Left Ventricular Myocardial Performance Index Research Articles

Left Ventricular Dysfunction in Hypertensive Patients and Inter-arm Pressure Difference

Background: Systolic inter-arm pressure difference (SIAD) is considered as cardiovascular risk. We aimed to ascertain whether the presence of (SIAD) is associated with impaired left ventricular (LV) functions or not. Methods: Blood pressure (BP) was measured on both arms of 81 participants, echocardiographic parameters of LV functions; ejection fraction, mitral E, A, eˋ, aˋand tricuspid regurgitant velocities, left atrial volume index, E/A and E/eˋ ratio, LV stiffness index and myocardial performance index (MPI) were measured, and global longitudinal strain (GLS) was assessed. Results: Higher SIAD level had good positive correlations with age, body mass index (BMI), duration of hypertension (HTN), MPI, and LV end-systolic volume. SIAD had good negative correlations with mitral E wave velocity, E/A ratio, eˋ and sˋ wave velocities, and with the average GLS. Impaired LV average GLS is independently associated with: Years from HTN discovery followed by BMI, gender, and age. Conclusion: BP reading in both arms on the first visit is not sufficient; hypertensive patients need evaluation of the SIAD on follow up. We need to consider the SIAD on risk stratification and BP control. This will be simple to follow in primary care and areas with low resources.

Combined myocardial performance index as an echocardiographic predictor of prognosis in acute ST-elevation myocardial infarction

Abstract Background Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. Right ventricular (RV) dysfunction can occasionally coexist with LV dysfunction. The most popular techniques for assessing systolic and diastolic function, respectively, the ejection fraction (EF) and transmitral flow, both have significant limitations. The myocardial performance index (MPI) is a single parameter that does not have these restrictions and can estimate both combined systolic and diastolic performance. We used the combined myocardial performance index (CMPI) (LV MPI + RV MPI) as a new predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI). Objectives The purpose of this study was to evaluate the CMPI as an echocardiographic prognostic indicator in STEMI patients. Methods 200 STEMI patients who underwent primary PCI were enrolled. Echocardiography was done within 24 h of clinical signs with measurement of LV MPI and RV MPI. The MPI was calculated as (isovolumic contraction time + relaxation time)/ejection time. The one-year cardiovascular mortality rate from the time of admission was selected as a prognostic indicator. Results The one-year cardiovascular mortality rate was 9% (18 patients). LV MPI was found to have a significant positive correlation with the development of 1-year death (p = 0.036), while CMPI was found to have a highly significant positive correlation (p = 0.0001). A cut-off point of MPI > 0.50 showed 65.9% specificity and 94.4% sensitivity for the prediction of one-year death (Area-0.659). On the other hand, a cut-off point of CMPI > 0.92 has shown 94.4% sensitivity and 95.1% specificity for identifying patients with a one-year death risk (Area - 0891). Conclusions The CMPI might be a strong prognostic predictor after acute STEMI.LVMPICMPI

Abstract 12735: Investigating Cardiac Function After Anthracycline Exposure in Childhood Cancer Survivors With Modifiable Cardiovascular Risk Factors

Introduction: Anthracycline exposure can lead to cardiac dysfunction, which may possibly be worsened by secondary cardiovascular risk factors (CVRFs), such as hypertension, hyperlipidemia, obesity and diabetes. The prognostic impact of CVRFs in childhood cancer survivors is largely unknown. Now with advanced cardiac imaging, it is now possible to identify how CVRFs might influence subclinical cardiac function. Hypothesis: Anthracycline-exposed childhood cancer survivors with CVRFs will demonstrate echocardiogram-based subclinical cardiac dysfunction more frequently than those without. Methods: This is a single-center, retrospective study. Inclusion criteria are: < 18 years old, history of anthracycline-containing chemotherapy and 2 echocardiograms performed. Exclusion criteria are: congenital cardiac disease, subsequent cancer relapse and inadequate imaging quality. Echocardiographic images were analyzed for longitudinal left ventricular strain, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Wilcoxon rank-sum test was used to compare measures of cardiac function between patients with at least one CVRF (at time of cancer diagnosis) and patients without. Results: There were 111 patients identified with 49.5% having dysfunction at some point in time. CVRFs were identified in 19 patients with the majority of those being obese (52.6%). At baseline, there was a statistically significant difference in mean strain between those with CVRFs vs those without (-19.4% vs -21.3%). At 1-6 months after chemotherapy completion, LVEF was significantly reduced in those with CVRFs vs those without (48.7% vs 59.7%) as well as mean strain (-15.8% vs -20.0%). At >5 years after chemotherapy, there was a decrease in strain magnitude in those with CVRFs vs those without (-17.7% vs -20.5%) along with abnormal mean MPI (0.57 vs 0.44). Conclusions: Anthracycline-exposed pediatric cancer survivors with CVRFs demonstrate reduced cardiac function at baseline and both at near-and long-term follow-up. Further investigation is warranted to investigate the significance of these reduced echocardiographic measures and CVRFs among childhood cancer survivors to mitigate cardiac morbidity as they age into adulthood.

