Heart Overload Research Articles

Effects of Natural Cytokine Complex on the Myocardial Blood Flow in Normal and under Conditions of Increased Hemodynamic Load.

The effects of a natural complex of cytokines IL-1, IL-2, IL-6, TNF, MIF, and GTFβ on myocardial blood flow were studied under control conditions and during acute experimental aortal stenosis. Systemic administration of the cytokine complex under control conditions led to moderate impairment of the blood flow in the myocardium associated with plethora and perivascular edema. The number of functioning vessels in the myocardium significantly increased under these conditions, which reflected enhancement of the coronary blood flow. The comparison of the myocardial blood flow under conditions of acute heart overload alone and in combination with systemic administration of the cytokine complex revealed similar changes. In both cases, moderate plethora in all compartments of the vascular network, moderate perivascular edema, and moderate blood stasis in the myocardial capillaries were seen. The only difference the increase in the density of functioning capillaries that was significantly more pronounced after cytokine administration. These data indicate that the increase in the blood cytokine level induced dilatation of myocardial vessels and intensification of blood flow in normal and under conditions of acute hemodynamic heart overload. Against the background of pronounced vasodilatation, the dyscirculatory changes in the myocardium were moderate. It was assumed that the increase in the duration or frequency of hypercytokinemia episodes can induce more severe blood flow disturbances in the myocardium.

Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies

High-dose chemotherapy (HDC) followed by stem cell transplantation (HSCT) is a well-established method in patients with hematological malignancies, and for last few years, many efforts have been made to estimate short- and long-term efficacy of this method, as well as early and late complications. The present study concentrates on cardiotoxic effects, mainly early changes using biochemical markers such as N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn). Simultaneously, the analysis of 12-lead ECG was done before and after the procedure in which the novel repolarization markers: Tp–e and Tp–e/QT ratio were measured, together with standard markers: QT, QTc. It was found that NT-pro BNP was significantly increased after HSCT in comparison to results before it, and no significant changes were present in Troponin levels. Simultaneously, Tp–e interval and Tp–e/QT ratio were significantly higher after HSCT. The use of cyclophosphamide, advanced age, and higher level of blood cholesterol concentration were risk factors for the increase in NT-proBNP and treatment with cyclophosphamide as well as fludarabine and higher creatinine levels were risk factors for the increase in Tp–e/QT ratio. In conclusion, in the early term evaluation after HSCT in patients with no previously diagnosed heart disease, the mild changes in markers of heart overload and repolarization were noted. The observations suggest that in all patients undergoing HSCT, even the ones without pre-existing cardiovascular disease, the evaluation, and monitoring of heart function should be considered.

Evaluation of hemodynamic parameters in patients with trombosis inferior vena cava system dependent on the treatment method

The aim — to evaluate blood flow parameters in patients with thrombosis inferior vena cava system depending on the treatment method.Materials and methods. The article presents the evaluation of hemodynamic parameters in 665 patients with different forms of deep thrombosis inferior vena cava system. The patients were divided into the following groups, according to the treatment method. The first A group consisted of 380 patients which underwent an open full or partial thrombectomy with or without surgical prophylactic of pulmonary thromboembolism. The first B group consisted of 50 patients which underwent the combined treatment with surgical prophylaxis of pulmonary thromboembolism. The second group included 235 patients which received only the conservative therapy. The laboratory and instrumental methods: ultrasound duplex scanning, X­ray phlebography, computer tomography, radionuclide fleboscintigraphy and echocardioscopy were used to carry out the study in patients. The combined treatment included regional thrombolytic therapy and a cava­filter implantation (n = 31) or surgical thrombectomy followed by intraoperative regional thrombolytic therapy (n = 19). All patients received anticoagulant, infusion­anesthetic and compression therapy regardless of surgical treatment.Results and discussion. The disabsorption of large venous collectors in the first group with partial thrombectomy resulted in a considerable increase in blood volume, whereas undergoing the radical thrombectomy recovered the blood volume back to normal values. The average transport time through the deep veins of shin and hip decreased from 53 — 68 s tо 7 — 12 s and tо 11 — 18 s in case of radical and partial thrombectomy, respectively. The linear blood speed increased from 1 — 3 сm/s tо 9 — 18 сm/s and 4 — 9 сm/sеconds in case of radical and partial thrombectomy, respectively. The load index increased from 1 — 2 to 2.8 — 3.4 and 2.2 — 2.8 in case of radical and partial thrombectomy, respectively. In the second group of patients, the average transport time after treatment was 22 — 32 seconds, the linear blood speed — 2 — 6 cm/sec, the load index — 1 — 1.5. The results of the blood renewal after the combined treatment in the first B group took an intermediate position between radical and partial thrombectomy: the average transport time is 9 — 14 seconds, the linear blood speed — 7 — 11 cm/sec and the loading index — 2.3 — 3.0. Any signs of right heart overload and symptoms of «stealing» of the peripheral arterial channel were not detected while forming an arteriovenous fistula with diameter of up to 4 mm. We found that the completion of hardware cavaplication, after thrombectomy from the inferior vena cava, did not aggravate the venous blood return to the heart.Conclusions. After the partial thrombectomy and combined treatment the surgical renewal of venous trunk permeability improved the venous blood flow, and with radical thrombectomy — restored it back to normal values. With conservative treatment, the venous blood flow did not restore due to pronounced signs of chronic venous insufficiency.

