Left Ventricle Dimensions Research Articles

New Mathematical Model for the Surface Area of the Left Ventricle by the Truncated Prolate Spheroid

The main aim of this study was the formula application of the superficial area of a truncated prolate spheroid (TPS) in Cartesian coordinates in obtaining a cardiac parameter that is not so much discussed in literature, related to the left ventricle (LV) surface area of the human heart, by age and sex. First we obtain a formula for the area of a TPS. Then a simple mathematical model of association of the axes measures of a TPS with the axes of the LV is built. Finally real values of the average dimensions of the humans LV are used to measure surface areas approximations of this heart chamber. As a result, the average superficial area of LV for normal patients is obtained and it is observed that the percentage differences of areas between men and women and their consecutive age groups are constant. A strong linear correlation between the obtained areas and the ventricular volumes normalized by the body areas was observed. The obtained results indicate that the superficial area of the LV, besides enabling a greater knowledge of the geometrical characteristics of the human LV, may be used as one of the normality cardiac verification criteria and be useful for medical and biological applications.

Echocardiographic findings in haemodialysis patients according to their state of hydration

BackgroundChronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. MethodsCross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. ResultsBased on TAFO three groups were defined: A- dehydrated, TAFO <-0.25 L 32 P (42%); B- normohydrated, TAFO between -0.25 and 1.5 l: 26 (34%); C- overhydrated, TAFO>1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. ConclusionsWe found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW.

THE ROLE OF IMMUNITY SUPPRESSION IN TREATMENT OF MYOCARDITIS

Regardless the common consensus on the benefits of immunity suppression in eosinophilic, granulomatous, giant cell and lymphocyte myocarditis, associated with systemic connective tissue diseases, and in rejection of transplanted heart, role of immune suppression therapy (IST) in treatment of lymphocyte inflammatory cardiomyopathy remains controversial. Previous retrospective studies revealed clinical improvement in 90% of patients with virus-negative inflammatory cardiomyopathy and absence of response or worsening of heart function in 85% of virus-positive inflammatory cardiomyopathy after immunity suppression. Other studies identified the enhanced expression of HLA in cardiomyocytes as an additional indicator of sensitivity of inflammatory cardiomyopathy to IST. Recently, the singlecenter randomized study was performed with double blind application of prednisone and azatioprin as addition to maintenance therapy in 85 patients with virus-negative inflammatory cardiomyopathy. The results of the study showed significant improvement of the left ventricle ejection fraction and decrease of the left ventricle dimensions in 88% patients among 43 of treated comparing to 42 patients on placebo demonstrated worsening of cardiac functioning in 83% cases (the TIMIC study). This data confirms the efficacy of immunity suppression in virus-negative inflammatory cardiomyopathy. Insufficiency of response in 12% cases undermines existence of non-revealed viruses and mechanisms of damage and inflammation, non-sensitive to immunity suppression. Restoring of cardiac function in patients actively responded to immunity suppression, was determined by inhibition of cardiomyocytes death and increase of cells proliferation with ad novo synthesized contractile material.

Long-Term Outcomes in Patients With Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction

BackgroundChronic severe aortic regurgitation (AR) imposes significant volume and pressure overload on the left ventricle (LV), but such patients typically remain in an asymptomatic state for a very long time. ObjectivesThis study sought to examine long-term outcomes in a contemporary group of patients with grade III+ chronic AR and preserved left ventricular ejection fraction (LVEF) and the value of aortic valve (AV) surgery on long-term survival. We also wanted to reassess the threshold of LV dimension, beyond which mortality significantly increases. MethodsThe authors studied 1,417 such patients (mean 54 ± 16 years of age, 75% men) seen between 2002 and 2010. Clinical data were obtained and Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. ResultsMean STS score was 5.5% ± 8%, and mean LVEF was 57 ± 4%, whereas 1,228 patients (87%) were asymptomatic, and 93 patients (7%) had indexed LV end-systolic dimension (iLVESD) ≥2.5 cm/m2. At 6.6 ± 3 years, 933 patients (66%) underwent AV surgery (36% isolated AV surgery, 16% concomitant coronary bypass, and 58% aortic replacement), and 262 patients (19%) died. In-hospital postoperative mortality was 2% (0.6% in isolated AV surgery). On multivariate Cox survival analysis, compared to the group of iLVESD <2.5 cm/m2 and no AV surgery, the 2 groups of iLVESD <2.5 cm/m2 with AV surgery and iLVESD ≥2.5 cm/m2 with AV surgery were associated with improved survival (hazard ratios: 0.62 and 0.42, respectively; both p < 0.01). Survival of patients who underwent AV surgery was similar to that of an age- and sex-matched U.S. population with 96% of deaths occurring in those with iLVESD <2.5 cm/m2. ConclusionsAt a high-volume experienced center, patients with grade III or greater AR and preserved LVEF demonstrated significantly improved long-term survival following AV surgery. The risk of death significantly increased at a lower LV dimension threshold than previously described.

