End-diastolic Internal Diameter Research Articles

Effect of Maximal Exercise on the Heart Rate, Blood Pressure and Level of Cardiac Remolding in Elite Athletes

Aim / Objective: The purpose of this study was to determine how intense exercise effect the blood pressure, heart rate and the extent upto, which the cardiac remolding may occur in elite athletes. Location of Study: This study was conducted in the Department of Physiology, Army Medical College, along with the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Methodology: There were 40 control participants and 40 elite endurance athletes. Clinical tests were performed on all the subjects to rule out an underlying medical condition or disease. Auscultatory method was used to measure the heart rate before exercise and immediately after exercise, Similarly the blood pressure was examined before and within 3 minutes after the physical activity. The left ventricular end-diastolic internal diameter (LVIDd), diastolic posterior wall thickness (PWTd), diastolic interventricular septal thickness (IVSTd), and left ventricular mass (LVM) were measured by echocardiography and determined using the Devereux formula. Before breakfast, the participants engaged in maximum physical activity on an electronic ergometer cycle until they were exhausted. Results: It was observed that when compared to the control group, the heart rates and blood pressure of athletes were noticeably lower. In contrast, LVIDd, IVSTd, PWTd, and LVM were higher in athletes than in healthy controls... Conclusion: The long term athletic training causes remodeling of the heart with increased dimensions of the left ventricle which reduces the heart rate and blood pressure in endurance trained athletes.

Two-dimensional speckle-tracking echocardiography in left ventricular systolic function in patients with systemic lupus erythematosus.

To investigate whether two-dimensional speckle-tracking echocardiography (2DSTE) can be considered a criterion for early left ventricular (LV) systolic impairment in patients with systemic lupus erythematosus (SLE) and to further explore the association with each other. We included 38 patients with SLE and assessed the degree of disease activity according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring criteria, together with 38 healthy controls who were matched by sex and age. Routine LV systolic function evaluation parameters were obtained by echocardiography as well as 2DSTE measurement of LV strain parameters to obtain global longitudinal strain (GLS) values, respectively. (I) On routine LV function parameters such as ejection fractions (EF) and left ventricular end-diastolic internal diameter (LVIDd), the SLE group and the control group did not reflect differences. In contrast, on the LV strain parameter obtained from 2DSTE measurements, the GLS values in all cardiac planes were lower in the SLE group than in the control group and showed statistically significant differences. (II) Correlation analysis showed that there was a correlation between SLEDAI and GLS, especially a meaningful correlation with GLS Avg and GLS A4C, with correlation coefficients of 0.35 and 0.47, respectively. The use of 2DSTE can detect early impaired LV systolic function in SLE patients, and GLS is progressively gaining attention as an indicator of subclinical myocardial injury and LV function in SLE patients. The correlation that exists between GLS and SLEDAI might contribute to a better assessment of cardiac involvement in SLE patients. Key Points • Cardiac involvement has become one of the major factors in the poor prognosis of SLE patients, which directly affects the mortality of SLE patients. Traditional echocardiography is difficult to detect early left ventricular function impairment, thus affecting clinicians' judgment and diagnosis. • 2DSTE can recognize subclinical myocardial injury in SLE patients at an early stage, and its derived strain parameters may be used as an indicator to evaluate myocardial involvement and reflect disease activity in SLE patients.

The athlete's heart: allometric considerations on published papers and relation to cardiovascular variables.

To evaluate the morphology of the "athlete's heart", left ventricular (LV) wall thickness (WT) and end-diastolic internal diameter (LVIDd) at rest were addressed in publications on skiers, rowers, swimmers, cyclists, runners, weightlifters (n = 927), and untrained controls (n = 173) and related to the acute and maximal cardiovascular response to their respective disciplines. Dimensions of the heart at rest and functional variables established during the various sport disciplines were scaled to body weight for comparison among athletes independent of body mass. The two measures of LV were related (r = 0.8; P = 0.04) across athletic disciplines. With allometric scaling to body weight, LVIDd was similar between weightlifters and controls but 7%-15% larger in the other athletic groups, while WT was 9%-24% enlarged in all athletes. The LVIDd was related to stroke volume, oxygen pulse, maximal oxygen uptake, cardiac output, and blood volume (r = ~ 0.9, P < 0.05), while there was no relationship between WT and these variables (P > 0.05). In conclusion, while cardiac enlargement is, in part, essential for the generation of the cardiac output and thus stroke volume needed for competitive endurance exercise, an enlarged WT seems important for the development of the wall tension required for establishing normal arterial pressure in the enlarged LVIDd.

