as the sum of all pixels with signal intensity (SI) ≥35 % of max SI from the complete myocardium, border zone: SI 35-50 % of max SI and core as SI ≥50 % of max SI. The 3D method yielded smaller infarct size (-2.8 ± 2.3 %) and core size (-3.0 ± 1.7 %) than the 2D method most similar to ours. There was no difference in the size of the border zone (0.2 ± 1.4 %). The 3D method demonstrated stronger correlations between scar size and left ventricular (LV) remodelling parameters (LV ejection fraction: r = -0.71, p < 0.0005, LV end-diastolic index: r = 0.54, p < 0.0005, and LV end-systolic index: r = 0.59, p < 0.0005) compared with conventional 2D methods. Infarct size estimation by our novel 3D automatic method is without the need for manual demarcation of the scar; it is less time-consuming and has a stronger correlation with remodelling parameters compared with existing methods.

Elite athletes with mitral or aortic regurgitation and their cardiopulmonary capability

Background Aortic or mitral valvular regurgitation (left cardiac valvular regurgitation, LCVR) of less than second-degree (<°II) occasionally found in competitive athletes is of questionable relevance. Precisely detectable by echocardiography there is scarce published data that clarifi es cardiopulmonary capacity or any limitations LCVR <°II may cause.Methods In this single-centre study we consecutively recruited highly trained athletes (n = 14) with LCVR <°II detected in 2D echo. Not included were athletes with multi-or right-cardiac valvular dysfunction and structural heart disease other than bicuspid aortic valve or mitral valve prolaps. Target parameters were determined by 2D echo and spiroergometry.Results There were no signifi cant diff erences with regard to age and body mass index. Echocardiographically determined muscle mass index was increased in both groups (134 ± 14.7 vs 129.6 ± 27.5; P= 0.69), whereas the left-ventricular end-diastolic diameter index was signifi cant higher in the LCVR <°II group (27.3 ± 1.3 vs 25.2 ± 2.4; P= 0.04). However, there were no signifi cant diff erences with regard to (oxygen uptake) VO2 at baseline (athletes with LCVR <°II 5.7 ± 0.9 vs controls 5 ± 0.96, P= 0.06), at the anaerobic threshold (athletes with LCVR <°II 47.3 ± 8.4 vs controls 47.4 ± 5, P= 0.97) and maximally (VO2max; athletes with LCVR <°II 57.7 ± 6.3 vs controls 57.1 ± 5.1, P= 0.81). Neither levels of lactate nor of brain natriuretic peptide diff ered significantly.Conclusion High level athletes presenting with aortic or mitral regurgitation <°II in are not disadvantaged with regard to their cardiopulmonary capability.

Echocardiographic Predictors of Mitral Regurgitation in High School and Collegiate Competitive Athletes

Previous studies have compared cardiac morphology between strength and endurance athletes, but few studies have examined predictors of valvular regurgitation in this population. This study evaluated predictors of mitral regurgitation (MR) in high school and collegiate athletes. Athletes in 9 different sports (n = 144) underwent transthoracic echocardiography. We used 97 sedentary patients as controls. Left ventricular (LV) end-diastolic diameter, septal wall thickness, posterior wall thickness, relative wall thickness (RWT), LV mass, LV volume, and mass/volume ratio were calculated and indexed for body surface area. Valvular regurgitation was graded from 0 to 4. Using logistic regression, RWT was associated with decreased odds of MR, with each 0.07 increase in RWT accounting for a 0.52 decrease in odds of MR (95% confidence interval 0.32 to 0.85, p = 0.009). Differences were best exemplified by comparison of soccer and football players, who represent predominantly aerobic versus predominantly isometric exercise, respectively. Soccer players had a larger LV end-diastolic index (29.2 ± 3 vs 24.9 ± 2.6, p <0.001), lesser RWT (0.33 ± 0.06 vs 0.38 ± 0.08, p = 0.014), and lower mass/volume ratio (1.04 ± 0.21 vs 1.29 ± 0.3, p <0.001), with a greater prevalence of MR (45.8% vs 8.5%). Sedentary subjects were similar to football players in LV volume and soccer players in LV mass. In conclusion, RWT is a negative predictor of MR, with higher values reducing the odds of MR. MR appears to be related to the relation between wall thickness and chamber size rather than chamber size alone.

