Myocardial Diastolic Function Research Articles

Impact of regional anesthesia on left and right ventricular performance after off-pump coronary artery bypass grafting: randomized controlled study

Introduction. New anesthesia techniques require evidence of the safety of their implementation, however there is still the opinion about negative impact of regional anesthesia on heart performance and central hemodynamics. The objective of our study was to evaluate effect of regional anesthesia on systolic and diastolic myocardial function in off-pump coronary artery bypass grafting (OPCAB).Materials and methods. A prospective randomized controlled trial included 45 patients who underwent elective OPCAB, equally divided into 3 groups – general anesthesia in combination with epidural anesthesia (GA+EA), general anesthesia with erector spinae plane block (GA+ESPB) and general anesthesia without regional anesthesia (GA). The systolic function of the left (LV) and right ventricle (RV), as well as the diastolic function of the LV were evaluated during five stages perioperatively, using echocardiography and thermodilution via Swan-Ganz catheter.Results. There were no intergroup differences in parameters of LV or RV systolic function and LV diastolic function during study stages. Perioperatively, there was a decrease in LV end-diastolic volume in the groups of OA+ESPB (p = 0.001) and OA (p = 0.003).At the end of the first postoperative day (POD), pulmonary artery wedge pressure decreased in the groups of OA+EA (p = 0.003) and OA+ESPB (p = 0.008); meanwhile, ejection time (p = 0.003) and velocity-time integral (p = 0.005) from RV reduced only in the OA+ESPB group. In the OA+EA group at the end of POD1, the reservoir strain of left atrium (p = 0.022) and isovolumic relaxation time (p = 0.006) decreased.Conclusion. In OPCAB, epidural anesthesia and ESPB do not result in deterioration of LV systolic and diastolic function and do not have a negative impact on the RV.

Sensitive detection of hemodynamic changes after fetoscopic laser photocoagulation by assessing intraventricular pressure difference in fetuses with twin-to-twin transfusion syndrome.

To assess the hemodynamics of twin-to-twin transfusion syndrome (TTTS), we measured the intraventricular pressure difference (IVPD), a sensitive marker of myocardial diastolic function, using fetal echocardiography. We included 28 monochorionic diamniotic (MD) twins diagnosed with TTTS who underwent fetoscopic laser photocoagulation (FLP) between 2018 and 2022. Color M-mode Doppler images of both cardiac ventricles were obtained before and after FLP. According to this evaluation, the IVPDs were divided into three groups; those with total, basal, and mid-apical IVPD. Of the 28 twins, 21 were available for analysis (including eight, eight, three, and two cases in stages Quintero Ⅰ, Ⅱ, Ⅲd, and Ⅲr, respectively). Comparing the pre and postFLP results, significant increases in total and mid-apical IVPD in the left ventricle (LV) of recipient twins were noted (total and mid-apical IVPD: p=0.026 and 0.013, respectively). In the LV of the donor twins, all IVPDs were significantly increased after FLP (total, basal, and mid-apical IVPD: p=0.003, 0.001, and 0.022, respectively). In addition, comparisons between the donor and recipient groups did not show significant differences in either ventricle before FLP. IVPD detected subtle hemodynamics changes, such as volume overload and diastolic dysfunction in TTTS before and after FLP. Therefore, IVPD may be a useful marker for monitoring myocardial diastolic function in TTTS.

Evolution of Natural Myocardial Shear Wave Behavior in Young Hearts: Determinant Factors and Reproducibility Analysis