Assessment of fetal myocardial performance index in pregnant women with SARS-CoV-2 infection: A prospective cohort study.

Our aim was to investigate the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on fetal myocardial performance in women who had it during their pregnancy. In our prospective cohort study including healthy pregnant women and pregnant with SARS-CoV-2 infection, we collected patients' data between June 2021 and April 2022. Maternal characteristics, gestational age at SARS-CoV-2 infection and ultrasound examination, and body mass index were noted. Fetal biometry, fetal anatomy scanning, placenta, amniotic fluid index (AFI), and Doppler parameters were routinely examined in all patients. Left ventricular myocardial performance index (MPI) was measured during fetal echocardiography examination. Doppler parameters, AFI, and MPI values were compared between two groups. Compared with the control group (n = 80), MPI values were found within normal limits in fetuses of pregnant women with SARS-CoV-2 infection (n = 80) (MPI: 0.38 ± 0.06 in the control groups vs. 0.39 ± 0.05 in the SARS-COV-2 positive group, p = 0.79). There was no relationship between SARS-CoV-2 infection and changes in AFI and umbilical artery pulsatility index (PI) values. Uterine artery PI values were significantly higher in pregnant women with (SARS-CoV-2) infection (0.81 in the control group vs. 0.97 in the SARS-CoV-2 group, p < 0.05). Fetal cardiac functions were not affected in pregnant women with previous (SARS-CoV-2) infection. Further metaanalyses are warranted to confirm the results.

Cardiopulmonary physiological effects of diuretic therapy in preterm infants with chronic pulmonary hypertension.

Using targeted neonatal echocardiography (TNE) to examine cardiopulmonary physiological impact of diuretics in preterm infants with chronic pulmonary hypertension (cPH). Retrospective study comparing TNE indices pre- and ≤2 weeks (post) of initiating diuretic therapy in infants born <32 weeks gestational age with cPH. Twenty-seven neonates with mean gestational age, birthweight and interval between pre-post diuretic TNE of 27.0 ± 2.8 weeks, 859 ± 294 grams, and 7.8 ± 3.0 days respectively were studied. Diuretics was associated with improvement in pulmonary vascular resistance [pulmonary artery acceleration time (PAAT); 34.27(9.76) vs. 40.24(11.10)ms, p = 0.01), right ventricular (RV) ejection time:PAAT ratio [5.92(1.66) vs. 4.83(1.14), p < 0.01)], RV fractional area change [41.6(9.8) vs. 46.4(6.5%), p = 0.03)] and left ventricular myocardial performance index [0.55(0.09) vs. 0.41(0.23), p < 0.01)]. Post-treatment, frequency of bidirectional/right-to-left inter-atrial shunts decreased significantly (24% vs. 4%, p = 0.05). Primary diuretic treatment in neonates with cPH may result in improvement in PVR, RV and LV function and compliance.

The assessment of fetal cardiac functions in pregnancies with autoimmune diseases: a prospective case-control study.