GW24-e2957 Efficacy of ivabradine in combination with metoprolol versus uptitration of metoprolol in patients after Q-wave myocardial infarction with early left ventricular systolic dysfunction

ObjectivesThe purpose of the study was to evaluate the effect of combination of ivabradine with metoprolol tartrate versus uptitration of metoprolol tartrate on left ventricular (LV) systolic function and plasma...

Reduced thoracic fluid content in early-stage primary biliary cirrhosis that associates with impaired cardiac inotropy

Primary biliary cirrhosis (PBC) is a chronic liver disease characterized by cholestasis. Recent MRI studies have confirmed the presence of cardiac abnormalities in noncirrhotic PBC patients. However, cardiorespiratory consequences of these abnormalities have not been explored. Thoracic fluid content (TFC) is a noninvasive bioelectrical impedance measure of the electrical conductivity of the chest cavity. We explored TFC and its relationship with cardiac contractility parameters in early-stage PBC patients, compared with chronic liver disease and community controls. TFC was measured in early-stage PBC (noncirrhotic; n = 78), nonalcoholic fatty liver disease (n = 23), and primary sclerosing cholangitis (n = 18) and in a community control population (n = 78). Myocardial contractility was measured as index of contractility, acceleration index, cardiac index, stroke index, left ventricular ejection time, and left ventricular work index. We also measured total arterial compliance and the Heather Index (HI; cardiac inotropy). The PBC group had significantly lower TFC compared with controls and the chronic liver disease groups (P < 0.0001). There was an association between increasing TFC and markers of cardiac function (cardiac index, stroke index, end-diastolic index, index of contractility, and acceleration index), together with indicators of cardiac inotropy and total arterial compliance. Multivariate analysis confirmed that the only parameter that independently associated with TFC was the marker of cardiac inotropy HI (P = 0.037; β 0.5). This study has confirmed that TFC is reduced in those with PBC, that this is specific to PBC, and that it associates independently with markers of cardiac inotropy.

Use of transthoracic impedance cardiography and tissue Doppler echocardiography in the cardiovascular assessment of atrial fibrillation patients subjected to electroversion

Atrial fibrillation (AF) is the commonest complex cardiac arrhythmia, affecting approximately 2% of the general population. To describe cardiovascular changes in tissue Doppler echocardiography (TDE) and impedance cardiography (ICG) in AF patients subjected to cardioversion. Forty-one patients (22 males and 19 females) with acute or persistent AF were examined by means of TDE and transthoracic ICG before electroversion, and then one week following the restoration of sinus rhythm. Additionally, the preand post-cardioversion serum levels of B-type natriuretic peptide (BNP) were determined. The restoration of sinus rhythm was reflected by a significant increase in the following ICG parameters (average changes are presented): stroke volume (+25 mL), stroke volume index (+11.8 m/m²), contractility index (+12.6/s), end-diastolic index (+12.3 mL/m²), acceleration index (+6/s²), and left ventricular ejection time (+56 ms). These changes were accompanied by a significant increase in the TDE parameters of tricuspid annular systolic velocity and mitral annular systolic velocities. Moreover, a significant decrease in early diastolic velocities was also observed following the restoration of sinus rhythm, along with significantly lower levels of BNP. Both TDE and ICG are modern, valuable diagnostic methods that complementarily explain changes occurring in the cardiovascular system of AF patients subjected to electroversion.

The Effects of Total Thyroidectomy on Cardiac Function in Old Rats using Echocardiographic Measures

