Left Ventricular Diastolic Diameter Research Articles

Comparison of the mid-term clinical efficacy and short-term complications of Y-type coronary artery bypass grafting and sequential bypass grafting of the great saphenous vein: a retrospective cohort study.

BackgroundThis study sought to compare and evaluate the clinical efficacy and safety of Y-type coronary artery bypass grafting (CABG) and sequential CABG. However, the prognosis and complication rate of the two treatments are different. Therefore, we need to systematically compare the efficacy and safety of the two surgical schemes.MethodsA total of 112 patients who underwent Y-type CABG and 113 patients who underwent sequential CABG were selected from January 2020 to December 2020. The patients undergoing Y-type CABG of the great saphenous vein (SV) were classified as the experimental group, and those undergoing sequential anastomosis were classified as the control group. The intraoperative blood flow at each anastomotic site of the venous sequential CABG, left ventricular ejection fraction (LVEF), and left ventricular diastolic diameter (LVEDD) at the end of 3 months, 6 months, and 1 year after surgery, the incidence rate of major adverse cardiovascular events, and coronary angiography (CAG) after readmissions due to similar symptoms were compared between the 2 groups. The bridging vascular blockage rate was also determined.ResultsThere was no significant difference in cardiac function between the 2 groups in the short term, and the incidence of major adverse cardiovascular events in the 2 groups mainly occurred in the middle-postoperative period (1 year after surgery) or later. There was no statistical difference in the intraoperative real-time blood flow measurements at each anastomosis of the venous bridge between the 2 groups. Compared to the control group, the LVEF of the experimental group was significantly increased at the 1-year follow-up point (51.6±5.1 vs. 67.6±5.6, P=0.001). During the operation of Y-type coronary artery bypass grafting, the incidence of major adverse cardiovascular events, vascular bridge, and anastomotic blockage were significantly decreased (16 vs. 39, P=0.023).ConclusionsLarge SV Y-type CABG can improve postoperative left heart function and reduce the incidence of postoperative adverse events, which may be of great significance for improving the postoperative mid-term survival rate of patients.

Prognostic Value of Echocardiographic Variables Prior to and Following Initiation of Parenteral Prostacyclin Therapy: An Observational Study

Echocardiographic parameters are used as prognostic markers in patients with pulmonary arterial hypertension (PAH) receiving parenteral (IV or subcutaneous [IV/SC]) prostacyclin therapy. However, data on how posttreatment echocardiographic results associate with outcomes are limited. Are echocardiographic parameters pre- and post-parenteral prostacyclin therapy in patients with PAH associated with long-term outcomes? In this retrospective cohort study, patients with PAH initiated on IV epoprostenol or IV/SC treprostinil therapy between 2007 and 2016 were included and followed up through May 31, 2020. Survival free from transplant was assessed from the time of IV/SC prostacyclin therapy initiation and from first follow-up echocardiogram following at least 90days of therapy. Patients with PAH initiated on IV/SC prostacyclin therapy (N= 118) were followed up for a median of 7.3 years. Survival was 86%, 79%, and 69%at 1, 2, and 3 years, respectively. Follow-up echocardiogram in 101 patients (median, 178days; interquartile range, 140-273days) showed improvement in five echocardiographic measures: right ventricular function, right ventricular systolic pressure, right ventricular diastolic diameter, left ventricular diastolic diameter, and tricuspid regurgitation (TR) severity. TR severity and pericardial effusion were associated with survival from IV/SC therapy initiation, whereas right ventricular diastolic diameter, right atrial (RA) size, TR severity, and inferior vena cava characteristics were associated with survival from first follow-up. In a multivariable analysis incorporating other prognostic measures at first follow-up, walk distance, functional class, N-terminal pro-B-type natriuretic peptide, and RA size resulted in the best fit model for survival. Echocardiographic variables improved following IV/SC therapy, and multiple echocardiographic measures associated significantly with survival, particularly when reassessed after at least 90days of therapy. RA size in particular may be useful in prognostication in follow-up of patients with PAH on IV/SC therapy.

Mid-term results of surgical aortic valve replacement with bioprostheses in hemodialysis patients.