This study aimed to assess the effect of the inflammatory process on fetal cardiac functions in pregnant women with autoimmune diseases (AID). This prospective study included 36 pregnant women with diagnosed AID. Nineteen systemic lupus erythematosus, 12 antiphospholipid syndrome, 5 Sjögren's syndrome, and 72 healthy pregnancies were included. Fetal cardiac functions were evaluated with pulsed-wave, tissue Doppler, and M-mode echocardiography. Sociodemographic data were similar in both groups. Significant increases were found in tricuspid E (43.5± 0.9, p<0.001) and A (59.2 ± 2.2, p<0.001) and E/A (0.74 ± 0.03, p<0.001), E'/A' (0.64 ± 0.15, p<0.001), E/E' (6.5 ± 0.6, p<0.001), and left ventricular myocardial performance index (0.54 ± 0.03, p=0.005). We demonstrated a significant decrease in tricuspid E' (6.7 ± 0.6, p<0.001) and S' (6.9 ± 1, p<0.001) and in TAPSE (7.7± 0.5, p=0.002). We also found a significantly prolonged PRinterval (130 ± 8, p<0.001). There was a significant increase in E' (6.8, p=0.033) and a significant decrease in E/E' ratio (6.4,p=0.027) in the group using hydroxychloroquine (HCQ) compared to non-users. We found that pregnancy with autoimmune diseases affects fetal heart functions. Additionally, hydroxychloroquine may positively affect the heart of AID fetuses. This information might be useful to clinicians in the follow-up of cardiovascular diseases.

Study of Echocardiogram Parameters from PPG Signal Using Self-Organized Operational Map-based Network.

Two crucial echocardiography parameters -left ventricular ejection fraction (LVEF) and myocardial performance index (MPI) are referred by clinicians to diagnose heart health. Here, an attempt was made to study the possibility of predicting values of LVEF and MPI from Photoplethysmography (PPG) signals. The classification of patients based on the LVEF and MPI values was also evaluated. After PPG signal feature extraction, the Dual Attention-Self Organised Operational Map-LSTM-Conv Network (DASLCN) was used to find the necessary results. Self-organized operational maps (SOOM) helped map the features before sending them to BiLSTM and 1D CNN layers. The results obtained were regression=0.86 with error% of 5.32±8.9 for MPI and accuracy=0.90 & sensitivity=0.89 for LVEF. This technique might help diagnose heart conditions from PPG signals without routine echocardiography.Clinical relevance- PPG is an easy cost-effective portable technique. Whereas, clinical echocardiography is possible only in specialized hospitals. Thus, exploring PPG signals to predict LVEF and MPI values were tried here. This study has been made on whether the grouping of patients based on the range of LVEF and MPI values was possible or not. Newly designed DASLCN helped to perform regression and classification in the same network.

Impact of overweight and obesity in the fetal cardiac function parameters in the second and third trimesters of pregnancy.

To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters. We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m2), 140 overweight (BMI 25-30 kg/m2) and 80 obese (BMI ≥ 30 kg/m2). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A'). We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups. We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.

#5711 MYOCARDIAL PERFORMANCE EVOLUTION AT 6 MONTHS FROM COVID-19 IN CKD PATIENTS

Abstract Background and Aims COVID-19 is associated with myocardial injury and in previous studies, patients with right ventricular dysfunction had an increased risk of all-cause death. In the general population, there is evidence that right ventricular strain improves at 6 months after COVID-19, but data about the course of other myocardial performance parameters are limited. Method CARDIO-SCARS in CKD is a currently ongoing observational cohort study that aims to assess the cardiovascular risk in a CKD (stages 3 to 5), dialysis and kidney transplant population following SARS-CoV2 infection, by using clinical evaluation, various techniques and both endothelial dysfunction and myocardial injury biomarkers (ClinicalTrial.gov Identifier NCT05125913). We hereby report the evolution of the main echocardiographic myocardial performance parameters at 6 months from COVID-19 disease. Results Our study included 222 patients (134 in the COVID-19 group and 88 in the control group). In the COVID-19 group, the echocardiography was performed at a mean distance of 2.21±1.9 months after testing positive for SARS-CoV-2. The mean age at baseline was 58.81±15.2 years and 53.41±14.14 years for the COVID-19 group and control group respectively. Atrial fibrillation, heart failure, ischemic heart disease and diabetes were more prevalent in the COVID-19 group. When analyzing the mean absolute difference between baseline and 6 months echocardiographic parameters using a two-sample t-Test, statistically significant results were observed for the left ventricular (LV) ejection fraction (EF), LV Tei Index, right ventricular (RV) Tei Index and RV free wall longitudinal strain (RVFWLS) as follows: Δ LVEF was 0.70±7.97% and -2.44±7.30% (p = 0.005), ΔLV Tei index was -0.04±0.19 and 0.0007± 0.11 (p = 0.024), Δ RV Tei index was -0.04±0.17 and 0.009±0.20 (p = 0.034) and ΔRVFWLS was -1.68±4.36% and -0.32±3.34% (p = 0.039) for the COVID-19 group and the control group respectively. Conclusion Our study is the first to describe the evolution of echocardiographic parameters post-COVID in a CKD population. Despite worse demographic and echocardiographic characteristics at baseline, patients from the COVID-19 group had a better evolution at 6 months, when compared to the control group. Both right and left ventricular myocardial performance indices improved for the COVID-19 patients and worsened for the control group.