Objectives: Doppler Echocardiography has been shown to reflect thyroid hormone action in primary thyroid dysfunction. The aim of the present study was to evaluate the cardiac function after total thyroidectomy in old rats using echocardiographic measures. Methods: Female Wistar rats aged 24 months old (referred to as adult) were divided into 2 groups with 15 animals each: Euthyroid (Eut) and Hypothyroid (Hypo) rats. Hypothyroidism was induced by total thyroidectomy. The plasmatic levels of T3, T4, TSH and free ionic calcium were measured. Echocardiographic analysis was performed using the following parameters: left ventricular end-diastolic (LVED) left ventricular end-systolic (LVES), ejection fraction (EF) and Tei index. Results: In both groups, the LVES ranged from 0.2 to 0.5 p <0.048 and the EF from 50.3 to 45.2 p<0.030.There was not statistically significant difference in HR, LVED and Tei-index values. It was observed decrease in T3 levels (72.0 to 30.4 μg/dl, p<0.001) and T4 levels (3.1 to 0.4 μg/dl, p<0.001) and increase in TSH levels (1.6 to 40.7 mU/mol, p<0.001) in Hypo group. The free ionic calcium levels increased from 0.1 to 0.9 mmol/L (p<0.001) in Hypo group. Conclusion: It was identified a reduction of cardiac function in old animals with hypothyroidism using Doppler- Echocardiography measures. These results indicated that hypothyroidism is associated with impairment in cardiac function in old patients and that Doppler echocardiography, is a useful and noninvasive tool for the diagnosis of cardiac dysfunction induced by this thyroid disorder.

An initial study on left ventricular diastolic function in patients with hypertrophy cardiomyopathy using single-beat, real-time, three-dimensional echocardiography

ObjectivesTo assess the regional diastolic function in patients with hypertrophic cardiomyopathy (HCM) by using single-beat, real-time, three-dimensional echocardiography (RT-3DE).MethodsSixty-five patients with HCM in sinus rhythm together with fifty age- and gender-matched normal controls were studied by two dimensional echocardiography (2DE) and RT-3DE. The parameters analyzed by RT-3DE included: left ventricular (LV) volumes, left ventricular ejection fraction (LVEF), end diastolic sphericity index (EDSI), diastolic dyssynchrony index (DDI), dispersion end diastole (DISPED), and normalized 17 segmental volume-time curves.ResultsEvaluated by RT-3DE, LVEF was slightly lower compared with 2DE (63.2 ± 6.8% vs. 59.1 ± 6.4%, P < 0.0001). Normal subjects had relatively uniform volumetric curves for all LV segments. In HCM patients, the segmental volumetric curves were dyssynchronous. Increased DDI and DISPED in end diastole were observed in patients with HCM (9.95 ± 3.75, 41.76 ± 17.19, P < 0.0001), and not all abnormal volumetric segments occurred in the hypertrophic regions.ConclusionsPatients with HCM have presented regional diastolic dyssynchrony in the diastole phase, and this preclinical lesion can be recognized by single-beat RT-3DE.

P 23: The possible contribution of thyroid hormones to insulin effect on beta adrenoceptor mediated cardiac responses in diabetic rats

