Left Ventricular End-systolic Stress Research Articles

Comparison of two ellipsoidal models for the estimation of left ventricular end-systolic stress in patients with significant coronary artery disease.

The shape of the left ventricle (LV) is an important index to explore cardiac pathophysiology. A comparison was provided to estimate circumferential, longitudinal, and radial wall stress in LV based on the thick-walled ellipsoidal models of Mirsky and Ghista-Sandler for discriminating significant coronary artery disease (CAD) patients from no CAD patients. According to the angiography findings, 82 patients with CAD were divided into two groups: 25 patients without significant CAD and 57 patients with significant CAD of single vessel and multivessel. An ellipsoidal LV geometry was used to calculate end-systolic passive stress as the mechanical behavior of LV. Echocardiographic views-based measurements of LV diameters used to estimate the end-systolic wall stress. Circumferential wall stress between the control group and significant CAD groups was significantly elevated for the Ghista model (P = 0.008); also, radial and longitudinal stress of the multi-vessel CAD group was significantly higher than the control group (P = 0.01 and P = 0.005, respectively). All stress parameters of the multi-vessel CAD group were statistically significant compared to the control group for the Mirsky model. Receiver operating characteristics curve analysis was shown the circumferential stress of multi-vessel CAD with an area under the curve (AUC) of 0.736 for the Ghista model and an AUC of 0.742 for the Mirsky model. These results indicated that Ghista and Mirsky model estimates of circumferential passive stress were the potential biomechanical markers to predict patients with multi-vessel CAD. It could be a noninvasive and helpful tool to quantify the contractility of LV.

Biomechanics and Myocardial Damage in Chronic Mitral Regurgitation

The 2014 ACC/AHA guidelines for surgery for asymptomatic chronic mitral regurgitation states as a class IIa recommendation that mitral valve (MV) repair could be considered if the left ventricular ejection fraction (LVEF) is greater than 0.60 and the LVESD less than 40 mm if there is a 95% probability of a durable repair with an expected mortality of less than 1%. However, adhering to these guideline surgical triggers uncovers a subset of patients (20% incidence) where the LVEF decreases post repair. Is this due to changing loading conditions or impaired myocyte contractility? In a study at University of Alabama at Birmingham of patients undergoing (MV) repair for chronic mitral regurgitation MRI derived left ventricular (LV) volumes demonstrated reverse diastolic remodelling while left ventricular end systolic remodelling was essentially unchanged following surgery. Myocardial strain rates were normal prior to mitral valve repair. However, in the face of unchanging left ventricular end systolic wall stress, strain rates decreased below normal following MV repair suggesting a decrease in left ventricular contractile performance. LV biopsies of these patients taken at the time of MV repair demonstrated deposition of lipofuscin which is composed of protein and lipid degradation residues. Lipofuscin accumulation may have a deleterious effect on myocyte function. These biopsies also demonstrated extensive myofibrillar degeneration. The desmin cytoskeleton in the myocardium forms a continuous network maintaining a spatial relationship between the contractile apparatus and mitochondria. The LV biopsies demonstrated desmin loss indicating substantial underlying cellular and molecular damage. Implications: At the time of correction of mitral regurgitation substantial LV damage has occurred. This suggests that an even earlier repair of mitral regurgitation should be considered.

Left Ventricular Function Assessed by One-Point Carotid Wave Intensity in Newly Diagnosed Untreated Hypertensive Patients.