Limited studies have assessed the factors affecting prognosis in hemodialysis (HD) patients who undergo surgical aortic valve replacement with a bioprostheses (SAVR-BP). This study aimed to evaluate the outcomes of HD patients who had undergone SAVR-BP for aortic stenosis (AS) and identify the risk factors for mortality. This retrospective study included 57 HD patients who had undergone SAVR-BP for AS between July 2009 and December 2020. Multivariate logistic regression was used to predict factors associated with mid-term outcomes and death or survival. Kaplan-Meier curves were also generated for mid-term survival. The in-hospital mortality rate was 8.8%, and the 5-year mortality rate was 42.1%. The independent predictors of 5-year mortality were preoperative age (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.175-2.083, p=0.002), hyperlipidemia (HR, 0.02; 95% CI, 0.002-0.297, p=0.004), left ventricular diastolic diameter (HR, 1.74; 95% CI, 1.142-2.649, p=0.010), left ventricular systolic diameter (HR, 0.61; 95% CI, 0.392-0.939, p=0.025), and Japan SCORE (HR, 1.28; 95% CI, 1.052-1.563, p=0.014). The postoperative predictors included intensive care unit stay (HR, 1.11; 95% CI, 1.035-1.194, p=0.004) and albumin level (HR, 0.38; 95% CI, 0.196-0.725, p=0.003). The 5-year prognosis of HD patients undergoing SAVR may be improved by early diagnosis (before the occurrence of LV hypertrophy/enlargement) and nutritional management with oral intake to alleviate postoperative hypoalbuminemia.Registration number of clinical studies: UMIN000047410.

Cardiovascular Protective Effects of Oral Hypoxia Inducible Factor Prolyl Hydroxylase Inhibitor Roxadustat in the Treatment of Type 4 Cardiorenal-Anemia Syndrome: Protocol of a Randomized Controlled Trial.

BackgroundPatients with chronic kidney disease (CKD) are at high risk of developing heart failure and anemia, which is defined as type 4 cardiorenal-anemia syndrome (CRAS). CRAS aggravates the deterioration of both kidney and heart function, ultimately resulting in a high mortality. This study aims to examine the efficacy and safety of roxadustat in the treatment of type 4 CRAS.Methods and DesignThis study is designed as a randomized, open-label, controlled trial. A total of 68 patients diagnosed with type 4 CRAS will be randomly divided into roxadustat group and erythropoietin with a 1:1 ratio. Participants in the roxadustat group will receive roxadustat with an initial dose of 70 or 100 mg three times a week, and participants in the erythropoietin group will receive subcutaneous injection of erythropoietin for 24 weeks, to maintain a hemoglobin ranging from 100 to 120 g per liter. The primary outcome is the change in heart function, including brain natriuretic peptide (BNP), 6-min walk test (6-WT), and left ventricular ejection fraction (LVEF). Secondary outcomes to be assessed include death, cardiovascular events, hospitalization regarding heart failure, Minnesota Heart Failure Quality of life scale (MLHFQ) score, New York Heart Association (NYHA) cardiac function grade, echocardiographic parameters including left ventricular diastolic diameter and volume (LVDD and LVDV) and ventricular mass (LVM), anemia related parameters, inflammatory parameters, and safety assessments.ConclusionThe findings of this study will provide potential evidence for roxadustat in CRAS management.Trial RegistrationChinese Clinical Trial Registry, ID: ChiCTR2100050031. Registered on 16 August 2021.

Optimization of Left Ventricle Size After VAD Implantation Prevents Incidence of Cerebral Infarction

<h3>Purpose</h3> Stroke after ventricular assist device (VAD) implantation is a critical complication. Previous studies have noted the distance between the inflow cannula and the left ventricular (LV) septum, as well as an angulation of the inflow cannula from the apical axis, related to the incidence of stroke. In the early phase after VAD implantation, diuresis is caused by improved renal blood flow, furthermore, rapid volume reduction of LV greatly changes circulating plasma volume, resulting in increased stroke risk; however, little is known about an appropriate indicator for the prevention of this phenomenon. The aim of this study is to analyze the relationship between LV size optimization and the incidence of stroke after VAD implantation. <h3>Methods</h3> Forty patients who underwent continuous-flow LVAD implantation from March 2011 to May 2020 at our hospital were enrolled and divided into the stroke and non-stroke groups. Left ventricular diastolic diameter (LVDd) shown by transthoracic echocardiography, a value of serum brain natriuretic peptide (BNP), cardiothoracic ratio (CTR) in chest X-ray findings, and the ratio of change of these parameters 1 month after implantation were retrospectively evaluated. <h3>Results</h3> As for device selection for 40 patients, EVAHEART in 25, HeartMateII in 6, Jarvik2000 in 4, HVAD in 4, and HeartMate3 in 2 were used. Nine patients were in the stroke group and the remaining 31 were in the non-stroke groups. Pre- and post-operative values for LVDd, BNP, CTR, and ratio of change of these parameters were shown below. The ratio of change in LVDd and BNP 1 month after implantation was significantly greater in the stroke group. <h3>Conclusion</h3> Optimization of left ventricle size based on the ratio of change of LVDd and BNP in the early phase after VAD implantation might prevent the incidence of stroke.

