Isovolumetric Contraction Time Research Articles

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

Objective: To evaluate left myocardial performance index (MPI) and time intervals in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser surgery. Methods: Fifty-one fetal pairs with TTTS and 47 uncomplicated monochorionic twin pairs were included. Left ventricular isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured using conventional Doppler. Results: Recipients showed prolonged ICT (46 ± 12 vs. 31 ± 8 vs. 30 ± 5 ms; p < 0.001) and IRT (51 ± 9 vs. 43 ± 8 vs. 43 ± 5 ms; p < 0.001) and higher MPI (0.57 ± 0.12 vs. 0.47 ± 0.09 vs. 0.44 ± 0.05; p < 0.001) than donors and controls. Donors showed shorter ET than recipients and controls (157 ± 12 vs. 169 ± 10 vs. 168 ± 10 ms; p < 0.001) and higher MPI than controls (0.47 ± 0.09 vs. 0.44 ± 0.05; p = 0.006). Preoperative MPI changes were observed in all TTTS stages. Time intervals partially improved after surgery. Conclusion: Donor and recipient twins had higher MPI due to different changes in the time intervals, possibly reflecting the state of hypovolemia in the donor and hypervolemia and pressure overload in the recipient.

Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia-1 disease.

To determine whether fetal isovolumetric time intervals can be an early sonographic marker of fetal anemia in fetuses with homozygous alpha thalassemia-1. Pregnancies at risk for fetal homozygous alpha thalassemia-1 disease at 18-22weeks were recruited before cordocentesis for hemoglobin typing. Isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) intervals were measured by placing pulsed wave Doppler sample volume within the left ventricle to obtain the mitral and aortic waveform. Time intervals were compared between the affected group of homozygous alpha thalassemia-1 fetuses and the unaffected group. Among 70 fetuses at risk, 28 cases were diagnosed as affected by homozygous alpha thalassemia-1 disease. Mean ICT and ICT+IRT intervals in the affected group were significantly longer than in the unaffected group (47.9±12.5ms vs 35.0±6.7ms, p<0.001; and 96.2±13.6ms vs 80.9±10.6ms, p<0.001. ICT effectively predicted affected fetuses with 71.4% sensitivity and 78.6% specificity using a cutoff value ≥40ms. Isovolumetric contraction time was significantly prolonged in fetal anemia from homozygous alpha thalassemia-1 during the early stage of hydropic changes. Because of its simple measurement and high efficacy, ICT can be a useful marker for prenatal screening of abnormal cardiac function in fetal anemia. © 2017 John Wiley & Sons, Ltd.

P22.08: Characteristics of interventricular shunt flow in fetuses with isolated ventricular septal defect assessed by dual Doppler imaging

Prenatal diagnosis of ventricular septal defect (VSD) can be difficult, even using colour Doppler imaging. One reason is that the interventricular shunt flow of fetuses is not as prominent as that of children because of the low pressure difference between ventricles. This study aimed to elucidate the characteristics of the interventricular shunt flow associated with the cardiac phase in fetuses with isolated VSD using dual Doppler imaging. We prospectively studied 18 consecutive fetuses that were prenatally diagnosed with isolated VSD. We simultaneously recorded shunt flow across VSD and mitral/aortic flow using dual Doppler. The cardiac cycle was divided into five phases isovolumetric relaxation time (IRT), early or late filling time, isovolumetric contraction time (ICT), and ejection time by the mitral/aortic flow waveforms; further, shunt flow direction and phase were decided. One fetus with muscular VSD was not evaluated due to difficulty in simultaneous recording of flow signals. The remaining 17 fetuses (11 perimembranous and 6 muscular) were assessed. During IRT, peak right-to-left shunt flow was demonstrated in 16 (94%) fetuses. In ICT and/or early ejection time, 15 (88%) fetuses showed peak left-to-right shunt flow. This study revealed a commonality of the interventricular shunt flow in isolated VSD fetuses. Right-to-left flow during IRT and left-to-right flow in ICT and/or early ejection time were consistently observed. These shunt flow characteristics can help in prenatal diagnosis of isolated VSD and in understanding the physiology of fetal circulation.

