Evaluation Of Left Ventricular Function Research Articles

Evaluation of left ventricular function with continuous echocardiography concomitant with left ventricular pressure measurement in isoflurane anesthetized rats for safety pharmacology study

Evaluation of left ventricular function with continuous echocardiography concomitant with left ventricular pressure measurement in isoflurane anesthetized rats for safety pharmacology study

Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension.

Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular (LV) function in hypertensive and white coat hypertensive overweight children and teenagers. The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the LV mass and function were performed in all participants. Using ABPM hypertension was confirmed in 20 (27%) children. In the 54 (73%) remaining children white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher LV mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and white coat hypertension-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic blood pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. In overweight children the diagnosis of hypertension should be confirmed in ABPM because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased SBPL and decreased systolic nocturnal deep because of the possibility of LV function impairment.

Echocardiographic assessment of left ventricular function

Bedside echocardiography is a cornerstone tool in the management of critically ill patients with hemodynamic compromise. This technique should be considered not only as an imaging technique but as well as a hemodynamical method. Both transthoracic and transesophageal approach are used in intensive care unit (ICU) patients. Left ventricular (LV) systolic function can be assessed in daily clinical practice by measuring ejection fraction (EF) and cardiac output. But these indices are dependent on load conditions. Mitral anterior plane systolic excursion and tissue Doppler imaging (TDI) and speckle tracking by measuring the systolic motion velocity of the mitral annulus and the LV strain may together assess the true contractility of the left ventricle. dP/dt measured on mitral regurgitation flow could help to assess LV contractility. Maximal elastance was described to be the best parameter to evaluate myocardial systolic function but not available in daily practice at the bedside in ICU patients. LV diastolic function and pressure are useful to have a comprehensive evaluation of LV function and could be assessed by recording the mitral flow using pulsed Doppler and the early diastolic velocity of mitral annulus recorded using TDI. Echocardiography should be done in patients with shock to assess the pathophysiology of the shock and in pulmonary oedema to distinguish patients with cardiogenic oedema or acute respiratory distress syndrome (ARDS). Only echocardiography may assess the hemodynamic of patient with shock and/or respiratory failure and the only tool which permits to diagnose the cause of this hemodynamical failure.

Clinical evaluation of left ventricular function and morphology using an accelerated k-t sensitivity encoding method in cardiovascular magnetic resonance

ObjectivesTo provide clinical validation of a recent 2D SENSE-based accelerated cardiovascular magnetic resonance (CMR) sequence (accelerated k-t SENSE), investigating whether this technique accurately quantifies left ventricle (LV) volumes, function, and mass as compared to 2D cine steady-state free precession (2D-SSFP).MethodsHealthy volunteers (n = 16) and consecutive heart failure patients (n = 26) were scanned using a 1.5 T MRI system. Two LV short axis (SA) stacks were acquired: (1) accelerated k-t SENSE (5–6 breath-holds; temporal/spatial resolution: 37 ms/1.82 × 1.87 mm; acceleration factor = 4) and (2) standard 2D-SSFP (10–12 breath-holds; temporal/spatial resolution: 49 ms/1.67 × 1.87 mm, parallel imaging). Ascending aorta phase-contrast was performed on all volunteers as a reference to compare LV stroke volumes (LVSV) and validate the sequences. An image quality score for SA images was used, with lower scores indicating better quality (from 0 to 18).ResultsThere was a high agreement between accelerated k-t SENSE and 2D-SSFP for LV measurements: bias (limits of agreement) of 2.4% (− 5.4% to 10.1%), 6.9 mL/m2 (− 4.7 to 18.6 mL/m2), − 1.5 (− 8.3 to 5.2 mL/m2), and − 0.2 g/m2 (− 11.9 to 12.3 g/m2) for LV ejection fraction, end-diastolic volume index, end-systolic volume index, and mass index, respectively. LVSV by accelerated k-t SENSE presented good agreement with aortic flow. Interobserver and intraobserver variabilities for all LV parameters were also high.ConclusionThe accelerated k-t SENSE CMR sequence is clinically feasible and accurately quantifies LV volumes, function, and mass, with short acquisition time and good image quality.

Low altitude simulation without hypoxia improves left ventricular function after myocardial infarction by reducing ventricular afterload.