Impact of Hemodialysis on Left Ventricular Mass in Patients With Chronic Kidney Disease

Context: Cardiac structural and functional abnormalities are very commonly seen in patients with end-stage renal disease (ESRD). Aim: The aim of this study was to determine the impact of hemodialysis (HD) on left ventricular mass (LVM) over a short period. Settings and Design: This study was a prospective observational study. Subjects and Methods: Twenty-five patients with ESRD, enrolled for HD from January 2018 to December 2019 at tertiary care hospital, were evaluated. All patients underwent two-dimensional echocardiography at the initiation of HD and 3 months later. Statistical Analysis Used: The software used in the analysis was SPSS 22.0 version and Graph Pad Prism 7.0 version. The paired t-test was used to analyze quantitative data. The Chi-square test was used for qualitative data. Data were analyzed by paired t-test. Results: The mean age of the cases was 44.92 ± 13.78 years. The left ventricular end-diastolic diameter in diastole, interventricular septum diameter in diastole, and posterior wall diameter in diastole decreased significantly (3.36 mm, −1.40 mm, and − 1.24 mm, respectively, P = 0.001, S) at the end of 3 months. The LVM and LVM index (LVMI) decreased significantly (−57.25 g and − 32.48 g/m2, respectively, P = 0.001, S) at the end of 3 months. At the end of 3 months, LVMI decreased significantly (148.24 ± 41.26 g/m2 vs. 115.76 ± 34.24 g/m2) which correlates with the increase in hemoglobin (7.62 ± 1.63 gm/dl vs. 8.44 ± 0.81 gm/dl) (P = 0.004, S), with improvement in BP (systolic 141.28 ± 21.70 to 136.32 ± 13.87 &amp; diastolic 86.16 ± 011.40 to 84.40 ± 8.36 mm of Hg) (P = 0.004, S) and with improvement in transferrin saturation (TSAT %) (30.05% ± 13.82% vs. 39.61% ± 14.32%) (P = 0.001, S). Conclusion: In patients with ESRD, cardiac dimensions were higher and LVM was increased at the initiation of HD. We found that LVMI regressed significantly with HD with optimum dry weight.

Predictive Value of Carbohydrate Antigen-125 in Determining the Left Ventricular Diastolic Dysfunction

Aim: Carbohydrate antigen-125 (CA-125) is a well-known marker for mesenchymal cell activation. It is being investigated as a predictive marker for cardiac pathologies due to pericardial or pleural mesenchymal cell activation. In this study, the relationship between left ventricular diastolic diameter (LVDd) and ejection fraction (EF) and serum CA-125 levels was investigated.Method: Thirty-eight patients who underwent coronary artery bypass graft operation were included in the study. LVDd and EF values were calculated. Routine blood parameters and serum CA-125 levels were obtained from blood samples. Patients were divided into groups according to LVDd (LVDd &amp;lt;50mm vs. ≥50mm) and EF (EF &amp;lt;50% vs. EF≥50%).Results: Among the low (&amp;lt;50%) and high (≥50%) EF groups, serum neutrophil, mean platelet volume (MPV), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), troponin-I, triglyceride, and very low density lipoprotein (VLDL) levels were statistically different (p&amp;lt;0.05). However, no statistical difference was observed between the low (&amp;lt;50mm) and high (≥50mm) LVDd groups in other blood parameters except for serum CA-125 levels (p&amp;gt;0.05). Higher serum CA-125 levels were obtained in patients with a high left ventricular diastolic diameter (≥50mm) (p&amp;lt;0.05). In addition, CA-125 was found to be an important predictor of left ventricular diastolic diameter with an optimal cut-off value of 0.644 kU/L (60% sensitivity and 78.3% specificity).Conclusion: According to our results, increased serum CA-125 level is an independent predictor of higher LVDd and may be a good indicator of left ventricular functions.

Conventional vs. Advanced Echocardiographic Parameters for Predict Fluid Responsiveness in Healthy Dogs