Myocardial diastolic function assessment in children by conventional echocardiography is challenging. High-frame rate echocardiography facilitates the assessment of myocardial stiffness, a key factor in diastolic function, by measuring the propagation velocities of myocardial shear waves (SWs). However, normal values of natural SWs in children are currently lacking. The aim of this study was to explore the behavior of natural SWs among children and adolescents, their reproducibility, and the factors affecting SW velocities from childhood into adulthood. One hundred six healthy children (2-18years of age) and 62 adults (19-80years of age) were recruited. High-frame rate images were acquired using a modified commercial scanner. An anatomic M-mode line was drawn along the ventricular septum, and propagation velocities of natural SWs after mitral valve closure were measured in the tissue acceleration-coded M-mode display. Throughout life, SW velocities after mitral valve closure exhibited pronounced age dependency (r=0.73; P<.001). Among the pediatric population, SW velocities correlated significantly with measures of cardiac geometry (septal thickness and left ventricular end-diastolic dimension), local hemodynamics (systolic blood pressure), and echocardiographic parameters of systolic and diastolic function (global longitudinal strain, mitral E/e' ratio, isovolumic relaxation time, and mitral deceleration time) (P<.001). In a multivariate analysis including all these factors, the predictors of SW velocities were age, mitral E/e', and global longitudinal strain (r=0.81). Natural myocardial SW velocities in children can be detected and measured. SW velocities showed significant dependence on age and diastolic function. Natural SWs could be a promising additive tool for the assessment of diastolic function among children.

Functional features of the myocardium in school-age children with chronic somatic pathology according to echocardiographic examination

The peculiarity of the modern pathology of childhood is the increasing frequency of transition of acute forms of diseases into recurrent and chronic ones and increasing primary chronic pathology. Systematic loads on «endurance» during training determine the necessity to study the possibilities of heart remodelling in school-age children against the background of chronic somatic pathology. Objective: to reveal structural and functional changes of myocardium in schoolchildren with chronic somatic pathology according to echocardiogram examination data. Materials and methods. We analysed 32 echocardiogram results in children aged from 7 to 17 years. The main group (n=16) - children with chronic somatic pathology out of exacerbation, control group (n=16) - children of the 2nd health group. Distribution of chronic somatic pathology in the main group: CNS diseases (n=4), kidney and urinary tract (n=5), GI (n=2), glands of internal secretion (n=3), vascular malformations (n=2). All children underwent echocardiogram examination with analysis of left ventricular ejection fraction systolic and diastolic myocardial function, left ventricular end-diastolic dimension, myocardial wall thickness, valve apparatus, presence/absence of physiological transudate in the pericardial cavity, and presence of small anomalies of cardiac development. Clinical and anamnestic data of the subjects, echocardiogram method and conventional statistical processing of the obtained results using STATISTICA for Windows software system were used to achieve the set goal and solve the research tasks. Results of the study. In the main group left ventricular ejection fraction was 61,8±1,57%, in the control group - 68,25±1,86% (p≤0,05). Left ventricular end-diastolic dimension was normal in both groups (p≥0.05). Concentric myocardial remodelling and increased myocardial wall thickness were found only in the main group in 18.8% (n=3) and 37.5% (n=6) of cases, respectively (p≤0.05). Valve pathology in the main and control groups was 43.8% (n=7) and 18.8% (n=3) of cases. Physiological transudate in the pericardial cavity was noted equally in both groups in 12.5% of cases. Small anomalies of cardiac development were detected in the main and control groups in 31.3% (n=5) and 18.8% (n=2) cases, respectively. Conclusion. Low values of left ventricular ejection fraction and increased myocardial wall thickness indicate a decrease in left ventricular function of the heart and a negative impact of metabolic disorders in children with chronic somatic pathology.

The Chinese cardiorespiratory and circulatory system at work in women and men: a case–control study

The physiology of prominent prognostic factors in the cardiorespiratory system remains unchartered in the world's largest ethnic group: Hans Chinese (HC). This study assessed and contrasted the fundamental variables in HC and European-American (EA) individuals. Healthy HC and EA adults (n=140, 43% ♀) closely matched by age, sex and physical activity were included. Body composition (DXA) and haematological variables (haemoglobin mass, blood volume (BV)) were measured at rest. Pulmonary O2 uptake (VO2) measurements along with cycle ergometry designed for accurate transthoracic echocardiography were implemented to assess cardiorespiratory structure/function up to peak effort. HC presented with higher body fat and lower lean body mass (LBM) percentage than EA irrespective of sex (P≤0.014). BV did not differ whereas blood haemoglobin concentration was lower in HC compared with EA, particularly in females (P=0.009). Myocardial diastolic and overall function at rest was enhanced in HC versus EA (P<0.001). During exercise, heart volumes and output per unit of body size did not differ between ethnicities, whereas larger heart volumes per unit of LBM were found in HC versus EA in females (P≤0.003). At high exercise intensities, VO2 (-16%) and the arteriovenous O2 difference (-28%) were markedly reduced in HC compared with EA in females (P≤0.024). In males, no physiological difference between HC and EA was observed during exercise. Notwithstanding lower LBM, HC are characterised by similar BV and cardiac capacity but reduced peak VO2 than EA in females, partly explained by low ethnic-specific blood O2 carrying capacity. Early Career Scheme (106210224, to D.M.) and Seed Fund (104006024, to D.M.).