Humans have a lower risk of death from myocardial infarction (MI) living at low elevations (<2500 m), which are not high enough to induce hypoxia. Both chronic hypoxia pre-MI, achieved by altitude simulation >5000 m, and intermittent hypobaric hypoxia post-MI can reduce MI size in rodents, and it is believed that hypoxia is the key stimulus. To explore mechanisms beyond hypoxia we studied whether altitude simulation <2500 m would also be associated with reduced infarct size. We performed left-anterior descending artery ligation on C57BL6 mice. Control mice (n = 12) recovered at 754 mmHg (atmospheric pressure, control), and treatment group mice (n = 13) were placed in a hypobaric chamber to recover 3-hours daily at 714 mmHg for 1 week. Echocardiographic evaluation of left ventricular function was performed on Day 0, Day 1 and Day 8. Intermittent hypobaric treatment was associated with a 14.2±5.3% improvement in ejection fraction for treatment group mice (p<0.01 vs. Day 1), with no change observed in control mice. Cardiac output, stroke volume, and infarct size were also improved in treated mice, but no changes were observed in HIF-1 activation or neovascularization. Next, we studied the acute hemodynamic effects of low altitude stimulation in intact mice breathing 100% oxygen using left ventricular catheterization and recording of pressure-volume loops. Acute reductions in barometric pressure from 754 mmHg to 714 mmHg and 674 mmHg were associated with reduced systemic vascular resistance, increased stroke volume and cardiac output, and no change in blood pressure or heart rate. Ex-vivo vascular function was studied using murine mesenteric artery segments. Acute reductions in barometric pressure were associated with greater vascular distensibility. We conclude that intermittent hypobaric treatment using simulated altitudes <2500 m reduces infarct size and increases ventricular function post-MI, and that these changes are related to altered arterial function and not hypoxia-associated neovascularization.

AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations.

AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations.

Evaluation of left ventricular functions in patients with retinal vein occlusion

Evaluation of left ventricular functions in patients with retinal vein occlusion

Evaluation of Left Ventricular Function after Percutaneous Recanalization of Chronic Coronary Occlusions: The Role of Two-Dimensional Speckle Tracking Echocardiography

Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evaluate the role of 2D speckle tracking in evaluation of the left ventricular (LV) systolic function in chronic total occlusion (CTO) patients before and at 1 day as well as 3 months after percutaneous coronary intervention (PCI). Patients and Methods: A prospective observational study included 40 patients diagnosed with coronary angiography to have a chronic total occlusion. Percutaneous coronary revascularization was performed according to standard practices with the femoral approach. Conventional 2D echocardiography was used to assess LV functions and wall motion abnormalities scoring index (WMAI). Using speckle-tracking echocardiography was to measure global longitudinal strain (GLS) and. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Forty patients were included in this study, with a mean age of 58.55 ± 7.98 years. GLS and WMAI difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p Conclusion: The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in GLS was more sensitive predictors for LV function improvement at 3-month follow-up.

Evaluation of left ventricular functions before and after iron therapy in patients with iron deficiency anemia

The aim of present study is to evaluate left ventricular (LV) functions using speckle tracking echocardiography (STE) after iron therapy in patients with iron deficiency anemia (IDA). We consecutively enrolled 92 patients with IDA who needed iron therapy and 82 age- and gender-matched healthy volunteers in our study. Their clinical, laboratory, conventional two-dimensional echocardiography (2DE), and STE examinations were performed to all patients before and after iron therapy. Echocardiographic measurements were compared with healthy controls. The hemoglobin level increased after iron therapy (7.2±2.9 vs. 12.1±2.0, p

Echocardiographic Evaluation of left Ventricular Function Following Late Percutaneous Coronary Intervention after Acute Anterior Myocardial Infarction with Left Ventricular Systolic Dysfunction

Background: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood.&#x0D; Objectives: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction.&#x0D; Methods: A total of 60 patients, &gt; 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period.&#x0D; Result: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 ml before PCI and 58.3±15.3 ml at discharge (p value 0.091) &amp; 44.1±17.6 ml after 3 months (p value &lt;0.001). LVEF was 40.2±3.1% before PCI, 40.2±3.3% at discharge (p value 0.509) &amp; 47.6±5.9% after 3 months (p value &lt;0.001). There was no significant improvement of LV function from baseline till discharge but significant improvement occurred after 3months.&#x0D; Conclusion: Using echocardiographic techniques, our results showed that left ventricular volume decreased and the left ventricular ejection fraction increased significantly after three months of late intervention.&#x0D; Bangladesh Heart Journal 2018; 33(2) : 90-93

