Heart Function Parameters Research Articles

Paroxysmal atrial fibrillation and the left heart structure and function in hypertensive patients

Objective. To identify the features of the left heart structure and function in patients with hypertension (HTN) and new onset paroxysmal atrial fibrillation (AF).Design and methods. We included HTN patients with left ventricular hypertrophy and valid 24-hour Holter monitoring carried out over the last month. Patients without AF paroxysms (age from 37 to 82 years, 38,4% men) were divided into two groups: the 1st group included 32 patients under 55 years of age, the 2nd group comprised 63 patients 55 years of age and older. Thirty-eight patients with AF paroxysms were included in the 3rd group (age from 56 to 74 years, men 28,9%). The parameters of the left heart structure and function, including the global longitudinal strain of the left ventricle and the left atrium strain in the reservoir and contraction phases, were assessed by echocardiography.Results. The average age of patients in the groups was 44,7 46,4 48,2 vs 61,9 63,7 65,4 vs 63,4 64,8 66,2 years (p < 0,001), and the average duration of HTN was 3,2 4,35,6 vs 6,9 7,99,1 vs 5,7 6,98,1 years (p < 0,001), respectively. The moderate and severe left ventricular hypertrophy and the diastolic dysfunction were found significantly less frequently in the 1st group than in other groups (5,0 12,528,1% vs 43,3 55,667,8% vs 36,8 52,668,5%, p < 0,001 and 5,2 18,832,3% vs 51,6 63,575,4% vs 53,6 68,483,2%, p < 0,001). In 1st group, the left atrial reservoir strain was higher than in the 2nd group, and in the 2nd group it was higher than in the 3rd group (24,7 26,3 28,0 vs 21,5 22,7 23,9 vs 17,8 19,2 20,5, p < 0,001). The left atrial contraction strain did not differ in the 1st and 2nd groups and it was higher than in the 3rd group (13,8 14,9 16,0 and 12,9 13,6 14,2 vs 9,6 10,3 11,1, p < 0,001). The multivariate logistic regression analysis showed that the left atrial strain in the contraction phase is a predictor of AF occurrence in HTN patients over 55 years old depends on. The chances of AF detecting in these patients increase by 3,122 9,21127,171 times (p < 0,001), if the left atrial strain in the contraction phase is below 13%.Conclusions. The left atrial strain in HTN patients with paroxysmal AF are significantly lower than in patients without cardiac arrhythmias independently of age and the left ventricular state. The left atrial contraction strain ≤ 13% is a predictor of the detection of AF paroxysms during 24-hour Holter monitoring in HTN patients aged 55 years and older.

The Impact of Pulmonary Hypertension on Functional and Morphological Parameters of Heart Function in COVID-19

The objective of the study: to evaluate functional and morphological parameters of cardiac function in patients with pulmonary hypertension and COVID-19.Subjects: The study included 53 patients of both genders with community-acquired multisegmental viral-bacterial pneumonia and COVID-19 who were treated in intensive care units. Patients were divided into three groups according to mean pulmonary artery pressure (mean PAP): in Group 1, mean PAP was < 25 mm Hg, in Group 2, mean PAP was 25-40 mm Hg, and in Group 3, mean PAP was ≥ 40 mm Hg.Results. Patients with COVID-19 and mean PAP > 40 mm Hg were found to have higher values of left and right atrial volume, myocardial thickness, heart rate, and mortality. However, they had lower values of arterial stroke pressure index, arterial compliance, specific peripheral resistance, and lower precapillary response.Conclusion. The severe course of COVID-19 is associated with severe pulmonary hypertension developed during extensive pneumonia combined with concomitant pathology. At the same time, impaired hemodynamics and altered sizes of heart chambers are observed in such patients.