To investigate whether newly diagnosed untreated hypertensive patients show higher left ventricular (LV) contractility, as assessed by traditional echocardiographic indices and carotid wave intensity (WI) parameters, including amplitude of the peak during early (W1 ) and late systole (W2 ). A total of 145 untreated hypertensive patients were compared with 145 age- and sex-matched normotensive subjects. They underwent comprehensive echocardiography and WI analysis. WI analysis was performed at the level of the common carotid artery. The diameter changes were the difference between the displacement of the anterior and posterior walls, with the cursors set to track the media-adventitia boundaries 2 cm proximal to the carotid bulb and calibrated by systolic and diastolic BP. Peak acceleration was derived from blood flow velocity measured by Doppler sonography with the range-gate positioned at the center of the vessel diameter. WI was based on the calculation of (dP/dt)×(dU/dt), where dP/dt and dU/dt were the derivatives of BP (P) and velocity (U) with respect to time. One-point pulse wave velocity (PWVβ) and the interval between the R wave on ECG and the first peak of WI (R-W1 ), using a high definition echo-tracking system implemented in the ultrasound machine (Aloka), were also derived. After adjustment for body weight, heart rate, and physical activity, the two groups had similar general characteristics and diastolic function. However, hypertensives showed significantly higher LV mass, LV ejection fraction (LVEF), circumferential and LV end-systolic stress, and one-point PWV as well as W1 (13.646 ± 7.368 vs 9.308 ± 4.675 mmHg m/s3 , P =.001) and W2 (4.289 ± 2.017 vs 2.995 ± 1.868 mmHg m/s3 , P =.001). Hypertensives were divided into tertiles according to LVEF: W1 (11.934 ± 5.836 vs 11.576 ± 5.857 vs 17.227 ± 8.889 mmHg m/s3 , P <.0001) was higher in the highest LVEF tertile along with relative wall thickness, midwall fractional shortening, endocardial fractional shortening, and R-W1 . Newly diagnosed hypertensives show increased LVM and LV contractility, including carotid WI parameters and R-W1 values, as compared with normotensive subjects, but no differences in LV diastolic function.

Insulin-Like Growth Factor 1 (IGF- 1) Levels And Left Ventricular Meridional End Systolic Stress (LVMESS) Interrelationship In Middle- Aged And Elderly Obese Subject With Type 2 Diabetes Mellitus

Background: Left ventricular meridional end systolic stress (LVMESS) is a quantitative determinant index of LV afterload which is an essential determinant of LV performance. The key factors influencing LVMSS, notably ventricular wall thickness, chamber size and configuration are shown to be altered by both obesity and type2 diabetes mellitus (T2DM). There exist reports implicating high free insulin-like growth factor 1 (IGF-1) but not growth hormone (GH) levels, with increased left ventricular mass index (LVMI), abnormal LV geometric remodeling, and A1c levels. Objective: to explore whether a meaningful link exists between LVMESS and free IGF-1 plasma levels, in obese middle-aged and elderly individuals with or without T2DM. Methodology: In this cross sectional study, a total of 145 participants Involved. Middle aged and elderly obese individuals with or without T2 DM were matched with healthy lean subjects of the same age group, with or without T2 DM. LVMESS and IGF-1 levels were compared between groups; group differences were analyzed using unpaired t test and linear correlation test. Data were expressed as the mean ± S.D, using SPSS version 18). Results: LVMESS values showed significant decrease in diabetic patients compared to control in both middle and old aged subjects. IGF-1, concentration levels were lower in the elderly obese diabetics compared to control, with significant (r=0.462; p= 0.04) negative correlation with LVMESS in healthy obese old aged, and a negative but non-significant correlation with LVMESS in lean old aged with or without diabetics Conclusion: Nonlinear correlation of IGF-1 levels with LVMESS obtained. It could be hypothesized that because of its negative significant correlation with LVMESS in the elderly non diabetic obese, IGF-1 free level could be utilized to serve as a predictor of impaired LV systolic function in these subjects. In addition the results could shed some light on IGF-1- LVMESS relationship, when considering IGF-1 therapy in certain conditions. Recommendation: It is suggested that using IGF-1 plasma levels in the elderly with or without T2DM could aid as predictor for LV global systolic dysfunction .However, larger sample size are to be considered.

Coronary slow flow phenomenon: Not only low in flow rate but also in myocardial energy expenditure