Left ventricular dysfunction in ADPKD and effects of octreotide-LAR: A cross-sectional and longitudinal substudy of the ALADIN trial

Background and aimIn autosomal dominant polycystic kidney disease (ADPKD) cardiac abnormalities have been observed before the onset of hypertension or renal dysfunction. We sought to characterize, in ADPKD patients, left ventricular (LV) function and its changes after somatostatin-analogue octreotide-LAR treatment. MethodsIn a 1:1:1 cross-sectional study, we evaluated LV function by speckle-tracking echocardiography in 34 ADPKD patients from one ALADIN-trial center and in 34 age- and gender-matched healthy controls and 34 equally-matched renal controls with non-cystic chronic kidney disease. Changes in LV function were compared in the 16 and 18 ADPKD patients originally randomized to 3 year-treatment with octreotide-LAR or placebo, respectively. ResultsLV twist and untwisting rates were lower in ADPKD patients that in healthy or renal controls (6.1 ± 2.6° vs. 11.1 ± 2.1° and 10.2 ± 3.7°; −49.5 ± 18.1°/s vs. −79.8 ± 12.2°/s and −84.3 ± 25.9°/s, respectively, all p < 0.001). The correlation between LV mass or diastolic BP and untwisting rate was positive in ADPKD patients (r = 0.38, p = 0.025 and r = 0.44, p = 0.011, respectively), not significant in healthy controls and negative in renal controls (r = −0.38; p = 0.023 and r = −0.40, p = 0.012, respectively. LV untwisting rate improved from −49.9 ± 18.6°/s to −70.3 ± 27.5°/s with octreotide-LAR, but did not change with placebo (p = 0.027 for treatment effect). At adjusted linear regression analysis, octreotide-LAR therapy emerged as the only independent predictor of untwisting rate improvement at final visit [beta coefficient −0.504 (95% CI −46.905–−6.367), p = 0.014]. ConclusionsIn ADPKD patients LV function is early impaired. Somatostatin-analogue therapy might help in preventing or ameliorating LV dysfunction in this population.Clinical Trial Registration http://www.clinicaltrials.gov, NCT0030928.

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

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

Decision support for assessment of left ventricular diastolic function.

Echocardiographic assessment of the left ventricular diastolic function (LVDF), an integrated part of evaluation of left ventricular function is still a delicate task and is performed with substantial inter‐rater variability. Therefore, we aimed to create and evaluate a guidelines‐based automated decision support. An algorithm was created for a hierarchical analysis of LVDF based on variables as recommended by the latest guidelines. Age‐adjusted normal ranges were pooled from previously published studies into an integrated reference table. For proof‐of‐concept, 20 echocardiographic examinations were analyzed offline by four experienced physicians with more than 10 years of echocardiographic experience. The first assessments were to be performed as they would be in the clinical practice. Six months later, the assessments were repeated based on the 2017 ASE/EACVI guidelines. The overall inter‐rater agreement for the first clinical assessments was moderate, while the guidelines‐based assessments had only fair inter‐rater agreement. Both kinds of manual assessment had poor agreement with the standardized automated assessment algorithm of LVDF. In conclusion, the presented automated decision support for evaluation of diastolic LV function by Doppler echocardiography is mainly based on current guidelines involving multiple parameters in combination. Incorporating age dependency aspects in our program (available for use at https://liu.se/en/research/left-ventricular-diastolic-function-decision-support) enhances the accuracy of the evaluation and reduces variability in evaluation of LVDF. The large inter‐rater variation in classification in this study also underscores the usefulness of tools to support a standardized evaluation.

Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice.