Renal iron deposition by magnetic resonance imaging in pediatric β-thalassemia major patients: Relation to renal biomarkers, total body iron and chelation therapy

BackgroundThe reciprocal of multiecho gradient-echo (ME–GRE) T2* magnetic resonance imaging (MRI) R2*, rises linearly with tissue iron concentration in both heart and liver. Little is known about renal iron deposition in β-thalassemia major (β-TM). AimTo assess renal iron overload by MRI and its relation to total body iron and renal function among 50 pediatric patients with β-TM. MethodsSerum ferritin, serum cystatin C, urinary albumin creatinine ratio (UACR), and urinary β2-microglobulin (β2 M) were measured with calculation of β2 M/albumin ratio. Quantification of liver, heart and kidney iron overload was done by MRI. ResultsSerum cystatin C, UACR and urinary β2 microglobulin as well as urinary β2m/albumin were significantly higher in β-TM patients than the control group. No significant difference was found as regards renal R2* between Patients with mean serum ferritin above 2500 μg/L and those with lower serum cutoff. Renal R2* was higher in patients with poor compliance to chelation therapy and positively correlated to indirect bilirubin, LDH, cystatin C and LIC but inversely correlated to cardiac T2*. Conclusionkidney iron deposition impairs renal glomerular and tubular functions in pediatric patients with β-TM and is related to hemolysis, total body iron overload and poor compliance to chelation.

Female rats with severe left ventricle volume overload exhibit more cardiac hypertrophy but fewer myocardial transcriptional changes than males

Aortic valve regurgitation (AR) imposes a volume overload (VO) to the left ventricle (LV). Male rats with a pathological heart overload usually progress more quickly towards heart failure than females. We examined whether a sexual dimorphism exists in the myocardial transcriptional adaptations to AR. Adult Wistar male and female rats either underwent a sham operation or were induced with AR and then followed for 26 weeks. Female AR rats gained relatively more LV mass than males (75 vs. 42%). They had a similar increase in LV chamber dimensions compared to males but more wall thickening. On the other hand, fatty acid oxidation (FAO)-related LV enzyme activity was only decreased in AR males. The expression of genes encoding FAO-related enzymes was only reduced in AR males and not in females. A similar situation was observed for the expression of genes involved in mitochondrial biogenesis or function as well as for genes encoding for transcription factors implicated in the control of bioenergetics and mitochondrial function (Errα, Errγ or Pgc1α). Although females develop more LV hypertrophy from severe VO, their myocardial gene expression remains closer to normal. This could provide survival benefits for females with severe VO.

Cardiogenic shock: can the well-forgotten old become the new?

