M-mode Echo Research Articles

Abstract P1062: Regional Differences In Sarcomeric Glycogen Synthase Kinase 3β Maintain Normal Chamber Level Function

The structure of the left ventricle is spatially and temporally heterogeneous. The heart’s electrical system helps synchronize these events, but mechanical events play an important role as well. However, experimental evidence of the regional mechanical processes that underpin a “normal contraction” remain largely unknown. Despite the differences in deformation between the anterior and posterior walls, sarcomere lengths during filling and ejection are the same in these regions. One explanation for this disconnect is the myocyte’s force production is different despite similar sarcomere lengths, a relationship known as Length Dependent Activation (LDA). Indeed, a modeling study suggested LDA is a critical regulator of mechanical synchrony in the left ventricle. We recently found the serine/threonine kinase GSK-3β localizes to the z-disc and can modulate LDA, and thus hypothesized it may play a role in maintaining normal cardiac synchrony. We used inducible cardiomyocyte specific GSK-3β KO mice and GSK-3βfl/fl/Cre- littermate Con treated with tamoxifen in which GSK-3β was KO for three weeks. We assessed regional differences in GSK-3β protein levels and found that Con mice had substantial regional heterogeneity: 50% more cytosolic GSK-3β in the posterior wall compared to the anterior wall; however, the myofilament-bound GSK-3β was the opposite, with 50% less GSK-3β in the posterior wall. This regional heterogeneity was lost in KO mice, in which protein levels were homogenously low. There were no differences detected by m-mode echo between Control and KO mice. However, strain analysis revealed a significant interaction (p=0.037) between genotype and region (Anterior vs. Posterior), in which regional differences in Systolic Strain Rate were ablated in the knockout. These data suggest that the regional differences in GSK-3β sarcomeric levels were important for maintaining regional functional heterogeneity. We further observed that sarcomeric GSK-3β levels (but not cytosolic) decreased in a mouse myocardial infarction model, which these findings suggest could worsen mechanical dyssynchrony post-infarct. Perhaps a possible therapy for mechanical dyssynchrony could involve regional restoration of sarcomeric GSK-3β levels to restore synchrony.

Abstract 12409: Two-Dimensional Speckle Tracking of the Ascending Aorta: A Novel Approach to Evaluate Arterial Stiffness in Pediatric Patients With Repaired Conotruncal Abnormalities

Introduction: Children with repaired conotruncal abnormalities (rCTA) are at risk for progressive aortic dilation and arterial stiffness even after surgical correction. Pediatric data regarding use of 2D speckle tracking echocardiography (STE) for assessment of arterial stiffness is lacking. Our aim was to assess the feasibility and utility of 2D-STE derived ascending aorta (AAo) stiffness in children with rCTA. Methods: This was a prospective study, where pediatric patients with rCTA were included and compared to age and sex matched healthy controls. AAo strain, stiffness index and distensibility were measured using M-mode echo across the short axis of the AAo at the level of the right pulmonary artery. Peak AAo global circumferential strain (GCS) was measured using the left ventricle dedicated GCS algorithm by TomTec software version 4.6 SP3, CPA. Results: Total of 19 cases [13 (68%) with Tetralogy of Fallot, 4 (21%) with transposition of great arteries and 2 (10.5%) with truncus arteriosus], with mean age of 10.6 ± 4.2 yr and 17 matched controls have been enrolled to date. No subjects were excluded due to poor strain tracking. Patients with rCTA showed statistically significantly lower AAo GCS (8.2 ± 1.4 vs 15.2 ± 1.3), M-mode AAo strain (12.2 ± 5.3 vs 19.6 ± 3.8), AAo distensibility (3.6 ± 1.1 vs 6.1 ± 1.2), and higher AAo stiffness index (5.5 ± 2.1 vs 3.1 ± 0.6) than controls; fig 1. AAo GCS had strong correlation with age since surgical repair (r -0.8, p<0.001); fig1. AAO distensibility and AAo stiffness index had moderate correlation (r -0.5; P<0.05, r 0.4; P<0.05 respectively) while M-mode AAO strain had weak correlation (-0.3 p=0.2) with age. Conclusions: 2D-STE measured AAo arterial stiffness is technically feasible in pediatric patients post rCTA and controls with significant between-group difference and a stronger correlation with age than the traditional measures of aortic stiffness. This may represent a new index in evaluating vascular biomechanics in pediatrics.