Left ventricular myocardial performance index in prehypertensive patients with normal coronary arteries.

Prehypertension, which may be the precursor of hypertension, is an important public health problem in the community. Myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. Thus, our aim was to evaluate left ventricule (LV) functions with the MPI in prehypertensive patients with normal coronary artery angiography. Forty prehypertensive patients (21 women and 19 men), with blood pressures between 120/80 and 139/89 mmHg, and 40 normotensive controls (18 women and 22 men), with blood pressures under 120/80 mmHg, were included in the study. Patient population comprised those who underwent coronary angiography because of typical angina and had normal coronary arteries. The MPI was calculated and compared between the two groups. No statistically significant differences were found between the two groups in terms of age, sex, or other demographic characteristics (P>0.05). Moreover, LV ejection fraction, late diastolic flow, deceleration time, isovolumetric contraction time, and ejection time values were not significantly different between the two groups (P>0.05). However, early diastolic mitral inflow velocity, E/A ratio, isovolumetric relaxation, and MPI were all significantly higher in the patient group than in the control group. The MPI was increased in prehypertensive patients. This result demonstrates that LV diastolic and systolic functions may be negatively affected in patients with prehypertension. The advantages of our method are as follows: it is simple, it does not demand special equipment, and it is not time consuming.

Utility of Cardiovascular Magnetic Resonance-Derived Wave Intensity Analysis As a Marker of Ventricular Function in Children with Heart Failure and Normal Ejection Fraction.

This study sought to explore the diagnostic insight of cardiovascular magnetic resonance (CMR)-derived wave intensity analysis to better study systolic dysfunction in young patients with chronic diastolic dysfunction and preserved ejection fraction (EF), comparing it against other echocardiographic and CMR parameters. Evaluating systolic and diastolic dysfunctions in children is challenging, and a gold standard method is currently lacking. Patients with presumed diastolic dysfunction [n = 18; nine aortic stenosis (AS), five hypertrophic, and four restrictive cardiomyopathies] were compared with age-matched control subjects (n = 18). All patients had no mitral or aortic incompetence, significant AS, or reduced systolic EF. E/A ratio, E/E' ratio, deceleration time, and isovolumetric contraction time were assessed on echocardiography, and indexed left atrial volume (LAVi), acceleration time (AT), ejection time (ET), and wave intensity analyses were calculated from CMR. The latter was performed on CMR phase-contrast flow sequences, defining a ratio of the peaks of the early systolic forward compression wave (FCW) and the end-systolic forward expansion wave (FEW). Significant differences between patients and controls were seen in the E/E' ratio (8.7 ± 4.0 vs. 5.1 ± 1.3, p = 0.001) and FCW/FEW ratio (2.5 ± 1.6 vs. 7.2 ± 4.2 × 10-5 m/s, p < 0.001), as well as-as expected-LAVi (80.7 ± 22.5 vs. 51.0 ± 10.9 mL/m2, p < 0.001). In particular, patients exhibited a lower FCW (2.5 ± 1.6 vs. 7.2 ± 4.2 × 10-5 m/s, p < 0.001) in the face of preserved EF (67 ± 11 vs. 69 ± 5%, p = 0.392), as well as longer isovolumetric contraction time (49 ± 7 vs. 34 ± 7 ms, p < 0.001) and ET/AT (0.35 ± 0.04 vs. 0.27 ± 0.04, p < 0.001). This study shows that the wave intensity-derived ratio summarizing systolic and diastolic function could provide insight into ventricular function in children, on top of CMR and echocardiography, and it was here able to identify an element of ventricular dysfunction with preserved EF in a small group of young patients.