Cardiogenic shock (CS) is considered to be the most severe variant of acute heart failure. It occurs against the background of myocardial infarction or non-coronary myocardial disease with the loss of 40-50% contractile ability by the left ventricular mass and acute heart overload of another genesis. The marked decrease of blood pressure is accompanied by generalized impairment of microcirculation in all organs. The acting recommendations for emergency assistance suggest to recover blood perfusion pressure in ischemic tissues by inotropic drugs vasopressors, crystalloids that eliminate hypovolemia. However, the recovery of hemodynamic parameters using these medicines is accompanied by increased load on the myocardium and causes only a slight temporary increase of blood pressure. Death rapidly occurs in almost 100% of cases because offast heart energy depletion There is no doubt that stable recovery of hemodynamic in CS is not possible without sustainable recovery of myocardial contractility. The effective discharge of myocardium by drugs should not be accompanied by deterioration of blood supply to peripheral organs. Taking into account the literature data and pharmacological properties of different groups of drugs, there is every reason to believe that nitroglycerin may be the drug of choice for the treatment of cardiogenic shock. It reduces myocardium preload without impairment of microcirculation in the peripheral organs. This conclusion is preliminary and requires verification in randomized trials.

Pulmonary dysfunction in thalassaemia major: is there any relationship with body iron stores?

Although pulmonary function abnormalities in thalassaemia major (TM) were described in 1980, the pathogenetic mechanism is not clear and data are contradictory, probably because of study heterogeneity and the multifactorial nature of the pathogenesis. We retrospectively analysed 73 adult TM patients to evaluate the prevalence of pulmonary dysfunction in adult TM and investigate relationships with iron load. All patients underwent body plethysmography and carbon monoxide diffusion (DLCO) was assessed in 63, in addition to blood tests, echocardiogram and T2* myocardial and liver magnetic resonance imaging. Restrictive lung disease was present in 26 (35·6%) patients. Serum ferritin levels were higher in patients with restrictive pattern (1526μg/l vs. 975μg/l, P=0·05). Restrictive lung disease did not correlate with cardiac or liver iron overload. However, considering only patients with serum ferritin >2500μg/l, those with restrictive pattern also had heart (T2* 14·28±9·99ms vs. 31·59±7·43ms) and liver iron overload (LIC 16·02±8·44mg vs. 5·02±2·69mg Fe/g dry weight) compared to those without restrictive pattern. Twenty-five patients (39·7%) had decreased DLCO. No correlation was observed with iron parameters. In our data restrictive pattern was predominant; we observed a relationship with serum ferritin levels suggesting that iron, particularly its chronic effect, could play a role in the pathogenesis of pulmonary disease.

Electrocardiographic aspects of morphogenesis of neuroleptic cardiopathy

To elucidate dynamics of ECG at different clinical stages of NCMP and evaluate its diagnostic value. Methods. We determined the frequency and informative values of 8 different ECG signs includingQTinterval corrected based at theBazettformula (QTc). Their informative value was estimated from the Kullback formula. The data obtained were analyzed by parametric and non-parametric statistics methods. Pathological changes of ECG parameters associated with NCM Preflect processes of structural rearrangement in the heart at different levels of its organization. The analysis of the available information showed that almost all ECG parameters have high diagnostic value listed in the following rank order (frequency/informativeness): rhythm disorder - 1/8, prolongation of the QTc interval - 4/3, conduction disorder - 2/2, diffuse muscular changes - 3/1, right heart overload - 5/6, left ventricular hypertrophy - 7-8/5, impaired electrical activity of myocardium - 7-8/5, deviation of the electrical axis to the left - 6/4. It seems appropriate to distinguish the following three maximally informative (and therefore most important) ECG signs indicative of developing NCMP: diffuse muscular changes, conduction disorder, and prolongation of the QTc interval. The analysis of the available information provides a new insight into dynamics of ECG signs associated with NCMP and permits to estimate the diagnostic value of pathological changes for its earlier detection.

Relaxin serum levels in acute heart failure are associated with pulmonary hypertension and right heart overload.

