Left Ventricle Systolic Function Research Articles

THE PREDICTION OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION

To study the parameters of the structural and functional state of the myocardium in patients with hypertension, to determine their prognostic value on the risk of atrial fibrillation (AF). The study involved 72 people: patients with hypertension and AF, with isolated hypertension and apparently healthy individuals. All of them performed echocardiography, blood pressure monitoring and monitoring of cardiogram. The dilatation of left atrial was founded: patients with the atrial fibrillation on the background of hypertension observed the most pronounced changes in the left atrial. In patients with hypertension without arrhythmias and in combination with atrial fibrillation severe left ventricular hypertrophy was observed. Left ventricle systolic function in groups has been stored but in patients with atrial fibrillation on the background of hypertension was significantly lower. The risk of atrial fibrillation in patients with hypertension prognostic value are the only values of the age, the volume index of the left atrial to the body surface area and left ventricular ejection fraction. The risk of AF in hypertension occurs over the age of 55 and each subsequent year increases it in 1,2 times, it increases with an index value of the left atrial to the body surface over 29 ml/m2 and with a decrease in left ventricular ejection fraction less than 58%.

Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods

Background: The torsional parameters of the left ventricle (LV) are sensitive indicators of the cardiac performance. The torsion/twist of the LV is the wringing motion of the heart around its long axis created by oppositely directed apical and basal rotations and is determined by contracting myofibers in the LV wall which are arranged in opposite directions between the subendocardial and subepicardial layers. This motion is essential for regulating the LV systolic and diastolic functions. Objectives: Recent advances in echocardiography techniques have allowed for quantification of LV mechanics. The aim of the present study was to compare various LV twisting and untwisting parameters in healthy human subjects determined by velocity vector imaging (VVI) and tissue Doppler imaging (TDI) at rest. Patients and Methods: All volunteers (47 healthy subjects in two groups: 24 subjects in VVI group and 23 subjects in TDI group) underwent complete echocardiographic study, and LV torsional parameters were assessed by VVI or TDI methods. In addition, LV torsion and LV twisting/untwisting rate profiles were calculated throughout cardiac cycle. Results: Twist degree was significantly lower in the VVI group than in the TDI group (P = 0.008, r = 0.56). LV torsion was lower in the VVI group but was not significant. (P = 0.13, r = 0.38). Twisting rate (P = 0.004, r = 0.66) and untwisting rate (P = 0.0001, r = 0.61) were lower in the VVI group, but when timing of untwisting rate was normalized by systolic duration, there was no significant difference between the two groups (P = 0.41, r = 0.59). Similarly, when peak untwisting rate was normalized by LV length, there was a significant decline in normalized peak untwisting rate in the VVI group (P = 0.004, r = 0.62), but not in peak twisting rate normalized by LV length (P = 0.12, r = 0.42). Peak untwisting rate normalized by LV torsion was not statistically different between the two groups (P = 0.05, r = 0.53). Conclusions: Results suggest that these methods cannot be interchanged, and VVI showed significantly lower LV peak twist, peak twisting rate and peak untwisting rate. However, when LV twist and LV twisting rates were normalized to LV length, values were comparable for both imaging techniques.

Interactions between immune, stress-related hormonal and cardiovascular systems following strenuous physical exercise.

Physical exercise represents a eustress condition that promotes rapid coordinated adjustments in the immune, stress-related hormonal and cardiovascular systems, for maintaining homeostasis in response to increased metabolic demands. Compared to the tight multisystem coordination during exercise, evidence of between-systems cross talk in the early post exercise is still lacking. This study was aimed at identifying possible interactions between multiple systems following strenuous physical exercise (Ironman race) performed by twenty well-trained triathletes. Cardiac hemodynamics, left ventricle systolic and diastolic function and heart rate variability were measured along with plasma concentrations of immune messengers (cytokines and C-reactive protein) and stress-related hormones (catecholamines and cortisol) both 24h before and within 20 min after the race. Observed changes in antiinflammatory pathways, stress-related hormones and cardiovascular function were in line with previous findings; moreover, correlating parameters' changes (post versus pre-race) highlighted a dependence of cardiovascular function on the post-race biohumoral milieu: in particular, individual post-race variations of heart rate and diastolic function were strongly correlated with individual variations of anti-inflammatory cytokines, while individual baroreflex sensitivity changes were linked to IL-8 increase. Multiple correlations between anti-inflammatory cytokines and catecholamines were also found according with the autonomic regulation of immune function. Observed post-race cytokine and hormone levels were presumptively representative of the increases reached at the effort end while the cardiovascular parameters after the race were measured during the cardiovascular recovery; thus, results suggest that sustained strenuous exercise produced a stereotyped cardiovascular early recovery, whose speed could be conditioned by the immune and stress-related hormonal milieu.