Analysis of the Effect of Extended Rehabilitation Care at Home on the Psychological Condition and Adherence to Medical Compliance Behavior of Patients with Coronary Heart Disease Combined with Heart Failure

Objective: To analyze the effects of providing extended rehabilitation nursing services at home to patients with coronary heart disease (CHD) combined with heart failure (CHF) on psychological improvement and adherence to medical compliance behavior. Methods: 79 patients with CHD with CHF admitted to Sijia Town Central Health Hospital, Haimen District, Nantong City, Jiangsu Province, between June 2021 and June 2023 were selected and grouped according to the randomized numerical table method. The control group (39 cases) was provided with conventional nursing care and extended rehabilitation nursing care at home was provided to the observation group (40 cases). The psychological status, adherence to medical behaviors, cardiac function, and complications between both groups were compared. Results: The scores of anxieties and depression self-assessment scales (SAS, SDS) of patients in the observation group were lower than those of the control group (t = 2.954, 3.212; P &lt; 0.05); the compliance of patients in the observation group was higher than that of the control group (P &lt; 0.05). The levels of left ventricular ejection fraction, end-systolic and end-diastolic internal diameters (LVEF, LVESD, LVEDD) of patients in the observation group at 58.02 ± 5.34 %, 44.49 ± 5.16 mm, and 49.16 ± 5.76 mm respectively were better than those of the control group after nursing care (t = 3.205, 3.288, 2.633; P &lt; 0.05); the complication rate of the observation group was lower than that of the control group (P &lt; 0.05). Conclusion: Extended rehabilitation nursing at home exhibited a psychological regulation effect on CHD with CHF patients, improved their medical compliance, improved cardiac function, reduced the incidence of complications, and had significant application value.

Effect of cardiac rehabilitation care after coronary intervention on cardiac function recovery and negative mood in patients with myocardial infarction.

Cardiovascular disease, particularly myocardial infarction (MI) profound impact on patients' quality of life and places a substantial burden on the healthcare and economy systems. Developments in medical technology have led to the emergence of coronary intervention as an essential method for treating MI. To assess the effects of cardiac rehabilitation care on cardiac function recovery and negative emotions in MI after coronary intervention. This study included a total of 180 patients with MI during the period from June 2022 to July 2023. Selected patients were divided into two groups: An observation group, which receiving cardiac rehabilitation care; a control group, which receiving conventional care. By comparing multiple observation indicators such as cardiac function indicators, blood pressure, exercise tolerance, occurrence of adverse cardiac events, and negative emotion scores between the two groups of patients. All the data were analyzed and compared between two groups. There were 44 males and 46 females in the observation group with an average age of 36.26 ± 9.88 yr; there were 43 males and 47 females in the control group, with an average age of 40.87 ± 10.5 yr. After receiving the appropriate postoperative nursing measures, the results of the observation group showed significant improvement in several indicators compared with the control group. Indicators of cardiac function, such as left ventricular end-diastolic internal diameter and left ventricular ejection fraction were significantly better in the observation group than in the control group (P < 0.05). Exercise endurance assessment showed that the 6-minute walking test distance was significantly increased in the patients of the observation group (P < 0.01). In addition, the incidence of adverse cardiac events was significantly lower in the observation group, and negative mood scores were significantly reduced (P < 0.05). Cardiac rehabilitation care after coronary intervention has a significant positive impact on functional recovery. This emphasizes the importance of cardiac rehabilitation care to improve patient recovery.

Radiographic and echocardiographic evaluation in rescued Korean raccoon dogs (Nyctereutes procyonoides koreensis).

