Diastolic Interventricular Septal Thickness Research Articles

PS 08-26 CORRELATION BETWEEN ORTHOSTATIC HYPOTENSION WITH CIRCDIAN RHYTHM, LEFT VENTRICULAR STRUCTURE AND FUNCTION IN AGED PATIENTS WITH HYPERTENSION

Objective: To investigate the correlation between Orthostatic hypotension with 24 hours ambulatory blood pressure circadian rhythm, left ventricular structure and function in eldly patients with hypertension. Design and Method: We enrolled 357 cases (Mean age: (68.85 ± 8.63). All the participants underwent 24hABPM and Cardiac ultrasonography. Based on orthostatic hypotension diagnostic criteria, the subjects were subdivided into 2 groups: 142 cases of OH group and the other 215 ones of non-OH group. Results: The mean 24 hours systolic blood pressure (24hSBP), night systolic blood pressure (nSBP) were higher in OH group than in non-OH group [(142.37 ± 16.69) vs(138.55 ± 16.22) mmHg, P = 0.03; (133.51 ± 14.13) vs (127.26 ± 13.63) mmHg,P = 0.00]. And a significantly more decrease of systolic blood pressure fall (SBPF) and diastolic blood pressure fall (DBPF) in OH group than in non-OH group[(6.17 ± 3.42) vs (7.08 ± 3.67)%,P = 0.02; (5.46 ± 2.69) vs (6.18 ± 3.21)%, P = 0.03]. Interventricular septal thickness in diastole(IVSD), left ventricular end-diastolic diameter(LVEDD), left ventricular mass index(LVMI) and left ventricular end-systolic diameter(LVESD) increased obviously in OH group than those in non-OH group [(10.79 ± 1.74) vs (10.35 ± 1.65) mm; (48.36 ± 5.13) vs (46.79 ± 6.05) mm, (128.48 ± 26.15) vs (122.64 ± 22.85)g/m2, (31.97 ± 5.06) vs (30.84 ± 4.81) mm; P = 0.02;0.01;0.03;0.03]. The ejection fraction(EF) and stroke volume(SV) were marked lower in OH group than in non-OH group. Conclusions: The hypertension is closely correlated to the abnormal circadian rhythm of 24hABPM and the damage of left ventricular structure and function in eldly patients with hypertension.

PP.12.19] THE CHARACTERISTICS OF ARTERIAL STIFFNESS AND CARDIAC REMODELING IN FEMALE HYPERTENSION PATIENTS

Objective: We hypothesized that cardiac remodeling would be associated with correlation index of arteriosclerosis. And there are differences between males and females. The porpose is to illustrate the characteristics of the arterial stiffness and cardiac remodeling in female hypertension patients. Design and method: One hundred and forty hypertensive patients provided written informed consent. Eligible participants were men and women aged 45 to 65 years old who had hypertension, defined as seated resting systolic blood pressure of 140 mmHg or higher or diastolic blood pressure of 90 mmHg or higher at both of the screening and recruitment visits or were taking an antihypertensive medication. Some indicators of the cardiac anatomy structures, the cardiac function was measured by M-mode echocardiography, two-dimensional echocardiography, doppler echocardiographic determination and tissue Doppler imaging. The SphygmoCor Vx Pulse Wave Velocity System was used to measure the carotid and femoral artery pulse wave velocity (cf-PWV). For testing the primary hypothesis, the efficacy analyses for the primary outcome were conducted according to the ITT principle. Results: There was a strong relationship between cardiac remodeling and correlation index of arteriosclerosis. In the following cases, we can see the same relationship: In the male and female patients, with the increase of augmentation index (AIx), ejection fraction (EF) were significantly increased (P < 0.001). In the females, AIx increase value, the decrease of ankle brachial index (ABI) and PWV rised with left ventricular end-diastolic dimension (LVDD), end-diastolic volume (EDV) and left ventricular mass index (LVMI) decreasing in patients (P < 0.05). In the male patients, the level of aortic artery systolic blood pressure (ASP) and cardio-ankle vascular index (CAVI) also raised with the rising of LVDD, LVMI and interventricular septal diastolic thickness (P < 0.05). Conclusions: In patients with hypertension, the cardiac remodeling is developing with the rising of correlation index of arteriosclerosis. Moreover, for females, the characteristic of cardiac remodeling is the decrease of LVDD. But in male patients, LVDD increasing is the main characteristic. We speculate that this difference may be related to sex hormones, but it is still necessary to confirm by multi center and large sample studies further.