Despite the promising results of serelaxin as a new potential acute heart failure (HF) therapy, its clinical use preceded the understanding of the endogenous relaxin system in HF. We aimed to evaluate relaxin circulating levels in a population of acute HF and their association with clinical and echocardiographic parameters. We included 117 patients from a registry of acute HF. Admission serum relaxin was measured using an enzyme-linked immunosorbent assay (ELISA) kit. Clinical, analytical, and echocardiographic parameters were compared between patients with relaxin levels above and below the median. Median age was 82 years [interquartile range (IQR) 72-87], 41% of the patients were male, and 63% had systolic dysfunction. Median serum relaxin was 31.4 pg/mL (IQR 0.6-89.8). Patients with relaxin levels above the median had more peripheral oedema (89.8% vs. 68.4%, P = 0.004) and a significantly higher sodium retention score (mean 4.8 ± 1.5 vs. 3.6 ± 2.0, P < 0.001). These patients also had significantly higher systolic pulmonary arterial pressure [median 47.0 (IQR 36.0-61.0) vs. 34.5 (IQR 25.0-51.0) mmHg, P = 0.002], higher prevalence of right ventricular (RV) systolic dysfunction (28.1% vs. 10.3%, P = 0.02), RV dilation (31.0% vs. 5.3%, P < 0.001), and right atrial dilation (66.1% vs. 36.5%, P = 0.002), and less inferior vena cava diameter variability (40% vs. 60%, P = 0.009). No differences were noted regarding admission blood pressure, left chamber dimensions, or LV function. In our population of acute HF patients, admission relaxin serum levels were associated with clinical and echocardiographic markers of pulmonary hypertension, RV dysfunction, and overload, suggesting a role for circulating relaxin as a biomarker in this setting.

Assessment of Heart and Liver Iron Overload in Thalassemia Major Patients Using T2* Magnetic Resonance Imaging.

Accumulation of excess iron in heart can lead to cardiac dysfunction, which is the most common cause of death in thalassemia major patients. Biopsy is an invasive procedure and therefore not an ideal option to assess iron load. However, standard/usual non-invasive methods, such as ferritin measurement, have some limitations and the results show poor correlations with iron load. Magnetic Response Imaging (MRI-T2*), as a non-invasive and reliable method for iron load assessment in organs such as liver and heart, can be suggested as a favorable alternative. This cross-sectional study was implemented in Thalassemia and Hemophilia Clinic Center (Sarvar) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from 2012 to 2013. After the approval of the research protocol by the local ethic committee, laboratory tests, including CBC and serum ferritin, were carried out, and echocardiography and heart and liver MRI-T2* were performed. All statistical analysis was done through SPSS software (version 11.5), using independent sample t test and Pearson's correlation coefficient test. A P value ≤0.05 was considered to be significant. 88 patients with the mean (±SD) age of 21.2 (±5.6) years, (range 11-37years) were observed. Iron load was assessed using MRI-T2* with the following results: Out of 88 patients, 48.9% had mild to severe cardiac siderosis, and 75.2% had mild to severe liver siderosis. We demonstrated a correlation between liver MRI-T2* and serum ferritin, and heart MRI-T2* and ejection fraction. However, no correlation between liver and heart MRI-T2* was observed. Heart and liver siderosis is a common and serious problem in thalassemia major patients, and MRI-T2* as a sensitive and non-invasive technique can be used for early/timely detection of siderosis and good therapeutic monitoring in these patients.

Systemic vasoconstriction modulates the responses of pulmonary vasculature and airway to vasoconstrictors in anesthetized rats

ABSTRACTPurpose: The physiological responses of the pulmonary vasculature and airway to various vasoconstrictors were studied using isolated perfused lungs and pulmonary arteries, but these responses were not systematically studied in in vivo rats. We determined these responses and modulating effects of systemic circulation in anesthetized rats. Methods: We measured directly pulmonary arterial pressure (PAP), left atrial pressure (LAP), aortic blood flow, and airway pressure (AWP) to determine pulmonary vascular resistance (PVR), following injections of angiotensin II (ANG II), endothelin-1 (ET-1), vasopressin, phenylephrine and thromboxane A2 mimetic U46619 in anesthetized SD rats. Results: ANG II, phenylephrine and vasopressin at high doses caused strong systemic vasoconstriction and left heart overload, resulting in a transient increase in LAP and pulmonary congestion, which consequently decreased PVR. Nonetheless, prior to LAP elevation, PVR was slightly but significantly increased by ANG II and phenylephrine. In contrast, ET-1 and U46619 substantially increased PVR in the absence of LAP elevation, while vasopressin did not increase PVR. In separate experiments, PAP and AWP increased when LAP was forcedly elevated. AWP was increased by U46619 through bronchoconstriction and by the other agents through increased LAP-induced pulmonary congestion. Conclusion: Airway constriction is induced by U46619, and pulmonary vasoconstriction is induced strongly by U46619 and ET-1, and weakly by ANG II and phenylephrine, but not by vasopressin in anesthetized rats. ANG II, vasopressin and phenylephrine exert indirectly a transient pulmonary vasodilatory action due to pulmonary congestion evoked by strong systemic vasoconstriction, which may account for weak pulmonary pressor responses to these agents.