Nyctereutes procyonoides koreensis (Korean raccoon dog), a member of the Canidae family, is anatomically similar to dogs. Previous studies have used vertebral heart scale measurements to measure the cardiac size of Korean raccoon dogs on thoracic radiographs; however, the use of additional cardiac size indices, such as vertebral left arial score, intercostal space, cardiothoracic ratio, and echocardiographic indices, has not been reported. Therefore, this study aimed to establish normal reference ranges for various thoracic radiographic and echocardiographic indices in normal Korean raccoon dogs. Twenty-six Korean raccoon dogs (11 males and 15 females) were included in this study. The thoracic radiographic indices, vertebral heart scale score, and vertebral left atrial score were measured in the right lateral view. The intercostal space and cardiothoracic ratio were measured in the ventrodorsal view. The echocardiograms were evaluated in the right parasternal long and short axis view and left parasternal apical view. The mean values for the thoracic radiographic and echocardiographic indices were as follows: vertebral heart scale, 9.12 ± 0.74; vertebral left atrial score, 1.5 ± 0.31; intercostal spaces, 3.17 ± 0.34; cardiothoracic ratio, 0.69 ± 0.07; left atrial to aortic root ratio, 1.22 ± 0.14; main pulmonary artery to aorta ratio, 1.22 ± 0.14; left ventricular end-diastolic internal diameter normalized for body weight, 1.36 ± 0.19; end-diastolic volume index, 51.07 ± 19.6; end-systolic volume index, 16.54 ± 7.45; the peak velocity of early diastolic transmitral flow, 73.13 ± 15.46 cm/s; and the ratio between the transmitral flow velocities and the peak early diastolic velocity, 1.77 ± 0.47. Only percent increase in the left ventricular end-systolic internal diameter was negatively correlated with body weight. The remaining indices showed no correlations with body weight. To the best of our knowledge, this is the first case report covering both thoracic radiographic and endocardiographic indices for Korean raccoon dogs. Thus, the thoracic radiographic and echocardiographic indices established in this study may be used to evaluate the cardiac condition of Korean raccoon dogs.

Resveratrol Inhibited Nanoparticles Stromal Interaction Molecule 2 in Regulating miR-20b-5p Signaling Pathway to Improve Mitochondrial Function During Myocardial Ischemia-Reperfusion Injury

Myocardial ischemia-reperfusion (IR) in diabetes can cause severe myocardial damages. In this study, resveratrol (RES) nanoparticles were used in diabetic myocardial IR rat model injury to assess its effect on mitochondria function. Rat models were assigned into sham group, IR group, IR+RES group, IR+RES+mir-NC group, and IR+RES+miR-20b-5p inhibitor group. Myocardial infarction area was measured by TTC in 5 rats from each group, and ultrasound was used to detect left ventricular end-systolic internal diameters (LVIDs) and end-diastolic internal diameters (LVIDd), along with analysis of cardiomyopathy by HE staining. miR-20b-5p and Stromal interaction molecule 2 (STIM2) expressions, cardiomyocyte proliferation, apoptosis, cell viability, mitochondrial function, and relationship between miR-20b-5p and STIM2 were also analyzed. Resveratrol (RES) nanoparticles were prepared successfully. Myocardial infarct size, LVIDd and LVIDs of rats in IR+RES group decreased (vs. IR group), but were higher than sham group. miR-20b-5p expression also increased in the IR+RES group (vs. IR group), and the above indicators were decreased by the miR-20b-5p inhibitor (vs. IR+RES group, P &lt;0.05). The myocardial changes in rats from the IR+RES+miR-20b-5p antagomir group were smaller (vs. IR group), while STIM2 expression was lower than in the IR group after using the RES nanoparticles (P &lt; 0.05). RES nanoparticles can thus enhance mitochondrial function and cell viability of cardiomyocytes, increasing cell proliferation rate and decreasing apoptosis rate (vs. IR group,P &lt;0.05). After using the RES nanoparticles to interfere with myocardial IR in the diabetic rats, they were found to inhibit STIM2 and improve mitochondria by regulating miR-20b-5p signaling pathway.

Effect of electroacupuncture on myocardial fibrosis in spontaneously hypertensive rats based on cholinergic anti-inflammatory pathway

