End-diastolic Thickness Research Articles

The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output.

The purpose of this study is to investigate the effect of the long-term aerobic exercises on cardiac structure, left ventricular stroke volume, and cardiac output. To achieve the purpose of the study, a total of 22 volunteers—including 10 people who have continued regular exercises and 12 people as the control group—were selected as subjects. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation, and the difference of the means between the groups was verified through an independent t-test. As a result, there were significant differences between groups in the left ventricular end-diastolic internal dimension, left ventricular end-systolic internal dimension, left ventricular end-diastolic septum thickness. There were significant differences between groups in left ventricular end-diastolic volume, left ventricular mass, and left ventricular mass index per body surface area. However, in cardiac function, only left ventricular stroke volume showed a significant difference between groups.

Adiponectin Upregulates MiR-133a in Cardiac Hypertrophy through AMPK Activation and Reduced ERK1/2 Phosphorylation.

Adiponectin and miR-133a are key regulators in cardiac hypertrophy. However, whether APN has a potential effect on miR-133a remains unclear. In this study, we aimed to investigate whether APN could regulate miR-133a expression in Angiotensin II (Ang II) induced cardiac hypertrophy in vivo and in vitro. Lentiviral-mediated adiponectin treatment attenuated cardiac hypertrophy induced by Ang II infusion in male wistar rats as determined by reduced cell surface area and mRNA levels of atrial natriuretic peptide (ANF) and brain natriuretic peptide (BNP), also the reduced left ventricular end-diastolic posterior wall thickness (LVPWd) and end-diastolic interventricular septal thickness (IVSd). Meanwhile, APN elevated miR-133a level which was downregulated by Ang II. To further investigate the underlying molecular mechanisms, we treated neonatal rat ventricular myocytes (NRVMs) with recombinant rat APN before Ang II stimulation. Pretreating cells with recombinant APN promoted AMP-activated protein kinase (AMPK) phosphorylation and inhibited ERK activation. By using the inhibitor of AMPK or a lentiviral vector expressing AMPK short hairpin RNA (shRNA) cancelled the positive effect of APN on miR-133a. The ERK inhibitor PD98059 reversed the downregulation of miR-133a induced by Ang II. These results indicated that the AMPK activation and ERK inhibition were responsible for the positive effect of APN on miR-133a. Furthermore, adiponectin receptor 1 (AdipoR1) mRNA expression was inhibited by Ang II stimulation. The positive effects of APN on AMPK activation and miR-133a, and the inhibitory effect on ERK phosphorylation were inhibited in NRVMs transfected with lentiviral AdipoR1shRNA. In addition, APN depressed the elevated expression of connective tissue growth factor (CTGF), a direct target of miR-133a, through the AMPK pathway. Taken together, our data indicated that APN reversed miR-133a levels through AMPK activation, reduced ERK1/2 phosphorylation in cardiomyocytes stimulated with Ang II, revealing a previously undemonstrated and important link between APN and miR-133a.

Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients

AimEvaluation of the effectiveness of the renal sympathetic denervation (RSD) in reducing lesions of target organs such as the heart and kidneys, in resistant hypertensive CKD patients. Methods and resultsForty-five patients were included and treated with an ablation catheter with open irrigated tip. RSD was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n=22), 3 (n=16), and 4 (n=7). Data were obtained at baseline and monthly until the 6th month of follow-up. Twenty-six out of the 45 patients had LVH and nineteen did not present LVH. The LV mass index decreased from 123.70±38.44g/m2 at baseline to 106.50±31.88g/m2 at the 6th month after RSD, P<0.0001. The end-diastolic left ventricular internal dimension (LVIDd) reduced from 53.02±6.59mm at baseline to 51.11±5.85mm 6months post procedure, P<0.0001. The left ventricular end-diastolic posterior wall thickness (PWTd) showed a reduction from 10.58±1.39mm at baseline to 9.82±1.15mm at the 6th month of follow-up, P<0.0001. The end-diastolic interventricular septum thickness (IVSTd) also decreased from 10.58±1.39mm at baseline to 9.82±1.15mm 6months post procedure, P<0.0001. The left ventricular ejection fraction (LVEF) improved from 58.90±10.48% at baseline to 62.24±10.50% at the 6th month of follow-up, P<0.0001. When the ∆ between baseline and the 6th month post RSD in LVH patients and non LVH patients were compared to the same parameters no significant difference was found. ConclusionsThe RSD seemed to be feasible, effective, and safe resulting in an improvement of echocardiographic parameters in LVH and non LVH CKD refractory hypertensive patients.