YIA 01-01 ADVERSE NEONATAL HEALTH CORRELATES WITH LONG TERM CARDIAC FUNCTIONAL AND STRUCTURAL REMODELING IN YOUNG ADULTS BORN PRETERM

Objective: Studies support a direct causal association between preterm birth and increased risk of cardiovascular diseases. Increased left and right ventricular mass, and impaired systolic and diastolic function were observed in young adults born preterm. Deleterious neonatal conditions, as in preterm birth, could significantly impact on myocardial tissue. We investigated how left ventricle (LV) echocardiographic parameters in young adults born preterm correlated with neonatal health parameters and interventions data. Design and Method: Forty-six young adults born preterm (gestational age < 29 weeks) were recruited. Neonatal data (gestational age, Apgar scores at 10 minutes after birth, and number of days of mechanical ventilation and oxygen therapy) was collected from medical records. Echocardiographic measurements of LV systolic and diastolic function, mass, and LV dimensions, volumes and wall thickness were taken. Spearman correlation (rs) was performed between neonatal and echocardiographic parameters. Results: Apgar scores correlated positively with ejection fraction and fractional shortening (rs: 0.430 and 0.428; P < 0.01), and negatively with LV mass index, septal thickness, LV diastolic diameter, LV end diastolic volume (-0.362, -0.386, -0.398 and -0.403; P < 0.05), and LV end systolic volume (-0.493; P < 0.01). Gestational age correlated negatively with LV diastolic diameter and LV end diastolic diameter (-0.342 and -0.348; P < 0.05). Number of days of mechanical ventilation and oxygen therapy correlated negatively with deceleration time and A wave duration (-0.336 for both, -0.378 and -0.386; P < 0.05). Conclusions: Prematurity-related neonatal conditions are associated with long term young adult cardiac structure and function.

LBPS 02–27 WHAT IS THE ASSOCIATION BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND SIX-MINUTE WALK TEST IN HYPERTENSIVE PATIENTS?

Objective: We aimed to find the association between the degree of LV diastolic dysfunction and the functional capacity assessed by 6-minute walk test (6MWT) in asymptomatic hypertensive patients. Design and Method: The study included 200 asymptomatic hypertensive patients. All patients had undergone full history taking, complete clinical examination, electrocardiography, echocardiography for assessment of left ventricle (LV) dimensions, systolic, and diastolic dysfunction, and 6MWT. Patients were classified into two groups according to the presence or absence of LV diastolic dysfunction. Results: The clinical and echocardiographic data were comparable between the two groups. Regarding 6MWT, at the end of the test patients with diastolic dysfunction had significantly higher systolic (p = 0.0088) and diastolic (p = 0.019) blood pressure and higher Borg score for dyspnea (p < 0.00001). Conclusions: The presence of LV diastolic dysfunction has a bad effect on 6MWT. The degree of LV diastolic dysfunction is correlated with the results of 6MWT. It may be important to investigate LV diastolic function in hypertensive patients.

Echocardiographic findings in haemodialysis patients according to their state of hydration

BackgroundChronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. MethodsCross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. ResultsBased on TAFO three groups were defined: A- dehydrated, TAFO <-0.25 L 32 P (42%); B- normohydrated, TAFO between -0.25 and 1.5 l: 26 (34%); C- overhydrated, TAFO>1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. ConclusionsWe found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW.