Remodeling and diastolic dysfunction of the left ventricle in patients with arterial hypertension and polymorphism rs5918 of the &lt;i&gt;ITGB3&lt;/i&gt; gene: cross-sectional study

OBJECTIVE: To identify diastolic myocardial function features in late postmenopausal women with polymorphic variants of the integrin beta-3 (ITGB3) gene and arterial hypertension.&#x0D; MATERIALS AND METHODS: This cross-sectional study enrolled 97 postmenopausal women, with a median age of 67 (6570) years. The duration of menopause was 18 (1621) years. Molecular genetic studies to assess ITGB3 (rs5918) T1565C polymorphism were performed. The study participants with the homozygous TT ITGB3 polymorphic variant comprised group 1, whereas group 2 included patients with the C allele (TC and CC genotypes). All patients underwent standard transthoracic echocardiography and assessment of left ventricular (LV) diastolic function by transmitral flow. LV diastolic dysfunction was classified into rigid, pseudonormal, and restrictive.&#x0D; RESULTS: Homozygous allelic variant TT was detected in 65 (67%) patients, heterozygous TC in 29 (30%), and homozygous polymorphic variant CC in 3 (3%). LVDD occurred in all patients included in the study. Among patients with the TT allelic variant of ITGB3, rigid LVDD was diagnosed in 34 (52%), and its pseudo-normal variant was detected in 31 (48%). Among TC and CC genotypes of C allele carriers, a pseudo-normal variant of LVDD (p 0.01), which occurred in 20 (62%) patients, was statistically significantly more frequently recorded, and 12 (38%) patients had a rigid type of LVDD. In addition, a rigid type LVDD was not detected in any case. Calcification of the mitral and aortic valve leaflets was detected in 24 (37%) cases in group 1 and in 9 (28%) patients in group 2 (p=0.68). In fibrous rings, calcifications were found in 34 (52%) patients in group 1 and 16 (50%) in group 2 (p=0.31), and the differences were not statistically significant.&#x0D; CONCLUSION: This study presents a significant contribution of the rs5918 polymorphism of ITGB3 in the development of myocardial remodeling and LVDD in postmenopausal women.

The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy

Plasma potassium (p-K) in the high-normal range has been suggested to reduce risk of cardiovascular arrythmias and mortality through electrophysiological and mechanical effects on the myocardium. In this study, it was to investigated if increasing p-K to high-normal levels improves systolic- and diastolic myocardial function in patients with low-normal to moderately reduced left ventricular ejection fraction (LVEF). The study included 50 patients (mean age 58 years (SD 14), 81% men), with a mean p-K 3.95 mmol/l (SD 0.19), mean LVEF 48% (SD 7), and mean Global Longitudinal Strain (GLS) -14.6% (SD 3.1) patients with LVEF 35–55% from “Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial” (POTCAST). Patients were given standard therapy and randomized (1:1) to an intervention that included guidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists targeting high-normal p-K levels (4.5-5.0 mmol/l). Echocardiography was done at baseline and after a mean follow-up of 44 days (SD 18) and the echocardiograms were analyzed for changes in GLS, mechanical dispersion, E/A, e’, and E/e’. At follow-up, mean difference in changes in p-K was 0.52 mmol/l (95%CI 0.35;0.69), P<0.001 in the intervention group compared to controls. GLS was improved with a mean difference in changes of -1.0% (-2;-0.02), P<0.05 and e’ and E/e’ were improved with a mean difference in changes of 0.9 cm/s (0.02;1.7), P = 0.04 and ? 1.5 (-2.9;-0.14), P = 0.03, respectively. Thus, induced increase in p-K to the high-normal range improved indices of systolic and diastolic function in patients with low-normal to moderately reduced LVEF.