Left ventricle mass index in paediatric intensive care unit acquired hypertension.

Hypertension acquired in paediatric critical patients is a recognised challenge, with variable reported frequency. Pain, agitation, and/or medications such as beta stimulants and corticosteroids are well-known risk factors. Sympathomimetics in septic patients can cause high blood pressure, especially with unobserved haemodynamic monitors. Beyond haemodynamic factors, several endocrinal-metabolic factors - including catecholamines, insulin, renin, angiotensin, the aldosterone system, and sodium consumption - may contribute to the left ventricular growth. It is well known that the sympathetic tone has a trophic effect on the heart muscle. A prospective cohort study was conducted during the year 2021. The children were divided into two groups: those who were critically ill with paediatric intensive care unit-acquired hypertension (n = 59) and those without paediatric intensive care unit-acquired hypertension (n = 62). We used the American Academy of Pediatrics' 2017 definition of hypertension to diagnose paediatric intensive care unit-acquired hypertension. Measurement of cardiac output and systemic vascular resistance was performed by cardiometry. Left ventricular myocardial performance and left ventricular mass index were measured by bedside echocardiography at the onset of hypertension diagnosis. Critically ill children with acquired hypertension had a higher cardiac index (p = 0.0001), systemic vascular resistance index (<0.0001), myocardial performance (0.037), and left ventricular mass index (0.009). The longer duration of stay observed in the hypertension group had no observable effect on mortality (<0.0001). Both myocardial performance and left ventricle mass index increased in critically ill children with paediatric intensive care unit-acquired hypertension.

Fetal left ventricular myocardial performance index measured at 11-14 weeks of gestation in fetuses with an increased nuchal translucency.

This study aimed to evaluate the effect of an increase in nuchal translucency (NT) thickness on the myocardial performance index (MPI) in fetuses without cardiac anomaly in the first trimester and to determine whether a difference in MPI between those with and without trisomy 21 in these fetuses could be determined. The study group consisted of 53 pregnancies complicated with increased NT thickness without any associated structural anomalies. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled as the control group. In the increased NT thickness group, the mean isovolumetric relaxation time (IRT) value (0.050 ± 0.011 s) was significantly higher and the mean ejection time (ET) value (0.149 ± 0.010 s) was significantly lower than those values in the normal NT thickness group (0.045 ± 0.005 and 0.155 ± 0.009 s, p=0.023 and p=0.009, respectively). We found a significantly higher mean left MPI value in the increased NT thickness group (0.574 ± 0.153) versus the normal NT thickness group (0.487 ± 0.107, p < 0.001). Within the increased NT thickness group, the mean left MPI value was similar in the fetuses with normal karyotype and those with trisomy 21 (p=0.419). We demonstrated a significantly greater mean MPI value in the increased NT thickness group than in the normal NT thickness group. Within the increased NT thickness group, no differences in the left MPI value in the fetuses with normal karyotype and the fetuses with trisomy 21 were found.

Amniotic fluid biomarkers of fetal stress response to cardiac dysfunction in twin-twin transfusion syndrome

Recipient twin (RT) cardiovascular changes in twin-twin transfusion syndrome (TTTS) are associated with increased mortality. This relationship is likely related to a cascade of pathophysiologic changes in the RT progressing to multisystem organ failure. We sought to evaluate biomarkers of inflammation, stress, and tissue injury within amniotic fluid (AF) of RTs undergoing selective fetoscopic laser photocoagulation (SFLP) for TTTS and examine their relationship with fetal echocardiographic findings. AF samples from RTs were obtained from 39 monochorionic-diamniotic pregnancies complicated by TTTS. Those without preoperative fetal echocardiograms or evidence of selective intrauterine growth restriction were excluded from analysis with 24 remaining samples. 15 commonly utilized clinical biomarkers for inflammation, stress, and tissue injury were assessed using a flow-cytometry based multiplex immunoassay. Fetal echocardiograms were performed prior to SFLP with myocardial performance index (MPI) utilized as a measure of cardiac dysfunction. Pearson’s correlation was used for data analysis. RT Left ventricular MPI (LV-MPI) ranged from 0.28-0.74, with 11/24 RTs demonstrating abnormal MPI for GA (Z-score > 2). RT AF cortisol (r = 0.4527, p = 0.020), IL-6 (r = 0.44, p = 0.025), CRP (r = 0.431, p = 0.028), and myoglobin (r = 0.401, p = 0.042) levels correlated with recipient left ventricular MPI (LV-MPI). AF cortisol strongly correlated with AF myoglobin (r = 0.576, p < 0.001). RT with abnormal LV-MPI exhibited significantly higher AF cortisol levels compared to those with normal LV-MPI (p = 0.029). RT amniotic fluid demonstrates markers of inflammation, stress and cardiac injury in recipient twins with cardiac dysfunction. These markers may be indicators of disease progression in TTTS secondary to cardiac dysfunction. The presence of these markers implicate stress and the immune response in the pathophysiologic response to cardiac dysfunction in TTTS.