Intramyocardial injection of SERCA2a-expressing lentivirus improves myocardial function in doxorubicin-induced heart failure.

Doxorubicin is an effective anticancer drug. The major limitation to its use is the induction of dose-dependent cardiomyopathy. No specific treatment exists for doxorubicin-induced cardiomyopathy and treatments used for other forms of heart failure have only limited beneficial effects. The contraction-relaxation cycle of the heart is controlled by cytosolic calcium concentrations, which, in turn, are critically regulated by the activity of the sarcoplasmic reticulum Ca(2) (+) ATPase (SERCA2a) pump. We hypothesized that SERCA2a gene transfer would ameliorate doxorubicin-induced cardiomyopathy. Lentiviral vectors LV-SERCA2a-GFP and LV-GFP were constructed and in vitro gene transfer of LV-SERCA2a-GFP confirmed SERCA2a expression by western blot analysis. Heart failure was induced by giving a single intraperitoneal injection of doxorubicin. LV-SERCA2a-GFP, LV-GFP vectors and phosphate-buffered saline (PBS) were injected under echocardiographic control to the anterior wall of the left ventricle. Echocardiography analyses were performed on the injection day and 28 days postinjection. On the injection day, there were no significant differences in the average ejection fractions (EFs) among SERCA2a (40.0%), GFP (41.1%) and PBS (39.4%) injected animals. On day 28, EF in the SERCA2a group had increased by 16.6 ± 6.7% to 46.4 ± 2.1%. By contrast, EFs in the GFP (40.2 ± 1.3%) and PBS (40.6 ± 1.4%) groups remained at pre-injection levels. In addition, end systolic and end diastolic left ventricle volumes were significantly smaller in the SERCA2a group compared to controls. SERCA2a gene transfer significantly improves left ventricle function and dimensions in doxorubicin-induced cardiomyopathy, thus making LV-SERCA2a gene transfer an attractive treatment modality for doxorubicin-induced heart failure. Copyright © 2016 John Wiley & Sons, Ltd.

Relation between Body Mass Index, Waist Circumference, and Echocardiographic Index of Left Ventricular Diastolic Function

weight, blood test, personal habits questionnaire, and echocardiographic indices were obtained. We analyzed the echocardiographic indices of left ventricular diastolic function with BMI and WC. Results: The left ventricle (LV) mass index (P = 0.007), LV dimension (P < 0.01), A (P < 0.01), Aʹ (P = 0.030), and E/Eʹ (P = 0.006) were higher, and E (P = 0.003), Eʹ (P < 0.01), E/A (P < 0.01) were lower in the overweight and obese groups than in the normal group. On multiple linear regression analysis, E/Eʹ correlated positively with age, gender, BMI and systolic blood pressure. In men, E/Eʹ correlated positively with age and BMI or WC. In women, only age had a positive correlation with E/Eʹ. Conclusion: In men, increased BMI or waist circumference are associated with an increase in E/Eʹ, which surrogates left ventricular diastolic dysfunction. In women, obesity and abdominal obesity have no correlation with E/Eʹ.

Reversal of abnormal cardiac parameters following mitral valve replacement for severe mitral stenosis in relation to pulmonary artery pressure: A retrospective study of noninvasive parameters - Early and late pattern.