Эффективность применения гепариноидов у пациенток с дисфункцией эндометрия на фоне недифференцированной дисплазии соединительной ткани

Objective. To study the effectiveness of heparinoid sulodexide in complex therapy of patients with endometrial dysfunction and concomitant undifferentiated connective tissue disease (UCTD). Patients and methods. We examined 88 patients with UCTD and endometrial dysfunction (the «thin endometrium» phenomenon). The therapeutic regimen of 41 patients (group 1а) additionally to cyclical therapy with 17-b estradiol and didrogesterone was supplemented by continuous heparinoid sulodexide for 3 menstrual cycles (MC), 20 patients (group 1b) in addition to cyclical therapy received the heparinoid from the 5th day of MC until the 7th day after ovulation, 27 patients of the reference group (group 2) received only cyclical therapy without heparinoid supplementation. Results. In patients of groups 1а and 1b, restoration of M-mode echo values ≥7mm was obtained in 71–73% of cases, the median endometrial thickness in group 1а increased by 2.8 mm, in group 1b – by 2.25 mm, in group 2 – only by 1.9 mm. The continuous intake of, including during menstruation, was not associated with an increase in blood loss nor changes in red blood counts. As was also found, in patients with UCTD who had algomenorrhoea with ultrasonic signs of varicose veins of the uterus administration of sulodexide resulted in a decrease of the severity of pain syndrome up to its complete disappearance. Conclusion. The treatment regimen for patients with endometrial dysfunction concomitant with UCTD НДСТ with inclusion of continuous heparinoid sulodexide (without a break during menstruation) enhances the effectiveness of therapy, does not involve a higher menstrual blood loss, and also has a positive effect on the severity of algomenorrhoea. Key words: algomenorrhoea, undifferentiated connective tissue disease, sulodexide, chronic endometritis

Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats.

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional imaging to study the cardiac anatomy of the left ventricle and M-mode echo to assess its dimensions. However, this could limit a comprehensive study. Herein, we describe a protocol that allows an assessment of the heart chamber size, left ventricular function (systolic and diastolic) and valvular function. A conventional medical ultrasound machine was used in this protocol and different echo views were obtained through left parasternal, apical and suprasternal windows. In the left parasternal window, the long and short axis were acquired to analyze left chamber dimensions, right ventricle and pulmonary artery dimensions, and mitral, pulmonary and aortic valve function. The apical window allows the measurement of heart chamber dimensions and evaluation of systolic and diastolic parameters. It also allows Doppler assessment with detection and quantification of heart valve disturbances (regurgitation or stenosis). Different segments and walls of the left ventricle are visualized throughout all views. Finally, the ascending aorta, aortic arch, and descending aorta can be imaged through the suprasternal window. A combination of ultrasound imaging, Doppler flow and tissue Doppler assessment have been obtained to study cardiac morphology and function. This represents an important contribution to improve the assessment of cardiac function in adult rats with impact for research using these animal models.

Abstract 296: B7-33, a Functionally Selective Relaxin Receptor 1 Agonist, Exerts Protective Effects Against Myocardial ischemia-Reperfusion Injury in Mice

Background: B7-33 is a peptide derived from the B-chain of human relaxin, and is shown to elicit biased signaling at relaxin receptor 1 (RXFP1) in human cell lines. The influence of B7-33 on myocardial ischemia-reperfusion (IR) injury and associated cardiac adverse remodeling is unknown. Methods and Results: Primary cardiomyocytes and cardiac fibroblasts were isolated from adult CD1 mice and subjected to simulated ischemia-reoxygenation (SIRO). Myocytes were placed in 1% O 2 chamber for 40 min, followed by 1 h of reoxygenation with control (myocyte media) or B7-33 (10, 50 or 100 nM)-infused media. Trypan blue staining showed a significant decrease in cell death with B7-33 concentrations of 50 nM and 100 nM ( Fig. A ).Treating myocytes with B7-33 for 15 min exhibited a dose-dependent increase in Erk1/2 phosphorylation, which reached statistical significance at 100 nM ( Fig. B ). Fibroblasts subjected to 4 h of hypoxia and 15 h of reoxygenation had increased viability (MTT assay) with B7-33 at all concentrations ( Fig. C ). In vivo , CD1 mice were subjected to IR injury via coronary artery ligation for 30 min, followed by 24 h of reperfusion. Vehicle (saline) or B7-33 (10 μg/kg) was injected i.p. at the onset of reperfusion. After 24 h, B7-33-treated mice demonstrated decreased infarct size (TTC stain) ( Fig. D ) and preserved fractional shortening (M-mode echo, Fig. E ) compared to vehicle-treated mice. Conclusion: Reperfusion therapy with B7-33 reduces infarct size post-MI, preserves cardiac function and protects cardiomyocytes and fibroblasts against SIRO. We propose that B7-33 might be effective against acute MI and a possible alternative to recombinant relaxin for clinical utility.