As is well known, diabetes-induced cardiovascular complications are leading factors of morbidity and mortality. Among them atherosclerosis, hypertension and heart failure are most important ones. The very first problem seen in diabetic heart is the decrease of beta adrenoceptor mediated cardiac responses. The decrease of catecholamine stimulated beta adrenoceptor responsiveness is mostly associated with diminished receptor sensitivity and density. Insulin treatment of diabetic rats has been demonstrated to correct these parameters. However, the improving effect of insulin is shown to be abolished in tyhroidectomized diabetic rats. Although the effect of the relationship between these two hormones on some pathways has already been studied, their exact role on beta adrenoceptor mediated cardiac responses is uncertain. Thus in the present study, we aimed to determine the possible relationship between insulin and thyroid hormones to normalization of diabetes induced cardiac abnormalities. Male Sprague-Dawley rats were used for this study. Ten days after surgical thyroidectomy, diabetes was induced with 38mg/kg streptozotocin by a single intravenous tail-vein injection. After 6-weeks of-diabetes induction, some groups (D-I, TxD-I) were treated with insulin (5–20U/kg/day, subcutan), some other groups (TxD-I-T2.5, TxD-I-T5) were administered insulin + thyroid hormone combination (2,5 or 5ug/kg/day T3 via osmotic minipump) for 2 weeks. Cardiac function was determined by the assessment of in vivo pressure-volume (PV) analysis and in vitro left ventricular papillary muscle experiments (isoprenaline, 0,0001uM-3uM; forskoline, 3uM). mRNA expressions of β1-AR and SERCA were evaluated by QPCR. Heart rate and end systolic pressure were markedly reduced in diabetic (D) and thyroidectomized diabetic (TxD) groups; however, they were improved with insulin treatment in D group. On the other hand, in TxD group, only insulin and 5ug/kg T3 combination (TxD-I-T5) ameliorated these parameters. End diastolic pressure and ejection fraction were found to be unchanged between the groups. Rate of contraction and relaxation, time constant of left ventricle pressure decay were reduced in D and TxD groups. These parameters were corrected significantly in D-I and TxD-I-T5 groups. Cardiac index was reduced in D and TxD groups. This parameter was not increased markedly in any of the treated groups. End systolic volume index was raised in D and TxD groups, and reduced only in D-I group. End diastolic pressure index was also increased in D and TxD groups. It was significantly decreased in D-I and TxD-I-T5 group. Isoprenaline, a nonselective β-AR agonist, induced concentrationdependent positive inotropic effects on papillary muscles of control rats (C). Maximum response (Emax) was markedly diminished in D and TxD groups. These parameters were ameliorated in D-I group significantly. Furthermore, in TxD-I-T5 group, the contractile response was enhanced compared to TxD group. Forskolin induced positive inotropic effect in all groups. The response was decreased in D and TxD groups. Insulin treatment improved this decrease in D-I and TxD-I-T5 groups. β1-AR mRNA levels were decreased both in D and TxD groups. Insulin treatment increased β1-AR mRNA levels. In TxD-I group insulin did not increase β1-AR mRNA levels. On the other hand, in TxD-I-T5 group β1-AR mRNA levels were significantly increased compared to TxD, TXD-I and TxD-I-T2.5 groups. SERCA mRNA levels were also found to be reduced in D and TxD groups. Insulin treatment did not correct the decrease in mRNA levels of SERCA of D and TxD groups. In TxD-I-T5 group, SERCA mRNA levels were significantly increased compared to TxD, TXD-I and TxD-I-T2.5 groups. Both in vivo and in vitro cardiac experiments showed that heart function was impaired in D and TxD groups. Insulin exerted beneficial effects only in D-I and TxD-I-T5 groups. As no improvement was seen in TxD-I group, it could be thought that insulin could not reverse beta adrenoceptor mediated cardiac responses in thyroid deficiency. The slight but still insignificant recovery that we observed in TxD-I-T2.5 group could be interpreted with inadequacy of T3 dose.

Predicting Left Ventricular Recovery After Replacement of a Regurgitant Aortic Valve in Pediatric and Young Adult Patients: Is It Ever Too Late?

The management of pediatric and adolescent patients with pure aortic valve regurgitation remains challenging and controversial (Christos et al., Eur J Cardiothorac Surg 17:125-133, 2000; Gersony and Sommerville, ACC Curr J Rev 31:97-98, 2000; Hasaniya et al., J Thorac Cardiovasc Surg 127:970-974, 2004; Sabet et al., Mayo Clin 74:14-26, 1999; Tweddell et al., J Thorac Cardiovasc Surg 129:551-558, 2005). We evaluated pediatric and young adult patients who underwent aortic valve replacement (AVR) primarily for aortic regurgitation in an effort to identify preoperative echocardiographic variables that are predictive of left ventricular (LV) recovery following AVR. Twenty-one patients with severe aortic valve regurgitation who underwent AVR were identified. Retrospective chart review for each patient was performed and transthoracic echocardiograms prior to and 6-months after AVR were analyzed. Improvement in LV size based on preoperative LV end-systolic dimension index when compared to 6-months post-AVR was observed in 68% of the patients. Patients with persistent dilation of their left ventricles had a greater preoperative LV end-systolic dimension index (p ≤ 0.05), a greater preoperative LV end-systolic dimension z-score (p ≤ 0.002), and a lower preoperative ejection fraction (EF) (p ≤ 0.001). A similar trend was present between the two cohorts in regards to LV end-diastolic parameters (LV end-diastolic dimension index and z-score), with patients with abnormal LV size at 6-month follow-up having larger preoperative dimensions. Increasing LV systolic dimensions and declining EF appear to be predictors of poor LV recovery following AVR in pediatric and young adult patients. LV end-systolic indices appear to be more predictive than LV end-diastolic indices. AVR should be performed prior to severe LV enlargement defined as an LV end-systolic dimension z-score >4.5.

11 Fluid Therapy Should be Guided by Fluid Responsiveness

BackgroundTo predict fluid response is very Important because a little or excessive expansion may alter the prognosis of the child in shock.MethodsWe review experimental and clinical articles in adult and...