Myocardial contractile reserve: a global approach by combining cardiopulmonary exercise test with exercise-echocardiography

Purpose: Several approaches are available to evaluate myocardial contractile reserve during exercise. Cardiopulmonary exercise test (CPET) allows a response characterization by well established variables with powerful prognostic power. Echocardiography allows for peak cardiac power output (CPO= mean BP x (SV/60) x HR) calculation, by incorporating flow measurement with blood pressure, which has been proposed as an index of energy imparted by the left ventricle (LV) to the volume of blood ejected per second. We aimed to explore if peak CPO reflects functional capacity as evaluated by CPET. Methods: 66 patients (mean age 64±11; male 81%) with different cardiovascular disease (HFrEF 59%, HFpEF 41%, aortic and mitral valvular disease 7.4%, aortic valvular disease 14.9%, mitral valvular disease 23.9%) in NYHA class II (50%), III (42%) and IV (8%) and mean EF of 51±16% were evaluated at rest and during incremental exercise (tiltable cycle ergometer) assessing peak CPO, peak VO2, VO2% of predicted peak and peak O2 pulse. Results: A good linear correlation was found between peak CPO and peak VO2, % of predicted peak VO2 and peak O2 pulse (Sperman's rho respectively of 0.619, 0.547 and 0.49, p <0,0001). The correlation was maintained along all the spectrum of LV systolic function at rest (see the figure), being patients with reduced EF (n 27) distributed on the left side of the regression due to the reduced contractile reserve. ![Figure][1] Conclusions: CPET indices of functional capacity showed a good correlation with echo-derived peak CPO, both in normal and reduced LV systolic function. These results confirm the potential prognostic role of such echocardiographic index and suggest the importance of systematically assess peak CPO during stress echocardiography. [1]: pending:yes

The diagnostic value of speckle-tracking echocardiography in myocarditis and dilated cardiomyopathy

The purpose of the investigation – to study the diagnostic opportunities of Speckle-Tracking Echocardiography (STE) in patients with Inflammatory Cardiomyopathy (ICM) and Dilated Cardiomyopathy (DCM). Materials and methods: We examined 27 patients: 14 – with ICM (1st group) and 13 – with DCM (2nd group), the average age was (36,1±3,2) and (37,6±2,8) years respectively. By the use of STE we studied the parameters of myocardial deformation, which were: the absolute values of Longitudinal Global Systolic Strain (LGSS), Circumferential Global Systolic Strain (CGSS), Radial Global Systolic Strain (RGSS), Velocity of LGSS (VLGSS), Velocity of CGSS (VCGSS) and Velocity of RGSS (VRGSS). In all patients were also performed the detection of serum antibody titers to the Myocardium (ATm) and the level of myocardium induced Blasttransformation Lymphocyte Activity (BTLAm). Both groups were comparable by the values of end systolic, end diastiolic volume, ejection fraction of the left ventricle (LV), which were measured by the use of 2D echocardiography and heart rate according to the ECG. Results: In the 1st group in comparison with the 2nd we detected the higher values of LGSS - (9,4±1,2) and (5,1±1,1) % (P<0,01), CGSS - (9,2±1,4) and (5,5±1,1) % (P<0,05), VCGSS - (0,65±0,08) and (0,42±0,06) s-1 (P<0,02) respectively. These findings provide the evidence of more pronounced impairment of LV contractile function in DCM than in ICM. The negative correlation was found in the 1st group between LGSS, CGSS, VCGSS and BTLAm - r=-0,47, (P<0,05); r=-0,37, (P<0,05); r=-0,38, (P<0,05) respectively and also between LGSS, CGSS, VLGSS and ATm titers - r=-0,42, (P<0,05); r=-0,57, (P<0,02); r=-0,41, (P<0,05) respectively. In the 2nd group we found correlation of STE parameters only with ATm titers, thus we observed the negative correlation between ATm titers and RGSS - r=-0,53, (P<0,02) as also with VRGSS r=-0,44, (P<0,05). These data may suggest the influence of both cellular and humoral autoimmune reactions on the impairment of the LV systolic function in ICM and only the humoral mechanisms in DCM that resulted in more pronounced myocardial damage associated with pathologic effects of ATm. Conclusion: The use of STE may be helpful for the assessment of LV contractile function in patients with inflammatory and dilated cardiomyopathy, we defined that DCM was characterized by more significant LV systolic dysfunction in comparison with ICM. We suggest the negative influence of both ATm and activated lymphocytes on the LV systolic function in ICM and only the antimyocardial antibodies in DCM.