Although the regression of pulmonary hypertension (PH) in mitral stenosis (MS) has been studied over varying periods postintervention, corresponding studies on the cardiac chamber alterations after surgery are very limited. We sought to determine the degree of reversal of these and the clinical status in connection with that of pulmonary artery pressures (PAPs) in the early and late postoperative periods. The preoperative, early, and 1-year postoperative data - functional class (FC), cardiothoracic ratio (CTR) in chest X-ray (CXR), and echocardiographically left atrium (LA), right atrium (RA), right ventricle (RV), left ventricle (LV), and pulmonary artery (PA) dimensions, PAP, tricuspid regurgitation (TR) - of 50 patients who had mitral valve replacement (MVR) for MS with PH were retrospectively analyzed for correlations with PAP (Pearson's), and their change (t-test), in relation to that in PAP. PH group-based [Group (Gp)-I PAP ≤60mmHg, Gp-II PAP >60mmHg] analysis highlighted the differences. All parameters significantly correlated with the baseline PAP (p < 0.05), except LA (r = 0.081, p = 0.577). Postoperatively, there was significant reduction in all parameters (p < 0.001) and increase in LV (p < 0.003). The PAP regression was 39.42%; with the decrease in CTR, LA, and RA related to it, the early changes being significant (p < 0.01). The RV and PA showed lesser reduction (8.61% and 9.42%), late reduction being more conspicuous. The changes were greater and significant in Gp-II (especially PAP, RV, and PA). At 1year, PAP normalized in only 19 (38%). Residual PH and chamber enlargement prevailed more in Gp-II. This study emphasizes the importance of the baseline PAP in MS to which was proportionate the functional disability and the cardiac chamber alterations (except LA). Their postoperative improvement accompanying the PAP regression differed in degree and time frame relative to PAP. The higher pressure group showed greater regression, but greater prevalence of residual abnormalities, suggesting that the pathologic changes in them might take longer to resolve, necessitating further evaluation.

Effects of exercise on dynamic cardiac function and survival after myocardial infarction

Objective To study the effects of exercise after myocardial infarction on the survival rate and the dynamic functioning of the left ventricle (LV). Methods Ninety-six male Sprague-Dawley rats were randomly assigned to a sedentary sham operation group (Sed-Sh), a previous exercise and sham operation group (PreE-Sh), a sedentary myocardial infarction (MI) group (Sed-MI), a previous exercise MI group (PreE-MI), a post exercise MI group (PostE-MI) and a combined exercise MI group (ComE-MI), each of 16.All of the rats underwent either MI induction or a sham MI operation, the PreE groups after exercising for 5 weeks on a treadmill. The Sed groups did not exercise. The Post E-MI group did not exercise before the operation, but performed treadmill exercises for 4 weeks beginning 8 weeks after the operation. The ComE-MI group exercised for 5 weeks before and 4 weeks after the operation. All the exercising rats ran on the treadmill for 60 minutes daily, 5 d/wk. Life situation and spontaneous mortality were recorded, and echocardiographic measurements were performed on the4thday and 2, 4, 8 and 12weeks after the operation. All of the rats were sacrificed at the end of the experiment. Results Compared with the Sed-Sh group, the Sed-MI group had significantly larger average LV dimensions at the end of both the diastol (LVEDd) and the systol (LVEDs, but it had lower average fractional shortening (FS) and a smaller average ejection fraction(EF) at all of the different measuring times. The PreE-MI group had significantly lower average LVEDd and LVEDs, but a significantly higher FS and EF than the Sed-MI group on the 4th day. However, 2 weeks after the intervention the difference in LVEDd between the two groups was no longer significant. Significantly higher FS and EF were observed in the PostE-MI group at 12 weeks compared to the Sed-MI group. The ComE-MI group had significantly lower average LVEDd and LVEDs, but significantly higher FS and EF at all the time points than the Sed-MI group. The ComE-MI group had a significantly lower average LVEDs but a higher average FS and EF than the PreE-MI group at 12 weeks after the intervention. Conclusion Pre-MI exercise improves LV function significantly at the early stage, though the difference is temporary. Post-MI exercise improves LV function in the longer term. Combined exercise improves LV function the most effectively. Key words: Exercise; Myocardial infarction; Left ventricular function; Survival rate

Left Atrial Area and Right Ventricle Dimensions in Non-gated Axial Chest CT can Differentiate Pulmonary Hypertension Due to Left Heart Disease from Other Causes