To observe the effect of electroacupuncture (EA) at "Neiguan" (PC 6) on myocardial fibrosis in spontaneously hypertensive rats (SHR), and explore preliminarily the mediating role of cholinergic anti-inflammatory pathway (CAP) and its downstream nuclear factor κB (NF-κB) signaling pathway. Six 12-week-old WKY male rats were employed as the normal group. Eighteen 12-week-old SHR were randomly divided into 3 groups, i.e. a model group, an EA group and a blocking group (EA after blocking α7 nicotinic acetylcholine receptor [α7nAchR]), with 6 rats in each one. In the EA group, EA was delivered at "Neiguan"(PC 6) and the site 0.5 cm from its left side, with disperse-dense wave, 2 Hz/15 Hz in frequency and 1 mA in current intensity. One intervention took 30 min and was given once every 2 days, lasting 8 weeks. In the blocking group, prior to each EA, the α7nAchR specific blocker, α-bungartoxin was injected intravenously in the tails of the rats. After EA intervention, the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the mean arterial pressure (MAP) were measured with non-invasive blood pressure monitor. Using echocardiogram, the left ventricular (LV) anterior wall end-diastolic thickness (LVAWd) , LV posterior wall end-diastolic thickness (LVPWd) and the LV end-diastolic internal diameter (LVIDd) were measured. The level of hydroxyproline (Hyp) in the myocardial tissue was determined by using alkaline hydrolysis, and that of acetylcholine (Ach) was detected by ELISA. With the real-time PCR adopted, the mRNA expression of NF-κB p65, tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 were determined. Compared with the normal group, SBP, DBP, MAP, LVAWd and LVPWd were increased (P<0.01), and LVIDd was decreased (P<0.01) in the rats of the model group. SBP, DBP, MAP and LVAWd were dropped (P<0.01, P<0.05), and LVIDd rose (P<0.01) in the EA group when compared with those in the model group. The differences in the above indexes were not statistically significant between the blocking group and the model group (P>0.05). Compared with the normal group, Hyp level and the mRNA expression of NF-κB p65, TNF-α, IL-1β and IL-6 in the myocardial tissue increased (P<0.01, P<0.05) and Ach level decreased (P<0.01) in the model group. Hyp level, the mRNA expression of NF-κB p65, TNF-α, IL-1β and IL-6 in the myocardial tissue were reduced (P<0.05, P<0.01) and Ach level rose (P<0.01) in the EA group when compared with those in the model group. These indexes were not different statistically between the blocking group and the model group (P>0.05). CAP may be involved in ameliorating the pathological damage of myocardial fibrosis during EA at "Neiguan"(PC 6). The underlying effect mechanism is associated with up-regulating the neurotransmitter, Ach and down-regulating mRNA expression of NF-κB p65 and pro-inflammatory factors such as TNF-α, IL-1β and IL-6 in myocardial tissue.

M-Mode Echocardiography in Canine Veterinary Practice: A Comprehensive Review of Left Ventricular Measurements in 44 Different Dog Breeds.

This review article focuses on the use of canine M-mode in veterinary medicine, specifically in assessing the left ventricle measurements in several breeds. It traces the historical development of echocardiography techniques, including A-mode, B-mode, and motion mode (M-mode), which provide accurate unidimensional records of cardiac structures. This article highlights the significance of M-mode measurements in diagnosing stage B2 of MMVD, where left ventricular end-diastolic internal diameter corrected with body weight (LVIDdN) is essential for identifying cardiac enlargement. It also explains the role of M-mode in diagnosing DCM, outlining criteria such as left ventricular dilatation. The authors emphasize the importance of breed-specific reference values for echocardiographic measurements due to variations in somatotype among dogs. This review provides a comprehensive table summarizing M-mode measurements of the left ventricle for 44 different dog breeds, including interventricular septum thickness, left ventricular internal diameter, and left ventricular posterior wall thickness during systole and diastole. This review's methodology involves compiling data from various scientific literature sources, providing an extensive tabular representation of M-mode measurements for different breeds, ages, and sexes. Overall, this review highlights the critical role of M-mode echocardiography in diagnosing and managing cardiac diseases in dogs, underscores the importance of breed-specific reference values, and presents a comprehensive summary of M-mode measurements for various dog breeds, aiding both clinicians and researchers.

The association between erector spinae muscle content and chronic heart failure and its severity.

Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF. A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626-0.811, P<0.001). Compared with the HFpEF group, the HFrEF group has a lower prevalence of CHD, LVEF decreased significantly, the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly, also patients in the HFrEF group had significantly lower ESM content compared with patients in the HFpEF group, and ESM is an independent predictor of the severity of heart failure, with an odds ratio of 0.514 (HFrEF group vs. HFpEF group, 95% confidence interval (0.418-0.633, P<0.05). The results of receiver operating curve analysis showed that the sensitivity and specificity of ESM content for the diagnosis of CHF were 65.6% and 71.6%, respectively, while the sensitivity and specificity of ESM content for predicting the severity of CHF were 47.1% and 89.1%, respectively. The ESM is of great value in predicting the onset and severity of CHF.

Relationship between ODI and sleep structure of obstructive sleep apnea andcardiac remodeling.