Background: Volume replacement is considered an essential component in the treatment of critically ill patients, but excess fluid administration can be as harmful as the lack of fluid therapy. Therefore, the volume replacement is only beneficial in patients deemed to be fluid responsive, that is, when the individual has an increase in their stroke volume after administration of a volume challenge. This study aim to assess whether conventional and advanced echocardiographic parameters for assessing left ventricular systolic function are able to predict fluid responsiveness in healthy spontaneously breathing dogs. The hypothesis was that some of these parameters would differ between responsive and non-responsive animals and could be used as a complementary measure for assessment of fluid responsiveness.Materials, Methods &amp; Results: A prospective study was carried out in which 22 client-owned healthy dogs over 1 year of age that presented to the Veterinary Medical Teaching Hospital for elective neutering procedure were included. All dogs underwent conventional and advanced echocardiographic examination to obtain the left ventricular internal diameter in diastole normalized (LVIDDn), left ventricular internal diameter in systole normalized (LVIDSn), ejection fraction (EF) and shortening fraction (SF) according to the Teischholz methodology, global longitudinal strain (GLS) and tissue motion annular displacement (TMAD). There parameters were evaluated before and after administration of a volume challenge with 10 mL/kg lactate ringer intravenously for 20 min. Based on the variation in aortic velocity integral time, 31.82% of dogs were considered responsive and 68.18% were non-responsive to the volume challenge. For advanced echocardiography, TMAD indexed by body weight (mm/kg) &gt; 0.89 (P = 0.004) and body surface area (mm/m2) &gt;18.9 (P = 0.004) after volume challenge had the best area under the curve values (both 0.895) and smaller gray zone intervals (0.52 - 0.81 and 14.89 - 17.88) for the identification of responsive dogs. Although, TMAD (mm/kg and mm/m2) before volume challenge was also higher in the responsive dogs (P = 0.041 and P = 0.029). As for conventional echocardiography, the LVIDDn &lt; 1.39 (P = 0.003) before volume challenge had the best area under the curve value (0.866) and the smallest gray zone interval (1.4 - 1.57) for the identification of responsive dogs. The GLS and the TMAD in milimeters (mm), percentage (%) and indexed by cubic root of weight (mm/∛kg) did not differ between the responsive and non-responsive dogs before and after volume challenge.Discussion: TMAD indexed by body weight (mm/kg) and body surface area (mm/m2) before and after volume challenge and the LVIDDn before volume challenge may be useful measures to complement the assessment of fluid responsiveness in spontaneously breathing dogs. This is the first study to use TMAD as a predictive parameter for fluid responsiveness in healthy, spontaneously breathing, dogs. Even it is an advanced echocardiographic technique, TMAD has advantages interms of execution time and the fact that it is less dependence on image quality or operator experience. It is possible that in the future such variables may form a useful part of the evaluation of fluid responsiveness in dogs. However, more studies are needed to better understand the applicability of these techniques, especially in dogs with hemodynamic changes. Keywords: canine, global longitudinal strain, stroke volume, tissue motion annular displacement, TMAD, VTI.

Assessment of left and right ventricular Tei indices in critically ill children with septic shock

BackgroundChildren with septic shock are subjected to global myocardial dysfunction. Myocardial performance (Tei) index has been used to detect the combined systolic and diastolic ventricular function in adult and neonatal sepsis. ObjectivesAssessment of left and right ventricular Tei indices in critically ill children with septic shock treated with inotropes and/or vasoactive agents. MethodsNinety children with septic shock and 90 controls were examined by conventional echocardiography. Cardiac chamber dimensions, ejection fraction, cardiac index, left and right ventricular Tei indices were measured. Severity of sepsis was detected using Pediatric index of mortality 2 score. ResultsPatients had significantly lower mean values of left ventricular internal diameter in diastole and left atrial diameter when compared to controls (p < 0.05). Patients and non-survivors had significantly higher mean values of left and right ventricular Tei indices when compared to controls and survivors respectively (p < 0.05). Mean values of ejection fraction and cardiac index were significantly lower in patients when compared to their controls (p < 0.001). Pediatric index of mortality 2 score correlated positively with the left ventricular Tei index (r = 0.334, p < 0.001), right ventricular Tei index (r = 0.544, p < 0.001) and negatively with the left ventricular internal diameter in diastole (r = − 0.224, p < 0.03). ConclusionPediatric sepsis is associated with global myocardial dysfunction. Tei index is a rapid simple parameter that can be used for the evaluation of myocardial dysfunction in children with septic shock. Pediatric index of mortality 2 score correlated positively with Tei indices, hence we recommend they could be used for grading of sepsis severity in the future.

Data Fusion Algorithm for Myocardial Proteomics and Its Research in Sports.

Sport is a type of comprehensive activity that the human body consciously engages in to improve physical fitness. Proteomics is a comprehensive technology dedicated to the study of all protein profiles expressed by a species, individual organ, tissue, or cell under specific conditions and specific times. Proteomics is a science that studies the protein composition of cells, tissues, or organisms and their changing laws with proteomics as the research object. Related technologies are now widely used in sports and other fields. The purpose of this article is to study myocardial proteomic technology and its application in sports. During the research process, the main methods used in this study are literature survey and controlled experiment. The results achieved and the problems in this field, followed by selecting 30 SD rats into 3 groups for control experiments. The results of the study showed that among the three groups of rats, the left ventricular ejection fraction of the sham operation group was the highest, which was 7.7% and 4.6% higher than that of the operation group and the model group, respectively. The operation group had the highest left ventricular short axis shortening rate, and the left ventricle diastolic inner diameter is the longest. It can be seen that myocardial proteomics can accurately reflect the heart condition of rats. In addition, the length, diastolic velocity, and diastolic time of cardiomyocytes of the three groups of rats were different. Among them, the cardiomyocytes of the operation group had the longest time and the longest diastolic time, which were 37.1% and 8.5% higher than those of the sham operation group and the model group.