Circumferential strain rate to detect lipopolysaccharide-induced cardiac dysfunction: a speckle tracking echocardiography study.

Lipopolysaccharide (LPS)-induced myocardial dysfunction is a widely used indicator to study septic cardiomyopathy (SC). This study investigated the efficiency of strain rate imaging (SRI) in detecting LPS-induced myocardial dysfunction. A total of 30 mice were randomly assigned to saline group (n=10), 10 mg/kg LPS group (n=10) and 20 mg/kg LPS group (n=10). Then at baseline, 6 and 20 h after LPS injection, 2-D and M-mode echocardiography were conducted with GE Vivid 7 ultrasound (il3L linear probe, 10.0-14.0 MHz) and Echopac PC software. Ejection fraction (EF) and fractional shortening (FS) were measured with M-mode tracings. Serum biochemical examination was then performed to evaluate sepsis-induced myocardial injury. In LPS 20 mg/kg group, at 6 h after LPS injection, SRI found significantly decreased early diastolic strain rate (SRe, 1.76±1.05 vs. 3.18±0.83 unit/s, P<0.05), but M-mode echo found no change in EF and FS. In 10 mg/kg LPS group, compared with those at 6 h after LPS injection, SRI found a decline in SRe (1.57±0.75 vs. 3.18±0.83 unit/s, P<0.05), and M-mode tracings found an elevation in EF (71.31%±11.68% vs. 55.36%±7.42%, P<0.05) and FS (35.67%±8.79% vs. 25.43%±4.32%, P<0.05) at 20 h. Furthermore, LPS elevated the levels of serum creatine kinase-MB (CK-MB) and cardiac troponin-T (cTnT) at 20 h. SRI is useful to early assess LPS-induced cardiac deformation in mice. circumferential strain rate (SRcirc) is a sensitive indicator for LPS-induced myocardial injury in severe sepsis.

Study of clinical and biochemical profile of subclinical hypothyroidism in children aged 2-12 years

Background: Subclinical hypothyroidism is quite a common clinical condition in pediatric population. Objective of this study was to understand the clinical and biochemical profile of Subclinical hypothyroidism in children attending endocrinology OPD at a tertiary care center in southern India. Methods: In this study 62 children diagnosed with subclinical hypothyroidism. Clinical assessment and laboratorial evaluation was carried out in a systematic way. Symptomatology, anthropometry, measurement of vital parameters such as heart rate, blood pressure, tests for anti-thyroid antibody, lipid profile, estimation of bone age, USG neck, assessment of left ventricular function using M-mode echo were carried out at the time of diagnosis . Results: Subclinical hypothyroidism is more common in female children, principle symptoms were neck swelling and weight gain, goitrous autoimmune thyroiditis is more common in female, significant number of children had positive anti-thyroid antibodies, mean TSH value of patients with positive anti-thyroid antibody was high, there was no delay in bone maturation in majority of children, both systolic and diastolic blood pressure were high, these children had abnormal lipid profile, heart rate and left ventricular function were normal. Conclusions: Subclinical hypothyroid children have higher risk of hypertension and pro-atherogenic lipid abnormalities. As there is a risk of progression to overt hypothyroidism these children needs regular follow up.

Familial history of hypertension as a predictor of increased arterial stiffness in normotensive offspring.

BackgroundIncreased arterial stiffness can be used as a prognostic marker of arterial hypertension. The relationship between arterial stiffness and arterial hypertension seems to be reciprocal.ObjectiveEvaluation of changes of the arterial elastic prosperities in normotensive subjects, with and without parental history of hypertension.Subjects and MethodsOne hundred and ten normotensive individuals, aged 20–30 years, were divided into two groups: group-A (n = 57) and group-B (n = 53) subjects with positive and negative parental history of hypertension, respectively. Systolic, diastolic and pulse pressures were measured using mercury sphygmomanometer. The elastic properties of the ascending aorta and the common carotid arteries were assessed using M-mode echo and B-mode imaging, respectively. Stiffness index of the digital volume pulse (SIDVP) was measured in the right index finger using photoplethysmography.ResultsGroup A subjects showed higher aortic stiffness index (p = 0.002), carotid stiffness index (p = 0.001), carotid pulse wave velocity (p ⩽ 0.001) and stiffness index of digital volume pulse (p = 0.001). Group A subjects showed lower aortic distensibility (p = 0.001), aortic strain (p = 0.004), changes in aortic diameter (p = 0.022), carotid distension (p = 0.026), carotid distensibility coefficient (p ⩽ 0.001) and carotid compliance coefficient (p = 0.002).ConclusionThe aortic and carotid stiffness parameters and SIDVP were higher in normotensive offspring of hypertensive parents. This finding could direct the attention towards the increased cardiovascular risk in this group and thus prompt earlier and tighter prevention of cardiovascular risk factors.