The purpose of the study was to evaluate the quantitative relationship between Oxygen Desaturation Index (ODI) and sleep structure of obstructive sleep apnea (OSA)and cardiac remodeling. In this study, patients were enrolled from January 2015 to October 2022, and were divided into 3 groups according to AHI: patients with AHI < 15, patients with 15 ≤ AHI < 30, and 260 patients with AHI ≥ 30. Stratified linear regression was used to analyze independent risk factors for cardiac remodeling in OSA. A total of 479 patients were enrolled.We found that compared with AHI < 15 group(n= 120), the group with AHI > 30 (n= 260)had increased left atrial anteroposterior diameter, left ventricular end-diastolic internal diameter, left ventricular posterior wall thickness, right ventricular anteroposterior diameter, and interventricular septal thickness (P < 0.05). The group with 15 ≤ AHI ≤ 30 (n= 99)had increased left atrial anteroposterior diameter (P < 0.05). Multivariate linear regression revealed that N2 sleep was an independent risk factor for left ventricular posterior wall thickness, with positive correlation (p < 0.05).N3 sleep was an independent risk factor for transverse right atrial diameter and right ventricular anteroposterior diameter, with negative correlation (P < 0.05).ODI was an independent risk factor for interventricular septal thickness, with positive correlation (P < 0.05).The arousal index was an independent risk factor for increased left atrial anteroposterior diameter, with positive correlation (P < 0.05). Increased ODI is an independent risk factor for interventricular septal thickness, while decreased slow wave sleep is an independent risk factor for right heart remodeling in OSA.

Investigating the effects of thermoneutral housing on skeletal and cardiac muscle function in D2 mdx mice

Since its discovery, the mdx mouse has been the foundation for research on Duchenne muscular dystrophy (DMD) and its potential therapies. Although, nearly all studies using mdx mice as an experimental model have been conducted under “standard” lab conditions using room (22C) instead of thermoneutral (TN, 30C) temperature housing. Room temperature (RT) is a mild cold stress to mice, causing metabolic adaptations that can confound experimental results, limiting their interpretation and translation to humans. This study investigated the effects of housing temperature on whole-body metabolism and skeletal and cardiac muscle function in the mdx mouse. To this end, 20 D2 mdx mice (age 5 weeks, n = 10 per group) were housed at RT and TN for 10 weeks. Metabolic cage analysis demonstrated that TN housed mdx mice displayed significantly decreased VO2 consumption and reduced food intake that was likely due to lowered daily energy expenditure. TN housed mice also had significantly lower respiratory exchange ratio values, indicative of increased fat metabolism. However, there were no differences in body mass or composition (i.e., % lean and fat mass). Treadmill-to-fatigue experiments revealed no differences in exercise performance. Furthermore, ex vivo muscle contractility analysis displayed no differences in extensor digitorum longus or soleus specific force generation between TN and RT housed mice. Analysis of cardiac structure/function demonstrated that TN housed mdx mice exhibited a reduction in cardiac output, which we attributed to diastolic dysfunction. While ejection fraction and fractional shortening were not different among the two groups, TN housing led to a significant reduction in end diastolic volume (EDV) and left ventricle internal diameter (diastole, LVID;d), as well as increased relative wall thickness (diastole, RWT;d) compared to RT housed mice. Though isovolumic relaxation time was prolonged in TN-housed mice, this did not reach statistical significance. Taken together, our results demonstrate that TN housing had minimal effects on skeletal muscle contractility, but did lead to signs of diastolic dysfunction in young mdx mice. Future studies will examine the effects of TN housing in aged mdx mice, when systolic dysfunction occurs, as well as any influence of TN housing on the efficacy of potential muscle wasting therapeutics. Overall, our results support the growing literature that highlights the importance of selecting the appropriate housing temperature when studying metabolism or muscle wasting conditions in mice. NSERC This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Echocardiographic assessment of left cardiac structure and function in antiretroviral therapy (ART)‐naïve people living with HIV/AIDS

Patients with human immunodeficiency virus (HIV) are at a significantly higher risk of cardiovascular disease (CVD) compared to HIV-negative people. Left heart dysfunction is the most common cardiac complication in people living with HIV/acquired immune deficiency syndrome (PLWHA), and diastolic dysfunction is an important predictor of cardiovascular events. The aims of this study were (1) to detect changes in left cardiac structure and function in antiretroviral therapy (ART)-naive PLWHA using echocardiography; and (2) to investigate the risk factors for the development of left ventricular diastolic dysfunction (LVDD) in ART-naive PLWHA. We retrospectively included 105 ART-naïve PLWHA and included 90 healthy subjects as controls to compare the differences in left heart structure and function between the two groups. Univariate and multifactorial logistic regression were employed to explore the risk factors of the development of LVDD in ART-naive PLWHA. The left ventricular end-diastolic internal diameter (LVEDD), left ventricular mass index (LVMI), and left atrial volume index (LAVI) were significantly greater in PLWHA than in controls (p < .05). The E/A ratio, lateral e' velocity, and mitral deceleration time were significantly lower in PLWHA than in controls (p < .05). Average E/e' ratio was significantly higher in PLWHA than in controls (p < .05). Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were not significantly different between PLWHA and controls (p > .05). Multifactorial logistic regression analysis showed that age, body mass index (BMI), and CD4+ count <200 cells/μL were independent risk factors for LVDD in ART-naive PLWHA (OR = 1.781, 1.228, 3.683, p < .05). Left ventricular systolic function did not differ between PLWHA and controls, and left ventricular diastolic function was lower in PLWHA than in controls. Age, BMI, and CD4+ count were independent factors affecting LVDD in ART-naive PLWHA.