Disease Progression of Hypertrophic Cardiomyopathy: Modeling Using Machine Learning.

BackgroundCardiovascular disorders in general are responsible for 30% of deaths worldwide. Among them, hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease that is present in about 1 of 500 young adults and can cause sudden cardiac death (SCD).ObjectiveAlthough the current state-of-the-art methods model the risk of SCD for patients, to the best of our knowledge, no methods are available for modeling the patient's clinical status up to 10 years ahead. In this paper, we propose a novel machine learning (ML)-based tool for predicting disease progression for patients diagnosed with HCM in terms of adverse remodeling of the heart during a 10-year period.MethodsThe method consisted of 6 predictive regression models that independently predict future values of 6 clinical characteristics: left atrial size, left atrial volume, left ventricular ejection fraction, New York Heart Association functional classification, left ventricular internal diastolic diameter, and left ventricular internal systolic diameter. We supplemented each prediction with the explanation that is generated using the Shapley additive explanation method.ResultsThe final experiments showed that predictive error is lower on 5 of the 6 constructed models in comparison to experts (on average, by 0.34) or a consortium of experts (on average, by 0.22). The experiments revealed that semisupervised learning and the artificial data from virtual patients help improve predictive accuracies. The best-performing random forest model improved R2 from 0.3 to 0.6.ConclusionsBy engaging medical experts to provide interpretation and validation of the results, we determined the models' favorable performance compared to the performance of experts for 5 of 6 targets.

Evaluation of cardiac injury with biomarkers and echocardiography after COVID-19 infection.

Coronavirus disease 2019 (COVID-19) causes cardiovascular damage in the acute period. Knowledge regarding cardiovascular damage after COVID-19 infection and during longer-term follow-up is currently limited. In our study, we aimed to compare cardiac and inflammatory markers and echocardiographic parameters between patients who had recovered from COVID-19 and control group. A total of 224 individuals were included, comprising 126 patients with a history of COVID-19 and 98 healthy controls. The demographic characteristics of the two groups were similar. Complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), N-terminal pro-B type natriuretic peptide (NT-ProBNP), D-dimer, haemoglobin A1C, troponin T and creatine kinase myocardial band (CK-MB) levels were compared between both groups. The mean follow-up period of the COVID-19 group was 58.39 ± 39.1 days (range:10 - 180 days post-COVID-19). Red cell distribution width (RDW), ESR, CRP, NT-ProBNP, D-dimer and troponin T values were significantly higher in the COVID-19 group compared to the control group. Left ventricular ejection fraction (LVEF) was significantly lower in the COVID-19 group. Left ventricular diastolic diameter (LVDD) and incidence of pericardial effusion were higher in the COVID-19 group. For multivariate analysis, possible factors identified by univariate analysis were subjected to multivariate logistic regression analysis to determine independent predictors of COVID-19. Among these factors, RDW, CRP and LVEF were independently higher in the COVID-19 group than in the control group. We conclude that although the clinical and prognostic significance of cardiac and other inflammatory markers in the acute phase of COVID-19 is known, we found that these biomarkers and echocardiography parameters can also be used in the follow-up of cardiac injury for a mid-term period post-infection.

Cardiac Resynchronization Therapy. Incidence and Mechanisms Involved in the Reduction of Functional Mitral Regurgitation

Background: Functional mitral regurgitation (FMR) is common in heart failure, and moderate/severe (M/S) FMR is associated with worse prognosis. Objective: The aim of this study was to describe the prevalence of FMR and the mechanisms involved in its reduction in responders to cardiac resynchronization therapy (CRT) at 6 months compared with 12 and 24 months. Methods: Between 2009 and 2018, 338 patients received CRT. Patients who showed NYHA functional class (FC) reduction ≥1 or left ventricular ejection fraction (LVEF) absolute increase ≥5% were considered responders. Functional mitral regurgitation was graded using a 4-point scale into none-, mild-, M- and S-FMR, and was related to echocardiographic measurements. Baseline patient characteristics were: age 64±10 years, men 71%, NYHA FC II-III 92%, left bundle branch block (LBBB) 67%, QRS ≥150 ms 75%, LV diastolic diameter (LVDD) 68±9 mm, LV systolic diameter (LVSD) 52±12 mm, and LV EF 24±7%. Results: The prevalence of FMR was 92.6%. At 6 months, 86% were responders, 23% improved from M/S-FMR to mild/none-FMR and there was strong reverse remodeling: LVDD 68±10 vs. 63±11 mm, (p=0.0001), LVSD 55±12 vs. 50±13 mm, (p=0.0006) and LVEF 25±11 vs. 33±10%, (p=0.00001). Comparing 6 with 12 months, 89.4% were responders and 8% improved M/S-FMR to mild/none-FMR. Comparing 6 with 24 months, 88% were responders and 14.6% improved M/S-FMR to mild/none-FMR. Between 6 and 12 and 6 and 24 months, there was no significant reverse remodeling. Conclusions: The prevalence of FMR was high. The highest reverse remodeling and FMR reduction was observed at 6 months, the former being the main mechanism of FMR reduction. This improvement persisted at 12 and 24 months.