Detection of early cardiac disease manifestation in propionic acidemia - Results of a monocentric cross-sectional study.

In propionic acidemia (PA) myocardial involvement is common and includes development of cardiomyopathy, life-threatening acute heart failure, and acquired long-QT syndrome. We sought to investigate which echocardiographic parameters of left ventricular systolic and diastolic function indicate early cardiac disease manifestation in PA. This is a prospective observational study (cross-sectional design) in a Tertiary Medical Care Center. Individuals with confirmed PA were enrolled and the following cardiac investigations were performed in all study individuals: echocardiographic measurements of systolic and diastolic left ventricular (LV) function (LV fractional shortening (LV-FS), LV ejection fraction by biplane modified Simpson's (LV-EF), mitral annular plane systolic excursion (MAPSE), LV global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE), pulsed Doppler analyses of mitral valve (MV) inflow velocities (MV E/A) and MV deceleration time (DT-E), tissue doppler imaging (TDI) of the mitral annulus (MV E/e'), and LV myocardial performance index (LV-MPI). LV and left atrial (LA) diameters were assessed. 12‑lead electrocardiograms (ECG) were recorded and corrected QT intervals (QTc) calculated. Clinical phenotype and laboratory parameters at the time of cardiac investigation were assessed. Besides descriptive analyses we analyzed frequency, onset, and combinations of echocardiographic and ECG data as well as their correlations with clinical and biochemical findings. The effects of 'age at visit' and LV functional parameters on QTc were analyzed with multiple regression. A total of 18 patients with confirmed PA were enrolled. Median age at PA onset was 6 days (range 1-357 days). Median age at visit for cardiac evaluation was 13.1 years (range 0.6-28.1 years). LV-GLS was abnormal in 72.2%, LV-EF in 61.1%, MAPSE in 50%, MV E/e' in 44.4%, LV-MPI in 33.3%, LV-FS in 33.3%, and MV E/A in 27.8%. In cases with normal or near normal LV-FS, LV-GLS was pathological in 5/10, LV-EF in 4/10, and MAPSE in 3/10. The probability of developing LV dysfunction - systolic and diastolic - increases with age. LV-MPI is a reliable parameter to indicate systolic LV-dysfunction in combination with a dilated LV, i. e. dilated cardiomyopathy (DCM) in PA. Multiple regression reveals a significant positive association between LV diameters and QTc. Abnormal LV-GLS significantly correlates with reduced muscle strength, muscle tone and/or abnormal gross motor function. Our data suggests a high prevalence of cardiac disease manifestation in PA, considerably higher than in previous studies, where only LV-FS was used to assess LV function. Usage of advanced echocardiographic techniques, such as LV-GLS assessment, may allow for early detection of subtle LV dysfunction in PA, and may lead to timely cardiac treatment but also consideration of liver transplantation to prevent development of manifest cardiac complications.