The effect of percutaneous mitral balloon valvuloplasty on left ventricle systolic functions by using strain and strain rate echocardiography

The effect of percutaneous mitral balloon valvuloplasty on left ventricle systolic functions by using strain and strain rate echocardiography

Obstructive sleep apnea and nocturnal hypertension are associated with concentric geometry and systolic dysfunction in patients with resistant hypertension. RESIST POL study

Purpose: To evaluate the impact of night blood pressure (BP) and coexisting obstructive sleep apnea (OSA) and metabolic syndrome (MS) on left ventricle geometry and systolic function in patients with resistant hypertension (RHT). Methods: We analyzed data from 155 patients with true RHT (92M, 63F). All patients underwent thorough examination including: biochemical evaluations (MS was defined by The Adult Treatment Panel (ATP) III), ambulatory blood pressure monitoring (ABPM), polysomnography (OSA was defined as apnea/hypopnea index>15/h) and echocardiography. LVMI, relative wall thickness (RWT), LVEF, midwall fractional shortening (mwFS) and global longitudinal strain (GLS) were measured. Results: Patients were divided into 4 groups based on presence of MS and OSA: group 1) OSA(-), MS (-) [n=42], group 2) OSA(+), MS(-) [n=14], group 3) OSA (-), MS(+) [n=46] and group 4) OSA(+), MS(+) [n=53]. There were no differences in 24h BP values between these groups. In group 3 and 4 concentric geometry was present in 48,9 and 60,4% respectively. There were no differences in LVEF between groups. Group 3 and 4 characterized by lower mwFS as compared with 1 group (16,40±1,9 and 15,38±2,2 vs 17,44±1,9; p<0,049 and p<0,0001 respectively). Group 4 had significantly lower GLS as compared with 1 group (-12,64±3,3 vs -15,59±4,0; p<0,001). On a multivariate logistic regression model factors independently associated with concentric geometry were age, night systolic BP values (OR-1,56, 95%Cl; 1,23-1,97, p<0,0001) and OSA (OR-4,03, 95%Cl; 1,82-8,94, p=0,001). In a multivariate linear regression model factor independently associated with GLS was OSA (beta=0,279,p=0,001) whereas factors independently associated with mwFS were age, gender, nocturnal systolic BP, concentric geometry and metabolic syndrome. Conclusions: In patients with true RHT obstructive sleep apnea and nocturnal hypertension are associated with high prevalence of concentric geometry and cause subclinical systolic dysfunction as assessed by GLS and mwFS.

High frequency of various viral agents and absence of Borrelia burgdorferi in the myocardium of subjects with normal left ventricular systolic function