Інноваційні підходи до оперативного лікування жінок репродуктивного та пременопаузального віку з гіперпластичними процесами ендометрія

The aim of the study: was improvement of results of surgical treatment of patients of reproductive age eligibility with hyperplastic processes of endometrium (HPE) through the introduction of individualized treatment algorithm with the use of monopolar radio wave and hysteroscopic endometrial ablation. Materials and methods. The study included 62 women with non-atypical form of hyperplasia of the endometrium who were treated at the Center of General gynecology of the clinical hospital «Feofania», gynecological Department at the city maternity hospital № 3 of Kyiv. Depending on the age group, nature of the pathological process and method of treatment is randomized, the distribution of women according to groups: group 1 – 41 women's reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), who were subjected to hysteroscopic monopolar endometrial ablation; group 2 – 21 female reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), which was held radiowave ablation of the endometrium (RHAE). In the 1st group the age of patients ranged from 42 to 54 years, mean age was 49.9±4.7 years. In the 2nd group the age of patients ranged from 41 to 53 years, mean age of 51.6±4.3 years. Results. A comparative analysis of the techniques for hysteroscopic monopolar ablation and RHEE showed the fact that for RHEE used local anesthesia, while carrying out hysteroscopic monopolar ablation was necessary intravenous anesthesia. The duration of the hysteroscopic monopolar endometrial ablation was 28.6±5.5 min, RAE – according to the standard method – 44.3±0.3 min. When performing hysteroscopic monopolar endometrial ablation in 2 patients (3.7%) patients observed the signs of intravasation of fluid, increased blood pressure and tachycardia. This syndrome was successfully docked, but in the future, women have conducted a thorough examination. When you run RHAE intraoperative complications have been identified. Conclusion. 1. Women with netipichnaya forms of endometrial hyperplasia eligibility and late reproductive age who do not have reproductive plans as an alternative to hysterectomy, in the presence of contraindications or ineffectiveness of hormone treatment may be recommended or radiowave monopolar hysteroscopic ablation of the endometrium. 2. Monopolar hysteroscopic endometrial ablation is indicated for women with netipichnaya forms of endometrial hyperplasia, can be used in the presence of submucous form of uterine fibroids, postoperative scars on the uterus, but in the absence of adenomyosis II–III degree. The effectiveness of monopolar hysteroscopic endometrial ablation in women with non-atypical form of hyperplasia of the endometrium is 87.8%. 3. Women after endometrial ablation should be under observation for two years. The method of choice for dynamic monitoring of the condition of the uterus in women who underwent endometrial ablation is transvaginal ultrasound which should be performed after 1, 3, 6, 12 and 24 months of follow up. 4. In case of recurrence of hyperplastic process of the endometrium (bleeding, thickening of the M-mode echo according to the ultrasound) shows a hysteroscopy with a mandatory histopathological examination and verification of the diagnosis. Key words: endometrial hyperplasia, women eligibility age, women of reproductive age, ablation of the endometrium.

Abstract 12903: The Myocardial Contraction Fraction Calculated From Two-dimensional Echocardiography is Associated With Lower Incidence of Heart Failure, Cardiovascular Disease and Mortality: The Cardiovascular Health Study

Introduction: The myocardial contraction fraction (MCF), the ratio of LV stroke volume (SV) to myocardial volume (MV), is a volumetric measure of myocardial shortening. With 3D-echocardiography and MRI, MCF distinguished pathologic from physiologic hypertrophy and predicted incident CV events. However, the association between 2D echo-determined MCF and adverse CV outcomes is not known, nor has the premise that this ratio adequately captures the predictive information of its components, SV and MV, been tested. Methods: Using CHS data, we calculated MCF from 2-D guided M-mode echo dimensions to estimate LV volumes and SV. MV was estimated from the measurements of LV mass divided by myocardial density. Among individuals with a normal EF, Cox regression was used to examine the associations between MCF with incident heart failure (HF), cardiovascular disease (CVD), and all-cause mortality adjusting for clinical and echo parameters. We further examined the validity of the premise that log(SV) and log(MV) contribute in the expected ratio of 1: -1 with our outcomes of interest. Results: 1556 participants were identified with an EF ≥ 55% (age 72±5) that had baseline echo data and available covariate information. MCF averaged 58% (Range: 21-104%). After controlling for CV, clinical risk factors, echo variables and NT-proBNP, a 10% relative increase in MCF was significantly associated with reduced risk of HF, CVD and death. When included separately in the models, both MV and SV showed significant associations with CVD and death, however, only MV was significant for HF and the coefficients violated the 1:-1 ratio suggesting MCF is not the best way to model this relationship. Conclusions: Among older adults with normal EF, 2D-echo MCF was associated with a lower risk of adverse CV outcomes after adjustment for clinical factors, echo parameters, and NT-proBNP. However, MCF compared to its component measures might be inadequate for risk prediction in HF.