Resveratrol ameliorates myocardial fibrosis by regulating Sirt1/Smad3 deacetylation pathway in rat model with dilated cardiomyopathy

BackgroundThe aim of this study was to investigate the effects of Resveratrol (RSV) in rats with dilated cardiomyopathy (DCM).MethodsPorcine cardiac myosin was used to set up rat model with DCM. RSV (10 mg/kg in RSV-L group and 50 mg/kg in RSV-H group) or vehicle was administered to rats with DCM once daily from the 28th day till the 90th day after the first immunization. Cardiac function of rats was evaluated by echocardiographic analysis. The deposition of fibrous tissues in the hearts was evaluated by Masson and picrosirius red staining. The mRNA levels of collagen type I (Col I), collagen type III (Col III) and silence information regulator 1 (Sirt1) were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The interaction of Sirt1 with Smad3 was revealed by coimmunoprecipitation.ResultsThe heart weight, heart weight/body weight ratio, left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were significantly increased in rats with DCM, and attenuated by RSV. RSV also positively decreased fibrosis, and the expression of Col I and Col III in the myocardium. The Sirt1 mRNA was significantly decreased in myosin-immunized hearts and was positively increased by RSV. The Sirt1 combined with Smad3 directly. Acetylation of Smad3 (Ac-Smad3) was significantly increased in DCM and was markedly decreased by RSV.ConclusionRSV effectively ameliorated myocardial fibrosis and improved cardiac function by regulating Sirt1/Smad3 deacetylation pathway in rat model with DCM.

Effects of Melatonin on Cardiac Function, Metabolic Stress and Apoptosis of Cardiomyocytes in Rats with Heart Failure after Myocardial Infarction

To research the effects of melatonin on cardiac function, myocardial cell metabolic stress and apoptosis in heart failure after myocardial infarction rats. Thirty specific-pathogen-free male Sprague Dawley rats were randomly divided into sham operation group (n=10), model group (n=10) and melatonin group (n=10). The model group and the melatonin group were constructed by ligating the left anterior descending coronary artery, while not in the sham operation group. Melatonin group (10 mg/kg) was intraperitoneally injected with melatonin (Sigma, United States of America) 30 min before operation. The sham operation group and the model group were injected intraperitoneally with the same amount of normal saline. The cardiac function of rats was measured by left ventricular ejection fraction, left ventricular fractional shortening, left ventricular end diastolic diameter and left ventricular end-systolic diameter. The myocardial cell apoptosis in ischemic areas of each group was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling staining. The expression of related proteins, measure myocardial fibrosis and determine the oxidative stress parameters (nicotinamide adenine dinucleotide phosphate oxidases activity, superoxide anion, malondialdehyde and superoxide dismutase) were detached via Western blot. Left ventricular fractional shortening % and left ventricular ejection fraction % in the melatonin group were significantly increased than those in the model group (p<0.05), while left ventricular end diastolic diameter and left ventricular end-systolic diameter in the melatonin group were significantly decreased (p<0.05). The apoptotic cardiomyocytes number in melatonin group was significantly less in model group (p<0.05). The levels of B-cell lymphoma 2 associated X-protein and caspase-3 protein in rat cardiomyocytes in melatonin group were significantly lower than those in model group (p<0.05). The proportion of sirius red staining in the melatonin group was significantly less than that in model group (p<0.05). Collagen I/III and transforming growth factor of rat cardiomyocytes in melatonin group-beta was significantly down-regulated than that in the model group (p<0.05). Nicotinamide adenine dinucleotide phosphate oxidase activity, superoxide anion and malondialdehyde level of rats in melatonin group were significantly decreased than those in model group, while superoxide dismutase activity was significantly increased than that in model group (p<0.05). Melatonin can improve heart failure and cardiac fibrosis by restraining oxidative stress in heart failure rats. Nicotinamide adenine dinucleotide phosphate oxidases 1 play an important role in regulating the role of melatonin in reducing cardiac fibroblasts fibrosis.