Left atrial function assessed by 3-dimensional echocardiography is an independent predictor for mortality in heart failure with reduced ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant TE 137/2020 Background. Patients with heart failure and reduced ejection fraction (HFrEF) are at high risk for death. So far, left ventricular ejection fraction (LVEF) measured by 2-dimensional echocardiography (2DE) has been considered the main predictor of mortality in HFrEF. However, there are new echo parameters reflecting cardiac remodeling, assessed by 3-dimensional echocardiography (3DE), that might improve risk stratification in HFrEF. Aim. To assess comparative prognostic value of left heart function and remodeling parameters, measured by 2DE versus 3DE, in patients with HFrEF. Methods. 142 consecutive patients (60 ± 17 years, 91 males), diagnosed with HFrEF, in sinus rhythm, were assessed by 2DE, using dedicated views for the LV and left atrium (LA), and by 3DE, with full-volume multi-beat acquisitions of the LV and LA. Left ventricular volumes (LVVs) were measured from 2DE views, using the modified Simpson biplane method, and from 3DE using dedicated software. Maximal and minimal indexed LAVs were measured from 2DE, using the biplane area-length formula (2D_LAVmax and 2D_LAVmin); and from 3DE, using dedicated software package (3D_LAVmax and 3D_LAVmin). Patients were followed for 5 years (57 ± 11 months) after the index event. Primary outcome was mortality. Secondary outcomes were a composite endpoint (CE) of death and hospitalization for heart failure (HHF); HHF; and a composite cardiac events end-point (MACE) of death, HHF, myocardial infarction, coronary revascularization, arrhythmias, or cardiac resynchronization therapy. Results. At 5 years we recorded 52 deaths, 70 CE, 36 HHF, and 73 MACE. At baseline, mean 2DE and 3DE LVEFs were 32 ± 10% and 32 ± 9%, respectively. There was no significant difference between the LVVs or LVEF by 2DE or 3DE between survivors and non-survivors. However, there was a significant difference for total and indexed 2D_LAVmax, 3D_LAVmax, and 3D_LAVmin (Table 1) between survivors and non-survivors. Similarly, there was no significant correlations with endpoints for the 2DE or 3DE LVVs. However, total and indexed 2D_LAVmax correlated with death, CE, HFH, and MACE, all with P < 0.03. Furthermore, total and indexed 3D_LAVmax, and 3D_LAVmin correlated with death, CE, HFH, and MACE, all with P < 0.05. In a linear multivariate regression model, that included 2DE and 3DE LVEF, indexed 2D and 3D LAV max and min, only indexed 3D_LAVmin was an independent predictor for death (p < 0.001), CE (p = 0.005), HFH (p = 0.009) and MACE (p = 0.006). Furthermore, by ROC analysis, an indexed LAV of 30 ml/m2 by 3DE was able to predict death ( Sb 94%, Sp 80%, AUC 0.70), CE (Sb 98%, Sp 80%, AUC 0.67), HFH (Sb 96%, Sp 80%, 0.67), and MACE (Sb 93%, Sp 76%, AUC 0.66). Conclusion. LVEF by 2DE and 3DE, while smaller in non-survivors, was unable to predict death in a small cohort of patients with HFrEF. However, LAVs, particularly by 3DE, were able to predict cardiac events, suggesting the potential key value of evolving cardiac substrate. Abstract Table 1

Sleeve Gastrectomy Ameliorates Diabetes-Induced Cardiac Hypertrophy Correlates With the MAPK Signaling Pathway.

Background: Cardiac hypertrophy as a main pathological manifestation of diabetic cardiomyopathy (DCM), is a significant complication of diabetes. Bariatric surgery has been proven to relieve DCM; however, whether it can alleviate diabetes-induced cardiac hypertrophy is undefined.Methods: Diabetic and obese rats were performed sleeve gastrectomy (SG) after having diabetes for 16weeks. The rats were euthanized 8weeks after SG. Metabolic parameters, heart function parameters, myocardial glucose uptake, morphometric and histological changes, and the expression level of mitogen-activated protein kinases (MAPKs) were determined and compared among the control group (CON group), diabetes mellitus group (DM group), sham operation group (SHAM group), and SG group.Results: Compared with the SHAM group, the blood glucose, body weight, insulin resistance, and other metabolic parameters were significantly improved in the SG group. There was also a marked improvement in myocardial morphometric and histological parameters after SG. Furthermore, the myocardial glucose uptake and heart function were reversed after SG. Additionally, the phosphorylation of MAPKs was inhibited after SG, including p38 MAPKs, c-Jun N-terminal kinases (JNKs), and extracellular signal-regulated kinases 1/2 (ERK1/2). The expression of DUSP6, which dephosphorylates ERK1/2, was upregulated after SG. These findings suggest that SG ameliorated diabetes-induced cardiac hypertrophy correlates with the MAPK signaling pathway.Conclusion: These results showed that diabetes-induced cardiac hypertrophy was ameliorated after SG was closely related to the inhibition of the MAPK signaling pathway and upregulation of DUSP6. Therefore, this study provides a novel strategy for treating diabetes-induced cardiac hypertrophy.