Longitudinal Changes in Cardiac Function Based on Serial Tissue Doppler and Doppler Imaging for Patients With Sickle Cell Anemia

Objective: The aim was to evaluate the long-term changes in systolic and diastolic functions with tissue Doppler imaging in children with sickle cell anemia. Materials and Methods: In this study, myocardial performance index of ventricles and mitral and tricuspid valve E/A ratios were calculated. Wall motion velocities of the interventricular septum, right and left ventricles, and mitral and tricuspid annulus were assessed during the systole (Sm), the early diastole (Em), and the late diastole (Am) with pulsed Doppler echocardiography. Results: These diagnostic parameters were obtained from 38 patients (mean 12.5 ± 3.2 years old) who were reached after a mean 6.7 years in long-term follow-up. Left ventricular and septal end-systolic and end-diastolic diameters, and right and left ventricular myocardial performance index were higher in patients ( P &lt; .05 and P = .001, respectively). The Em, Am, and Sm velocities of the right ventricle and septum were significantly lower in the patients at the baseline measures ( P &lt; .05) and all these velocities decreased significantly in patients over time compared with their baseline values ( P &lt; .05). In addition, it was observed that myocardial performance index values of the right and left ventricles increased significantly over time ( P &lt; .05). Conclusion: This is the first study reflecting the age-related changes in global systolic and diastolic functions in sickle cell anemia by serial imaging.

The effect of L-thyroxine treatment on ventricular dysfunction and pulmonary arterial stiffness in patients with subclinical hypothyroidism.

In our study, we aimed at evaluating the change in biventricular functions and pulmonary arterial stiffness (PAS) in patients with subclinical hypothyroidism (SH) in whom euthyroidism was achieved with L-thyroxine therapy. 70 SH patients and 75 healthy volunteers were included in our study consecutively. Baseline demographic and echocardiographic data of the participants were recorded. The data obtained in the control evaluation 6 months after the euthyroidism were achieved in the SH group patients started on L-thyroxine treatment and then compared with the baseline measurements. The mean age of patients in the SH group was 44.1 ± 9.4 years and 47.1% were women. Euthyroidism in SH patients was achieved with a mean daily L-thyroxine treatment of 59 µg/day for a mean of 16.1 ± 4.5 weeks. Positive changes in metabolic and hormonal profiles were achieved after L-thyroxine treatment in SH patients. It was determined that left ventricular and right ventricular isovolumetric relaxation and myocardial performance index were higher in SH patients compared to the control group, and these measurements were observed to decrease significantly with L-thyroxine treatment (p < 0.05 for each). While PAS was 16.9 ± 3.1 kHz/ms in the control group, it was 25.2 ± 5.3 kHz/ms in the SH group (p < 0.05). After L-thyroxine treatment, PAS measurements decreased to 17.2 ± 3.2 kHz/ms (p < 0.05) in the SH group and showed a positive change. Thyroid-stimulating hormone (TSH) change (Δ TSH) with Δ E/A ratio (r: -0.407, p < 0.001), right ventricular myocardial performance index (Δ RV MPI) change (r: 0.404, p < 0.001) and PAS change (Δ PAS) (r: 0.458, p < 0.001) found to be correlated. SH is associated with dysfunction in the biventricular and pulmonary vascular bed. Biventricular functions and PAS change positively in SH patients with L-thyroxine treatment.

Effect of positive end-expiratory pressure on cardiac function in patients with early left ventricular diastolic dysfunction: a prospective cohort study