Assessment of Cardiac Function in Fetuses of Gestational Diabetic Mothers During the Second Trimester.

Fetuses of diabetic mothers may have structural or functional cardiac abnormalities which increase morbidity and mortality. Isolated functional abnormalities have been identified in the third trimester. The aim of the present study was to assess fetal cardiac function (systolic, diastolic, and global myocardial performance) in the second trimester in mothers with gestational diabetes, and also to relate cardiac function with glycemic control. Mothers with gestational diabetes mellitus referred for fetal cardiac evaluation in the second trimester (between 19 and 24 weeks) from March 2015 to February 2016 were enrolled as case subjects in this study. Non-diabetic mothers who had a fetal echocardiogram done between 19 and 24 weeks for other indications were enrolled as controls. Functional cardiac variables showed a statistically significant difference in isovolumetric relaxation and contraction times and the myocardial performance index and mitral E/A ratios in the gestational diabetic group (p = 0.003). Mitral annular plane systolic excursion was significantly less in the diabetic group (p = 0.01). The only functional cardiac variable found abnormal in mothers with poor glycemic control was the prolonged isovolumetric relaxation time. Functional cardiac abnormalities can be detected in the second trimester in fetuses of gestational diabetic mothers and timely intervention can improve postnatal outcomes.

Characterization of left ventricle energy loss in healthy adults using vector flow mapping: Preliminary results.

Energy loss (EL) is a new quantitative hemodynamic index based on vector flow mapping (VFM). This study aimed to characterize EL of the left ventricle (LV) in healthy adults. Fifty-one healthy adults were enrolled in this study. EL of LV was analyzed frame by frame using color Doppler images of a standard apical three-chamber dynamic view on an offline VFM workstation. The average EL of systole and diastole was calculated, and the results were averaged over three cardiac cycles. The average EL for systole and diastole was 11.07±5.82J/m/s and 11.58±5.54J/m/s, respectively. Multivariate regression analysis showed that the aortic velocity time integral (AOVTI), A-wave peak velocity, and isovolumetric contraction time (IVCT) were independently associated with the average systolic EL. E-wave peak velocity, height, and IVCT were independently associated with the average diastolic EL. For females, the average systolic and diastolic EL was 12.66±7.06J/m/s and 13.90±5.37J/m/s, respectively. For males, the systolic and diastolic EL was 9.29±3.33J/m/s and 8.97±4.55J/m/s, respectively. Energy loss in LV changes regularly during the cardiac cycle. The average systolic EL has a high positive correlation with AOVTI, whereas the average diastolic EL has with E-wave peak velocity. Women have higher average EL than men in both systole and diastole. By recognizing the EL characterization of healthy adults, the variation in EL may reflect cardiac dysfunction. These were preliminary results, and thus, the clinical implications of EL warrant further investigation.

Glucocorticoid receptor alters isovolumetric contraction and restrains cardiac fibrosis.

Corticosteroids directly affect the heart and vasculature and are implicated in the pathogenesis of heart failure. Attention is focussed upon the role of the mineralocorticoid receptor (MR) in mediating pro-fibrotic and other adverse effects of corticosteroids upon the heart. In contrast, the role of the glucocorticoid receptor (GR) in the heart and vasculature is less well understood. We addressed this in mice with cardiomyocyte and vascular smooth muscle deletion of GR (SMGRKO mice). Survival of SMGRKO mice to weaning was reduced compared with that of littermate controls. Doppler measurements of blood flow across the mitral valve showed an elongated isovolumetric contraction time in surviving adult SMGRKO mice, indicating impairment of the initial left ventricular contractile phase. Although heart weight was elevated in both genders, only male SMGRKO mice showed evidence of pathological cardiomyocyte hypertrophy, associated with increased myosin heavy chain-β expression. Left ventricular fibrosis, evident in both genders, was associated with elevated levels of mRNA encoding MR as well as proteins involved in cardiac remodelling and fibrosis. However, MR antagonism with spironolactone from birth only modestly attenuated the increase in pro-fibrotic gene expression in SMGRKO mice, suggesting that elevated MR signalling is not the primary driver of cardiac fibrosis in SMGRKO mice, and cardiac fibrosis can be dissociated from MR activation. Thus, GR contributes to systolic function and restrains normal cardiac growth, the latter through gender-specific mechanisms. Our findings suggest the GR:MR balance is critical in corticosteroid signalling in specific cardiac cell types.