Background and aimCoronary slow flow phenomenon (CSFP) is a miscellaneous clinical entity leading to angina-like symptoms, and electrocardiographic and scintigraphic evidence of ischemia. The impact of this syndrome on myocardial performance has not been comprehensively evaluated. In this study, we sought to evaluate the myocardial energy expenditure (MEE) in patients with CSFP and its relationship with exercise capacity. Methods and resultsA total of 64 patients (64.1% male, mean age 53.2 ± 10.3 years) with CSFP and 64 patients (60.9% male, mean age 52.2 ± 10.9 years) with normal coronary artery as control group were included. MEE was calculated by a validated formula that uses transthoracic echocardiography (TTE) parameters, including left ventricular circumferential end-systolic stress, stroke volume, and ejection timeCSFP patients had significantly lower MEE (0.79 cal/systole ± 0.15 vs. 0.91 cal/systole ± 0.09, p < 0.001). In correlation analysis, MEE had a significant negative correlation with mean corrected TIMI frame count (mTFC) (β = −0.523; p < 0.001) and positive correlations with metabolic equivalents (METs) (β = 0.560; p < 0.001), rate pressure product (β = 0.649; p < 0.001), and exercise duration (β = 0.408; p < 0.001). At multivariate analysis, MEE was demonstrated as an independent predictor of CSFP (OR 1.863, CI 95% 1.485–2.338 p < 0.001). ConclusionMyocardial energy consumption, as a calculation obtained from TTE parameters, was reduced in patients with CSFP, and it had a significant relationship with exercise capacity. Considering its significant correlation with exercise capacity, myocardial energy consumption seemed to use evaluation of myocardial performance and functional status in another cardiovascular disease.

Glomerular normofiltration in hypertension may mask a state of former hyperfiltration

Objective: In the majority of hypertensive subjects normofiltration represents a state of preserved renal function. However, previous research has shown that some normofilterers may represent a group of former hyperfilterers with increased risk of microalbuminuria. We did a prospective study to investigate whether in hypertensive normofilterers with former glomerular hyperfiltration, clinical characteristics differ from those of true normofilterers. Design and methods: Creatinine clearance (CrCl) and albumin excretion rate (AER) were measured at entry and after 8.5 years of follow-up, in 534 young-to-middle-age stage 1 hypertensive subjects from the HARVEST (mean age 34.6±8.3 years, 69% men). Glomerular hyperfiltration was defined as a CrCl≥150 ml/min/1.73m2. Baseline ambulatory BP, 24h urinary epinephrine, echocardiographic data, and routine blood tests were also obtained. Results: At follow-up end, 442 participants were normofilterers. Of these, 395 had normal CrCl also at baseline (true normofilterers, Group 1) whereas 47 subjects had a baseline CrCl ≥150 ml/min/1.73m2 (former hyperfilterers, Group 2). Participants of Group 2 had higher age-and-sex-adjusted systolic blood pressure (p=.007) than those of Group 1. In addition, 24h urinary epinephrine (p<.001), heart rate (p=.05), ambulatory night-time BP fall (p=.004), and left ventricular end-systolic stress (p=.01) were higher in Group 2. During the follow-up, subjects of Group 2 had a greater baseline-adjusted increase in glucose than those of Group 1 (p=.03) and a tendency to the impairment in the other metabolic data. At follow-up end, microalbuminuria was 5.3% in subjects of Group 1 and was 36.2% in those of Group 2 (p<0.0001). This difference held true in a multivariable logistic regression in which several confounders, ambulatory blood pressure, baseline AER, and other risk factors were taken into account (p<0.0001). Conclusions: These data show that hypertensive normofilterers with former hyperfiltration are a distinct subgroup characterized by higher sympatho-adrenergic activity and poorer metabolic profile. These patients are at increased risk of renal damage and should be treated earlier for hypertension

Conventional versus complete chordal-sparing mitral valve replacement: eff ects on left ventricular function and end-systolic stress

Background This study aims to assess the eff ects of bileafl et preservation versus conventional technique during mitral valve replacement (MVR) on left ventricular functions and end-systolic stress (ESS).Methods Between September 2005 and January 2009, sixty-fi ve patients with mitral regurgitation underwent MVR surgery. In a non-randomized fashion, 34 patients had conventional MVR without chordal/leafl et preservation (group I, c-MVR), and 31 had MVR with total chordal/bileafl et preservation (group II, b-MVR). A prospective clinical and echocardiographic follow-up of patients was performed preoperatively, at 3 months and by 1 year postoperatively.Results Left ventricular end-systolic/end-diastolic dimensions and volumes decreased by 1 year in the b-MVR group. Left ventricular ESS decreased only in the bileafl et sparing MVR group after surgery, and this decrease was signifi cant by 1 year, compared with the c-MVR group (P= 0.008). Left atrial diameter signifi cantly decreased in both groups. Only one patient died, due to posterior wall rupture after a c-MVR procedure. One patient undergoing a b-MVR procedure needed re-operation because of prosthetic valve endocarditis.Conclusion Bileafl et preservation during MVR has a benefi cial eff ect on left ventricular function, compared with conventional MVR. Left ventricular ESS improves after bileafl et-sparing MVR and may be an important indicator of myocardial function after mitral valve surgery.