PS 17-36 THE CHARACTERISTICS OF ARTERIAL STIFFNESS AND CARDIAC REMODELING IN MIDDLE-AGED FEMALE HYPERTENSIVE PATIENTS

Objective: We hypothesized that cardiac remodeling would be associated with correlation index of arteriosclerosis. And there are differences between males and females. The purpose of this study is to illustrate the characteristics of the arterial stiffness and cardiac remodeling in female hypertension patients. Design and method: One hundred and forty hypertensive patients provided written informed consent. Eligible participants were men and women aged 45 to 65 years old who had hypertension. Some indicators of the cardiac anatomy structures, the cardiac functionwere measured by M-mode echocardiography, two-dimensional echocardiography, doppler echocardiographic determination and tissue Doppler imaging. The SphygmoCor Vx Pulse Wave Velocity System was used to measure the carotid and femoral artery pulse wave velocity (cf-PWV). For testing the primary hypothesis, the efficacy analyses for the primary outcome were conducted according to the ITT principle. Results: There was a strong relationship between cardiac remodeling and correlation index of arteriosclerosis. In the following cases, we can see the same relationship: in the male and female patients, with the increase of augmentation index (AIx), ejection fraction (EF) were significantly increased (P < 0.001). in the females, AIx increase value, the decrease of ankle brachial index (ABI) and PWV rised with left ventricular end-diastolic dimension (LVDD), end-diastolic volume (EDV) and left ventricular mass index (LVMI) decreasing in patients (P < 0.05). in the male patients, the level of aortic artery systolic blood pressure (ASP) and cardio-ankle vascular index (CAVI) also raised with the rising of LVDD, LVMI and interventricular septal diastolic thickness (P < 0.05). Conclusions: In female patients with hypertension, the characteristic of cardiac remodeling is the decrease of LVDD. But in male patients, LVDD increasing is the main characteristic. It is still necessary to detect the sex hormones, in order to confirm the differences characteristic of cardiac between males and females are related to them.

Is the Increased Septal Perfusion the Signal of Asymmetrical Septal Hypertrophy?

In this study, we have compared scintigraphic and echocardiographic data in order to investigate whether increased septal perfusion represents asymmetrical septal hypertrophy (ASH), which is a symptom followed in the scintigraphy of myocardial perfusion. The study consists of a total of 186 patients (120 females and 66 males with an average age of 59.45 ± 11.54 years) who had normal myocardial perfusion scintigraphy and echocardiography examinations. Statistical comparison of septal wall thickness measurements obtained from echocardiography and septal-to-lateral wall ratios (S/L ratio) was performed scintigraphically. Left ventricular mass values were obtained as both scintigraphic and echocardiographic data and their correlations were evaluated in order to assess the presence of left ventricular hypertrophy (LVH). In statistical analyses, the values of interventricular septal thickness in diastole (IVSd), left ventricle posterior wall thickness in diastole (LVPWd), left ventricle mass (LVM), and left ventricle mass index (LVMI) were found to be significantly higher in group 2 (S/L ratio >1) compared to group 1 (S/L ratio <1). In addition, S/L ratio is significantly correlated with echocardiographic IVSd, LVPWd, LVM, LVMI, and scintigraphic LVM (rest) values. Furthermore, echocardiographic LVM and LVMI values were significantly correlated with LVM and LVMI values obtained from scintigraphy. It should be known that increased S/L ratio that can be monitored during scintigraphic studies can be an indicator of septal hypertrophy and/or LVH, however, further examination and close follow-ups should be performed in necessary cases.

Associations among chronic kidney disease, high total p-cresylsulfate and left ventricular systolic dysfunction