Temporal Sequential Pattern of Right Ventricular Free Wall Contraction in Normal Children.

The temporal sequence of right ventricular (RV) deformation is related to RV dysfunction. The sequence of RV free wall contraction was investigated.Methods and Results:In this prospective study, strain profiles using speckle-tracking echocardiography and tissue Doppler-derived pulmonary and tricuspid annular motion were assessed in 60 normal children. Circumferential RV free wall strain of 3 individual segments (anterior, lateral, and inferior) was evaluated. Longitudinal strain was assessed in 3 individual segments (RV outflow tract [RVOT], apical, and RV inflow tract [RVIT]). The isovolumetric contraction time (ICT) and the time interval between the onset of the QRS wave to the peak s' wave were measured for pulmonary and tricuspid annular motion velocities. The time to peak circumferential strain was significantly lower in the anterior than in the lateral and inferior segments (339.1±19.5, 358.3±21.8, and 366.6±22.4 ms, respectively; P<0.0001). Longitudinal deformation of the RVOT segment occurred before the apical and RVIT segments (351.8±23.1, 366.3±20.1, and 369.2±21.3 ms, respectively; P<0.0001). The ICT and the time to peak s' were significantly shorter in pulmonary than in tricuspid annular motion (49.4±10.1 vs 58.0±13.2 ms; and 104.7±12.2 vs. 160.5±27.1 ms; P<0.0001 for each). Longitudinal deformation of RVOT precedes RVIT. Circumferential deformation occurs in the anterior segment before the lateral and posterior segments. The presence of mechanical time heterogeneity appears important for RV performance.

Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus.

Fetal cardiac left ventricular function in pregnant women with pregestational or gestational diabetes mellitus was investigated by exploring fetal myocardial performance index (MPI) and E wave/A wave peak velocity (E/A) ratio. Seventy pregnant women with either pregestational or gestational diabetes mellitus and with no other systemic or pregnancy related disorders were compared with 70 gestational age matched healthy controls by means of fetal left ventricular MPI and E/A ratio. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods: ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT), which were employed in the calculation of MPI (MPI = [ICT + IRT]/ET). Statistical analyses were conducted using receiver operating characteristic analysis and independent two-sample t, Mann-Whitney U and chi-square tests. Fetal left ventricular MPI values were significantly higher in the diabetic group compared with controls (0.56 ± 0.09 vs 0.36 ± 0.04, P < 0.001), whereas E/A ratio was lower (0.66 ± 0.11 vs 0.69 ± 0.09, P = 0.049). The adverse perinatal outcome rate was also higher in the diabetic group. Receiver operating characteristic analysis revealed > 0.39 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 90.9%, specificity: 47.7%, area under the curve: 0.690, 95% confidence interval: 0.598-0.782, P < 0.001). We conclude that fetuses of diabetic mothers have significant left ventricular systolic and diastolic dysfunction. MPI may be used in the prediction of adverse perinatal outcome in diabetic pregnancies.

Myocardial Function Pre- and Post-Fetal Endoscopic TrachealOcclusion (FETO) in Fetuses with Left-Sided Moderate to Severe Congenital Diaphragmatic Hernia.