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients.

BackgroundGRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI).ObjectiveThe present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS.MethodsWe evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS).ResultsSystolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438).ConclusionEnd-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

Evaluation of left atrial function in patients with iron-deficiency anemia by two-dimensional speckle tracking echocardiography.

BackgroundIron-deficiency anemia (IDA) is a global health problem and a common medical condition that can be seen in everyday clinical practice. And two-dimensional speckle tracking echocardiography (2D-STE) has been reported very useful in evaluating left atrial (LA) function, as well as left ventricular (LV) function. The aim of our study is to evaluate the LA function in patients with IDA by 2D-STE.Methods65 patients with IDA were selected. This group of patients was then divided into two groups according to the degree of hemoglobin: group B (Hb > 90 g/L) and group C (Hb60 ~ 90 g/L). Another 30 healthy people were also selected as control group A. Conventional echocardiography parameters, such as left atrial diameter (LAD), peak E and A of mitralis (E, A), E/A, end-diastolic thickness of ventricular septum (IVST d), end-diastolic thickness of LV posterior wall (PWTd) and left ventricular end-diastolic dimension (LVDd) were obtained from these three groups. Left atrial minimum volume (LAVmin), left atrial pre-atrial contraction volume (LAVp) and left atrial maximum volume (LAVmax) were measured by Simpson’s rule, whereas left atrial active ejection fraction (LAAEF) and left atrial passive ejection fraction (LAPEF) were obtained from calculation. Two-dimensional images were acquired from apical four-chamber view and two-chamber view to store images for offline analysis. The global peak atrial longitudinal strain and strain rate of systolic LV (GLSs, GLSRs) as well as early and late diastolic LV strain rate (GLSRe, GLSRa) curves of LA were acquired in each LA segment from basal segment to top segment of LA by 2D-STE.ResultsCompared with group A, there were no differences between group B and group A (all P > 0.05). The LAAEF and GLSRa were significantly higher in group C compared with those of group A and group B (all P < 0.01). The LAPEF, GLSs, GLSRs and GLSRe were significantly lower in group C compared with those of group A and group B (all P < 0.01).Conclusions2D-STE could evaluate the LA function in patients with IDA.

Endogenous contrast T1rho cardiac magnetic resonance for myocardial fibrosis in hypertrophic cardiomyopathy patients

BackgroundLate gadolinium enhancement (LGE) is a standard method to evaluate myocardial fibrosis, but restricted due to contrast agent contraindications. Non-contrast T1rho can generate endogenous contrast, and detect fibrosis in chronic myocardial infarction. However, T1rho for hypertrophic cardiomyopathy (HCM) patients is still unreported. The present study aimed to investigate T1rho for fibrotic assessment and the clinical implication in HCM patients. Methods18 HCM patients and 8 controls underwent T1rho, cine, and LGE cardiac magnetic resonance (CMR). T1rho relaxation time maps were created. Left ventricular (LV) parameters assessed included wall thickness, wall thickening, chamber volumes, ejection function, and fibrotic size. New York Heart Association (NYHA) functional classification was conducted. ResultsHyper-T1rho value was identified in 12 HCM patients, consistent with LGE. The mean T1rho values of controls, LGE-negative patients, and remote myocardium of LGE-positive patients were 42.2±1.6ms, 43.9±2.5ms, and 42.5±1.2ms respectively, and these values showed no significant difference (all p>0.05). T1rho-3-SD and T1rho-4-SD fibrotic sizes (32.5±14.0% and 25.1±11.5%) did not differ from LGE fibrotic size (28.1±11.2%) (both p>0.05). For the fibrotic size, T1rho-3-SD method obtained the strongest correlation with LGE (r=0.88, p<0.001), and T1rho-4-SD obtained the minimal mean difference with LGE (−3.1%; −15.2 to 9.1%), compared with other SDs. All the fibrotic sizes assessed by both methods correlated directly with LV maximal end-diastolic thickness (all p<0.05). Negative correlation was found between T1rho-4-SD fibrotic size and LV ejection fraction (r=−0.49, p=0.11). T1rho-4-SD fibrotic size showed positive correlation with NYHA class (r=0.46, p=0.13). ConclusionsT1rho CMR has potential to detect fibrosis in HCM patients. 4-SD may be the appropriate threshold for assessment.