BackgroundA significant number of patients with chronic kidney disease (CKD) have cardiac abnormalities, and left ventricular systolic dysfunction (LVSD) is a common manifestation. p-Cresylsulfate (PCS), a protein-bound uraemic retention solute, is known to cause endothelial dysfunction and possibly plays a role in coronary atherosclerosis. Furthermore, the associations among serum total PCS, major adverse cardiovascular events, all-cause mortality, and QTc prolongation have also been found in previous studies. We thus investigated the association of total PCS and CKD with LVSD in the clinical setting. MethodsWe included 403 consecutive patients with stable angina. To evaluate LV function, all patients underwent echocardiography. To measure the serum total PCS concentrations and estimated glomerular filtration rate (eGFR), blood samples were obtained. ResultsMultiple regression analysis showed that left atrium diameter, left ventricular mass index, end diastolic interventricular septal thickness, left ventricular end-systolic diameter, left ventricular end-systolic volume, stroke volume, left ventricular end-systolic volume index, left ventricular ejection fraction (LVEF), and the interventricular septum/posterior wall of the left ventricle were independently associated with total PCS (all p<0.05). In addition, a significantly decreased LVEF was present in patients with lower and higher serum total PCS and with CKD, and with higher serum total PCS and without CKD than from those with lower serum total PCS concentrations and without CKD (p=0.004). In the multivariate logistic regression analysis, when patients without CKD and lower PCS were used as reference group, patients with the higher total PCS concentration and without CKD had an odds ratio of 3.59 for the risk of LVSD, the lower total PCS concentration and with CKD had an odds ratio of 3.89 for the risk of LVSD, and the higher total PCS concentration and with CKD had an odds ratio of 4.04 for the risk of LVSD (p=0.039, p=0.038, and p=0.020, respectively). ConclusionsHigh serum concentrations of total PCS or CKD, or both, represent an increased risk of impaired LV systolic function in stable angina patients.

Cardiac structure and function and effects of enzyme replacement therapy in patients with mucopolysaccharidoses I, II, IVA and VI.

While enzyme replacement therapy (ERT) has been shown to improve endurance and joint mobility for patients with mucopolysaccharidoses (MPS) I, II, IVA and VI, the impact of ERT on cardiac abnormalities remains uncertain. Medical records and echocardiograms of 28 Taiwanese MPS patients (9 with MPS I, 7 with MPS II, 7 with MPS IVA, and 5 with MPS VI) treated with ERT for 1-10.8years were retrospectively reviewed. At start of ERT, z scores>2 were identified in 46% and 75% for left ventricular mass index (LVMI) and interventricular septum thickness in diastole (IVSd) in these patients, respectively. Twenty-four patients (86%) had valvular heart disease. After ERT, the mean IVSd z score of all patients decreased significantly from 3.87 to 2.57 (p=0.016). For 11 patients starting ERT before 12years of age, z scores for both LVMI and IVSd decreased significantly (p<0.01) after ERT. However, the condition of valve regurgitation or stenosis did not show improvement despite ERT. ERT was shown to be an effective therapy for reducing cardiac hypertrophy, with best results seen when ERT was started at an early age. ERT, however, had little impact on valvular heart disease.

Renal Denervation Attenuates Multi-Organ Fibrosis and Improves Vascular Remodeling in Rats with Transverse Aortic Constriction Induced Cardiomyopathy

Background/Aims: To investigate the effects of renal denervation (RDN) on multi-organ fibrosis and vascular remodeling in cardiomyopathy. Methods: Thirty-six male Sprague-Dawley rats underwent transverse aortic constriction (TAC). Five weeks later, 28 surviving TAC rats were randomly assigned to three groups: (1) RDN, (2) Sham, (3) Carvedilol. Six male Sham TAC rats served as the Control. Ten weeks after TAC, samples were collected. Results: TAC rats showed an increased diastolic interventricular septal thickness at week 5. At 10 weeks, Masson staining showed that left ventricular and renal glomerular fibrosis were significantly reduced in RDN compared with Sham group. In comparison to Sham group, hepatic perivascular fibrosis was attenuated in both RDN and Carvedilol group, so were the media thickness and the media/lumen of aorta. The plasma levels of B-type natriuretic peptide (BNP), Cystatin C (Cys-C), Alanine Transaminase, angiotensin II (Ang II), transforming growth factor beta 1 (TGF-β1), and malondialdehyde increased, and total superoxide dismutase (T-SOD) decreased in Sham but not in RDN group, compared with Control group. Both RDN and Carvedilol reduced the Cys-C and TGF-β1 levels, and restored T-SOD concentration, compared with Sham group. While only RDN lowered the plasma levels of BNP and Ang II. No significant effects of RDN on blood pressure (BP) and heart rate (HR) were oberved. Conclusions: RDN can attenuate multi-organ fibrosis and improve vascular remodeling independent of BP and HR change in TAC-induced cardiomyopathy. These effects of RDN may be associated with the direct inhibition of renin-angiotensin-aldosterone system and oxidative stress.

Renal Denervation Findings on Cardiac and Renal Fibrosis in Rats with Isoproterenol Induced Cardiomyopathy.