Abstract 19684: Abnormal Aortic Wall Properties in Children with Isolated Bicuspid Aortic Valve

Introduction: Abnormal aortic wall properties have been reported in patients with isolated bicuspid aortic valve (IBAV) even in the absence of significant aortic stenosis or regurgitation. Hypothesis: We sought to assess aortic distensibility (DIS) and stiffness index (SI) in children with IBAV compared to age group-matched subjects with normal tricuspid aortic valves (TAV) and to determine whether these abnormalities in the aortic wall properties correlate with bicuspid valve morphology or left ventricular systolic or diastolic function. Methods: Children ages 8-18 years with an IBAV and age group-matched controls with a TAV were prospectively enrolled. Subjects with greater than mild stenosis or mild regurgitation were excluded. Using echo, aortic valve morphology, aortic root (AoR) and ascending aorta (AAo) diameters and z-scores were determined. Left ventricular shortening fraction (LVSF), DIS and SI were measured using M-mode echo. Diastolic function was determined using mitral valve septal E/Ea. Blood pressure (BP) was measured at the time of echo. Results: Nineteen had IBAV and 17 had TAV. There were no significant differences in age, weight, height or BP between the two groups. In the IBAV group, 11 had right-left type (R/L) and 8 had right-non type (R/N). There was no significant difference in AoR z-scores between groups. The IBAV group had larger AAo z-scores (2.48±1.9 vs. -0.02±0.98, p&lt;0.0001), decreased DIS (9.6±4 vs. 12.3±3.1 cm2 dynes-1 x 10-6, p&lt;0.05) and increased SI (21.4±9.2 vs. 14.4±3.8, p=0.007) compared to the TAV group. There were no differences in these variables between the R/L or R/N subgroups. No correlation was seen between aortic wall properties and ventricular function in the IBAV group. By multivariate regression, presence of an IBAV (coefficient = -2.4, p=0.03), LVSF (coefficient = -0.35, p=0.01) and age-adjusted systolic BP (coefficient = -0.13, p=0.03) were independently associated with DIS. Similarly, presence of an IBAV (coefficient = 6.7, p=0.005) and age (coefficient=0.85, p=0.02) were independently associated with SI. Conclusions: Children with IBAV have decreased DIS and SI even without hemodynamic abnormalities. Long-term studies to determine the impact of these findings on cardiovascular risk are needed.

Recurrent Syncope 31 Years After Mitral Valve Replacement

43-year—old man was admitted to the coronary care unit because of recurrent syncope. His medical history included pulmonic valve angioplasty at age 9 years, mechani-cal mitral valve replacement because of severe mitral regur-gitation caused by congenital atrioventricular canal, and pacemaker implantation because of complete atrioventricular block. On admission he was orthopneic, his blood pressure was 78/45 mmHg, and his pulse was 72 beats per minute, irregu -lar. On auscultation, lungs were clear and there were irregular cardiac sounds of mechanical mitral prosthesis. There were no signs of peripheral edema. ECG showed slow atrial fibrillation with intermittent ventricular pacing. International normalized ratio was in high therapeutic range, at 4.5. Echo examination showed intermittent opening of the mitral valve 1:2. This was confirmed by continuous wave Doppler, M-mode echo, and color M-mode echo (Figure) with mildly elevated gradient 20/8 mmHg. Cine fluoroscopy showed intermittent open -ing of the mitral prosthesis (online-only Data Supplement Movie I; Bjork -Shiley mono-leaflet tilting disk).The patient underwent surgery. Massive calcified pan-nus covered the valve and interfered with the opening of the prosthesis.Intermittent opening of prosthetic mitral valve is rare