BackgroundIt is unknown whether axial non-gated CT can distinguish World Health Organization Group 2 pulmonary hypertension (pulmonary hypertension due to left heart disease) from non-Group 2 pulmonary hypertension. ObjectiveThe study was performed to identity imaging parameters in non-gated chest CT that differentiate Group 2 from non-Group 2 pulmonary hypertension. MethodsAmong 158 patients who underwent right heart catheterization for evaluation of pulmonary hypertension, 112 had sufficient data and chest CT for review. Invasive hemodynamic data and numerous variables obtained from axial CT images (maximum diameters of main, right, left pulmonary arteries, ascending aorta, main pulmonary artery to ascending aorta diameter ratio, right atrial diameter, left atrial area and right ventricular size) were collected. CT variables were validated against hemodynamic data to identify parameters that would allow to differentiate pulmonary hypertension due to left heart disease (Group 2) from non-Group 2 pulmonary hypertension. ResultsBased on right heart catheterization data, we identified 53 patients with Group 2 pulmonary hypertension, 50 patients with non-Group 2 pulmonary hypertension, and 9 subjects with no pulmonary hypertension. In patients with a dilated pulmonary artery (n = 84), the ROC curve for left atrial area (area under the ROC curve 0.76 ± 0.06) independently distinguished patients with Group 2 pulmonary hypertension (n = 42) from patients with non-Group 2 pulmonary hypertension (n = 42). A dilated left atrium (>20 mm2) in combination with a normal right ventriuclar size had a sensitivity of 77% and specificity of 94% for Group 2 pulmonary hypertension. ConclusionsIn patients with a dilated pulmonary artery on chest CT, left atrial area and right ventricular dimensions may aid to diagnose pulmonary hypertension and to distinguish underlying cardiac disease from other causes.

Short term omega-3 polyunsaturated fatty acid supplementation induces favorable changes in right ventricle function and diastolic filling pressure in patients with chronic heart failure; A randomized clinical trial

IntroductionOmega-3 polyunsaturated fatty acids (omega 3-PUFAs) seem to favorably affect cardiac hemodynamics and may benefit the clinical course of heart failure patients. The role of omega 3-PUFAs supplementation on the left and right ventricular function of patients with chronic compensated systolic heart failure, under optimal treatment, was studied. Methods205 consecutive patients with chronic compensated heart failure, due to ischemic (IHF) or dilated cardiomyopathy (DCM)-NYHA classification I–III, under optimal medical treatment, were enrolled. Participants were 1-to-1 randomized on 1000mg omega 3-PUFA supplementation or no supplementation, in a non-blinded fashion. Echocardiographic assessment was performed at first visit and 6months after. Plasma BNP and serum creatinine levels were also measured. ResultsAs compared with the control group, BNP levels in omega 3-PUFA intervention group were 34.6% lower (p=0.001); end-diastolic and end-systolic left ventricle dimensions were decreased by 2.5% (p=0.047) and 3.7% (p=0.01), maximum diameter of left atrium was decreased by 8.4% (p=0.004), left atrium ejection fraction was ameliorated by 6.03% (p=0.021) and as regards tissue Doppler parameters, TDI_Etv/Atv was decreased in omega 3-PUFA intervention group by 6.3% (p=0.038). Moreover, improvement in diastolic indices was more prominent in subjects with DCM as compared to IHF patients. ConclusionOmega 3-PUFA supplementation was associated with improved left diastolic function and decreased BNP levels in patients with chronic heart failure. These findings suggest a beneficial role of omega 3-PUFAs on the hemodynamic course of patients with systolic heart failure.