FETO was performed at 32.5 (SD 2.4) weeks of gestation. There was no statistically significant change in myocardial function in fetuses treated by FETO except a slight prolongation of the ICT of the left ventricle in PW-TDI. The myocardial function of fetuses with CDH pre- and post-FETO and fetuses with CDH without FETO was comparable to that of healthy controls. Conclusion In our series FETO did not affect myocardial function in fetuses with left-sided CDH. Although ventricular preload increases, FETO seems to have no short-term impact on fetal myocardial performance.

PP.33.14] TEI INDEX AS A TOOL FOR THE DIAGNOSIS OF LEFT VENTRICULAR DYSFUNCTION WITH PRESERVED EJECTION FRACTION IN HYPERTENSIVE PATIENTS

Objective: The frequency of left ventricular dysfunction (LVD) in patients (p) with hypertension (HBP) and the methodologies used for its detection are controversial issues. The Ventricular Performance Index, known as Tei index, simultaneously evaluates systolic and diastolic function, and could be a useful tool in HBP p with preserved ejection fraction (PEF). To determine the frequency of LVD in HBP p with PEF by Tei Index. Design and method: Case – control study. Patients divided in three groups: 1) HBP p without left ventricular hypertrophy (LVH); 2) HBP with LVH; 3) non-HBP controls. Volumetric >54% was considered PEF. Left ventricular mass index was measured by Devereux method, LVH was considered with values >95 g/m2 in women and >115 g/m2 in men. Transmitral diastolic peak early flow to septal/lateral mitral annulus average peak early diastolic velocities (E/e’ ratio). Systolic and diastolic functions were assessed by standard echocardiography and tissue Doppler and measured as the average diastolic excursion rate of the septal and lateral walls at the mitral annulus level in diastole (e’ wave) and systole (s wave). Left atrial volume index (LAVI) was measured. 2013 ESH / ESC Hypertension Guidelines cutoff values were considered. Tei index was measured at the lateral and septal walls of the left ventricle in the apical 4-chamber view by tissue Doppler, three measurements of isovolumetric contraction time, ejection time, and isovolumic relaxation time were averaged and a value >0.40 was considered abnormal. Statistical analysis: ANOVA test, p < 0.05 was considered statistically significant. Results: The mean sample age was 57.3+14.5 years, 54.2 % p were males. 88 non LVH HBP p; 19 LVH HBP p; and 11 non-HBP controls were included. Table shows systolic and diastolic left ventricular function results:Conclusions: 1) abnormal left ventricular function is frequent in HBP p, even in the absence of LVH; 2) tissue Doppler obtained Tei Index is a useful tool for the diagnosis of LVD.

Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy?

Objective: To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP).Methods: Forty-one ICP cases were compared with 41 gestational age-matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods [ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)], which were employed in the calculation of mod-MPI [mod-MPI = (ICT + IRT)/ET]. The E/A ratio was calculated as well.Results: Fetal left ventricular mod-MPI values were significantly higher in the ICP group compared to controls (0.56 ± 0.09 versus 0.37 ± 0.04, p < 0.001), whereas the E/A ratio was lower (0.62 ± 0.11 versus 0.69 ± 0.10, p = 0.011). The optimal cutoff level for mod-MPI in prediction of adverse perinatal outcomes was >0.48 [sensitivity: 81.8%, specificity: 67.6%, area under the curve (AUC): 0.750, 95% CI: 0.613–0.887, p = 0.008].Conclusions: Fetuses of ICP cases have significant left ventricular dysfunction. Mod-MPI can be used in the prediction of adverse perinatal outcomes in ICP.