Cardio-renal fibrosis plays key roles in heart failure and chronic kidney disease. We sought to determine the effects of renal denervation (RDN) on cardiac and renal fibrosis in rats with isoproterenol induced cardiomyopathy. Sixty male Sprague Dawley rats were randomly assigned to Control (n = 10) and isoproterenol (ISO)-induced cardiomyopathy group (n = 50). At week 5, 31 survival ISO-induced cardiomyopathy rats were randomized to RDN (n = 15) and Sham group (n = 16). Compared with Control group, ejection fraction was decreased, diastolic interventricular septal thickness and left atrial dimension were increased in ISO-induced cardiomyopathy group at 5 week. After 10 weeks, cardio-renal pathophysiologic results demonstrated that the collagen volume fraction of left atrio-ventricular and kidney tissues reduced significantly in RDN group compared with Sham group. Moreover the pro-fibrosis factors (TGF-β1, MMP2 and Collagen I), inflammatory cytokines (CRP and TNF-α), and collagen synthesis biomarkers (PICP, PINP and PIIINP) concentration significantly decreased in RDN group. Compared with Sham group, RDN group showed that release of noradrenaline and aldosterone were reduced, angiotensin-converting enzyme (ACE)/angiotensin II (Ang II)/angiotensin II type-1 receptor (AT1R) axis was downregulated. Meanwhile, angiotensin-converting enzyme 2 (ACE2)/angiotensin-1-7 (Ang-(1-7))/mas receptor (Mas-R) axis was upregulated. RDN inhibits cardio-renal fibrogenesis through multiple pathways, including reducing SNS over-activity, rebalancing RAAS axis.

Adipose Tissue Lipolysis Promotes Exercise-induced Cardiac Hypertrophy Involving the Lipokine C16:1n7-Palmitoleate

Endurance exercise training induces substantial adaptive cardiac modifications such as left ventricular hypertrophy (LVH). Simultaneously to the development of LVH, adipose tissue (AT) lipolysis becomes elevated upon endurance training to cope with enhanced energy demands. In this study, we investigated the impact of adipose tissue lipolysis on the development of exercise-induced cardiac hypertrophy. Mice deficient for adipose triglyceride lipase (Atgl) in AT (atATGL-KO) were challenged with chronic treadmill running. Exercise-induced AT lipolytic activity was significantly reduced in atATGL-KO mice accompanied by the absence of a plasma fatty acid (FA) increase. These processes were directly associated with a prominent attenuation of myocardial FA uptake in atATGL-KO and a significant reduction of the cardiac hypertrophic response to exercise. FA serum profiling revealed palmitoleic acid (C16:1n7) as a new molecular co-mediator of exercise-induced cardiac hypertrophy by inducing nonproliferative cardiomyocyte growth. In parallel, serum FA analysis and echocardiography were performed in 25 endurance athletes. In consonance, the serum C16:1n7 palmitoleate level exhibited a significantly positive correlation with diastolic interventricular septum thickness in those athletes. No correlation existed between linoleic acid (18:2n6) and diastolic interventricular septum thickness. Collectively, our data provide the first evidence that adipose tissue lipolysis directly promotes the development of exercise-induced cardiac hypertrophy involving the lipokine C16:1n7 palmitoleate as a molecular co-mediator. The identification of a lipokine involved in physiological cardiac growth may help to develop future lipid-based therapies for pathological LVH or heart failure.

QT interval, general mortality and the role of echocardiographic parameters of left ventricular hypertrophy: Results from the prospective, population-based CARLA study.

There is convincing evidence of an association between the QT interval on electrocardiograms and general mortality. However, results are inconclusive regarding the extent to which this association depends on ventricular mass and size. Data were obtained from the prospective, population-based CARLA study, with a mean follow-up of 8.8 years, after exclusion of subjects with atrial fibrillation (919 men, 797 women aged 45-83 years remained eligible). Echocardiographic parameters were left ventricular mass index, left ventricular diastolic dimension index, diastolic interventricular septum thickness, diastolic left ventricular posterior wall and the relative left ventricular wall thickness. Heart rate-corrected QT interval (QTc) was measured with standard 12-lead electrocardiograms using the MEANS algorithm. The association between QTc and survival was modelled using Cox-regression models (crude- and covariate-adjusted). Values were standardized by dividing the QTc by the standard deviation. The association between QTc and survival was assessed in terms of tertiles of echocardiographic parameters. In covariate-adjusted models, QTc was associated with general mortality (hazard ratio (HR): 1.19; 95% confidence interval (CI): 1.03, 1.38). Compared with higher tertiles, subjects in the lowest tertile of left ventricular mass index (HR=1.73, 95% CI: 1.26, 2.36) showed the strongest association with general mortality, which was also true for the lowest tertile of diastolic left ventricular posterior wall thickness (HR=1.49, 95% CI: 1.10, 2.02). In the general population, the association between QTc and general mortality is strongest in subjects with low left ventricular mass index and diastolic thickness of the left ventricular posterior wall, thus the prognostic value of QTc needs to be interpreted with regard to these echocardiographic parameters.