Acute myocardial infarction can lead to acute heart failure and cardiogenic shock. The evaluation of hemodynamics is critical for the evaluation of any potential therapeutic approach directed against acute left ventricular (LV) dysfunction. Current imaging modalities (e.g., echocardiography and magnetic resonance imaging) have several limitations since data on LV pressure cannot directly be measured. LV catheterization in mice undergoing coronary artery occlusion could serve as a novel method for a real-time evaluation of LV function. At the beginning of the procedure, mice were anesthetized followed by endotracheal intubation. For LV catheterization, the right carotid artery was exposed via middle-neck incision. The catheter was introduced and placed into the LV cavity. Left thoracotomy was conducted and the left main coronary artery (LCA) was ligated. To induce reperfusion, the suture was released after 45 min. Pressure-volume data was recorded at all times. Ligation of the LCA caused a decrease in LV systolic function as evidenced by a 30% reduction in stroke volume, LV ejection fraction (EF), and cardiac output. Maximum dP/dt as a parameter for LV contractility was also significantly reduced and diastolic function was severely impaired (minimum dP/dt -40%). Reperfusion over a period of 20 min did not lead to a complete recovery of LV function. Real-time pressure-volume analysis served as a valid procedure for monitoring cardiac function during acute myocardial infarction in mice. Maintaining stable anesthesia and a standardized surgical approach was crucial to ensure valid results. As the early phase of acute myocardial infarction is critical for morbidity and mortality, the delineated method could be beneficial for preclinical evaluation of new strategies for cardioprotection.

Canagliflozin Improves a Left Ventricular Diastolic Dysfunction without Affecting Baroreflex Sensitivity in Type 2 Diabetes

In type 2 diabetes, there is no effective treatment for gradual progression of left ventricular (LV) diastolic dysfunction and reduced baroreflex sensitivity (BRS), which is a sensitive measure of cardiovascular (CV) autonomic function. Here we prospectively evaluated the effect of Canagliflozin, sodium-glucose cotransporter (SGLT) 2 inhibitor, on LV diastolic dysfunction and BRS at the same time. 37 type 2 diabetic patients with high risks of CV disease were enrolled. All participants were evaluated LV function, BRS, HbA1c, Hb, BNP and t-PA-PAI-1 complex before and after 3 months of the additional treatment with Canagliflozin. Multiple-linear regression was used to assess individual and cumulative effects of δearly diastolic velocity/basal septal diastolic velocity (E/e’) and δLV mass index. UMIN000025964 for Clinical Trials Registry. Characteristics of the subjects are age 64.2 ± 8.1 years (mean±SD), HbA1c 7.9±0.7%, diabetes duration 13.5 ± 8.1 years, complicated CV disease 32.4%. E/e’ ratio (13.7 ± 3.5 to 12.1 ± 2.8, p = 0.001), LV mass index (82.0 ± 15.8 to 77.3 ± 16.4 g/m2, p = 0.003), HbA1c (7.9 ± 0.7 to 7.1 ± 0.6%, p = 0.000), and t-PA-PAI-1 complex (27.0 ± 15.8 to 19.4 ± 7.0 ng/mL, p =0.002) were decreased and Hb (13.9 ± 1.2 to 14.7 ± 1.4 g/dL, p =0.000) was increased. The level of BRS (10.7 ± 8.5 to 10.2 ± 7.3 msec/mmHg, p = 0.721) and BNP (15.1 ± 10.7 to 13.5 ± 10.1 pg/dL, p = 0.062) did not show any differences. Interestingly, δE/e` were negatively correlated with baseline E/e` and δHb (r=-0.618, p=0.000; r=-0.496, p=0.002, respectively). Multiple regression model still revealed that δE/e` were related to baseline E/e` (β=-0.581, p=0.007) and δHb (β=-0.406, p=0.009) independently of age, sex, and baseline SBP (R-squared 0.469). Canagliflozin improved LV diastolic dysfunction without reducing BRS in type 2 diabetic patients with high CV disease risk. Our results suggest that greater increase of Hb is a surrogate marker of improvement of diastolic function. Disclosure D. Matsutani: None. M. Sakamoto: None. Y. Kayama: None. K. Utsunomiya: None.

Echocardiographic Strain Analysis for the Early Detection of Left Ventricular Systolic/Diastolic Dysfunction and Dyssynchrony in a Mouse Model of Physiological Aging.