Role of Tissue Doppler Echocardiography in the Diagnosis of Early Left Ventricular Dysfunction in Rheumatoid Arthritis

AbstractObjective: Rheumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alterations. The purpose of our study is the usefulness of Tissue Doppler echocardiography to detect the nature and extent of cardiac involvement in RA patients with no symptoms of cardiac disease, in comparison with a control sample.Methods: We selected 21 patients affected by rheumatoid arthritis. No patient had any symptoms of cardiac disease. As a control group we studied 21 volunteers, randomly selected among a larger group of subjects who had come for routine check-up. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographic examination was carried out on each subject.Results: out of 21 RA patients, 16 females 5 males with an average age of 38±9 years. Both the study group and control were matched with respect to age and sex. In RA patients we found a higher prevalence of several tissue Doppler parameters abnormalities. Patients with RA showed significantly higher tricuspid annular plane systolic ejection (TAPSE) 2.49±0.19 vs. 2.36±0.22 (p= 0.04), isovolumetric contraction time (IVCT) 48.8±11.7 vs. 41.2±7.7 msec, (p=0.02), isovolumetric velocity (IVV) 12.26±2.23 vs. 15.71±1.89 m/sec ( p = 0.00) acceleration time (AT) 0.43±0.05 vs. 0.35+0.05 msec (p = 0.00) lower isovolumetric acceleration (IVA) 28.68±6.57 vs. 45.8±10.1 m/sec2 (p = 0.00) early diastolic velocity (E)′ 10.48±1.99 vs. 13.02±1.54 cm/sec (p = 0.00). No significant difference was noted with IVRT (isovolumetric relaxation time) and A′ (late diastolic velocity). Duration of RA did not affect the significance of these parameters.Conclusion: There was subclinical LV systolic and diastolic dysfunction with normal EF, detected by tissue Doppler imaging in Rheumatoid arthritis patients.

Detection of Early Right Ventricular Dysfunction in Young Patients With Thalassemia Major Using Tissue Doppler Imaging.

BackgroundMyocardial iron overload is the most common cause of mortality in patients with thalassemia major (TM), also known as beta-thalassemia. T2* cardiovascular magnetic resonance imaging (MRI) is the best way of monitoring cardiac iron, and new echocardiographic techniques can be used to assess cardiac function.ObjectivesThe aim of this study was to assess the systolic and diastolic right ventricular (RV) function of patients with TM using tissue Doppler imaging (TDI) and to determine whether this echocardiographic technique is an adequate diagnostic tool for the screening and detection of subclinical cardiac dysfunction.Patients and MethodsEighty-four patients with TM were evaluated by conventional echocardiography and pulse-wave TDI. The data of the TM group (Group 1) were compared with that of 85 age- and sex-matched healthy controls (Group 2). Cardiovascular T2* MRI examinations were performed in 49 of the 85 patients.ResultsThe patients with TM had significantly lower values for weight, height, body mass index, systolic arterial pressure, deceleration time, E’/A’, and ejection time (ET) than the controls. Group 1 also had significantly higher values for peak early diastolic velocity (E) over peak late diastolic velocity (A), peak early diastolic velocity of TDI (E’), peak late diastolic velocity of TDI (A’), E/E’, isovolumetric relaxation time, isovolumetric contraction time, and RV magnetic perfusion imaging (MPI) than Group 2.ConclusionsRV diastolic dysfunction occurs before systolic deterioration in patients with TM and cannot be screened with conventional echocardiographic techniques. In routine practice, TDI measurements, MPI (for global function) and the E/E’ parameter (for diastolic function) can be used to screen and detect early RV dysfunction.

Comprehensive MRI for the detection of subtle alterations in diastolic cardiac function in apoE/LDLR(-/-) mice with advanced atherosclerosis.