Assessment of left-ventricular mass and remodeling in obese adolescents

Although there have been several studies about the impact of obesity on left-ventricular mass (LVM) and remodeling and their influence on cardiovascular morbidity and mortality, no studies are available on the best echocardiographic technique to study them. In addition, the role of systemic hypertension on LVM in obese adolescents has not been adequately investigated. To compare LVM and remodeling pattern assessed by M-mode, two-dimensional (2D) and three-dimensional (3D) echocardiography in obese adolescents, and to correlate LVM with 24-h ambulatory blood pressure measurements. We studied 120 adolescents: 86 obese patients by M-mode, 2D and 3D echocardiography and 34 normal individuals by echo and magnetic resonance imaging (MRI). In normal individuals LVM was assessed by 3D echo and had the strongest correlation to MRI. In obese adolescents left-ventricular geometry was abnormal in 27 patients (31%) by 3D echo, in 21 patients (24%) by 2D echo and in 43 patients (50%) by M-mode. Mean SBP was significantly related to relative wall thickness, body mass index (BMI) and LVM/h evaluated by 3D echo [r=0.52 (P<0.0001), r=0.36 (P=0.004) and r=0.28 (P=0.03), respectively]. However, at a multivariate analysis, BMI showed a stronger correlation with LVM/h assessed by 3D compared to mean SBP (r=0.44 and P=0.001 vs. r=0.26, P=0.1). In young patients LVM assessed by 3D echo had the strongest correlation to MRI compared to 2D and M-mode echo. In obese adolescents, 3D echo showed left-ventricular remodeling in 31% with LVM more significantly correlated with BMI compared to mean SBP.

Mitral valve m-mode echo in complete heart block with atrial tachycardia

We report a 48-year-old man who presented with history of syncope. Electrocardiogram on admission showed infrahisian complete heart block with a ventricular rate of 36 beats per min with wide QRS junctional escape and atrial rate was 188 beats per min. Transthoracic echocardiogram showed fine vibratory movement of both mitral leaflet tips. M-mode evaluation of mitral leaflets showed multiple 'a' waves corresponding to atrial tachycardia rate.

Left ventricular inflow propagation velocity for diastolic function testing: head-to-head comparison between velocity-encoded MRI and color M-mode Doppler echocardiography

Background The inflow propagation velocity (Vprop) of the early filling wave has been proposed as an accurate marker of left ventricular (LV) diastolic function [1]. Traditionally, Color M-mode echo Doppler is used for Vprop-assessment. However, this method has not been validated against an alternative modality such as velocity-encoded (VE) MRI for assessing Vprop. The purpose of this study was to compare Vprop assessed from high temporal VE MRI with Color M-mode echo Doppler in patients with ischemic cardiomyopathy. Methods

M-Node Echocardiographic Assessment of D-Transposjtjon of the Great Arteries and Associated Defects

INTRODUCTION: M-mode echocardiography has proven to be a reliable means for the diagnosis of d-transposition of the great arteries (8, 5). The M-mode echo diagnostic criteria are the demonstration of: (1) an anterior aorta, identified by delayed opening of its semilunar valve compared to the pulmonary valve, and (2) the aorta being situated rightward and anteriorly vis-a—vis the posterior pulmonary artery. MATERIAL AND METHODS: Forty—one patients with d-transvositjon of the great arteries were studied prior to, and 73 following Mustard operation and correction of associated lesions. Seventeen patients had sequential pre- and postoperative echocardio— graphic and cardiac catheterization studies. The echocardiograrns were obtained within 24 hours of cardiac catheterization. Hemodynamic data were obtained at cardiac catheterization using fluid—filled catheters and Statham gauge pressure transducer prior to the angio-graphic studies. Right ventricular angio— graphic volumes and ejection• fractions were obtained in 18 patients using Simpson’s method (7). Superior vena caval, right ventricular and left ventricular selective cineangiograms were also obtained. RESULTS: Preoperative Studies Forty-one patients with d-transposition of the great arteries were studied prior to the Mustard operation and correction of associated lesions. The echocardiographic and hemodynamic data of these patients are presented in Table 1. The age ranged between 1 day and 13 years (mean 3.2±4.2 years). Preoperatively, the PEP/RVET ratio was > 0.50 in only one patient; postoperative1y,.the ratio was 0.50 in 4 patients and in 2 of these hemodynamically significant tricuspid regurgita‘ don and angiographically estimated reduced ejection fraction (0 . 50) was noted. DISCUSSION: This study confirms that M-mocle echocard iography is a reliable means for diagnosing d-transposed great arteries. The transducer angulation (from the standard 4th intercostal parasternal space) required to detect the transp osed aorta is rightward and anterior (toward the right shoulder) from the posterior vessel, as opposed to an anterior and leftward angulation required to detect the anterior vessel (pulmonary Artery) in normally related great vessel.In summary, M-mode echocardiography prov ides not only a reliable means of diagnosing d-transposition of the great arteries, but is also useful for assessing the presence of associated lesions. Changing hemodynamic parameters in patients with transposition of the great arteries can be followed before and after the Mustard operation by longitudinal echocardiographic ass essment -