Golden ratio between left ventricular and aortic dimensions

Golden ratio was anciently described by Phythagoras and developed by Leonardo Pisano Fibonacci in 1202 [ 1 Henein M.Y. Zhao Y. Nicoll R. Sun L. Khir A.W. et al. the Golden Ratio CollaboratorsThe human heart: application of the golden ratio and angle. Int. J. Cardiol. 2011; 150: 239-242 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar , 2 Benavoli A. Chisci L. Farina A. Fibonacci sequence, golden section. in: Kalman filter and optimal control signal processing. 89. 2009: 1483-1488 Google Scholar ]. Numerous studies; either architectural or medical articles; have reported that the ratio of 1.618… was detected among the geometrical or anatomical constitutes of a whole structure [ [1] Henein M.Y. Zhao Y. Nicoll R. Sun L. Khir A.W. et al. the Golden Ratio CollaboratorsThe human heart: application of the golden ratio and angle. Int. J. Cardiol. 2011; 150: 239-242 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ]. It was previously proposed to be fulfilling the aesthetical criteria among proportions of human body, limbs, and facial elements. However recent studies documented that it existed in further details and variables of cardiac structure and hemodynamic variables. It was documented that the branching of coronary anatomy from the beginning to their distals has being according to the Fibonacci sequence and Golden ratio [ [3] Ashrafian H. Athanasiou T. Fibonacci series and coronary anatomy. Heart Lung Circ. 2011; 20: 483-484 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar ]. Yetkin et al. also revealed that twenty four hours, daytime, and nighttime systolic and diastolic blood pressure and the pulse pressure presented a daily variation in accordance to golden ratio [ [4] Yetkin E. Topbas U. Yanik A. Yetkin G. Does systolic and diastolic blood pressure follow golden ratio?. Int. J. Cardiol. 2014; 176: 1457-1459 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar ]. It was also reported that although left ventricle dimensions significantly varied among healthy individuals from different ethnic populations golden ratio did not differ according to ethnicity [ [1] Henein M.Y. Zhao Y. Nicoll R. Sun L. Khir A.W. et al. the Golden Ratio CollaboratorsThe human heart: application of the golden ratio and angle. Int. J. Cardiol. 2011; 150: 239-242 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ]. More importantly it was detected that Golden ratio of the left ventricle was significantly reduced in association with congestive heart failure due to the distortion of left ventricle [ [1] Henein M.Y. Zhao Y. Nicoll R. Sun L. Khir A.W. et al. the Golden Ratio CollaboratorsThe human heart: application of the golden ratio and angle. Int. J. Cardiol. 2011; 150: 239-242 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ]. It has also prognostic value for the long term follow-up.

Abstract 13533: Impact of Cola Drinking on the Cardiorenal Axis in Rats

Introduction. The cardiorenal syndrome is a constellation of interactive cardiac and renal risk factors. We reported that chronic cola drinking induces metabolic syndrome and pro-oxidative metabolism in rats. Hypothesis . To evaluate whether chronic cola drinking affects cardiorenal integrity in relation with oxidative metabolism and local inflammation in rats. Methods. Male Wistar rats drank ad libitum regular cola (C, n=12) or water (W, n=12). Measures/recordings: body weight (weekly), nutritional data (twice a week); at 0 mo and 6 mo: plasma glucose, cholesterol fractions, TG, uric acid, creatinine (enzymocolorimetry), coenzyme Q-10 (RP-HPLC-ED), SBP (plethysmography), echocardiograms (awake rats). At 6 mo euthanasia was performed. The heart and kidneys were excised and processed for histopathology and immunohistochemical IL-6 and TNFα staining. Glomerulosclerosis and histopathology score were semiquantitatively evaluated. ANOVA, Bonferroni t-test, Pearson r, p&lt;0.05 significant. Results. Compared with W, C rats showed: I). overweight (8%, p&lt;0.05), hyperglycemia (11%, p&lt;0.05), hypertriglyceridemia (2-fold, p&lt;0.001), higher atherogenic index in plasma (2-fold, p&lt;0.01), lower Q 10 levels (-55%, p&lt;0.05); II). higher LV diastolic diameter (+9%, p&lt;0.05) and volumes (diastolic 26%, p&lt;0.01; systolic 24%, p&lt;0.05), posterior wall thinning (-8%, p&lt;0.05) and larger cardiac output (24%, p&lt;0.05); III). glomerulosclerosis (21%, p&lt;0.05), higher histopathological score (13%, p&lt;0.05), IL-6 (7-fold, p&lt;0.001) and TNFα (4-fold, p&lt;0.001) expression; IV). Left ventricle dimensions were strongly correlated with IL-6 (74%, r=0.86, p&lt;0.001) and TNFα (52%, r=0.72, p&lt;0.001). Controlling for either or both TG and Q 10 reduced the strength of correlations or nearly abolished them. Conclusions . Cardiac remodeling was associated with increased pro-inflammatory cytokines and renal damage. Cardiorenal association was highly dependent on hypertriglyceridemia and Q10 level. Hypertriglyceridemic lipotoxicity in a context of defective antioxidant and anti-inflammatory protection due to low Q10 level might be involved in the cardiorenal syndrome induced by chronic cola drinking in rats.

Risk factors for pulmonary hypertension in maintenance hemodialysis patients: a cross-sectional study.