Cardiac involvement in active uncomplicated acromegaly

Increased cardiovascular mortality is present in acromegaly. A late frequent complication of this disease is congestive heart failure. At present it is unclear whether the acromegalic heart disease is principally due to the growth hormone excess or to diabete mellitus, hypertension, and coronary artery disease often present in acromegalic patients. The aim of this study was an attempt to clarify this issue. Thus, we studied by echocardiography and radionuclide ventriculography at rest and during exercise 11 patients with active uncomplicated acromegaly in comparison with 12 normal subjects, comparable for age and sex distribution. The results have shown comparable heart rate and blood pressure in patients and control subjects. Moreover, increased left ventricular mass (117±19 vs 79±18 g/m2; p<0.001) with normal internal dimensions; normal ejection fraction at rest, but impaired during exercise (59±8 vs 74±7 %, p<0.001); impairment of diastolic function as documented by reduced peak filling rate (2.6±0.6 vs 3.17±0.3 EDV/s, p<0.01) and prolonged time to peak filling rate (209±78 vs 134±53 ms, p<0.01); and reduction of left ventricular end-systolic stress (49±7 vs 62±8×10 dynes/cm2, p<0.001) were demonstrated in acromegalic patients. These results confirm those of the previous studies and better clarify the pathophysiological mechanisms at the base of acromegalic heart disease.

CMR features of peri-partum cardiomyopathy

Results Out of a total of 6823 patients, 16 were initially diagnosed with PPC. Two of these were excluded (one patient had her scan one year following delivery and a second patient was found to have severe 3 vessel coronary artery disease). The remaining 14 patients were 30 ± 5.6 years of age. CMR was performed 15 ± 16.7 (range 3 to 54) days post partum. Mean systolic blood pressure was 119 ± 23 mmHg and heart rate was 80 ± 21 beats per minute. Pertinent measures of left ventricular function included an ejection fraction of 36 ± 12% and cardiac index of 3.4 ± 0.8 L/min/ m2. 12/14 (86%) had an increased left ventricular end diastolic volume index (range 101-192; normal 55-103 ml/m). Left ventricular mass index was within normal limits in 11/14 (79%) patients. Left ventricular end systolic wall stress index was abnormal in all but one patient (70 ± 18.5 103 N/m2, normal <45 103 N/m2).

Reduction of myocardial blood flow reserve in idiopathic dilated cardiomyopathy without overt heart failure and its relation with functional indices: an echo-Doppler and positron emission tomography study

Myocardial blood flow during pharmacological vasodilatation is depressed in patients with idiopathic dilated cardiomyopathy even the in absence of overt heart failure; the extent of myocardial blood flow abnormalities is not predictable by left ventricular ejection fraction (LVEF) and diastolic dimensions. To assess whether myocardial blood flow impairment in idiopathic dilated cardiomyopathy without overt heart failure can be related to Doppler-derived dP/dt and to echocardiographically determined left ventricular end systolic stress - which is linked to myocardial blood flow reserve in advanced disease. Twenty-six patients, New York Heart Association Class I-II, (LVEF 37.4 +/- 1.4%, left ventricular diastolic dimensions 62.6 +/- 0.9 mm) underwent resting/dipyridamole [13N]NH3 flow positron emission tomography and an ultrasonic study. Regional myocardial blood flow values (ml/min per g) were computed from positron emission tomography data in 13 left ventricular (LV) myocardial regions and averaged to provide mean myocardial blood flow and myocardial blood flow reserve, defined as dipyridamole/resting mean myocardial blood flow ratio. Resting myocardial blood flow was 0.686 +/- 0.045, dipyridamole myocardial blood flow 1.39 +/- 0.15 and myocardial blood flow reserve 2.12 +/- 0.2, lower than in controls (P < 0.01). The ratio dP/dt was directly related to dipyridamole myocardial blood flow and myocardial blood flow reserve (r = 0.552 and 0.703, P < 0.005 and P < 0.0001); no relation was found between myocardial blood flow and LVEF left ventricular diastolic dimensions, and left ventricular end systolic stress. In idiopathic dilated cardiomyopathy patients without overt heart failure, the extent of myocardial blood flow reserve impairment is related to dP/dt but not to more classical indices of left ventricular function.