To evaluate the effect of positive end-expiratory pressure (PEEP) ventilation on cardiac function in patients with early left ventricular (LV) diastolic dysfunction undergoing laparoscopic radical gastrectomy. Patients who underwent laparoscopic radical gastrectomy under elective general anesthesia from July 2021 to February 2022 at the Subei People's Hospital were enrolled [age 60-75 years old, American Society of Anesthesiologists (ASA) grade I-II, and left ventricular ejection fraction (LVEF) > 0.50]. Transthoracic echocardiography (TTE) was performed before operation, and the peak early diastolic velocity (E peak) and peak late diastolic velocity (A peak) at the mitral ostium were recorded and the E/A and E peak deceleration time (DT) were calculated. Then isovolumic relaxation time (IVRT) and early peak mitral annular diastolic velocity (e') were recorded and left ventricular E/e' (LVE/e') was calculated. According to the E/A, mitral e', LVE/e', DT, and IVRT, the patients were divided into early LV diastolic dysfunction group (E/A < 1, mitral e' < 7 cm/s, LVE/e' > 14, DT > 200 ms, and IVRT > 100 ms) and normal cardiac function group (1 < E/A < 2, 160 ms < DT < 240 ms, and 70 ms < IVRT < 90 ms), with 35 patients in each group. Both groups were received fixed 5 cmH2O (1 cmH2O ≈ 0.098 kPa) PEEP 5 minutes after the beginning of the pneumoperitoneum until the end of the procedure. A volume controlled ventilation was used with a tidal volume (VT) of 7 mL/kg, an inspired oxygen concentration of 0.60, and an inspiratory to expiratory ratio of 1:2. Left and right myocardial systolic and diastolic function related parameters, including LVEF, LV global longitudinal strain (LVGLS), tricuspid annulus plane systolic migration (TAPSE), the peak early diastolic velocity (E peak) at the mitral and tricuspid valve ostia and the peak early diastolic velocity (e') at the corresponding annulus were measured by transesophageal echocardiography (TEE) before tracheal intubation (T0), 5 minutes after the pneumoperitoneum (T1), 5 minutes after PEEP ventilation (T2), 30 minutes after PEEP ventilation (T3), and 5 minutes after the end of pneumoperitoneum (T4), respectively. The left and right ventricular myocardial performance index (LVMPI/RVMPI) was calculated. Finally, 60 patients were included in the analysis, including 28 patients in the early LV diastolic dysfunction group and 32 patients in the normal cardiac function group. Compared with those at T0, mean arterial pressure (MAP), LVEF, mitral e', LVGLS, tricuspid e' and TAPSE were significantly lower in the normal cardiac function group at T1, and the early LV diastolic dysfunction group at T1, T2, and T3, and LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those at T0 (LVE/e': 16.52±1.26 vs. 14.32±1.09, and RVE/e': 18.71±1.74 vs. 16.51±1.93, respectively, both P < 0.05), Mitral e' and tricuspid e' were significantly lower than those at T0 [mitral e' (m/s): 0.07±0.01 vs. 0.09±0.01, tricuspid e' (m/s): 0.06±0.01 vs. 0.08±0.01, both P < 0.05]. Compared with the normal cardiac function group, MAP, LVEF, mitral e', LVGLS, tricuspid e', and TAPSE at T1, T2, and T3 were significantly lower in the early LV diastolic dysfunction group, while LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those in the normal cardiac function group (LVE/e': 16.52±1.26 vs. 9.87±1.25, RVE/e': 18.71±1.74 vs. 10.97±1.70, both P < 0.05). Mitral e' and tricuspid e' were significantly lower in the normal cardiac function group [mitral e' (m/s): 0.07±0.01 vs. 0.11±0.02, tricuspid e' (m/s): 0.06±0.01 vs. 0.10±0.02, both P < 0.05]. In early LV diastolic dysfunction patients, compared with patients with normal cardiac function, 5 cmH2O PEEP can further exacerbate left and right myocardial systolic and diastolic function in patients during pneumoperitoneum; when the pneumoperitoneum was ended, 5 cmH2O PEEP only worsen left and right myocardial diastolic function in patients, and did not affect left and right myocardial systolic function.

MYOCARDIAL PERFORMANCE INDEX AS AN ECHOCARDIOGRAPHIC PREDICTOR OF EARLY HEART FAILURE IN ACUTE ST ELEVATION MYOCARDIAL INFARCTION

Myocardial infarction causes variable degrees of left ventricular (LV) systolic and diastolic dysfunctions. The ejection fraction (EF) and transmitral ow are the frequently used method for evaluating the systolic and diastolic functions respectively with considerable limitations. The MPI is a single independent parameter, capable of estimating both systolic and diastolic performance combined and lacks such limitations. We enrolled 100 patients presented with a rst acute STEMI who have undergone Thrombolysis. Echocardiography was done within 24 h of chest pain with measurement of MPI. The LV MPI was calculated as (isovolumic contraction time ''ICT” + relaxation time ''IRT”)/Ejection time ''ET”. simultaneously, clinical and echocardiographic variables were analyzed and CHF was dened as Killip class &gt;=II. Results: Early in-hospital HF occurred in 38 of patients (38%). Ejection fraction was found to have a highly signicant negative correlation with the development of in-hospital HF (p = .0001), while MPI was found to have a highly signicant positive correlation (p = .0001). Acut-off point of MPI &gt; 0.72 showed a very high specicity (93.6%) and sensitivity (77.3%) for identifying patients with HF. On the other hand, a cut-off point of EF &lt;=32% has shown 93.4% specicity and 57.5% sensitivity for HF prediction. Conclusions: The MPI might be a strong predictor of in-hospital HF after acute ST elevation M

Clinical and instrumental indicators of acute myocardial infarction without coronary artery obstruction