Right heart condition in patients with COVID-19 pneumonia

Aim. To assess right heart condition in patients with coronavirus disease 2019 (COVID-19) pneumonia.Material and methods. One hundred and five patients with COVID-19 pneumonia were divided into 3 groups depending on the involvement of lung parenchyma: group I — 0-25%, II — 25-50%, III — 50-75%. The clinical status of patients was assessed using the NEWS2 and SHOKS-COVID scales. A complete blood count and biochemical blood tests were performed to determine the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I. Echocardiography was performed to assess the right heart structural, hemodynamic and functional parameters.Results. In patients with COVID-19 pneumonia, with an increase in lung parenchyma involvement, the intensity of systemic inflammatory response increased: C-reactive protein, group I — (4 [1,9; 35] mg/l), in III — (70,5 [33; 144] mg/l) (pI-III=0,012); myocardial stress marker level increased: NT-proBNP, group I — 77 [48; 150] ng/l, group III — 165 [100; 287] ng/l (pI-III=0,047). The dependence of NT-proBNP on C-reactive protein level was revealed (r=0,335, p=0,03). Intergroup comparison did not reveal significant differences between the main right heart functional parameters: TAPSE, Tei index (PW and TDI), FAC of the right ventricle (RV) (p>0,05). However, differences in the tricuspid annular peaks were found as follows: group I — 0,14 [0,12; 0,14] m/s, group II — 0,14 [0,12; 0,15] m/s, group III — 0,16 [0,14; 0,17] m/s (pI-II=0,012, pI-III=0,014) and RV global longitudinal strain: group I — 19,63±7,72%, group III — 27,4±5,93% (pI-III=0,014). The relationship between the RV global longitudinal strain and SHOKS-COVID score was confirmed (r=0,381; p=0,024).Conclusion. Patients with COVID-19 pneumonia showed no signs of right heart dysfunction. The development of RV hyperfunction was noted. Most likely, this is a compensatory mechanism in response to acute RV afterload. NT-proBNP increase under conditions of an inflammatory response may indicate myocardial stress. The results obtained allow to expand our understanding of the right heart condition in patients with COVID-19 pneumonia.

Intermittent therapy with levosimendan in patients with advanced heart failure

Abstract Introduction Therapeutic options for patients with advanced heart failure on the high-urgent (HU) heart transplant (HTx) waiting list are limited. In view of the limited data on the usefulness of classic inotropes, the calcium sensitizer levosimendan (Lev) may be a possible alternative for patients in need of a repetitive therapy with an inotropic agent as a bridge to HTx. Method In a single-center open-label study we retrospectively analyzed data from 34 HU-listed patients (from a total collective of 95 HU patients) who repetitively received Lev (12.5 mg; 0,05–0.1 μg/kg/min over 24–48h) in 2–8 weeks intervals due to cardiac instability and/or progressive second organ dysfunction. Potential side effects as well as changes of kidney, liver and heart functional parameters were evaluated (0–6 days before, 4–8 days and 14–20 days after Lev infusion). Patient collective: age 51±10 years, 6 women, 28 men; NYHA stage III-IV. 11 Patients with ischemic cardiomyopathy (32%), 19 patients with dilated cardiomyopathy (56%), 4 patients with arrhythmogenic right ventricular cardiomyopathy (12%). Results The waiting time for HTx was up to 12 months (6±5 months). There were no adverse, serious events (resuscitation, defibrillation for ventricular tachycardia (VT), intubation and ventilation, renal replacement therapy) up to 7 days after Lev infusion. Transient cardiac arrhythmias (ventricular bursts or non-sustained VTs) occurred in 11 patients (32%) with spontaneous termination and no need of urgent anti-arrhythmic therapy. The values for sodium, potassium, Hb and CRP did not change significantly after Lev. In contrast, there was a significant reduction in creatinine after 4–8 days (initially 1.43±0.4 mg/dl; after 4–8 days 1.28±0.3; p<0.0005) with an increase again after 14–20 days (1.43±0.3 mg/dl). The bilirubin value was significantly reduced after 4–8 days (initially 1.63±0.7 mg/dl; after 4–8 days 1.30±0.5; p<0.0005) with only partial (non-significant) increases again over the course (1.34±0.5 mg/dl). The BNP value was significantly reduced 4–8 days after administration of Lev (initially 1565±1136 ng/l; after 4–8 days 1103±895; p<0.0001) and increased again in the longer time course (1462±1001 ng/l; p<0.001 versus 4–8 days). 28 patients were successfully transplanted (82%). 6 patients remained without HTx (18%), of which 1 patient (3%) with clinical improvement could be discharged. 2 patients (6%) received an LVAD and 3 patients (9%) died during the waiting period. Conclusion Intermittent therapy with Lev as “a bridge to transplant” is safe and effective concerning deterioration of heart failure and prevention of progressive kidney/hepatic dysfunction. However, a prospective randomized multi-center trial is necessary to underscore the encouraging data of this observational, single center study. Funding Acknowledgement Type of funding sources: None.