Introduction: Inflammatory cardiomyopathy (DCMi) is a term used for systolic dysfunction of the Left Ventricle (LV) associated with persistent inflammation of the myocardium. Endomyocardial Biopsy (EMB) with an evidence of myocardial infection and /or inflammation is considered as the gold standard in the diagnosis of DCMi. However, recent studies using PCR methodology showed the presence of the viral genome (parvovirus B19 in particular) in individuals with normal LV systolic function. So far, there are no data about the presence of Borrelia burgdorferi (Bb), another potential pathogen of DCMi, in the myocardium of subjects with normal LV systolic function. Aim of the study: To determine the prevalence of viral agents and Bb in individuals with normal LV systolic function and no history suggestive of DCMi by electron microscopy. Methods: We investigated 38 patients (67±7 years, 6 women) with normal EF undergoing myocardial revascularization and/or heart valve surgery. During the surgery procedure we obtained samples of the right atrial appendage which were subsequently examined by electron microscopy for the presence of viral agents and Bb and by immunohistochemistry to detect inflammatory cells. Results: Viral agents were found in 25 subjects (66% of the study group) Herpesviridae family viral presence was detected in 34% of the studied subjects, Picornaviruses in 26%, a virus belonging to the Parvoviridae family in 13% and a member of the Paramyxoviridae in 3%. On the other hand, Bb was not detected in any case. Immunohistological examination did not demonstrate myocardial inflammation in any of the study subjects. Conclusions: The high prevalence of various viral agents in the myocardium of subjects with normal LV systolic function and the absence of immunohistological markers of myocardial inflammation proves that mere presence of viruses within the myocardium cannot be put into direct causal relationship with the development of DCMi. On the contrary, the absence of Bb in these individuals supports the idea of Bb pathogenicity in relation to development of the LV systolic dysfunction. The research project has been supported by the Czech Society of Cardiology.

Difference in cardiac manifestation between liver transplantation candidates with alcoholic and hepatitis related cirrhosis

Purpose: Cardiac event is the main cause of mortality during liver transplantation and patients with cirrhosis are associated with myocardial dysfunction. However, limited data is available regarding the characteristics of cardiac function between LTx candidates with alcoholic and hepatits related cirrhosis. The aim of the study was to compare the cardiac function between patients with alcoholic and hepatitis related cirrhosis who were candidates for LTx. Methods: A total of 88 patients with cirrhosis referred for LTx and 88 age and gender- matched controls were evaluated by transthoracic echocardiography. Clinical parameters, conventional echocardiographic and tissue Doppler-derived parameters of the left ventricle (LV) were obtained in all subjects. Liver status of cirrhotic patients was evaluated by the model for end-stage liver disease (MELD) scores. Results: Despite a similar LV dimension and LV ejection fraction, patients with cirrhosis had a higher prevalence of diastolic dysfunction (54% vs. 37%, p=0.01) and LV filling pressure as estimated by E/E' ratio (10.9±3.9 vs. 7.4±1.9, p<0.01) compared with controls. Age, gender and MELD were similar between patients with alcoholic and hepatitis related cirrhosis. The prevalence of diastolic dysfunction was also similar (54% vs 52%, p=1.0). However, patients with alcoholic related cirrhosis had lower LV ejection fraction (n=20; 51±14% vs. n=68; 62±8%) and larger LV end-systolic dimension (51±22ml vs. 31±12ml) and LV mass index (104±20g/m2 vs. 87±22g/m2) compared with patients with hepatitis related cirrhosis (all p<0.01). Conclusion: LTx candidates are associated with diastolic dysfunction and a higher LV filling pressure compared with controls. Importantly, patients with alcoholic related cirrhosis had a lower LV systolic function and a larger LV dimension compared with patients with hepatitis related cirrhosis. These important difference in cardiac dysfunction in patients with alcoholic related cirrhosis suggested the need for intensive preoperative risk stratification and monitoring during LTx.

Functional capacity benefits of cardiac rehabilitation after acute coronary syndrome are sustained in time and independent of left ventricle systolic function

Functional capacity benefits of cardiac rehabilitation after acute coronary syndrome are sustained in time and independent of left ventricle systolic function

Clinical predictors of long term survival in patients with impaired left ventricle systolic function undergoing mitral valce repair