324 Thrombo-embolic disease in CF patients: Difficult to diagnose, difficult to treat

The diagnosis of thrombo-embolic disease in CF patients is often difficult because of overlapping symptoms/signs with CF lung disease. We, here, report on the 3 cases to raise awareness about this complication. Patient 1 is waitlisted for lung transplantation (LTx). He receives regular intravenous (iv) antibiotic courses via peripherally inserted central catheters (PICCs). Recently, 24 hrs after removal of a PICC he presented with acute respiratory distress and left-sided thoracic pain. Angio CT demonstrated pulmonary embolism (PE) in the left lower lobe. Echocardiography showed new pulmonary hypertension (PH) and right heart overload. Patient 2 is also waitlisted for LTx. She receives regular iv courses via a port-a-cath (PAC). During an iv course she deteriorated and developed new significant hemoptysis. Angio CT showed bilateral PE. Echocardiography revealed an echogenic structure at the tip of the PAC, which was believed to be a thrombus. Patient 3, a 17-yr-old girl with severe CF lung disease, developed fever, dyspnea and thoracic pain after a transatlantic flight. Chest X-ray showed a pneumothorax. Additionally, angio CT revealed bilateral pulmonary emboli. In none of the patients deep venous thrombosis was found. Patients 1 and 3 received subcutaneous heparin; in Patient 2 the PAC was replaced, heparin was not given because of persisting hemoptysis. The possible diagnosis of PE should be kept in mind in CF patients presenting with new respiratory symptoms and signs, especially in sicker patients and those equipped with removable/implanted central venous catheters. Treatment is not always straightforward because of the possibility of significant hemoptysis.

Heart coherence: a new tool in the management of stress on professionals and family caregivers of patients with dementia.

We describe a stress management intervention intended to reduce the damage and stress impact on the heart physiology and function of a group of caregivers (professional and non-professional) who work with patients with dementia. The intervention consisted in applying heart coherence techniques in a population of 72 caregivers of patients with dementia (42 professional and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six months after the training they were able to generate appropriate patterns of heart coherence, with a statistically significant decrease in their heart overload. We conclude that training in techniques of heart coherence and positive psychology had effective results on the stress management of the participant caregivers. This was a simple, inexpensive technique with lasting results. To our knowledge this is the first research in Spain studying the application of heart coherence techniques to caregivers of people with dementia.

Partial anomalous pulmonary venous connection with acquired valve disease

We describe the rare case of a 76-year-old man with left partial anomalous pulmonary venous connection with intact atrial septum. He experienced dyspnea due to significant aortic stenosis and mitral regurgitation, and required valve repair. Preoperative computed tomography revealed connection of the left upper pulmonary vein to the innominate vein. Although right heart overload was not recognized, we repaired the left partial anomalous pulmonary venous connection with concomitant aortic valve replacement and mitral annuloplasty, because of the potential for unpredictable harmful effects of a residual left-to-right shunt. The patient recovered well with no signs of left upper lung congestion.