A retrospective study: do patients with left ventricular ejection fraction ≤50% benefit from heart valve surgery?

Left ventricular ejection fraction (LVEF) is an indicator of heart failure, and it is controversial whether patients with reduced preoperative left ventricular ejection fraction can benefit from heart valve surgery. We aimed to assess the differences in clinical characteristics after surgery in patients with different grades of reduced preoperative LVEF to guide clinical management. A total of 100 heart valve disease patients with low LVEF (≤50%) who had undergone valve surgery in the Department of Cardiology. The patients were divided into three groups according to their LVEF measured by echocardiography before surgery, with LVEF ≤40% as group A, 40%< LVEF ≤45% as group B, and 45%< LVEF ≤50% as group C. Clinical characteristics such as postoperative LVEF values, oxygenation index, liver function and inflammatory index, intra-aortic balloon pump (IABP) utilization rate, and mortality were compared among the three groups of patients. There was no statistically significant difference in the preoperative baseline data between the three groups of patients (P>0.05). The clinical outcomes of patients in group A (n=28) were similar to those of patients in groups B (n=39) and C (n=33) (P>0.05). The vasoactive-inotropic score (VIS), postoperative ventilator use time, length of stay in the care unit, IABP use rate, and mortality rate on the first postoperative day were higher in group A. By comparing the preoperative and postoperative (within 48 hours and 3 months after surgery) cardiac echocardiograms of the three groups, we learned that LVEF increased, LV end-systolic internal diameter and LV end-diastolic internal diameter decreased, and ventricular remodeling improved after surgery compared with the preoperative period (P<0.05). The postoperative improvement was more obvious in group A than in groups B and C. Three months after surgery, LVEF increased to 55%, the LV end-systolic internal diameter decreased to 39 mm, and the LV end-diastolic internal diameter decreased to about 55 mm in each group (P>0.05). Patients with heart valve disease and low LVEF should be actively treated with heart valve surgery, which can significantly improve the patient's left ventricular reverse remodeling and cardiac function, thereby facilitating survival.

Evaluation for the Relationship Between Normal Serum Level of Thyroid Hormones and Left Ventricular Systolic and Diastolic Dysfunction

Background: Thyroid hormones play an important role in cardiac tissue function. Therefore, it is important to understand the relationship between thyroid hormone levels and cardiac disorders. Objectives: The present study aimed to assess the relationship between normal serum level of thyroid hormones and left ventricular systolic and diastolic dysfunction. Methods: In this cross sectional descriptive retrospective study, 391 patients were selected. They were referred to the Rajaie Cardiovascular Research Center, Tehran, Iran from 2019 to 2021. After extracting echocardiographic and laboratory data from the clinical records, the parameters affecting the left ventricular systolic and diastolic dysfunction were analyzed using statistical software. Results: The mean age of patients was 41 ± 12.8 years. Among them 58.1% of all patients were female. Tricuspid regurgitation (TR) severity had a significant relationship with thyroid stimulating hormone (TSH) level (P = 0.02). End diastolic interventricular septum thickness (IVSD) was inversely associated with thyroxin4 (T4) level (P = 0.04). Mitral valve inflow deceleration time (MVDT) was inversely correlated with thyroxin3 (T3) (P = 0.04). Left ventricular ejection fraction (LVEF) was inversely related to TSH level and end diastolic right ventricular internal diameter (RVIDd) was directly related to TSH (P = 0.05). Conclusions: Thyroid hormone levels in the normal range can be associated with the tricuspid regurgitation severity, end diastolic right ventricular internal diameter (RVIDd), mitral valve inflow deceleration time (MVDT), and. end diastolic interventricular septum thickness (IVSD). Due to the high prevalence of heart disorders, information on thyroid hormone levels can be helpful in the identification and timely treatment of these disorders.