The impact of ischemic preconditioning on hemodynamic, biochemical and inflammatory alterations induced by intra-abdominal hypertension: an experimental study in a porcine model

Intra-abdominal hypertension (IAH) has several pathophysiologic implications on human organs and systems. The aim of this experimental study was to investigate whether ischemic preconditioning (IP), namely the application of IAH for a small period of time prior to establish pneumoperitoneum, can attenuate the hemodynamic, biochemical and inflammatory alterations observed during IAH. Twenty-four pigs were divided into three groups: group A (control group), group B (pneumoperitoneum of 30mmHg) and group C (ischemic preconditioning, consisting of pneumoperitoneum of 25mmHg for 15min and subsequent pneumoperitoneum of 30mmHg). Hemodynamic (central venous pressure, cardiac index, mean arterial pressure, heart rate, stroke volume index, systemic vascular resistance index, global end-diastolic index, intrathoracic blood index and extravascular lung water index), biochemical (serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), urea and creatinine) and inflammatory (tumour necrosis factor-α, interleukin (IL)-6, IL-10 and C-reactive protein) parameters were measured. (a) Hemodynamics: The increase of central venous pressure monitoring and heart rate and the decrease of cardiac index, mean arterial pressure, stroke volume index, global end-diastolic volume index and intrathoracic blood volume index with the establishment of pneumoperitoneum were attenuated by IP. Systemic vascular resistance index and extravascular lung water were not affected. (b) Urea significantly increased with the pneumoperitoneum. IP, however, attenuated this effect. Οther biochemical parameters (SGOT, SGPT, ALP, γ-GT and creatinine) had a similar upward trend during IAH, which was reversed with IP. (c) Inflammatory parameters: CRP was increased with pneumoperitoneum, an effect that was attenuated with the application of IP. Νo significant differences were observed for interleukins. Ischemic preconditioning seems to attenuate the pathophysiologic alterations of several hemodynamic, biochemical and inflammatory parameters observed during IAH.

Postoperative Recurrence of Mitral Regurgitation After Annuloplasty for Functional Mitral Regurgitation

We investigated predictive factors of postoperative recurrence of mitral regurgitation (MR) after mitral valve annuloplasty for functional ischemic MR. This study was a retrospective review of patients with functional MR who underwent mitral ring annuloplasty at our institution from 1998 to 2008. Records were reviewed for perioperative variables, including echocardiographic measurements. Recurrence was defined as MR grade moderate (3+) or greater on any postoperative echocardiogram. Of 548 patients who underwent mitral annuloplasty for functional MR, echocardiogram reports were available for review for 250. These patients comprised the study cohort. There were 154 patients with concomitant coronary artery bypass grafting. The left ventricular (LV) end-diastolic (LVED) index was calculated by dividing the LVED dimension by body surface area (BSA). A high LVED index (>3.5 cm/m2) was predictive of MR recurrence (p=0.047): the recurrence rate was 20.3% (13 of 64) in high-index patients and 10.2% (19 of 186) in low-index (<3.5 cm/m2) patients. Median recurrence-free survival was 35 months (range, 19 to 59 months) in high-LVED-index patients and 46.5 months (range, 22 to 75 months) in low-LVED-index patients (p=0.048). Preoperative MR severity and LV ejection fraction were not predictive of MR recurrence. Careful analysis of the preoperative echocardiogram using a novel, easily calculated variable, the LVED index, may help identify patients who are at greater risk for MR recurrence and reduced survival. Such information could prompt consideration of alternative or additional interventions in these patients.

Evaluation of cardiac functions in term small for gestational age newborns with mild growth retardation: A serial conventional and tissue Doppler imaging echocardiographic study