Right heart overload due to pulmonary trunk obstruction after Bentall procedure

Right heart overload due to pulmonary trunk obstruction after Bentall procedure

Análise das respostas cardiovasculares agudas ao exercício resistido em diferentes intervalos de recuperação

INTRODUCAO: O sistema cardiovascular sofre sobrecarga durante a pratica de exercicios fisicos. Entretanto, pouco se sabe sobre a resposta cardiaca em diferentes intervalos de recuperacao (IR). OBJETIVO: O presente estudo teve como objetivo analisar a sobrecarga cardiaca, utilizando como parâmetro cardiovascular a frequencia cardiaca (FC), pressao arterial sistolica (PAS) e duplo-produto (DP) em IR distintos (IR), sendo delimitados em 45'' (IR45''), 60'' (IR60'') e 90'' (IR90''). METODOS: O estudo analisou 10 voluntarios do genero masculino, com idade 21,5 ± 6,04 anos, peso 77,5 ± 10,62 kg e altura 179 ± 7 cm, que foram submetidos a um protocolo de tres series de 12 repeticoes a 60% de uma repeticao maxima (1RM) no aparelho leg press 45o. O teste de Wilcoxon foi utilizado para comparar as variaveis hemodinâmicas tendo nivel de significância quando p ≤ 0,05. RESULTADOS: Houve diferenca significativa de todas as variaveis quando compara-se o estado pre-esforco com as series subsequentes. A PAS apresentou diferenca entre a primeira e as demais series. Foi observada diferenca entre a segunda e terceira serie com IR45'', alem de na terceira serie o IR45'' apresentar maiores valores quando comparados ao IR90''. De forma semelhante, a FC apresentou diferenca entre a primeira e todas as series, em todos os IR. Os IR45'' e IR60'' apresentaram diferenca entre a segunda e terceira series. Contudo, o DP demonstrou diferenca entre a primeira e todas as series em todos os IR, alem de IR45'' e IR60'' apresentar diferenca entre a segunda e terceira serie. CONCLUSAO: De acordo com os resultados encontrados, conclui-se que a PAS e FC e sensivel ao numero de series intrasseries, porem, nao houve diferenca quando se compara os IR entre si. Contudo, ha maior tendencia do IR45'' causar aumento da sobrecarga cardiaca, principalmente pelo aumento da PAS.

Correlations Between Pancreatic Iron Burden and Heart Iron Overload and Function by MRI in a Large Cohort of Thalassemia Major Patients.

AbstractAbstract 2123 Background.The leading cause of death in thalassemia major patients remains the heart failure, but impairment of the endocrine and exocrine function of the pancreas is a common complication. Multiecho T2* Magnetic Resonance Imaging (MRI) is a well established technique for heart and liver iron overload assessment. Little is known about the relationship between myocardial iron burden and cardiac function with pancreatic siderosis.Aim of our study was to investigate using quantitative MRI the correlation between heart iron overload and function with pancreatic siderosis in thalassemia major patients. Methods.We studied 147 thalassemia major patients (233 males, mean age 31±9 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia network where MRI (1.5 T) was performed using standardized and validated procedures. Myocardial iron overload was measured by T2* multislice multiecho technique. Biventricular function parameters were quantitatively evaluated by cine images. Pancreatic iron burden was measured using a T2* gradient-echo multiecho sequence. The images were analyzed using a previously validated, custom-written software (HIPPO-MIOT IFC-CNR®). Results.Significant positive correlations of the global pancreas T2* values were demonstrated for global heart T2* values (r=0.355, P<0.0001; Figure 1), number of segments with normal T2* (r=0.389, P<0.0001) and T2* values in the mid-ventricular septum (r=0.323, P<0.0001). Of the 136 patients with pancreatic iron overload, 45 (33.1%) had a pathological global heart T2* value. No patients without pancreatic iron overload had cardiac iron overload. A normal global pancreas T2* value showed a negative predictive value of 100% for cardiac iron.Pancreatic T2* values were positively related with left ventricular (r=0.21, P=0.028; Figure 2A) and right ventricular (r=0.23, P=0.015; Figure 2B) ejection fractions. No significant correlation was found between pancreatic T2* values and biventricular volumes. Conclusions.Pancreatic iron overload is positively correlated to myocardial iron overload and negatively correlated to bi-ventricular systolic function. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Slope effect on pushing forces

In some occupations pushing forces are frequent when performed on horizontal ground and are standardized (ISO 2002). In special cases employees are obliged to grow container on slopes and the strains are poorly investigated. The objective of this work is to measure forces required to push garbage container on horizontal and inclined at 0, 4, 11 and 16 % grounds. Sudden and significant increases in heart rate reflect the possible risk of heart overload in long displacements. This study proposes realistic limits and provides a simple and protective tool for a group of employees without distinction of age or gender. These limits can even be reduced to a quasi-linear model where push 200 kg is the maximum for 0% slope and 60 kg for 10% slope.