Mendelian randomization study of the relation between adiponectin and heart function, unravelling the paradox

High adiponectin concentrations are generally regarded as beneficial with regard to cardiometabolic health, but have been paradoxically associated with increased cardiovascular disease risk, specifically heart failure, in individuals at high cardiovascular risk. We aimed to investigate the association between adiponectin and heart function parameters, and inversely, we estimated the effect of genetically-determined heart function and NT-proBNP as the main marker of heart failure on adiponectin using Mendelian randomisation.Observational analyses between adiponectin and measures of heart function, i.e. E/A ratio, left, and right ventricular ejection fraction, were performed in participants of the Netherlands Epidemiology of Obesity (NEO) study, assessed by MRI of the heart (n = 1,138). Two-sample Mendelian randomisation analyses were conducted to estimate the effect of NT-proBNP and heart function on adiponectin concentrations using publicly-available summary statistics (ADIPOGen; the PLATO trial).The mean (standard deviation) age was 56 (6) years and mean body mass index was 26 (4) kg/m2. Per five μg/mL higher adiponectin, the E/A ratio was −0.05 (95 % CI: −0.10, −0.01) lower, left ventricle ejection fraction was −0.5 % (95 % CI: −1.1, 0.1) lower, and right ventricle ejection fraction was 0.5 % (95 % CI: −0.1, 1.2) higher. Genetically-determined NT-proBNP was causally related to adiponectin concentrations in ADIPOGen: per doubling of genetically-determined NT-proBNP, adiponectin concentrations were 11.4 % (95 % CI: 1.7, 21.6) higher.With causal MR methods we showed that NT-proBNP affects adiponectin concentrations, while adiponectin is not associated with heart function parameters. Therefore, reverse causation may explain the adiponectin paradox observed in previous studies.

Doxorubicin induces wide-spread transcriptional changes in the myocardium of hearts distinguishing between mice with preserved and impaired cardiac function

AimsDoxorubicin (DOX) is an important drug for the treatment of various tumor entities. However, the occurrence of heart failure limits its application. This study investigated differential gene expression profiles in the left and right ventricles of DOX treated mice with either preserved or impaired myocardial function. We provide new mechanistic insights into the pathophysiology of DOX-induced heart failure and have discovered pathways that counteract DOX-induced cardiotoxicity. Main methodsWe used in total 48 male mice and applied a chronic low dose DOX administration (5 mg/kg per injection, in total 20 mg/kg over 4 weeks) to induce heart failure. Echocardiographic parameters were evaluated one week after the final dose and mice were separated according to functional parameters into doxorubicin responding and non-responding animals. Post mortem, measurements of reactive oxygen species (ROS) and gene expression profiling was performed in separated right and left hearts. Key findingsWe detected significant ROS production in the left heart of the mice in response to DOX treatment, although interestingly, not in the right heart. We found that transcriptional changes differ between right and left heart correlating with the occurrence of myocardial dysfunction. SignificanceDoxorubicin induces changes in gene expression in the entire heart of animals without necessarily impairing cardiac function. We identified a set of transcripts that are associated with DOX cardiotoxicity. These might represent promising targets to ameliorate DOX-induced heart failure. Moreover, our results emphasize that parameters of left and right heart function should be evaluated during standardized echocardiography in patients undergoing DOX therapy.

Effect of prone position ventilation on right heart function in patients with acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a severe respiratory disease with a high mortality rate. It is characterized by acute onset of pulmonary edema, hypoxemia, and the need of mechanical ventilation. As the primary treatment, ventilation has been considered effective in treating patients with ARDS. Recently, numerous studies have shown that prone position ventilation demonstrates more efficacy compared with traditional supine position. However, the potential impact of the non-physiological prone position on patients remains unclear. Current study aims to evaluate the effect of prone position ventilation on right heart function in ARDS patients. Following Berlin Diagnostic Criteria, 80 eligible patients were recruited and randomly assigned into prone position ventilation group and supine position ventilation group. Different ventilation methods were implemented in these two groups. Both positions showed the beneficial effects, as evidenced by decreased PV score and APACHE II score, enhanced blood gas index and right heart function parameters, and the prognosis analysis. However, compared with those receiving SPV treatment, the patients demonstrated greater benefits from PPV treatment, with significant differences in PV score (p < 0.01) and APACHE II score (p < 0.001), blood gas index such as PAPm (p < 0.05), and right heart function indicators (p < 0.05). Prone position mechanical ventilation is more beneficial than supine position ventilation in improving the blood gas status of patients with moderate to severe ARDS, and it is more helpful to reduce the load on the right heart and promote the recovery of patients.