Pulmonary hypertension (PH) in maintenance hemodialysis (MHD) patients has attracted increasing attention. This cross-sectional survey aimed to explore PH prevalence and identify potential risk factors in MHD patients. A total of 136 MHD patients were assessed at the Fifth Affiliated Hospital of Sun Yat-sen University (China) between October 2012 and November 2014. Relevant parameters included primary disease, dialysis duration, height, weight, and interdialytic weight gain. Doppler echocardiography was performed post-hemodialysis to evaluate cardiac structure and function; fistula diameters and blood flow rates were measured by vascular ultrasound. Before and 4 weeks after echocardiography, biochemical parameters were measured. Patients were divided into PH and nPH groups, and their primary diseases were analyzed. T test and Chi-square test were used as appropriate; Pearson’s correlation and logistic regression analysis were employed to assess possible PH risk factors. PH prevalence was 38.23 % in MHD patients and 73.68 % in those with concurrent diabetes, i.e., higher than in chronic glomerulonephritis (35 %) and hypertension (33.33 %) groups. Interestingly, PH was positively correlated with left atrium, right atrium, and ventricle dimensions, and the degree of cardiac hypertrophy. In addition, diabetes and interdialytic weight gain were positively correlated with PH, while hemoglobin levels showed a negative correlation. Finally, multiple logistic regression analysis revealed interdialytic weight gain and hemoglobin as major risk factors for PH in MHD patients. PH prevalence was 38.23 % in MHD patients, a ratio increased in individuals with concurrent diabetes. Other major risk factors for PH in MHD patients include declined hemoglobin levels and increased interdialytic weight gain.

Age-Related Left Ventricular Changes and Their Association with Leukocyte Telomere Length in Healthy People

IntroductionWith advancing age the left ventricle (LV) undergoes structural and functional changes, thereby creating the substrate for the development of diseases. One possible mechanism of the ageing heart is a cellular senescence. Leukocyte telomere length (LTL) is a marker of replicative ageing. The purpose of this study was to evaluate the structure and function of the LV in people of different ages free of cardiovascular diseases (CVD) and regular drug medication and to assess their relationship with LTL. We hypothesized that age-related changes in LV myocardium are associated with telomere length.MethodsThe study population consisted of 150 healthy, non-obese volunteers aged 28 to 78 years without history of CVD, significant deviations by 12-lead electrocardiogram and negative exercise test (treadmill stress test). All the participants underwent standardized transthoracic echocardiography using an available system (iE33; Philips). The LTL was measured by real-time quantitative polymerase chain reaction. We determined the relative ratio of telomere repeat copy number (T) to single-copy gene copy number (S).ResultsIn the older people there was a higher wall thickness than in the younger (1.03±0.09 vs. 0.88±0.10, p<0.01), whereas LV mass index was comparable between them (85.8±15.40 vs. 83.1±11.8, p = 0.20). There was a decrease in LV dimensions with advancing age (p<0.001). Older subjects had impairment in LV relaxation. LTL was associated with decreased E/A, Em/Am ratio (β = -0.323, p = 0.0001) after adjusting for age, sex and risk factors. There is no relation between the LTL and the structure of LV.ConclusionsOur data suggest that the ageing process leads to changes in LV structure and diastolic function and is linked with a phenotype of concentric LV remodeling. Telomere attrition is associated with age-related LV diastolic dysfunction. Telomere length appears to be a biomarker of myocardial ageing.

Effectiveness of bone marrow mononuclear cells delivered through a graft vessel for patients with previous myocardial infarction and chronic heart failure: an echocardiographic study of left ventricular remodeling.