Objective: Mitral valve repair improves symptoms and reduces myocardial remodeling, however in patients with significantly impaired left ventricle systolic function its impact on long term prognosis remains controversial. The aim of the study was to determine the predictors of long term survival in patients with concomitant systolic heart failure and mitral insufficiency undergoing mitral valve repair. Patients and methods: We included 39 patients (aged 63±12 years, 12 women) with LVEF≤40% (mean 32.3±5.7%, ranged: 15-40%) undergoing mitral valve repair. Patients scheduled for concomitant aortic valve surgery, surgical ventricle restoration or operation due to infective endocarditis were excluded from the analysis. Most patients (n=31, 79%) were significantly symptomatic (NYHA class III or IV), although only one required inotropic support as well as IABP before surgery. In 26 cases (67%) mitral insufficiency had an ischemic etiology. Predicted 30-days mortality as estimated by EuroSCORE II or STS risk models was 3.25 and 4.85% (median), respectively. All patients underwent mitral valve repair (restrictive annuloplasty was done in all cases and an additional intervention on mitral valve, e.g. chordal transfer, posterior leaflet quadrangular resection in 6 cases). Moreover, 18 patients underwent coronary artery bypass grafting, 9 - tricuspidal valve repair and 3 - surgical ablation of atrial arrhythmia. 34 demographic, clinical and echocardiographic parameters were analyzed to identify the independent risk factors for late mortality. Results: During median 3.3 years (IQR: 2-5 years) of follow up 13 patients died. There was one intrahospital death (30-days mortality was 2.5%). The 2- and 5- years cumulative survival was 77 and 66%. Multivariate Cox analysis revealed that the independent predictors for death was COPD (HR 7.95, 95% CI 6.66-9.25) and the need of intense postoperative inotropic support (at least two inotropes for at least 48 hours; HR 7.76, 95% CI 6.52-9.0). Surprisingly, according to the univariate analysis, none of the parameters analyzed (including i.e. left ventricle diameter, renal function, concomitant surgical procedure) except for the mentioned above and the length of stay at the ICU (which in fact is strongly correlated with the postoperative heart failure) differed between survivors and non-survivors. Conclusions: Severe postoperative heart failure that could represent poor reserve of impaired left ventricle predicted worse long term prognosis after mitral valve repair. COPD increased late mortality independently of pulmonary hypertension.

Activation of Hypoxia Response in Endothelial Cells Contributes to Ischemic Cardioprotection

Small-molecule inhibition of hypoxia-inducible factor prolyl 4-hydroxylases (HIF-P4Hs) is being explored for the treatment of anemia. Previous studies have suggested that HIF-P4H-2 inhibition may also protect the heart from an ischemic insult. Hif-p4h-2(gt/gt) mice, which have 76 to 93% knockdown of Hif-p4h-2 mRNA in endothelial cells, fibroblasts, and cardiomyocytes and normoxic stabilization of Hif-α, were subjected to ligation of the left anterior descending coronary artery (LAD). Hif-p4h-2 deficiency resulted in increased survival, better-preserved left ventricle (LV) systolic function, and a smaller infarct size. Surprisingly, a significantly larger area of the LV remained perfused during LAD ligation in Hif-p4h-2(gt/gt) hearts than in wild-type hearts. However, no difference was observed in collateral vessels, while the size of capillaries, but not their number, was significantly greater in Hif-p4h-2(gt/gt) hearts than in wild-type hearts. Hif-p4h-2(gt/gt) mice showed increased cardiac expression of endothelial Hif target genes for Tie-2, apelin, APJ, and endothelial nitric oxide (NO) synthase (eNOS) and increased serum NO concentrations. Remarkably, blockage of Tie-2 signaling was sufficient to normalize cardiac apelin and APJ expression and resulted in reversal of the enlarged-capillary phenotype and ischemic cardioprotection in Hif-p4h-2(gt/gt) hearts. Activation of the hypoxia response by HIF-P4H-2 inhibition in endothelial cells appears to be a major determinant of ischemic cardioprotection and justifies the exploration of systemic small-molecule HIF-P4H-2 inhibitors for ischemic heart disease.