ApoE/LDLR(-/-) mice represent a reliable model of atherosclerosis. However, it is not clear whether cardiac performance is impaired in this murine model of atherosclerosis. Here, we used MRI to characterize cardiac performance in vivo in apoE/LDLR(-/-) mice with advanced atherosclerosis. Six-month-old apoE/LDLR(-/-) mice and age-matched C57BL/6J mice (control) were examined using highly time-resolved cine-MRI [whole-chamber left ventricle (LV) imaging] and MR tagging (three slices: basal, mid-cavity and apical). Global and regional measures of cardiac function included LV volumes, kinetics, time-dependent parameters, strains and rotations. Histological analysis was performed using OMSB (orceine with Martius, Scarlet and Blue) and ORO (oil red-O) staining to demonstrate the presence of advanced coronary atherosclerosis. MR-tagging-based strain analysis in apoE/LDLR(-/-) mice revealed an increased frequency of radial and circumferential systolic stretch (25% and 50% of segments, respectively, p ≤ 0.012), increased radial post-systolic strain index (45% of segments, p = 0.009) and decreased LV untwisting rate (-30.3° (11.6°)/cycle, p = 0.004) when compared with control mice. Maximal strains and LV twist were unchanged. Most of the cine-MRI-based LV functional and anatomical parameters also remained unchanged in apoE/LDLR(-/-) mice, with only a lower filling rate, longer filling time, shorter isovolumetric contraction time and slower heart rate observed in comparison with control mice. The coronary arteries displayed severe atherosclerosis, as evidenced by histological analysis. Using comprehensive MRI methods, we have demonstrated that, despite severe coronary atherosclerosis in six-month-old apoE/LDLR(-/-) mice, cardiac performance including global parameters, twist and strains, was well preserved. Only subtle diastolic alterations, possibly of ischemic background, were uncovered. Copyright © 2016 John Wiley & Sons, Ltd.

Autoimmune Response Confers Decreased Cardiac Function in Patients with Rheumatic Mitral Lesion following Valve Replacement

Purpose: To explore the effect of autoimmune response on the decreased cardiac function in patients with rheumatic mitral lesion following valve replacement.Methods: In this case-controlled study, 29 patients who had undergone valve replacement as a result of mitral lesion were enrolled (mean age = 48.7 years). Twenty healthy volunteers were selected as control (mean age = 47.5 years). Plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high –sensitivity C-reactive protein (hs-CRP) and echocardiographic indices of heart function in the two groups were investigated, respectively. Body mass index (BMI) was also calculated.Results: TNF-α, IL-6 and hs-CRP levels in plasma were significantly higher than those in controls (p &lt; 0.05; 22.23 pg/mL vs. 13.24 pg/mL, 53.42 pg/mL vs. 9.57 pg/mL, and 2.12 μg/mL vs. 0.97 μg/mL, respectively). The indices of left atrial diameter (LAD), left ventricular end-diastolic diameter (LDD) and isovolumetric contraction time (ICT) were significantly higher (p &lt; 0.05; 4.72 cm vs. 3.78 cm, 4.85 cm vs. 4.37 cm, and 76.38 ms vs. 66.24 ms, respectively), but those of early diastolic velocity (Ea), late diastolic velocities (Aa) and ejection time (ET) were significantly lower (p &lt; 0.05; 7.65 cm/s vs. 16.8 cm/s, 5.56 cm/s vs. 12.9 cm/s, and 261.54 ms vs. 276.14 ms, respectively). Two-dimensional echocardiography obtained the same results.Conclusion: Valve replacement in patients with rheumatic heart disease (RHD) does not attenuate inflammatory response; rather, autoimmune response would keep affecting decreased heart function in RHD patients who have received mitral valve replacement.Keywords: Tumor necrosis factor-α, Interleukin-6, High sensitivity C reactive protein, Mitral lesion, Mitral valve replacement

Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome.