Echocardiographic indicators of fluid responsiveness in hospitalized dogs with compromised hemodynamics and tissue hypoperfusion.

To evaluate the accuracy of selected echocardiographic variables used to predict fluid responsiveness in hospitalized dogs with compromised hemodynamics and tissue hypoperfusion. Diagnostic test study in a prospective cohort of hospitalized dogs. Veterinary referral clinics. Forty-four hospitalized dogs with compromised hemodynamics and tissue hypoperfusion were utilized in this study. Echocardiographic examination before and after fluid replacement with 30ml/kg of lactated Ringer's solution. Pre-fluid replacement measurements of velocity of transmitral E wave (E-peak), the left ventricular end-diastolic internal diameter normalized to body weight (LVIDdN), and the left ventricular end-systolic internal diameter normalized to body weight (LVIDsN) were significantly lower in fluid-responsive patients compared with nonresponders (P<0.001). The area under the receiver operating characteristic curve (AUROC) with its 95% confidence interval (CI) for each significant predictor was as follows: E-peak 0.907 (0.776-1.000, P<0.001) and LVIDdN 0.919 (0.801-1.000, P<0.001). The predictive capacity of LVIDsN was not significantly better than chance (AUROC, 0.753; 95% CI, 0.472-1.000, P=0.078). A significant negative linear correlation was observed between the percentage of increase in velocity-time integral after expansion and the echocardiographic variables LVIDdN (rs =-0.452, P =0.023) and E-peak (rs =-0.396, P=0.008) pre-fluid replacement. The intraobserver and interobserver variability was very low(<5 %) for all measurements. In this study using critically ill dogs with compromised hemodynamics and tissue hypoperfusion, pre-fluid replacement measurements of LVIDdN and E-peak adequately predict fluid responsiveness. Because a small number of fluid nonresponders were involved in the present study (11.4%), further studies that include larger numbers of fluid-nonresponsive animals are required.

The leaflet-annulus index in canine myxomatous mitral valve disease

Myxomatous mitral valve disease (MMVD) is the most common chronic heart valve disease, leading to the eccentric hypertrophy. Recently, the leaflet-annulus index (LAI), which focuses on the mitral valve apparatus, has been considered a prognostic factor for human mitral regurgitation (MR); however, it has not been reported in veterinary medicine. In the present study, we retrospectively evaluated the LAI in dogs with MMVD. Eight-three dogs with MMVD diagnosed using echocardiography were included in this study. The anteroposterior length, anterior and posterior cusp coaptation lengths, LAI, left ventricular end-diastolic internal diameter normalized to body weight (LVIDDN), and left atrium to aorta ratio (LA/Ao) were measured. A significant correlation between the LAI, LVIDDN, and LA/Ao of MR grading, and left ventricle dilation was observed. In conclusion, LAI could help determine annular widening, suggesting the decision of an appropriate for SVR in clinical settings.

Diagnostic efficacy of two-dimensional echocardiography combined with coronary angiogram in patients with acute myocardial infarction, and the effectiveness of atorvastatin

Purpose: To investigate the diagnostic significance of two-dimensional echocardiography (2DE) combined with coronary angiogram in patients with acute myocardial infarction, and to determine the effectiveness of atorvastatin.Methods: Patients (n = 100) with acute myocardial infarction admitted in Affiliated Hospital of Jinggangshan University, Ji’an, China, were divided into control group (CG) treated with conventional therapy, and study group (EG) treated with atorvastatin, in addition to conventional therapy. The diseased vessels examined by echocardiography and coronary angiogramv were recorded and compared. The effectiveness of atorvastatin treatment was assessed by evaluating myocardial injury, oxidative stress, vascular injury and cardiac function indices, viz, left ventricular ejection fraction (LVEF), left ventricular end-diastolic internal diameter (LVEDD), left ventricular end-systolic internal diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV).Results: The number of double and multiple lesions shown on coronary angiogram were significantly higher than those shown in echocardiography. Phosphocreatine kinase (CK), creatine kinase isoenzyme (CK-MB) and cardiac troponin T (cTnT) improved significantly in both groups after surgery, with CK-MB significantly lower in EG than those in CG at 1 and 3 days post-operation. Interleukin-6 (IL- 6) was significantly lower in EG than in CG at 1 and 7 days after the surgery (p &lt; 0.05). N-terminal Btype natriuretic peptidogen (NT-proBNP) was lower in EG than in CG on the 3rd day after surgery (p &lt; 0.05). Superoxide dismutase (SOD) was significantly higher in EG than in the CG at 1, 3 and 7 days after surgery. The QRS scores significantly improved in both groups after surgery (p &lt; 0.05).Conclusion: Echocardiography, when used in combination with coronary angiogram, accurately assesses the coronary lesions in acute myocardial infarction, and atorvastatin treatment after PCI reduces myocardial injury, relieves inflammation, and promotes the recovery of cardiac function in patients.