Identification of a definite diabetic cardiomyopathy in type 2 diabetes by comprehensive echocardiographic evaluation: A cross‐sectional comparison with non‐diabetic weight‐matched controls

Subclinical left ventricular (LV) dysfunction is prevalent in type 2 diabetes (T2DM). As obesity has been proposed as one causal factor in the disease process, this could bias the reported prevalences. We wanted to characterize echocardiographic LV dysfunction in obese T2DM subjects as compared to non-diabetic obese controls. One hundred patients with T2DM without clinical signs of heart failure (29% females, mean ± SD age 58.4 ± 10.5 years, body mass index (BMI) 30.1 ± 5.5 kg/m(2), blood pressure (BP) 141 ± 18/83 ± 9 mmHg) and 100 non-diabetic controls (29% females) matched for age (58.6 ± 10.5 years), BMI (29.8 ± 4.0 kg/m(2) and systolic BP (140 ± 14 mmHg) underwent echocardiography and color tissue Doppler imaging (TDI). Diastolic function was evaluated with conventional Doppler recordings and early (e') and late (a') myocardial velocities. The ratio between early transmitral filling (E) and the corresponding myocardial tissue velocity (e') served as an index of LV filling pressure. T2DM patients had more concentric hypertrophy with a relative wall thickness of 0.42 ± 0.07 vs controls 0.38 ± 0.07, P < 0.001. The T2DM group had signs of diastolic dysfunction with lower E/A ratio (0.91 ± 0.27 vs. 1.12 ± 0.38, P < 0.001), deceleration time (195 ± 49 vs 242 ± 72 ms, P < 0.001), e' (5.7 ± 2.0 vs. 6.6 ± 1.8 cm/s, P = 0.001), and a' (6.5 ± 2.0 vs. 7.6 ± 1.5 cm/s, P < 0.001) compared to the controls, and higher E/e' (13.3 ± 4.7 vs. 11.1 ± 3.5, P < 0.001). Thus, there were indications of pseudo normalization and increased filling pressure in the T2DM group, whereas the controls had evidence for relaxation abnormalities without elevated filling pressure. Compared to a non-diabetic obese group, more advanced subclinical impairment of diastolic function was seen in T2DM.

Assessment of left ventricular function by two-dimensional speckle-tracking echocardiography in small breed dogs with hyperadrenocorticism

BackgroundHyperadrenocorticism (HAC) is associated with an increased prevalence of hypertension. This study investigated the left ventricular function using two-dimensional speckle-tracking echocardiography (2D-STE) in small breed dogs affected with spontaneous HAC.Age-matched healthy controls (n = 9), dogs with pituitary-dependent hyperadrenocorticism (PDH, n = 10), and dogs with adrenal-dependent hyperadrenocorticism (ADH, n = 9) were included in this study. Conventional echocardiography, global longitudinal and circumferential strain, and strain rate were assessed.ResultsOn group-wise comparison, left ventricular free wall (LVFWd) and interventricular septal thickness in diastole (IVSd) were thickest in the ADH group, followed by the PDH and controls (P = 0.014 and P = 0.001, respectively). Neither LVFWd nor IVSd was correlated with systemic blood pressure (P = 0.238 and P = 0.113, respectively). The values of all variables derived from the global strain and strain rate in longitudinal and circumferential directions followed the same pattern: highest in the controls, followed by PDH and then ADH (all P < 0.05, respectively). On multiple regression analyses, global longitudinal strain, global longitudinal strain rate in systole and early diastole, and global circumferential strain all decreased linearly with increased IVSd (all P < 0.05).ConclusionsLeft ventricular hypertrophy (LVH) was more prevalent in the HAC group compared to the control group. Association between hypertension and development of LVH was not identified. Decreased global longitudinal and circumferential strains were associated with increased IVSd. 2D-STE revealed significant decreases in systolic functions that were undetected using conventional echocardiography in the ADH and PDH groups.