To establish normal reference ranges for the fetal left modified myocardial performance index (Mod-MPI) measured by the Auto Mod-MPI system and evaluate Mod-MPI changes in recipients of twin-to-twin transfusion syndrome (TTTS) before and after fetoscopic laser coagulation. This was a prospective longitudinal study of normal singleton fetuses from 12.0 to 40.0 weeks of gestation. TTTS cases treated by laser coagulation were reviewed for Mod-MPI measurements of recipients. All measurements were performed using the Auto Mod-MPI system by a single experienced operator. Among a total 447 examinations from 222 fetuses, we were unable to measure the Mod-MPI in two cases, and therefore, 445 examinations were analyzed. The median Mod-MPI consistently increased from 0.44 to 0.56 throughout gestation. The median isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) also increased with advancing gestational age. The ejection time (ET) increased until 27 weeks of gestation and decreased thereafter. In the 30 recipients, Mod-MPI, ICT, and IRT increased before laser coagulation and significantly decreased after laser coagulation. Normal reference values for left Mod-MPI were established using the Auto Mod-MPI system, and these might be useful for assessing cardiac function in TTTS. © 2016 John Wiley & Sons, Ltd.

Assessment of the left ventricular function in normotensive prediabetics: a tissue Doppler echocardiography study.

Several studies have shown that left ventricular (LV) dysfunction is increased in individuals with diabetes. However, there are scarce data about LV function in prediabetics. This study assessed the early changes in LV diastolic and systolic myocardial function in normotensive prediabetics using tissue Doppler echocardiography (TDE). We evaluated 94 patients with prediabetes (mean age of 50.8 ± 6.9 years, 78 female) without known cardiovascular diseases and 70 healthy volunteers with similar demographic characteristics. Systolic and diastolic function of the left ventricle was evaluated with transthoracic echocardiography according to the latest consensus recommendations including TDE. The mean results of septal and lateral parts of the mitral annulus Pulsed wave TDE showed that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em to atrial peak velocity (Am) ratio were significantly lower whereas early diastolic peak flow velocity (E) to Em ratio, myocardial isovolumetric relaxation time (IVRTm), myocardial isovolumetric contraction time (IVCTm) and myocardial performance index (MPI) values were significantly higher in patients with prediabetes (preDM). In addition, mean left atrium (LA) diameter measured with M-mode echocardiography was significantly higher in prediabetics than controls. PreDM is associated with subclinical LV systolic and diastolic dysfunction as evaluated by TDE.

Color Tissue Doppler to Analyze Fetal Cardiac Time Intervals: Normal Values and Influence of Sample Gate Size.

To assess the time intervals of the cardiac cycle in healthy fetuses in the second and third trimester using color tissue Doppler imaging (cTDI) and to evaluate the influence of different sizes of sample gates on time interval values. Time intervals were measured from the cTDI-derived Doppler waveform using a small and large region of interest (ROI) in healthy fetuses. 40 fetuses were included. The median gestational age at examination was 26 + 1 (range: 20 + 5 - 34 + 5) weeks. The median frame rate was 116/s (100 - 161/s) and the median heart rate 143 (range: 125 - 158) beats per minute (bpm). Using small and large ROIs, the second trimester right ventricular (RV) mean isovolumetric contraction times (ICTs) were 39.8 and 41.4 ms (p = 0.17), the mean ejection times (ETs) were 170.2 and 164.6 ms (p < 0.001), the mean isovolumetric relaxation times (IRTs) were 52.8 and 55.3 ms (p = 0.08), respectively. The left ventricular (LV) mean ICTs were 36.2 and 39.4 ms (p = 0.05), the mean ETs were 167.4 and 164.5 ms (p = 0.013), the mean IRTs were 53.9 and 57.1 ms (p = 0.05), respectively. The third trimester RV mean ICTs were 50.7 and 50.4 ms (p = 0.75), the mean ETs were 172.3 and 181.4 ms (p = 0.49), the mean IRTs were 50.2 and 54.6 ms (p = 0.03); the LV mean ICTs were 45.1 and 46.2 ms (p = 0.35), the mean ETs were 175.2 vs. 172.9 ms (p = 0.29), the mean IRTs were 47.1 and 50.0 ms (p = 0.01), respectively. Isovolumetric time intervals can be analyzed precisely and relatively independent of ROI size. In the near future, automatic time interval measurement using ultrasound systems will be feasible and the analysis of fetal myocardial function can become part of the clinical routine.