Cardiac structure and function in Cushing's syndrome: a cardiac magnetic resonance imaging study.

Background:Patients with Cushing's syndrome have left ventricular (LV) hypertrophy and dysfunction on echocardiography, but echo-based measurements may have limited accuracy in obese patients. No data are available on right ventricular (RV) and left atrial (LA) size and function in these patients.Objectives:The objective of the study was to evaluate LV, RV, and LA structure and function in patients with Cushing's syndrome by means of cardiac magnetic resonance, currently the reference modality in assessment of cardiac geometry and function.Methods:Eighteen patients with active Cushing's syndrome and 18 volunteers matched for age, sex, and body mass index were studied by cardiac magnetic resonance. The imaging was repeated in the patients 6 months (range 2–12 mo) after the treatment of hypercortisolism.Results:Compared with controls, patients with Cushing's syndrome had lower LV, RV, and LA ejection fractions (P < .001 for all) and increased end-diastolic LV segmental thickness (P < .001). Treatment of hypercortisolism was associated with an improvement in ventricular and atrial systolic performance, as reflected by a 15% increase in the LV ejection fraction (P = .029), a 45% increase in the LA ejection fraction (P < .001), and an 11% increase in the RV ejection fraction (P = NS). After treatment, the LV mass index and end-diastolic LV mass to volume ratio decreased by 17% (P < .001) and 10% (P = .002), respectively. None of the patients had late gadolinium myocardial enhancement.Conclusion:Cushing's syndrome is associated with subclinical biventricular and LA systolic dysfunctions that are reversible after treatment. Despite skeletal muscle atrophy, Cushing's syndrome patients have an increased LV mass, reversible upon correction of hypercortisolism.

Hypertension and hypertensive cardiomyopathy in patients with a relapse‐free history of phaeochromocytoma

In patients with a relapse-free history of phaeochromocytoma/paraganglioma (PCC/PGL), persistent hypertension has been reported, but has not been well characterized. In 28 patients [mean age 54·5 (26-81) years] with a relapse-free history of PCC/PGLs, we prospectively analysed resting, supine blood pressure (BP), ambulatory BP, echocardiography, exercise testing, metabolic parameters and retrospectively collected data from the time of diagnosis (baseline). Echocardiographic measures were compared to healthy (n = 28) and hypertensive controls (n = 15). Median follow-up was 6 [1-16] years. Three patients had normal office and ambulatory BP and three patients had only increased office BP. Fifty-four per cent of patients had a blunted circadian rhythm. Comparing normal, hypertensive and PCC/PGL patients, we found significant differences in end-diastolic septal thickness (8·8 ± 0·2, 13·8 ± 0·4, 10·0 ± 0·3 mm, P < 0·05), septal basal thickness (9·0 ± 0·3, 15·9 ± 0·5, 11·2 ± 0·4 mm, P < 0·05) and left ventricular mass (143 ± 8, 255 ± 19, 169 ± 9 g, P < 0·05). In five patients, seven major cardiovascular events were observed. Compared to baseline, no significant difference was found in systolic (140 ± 35 vs 137 ± 18 mmHg) and diastolic (85 ± 18 vs 83 ± 10 mmHg) BP. An increase or a decrease in BP (>10 mmHg) was found in 36% and 39% of patients, respectively. The number of antihypertensive drugs had not changed [1 (0-3) vs 1 (0-4)]. Fewer patients received insulin (1 vs 3) or oral antiglycaemic drugs (2 vs 7). Our data indicate that hypertension persists after removal of PCG/PGL in a substantial proportion of patients. Hypertensive heart disease is common, and cardiovascular events are frequent in patients with a history of PCC/PGL.

Evaluation of Shear Stress in the Popliteal Artery in Patients With Type 2 Diabetes Mellitus Using Vascular Sonography