STUDY ON CARDIOVASCULAR MONITORING AND DIAGNOSIS OF ATHLETES

ABSTRACT Introduction: The study and collection of athletes’ heart function index parameters and the correct and reasonable evaluation of body functions can effectively adjust training plans and avoid athletes’ bodily exhaustion. Objective: To study the diagnosis of myocardial injury by cardiovascular monitoring in athletes from two aspects: extraction of characteristic parameters of heart function and research of signal processing. Methods: The heart function intelligent evaluation algorithm was studied by using multi-source information fusion, and embedded technology; miniature sensors were used as well. Results: The incidence of severe ventricular arrhythmia was lower in both groups. The incidence of sinus arrhythmia and intermittent second degree I atrioventricular block in the high-intensity group was significantly higher than that in the control group. The number of atrial and ventricular premature beats was lower in the control group, but increased significantly in the high-intensity group. Conclusions: This study applied the theory of multi-source information fusion to carry out representative research on the intelligent monitoring and evaluation of the heart function of elite athletes, centering on the application requirements of the heart function monitoring of elite athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.

Improvement of cardiac and systemic function in old mice by agonist of growth hormone-releasing hormone.

Age-related diseases such as cardiovascular diseases portend disability, increase health expenditures, and cause late-life mortality. Synthetic agonists of growth hormone-releasing hormone (GHRH) exhibit several favorable effects on heart function and remodeling. Here we assessed whether GHRH agonist MR409 can modulate heart function and systemic parameters in old mice. Starting at the age of 15 months, mice were injected subcutaneously with MR409 (10 µg/day, n = 8) or vehicle (n = 7) daily for 6 months. Mice treated with MR409 showed improvements in exercise activity, cardiac function, survival rate, immune function, and hair growth in comparison with the controls. More stem cell colonies were grown out of the bone marrow recovered from the MR409-treated mice. Mitochondrial functions of cardiomyocytes (CMs) from the MR409-treated mice were also significantly improved with more mitochondrial fusion. Fewer β-gal positive cells were observed in endothelial cells after 10 passages with MR409. In Doxorubicin-treated H9C2 cardiomyocytes, cell senescence marker p21 and reactive oxygen species were significantly reduced after cultured with MR409. MR409 also improved cellular ATP production and oxygen consumption rate in Doxorubicin-treated H9C2 cells. Mitochondrial protein OPA1 long isoform was significantly increased after treatment with MR409. The effects of MR409 were mediated by GHRH receptor and protein kinase A (PKA). In short, GHRH agonist MR409 reversed the aging-associated changes with respect of heart function, mobility, hair growth, cellular energy production, and senescence biomarkers. The improvement of heart function may be related to a better mitochondrial functions through GHRH receptor/cAMP/PKA/OPA1 signaling pathway and relieved cardiac inflammation.

The role of thyrostatic agents in the treatment of chronic heart failure patients with comorbid coronary artery disease and thyrotoxicosis

Background: Thyroid dysfunction exerts a pronounced effect on the cardiovascular system, and, if comorbid with an existing cardiovascular disorder, may lead to a significant deterioration in the outcome, thus obviating the need for timely diagnosis and therapy optimization.Aim: To evaluate the effect of combination therapy, including thyrostatics, on the clinical symptoms of chronic heart failure (CHF), heart rate variability, NT-proBNP concentration, and structural and functional parameters of the left heart in patients with comorbid coronary artery disease (CAD) and thyrotoxicosis.Materials and methods: This open-label comparative study included 77 patients aged 45–65 years. The study group consisted of 36 patients with thyrotoxicosis, CAD and CHF II–III functional class, whereas the comparison group consisted of 41 patients with thyrotoxicosis without cardiovascular diseases. The patients were assessed clinically at baseline and after 6 months of therapy with addition of a thyrostatic, with tolerance to physical activity, measurements of NT-proBNP levels, 24-hour Holter monitoring, and echocardiography.Results: At 6 months of the combination therapy including a thyrostatic, with stable drug-induced euthyroidism, the patients in the group 1 showed an increase in the distance of a 6-minute walking test (p&lt;0.001) and a decrease in CHF clinical symptoms. The incidence of heart rhythm disorders decreased (supraventricular extra systoles from 31% to 16%, ventricular extra systoles from 21% to 4%, atrial fibrillation from 32% to 23%; p&lt;0.05), with a positive trend for spectral and temporal parameters of heart rate variability. The NT-proBNP level in patients with CAD, CHF and thyrotoxicosis decreased by 42.9% (p=0.001). During euthyrosis, echocardiography in the patients with ischemic CHF and concomitant thyrotoxicosis showed a significant increase in stroke volume (p=0.03), stroke ejection index (p=0.04), left ventricular ejection fraction (p=0.01), a decrease in the value of myocardial stress (p=0.02), and transmitral blood flow parameters (E/A, p&lt;0.05). This indicates an improvement in systolic and diastolic left ventricular function after normalization of thyroid function.Conclusion: The inclusion of thyreostatics to the combination therapy and the achievement of euthyrosis have contributed to increased tolerance to physical activity, reduction of sympathetic activity level of the autonomic nervous system and frequency of heart rhythm disorders, reduced the NT-proBNP levels, improved systolic and diastolic left ventricular function in patients with ischemic CHF and concomitant thyrotoxicosis.