943 Impact of underlying cardiopathy on left ventricular remodelling after cardiac resynchronization therapy

, p<0.02), in the office diastolic blood pressure (83.0±6.2 vs 77.0±7.5 mm Hg, p<0.008) and heart rate (76.1±14.0 vs 66.3±9.7 bpm, p<0.02). No differences were found in left ventricular diameters, volumes, mass, meridional and circumferential end-systolic stress, total peripheral resistence, stroke volume and cardiac output. The relative wall thickness (RWT) was significantly increase in black (0.42±0.04 vs 0.36±0.05, p<0.0001), suggesting a tendency to a concen- tric remodelling. The left systolic function estimated by conventional param- eters was unchanged. Doppler analysis of tissue kinetics showed a signifi- cant increase in black subjects of septal S and E waves, as peak velocity (pv) and time velocity integral (tvi), when compared with white subjects. The MPI in black subjects was significantly increase (0.46±0.05 vs 0.39±0.05, p<0.0003), due to a significant prolongation of ICT (62.1±19.1 vs 51.4±9.9 msec). A significant correlation between MPI and RWT (r=0.54, p<0.001) and left ventricular mass (r=0.54, p<0,001) respectively were demonstrated. Besides, MPI correlate with Spv (r=0.55, p<0.001) and Stvi (r=0.38, p<0.001) waves. In conclusion our data confirm that MPI is increase in black healthy subject and is geometry-dependent, in contrast with current literature. Besides, we found correlations between MPI and systolic indexes derived from DTE. These findings also suggest that racial differences in left ventricular perfor- mance and systolic function exist even in absence of other conventional echocardiographic changes.

At the Beginning of Stiffening

Brachial cuff blood pressure (BP) continues to guide almost every decision related to the clinical management of the hypertensive patient. However, the BP within the central aorta (ie, aortic pressure) is receiving growing attention for 2 main reasons. First, brachial BP does not necessarily predict aortic pressure, and subjects with equal values of brachial cuff pressure may differ markedly in their aortic pressure.1 Second, aortic pressure may be superior to brachial BP for the prediction of several vascular complications, including the degree of carotid atherosclerosis,2 the extent of coronary artery disease,3 the likelihood of reocclusion after angioplasty,4 and, more important, the risk of major cardiovascular events.1,5 Aortic BP may be estimated noninvasively from analysis of peripheral radial artery waveforms with applanation tonometry. Although the reliability of derived aortic BP is crucially dependent on the validity of the transfer function used to generate the central aortic waveforms, the correspondence between estimated central aortic and intra-arterial systolic BP and pulse pressure (PP) seems to be quite close.6 In addition to central PP, pulse …

Relations of longitudinal left ventricular systolic function to left ventricular mass, load, and Doppler stroke volume

To evaluate whether the peak systolic velocities of the displacement of the lateral mitral anulus (Sa) and of the mid-portion of the interventricular septal wall (Sm) correlate with measures of left ventricular load, left ventricular mass, and Doppler stroke volume in normotensive and hypertensive subjects without clinically overt cardiovascular disease. Tissue Doppler imaging was used to evaluate Sa and Sm in apical 4-chamber view; standard echocardiographic procedures were used to assess left ventricular structure and traditional parameters of systolic function (ejection fraction, stress-corrected midwall shortening, meridional and circumferential end-systolic stress); pulsed Doppler was employed to evaluate stroke volume. In 87 subjects meeting inclusion criteria, Sa and Sm were not significantly correlated either with left ventricular end-diastolic volume and end-systolic stress, or with stroke volume; in contrast, endocardial and midwall fractional shortening were lower with higher afterload, as expected. Fractional shortening at endocardium and midwall, and Sm were lower with higher left ventricular mass. Mean Sa and Sm values were lower in subjects with low vs. those with normal stress-corrected midwall shortening, but low Sa was not associated with lower stress-corrected midwall shortening in our study sample. While Sa and Sm might be indices of longitudinal left ventricular systolic mechanics, they should not be considered as measures of left ventricular contractility alternative to well-established parameters of systolic function, such as stress-corrected midwall shortening, in subjects at rest without overt heart disease.