The aim of this study was to use vascular sonography to evaluate the dynamic forces acting on the wall of the popliteal artery in patients with type 2 diabetes mellitus (T2DM) compared to a control group without diabetes. Forty patients with T2DM and 20 control subjects were enrolled in the study. Patients were divided according to their measured Ankle-Brachial Index (ABI) into two groups, those with evidence of peripheral vascular disease (PVD) based on an ABI &lt; 0.9 (n = 18) and those without peripheral vascular disease (N-PVD, ABI ≥ 0.9, n = 22). The systolic and diastolic internal diameter (IDs, IDd) and the end-diastolic intima media thickness (IMT) of the popliteal artery were measured. Hemodynamic parameters measured were the peak systolic velocity, end-diastolic velocity, and the mean velocity (Vs, Vd, Vm). The peak systolic and mean shear stress (Ts, Tm) were calculated using the Hagen-Poiseuille formula. The shear stress of the popliteal artery was significantly decreased in patients with diabetes in the PVD group compared to the N-PVD group ( P &lt; .05). Shear stress also was significantly decreased in both the N-PVD and the PVD patients compared to the control group ( P &lt; .05). The shear stress may be a reliable index for the assessment of lower extremity arterial disease status in patients with diabetes mellitus at an early stage when the vascular IMT remains normal.

Diastolic dysfunction and cardiovascular risk in old subjects: Possible association with NAFLD?

Non-alcoholic fatty liver disease (NAFLD) is frequently associated with metabolic syndrome (MS) and may represent a cardiovascular (CV) risk factor. Functional cardiac abnormalities have been reported in patients with NAFLD. The aim of this paper is to investigate whether these findings are present also in elderly people. We tested 171 subjects aging more than 65 years, enrolled in a prospective study on CV risk reduction, for laboratory examination, abdominal ultrasound for evaluation of hepatic steatosis and standard echocardiography for determining morphological and functional cardiac parameters. Higher BMI, serum levels of glucose, triglycerides, cholesterol, insulin and visceral adipose tissue and lower serum levels of HDL-cholesterol were significantly associated with NAFLD. Furthermore, subjects with NAFLD had higher prevalence of diabetes, pathological waist-circumference, insulin-resistance and positive ATP-III criteria. While NAFLD had only a borderline significant association with higher end-diastolic thicknesses of left-ventricle posterior wall (edPW) and right-ventricle wall, higher values of edPW and end-diastolic thickness of interventricular septum were significantly correlated with glucose levels above 100mg/dl, hypertension, MS and insulin-resistance. Moreover, subjects with MS and/or pathological waist-circumference had a lower early-diastolic mitral annular motion, whereas those with insulin-resistance had lower E/A ratio and early-diastolic filling peak velocity. Regression analyses identify hypertension and pathological waist-circumference as factors independently associated to pathological edPW, and hypertriglyceridemia to pathological left-ventricle mass. In conclusion, an ultrasonographic diagnosis of NAFLD in old subjects may be an “alert” on the coexistence of multiple CV risk factors and on the presence of possible alterations of cardiac morphology and diastolic function.

Risk stratification at diagnosis for children with hypertrophic cardiomyopathy: an analysis of data from the Pediatric Cardiomyopathy Registry

Treatment of children with hypertrophic cardiomyopathy might be improved if the risk of death or heart transplantation could be predicted by risk factors present at the time of diagnosis. We analysed data from the Pediatric Cardiomyopathy Registry, which collected longitudinal data for 1085 children with hypertrophic cardiomyopathy from 1990 to 2009. Our goal was to understand how patient factors measured at diagnosis predicted the subsequent risk of the primary outcome of death or heart transplantation. The Kaplan-Meier method was used to calculate time-to-event rates from time of diagnosis to the earlier of heart transplantation or death for children in each subgroup. Cox proportional-hazards regression was used to identify univariable and multivariable predictors of death or heart transplantation within each causal subgroup. The poorest outcomes were recorded for the 69 children with pure hypertrophic cardiomyopathy with inborn errors of metabolism, for whom the estimated rate of death or heart transplantation was 57% (95% CI 44-69) at 2 years. Children with mixed functional phenotypes also did poorly, with rates of death or heart transplantation of 45% (95% CI 32-58) at 2 years for the 69 children with mixed hypertrophic and dilated cardiomyopathy and 38% (95% CI 25-51) at 2 years for the 58 children with mixed hypertrophic and restrictive cardiomyopathy. For children diagnosed with hypertrophic cardiomyopathy at younger than 1 year, the rate of death or transplantation was 21% (95% CI 16-27) at 2 years. For children diagnosed with hypertrophic cardiomyopathy and a malformation syndrome, the rate of death or transplantation was 23% (95% CI 12-34) at 2 years. Excellent outcomes were reported for the 407 children who were diagnosed with idiopathic hypertrophic cardiomyopathy at age 1 year or older, with a rate of death or heart transplantation of 3% (95% CI 1-5) at 2 years. The risk factors for poor outcomes varied according to hypertrophic cardiomyopathy subgroup, but they generally included young age, low weight, presence of congestive heart failure, lower left ventricular fractional shortening, or higher left ventricular end-diastolic posterior wall thickness or end-diastolic ventricular septal thickness at the time of cardiomyopathy diagnosis. For all hypertrophic cardiomyopathy subgroups, the risk of death or heart transplantation was significantly increased when two or more risk factors were present and also as the number of risk factors increased. In children with hypertrophic cardiomyopathy, the risk of death or heart transplantation was greatest for those who presented as infants or with inborn errors of metabolism or with mixed hypertrophic and dilated or restrictive cardiomyopathy. Risk stratification by subgroup of cardiomyopathy, by characteristics such as low weight, congestive heart failure, or abnormal echocardiographic findings, and by the presence of multiple risk factors allows for more informed clinical decision making and prognosis at the time of diagnosis. US National Institutes of Health and Children's Cardiomyopathy Foundation.