The Dilated Coronary Sinus: Utility of Coronary Sinus Cross-Sectional Area and Eccentricity Index in Differentiating Right Atrial Pressure Overload from Persistent Left Superior Vena Cava

Pulmonary hypertension and right atrial pressure overload (RAPO) cause dilation of the coronary sinus (CS). Persistent connection of the left superior vena cava (LSVC) to the CS is another cause of CS dilation. The purpose of this study was to evaluate the usefulness of coronary sinus cross-sectional area (CSA) and eccentricity index (EI) in differentiating persistent LSVC from right heart overload and RAPO in patients with dilated CS. We identified 15 patients with a dilated CS by echocardiography. Offline analysis was used to measure CS-CSA and CS-EI at end-diastole in the parasternal long axis plane. EI was defined as B/A, where A is the widest diameter and major axis of the CS, and B is the diameter of the minor axis (perpendicular to and bisecting A at its midpoint). Persistent LSVC was confirmed by either computed tomography or injection of agitated saline in the left antecubital vein. CS-CSA was significantly larger in PLSVC group than in group with RAPO. Also, CS-EI was lower in PLSVC than in RAPO group (P = 0.0003). EI was the most sensitive and specific discriminator between patients with persistent LSVC vs. RAPO. CS-EI was <0.8 in all PLSVC patients and >0.8 in all RAPO patients (sensitivity and specificity = 100%). Patients with persistent LSVC have a significantly higher CS-CSA than those with elevated RA pressure. When dilated CS is present, a CS-EI <0.8 is 100% sensitive and specific for persistent LSVC. Thus, the CS-EI can be used in cases of dilated CS to diagnose the presence of persistent LSVC with a very high degree of certainty, and can help differentiate this congenital anomaly from RAPO.

Iron overload in Brazilian thalassemic patients.

ABSTRACTObjectives:To evaluate the use of magnetic resonance imaging in patients with β-thalassemia and to compare T2* magnetic resonance imaging results with serum ferritin levels and the redox active fraction of labile plasma iron. We have retrospectively evaluated 115 chronically transfused patients (65 women). We tested serum ferritin with chemiluminescence, fraction of labile plasma iron by cellular fluorescence and used T2* MRI to assess iron content in the heart, liver, and pancreas. Hepatic iron concentration was determined in liver biopsies of 11 patients and the results were compared with liver T2* magnetic resonance imaging. The mean serum ferritin was 2,676.5 +/- 2,051.7 ng/mL. A fraction of labile plasma iron was abnormal (> 0,6 Units/mL) in 48/83 patients (57%). The mean liver T2* value was 3.91 ± 3.95 ms, suggesting liver siderosis in most patients (92.1%). The mean myocardial T2* value was 24.96 ± 14.17 ms and the incidence of cardiac siderosis (T2* < 20 ms) was 36%, of which 19% (22/115) were severe cases (T2* < 10 ms). The mean pancreas T2* value was 11.12 ± 11.20 ms, and 83.5% of patients had pancreatic iron deposition (T2* < 21 ms). There was significant curvilinear and inverse correlation between liver T2* magnetic resonance imaging and hepatic iron concentration (r= -0.878; p < 0.001) and moderate correlation between pancreas and myocardial T2* MRI (r = 0.546; p < 0.0001). A high rate of hepatic, pancreatic and cardiac impairment by iron overload was demonstrated. Ferritin levels could not predict liver, heart or pancreas iron overload as measured by T2* magnetic resonance imaging. There was no correlation between liver, pancreas, liver and myocardial iron overload, neither between ferritin and fraction of labile plasma iron with liver, heart and pancreas T2* values.