Cardiac Involvement among HIV-positive Individuals less than 18 years of Age on Antiretroviral Therapy- An Observational Study from a Rural Tertiary Care Hospital, West Bengal, India

Introduction: With advancement of medical science, individuals diagnosed with Human Immunodeficiency Virus (HIV) infections are getting treated earlier and a fewer of them develop Acquired Immunodeficiency Syndrome (AIDS)-related complications. But the downside is that there is an earlier onset and higher relative risks for different chronic diseases including cardiovascular diseases. Aim: To determine the proportion and pattern of cardiac involvements among children undergoing treatment for HIV infection and to correlate various cardiac findings with duration of Antiretroviral Therapy (ART) among them. Materials and Methods: An observational cross-sectional study was conducted among 136 HIV infected patients attending Paediatrics and General Medicine Outpatient Departments of North Bengal Medical College and Hospital (NBMCH) from October 2019 to March 2021. All patients were assessed clinically and underwent two dimensional (2D) echocardiography, Motion mode (M mode) and colour doppler for assessing cardiac involvement. Collected data were analysed using Statistical Package for the Social Sciences (SPSS) software version 22.0 and Pearson’s Correlation test was applied to test association between duration of ART and different echocardiographic parameters. Results: The mean age of the study participants was 10.14 years and the mean duration of ART was 49.18 months. Almost half (48.5%) of the HIV-positive individuals had cardiovascular findings. The most common echocardiographic change noted in patients was diastolic dysfunction 39 (28.7%) followed by Pericardial Effusion (PE) 29 (21.3%) and systolic dysfunction 28 (20.6%). Statistically significant positive correlation between changes in the values of Left Ventricular Internal Diameter in Diastole (LVIDD) (r=0.982), Left Atrium (LA) (r=0.634), mean Pulmonary Artery Pressure (mPAP) (r=0.200) with duration of ART was noted. Negative correlation was seen between duration of ART with ejection fraction (r=-0.984) and Tricuspid Annular Plain Systolic Excursion (TAPSE) (r=-0.438). This indicated that all these important cardiological parameters became worser with advancement of treatment. Conclusion: Cardiac involvements among HIV positive individuals undergoing ART were still high. There was definite correlation between cardiac involvement and duration of ART.

Role of aerobic physical training on cardiac autonomic and morphophysiological dysfunction in hypertensive rats subjected to ovarian hormone deprivation.

Here we investigated the effects of physical training on cardiovascular autonomic control and cardiac morphofunctional parameters in spontaneously hypertensive rats (SHRs) subjected to ovarian hormone deprivation. Forty-eight 10-week-old SHRs were divided into two groups: ovariectomized (OVX, n=24) and sham (SHAM, n=24). Half of each group (n=12) was trained by swimming for 12 weeks (OVX-T and SHAM-T). Cardiac morphology and functionality were assessed using echocardiography, and autonomic parameters were assessed using double pharmacological autonomic block, baroreflex sensitivity (BRS), and analyses of heart rate variability (HRV) and blood pressure variability (BPV). Ovariectomy did not influence the cardiac autonomic tonus balance unlike physical training, which favored greater participation of the vagal autonomic tonus. Ovariectomy and aerobic physical training did not modify HRV and BRS, unlike BPV, for which both methods reduced low-frequency oscillations, suggesting a reduction in sympathetic vascular modulation. Untrained ovariectomized animals showed a reduced relative wall thickness (RWT) and increased diastolic and systolic volumes and left ventricular diameters, resulting in increased stroke volume. Trained ovariectomized animals presented reduced posterior wall thickness and RWT as well as increased final diastolic diameter, left ventricular mass, and stroke volume. Ovarian hormone deprivation in SHRs promoted morphofunctional adaptations but did not alter the evaluation of cardiac autonomic parameters. In turn, aerobic physical training contributed to a more favorable cardiac autonomic balance to the vagal autonomic component and promoted morphological adaptations but had little effect on cardiac functionality.

Study of Echocardiographic Measurements to Estimate the Physiological Cardiac Efficiency in Apparently Healthy Patients Visiting University Hospital for Cardiac Evaluation

Background Healthy cardiac function is evaluated by echocardiography in the non-invasive cardiology department. Cardiac functional and structural evaluation is assessed by cardiologists based on a physiologically defined normal range. We want to compute the physiological value of variables in the healthy population.&#x0D; Objective To compute and compare the recorded echocardiographic parameters among apparently healthy patients.&#x0D; Method This is a retrospective study and a total of 544 subjects whose standard reference range was within the normal limit are included for computational study. 268 males (52.8%) and 240 females (47.2%) were studied for the size of the aortic root, size of the left atrium, left ventricular internal diameter during diastole (LVIDd) and systole (LVIDs), interventricular septum during diastole and systole (IVSd and IVSs), left ventricular posterior wall during diastole (LVPWd) and systole (LVPWs) and ejection fraction (EF).&#x0D; Result Ejection fraction (EF) is not significantly different (p=0.14) between genders, Mean±SD; 70.45±6.7 for females and Mean±SD; 68.34±7.18 for males. The mean age of examined female patients is Mean±SD; 36.88±12.6 which is not significantly different with male patients age Mean±SD; 38.28±12.5. Males have larger left ventricular internal diameter in diastole, Mean±SD; 43.90±6.4 than females Mean±SD; 41.37±8.08. Ejection fraction for females is Mean±SD; 70.45±6.7, for males is Mean±SD; 68.34±7.18 with p=0.14.&#x0D; Conclusion Absolute echocardiographic measurements vary physiologically between apparently healthy genders yet the ejection fraction is not significantly different between both the genders in the examined Nepali population.