Diagnostic value of plasma concentration of pro-brain natriuretic peptide in congestive heart failure in pediatric patients with ventricular septal defects

The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNP and NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD). Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHF group (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied. Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944. Plasma NT-proBNP level could be used to assess cardiac function and diagnose CHF in pediatric patients with VSD.

Relation of echocardiographic left ventricular mass, geometry and wall stress, and left atrial dimension to coronary calcium in young adults (the CARDIA study)

We examined the relation of measures of echocardiographic left ventricular mass and geometry with coronary artery calcium (CAC) in 2,724 young adults. After adjustment for other coronary risk factors, left atrial dimension remained associated with the presence of CAC, and among subjects positive for CAC, left ventricular mass, end-systolic stress, and septal and posterior wall thicknesses in diastole remained associated with an increased extent of CAC.

Relationship between left ventricular geometry and left atrial size and function in patients with systemic hypertension.

Arterial hypertension determines distinct adaptive left ventricular geometric responses, which may differently affect left ventricular function and left atrial performance. In this study, the effect of left ventricular geometry on left atrial size and function, and the relationship between left atrial size and left ventricular mass were assessed in 336 patients with systemic arterial hypertension who had undergone Doppler echocardiography. Patients were classified into concentric (110 patients with concentric left ventricular geometry defined as relative wall thickness > or = 0.44) and eccentric groups (226 patients with relative wall thickness < 0.44). Comparison to the latter, the former had greater left atrial size, left atrial ejection force, left ventricular mass and lower left ventricular midwall fractional shortening. Left ventricular concentric, rather than eccentric, geometry emerged by multivariate analysis as a factor independently associated with the highest degree of left atrial ejection force. Left atrial size was positively related to left ventricular mass in the whole population (r = 0.65, SEE = 6 ml, P < 0.00001). This relationship was maintained in the subgroups with concentric (r = 0.65, SEE = 6 ml, P < 0.00001) or eccentric geometry (r = 0.59, SEE = 6 ml, P < 0.00001). Our results indicate that the relationship of left ventricular geometry to both left atrial size and ejection force in hypertensive patients is relevant. Concentric left ventricular geometry is associated with greater left atrial size and ejection force than eccentric geometry, suggesting that increased left ventricular stiffness has a greater effect in stimulating left atrial performance than left ventricular end-systolic stress. The degree of left atrial enlargement similarly depends on left ventricular mass in patients with concentric and eccentric geometry.

Late anthracycline cardiotoxicity after childhood cancer: a prospective longitudinal study.

The objective of the current study was to examine the risk factors for progression in severity of anthracycline-induced cardiac dysfunction, thereby providing information that is useful in refining cancer treatment regimes and guiding follow-up. Serial echocardiograms were performed on 101 acute lymphoblastic leukemia survivors and 83 Wilms tumor survivors after a mean interval of 6.2 years and 6.7 years since last anthracycline dose, respectively, at first study, and after 10.3 years and 11.1 years, respectively, at second study. The paired data were contrasted with data from 100 normal subjects, and potential correlations with follow-up interval, cumulative dose, cancer diagnosis, gender, age at diagnosis, and growth were explored using univariate and multiple regression techniques. The most important predictor of worsening cardiac performance was total anthracycline dose. As a group, patients receiving < 240 mg/m(2) showed no deterioration of left ventricular end systolic stress at > 10 years from the end of treatment. Survivors who have received low-dose anthracycline require cardiac surveillance infrequently. In good prognosis tumors, cumulative anthracycline dose should be maintained at < 250 mg/m(2).