Age- and Sex-Specific Changes in CMR Feature Tracking-Based Right Atrial and Ventricular Functional Parameters in Healthy Asians.

Cardiovascular magnetic resonance (CMR) is the reference standard for non-invasive assessment of right-sided heart function. Recent advances in CMR post-processing facilitate quantification of tricuspid annular (TA) dynamics and longitudinal strains of the right ventricle (RV) and right atrium (RA). We aimed to determine age- and sex-specific changes in CMR-derived TA dynamics, and RV and RA functional parameters in healthy Asian adults. We studied 360 healthy subjects aged 21–79 years, with 30 men and 30 women in each of the six age groups. Functional parameters of RV and RA were measured on standard four-chamber cine CMR using fast feature tracking: (1) TA peak velocities (systolic velocity S′, early diastolic velocity E′, late diastolic velocity A′) and TA plane systolic excursion (TAPSE); (2) RV global longitudinal strain (GLS) and strain rates; and (3) RA phasic longitudinal strains and strain rates. S′ and TAPSE exhibited negative correlations with age. RV GLS was significantly higher in females than in males but not associated with age in both sexes. Females had similar E′, lower A′, and higher E′/A′ ratios compared to males. Positive associations of E′ and E′/A′, and negative association of A′ with age were observed in both sexes. Females had higher RA reservoir and conduit strains compared to males. There were significantly negative and positive associations between RA conduit and booster strains, respectively, with age. Age- and sex-specific reference ranges were established, and associations revealed, for fast CMR feature tracking parameters of right heart function in a large normal Asian population.

Cardiac 18F-FDG Positron Emission Tomography: An Accurate Tool to Monitor In vivo Metabolic and Functional Alterations in Murine Myocardial Infarction.

Cardiac monitoring after murine myocardial infarction, using serial non-invasive cardiac 18F-FDG positron emissions tomography (PET) represents a suitable and accurate tool for in vivo studies. Cardiac PET imaging enables tracking metabolic alterations, heart function parameters and provides correlations of the infarct size to histology. ECG-gated 18F-FDG PET scans using a dedicated small-animal PET scanner were performed in mice at baseline, 3, 14, and 30 days after myocardial infarct (MI) by permanent ligation of the left anterior descending (LAD) artery. The percentage of the injected dose per gram (%ID/g) in the heart, left ventricular metabolic volume (LVMV), myocardial defect, and left ventricular function parameters: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and the ejection fraction (EF%) were estimated. PET assessment of the defect positively correlates with post-infarct histology at 3 and 30 days. Infarcted murine hearts show an immediate decrease in LVMV and an increase in %ID/g early after infarction, diminishing in the remodeling process. This study of serial cardiac PET scans provides insight for murine myocardial infarction models by novel infarct surrogate parameters. It depicts that serial PET imaging is a valid, accurate, and multimodal non-invasive assessment.

Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET).

Exercise Doppler echocardiography (EDE) is a well-validated tool in ischemic and valvular heart diseases. However, its use in the assessment of the right heart and pulmonary circulation unit (RH-PCU) is limited. The aim of this study is to assess the semi-recumbent bicycle EDE feasibility for the evaluation of RH-PCU in a large multi-center population, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension (PH). From January 2019 to July 2019, 954 subjects [mean age 54.2 ± 16.4years, range 16-96, 430 women] underwent standardized semi-recumbent bicycle EDE with an incremental workload of 25 watts every 2min, were prospectively enrolled among 7 centers participating to the RIGHT Heart International NETwork (RIGHT-NET). EDE parameters of right heart structure, function and pressures were obtained according to current recommendations. Right ventricular (RV) function at peak exercise was feasible in 903/940 (96%) by tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) by tissue Doppler-derived tricuspid lateral annular systolic velocity (S') and 445/672 (66.2%) by right ventricular fractional area change (RVFAC). RV-right atrial pressure gradient [RV-RA gradient = 4 × tricuspid regurgitation velocity2 (TRV)] was feasible in 894/954 patients (93.7%) at rest and in 816/954 (85.5%) at peak exercise. The feasibility rate in estimating pulmonary artery pressure improved to more than 95%, if both TRV and/or right ventricular outflow tract acceleration time (RVOT AcT) were considered. In high specialized echocardiography laboratories semi-recumbent bicycle EDE is a feasible tool for the assessment of the RH-PCU pressure and function.