Effect of chronic left ventricular unloading on myocardial remodeling: Multimodal assessment of two heterotopic heart transplantation techniques

Cardiac recovery is possible by means of mechanical unloading yet remains rare. Excessive unloading-associated myocardial atrophy and fibrosis may adversely affect the process of reverse remodeling. In this study, we sought to evaluate the effect of different intensities of chronic left ventricular (LV) unloading on myocardial remodeling. Twenty-five isogenic Lewis rats underwent complete LV unloading (CU, n = 15) induced by heterotopic heart transplantation or partial LV unloading (PU, n = 10) by heterotopic heart-lung transplantation. Information obtained from serial echocardiography, 2-deoxy-2[(18)F]fluoro-d-glucose ((18)F-FDG)-positron emission tomography, and an LV pressure-volume catheter were used to evaluate the morphology, glucose metabolism, and hemodynamic performance of the orthotopic hearts and heterotopic transplants over 4 weeks. Cell size, collagen content, tissue cytokines (interleukin [IL]-1α, IL-2, IL-6, IL-10, tumor necrosis factor-α, and vascular endothelial growth factor), and matrix metalloproteinase-2 and -9 were also determined. The recorded parameters included LV end-systolic dimension, LV end-diastolic dimension, posterior wall thickness, diastolic interventricular septum thickness, LV fractional shortening, and LV ejection fraction. We demonstrated an LV load-dependent relationship using echo-based structural (left posterior wall thickness, diastolic interventricular septum thickness, and left ventricular end-diastolic dimension) and functional (LV fractional shortening and LV ejection fraction) parameters, as well as an (18)F-FDG uptake (all p < 0.05). This load-dependent relationship was also evidenced in measurements from the pressure-volume conductance catheter (stroke volume, stroke work, cardiac output, dP/dTmax, and -dP/dTmin; all p < 0.05). Significant myocardial atrophy and fibrosis were observed in unloaded hearts, whereas concentrations of cytokines and matrix metalloproteinases were comparable in both unloading conditions. Partial and complete unloading affected the remodeling of non-failing hearts in a rodent model to different extents on myocardial atrophy, fibrosis, glucose metabolism, and mechanical work. Cardiac atrophy is the prominent change after mechanical unloading, which exaggerates the proportion of total collagen that is responsible for diastolic dysfunction.

Effects of transcatheter aortic valve implantation on ascending aorta wall elastic properties: Tissue Doppler imaging and strain Doppler echocardiography study

BackgroundAortic elastic properties are determinants of left ventricular function by means of ventriculo-arterial coupling and indicators of cardiovascular risk. Aortic valve stenosis surgical replacement temporary reduces aortic function damaging vasa vasorum, while transcatheter aortic valve implantation (TAVI) does not influence it in the short term. We studied aortic distensibility, stiffness, M-mode strain and tissue strain after 6 and 12 months from TAVI. MethodsWe enrolled 15 patients with symptomatic severe aortic stenosis who underwent CoreValve prosthesis (Medtronic, Minneapolis, MN) implantation. Everyone had blood pressure measurement and echocardiography registration before TAVI and after 6 and 12 months. ResultsAfter TAVI NYHA class (p = 0.016), peak and mean aortic valve gradients (p < 0.001 for both) improved. Aortic distensibility increased (p = 0.032 in the first 6 months, p = 0.005 in the second 6 months, and p = 0.003 from baseline to 12 months), as well as stiffness decreased (p = 0.034; 0.090; 0.001), M-mode strain and tissue strain ameliorated (p = 0.041; 0.004; 0.004; and p = 0.013; 0.002; 0.001, respectively), tissue Doppler imaging improved (S′ wave: p = 0.289; 0.347; 0.018. E′ wave: p = 0.018; 0.113; 0.007. A′ wave: p = 0.002; 0.532; 0.001). Moreover, some left ventricular parameters improved at 6 months, such as ejection fraction (from 49 ± 16 to 57 ± 11%; p = 0.044) and diastolic interventricular septum thickness (from 14 ± 2 to 12 ± 2 mm; p = 0.010). Even systolic pulmonary artery pressure (p = 0.019) and left diastolic dysfunction grade ameliorated (p = 0.042). ConclusionsFor the first time we demonstrated that aortic elastic properties improve at 6 and 12 months after TAVI, thus influencing ventriculo-arterial coupling and ameliorating left ventricular function.