Natural shear waves show sequential changes in myocardial stiffness In paediatric multi-inflammatory systemic syndrome post COVID

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Egyptian ministry of research and higher education Background Multi-inflammatory systemic syndrome post COVID infection (MIS-C) in children causes myocarditis and affects myocardial diastolic function. Recent high frame rate echocardiography allows to assess myocardial shear waves (SW). SW are mechanical waves generated by mitral and aortic valve closure (MVC &amp; AVC). Their propagation velocities are related to myocardial stiffness (MS), a determinant of diastolic function. Nevertheless, this has not yet been tested in paediatric cardiology and in this pathology. Purpose This study aimed at exploring the changes in natural SW propagation velocity as measure of myocardial diastolic properties in paediatric patients with MIS-C. Methods Seven MIS-C children (mean age 6.7 ±3.6 years) were prospectively followed over 6 months (group A). As a control group; one hundred-four healthy volunteers (HV) (mean age 10.2 ±4.4 years) were recruited (group B). High-frame rate echocardiography was used to obtain parasternal long axis views of all subjects at a frame rate of 1580 ±113 Hz. An anatomical M-mode was drawn along the interventricular septum and Tissue Doppler acceleration maps were extracted to measure SW propagation speed after MVC and AVC (Figure 1). Independent sample t-test was used to compare between both groups. Repeated measures analysis of variance (ANOVA) was used to show sequential changes during follow-up. Results SW propagation velocities were significantly higher among MIS-C patients than in HV group after both MVC (4.3 ±0.6 m/s vs 2.8 ±0.3 m/s respectively, p&amp;lt;0.001) and AVC (5.2 ±0.6 m/s vs 3.0 ±0.3 m/s respectively; p&amp;lt;0.001). Interestingly, SW propagation speeds in MIS-C patients declined significantly with myocardial recovery during course of disease (figure 2) and normalised 6 months post discharge (MVC: 2.9 ±0.3 m/s; P&amp;lt;0.001, AVC: 3.2 ±0.4 m/s; P&amp;lt;0.001) compared to admission. Conclusions SW speed found to be 1.5 to 1.7 fold higher with myocardial inflammation in MIS-C patients compared to HV. Values normalised within 6 months. These findings indicate that SW velocities can show sequential changes in the course of a disease and suggest that SW imaging has potential to serve as a new non-invasive diagnostic tool in paediatric cardiac diseases.

Association between insulin resistance indices and perioperative functional status and immediate prognosis in patients with carbohydrate metabolism disorders undergoing coronary artery bypass grafting