Protective effects of Cyathula prostrata leaf extract on olanzapine-induced obese rats

Olanzapine, an atypical antipsychotic drug often induces excessive weight resulting in obesity. The adverse effect hinder adherence to drug regimens and therefore relapse into psychosis. Traditionally in Nigeria, leaf broth from Cyathula prostrata leaf is consumed to achieve weight loss. Rats were first administered 50-200 mg/kg bw CPLE and orlistat (5 mg/kg bw), used as reference. Rats were then administered 8 mg/kg bw of olanzapine one hour after the administration of the CPLE and orlistat, all the administration were done for 28 days. Those with body mass index (BMI) ˃ 0.5 g/cm2 were considered obese. The influence of the extract at varying doses on BMI, lipid profiles, oxidative and enzyme markers in the heart and liver of the obese rats were evaluated. Anthropometric data showed that CPLE significantly (p &lt; 0.05) induced weight loss and attenuated BMI increase when compared to untreated olanzapine-induced obese rats. Biochemical analyses also revealed reduction in the serum level of LDL-c, total cholesterol, triglycerides, lipase and creatine kinase activities in CPLE-treated groups. Concentration of malondialdehyde was decreased, while the activities of antioxidant enzymes as well as that of alkaline phosphatase, alanine and aspartate aminotransferase were increased following administration of CPLE to the obese rats. Findings from this study supported the indigenous use of extracts from C. prostrata leaf in the management of obesity. The study concluded that CPLE can protect against weight gain, obesity, dyslipidaemia, oxidative stress and alteration in the heart and liver function parameters induced by olanzapine co-administration in rats.

Characteristics of LVAD Turn-Down Study to Predict Myocardial Recovery and Successful LVAD Decommissioning

<h3>Purpose</h3> Myocardial recovery after left ventricular device (LVAD) implantation is important to identify; however, identifying predictors of successful LVAD decommissioning, and recurrence of heart failure remains a challenge. <h3>Methods</h3> We performed a retrospective analysis on individuals who underwent a protocolized echocardiographic and invasive hemodynamic turn-down study. Patients were selected based on normalized hemodynamics, clinical stability and LVEDD <5.5 cm. <h3>Results</h3> A total of 12 patients underwent the LVAD weaning protocol. Of those patients, 42% (5/12) underwent LVAD decommissioning with sustained recovery (SR) (median 13 months) while 58% (7/12) failed recovery (FR) by requiring LVAD re-implantation after decommissioning or failed turn-down study precluding LVAD decommission. In FR versus SR patients LV-end systolic (LVESD) and -end diastolic (LVEDD) diameter were higher at the start (LVESD 4.8 ± 0.4 FR vs 3.5 ± 0.3 SR, p<0.05, Fig A; LVEDD 5.3 ± 0.3 FR vs 4.5 ± 0.2 mm SR, p = 0.066, Fig C) and end (LVESD 4.6 ± 0.5 FR vs 3.2 ± 0.3 mm SR, p<0.05, Fig B; LVEDD 5.4 ± 0.3 FR vs 4.6 ± 0.2 mm SR p = 0.10, Fig D) of the turn-down. Ejection fraction did not differ at start or end of the turn-down study between groups (Fig E,F). Hemodynamic parameters of right heart function differed between FR and SR patients. Central venous pressure (CVP) increased in the FR group through the turn-down study, whereas CVP decreased or did not change in the SR group (∆CVP 1.5 ± 0.8 FR; -1.0 ± 0.4 mmHg SR, p<0.05; Fig G). Pulmonary artery pulsatility index (PAPI) decreased in FR patients at the end of turn-down study, whereas PAPI increased in those with SR (∆PAPI -0.6 ± 0.2 FR; 0.6 ± 0.5 mmHg SR, p<0.05; Fig H). LVAD power prior to LVAD turn-down was higher in FR relative to SR patients (4.1 ± 0.3 FR; 2.9 ± 0.3 W SR, p<0.05, Fig I). <h3>Conclusion</h3> In our cohort of LVAD turn-down studies, we were able to identify echo parameters, invasive hemodynamics, and LVAD pump parameters that differed between patients with failed and sustained recovery.