A Randomized Study Assessing the Effect of Diet in Cats with Hypertrophic Cardiomyopathy

BackgroundDiet might influence progression of hypertrophic cardiomyopathy (HCM).ObjectiveTo investigate whether diet composition could alter clinical, biochemical, or echocardiographic variables in cats with HCM.AnimalsTwenty‐nine cats with HCM (International Small Animal Cardiac Health Council stage 1b) examined at a university teaching hospital.MethodsRandomized, placebo‐controlled trial. After physical examination, echocardiogram, and blood collection, cats were randomized to 1 of 3 diets, which varied in carbohydrate and fat content and ingredients. Measurements were repeated after 6 months.ResultsThere were no significant differences among the 3 groups at baseline. After 6 months, there were no significant changes in the primary endpoints, left ventricular free wall (Group A, P = .760; Group B, P = .475; Group C, P = .066) or interventricular septal thickness in diastole (Group A, P = .528; Group B, P = .221; Group C, P = .097). Group A had significant increases in BUN (P = .008) and cholesterol (P = .021), while Group B had significant increases in BUN (P = .008), cholesterol (P = .007), and triglycerides (P = .005), and significant decreases in NT‐proBNP (P = .013) and hs‐troponin I (P = .043). Group C had significant decreases in body weight (P = .021), left atrial dimension (P = .035), interventricular septal thickness in systole (P = .038), and liver enzymes (P = .034–.038).Conclusions and Clinical ImportanceThese data suggest that diet might influence some clinical, biochemical, and echocardiographic variables in cats with HCM.

Carotid atherosclerosis and right ventricular diastolic dysfunction in a sample of hypertensive Nigerian patients.

AimTo determine the association of carotid atherosclerosis and right ventricular diastolic dysfunction (DD) among treated hypertensive Nigerian patients.MethodsThis was a single center cross-sectional study performed at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria between January and December 2012. The study included 122 hypertensive Nigerians (mean age, 57.3 ± 14.7 years, 36.9% women). Patients’ clinical, demographic, and echocardiographic parameters were obtained. Diastolic dysfunction was assessed with the trans-tricuspid Doppler flow.ResultsPatients with DD were significantly older than those with normal diastolic function. Mean and maximum carotid intima media thickness measurements were significantly higher among patients with right ventricular DD than in those with normal diastolic function. Mean systolic blood pressure (148.3 ± 31.9 vs 128.0 ± 2.8 mm Hg, P = 0.049) and interventricular septal thickness in diastole (12.8 ± 2.3 vs 11.6 ± 2.8mm, P = 0.048) were significantly higher and tricuspid annular pulmonary systolic excursion (33.6 ± 4.9 vs 23.0 ± 4.2 mm, P = 0.035) was significantly lower in patients with right ventricular DD than in those with normal diastolic function. Carotid intima media thickness measurements were correlated with early trans-tricuspid Doppler flow and early transtricuspid diastolic flow/late right atrial transtricupsid diastolic flow ratio.ConclusionRight ventricular DD in hypertensive patients was significantly correlated with increased carotid atherosclerosis. Carotid intima media thickness measurements may therefore be a surrogate marker for DD in hypertensive subjects.

The Reduction of Left Ventricular Hypertrophy After Renal Transplantation Is Not Influenced by the Immunosuppressive Regimen

BackgroundCardiovascular (CV) disease is the first cause of death after kidney transplantation. Left ventricular hypertrophy (LVH) is one of the main CV risk factors. It has been reported that the antiproliferative properties of everolimus (EVE) treatment may decrease left ventricular mass. The aim of this study was to evaluate the evolution of LVH in two groups of kidney transplant recipients receiving immunosuppressive treatment with low-dose calcineurin inhibitor (CNI) + EVE or CNI + mycophenolate mofetil (MMF). MethodsWe evaluated 104 patients of mean age 47.5 ± 13.1 years who underwent kidney transplantation between January 2006 and December 2009 pretransplant by echocardiography, which was repeated every year for 3 years during which all patients continued the initial therapy. Over the 3-year period 76 subjects were treated with MMF, and 28 with EVE. We recorded left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness in diastole (IVSTD), left ventricular posterior wall thickness in diastole (LVPWD), left ventricular end-diastolic volume and end-systolic volume during the follow-up echocardiographic evaluations. ResultsNo differences in the evolution of the echocardiographic parameters were observed between the two groups—MMF versus EVE group: LVEDD, 50.3 ± 5.1 versus 51.2 ± 6.7 mm; IVSTD, 11.2 ± 1.9 versus 11.3 ± 2 mm; LVPWD, 10.2 ± 1.9 versus 10.5 ± 1.7 mm; relative wall thickness, 0.041 ± 0.08 versus 0.42 ± 0.08; ejection fraction, 63 ± 6% versus 61 ± 5%; and left ventricular mass index, 113 ± 28.9 versus 121.9 ± 39.4 g/m2, respectively. Compared with pretransplant echocardiographic evaluations, similar reductions in left ventricular mass index were noted in both groups after transplantation. ConclusionsWe observed that after renal transplantation there was a reduction of the LVH respect to the pretransplant dialytic status. The two immunosuppressive regimen did not influence the evolution of post-transplant LVH.