Highlights. Patients with coronary artery disease undergoing coronary artery bypass grafting have a high prevalence of type 2 diabetes mellitus and prediabetes. The frequency of postoperative stroke and hospital stay is significantly higher in patients with impaired carbohydrate metabolism.Insulin resistance markers are associated with a variety of perioperative characteristics, but according to multivariate analysis, only free fatty acids and HOMA-IR were independent predictors of hospitalacquired complications and long-term hospital stayAim. To analyze insulin resistance markers and their association with the preoperative outcome and in-hospital complications of coronary bypass grafting (CABG) in patients with type 2 diabetes mellitus (DM 2), prediabetes and normoglycemia.Methods. The study included 383 consecutive patients undergoing CABG at the same center. Glycemic status, free fatty acids (FFA), fasting insulin, glucose, lipid profile of all patients were determined before surgery and the following insulin resistance indices (IR) were calculated: HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), QUICKI (Quantitative Insulin Sensitivity Check Index), Revised QUICKI, McAuley. Patients were divided into 2 groups: the group that included patients with carbohydrate metabolism disorders (CMD), type 2 diabetes mellitus and prediabetes (n = 192), and the group of patients without CMD (n = 191). Perioperative characteristics of patients, postoperative complications and their association with insulin resistance markers were analyzed.Results. FFA and calculated indices of insulin resistance such as HOMA-IR, QUICKI, RevisedQUICKI, and McAuley correlated with the following perioperative characteristics: the duration of surgical intervention and cardiopulmonary bypass, lipid levels, coagulation index, left ventricular dimension and myocardial diastolic function, etc. The analysis of in-hospital complications revealed that the frequency of postoperative stroke (p = 0.044) and hospital stay after CABG &gt;30 days (p = 0.014) was significantly higher in patients with CMD. According to the results of multivariate analysis, the predictors of the composite endpoint (hospital stay after CABG&gt;10 days and/or significant perioperative complication) were as follows: female sex (odds ratio (OR) 2.862, 95% confidence interval (CI) 1.062-7.712, p = 0.036); age (OR 1.085, 95%CI 1.027–1.147, p = 0.003); duration of cardiopulmonary bypass (OR 1.146, 95%CI 1.008–1.301, p = 0.035); body mass index (OR 1.125, 95% CI 1.035–1.222, p = 0.005), left atrial dimension (OR 5.916 95% CI 2.188–15.996, p&lt;0.001); any CMD (OR 1.436, 95%CI 1.029–2.003, p = 0.032), type 2 DM (OR 2.184, 95%CI 1.087–4.389, p = 0.027), FFA levels (OR 5.707, 95%CI 1.183–27.537, p = 0.029) and HOMA–IR index (OR 1.164, 95%CI 1.025–1.322, p = 0.019).Conclusion. FFA, HOMA-IR, QUICKI, Revised-QUICKI, and McAuley correlate with a variety of perioperative characteristics of patients undergoing CABG, but multivariate analysis revealed that only FFA levels and the HOMA-IR can be used as predictors of in-hospital complications and prolonged hospital stay.

The state of systolic and diastolic myocardial functions in patients with severe obstructive sleep apnea and their dynamics during CPAP therapy

Aim. To evaluate the change in the parameters of systolic and diastolic myocardial functions in patients with severe obstructive sleep apnea (OSA) syndrome before and after CPAP therapy.&#x0D; Materials and methods. Forty eight patients with severe OSA aged 4574 years were examined. All patients underwent questionnaires, echocardiography with tissue Dopplerography, speckle-tracking echocardiography. At the end of the three-month course of CPAP therapy, the patients were re-examined, followed by a comparative analysis of the data obtained.&#x0D; Results. In patients with severe OSA after CPAP therapy, the ejection fraction of the left ventricle and the amplitude of systolic displacement of the fibrous ring of the tricuspid valve significantly increased, which indicated an increase in the relative capacity of the ventricular myocardium. The performed CPAP therapy had a positive effect on the diastolic function of the myocardium of both ventricles, which was manifested in an increase in the ratio of peak rates of early and late transmitral and transtricuspidal diastolic flows. The rate of transtricuspidal regurgitation and systolic pressure in the pulmonary artery decreased in dynamics.&#x0D; Conclusion. The use of CPAP therapy improves systolic and diastolic heart function, leads to a decrease in systolic pressure in the pulmonary artery in patients with severe OSA. The results obtained substantiate the importance of early initiation of CPAP therapy in the complex treatment of patients with OSA.