Effects of Therapeutic Hypothermia on Left Ventricular Function Assessed by Ultrasound Imaging

Therapeutic hypothermia is used after cardiac arrest. The aim of this study was to investigate the effects of therapeutic hypothermia on left ventricular (LV) function assessed by ultrasonic imaging. In 10 pigs, LV volumes, ejection fractions, and longitudinal strain were measured using two-dimensional echocardiography. Midwall fractional shortening and end-systolic wall stress were calculated. Wall thickness was continuously measured using an epicardial ultrasonic transducer placed on the LV anterior wall. Wall thickening velocity (S') and pressure-wall thickness loops were used to assess systolic function. Diastolic function was assessed by echocardiographic transmitral flow and mitral annular velocity (e') measurements, calculation of the LV relaxation constant, and determination of LV stiffness and restoring forces using the end-diastolic pressure-wall thickness relation during volume unloading. Early wall thinning velocity (e'wt) and early diastolic wall thinning were calculated. Measurements were done at 38°C and 33°C, at spontaneous heart rate and at atrial pacing at 100 beats/min. End-diastolic volume, stroke volume, midwall fractional shortening, and longitudinal strain remained unchanged during hypothermia, but end-systolic wall stress, S', and pressure-wall thickness loop area decreased. A shift from early to late diastolic LV filling occurred during hypothermia, with concurrent decreases in e', e'wt, and early wall thinning fraction. Relaxation was prolonged, LV stiffness was increased, and restoring force was decreased during hypothermia. Hypothermia induced a decrease in relative diastolic duration at spontaneous heart rate, which was further reduced during pacing. During paced heart rate at 33°C, stroke volume, ejection fraction, and strain were reduced. Hypothermia induced systolic and diastolic dysfunction, with reduced tolerance to increased heart rate. These findings may have implications for patient management during hypothermia.

Subxiphoid echocardiographic evaluation of right heart function in patients with chronic obstructive pulmonary disease

PURPOSE: The purpose of this study is to evaluate by subxiphoid echocardiography the sensitivity and specificity of various echocardiographic parameters for early diagnosis and survival of patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Subxiphoid echocardiography was performed in 75 COPD patients to evaluate inferior vena cava dimension (IVCD), its collapsibility index (CI), end-diastolic right ventricular dimension (EDRVD), end-diastolic right ventricular thickness (EDRVT) (M-mode), right atrial area (RAA), right ventricular areas and right ventricular area shortening fraction. Results were compared to those of 30 healthy controls. Patients in sinus rhythm were divided in two according to there NYHA class (I+II and III+IV) an in three according to there acid-base blood gases status. RESULTS: All the indexes were equally and significantly changed in the patients with RVH/PH and those with COPD and atrial fibrillation (AF) when compared to controls. COPD patients with neither ECG criteria for RV hypertrophy (RVH), nor x-ray evidence of pulmonary hypertension (PH) presented with significantly greater EDRVA and RAA and normal IVC/CI. In both cases, according to cardiac and respiratory severity status subdivision, significant changes in any indexes with worsening of cardiac and respiratory failure were observed. Best sensitivity, specificity and predictive accuracy for early diagnosis were established for IVCD/CI and EDRVT. During the two-year study period, seven (9%) patients died in end stage respiratory and heart failure because of considerably reduced right heart performance. CONCLUSION: Subxiphoid echocardiography may be used for early detection of cor pulmonale, evaluation of right heart dysfunction and prognosis in COPD patients. Scripta Scientifica Medica 2013; 45(2): 55-60.