Pulse pressure/stroke index and left ventricular geometry and function

To evaluate the relationship between arterial stiffness estimated by the pulse pressure/stroke index ratio (PP/SVi) and prognostically relevant abnormalities of left ventricular geometry and function. Baseline data from the echocardiographic substudy of the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study were used. Patients involved in the present study had stage II-III hypertension and electrocardiographic left ventricular hypertrophy; those with a history of coronary heart disease or segmental wall motion abnormalities were excluded. Plasma glucose, total and high-density lipoprotein (HDL) cholesterol and creatinine concentrations and urinary albumin/creatinine were assessed by standard methods. The study sample (n = 667) was subdivided into tertiles of PP/SVi. With greater PP/SVi, age, proportion of women and prevalence of type 2 diabetes, systolic and mean blood pressures were greater, whereas body mass index, body height and diastolic blood pressure were lower. Total and HDL cholesterol, creatinine and albuminuria did not differ among the three groups. After adjustment for age, sex and body size, greater PP/SVi was related to concentric left ventricular geometry, but showed a weak negative relationship to left ventricular mass and aortic root diameter; the prevalence of aortic fibrocalcification and left atrial diameter did not differ among tertiles of PP/SVi. PP/SVi was related to greater left ventricular end-systolic stress; stress-corrected left ventricular chamber function was greater with greater PP/SVi, whereas myocardial contractility did not differ significantly among the three groups. Greater PP/SVi was related to greater mitral E-wave/A-wave ratio and shorter isovolumic relaxation time independently of age, sex, left ventricular geometry, systolic function and other confounders. Increased estimated arterial stiffness is associated with concentric left ventricular geometry and with diastolic left ventricular abnormalities suggestive of increased diastolic left ventricular stiffness.

Association between left ventricular structure and cardiac performance during effort in two morphological forms of athlete’s heart

Aim: The aim of the study was to evaluate in 263 competitive athletes possible correlations between changes induced by different sport activities in left ventricular (LV) structure and cardiac response during maximal physical effort. Methods: A total of 160 top-level endurance athletes (ATE; swimmers, runners; 28±4 years; 98 male) and 103 strength-trained athletes (ATS; weight-lifters, body-builders; 27±5 years; male), selected on the basis of training protocol (dynamic vs. static exercise), underwent standard Doppler echocardiography, heart rate variability analysis and maximal exercise stress test by bicycle ergometry. M- and B-mode echocardiographic LV measurements were determined at rest, while the following functional indexes were assessed during effort: maximal heart rate (HR), maximal systolic blood pressure (SBP) and maximal workload (Watts reached by bicycle test). Results: The two groups were comparable for age and sex, but ATS at rest showed higher HR, SBP, and body surface area (BSA). By echo analysis, LV mass index and ejection fraction did not significantly differ between the two groups. However, ATS showed increased sum of wall thickness (septum+posterior wall), relative wall thickness and LV end-systolic stress, while LV stroke volume and LV end-diastolic diameter ( P<0.01) were greater in ATE. HR variability analysis underlined in ATE increased indexes of vagal tone ( P<0.01). During maximal physical effort, ATE showed a better functional capacity, with greater maximal workload ( P<0.001) reached with lower maximal HR and SBP. After adjusting for HR, age, sex, BSA and SBP, distinct multiple linear regression models evidenced in ATE independent associations of maximal effort workload with LV end-diastolic diameter ( P<0.001), HR ( P<0.001) at rest and LV end-systolic stress ( P<0.01) were found in ATE. On the other hand, independent direct correlation of SBP max during effort with sum of wall thickness ( P<0.001), BSA ( P<0.05) and LV end-systolic stress ( P<0.001) was evidenced in ATS. Conclusions: LV structural changes in competitive athletes represent adaptation to hemodynamic overload induced by training and are consistent with different kinds of sport activity. Work capacity during exercise is positively influenced by preload increase in ATE, while increased afterload due to isometric training in ATS determines higher systemic resistance during physical effort.

Design and baseline characteristics for the ACE Inhibitor After Anthracycline (AAA) study of cardiac dysfunction in long-term pediatric cancer survivors

Purpose The ACE Inhibitor After Anthracycline (AAA) study is a randomized, double-blind, controlled clinical trial comparing enalapril with placebo to determine whether treatment can slow the progression of cardiac decline in patients who screen positive for anthracycline cardiotoxicity. Methods The primary outcome measure is the rate of decline, over time, in maximal cardiac index (in liters per minute per meters squared) at peak exercise; the secondary outcome measure is the rate of increase in left ventricular end systolic wall stress (in grams per centimeters squared). Patients >2 years off therapy and <4 years from diagnosis, aged 8 years and older, were eligible if they had received anthracyclines and had at least one cardiac abnormality identified at any time after anthracycline exposure. Results A total of 135 patients were randomized to enalapril or placebo. Baseline characteristics were similar across treatment groups. Conclusions The AAA study will provide important information concerning the efficacy of using angiotensin-converting enzyme inhibitors to offset the effects of late anthracycline cardiotoxicity. (Am Heart J 2001;142:577-85.)