Heart disease is the leading cause of hospitalization and death worldwide, severely affecting health care costs. Aging is a significant risk factor for heart disease, and the senescent heart is characterized by structural and functional changes including diastolic and systolic dysfunction as well as left ventricular (LV) dyssynchrony. Speckle tracking–based strain echocardiography (STE) has been shown as a noninvasive, reproducible, and highly sensitive methodology to evaluate LV function in both animal models and humans. Herein, we describe the efficiency of this technique as a comprehensive and sensitive method for the detection of age-related cardiac dysfunction in mice. Compared with conventional echocardiographic measurements, radial and longitudinal strain, and reverse longitudinal strain were able to detect subtle changes in systolic and diastolic cardiac function in mice at an earlier time point during aging. Additionally, the data show a gradual and consistent decrease with age in regional contractility throughout the entire LV, in both radial and longitudinal axes. Furthermore, we observed that LV segmental dyssynchrony in longitudinal axis reliably differentiated between aged and young mice. Therefore, we propose the use of echocardiographic strain as a highly sensitive and accurate technology enabling and evaluating the effect of new treatments to fight age-induced cardiac disease.

Evaluation of left ventricular functions by conventional echocardiography and tissue Doppler imaging in children with rheumatic valve disease

Amac: Romatizmal kardit tanisi ile izlenen mitral yetmezlikli cocuklarda sol ventrikul fonksiyonlarini geleneksel ekokardiyografi ve doku Doppler goruntu- leme yontemiyle degerlendirip, sonuclari saglikli kontrol grubu ile karsilastirmayi amacladik. Gerec ve Yontem: Pediatrik kardiyoloji klinigimizde romatizmal kardit sonrasi mitral yetmezlik tanisi ile izlenen 30 hasta ve 5-15 yaslari arasinda 30 saglikli cocuk calismaya dahil edildi. Hasta grubu hafif-orta dereceli mitral yetmezlik ve agir mitral yetmezlik olarak siniflandirildi. Tum ekokardiyografik olcumler ca- lisma grubunun klinik ve laboratuvar sonuclarina kor olan uzman bir pediatrik kardiyolog tarafindan yapildi. Bulgular: Agir mitral yetmezlikli hastalarda sol ventrikul diyastol sonu caplari kontrol grubuna gore anlamli derecede artis gosterdi (4.62±0.82 cm, 3.92±0.39 cm; p=0.008). Yine sol ventrikul sistol sonu caplarinda agir mitral yetmezlikli hastalarda kontrol grubuna gore anlamli olarak artmis bulundu (2.81±0.51, 2.43±0.25, p=0.01). Ejeksiyon fraksiyonu ve fraksiyonel kisalma acisindan gruplar arasinda istatistiksel olarak anlamli fark yoktu (p>0.05). Doku Doppler gorun- tuleme yontemiyle olculen erken diyastolik pik miyokard hizi gruplar arasinda istatistiksel olarak anlamli farklilik gostermedigi halde (p>0.05), atriyal pik sisto- lik hiz, agir mitral yetmezlikli hastalarda, hem kontrol hem de hafif-orta mitral yetmezlikli hastalara gore anlamli derecede yuksek olculdu (sirasiyla p<0.001, p=0.001). Sonuc: Calismamizda, geleneksel ekokardiyografik olcumlerle elde edilen sol ventrikul sistolik ve diyastolik fonksiyonlari acisindan kontrol grubu ile mitral yetmezlikli hasta gruplari arasinda istatistiksel olarak anlamli bir farklilik bulunamamistir. Buna ragmen mitral yetmezlikli hasta grubunda sol ventrikuler fonksiyonlardaki subklinik bozulma doku Doppler goruntuleme yontemiyle saptanmistir.

Rationale and Design of the SENECA (StEm cell iNjECtion in cAncer survivors) Trial