GW24-e3111 Comparations of two common mouse models of chronic heart failure by echocardiography

ObjectivesTo compare the recorded echocardiographic parameters in two common mouse models of chronic heart failure.MethodsKM mice were subjected to transverse aortic constriction (TAC), myocardial infarction induced by coronary artery ligation...

Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia

The study was designed to assess left ventricular (LV) systolic and diastolic function in hypertensive patients with or without Hhcy. The study participants consisted of 40 hypertensive patients with Hhcy, 40 hypertensive patients without Hhcy and 40 age-matched healthy control participants. Cardiac functions were determined using echocardiography and the Tei index was calculated for analysis. LAVI (left atrial volume index), IVST (interventricular septum thickness in diastole), PVST (posterior ventricular septum thickness in diastole), LVMI (left ventricular mass index), E/A (peak early and late diastolic transmitral filling flow velocities ratio), DT (deceleration time of the E wave), IRT (isovolumic relaxation time), and the Tei index were different in the hypertensive patient groups (hypertension with Hhcy and hypertension without Hhcy) compared with the controls. The Tei index was significantly higher in the hypertensive groups compared with the controls (0.62 ± 0.05, 0.51 ± 0.04, and 0.40 ± 0.04, respectively, p < 0.01). Significant differences were also observed between the hypertensive patients with Hhcy and the hypertensive patients without Hhcy regarding LAVI (25.6 ± 4.7 versus 22.9 ± 3.5 ml/m2), E/A (0.73 ± 0.22 versus 0.92 ± 0.14), DT (93.1 ± 6.9 versus 84.3 ± 8.1 ms), IRT (93.1 ± 6.9 versus 84.3 ± 8.1 ms) and the Tei index. Significant correlations were observed between serum homocysteine levels and LV diastolic function parameters (LAVI: r = 0.39, E/A: r = −0.32, DT: r = 0.47, IRT: r = 0.51, p < 0.05). We found that Hhcy had contributory effects on myocardial impairment induced by hypertension. Moreover, there were strong relationships between homocysteine level and LV diastolic dysfunction parameters.

Catheter-based Treatment in Patients with Critical Pulmonary Stenosis or Pulmonary Atresia with Intact Ventricular Septum: A Single Institute Experience with Comparison between Patients with and without Additional Procedure for Pulmonary Flow

We report a single institute experience of transcatheter pulmonary valvotomy using the soft end of a guidewire followed or not by a systemic-pulmonary shunt in patients with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). In addition, we compare patients with or without an additional source of flow to support the pulmonary circulation after successful pulmonary valvotomy. All neonates with PAIVS or CPS who underwent primary transcatheter pulmonary valvotomy between January 2004 and December 2010 were reviewed retrospectively. Some of them needed an additional source of flow to support the pulmonary circulation. We performed a comparison between those who required an additional source of pulmonary flow and those who did not. The initial procedure was successful in 20 out of 22 patients (seven of nine with PAIVS; all of 13 with CPS), but 10 of them needed an additional source of flow to support the pulmonary circulation: nine had arterial duct stenting and one had surgical Blalock-Taussig shunt. There were no deaths or major acute complications, except for femoral artery occlusion in three patients. The bipartite right ventricular morphology, the tricuspid z-score of ≤-0.74, the tricuspid to mitral valve ratio of ≤ 0.9, and the z-score of the diastolic interventricular septal thickness ≥ 2.37 in preprocedural examination showed more tendency of needing shunt placement. Transcatheter pulmonary valvotomy using the soft end of a guidewire followed or not by the arterial duct stent implantation was an effective approach in those patients. The angiographic distinction between CPS and PAIVS did not affect anything in this study including the procedural method, success, and odds for reintervention. The degree of right ventricle cavity hypoplasia provided the main restriction to forward flow after pulmonary valvotomy.