BackgroundThe aim of this study is to evaluate the cardiac functions of term small for gestational age (SGA) babies with mild growth retardation by echocardiography during the postnatal period. Methods and resultsThirty term SGA (2271±207g/38–41weeks (mean 39.5weeks)) and 30 term AGA (3298±338g/38–41weeks (mean 39weeks)) newborns as the control group, with normal general health status and with no nutritional problems were evaluated at three time points, on the 3rd postnatal day, at the 3rd and the 6th months. In the initial analysis, heart rate, left ventricular end diastolic diameter index (LVEdDI), cardiac index (CI), all E/A, Em/Am and E/Em ratios, pulsed wave Doppler myocardial performance index (MPI), and tissue Doppler imaging MPI values were higher in SGA babies than the control group. In the last analysis, only heart rate, LVEdDI and CI values were different between SGA and control groups. ConclusionsSystolic and diastolic cardiac dysfunctions were determined in SGA babies with mild growth retardation during the first 6months of postnatal period. Any disease that affects the hemodynamic stability of these patients during postnatal period may lead to early progressive deterioration in cardiac functions. Furthermore, many of the cardiac functions of these babies have been improved about the 6th month period, and high levels of heart rate and LVEdDI may be suggested as an indicator of cardiac remodeling.

Effects of alprostadil on hemodynamic parameters of intrinsic artery of kidney in the early stage of rental inadequacy in diabetic nephropathy observed by color doppler ultrasonography

To investigate the effects of alprostadil on the change of hemodynamic parameters of intrinsic artery of kidney in the early stage of renal inadequacy in diabetic nephropathy and the application value of color doppler ultrasonagraphy. Thirty normal subjects were in control group, while fifty subjects were in the treatment group who were diagnosed as being in the early stage of rental inadequacy in diabetic nephropathy. Color doppler ultrasonography was used to examine the segmental rental artery (SRA), interlobular artery (IRA) and arcuate rental cortex artery (ARA), meanwhile observation and analyses were made towards its peak systolic blood flow velocity (Vsmax), end diastolic blood flow velocity (Vdmin) and pulse index (RI). Compared with the control group, Vdmin and Vsmax of SRA, ARA and IRA was reduced markedly before Alprostadil treatment, but RI rised remarkably (P<0.05). Vsmax of SRA and Vdmin of SRA and ARA were up evidently (P<0.05), but RI decreased significantly (P<0.05). Color doppler ultrasonography is of value in assessing renal inadequacy of diabetic nephropathy. Alprostadil plays an active role in improving renal bloodstream in the early stage of renal inadequacy in diabetic nephropathy, and RI can be served as a sensitive index to evaluate its effect. Key words: Diabeticnephropathy, color doppler ultrasonography, alprostadil, intrinsic artery of kidney, resistance index.

Predicting Erectile Dysfunction Following Surgical Correction of Peyronie's Disease without Inflatable Penile Prosthesis Placement: Vascular Assessment and Preoperative Risk Factors

Surgical therapy remains the gold standard treatment for Peyronie's Disease (PD). Surgical options include plication, grafting, and placement of inflatable penile prosthesis (IPP). Postoperative erectile dysfunction (ED) is a potential complication for PD surgery without IPP. We present our large series follow-up to evaluate preoperative risk factors for postoperative ED. The aim of this study is to evaluate preoperative risk factors for the development of ED following surgical correction of PD taking into account the degree of curvature, graft size, surgical approach, hypertension, hyperlipidemia, diabetes, smoking history, preoperative use of phosphodiesterase 5 inhibitors (PDE5), and preoperative duplex ultrasound findings including peak systolic and end diastolic velocities and resistive index. We identified 218 men undergoing either tunica albuginea plication (TAP) or partial plaque excision with pericardial grafting for PD following a previously published algorithm between November 1992 and April 2007. Preoperative and postoperative erectile function, curvature characteristics, presence of vascular risk factors, and duplex ultrasound findings were available on 109 patients. Our primary outcome measure is the development of ED after surgery for PD. Ten percent of TAP and 21% of plaque excision with grafting patients developed postoperative ED. Neither curve direction (P = 0.76), graft area (P = 0.78), surgical approach (P = 0.12), chronic hypertension (P = 0.51), hyperlipidemia (P = 0.87), diabetes (P = 0.69), nor smoking history (P = 0.99) were significant predictors of postoperative ED. No combination of risk factors was found to be predictive of postoperative ED. Preoperative use of PDE5 was not a significant predictor of postoperative ED (P = 0.33). Neither peak systolic, end diastolic, nor resistive index were significant predictors of ED (P = 0.28, 0.28, and 0.25, respectively). This long-term follow-up of a large published series suggests that neither preoperative risk factors nor preoperative duplex ultrasound findings are predictive of postoperative ED, thus reinforcing the use of previously published preoperative treatment algorithms.