The usefulness of plasma asymmetric dimethylarginine (ADMA) levels and tissue doppler echocardiography for heart function in term infants born to mothers with gestational diabetes mellitus

Objective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes.Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group (n = 25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured.Results: In the first analysis, 10 patients (40%) had a septal thickness of 6 mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness ≥6 mm and the group with <6 mm.Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn.

Early predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension

Our aim was to investigate the relationships between left atrial (LA) structural and functional changes and left ventricular (LV) dysfunction related to LV pressure overload in asymptomatic patients with hypertension. One hundred and twenty-six asymptomatic patients with hypertension and LV ejection fraction (EF) ≥60% were studied. Conventional, pulsed and tissue Doppler, and two-dimensional speckle-tracking echocardiography (2DSTE) were performed to seek the independent determinants for alterations in LA structure and function. LA volume index (LAVI) correlated with age, body mass index (BMI), end-diastolic ventricular septal thickness (VSth), end-diastolic LV posterior wall thickness, relative LV wall thickness (RWT), LV mass index, peak A velocity of transmitral flow, E/e’, and peak systolic and early diastolic LA strains and strain rates. Peak LA strain during ventricular systole (S-LAs) correlated with age, BMI, heart rate (HR), end-systolic LV diameter, LAVI, VSth, RWT, LVEF, e’, E/e’, peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate. Multivariate regression analyses indicated that LV mass index, peak A velocity, E/e’, and S-LAs are defined as strong predictors related to LAVI, and that BMI, HR, LAVI, and peak systolic LV radial strain are defined as strong predictors related to S-LAs. In conclusion, 2DSTE demonstrated that alterations in LA structure and function are mainly associated with LV diastolic and systolic dysfunction, respectively, in preclinical patients with hypertension.

Focused Transthoracic Echocardiography by Sports Medicine Physicians

The purpose of this study was to investigate whether sports medicine physicians can use portable echocardiography to obtain measurements pertinent to hypertrophic cardiomyopathy. Thirty male collegiate athletes, aged 18 to 21 years, were prospectively enrolled. Focused portable echocardiography was performed by a board-certified sports medicine physician and a resident physician, followed by comprehensive echocardiography within 2 weeks by a registered diagnostic cardiac sonographer. A left parasternal long-axis view was acquired to measure 3 dimensions: (1) end-diastolic interventricular septal thickness (IVSd), (2) end-diastolic left ventricular internal diameter (LVIDd), and (3) end-diastolic left ventricular posterior wall thickness (LVPWd). Intraclass correlation coefficients between the sports medicine physician and the sonographer were strong: 0.77 for IVSd, 0.73 for LVIDd, and 0.64 for LVPWd. Intraclass correlation coefficients between measurements by the resident physician and sonographer were strong to moderate: 0.61 for IVSd, 0.62 for LVIDd, and 0.63 for LVPWd. Across all 3 readers, intraclass correlation coefficient calculations were 0.77 for IVSd, 0.81 LVIDd, and 0.75 for LVPWd, which indicated strong inter-rater reliability. Sports medicine physicians are able to obtain measurements relevant to the diagnosis of hypertrophic cardiomyopathy with focused portable echocardiography that are consistent with comprehensive echocardiography by a registered sonographer.

Antihypertensive combination therapy effects on cardiac remodelling in elderly patients