Evaluation of systolic function of left ventricular in the short axis views in diabetic patients with ejection fraction>50％with velocity vector imaging and dobutamine stress echocardiography

Objective To evaluate the systolic function of left ventricle(LV) in the short axis views in diabetic patients with ejection fraction (EF) value ＞ 50％ with velocity vector imaging (VVI) and dobutamine stress echocardiography (DSE).Methods 30 diabetic patients,which were excluded from coronary artery disease,hypertension,valvular heart diseases,congenital heart diseases,and EF value ＞50 ％by echocardiography,and 20 volunteers with age and sex matched were involved in the study.Twodimensional VVI echocardiographic cine loops were stored at baseline and dobutamine stress (10,20,30 and 40 μg · kg-1 · min-1) in the basal,middle and apical short axis views of LV.The maximum systolic velocity (Vs),strain (e) and strain rate (SR) were obtained from sygno VVI software.Results The Vs,e and SR showed decrement tendency from basal to apical short axis view whether in the control group or in the DM group.At baseline,the SR in the apical view decreased significantly in the DM group than that in the control group (P ＜0.05),other parameters were comparable between the two groups.After 10 μg· kg-1 · min-1 dobutamine stress,the SR in the middle and apical views and Vs,e in the apical view decreased significantly in the DM group than those in the control group (all P ＜ 0.05).After 20μg· kg-1 · min-1 dobutamine stress,the SR in the basal,middle and apical views and Vs,e in the middle and apical views decreased significantly in the DM group than those in the control group (all P ＜0.05).After the maximum dobutamine stress,all parameters decreased significantly in the DM group than those in the control group (all P ＜0.05).Conclusions The systolic function impairment of DM patients appeared first in the apical tissue of LV,SR was more sensitive index than velocity arnd strain,DSE could increase the sensitivity of VVI parameters in detecting the myocardial systolic function impairment in the earlier stage. Key words: Echocardiography, stress; Diabetes mellitus; Ventricular function, left; Dobutamine; Velocity vector imaging

Adrenal gland dysfunction and myocardial Tissue Doppler echocardiographic abnormalities in Patients with Beta Thalassemia Major: cross sectional study

Background: Adrenal, parathyroid gland and myocardial echocardiographic abnormalities are recognized with variable outcomes in patients with transfusion dependent Beta-Thalassemia major (-TM). Aim: In this cross-sectional analytic study in patients with -TM, we evaluate the left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram with simultaneous measurement of serum level of cortisol and parathyroid hormone. Methods: The study was conducted on patients with ?-TM (n = 99, age 15.928.92 years) and compared with an age-matched controls (n = 98 age 15.798.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with ?-TM compared with controls, have significantly thicker LV septal wall index of 0.65 0.26 vs. 0.44 0.2190, P&lt;0.001 and LV posterior wall of 0.65 0.235 vs. 0.43 0.214, P&lt; 0.001, with no significant dilation of LV cavity in systole and diastole. The systolic function of LVFE% was normal of 51.95?5.5 vs. 5.0?5.6, p=0.23. Furthermore patients with ?-TM have higher E/A ratio (1.540.18 vs. 1.230.17, P&lt;0.01) and shorter deceleration time (DT) (170.5313.3 vs. 210.5019.20 m sec, P&lt;0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in ?-TM group (19.682.81 vs. 13.861.41, P&lt;0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in ?-TM group compared with controls with Sm, of 4.821.2 vs. 6.222.1 cm/sec, P&lt;0.05 and (Em) of 3.512.7 vs. 4.122.5 cm/sec P&lt;0.05, respectively). The tricuspid valve velocity was significantly higher in ?-TM patients compared with controls (2.850.56 vs. 1.7430.47 m/sec, respectively, P&lt;0.01). The prevalence of adrenal insufficiency in patients with -TM was 16 %, hypoparathyroidism of 4.5%. There was a weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with ?-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ?160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.

Acute right ventricular pressure overload compromises left ventricular function by altering septal strain and rotation