Assessment of Diastolic Myocardial Function in Neonates with Patent Ductus Arteriosus by Tissue Doppler Imaging

Assessment of Diastolic Myocardial Function in Neonates with Patent Ductus Arteriosus by Tissue Doppler Imaging

Insulin resistance and heart failure with preserved ejection fraction. Pathogenetic and therapeutic crossroads

Insulin resistance, which is a fundamental pathogenetic factor of prediabetes, is closely associated with abdominal obesity on the one hand and the development of cardiovascular diseases, heart failure (HF), on the other. The pathogenetic role of insulin resistance is multifaceted and consists in the acceleration of atherosclerosis, the formation of left ventricular myocardial hypertrophy, including through mechanisms that do not depend on blood pressure, as well as the development of its diastolic dysfunction. The latter is the starting point for starting HF with preserved ejection fraction (HFpEF).Compared with patients with HF with reduced ejection fraction, the presence of HFpEF determines a higher frequency of hospitalizations not due to decompensation of heart failure, but due to concomitant diseases, such as destabilization of the course of arterial hypertension, decompensation of type 2 diabetes mellitus, curation of which, in general, has a greater impact in terms of improving prognosis. Thus, in patients with prediabetes and HFpEF, the correction of insulin resistance as the underlying cause and trigger of cardiometabolic disorders can potentially improve not only insulin-glucose homeostasis, but also the parameters of myocardial diastolic function. This literature review is devoted to the accumulated experience of using metformin as a «strategic» antidiabetic drug in HFpEF and considering potential new points of its application as a protector of the cardiovascular system.

Diastolic dysfunction in late postmenopausal patients with undifferentiated connective tissue disease and hypertension

Aim. To assess myocardial diastolic function (DF) in late postmenopausal women with undifferentiated connective tissue disease (UCTD) and hypertension (HTN).Material and methods. This cross-sectional study included 135 postmenopausal women, the median age of which was 68 years (65÷70,5 years). The anamnesis was collected using a standardized questionnaire. Verification of UCTD was carried out according to clinical guidelines. All patients underwent standard transthoracic echocardiography. The assessment of left ventricular (LV) DF was carried out according to the transmitral flow. LV diastolic dysfunction (DD) was classified into three types: rigid, pseudonormal, and restrictive. Statistical processing was carried out in the STATISTICA 13.0 environment. The measure of data averaging is the median, the measure of dispersion is 25%÷75%. The significance of differences was assessed using the Mann-Whitney test. Differences were considered significant at p˂0,05.Results. Group 1 — 20 (14,8%) patients with verified UCTD and HTN, group 2 — 88 (65,2%) patients with HTN without UCTD, control group — 23 (30%) patients without HTN and UCTD. There were no differences in age, duration of postmenopause and body mass index between the groups. In the first group, a significant decrease in the ratio of peak early to late diastolic LV filling velocity was revealed (p˂0,01). A significant increase in left ventricular end-systolic wall stress revealed in group 1. In 108 (100%) patients, LVDD was detected; among the patients of the control group, DD was not detected. In 8 (40%) patients in group 1, a pseudo-normal type of DD was detected, while in 12 out of 20 patients (60%) — rigid type of DD. When assessing DF in patients of group 2, a significant decrease was found in the ratio of peak early to late diastolic LV filling velocity, a significant increase in LV end-diastolic wall stress and end-diastolic pressure. In 2 out of 3 (57,80%) patients of group 2, DD of the rigid type was detected, while pseudonormal type — in 32,2% of patients in this group. Group 2 patients had a significant decrease in the early diastolic mitral annular velocity (p˂0,01).Conclusion. The analysis of myocardial echocardiographic characteristics indicates a significant contribution of HTN-associated UCTD to the development of LVDD in postmenopausal women.

Myocardial function and myocardial work in young adults born very preterm or with extremely low birthweight – a regional cohort study