Combination of the Modified Loop Technique and De Vega Annuloplasty in Dogs with Mitral Regurgitation.

Simple SummaryDogs, like humans, may develop valvular disease, which is particularly common in older, small-sized dogs and is one of the most common causes of canine death. Canine valvular disease generally has a good prognosis. However, approximately 30% of dogs develop congestive heart failure, particularly when the mitral valve is affected, and most dogs with severe congestive heart failure die within a year of pulmonary edema. Although cardiac surgery with extracorporeal circulation can be performed in dogs and can significantly prolong survival, the dogs’ small size is challenging from a surgical perspective, and the success rate depends on the surgeon’s skill. Mitral valve repair in dogs involves suturing cardiac tendons using polytetrafluoroethylene sutures, which are slippery and difficult to ligate at the targeted length. Moreover, the appropriate length of the artificial tendon in dogs has not been determined. The mitral annulus surrounding the mitral valve also needs to be stitched down, but the amount that should be stitched down in dogs is not known because prosthetic valve rings were not manufactured for dogs. Due to the lack of reports detailing surgical procedures in dogs, we describe in detail a surgical technique for canine mitral valve repair.Background: Detailed surgical techniques for treating canine mitral regurgitation have not been previously reported. Method: This case series included six consecutive client-owned dogs with mitral regurgitation. All dogs underwent a combined protocol, including the modified loop technique and De Vega annuloplasty (MODEL surgery), in 2021. Artificial loops covering 80% of the length of the strut chordae tendineae were used for chordal replacement. Mitral annuloplasty was subjectively performed, targeting the circumference of the septal leaflet. Results: The breeds were Chihuahua-mixed breed, Spitz, Pomeranian, Cavalier King Charles Spaniel, and Chihuahua, with average ages and weights of 11.4 ± 2.3 years and 5.49 ± 2.98 kg, respectively. The aortic cross-clamp, pumping, and surgery times were 64.0 ± 7.5 min, 168.5 ± 39.1 min, and 321.0 ± 53.1 min, respectively. After MODEL surgery, left atrial-to-aortic ratios significantly decreased from 2.20 ± 0.18 to 1.26 ± 0.22 (p < 0.01), and left ventricular end-diastolic internal diameter normalized to body weight significantly decreased from 2.03 ± 0.26 to 1.48 ± 0.20 (p < 0.01). In all cases, the clinical signs disappeared or improved significantly. Conclusions: MODEL surgery increased mitral valve coaptation, normalized heart sizes, and significantly improved clinical signs in dogs with mitral regurgitation.

Reference Values of M-mode Echocardiographic Parameter in Adult Toy Breed Dogs.

Introduction:Myxomatous mitral valve disease (MMVD) is one of the most common heart diseases in dogs, and there is a dearth of reports that have investigated reference values for left ventricular end-diastolic internal diameter corrected for body weight (LVIDDN) exclusively in toy breeds.AnimalsEighty-six client-owned healthy dogs weighing <5 kg, including Toy Poodles, Chihuahuas, Yorkshire Terriers, Papillon, and other small breeds or small mixed breeds (mixed breed, Pomeranian, dachshund, Shih Tzu, and Maltese). In this retrospective single-center study, data were collected from dogs attending clinic for annual checkup between April 2014 and March 2021.Materials and MethodsExperienced echocardiographers performed transthoracic echocardiography, with reference ranges established using healthy dogs. Measurements of body weight (BW), heart rate, and several echocardiographic variables were obtained. The association between BW and echocardiographic parameters was assessed by linear regression analyses. M-mode measurements were obtained and normalized using equations developed from the regression analyses.ResultsThe LVIDDN value for 95% of dogs weighing <5 kg was achieved by dividing the M-mode measurement by BW raised to the power 0.332. The upper limit of the prediction interval for breeds weighing <5 kg was much lower than the value currently applied.ConclusionsWe propose a reference LVIDDN value of ≥1.6 for the diagnosis of stage B2 MMVD in toy breed dogs. The results of our study will guide clinicians in deciding when to start treatment for MMVD in small breed dogs.