The graft of stem cells to treat ischemic cardiomyopathy is popular in many clinical trials. The aim of this study was to evaluate the effectiveness of isolated coronary artery bypass graft combined with bone marrow mononuclear cells (BMMNC) delivered through graft vessels to improve left ventricular remodeling of patients with previous myocardial infarction and chronic heart failure using echocardiography. Patients with previous myocardial infarction and chronic heart failure were randomly allocated to one of the two groups: CABG only (18 patients), or CABG with BMMNC transplantation (24 patients). Echocardiographic parameters were measured on B-mode imaging, 3D imaging and color flow imaging. RESULTS Post-operative LVEDD (end-diastolic dimension of left ventricle), LVESD (end-systolic dimension of left ventricle), LVEDV (end-diastolic volume of left ventricle), LVESV (end-systolic volume of left ventricle), LVEDVI (LVEDV indexed to body surface area), LVESVI (LVESV indexed to body surface area), LV-mass (mass of left ventricle) and LV-massI (LV-mass indexed to body surface area) were significantly improved compared with those obtained prior to operation in CABG+BMMNC group (al p<0.05). The same parameters were not significantly different pre- and postoperative in the CABG group (al p>0.05). Postoperative mitral regurgitation score was not significantly different from those prior to operation in both groups (al p>0.05). In Chi-square tests, LVEDD, LVESD, LVEDV, LVESV, LVEDVI, LVESVI, LV-mass, LV-massI were determinants of the left ventricular remodeling. The improvement of left ventricular remodeling in CABG+BMMNC group was better than in the CABG group and this improvement was verified by echocardiography.

Increased risk of stroke among hypertensive patients with abnormally short sleep duration: analysis of the national health interview survey

acute myocardial infarction .This study aimed to investigate the association between MMP-9 and TIMP-1 levels and the occurrence of LVH in resistant hypertensive patients (RHTN) and mild to moderate hypertensives (HTN). Methods:We measured plasma TIMP-1 and MMP-9 (ELISA) in 126 HTN subjects and 86 RHTN patients. LVH was analyzed by left ventricle (LV) mass index (LVMI). Measurements of the dimensions of the LV were performed using the American Society of Echocardiography recommendations. The Mann-whitney test was used to compare the levels of biomarkers of extracellular matrix and IMVE between the groups while Spearman’s correlation was used to determine the relationship between the variables. Results: Resistant hypertensive patients had higher prevalence of HVE (66%) compared to mild to moderate hypertensive (46%), p1⁄40.005. Higher levels of TIMP-1 (mean SD) were found in RHTN (93.75 29.09 pg/mL) compared with HTN individuals (86.24 27.53 pg/mL) while lower MMP-9/TIMP-1 relationship was observed in RHTN group (0.37 0.5 vs. 0.77 1.75, p1⁄40.015). No differences were found between MMP-9 levels between the groups. TIMP1 levels were inversely correlated with LVMI in RHTN group (r1⁄4 -0.31 p1⁄40.005). Conclusion: RHTN patients had higher prevalence of LVH and higher TIMP-1 plasma levels. Moreover, RHTN group presented lower MMP-9/ TIMP-1 ratio compared to HTN. These data suggest that changes in the MMP-9/TIMP-1 balance may play an important role in the structural and clinical manifestations of resistant hypertension.

Cardioprotection by curcumin post-treatment in rats with established chronic kidney disease.

The pathogenic mechanisms leading to cardiovascular disorders in patients with chronic kidney disease have not been clearly established, although increased oxidative stress has been pointed out as a potential cause. Therefore, as cardiovascular events are still the first cause of death in patients with chronic kidney disease and traditional drugs or therapies rarely have effects on cardiac complications, we sought to determine the effect of curcumin in treating cardiac dysfunction in rats with established chronic renal disease. Treatment consisted in daily administration of curcumin (120 mg/kg/day) dissolved in 0.05% carboxymethylcellulose via oral gavages during 30 days, beginning from day 30 after 5/6 nephrectomy (5/6Nx). Cardiac function, markers of oxidative stress, activation of PI3K/Akt/GSK3β and MEK1/2-ERK1/2 pathway, metalloproteinase-II (MMP-2) content, overall gelatinolytic activity, ROS production and mitochondrial integrity were evaluated after 1-month treatment. Curcumin restored systolic blood pressure, diminished interventricular and rear wall thickening, decreased left ventricle dimension at end-systole (LVSd) and restored ejection fraction in nephrectomized rats. Also, it diminished metalloproteinase-II levels and overall gelatinase activity, decreased oxidative stress and inhibited the mitochondrial permeability transition pore opening. Our findings suggest that curcumin might have therapeutic potential in treatment of heart disease in patients with established CKD by attenuating oxidative stress-related events as cardiac remodeling, mitochondrial dysfunction and cell death.