Abstract Background Preterm birth and low birthweight have been associated with increased risk of cardiovascular disease and heart failure at young adult age. However, clinical studies of myocardial function have reported diverging results. Echocardiographic strain analyses allow detection of subclinical early stages of cardiac dysfunction, and non-invasively estimation of myocardial work derived from left ventricular pressure-strain loops provides additional information on cardiac function. Purpose We aimed to compare systolic and diastolic myocardial function including measures of myocardial work in young adults born very preterm (&amp;lt;29 weeks of gestation) or with extremely low birthweight (&amp;lt;1000 g) (PB/ELBW) and term-born age-and gender matched controls. Methods 63 PB/ELBW and 64 controls born in Norway in the periods 1982–1985, 1991–1992, and 1999–2000 were examined with echocardiography. Left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), traditional diastolic parameters and left atrial longitudinal strain were measured. Myocardial work was estimated by the echocardiographic software from LV pressure-strain loops after determination of GLS and construction of a LV pressure curve derived from brachial cuff pressure recording and timing of mitral valve opening and closure. Results The PB/ELBW with mean age 27 years (standard deviation (SD) 6), mean birthweight 945 g (SD 217) and mean gestational age 27 weeks (SD 2) had LV systolic function mainly within normal range. Only four (&amp;lt;1%) had EF &amp;lt;50%, but 12 (19%) had borderline impaired GLS &amp;gt;−18% or impaired GLS &amp;gt;−16%. Mean GLS in PB/ELBW (−19.7% (95% confidence interval (CI): −20.4, −19.1)) was impaired compared to controls (−20.4% (95% CI: −20.9, −20.0)), p=0.01. Lower birthweight was correlated to more impaired GLS (Pearson correlation coefficient −0.2). Estimated means of EF, measures of diastolic function, left atrial reservoir strain, global constructive and wasted work, global work index and global work efficiency was similar in PB/ELBW and controls. Conclusions The young adults born preterm or with extremely low birthweight had LV systolic function mainly within normal range, but GLS was impaired compared to controls, and lower birthweight was associated with more impaired GLS. Diastolic function and global work index were similar compared to controls. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Western Norway Health Authority

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.

Interstitial Collagen Loss, Myocardial Remodeling, and Function in Primary Mitral Regurgitation

Interstitial collagen loss and cardiomyocyte ultrastructural damage accounts for left ventricular (LV) sphericity and decrease in LV twist and circumferential strain. Normal LV diastolic function belies significantly abnormal left atrial (LA) function and early LV diastolic untwist rate. This underscores the complex interplay of LV and LA myocardial remodeling and function in the pathophysiology of primary mitral regurgitation. In this study, we connect LA function with LV systolic and diastolic myocardial remodeling and function using cardiac magnetic resonance tissue tagging in primary mitral regurgitation.

The value of myocardial work in assessment of ventricular function in patients with non-obstructive hypertrophic cardiomyopathy

BackgroundTo evaluate myocardial work using speckle tracking echocardiography in patients with non-obstructive hypertrophic cardiomyopathy (HCM).MethodsFifty patients with HCM and 50 normal controls were included. Left ventricular ejection fraction (LVEF) was quantified using the bi-plane Simpson’s method. Myocardial work parameters, which included global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE), were derived from the 2D strain-pressure loop.ResultsThe patient group was older (49.19 ± 14.69 vs. 37.16 ± 7.49 years old) and had a higher body mass index (24.93 ± 3.67 vs. 23.26 ± 3.32 kg/m2) and systolic blood pressure (121.81 ± 16.50 vs. 115.30 ± 11.01 mmHg) (P < 0.05). The mean LVEF in patients was 51%, with 54% of patients had LVEF ≤ 50%. Compared to controls, GWI (946.42 ± 360.64 vs. 1639.72 ± 204.56 mmHg%), GCW (1176.94 ± 373.23 vs. 1960.16 ± 255.72 mmHg%), and GWE (83.96 ± 7.68 vs. 95.26 ± 1.98%) were significantly decreased, while GWW (158.17 ± 82.47 vs. 79.12 ± 40.26 mmHg%) was significantly increased (P < 0.05) in the patient group. In patients, GWE showed a trend of positive correlation with LVEF (r = 0.276, P = 0.06), while GWW had a trend of negative correlation with LVEF (r = − 0.241, P = 0.09). No correlation between myocardial work and LV diastolic function or QRS duration was observed. Maximal wall thickness significantly correlated with all the myocardial work parameters.ConclusionsAssessing myocardial work adds useful information of LV function in patients with non-obstructive HCM.