Characterizing cardiac phenotype in Friedreich's ataxia: The CARFA study

Friedreich's ataxia is an autosomal recessive mitochondrial disease caused by a triplet repeat expansion in the frataxin gene (FXN), exhibiting cerebellar sensory ataxia, diabetes and cardiomyopathy. Cardiac complications are the major cause of early death. To characterize the cardiac phenotype associated with Friedreich's ataxia, and to assess the evolution of the associated cardiopathy over 1 year. This observational single-centre open label study consisted of two groups: 20 subjects with Friedreich's ataxia and 20 healthy controls studied over two visits over 1 year. All subjects had transthoracic echocardiography, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, quantification of serum cardiac biomarkers and neurological assessment. Patients with Friedreich's ataxia had left ventricular hypertrophy, with significantly smaller left ventricular diastolic diameters and volumes and increased wall thicknesses. Cardiac magnetic resonance imaging demonstrated significant concentric left ventricular remodelling, according to the mass/volume ratio, and focal myocardial fibrosis in 50% of patients with Friedreich's ataxia. Cardiopulmonary exercise testing showed alteration of left ventricular diastolic filling in patients with Friedreich's ataxia, with an elevated VE/VCO2 slope (ventilatory flow/exhaled volume of carbon dioxide). High-sensitivity troponin T plasma concentrations were higher in subjects with Friedreich's ataxia. None of the previous variables changed at 1 year. Neurological assessments remained stable for both groups, except for the nine-hole pegboard test, which was altered over 1 year. The multivariable characterization of the cardiac phenotype of patients with Friedreich's ataxia was significantly different from controls at baseline. Over 1 year there were no clinically significant changes in patients with Friedreich's ataxia compared with healthy controls, whereas the neurological severity score increased modestly.

Progressive left and right heart dysfunction in coronavirus disease-19: Prospective echocardiographic evaluation.

AimsCardiac dysfunction in coronavirus disease-19 (COVID-19) has been reported during acute phase but serial changes have not been well studied. To determine serial changes in type and severity of echocardiographic left and right heart functions we performed a prospective study.Methods and resultsSuccessive COVID-19 patients at discharge from the hospital from June to December 2020 were enrolled. Clinical details were obtained and echocardiography was performed using Philips IE33X-Matrix. Follow-up evaluation was performed after 3 months. In total, 1789 COVID-19 patients were evaluated. Baseline echocardiography was performed in 1000 eligible patients (men 611, women 389). Mean age was 50.2 ± 15 years, hypertension was in 44.0%, diabetes in 49.4%, and coronary disease in 10.8%. COVID-19 was mild in 47.0%, moderate in 39.5%, and severe in 13.5%. Baseline cardiac parameters were more impaired in severe vs. moderate or mild COVID-19. At 3 months, in 632 patients where baseline and follow-up data were available, decline was observed in select left [left ventricular internal diameter in diastole +0.9 ± 0.2 mm, left atrial volume +7.6 ± 0.1 mL/m2, mitral E/e′ +4.8 ± 0.1, and left ventricular ejection fraction (LVEF) −3.7 ± 0.2%] and right [right ventricular internal diameter in diastole +2.1 ± 0.1 mm, right atrial internal dimension +1.6 ± 0.1 mm, tricuspid Vmax +1.0 ± 0.1 cm, and tricuspid annulus plane systolic excursion (TAPSE) −2.7 ± 0.2 mm] heart variables (P < 0.001). Compared to mild COVID-19, decline was significantly greater in moderate/severe disease, LVEF −1.1 ± 0.3 vs. −3.8 ± 0.3%; mitral E/e′ +3.2 ± 0.1 vs. +4.8 ± 0.1, tricuspid Vmax +0.3 ± 0.1 vs. +1.0 ± 0.1 cm, and TAPSE −0.7 ± 0.2 vs. −2.7 ± 0.2 mm (P < 0.001).ConclusionThis study shows impaired cardiac functions in severe and moderate COVID-19 compared to mild at hospital discharge and progressive decline in left and right heart functions at 3 months. Impairment is significantly greater in patients with moderate to severe disease.