Aim. To investigate potential regression of left ventricular (LV) remodelling in elderly patients receiving antihypertensive combination therapy. Materials and methods. The study included 80 patients (23 men, 57 women) with arterial hypertension (AH) and different levels of cardiovascular risk, aged 60–86 years (mean age 72,4±6,5 years; median age 72 years; interquartile range 69,5–76 years). The mean AH duration was 19,6±6,8 years. All patients underwent echocardiography at baseline and 6 months after the beginning of antihypertensive combination therapy: fixeddose combinations of an ACE inhibitor and a diuretic (perindopril + indapamide), or an ACE inhibitor plus a calcium antagonist (lisinopril + amlodipine). Statistical analyses were performed using “Statistica-6.0” software package (StatSoft Inc., 1984–2001). Results. The study participants had high and very high levels of cardiovascular risk. Six patients (7,5%) had Stage II AH, while 72 (92,5%) had Stage III AH. In 60 patients (75,0%), AH was combined with coronary heart disease (CHD), in 2 (2,5%) with diabetes mellitus (DM), in 16 (20%) with CHD and DM. Isolated systolic AH (ISAH) was registered in 35 patients (44%). At baseline, echocardiography parameters were similar across clinical groups. After 6 months of combination therapy, positive dynamics of echocardiography parameters was observed: for example, left atrium size was significantly lower in patients treated with perindopril and indapamide, compared to patients who received lisinopril and amlodipine or controls. Similar findings were obtained for end-diastolic dimension and interventricular septum thickness. In contrast to the other two groups, the control group did not demonstrate any significant dynamics of end-systolic dimension (p>0,05). Patients treated with perindopril and indapamide showed the best dynamics ofLV myocardial mass index (from 121,6±16,42 to 111,0±13,59) andLV myocardial mass (from 229,2±47,91 to 204,7±51,01). In all groups, there was an improvement in diastolic function, which manifested in a significant E/A reduction. Conclusion. In elderly AH patients with high and very high cardiovascular risk, antihypertensive combination therapy was associated with a significant regression inLV remodelling. The optimal combination included an ACE inhibitor and a diuretic (perindopril arginine and indapamide).

Association of CD36 gene polymorphisms with echo- and electrocardiographic parameters in patients with early onset coronary artery disease

IntroductionCD36 plays an important role in long-chain fatty acid homeostasis in skeletal muscle and the myocardium. CD36 deficiency may lead to reduced myocardial uptake of long-chain fatty acid. Therefore, different mutations of the CD36 gene may contribute to the clinical heterogeneity of cardiac hypertrophy.Material and methodsThe objective of the study was to investigate whether there is an association between the sequence changes in CD36 and echocardiographic and electrocardiographic parameters in Caucasian patients with early onset coronary artery disease. The study group comprised 100 patients. Electrocardiography and echocardiography were performed in all patients. Amplicons of exons 4 to 6 including fragments of introns were studied using the denaturing high-performance liquid chromatography technique.ResultsIVS3-6TC (rs3173798) heterozygotes had impaired left ventricle diastolic function. 573GA heterozygotes (rs5956) had higher frequency of pseudonormal left ventricular diastolic function and it was confirmed by the increase in wave A’ in the tissue Doppler. 591AT genotype was associated with borderline higher posterior wall end-diastolic thickness and lower E/A ratio. These results are consistent with electrocardiography parameters which could reflect left ventricular hypertrophy (higher RV5(6) and RV5(6) + SV1(2) parameters, depressed ST segments and tendency to longer Qtc II interval) in 591AT heterozygotes.ConclusionsDetected variant alleles of CD36 may be associated with features of left ventricular hypertrophy and impaired diastolic function.

Evaluation of chronic ischemic heart disease with myocardial perfusion and regional contraction analysis by contrast-enhanced 256-MSCT

To investigate myocardial viability in chronic ischemic heart disease by myocardial perfusion and regional contraction analysis using 256-slice MSCT coronary angiography (CCTA). In 30 patients with prior myocardial infarction (MI), CCTA with retrospective ECG-gating and stress-redistribution thallium-201 SPECT were performed. Using the same raw data as used for CCTA, myocardial perfusion imaging (CT-MPI) was reconstructed at four phases during the cardiac cycle. Mean myocardial attenuation and wall thickness at end-systole and end-diastole were measured in the MI areas depicted by SPECT, and they were compared between viable and non-viable segments categorized by SPECT. End-systolic thickness was significantly greater for viable than for non-viable segments (12.0 ± 3.2 vs. 9.6 ± 3.5 mm, p = 0.0017). There was no difference in end-diastolic thickness. Myocardial attenuation was significantly higher for viable than for non-viable segments in the subendocardium (62 ± 13 vs. 70 ± 11 HU, p = 0.003) and the epicardium (65 ± 13 vs. 80 ± 15 HU, p = 0.0002). The systolic wall thinning and epicardial low-attenuation areas were the indicative findings of CT-MPI for non-viable segments in the prior MI.

ASSESSMENT OF LEFT VENTRICULAR MASS IN POSTOPERATIVE PATIENTS WITH ORTHOTOPIC HEART TRANSPLANTATION BY ULTRASOUND ECHOCARDIOGRAPHY

ObjectivesAfter orthotopic heart transplantation (HT), hypertension commonly occurs because of adverse effects of immunosuppression. Left ventricular hypertrophy (LVH) has been shown to predict increased cardiovascular morbidity and mortality. The aims...