ObjectivesSENECA (StEm cell iNjECtion in cAncer survivors) is a phase I, randomized, double-blind, placebo-controlled study to evaluate the safety and feasibility of delivering allogeneic mesenchymal stromal cells (allo-MSCs) transendocardially in subjects with anthracycline-induced cardiomyopathy (AIC). BackgroundAIC is an incurable and often fatal syndrome, with a prognosis worse than that of ischemic or nonischemic cardiomyopathy. Recently, cell therapy with MSCs has emerged as a promising new approach to repair damaged myocardium. MethodsThe study population is 36 cancer survivors with a diagnosis of AIC, left ventricular (LV) ejection fraction ≤40%, and symptoms of heart failure (NYHA class II-III) on optimally-tolerated medical therapy. Subjects must be clinically free of cancer for at least two years with a ≤ 30% estimated five-year risk of recurrence. The first six subjects participated in an open-label, lead-in phase and received 100 million allo-MSCs; the remaining 30 will be randomized 1:1 to receive allo-MSCs or vehicle via 20 transendocardial injections. Efficacy measures (obtained at baseline, 6 months, and 12 months) include MRI evaluation of LV function, LV volumes, fibrosis, and scar burden; assessment of exercise tolerance (six-minute walk test) and quality of life (Minnesota Living with Heart Failure Questionnaire); clinical outcomes (MACE and cumulative days alive and out of hospital); and biomarkers of heart failure (NT-proBNP). ConclusionsThis is the first clinical trial using direct cardiac injection of cells for the treatment of AIC. If administration of allo-MSCs is found feasible and safe, SENECA will pave the way for larger phase II/III studies with therapeutic efficacy as the primary outcome.

Evaluation of Left Ventricular Function, Contractility and Ejection Fraction in COPD Patients by Echocardiography

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. According to global initiative for chronic obstructive lung disease, COPD is defined as FEV1/FVC<70% by spirometry. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle, leading to development of pulmonary hypertension, cor-pulmonale, right ventricular dysfunction as well as left ventricular dysfunction. The significance of the right ventricular performance is recognized as one of the factors determining the clinical course and prognosis in COPD, but a potential role of the left ventricle is, however, less studied. The aim of this study was primarily to evaluate left ventricular function in COPD patients by echocardiography and to study the correlation between echocardiography findings and the severity of COPD based on GOLD1 criteria. A total of 100 patients were selected for this study, including 72 male patients and 28 female patients, aged 50–70 years, from outpatient department of medicine department, medical wards, TB and chest ward of Dr Baba Sahib Ambedkar Hospital, Delhi, considering the exclusion and inclusion criteria. In mild COPD group, only one patient was found to have systolic dysfunction out of 52 patients (1.92%), in moderate COPD group, 2 patients had systolic dysfunction out of 32 patients (6.25%), whereas in severe COPD, six patients had systolic dysfunction out of 16 patients (37.5%). So, in total, 9% patients had systolic dysfunction. 28% of patients were found to have left ventricular diastolic dysfunction in our study. COPD patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. A clear correlation was found between value of fractional shortening (FS) of left ventricle (a measure of contractility), and severity of COPD and FS value significantly decreased as the severity of COPD increased. In this study, ejection fraction (EF) was found to be preserved in mild and moderate COPD, albeit mean EF was found to be reduced in moderate COPD. In severe COPD group, EF was significantly lowered.

Imaging Insights on the Aorta in Aging.

The aorta has 2 main functions, conduit and cushion, and is designed to transmit blood to the periphery and buffer pulsatile stress from ventricular contraction. In the interaction between the structural and functional changes of the aorta, aging and disease processes impact on aortic material properties and hemodynamics. For a comprehensive assessment of changes in aortic structure and function associated with aging and disease, noninvasive cardiovascular imaging techniques, especially magnetic resonance imaging, have recently been developed. Magnetic resonance imaging allows for direct and accurate measurement of different aortic characteristics including structural measures such as aortic area or volume, aortic length, curvature, and aortic wall thickness and functional measures such as aortic strain, distensibility, and pulse wave velocity. Excellent reproducibility of magnetic resonance imaging methods allows us to assess the response of the whole aorta to both pharmacological and nonpharmacological therapies. Aortic flow and functional assessment could be added to clinical routine cardiac magnetic resonance as a comprehensive imaging modality primarily performed for the noninvasive evaluation of left ventricular function, left ventricular load, and vascular/ventricular coupling. New techniques such as 4-dimensional flow could provide and further elucidate the combined age-related effects of altered aortic geometry and function. This following review will describe the pathophysiological aspects of the aorta and the ability, value, and prospects of cardiovascular imaging, especially magnetic resonance imaging, to study age-related changes in aortic structure and function and assess the relationship between these alterations and cardiovascular disease.