Abstract 253: The Tyrosine Kinase ErbB2 Inhibitor Lapatinib and the Anti-ErbB2 Antibody Trastuzumab Depress Cardiac Function Without Inducing Left Ventricular Dilation in Mice

Background: ErbB2, tyrosine kinase receptor of the EGFR family, overexpressed in about 25% of breast cancers, modulates development and function in the myocardium. Lapatinib (LAP) is a small molecule that inhibits ErbB2-tyrosine kinase domain. The few existing trials report it to be associated with a low risk of LV dysfunction (2%), while the prototypical antibody Trastuzumab (TRAS) increases the frequency of asymptomatic ejection fraction decrease by 3-18%, and the risk of heart failure by 2-4%. Here, we characterize our LAP murine cardiotoxicity model in vivo by echocardiography, comparing it to TRAS and doxorubicin (DOX) cardiotoxicities. Methods: LV end-diastolic and end-systolic diameters (LVEDD and LVESD) were assessed. LV function was measured with fractional shortening (FS) by M-mode echo, and with radial myocardial strain (%) with speckle tracking (ST) in sedated C57BL6 mice (2-4 mo. old) at day 0, and after 2 and 7 days of daily administration of LAP (100mg/kg/day orally), and in control mice. For comparison we used our well-established models with TRAS (2.25 mg/kg/day, ip), and DOX (2.17 mg/kg/day ip) as positive control. Results: FS was already reduced with DOX at 2 days: 52±.2%, p&lt;.001 vs 60±.4% (sham), while LAP and TRAS decreased FS only at 7 days (56±2 and 49±1.5%, respectively, both p&lt;.05 vs 60±.5% for sham). Interestingly, FS reduction with LAP was milder than with TRAS (p=.01). At 7 days, both LAP and TRAS only increased LVESD: 1.23±.07 and 1.49±.07mm, respectively, both p&lt;.05 vs 1.1±.03mm (sham). On the other hand, at 7 days DOX induced LV dilation, with significant enlargement of both LVESD (1.55±.08mm) and LVEDD (3.04±.06mm; sham=2.81±.03mm), both p&lt;.005. Importantly, from a diagnostic point of view, myocardial strain was reduced early at 2 days with LAP and TRAS, predicting cardiotoxicity: 34±7% for LAP, 44±7% for TRAS, both p&lt;.05 vs sham (66±.6%). Conclusions: Differently from DOX, ErbB2 inhibition in mice does not produce LV dilation, but only decreases LV function. In particular, specifically targeting ErbB2-tyrosine kinase domain with LAP confers less cardiotoxicity than TRAS. Myocardial strain identifies LV systolic dysfunction earlier than conventional echo and can be a useful tool to predict ErbB2 inhibitors cardiotoxicity.

Study Of Cardic Valvular Calcification In ESRD Patients On Regular Hemodialysis (A Single Center Study)

Cardiac valve calcification are common among patients with chronic kidney disease (CKD). Risk factors include alterations in calcium and phosphorus metabolism, elevated calcium phosphorus product and persistent elevations in plasma parathyroid hormone (PTH). Echocardiography is a simple and inexpensive method for detection of valvular calcifications as suggested by KDIGO guidelines. 60 Patients on regular HD constituted group A (36 males and 24 females) and 25 healthy volunteers constituted group B. Group A was subdivided into: Group I: 21 patients with no valvular calcification, group 2: 26 patients with aortic valve calcification and group 3: 13 patients with aortic and mitral valve calcification. For all, the following was done: clinical examination, serum Ca, serum P, serum albumin, serum creatinine, BUN and PTH level in blood. M-mode echo cardiography was done for all. Age, duration of dialysis and duration of 1ry kidney disease was higher in group 2 and 3 compared to group 1 (p = 0.0001). Calcium was higher in group 2 than group 1 (p = 0.09) and group 3 (p = 0.004) than group I phosphorus was higher in group 2 and 3 than group 1 (P = 0.001). P was higher in group 3 than group 2 (p = 0.0001). Ca x P was higher in group 2 and 3 than group 1 (p = 0.0001), in group 3 than group 2 (p = 0.01) PTH was higher in group 1 than group 2 (p = 0.06). Cardiac dysfunction by echocardiography was least in group 1, increasing in group 2 and being highest in group 3. It was found that calcified valve groups has taken higher doses of Calcium and Vitamin D3 . We have to take care on prescribing Ca and vitamin D3 to ESRD patients on regular HD.