The frequency of myocardial infarction with non-obstructive coronary arteries (MINOCA) ranges from 5 to 11.1% in the structure of all myocardial infarctions. Left ventricular myocardial performance index (LV MPI) is the only echocardiographic independent predictor of unfavourable prognosis in patients with acute coronary syndrome. Purpose: to study risk factors for coronary heart disease, laboratory and echocardiographic indicators with the calculation of LV MPI in patients within the acute period of myocardial infarction. Material and methods. The study included 72 patients diagnosed with myocardial infarction. 40 patients had single-vessel coronary artery disease, 32 patients did not have stenosis &gt; 50% according to coronary angiography. All patients underwent clinical examination, electrocardiography, clinical blood analysis and body chemistries. Echocardiography was performed on the first day of the disease. Results. A statistically significant difference among risk factors is hereditary load; in patients with MINOCA, it is the level of low-density lipoproteins and triglycerides. The glomerular filtration rate by CKD-Epi is lower by 17.6 ml/min (p = 0.0007). The LV ejection fraction, MPI is higher in patients with MINOCA (p = 0.001), in 3 patients (7.5%) who underwent percutaneous coronary intervention, LV MPI was 22.6%. Findings. 1. According to clinical signs, patients with MINOCA had a more severe course of the acute period. 2. Indicators of intracardiac hemodynamics are better in the group of patients with myocardial infarction, including the left ventricular myocardial performance index

Left Ventricular Dysfunction Persists in the First Week after Re-Warming following Therapeutic Hypothermia for Hypoxic-Ischaemic Encephalopathy

Objectives: The aim of this study was to assess serial myocardial function in newborn infants receiving therapeutic hypothermia (TH) as treatment for moderate to severe hypoxic-ischaemic encephalopathy (HIE). Methods: Serial echocardiography was performed in 20 term infants receiving TH on days 1–3 and again after re-warming. Left ventricular (LV) fractional shortening, LV cardiac output, and tissue Doppler imaging-derived myocardial velocities and myocardial performance index were measured. Similar assessments were obtained from 20 well term infants within 48 h of birth. Results: LV fractional shortening (LVFS) was similar between cases and controls during all measurements (25.3% vs. 27.4%). The mean LV cardiac output on day 1 was significantly lower in cases (109 mL/kg/min) than in controls (162 mL/kg/min) but increased after re-warming (145 mL/kg/min). All myocardial velocities were significantly lower in cases on day 1, increased during TH, but LV indices remained consistently lower compared to controls even after re-warming. LV myocardial performance index was higher in cases compared to controls on day 1, improved during TH but remained abnormal after re-warming. The right ventricular myocardial performance index was similar between cases and controls. Conclusion: Among infants affected by moderate to severe HIE, LV function appears to be more affected than right ventricular function with LV dysfunction persisting after completion of TH. LVFS was not useful to determine dysfunction in this cohort.

Effect of food intake on echocardiographic measurements in healthy elderly

This study evaluates whether food intake affects systolic and diastolic echocardiographic measurements in healthy seniors. Thirty healthy subjects 65-70 years of age were investigated with echocardiography, at fasting and then 30, 90, and 180 min after a meal. After 30 min the biggest changes were seen in left ventricular wall stress and myocardial performance index with a decrease of 45% and 33%, respectively, compared to fasting values. Significant (p<.05) increases also were seen in left ventricular stroke volume, left ventricular cardiac output, left ventricular cardiac index, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, the E/A ratio, pulsed tissue Doppler peak systolic (s') and early (e') and late (a') diastolic velocities, pulmonary vein peak velocities in systole (S) and diastole (D), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and global longitudinal strain (GLS) (increases ranging 6%-19%). After 90 min there remained a decrease in wall stress and myocardial performance index of 31% and 17%, respectively, and smaller, but still significant, changes could be seen in left ventricular stroke volume, left ventricular outflow velocity-time integral, MAPSE (lateral), TAPSE, GLS, and a few pulsed tissue Doppler peak systolic velocities and late diastolic velocities. An increase also could be seen in deceleration time of E-wave (DT). After 180 min, all variables except DT were back at baseline or below. No significant changes were seen in S/D ratio, lateral early diastolic velocity (e' lateral) and E/e'ratio. This study shows that food intake affects commonly used echocardiographic parameters, both systolic and diastolic, in healthy seniors. With a few exceptions, the changes seen in the older population were less pronounced than previous studies in younger subjects.