While right ventricular (RV) dysfunction has long been known to affect the performance of left ventricle (LV), the mechanisms remain poorly defined. Recently, speckle-tracking echocardiography has demonstrated that preservation of strain and rotational dynamics is crucial to both LV systolic and diastolic function. We hypothesized that alteration in septal strain and rotational dynamics of the LV occurs during acute RV pressure overload (RVPO) and leads to decreased cardiac performance. Seven anesthetized pigs underwent median sternotomy and placement of intraventricular pressure-volume conductance catheters. Two-dimensional echocardiographic images and LV pressure-volume loops were acquired for offline analysis at baseline and after banding of the pulmonary artery to achieve RVPO (>50 mmHg) induced RV dysfunction. RVPO resulted in a significant decrease (P < 0.05) in LV end-systolic elastance (50%), systolic change in pressure over change in time (19%), end-diastolic volume (22%), and cardiac output (37%) that correlated with decrease in LV global circumferential strain (58%), LV apical rotation (28%), peak untwisting (reverse rotation) rate (27%), and prolonged time to peak rotation (17%), while basal rotation was not significantly altered. RVPO reduced septal radial and circumferential strain, while no other segment of the LV midpapillary wall was affected. RVPO decreased septal radial strain on LV side by 27% and induced a negative radial strain from 28 ± 5 to -16 ± 2% on the RV side of the septum. The septal circumferential strain on both LV and RV side decreased by 46 and 50%, respectively, following RVPO (P < 0.05). Our results suggest that acute RVPO impairs LV performance by primarily altering septal strain and apical rotation.

Myofilament Ca2 + desensitization mediates positive lusitropic effect of neuronal nitric oxide synthase in left ventricular myocytes from murine hypertensive heart

Neuronal nitric oxide synthase (NOS1 or nNOS) exerts negative inotropic and positive lusitropic effects through Ca2+ handling processes in cardiac myocytes from healthy hearts. However, underlying mechanisms of NOS1 in diseased hearts remain unclear. The present study aims to investigate this question in angiotensin II (Ang II)-induced hypertensive rat hearts (HP). Our results showed that the systolic function of left ventricle (LV) was reduced and diastolic function was unaltered (echocardiographic assessment) in HP compared to those in shams. In isolated LV myocytes, contraction was unchanged but peak [Ca2+]i transient was increased in HP. Concomitantly, relaxation and time constant of [Ca2+]i decay (tau) were faster and the phosphorylated fraction of phospholamban (PLN-Ser16/PLN) was greater. NOS1 protein expression and activity were increased in LV myocyte homogenates from HP. Surprisingly, inhibition of NOS1 did not affect contraction but reduced peak [Ca2+]i transient; prevented faster relaxation without affecting the tau of [Ca2+]i transient or PLN-Ser16/PLN in HP, suggesting myofilament Ca2+ desensitization by NOS1. Indeed, relaxation phase of the sarcomere length–[Ca2+]i relationship of LV myocytes shifted to the right and increased [Ca2+]i for 50% of sarcomere shortening (EC50) in HP. Phosphorylations of cardiac myosin binding protein-C (cMyBP-C282 and cMyBP-C273) were increased and cardiac troponin I (cTnI23/24) was reduced in HP. Importantly, NOS1 or PKG inhibition reduced cMyBP-C273 and cTnI23/24 and reversed myofilament Ca2+ sensitivity. These results reveal that NOS1 is up-regulated in LV myocytes from HP and exerts positive lusitropic effect by modulating myofilament Ca2+ sensitivity through phosphorylation of key regulators in sarcomere.

Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major

To evaluate the changes in the LV systolic and diastolic function in children with beta-thalassemia major (β-TM) using pulsed wave tissue doppler (TD) echocardiography. Clinical, conventional echo doppler and pulsed wave tissue doppler imaging parameters were compared in 40 beta-thalassemia major patients (mean age, 6.52 ± 3.5 y) and 25 age and sex matched normal subjects (mean age, 6.5 ± 2.7 y). There were no significant statistical differences between mean fractional shortening (FS) and ejection fraction (EF) of left ventricle (LV) of the patients and control group. Children with beta-thalassemia had significantly lower E' wave velocities measured at the left ventricular septal annulus (8.1 ± 3.3 vs. 13 ± 2.5, P < 0.001), lateral margin of the mitral annulus (9.1 ± 5.4 vs. 13.3 ± 2.5, P < 0.001) and lateral margin of the tricuspid annulus (9.3 ± 3.9 vs. 13.3 ± 2.5, P < 0.001) when compared to the control group. Furthermore children with beta-thalassemia had significantly lower E'/A' wave ratio at the left ventricular septal annulus (0.76 ± 0.34 vs. 1.36 ± 0.23), lateral margin of the mitral annulus (0.83 ± 0.17 vs. 1.28 ± 0.22), and lateral margin of the tricuspid annulus ((0.90 ± 0.27 vs. 1.26 ± 0.23, (P < 0.05) when compared to the control group. This study showed that patients with beta-thalassemia major and normal conventional echo doppler parameters had statistically significant changes detected by pulsed wave tissue doppler imaging.

Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions

Fragmented QRS complexes (fQRS) have been associated with increased morbidity and mortality, sudden cardiac death, and recurrent cardiovascular events. The association between left ventricular systolic and diastolic functions and presence of fragmented QRS has not been comprehensively studied to date. We tested the hypothesis that the presence of fragmented QRS is associated with left ventricular systolic and diastolic dysfunction. The study included 259 patients who were consecutively admitted to our outpatient clinic for cardiovascular risk factor management. Extensive echocardiographic parameters were obtained from all patients and these were compared with the presence and number of fQRS. Patients with fQRS were of older age (58 ± 12 vs. 55 ± 13 years, p = 0.03) and had prolonged QRS time (105 ± 12 vs. 93 ± 10 ms, p < 0.001) and a higher rate of Q waves on ECG (36% vs. 11%, p < 0.001). In addition, they had worse systolic (lower LVEF%, 44 ± 17 vs. 61 ± 12, p < 0.001) and diastolic functions (DT, 177 ± 77 vs. 211 ± 59 ms, p < 0.001; IVRT, 81 ± 27 vs. 92 ± 22 ms, p = 0.001; Em, 9 ± 4 vs. 10 ± 4 cm/s, p = 0.008; E/Em ratio, 11 ± 5 vs. 8 ± 4, p < 0.001) in comparison to patients with nonfragmented QRS. There was a significant negative correlation between the number of fQRS and left ventricle systolic functions (for LVEF%, r = - 0.595, p < 0.001). After adjustment for age and gender, the number of fQRS remained significantly negatively associated with left ventricular systolic and diastolic functions. We found that fQRS is related to left ventricular systolic dysfunction and diastolic dysfunction. fQRS, which may be the result of myocardial ischemia or scar on myocardial electrical parameters at the cellular level, may represent inadequate systolic and diastolic functions.

Assessment of left ventricular functions in patients with Sjögren's syndrome using tissue doppler echocardiography

In our study, we aimed to evaluate left ventricular function in patients with Sjögren syndrome (SS) using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) in addition to conventional echocardiographic methods. We evaluated 50 patients with SS and 48 healthy volunteers with similar demographic characteristics. Systolic and diastolic functions of the left ventricle were analyzed with standard two-dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) Doppler and tissue Doppler imaging. Septal part of the mitral annulus PW TDE showed that systolic myocardial wave (Sm), early diastolic myocardial wave (Em), late diastolic myocardial wave (Am) and Em/Am ratios are significantly lower, and myocardial isovolumetric relaxation time (IVRTm) and MPI values are significantly higher in patients with SS. Lateral site of the mitral annulus PW TDE showed that Em, Sm and Em/Am ratios are significantly lower, and IVRTm and MPI values are significantly higher in patients with SS compared with healthy controls. In this study, it was shown that both left ventricle systolic and diastolic functions of patients with SS were disturbed.

Bedside Lung Ultrasound: A Case of Neurogenic Pulmonary Edema

Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the bedside relevant information on the state of aeration and ventilation of the lung. We describe a case report of acute respiratory insufficiency after posterior cranial fossa surgery. The patient underwent a subtotal meningiomectomy. Postoperative course was complicated by respiratory failure with unstable hemodynamic parameters. The pulmonary edema was suspected, and sonography examination was performed. Lung ultrasound showed typical signs for non-cardiogenic pulmonary edema. Transthoracic echocardiography showed preserved left ventricle systolic function, but signs of the severe hypovolemia were found. We corrected for the preload and ventilator support settings. Within 24 h, her respiratory status improved with a resolution of the pulmonary edema. Lung ultrasound at the bedside can provide accurate information on lung status in neurocritically ill patients with acute respiratory failure. The addition of transthoracic echocardiography to lung sonography provides an additive insight on the eventual pulmonary involvement. Lung ultrasound has the potential to become a reference tool for bedside dynamic respiratory monitoring in the Neuro ICU.