Assessment of diastolic myocardial function in neonates with patent ductus arteriosus using tissue Doppler imaging

Background: The present study was an analytic case control study was done and included full and preterm neonates with PDA and respiratory distress. Neonates with no PDA were also included as a control. Aim of the study: This study aimed to assess diastolic myocardial functions in neonates with different degrees of ductal patency in 1st week of life using tissue Doppler imaging. Methods: The study was conducted at neonatal intensive care unit (NICU) in Bab-Sheria hospital, pediatric department, faculty of medicine, Al Azhar University in the period from June 2018 to June 2021. The present work was conducted on fifty Neonates categorized into 3 groups as follow: Haemodynamically significant dusctus arteriosus cases: ductal diameter more than 2.5 mm and left atrium to aorta (LA: AO) ratio more than 1.5. Non haemodynamically significant ductus arteiosus cases: ductal diameter less than 2.5 mm or (LA: AO) ratio less than 1.5 and Non patent dusctus arteriosus ( Control group). Results: Amount of left-to-right shunt will increase according to the size of the systemic-to-pulmonary communication, and it results in an increased pulmonary blood flow which agrees with our study.

Attenuation of ROS/Chloride Efflux-Mediated NLRP3 Inflammasome Activation Contributes to Alleviation of Diabetic Cardiomyopathy in Rats after Sleeve Gastrectomy.

Diabetic cardiomyopathy (DCM) can develop in diabetes mellitus and is a major cause of morbidity and mortality. Surgical bariatric surgery procedures, such as sleeve gastrectomy (SG), result in remission of type 2 diabetes and have benefits regarding systolic and diastolic myocardial function. The NLR family pyrin domain containing 3 (NLRP3) inflammasome appears to participate in the development of DCM. However, whether SG surgery affects myocardial NLRP3 inflammasome-related pyroptosis to improve cardiac function remains unclear. This study was aimed at investigating the effect of SG surgery on NLRP3-associated pyroptosis in rats with DCM. We also examined cellular phenotypes and molecular mechanisms in high glucose-stimulated myocytes. The rat model of DCM was established by high-fat diet feeding and low-dose streptozotocin injection. We observed a metabolic benefit of SG, including a reduced body weight, food intake, and blood glucose levels and restored glucose tolerance and insulin sensitivity postoperatively. We observed a marked decline in glucose uptake in rats with DCM, and this was restored after SG. Also, SG alleviated the dysfunction of myocardial contraction and diastole, delayed the progression of DCM, and reduced the NLRP3 inflammasome-mediated myocardial pyroptosis in vivo. H9c2 cardiomyocytes showed membrane disruption and DNA damage under a high glucose stimulus, which suggested myocardial pyroptosis. Using a ROS scavenger or chloride channel blocker in vitro restored myocardial NLRP3-mediated pyroptosis. Furthermore, we found that chloride efflux acted downstream of ROS generation. In conclusion, SG may ameliorate or even reverse the progression of DCM. Our study provides evidence that the SG operation alleviates NLRP3 inflammasome dysregulation in DCM. Clearance of ROS overburden and suppression of chloride efflux due to SG might act as the proximal event before inhibition of NLRP3 inflammasome in the myocardium, thus contributing to morphological and functional alleviation of DCM.

HYPERURICEMY: EFFECT ON THE CHRONIC HEART FAILURE PATHOGENESIS

Purpose - a literature review of the published clinical studies on the effects ofhyperuricemy on the chronic heart failure course(CHF).Conclusions. Studies show that uric acid is associated with cardiovascular disease, and hyperuricemy is common in patients with CHF. Hyperuricemy is associated withimpaired peripheral blood flow and decreased vascular dilatation, which is closelycorrelated with clinical status and reduced physical ability. Recent studies also suggesta close correlation between uric acid levels and myocardial diastolic function and,more importantly, uric acid is determined by a strong, independent prognostic predictorin CHF patients. Current experimental and clinical studies have shown that inhibitionof xanthine oxidase causes significant beneficial pathophysiological changes. Evidenceof this effect suggests that myocardial energy metabolism, endothelial dysfunction,and exercise tolerance are improved at the expense of the decrease of oxidative stressmanifestations, therefore, lowering of the serum levels of the uric acid is a promisingtherapeutic target for improving the treatment of CHF patients.