Study Of Cardic Valvular Calcification In ESRD Patients On Regular Hemodialysis (A Single Center Study)

Cardiac valve calcification are common among patients with chronic kidney disease (CKD). Risk factors include alterations in calcium and phosphorus metabolism, elevated calcium phosphorus product and persistent elevations in plasma parathyroid hormone (PTH). Echocardiography is a simple and inexpensive method for detection of valvular calcifications as suggested by KDIGO guidelines. 60 Patients on regular HD constituted group A (36 males and 24 females) and 25 healthy volunteers constituted group B. Group A was subdivided into: Group I: 21 patients with no valvular calcification, group 2: 26 patients with aortic valve calcification and group 3: 13 patients with aortic and mitral valve calcification. For all, the following was done: clinical examination, serum Ca, serum P, serum albumin, serum creatinine, BUN and PTH level in blood. M-mode echo cardiography was done for all. Age, duration of dialysis and duration of 1ry kidney disease was higher in group 2 and 3 compared to group 1 (p = 0.0001). Calcium was higher in group 2 than group 1 (p = 0.09) and group 3 (p = 0.004) than group I phosphorus was higher in group 2 and 3 than group 1 (P = 0.001). P was higher in group 3 than group 2 (p = 0.0001). Ca x P was higher in group 2 and 3 than group 1 (p = 0.0001), in group 3 than group 2 (p = 0.01) PTH was higher in group 1 than group 2 (p = 0.06). Cardiac dysfunction by echocardiography was least in group 1, increasing in group 2 and being highest in group 3. It was found that calcified valve groups has taken higher doses of Calcium and Vitamin D3 . We have to take care on prescribing Ca and vitamin D3 to ESRD patients on regular HD.

The impact of two different doses of chelating therapy (deferasirox) on echocardiographic tissue Doppler indices in patients with thalassemia major

Chelating therapy in transfusion-dependent patients with β-thalassemia major (β-TM) is mandatory to reduce the toxic effect of iron on the myocardium. To evaluate the impact of low and high dose of oral chelating therapy (deferasirox) on pulsed and tissue echocardiographic indices in patients with β-TM. This interventional study conducted on patients with transfusion-dependent β-TM (n=38) on deferasirox 20 mg/kg/d medication, group (DFX-20) for at least 6 months, followed by administration of a higher dose of deferasirox, 40 mg/kg/d, group (DFX-40) for another 6 months. Pulsed and tissue Doppler echocardiography carried out at the beginning and at the end of treatment interval (6 months) for both groups, with monthly blood analysis of serum ferritin, alanine transaminase, hemoglobin, and creatinine. An age-matched control group of 38 patients was evaluated for echo Doppler blood analysis. Patients of group DXF-40 compared with group DFX-20, the tissue Doppler echocardiogram showed lower E/Em ratio (16.01 ± 2.85 vs. 19.68 ± 2.81, P<0.05), higher systolic wave velocity (Sm) (5.87 ± 1.40 vs. 4.80 ± 1.20, P<0.05), and higher early diastolic wave (Em) velocity (4.25 ± 1.70 vs. 3.50 ± 1.80, P<0.05), respectively. Patients in group DFX-20, compared with control group, had M-Mode echo with thicker left ventricle (LV) septal wall (P<0.001) and posterior wall (P<0.01), higher left ventricle end diastolic diameter index (P<0.05). The pulsed Doppler echocardiogram showed a higher LV transmitral E wave velocity (P<0.05), higher E/A ratio (P<0.01), and the duration of deceleration time was significantly shorter (P<0.01). There were no significant changes observed in the left ventricle ejection fraction percentage (LVEF%) or fractional shortening between both treatment groups. Serum ferritin was significantly lower in DFX-40 group compared with DFX-20 β-TM group (338). There was a significant positive correlation between the serum ferritin and the E/Em ratio (r=0.31, P<0.001). The tricuspid valve velocity was significantly higher in β-TM patients compared with the control group (P<0.05). The increment of oral deferasirox as chelating therapy in β-TM patients to 40 mg/kg/d over 6 months duration showed a significant increments of systolic and diastolic tissue Doppler velocities with a significant reduction of E/Em ratio in comparison with 20 mg/kg/d. There were no changes of LVEF. A longer duration of follow-up may be justified in such group of patients.