Features of anaesthetic echocardiomonitoring in dogs weighing up to 10 kg with heart disease

A traumatic factor affecting tissues causes a complex of morphological and functional disorders of structures. The body responds to this damage with a protective-adaptive reaction, which regulates the effect of the stimulus by the neurohumoral defense of the body. Decreased cell resistance and physiological functions result from disorders of the nervous and endocrine system. In terms of anesthetic complications and mortality related to anesthesiological practice, which are the cause of 25-50% of fatal outcomes after non-cardiological operations. The aim of the work was a comparative assessment of echocardiographic parameters of systolic and diastolic heart function in dogs that were undergoing elective anesthesia. Ultrasonographic examination was performed initially before and after general anesthesia based on propofol, isoflurane and zoletil. In the long term, after 1 month and 1 year after anesthesia. The results of the study showed a decrease in the systolic and diastolic functions of the heart. The criterion for assessing systolic function is a decrease in the ejection fraction, an increase in end-systolic and end-diastolic size. The criterion for assessing diastolic function is a decrease in the maximum speed of the transmitral flow during early diastole and an increase in the maximum speed of the transmitral flow during the late diastole. A month after anesthesia, the progression of a decrease in myocardial contractility was revealed. Due to an increase in the end-diastolic volume in a month and a year after anesthesia, the overloaded left ventricle maintained a normal cardiac output even with a decrease in the fraction of the emission.

Structural and functional indicators of the heart of patients with ischemic heart disease and type 2 diabetes mellitus. Rhythmoinotropic response isolated myocardium at different levels of glycated hemoglobin

BACKGROUND: Adequate glycemic control can significantly reduce the risk of developing cardiovascular events. However, until now, glycaemic targets in aged patients remain a subject of discussion, especially in the conditions of the combined development of Type 2 Diabetes Mellitus (T2DM) and ischemic heart disease (IHD).AIMS: To examine the structural and functional heart parameters in patients with IHD associated with T2DM and the rhythmoinotropic responses of their isolated myocardium depending on glycated hemoglobin level.MATERIALS AND METHODS: The study included 44 patients with a diagnosis of "chronic IHD associated with T2DM", of which 2 groups were formed. Patients with glycated hemoglobin level (HbA1c) &lt;8% were included in the 1st group, and patients with HbA1c ≥8% were included in the 2nd group. The structural and functional heart parameters obtained with ultrasonography, and the rhythmoinotropic responses of myocardium in patients ex vivo were analyzed using the right atrial appendage fragments obtained during elective coronary artery bypass graft. The inotropic response of muscle strips at a basic stimulation frequency of 0,5 Hz to testing influences was assessed. An extrasystolic test and post-rest test were performed.RESULTS: It was found that extrasystolic contractions of isolated myocardial strips in patients of the 2nd group appeared at shorter extrasystolic intervals, which indicates a greater excitability of the myocardium in patients of this group. Postextrasystolic muscle contractions in patients of the 2nd group had significant potentiation. The amplitude of the muscle strips contractions in patients of both groups was potentiative after short rest periods. However, with an increase in the rest duration, potentiation of contractions was observed only in the group with a higher HbA1c level. According to the ultrasonography data, it was found that the values of the endsystolic and diastolic volumes, the interventricular septum thickness and the left ventricular (LV) myocardium mass were significantly lower in the patients of the 1st group compared with the corresponding indicators in the patients of the 2nd group. The early LV filling velocity (peak E) was significantly lower in the patients of the 1st group, which indicates a slower LV relaxation. At the same time, the rapid LV filling velocity did not have a significant intergroup difference, but this indicator exceeded the reference values in both groups.CONCLUSIONS: With a moderately increased glycemic level (9,2 [8,0; 10,3]%), the structural and functional heart parameters are preserved both at the level of the isolated myocardial tissue and at the level of the whole heart.

Структурно-функциональные показатели сердца пациентов с ишемической болезнью сердца и сахарным диабетом 2 типа. Ритмоинотропная реакция изолированного миокарда при разном уровне гликированного гемоглобина

BACKGROUND : Adequate glycemic control can significantly reduce the risk of developing cardiovascular events. However, until now, glycaemic targets in aged patients remain a subject of discussion, especially in the conditions of the combined development of Type 2 Diabetes Mellitus (T2DM) and ischemic heart disease (IHD). AIMS : To examine the structural and functional heart parameters in patients with IHD associated with T2DM and the rhythmoinotropic responses of their isolated myocardium depending on glycated hemoglobin level. MATERIALS AND METHODS : The study included 44 patients with a diagnosis of chronic IHD associated with T2DM, of which 2 groups were formed. Patients with glycated hemoglobin level (HbA 1c ) <8% were included in the 1 st group, and patients with HbA 1c ≥8% were included in the 2 nd group. The structural and functional heart parameters obtained with ultrasonography, and the rhythmoinotropic responses of myocardium in patients ex vivo were analyzed using the right atrial appendage fragments obtained during elective coronary artery bypass graft. The inotropic response of muscle strips at a basic stimulation frequency of 0,5 Hz to testing influences was assessed. An extrasystolic test and post-rest test were performed. RESULTS : It was found that extrasystolic contractions of isolated myocardial strips in patients of the 2 nd group appeared at shorter extrasystolic intervals, which indicates a greater excitability of the myocardium in patients of this group. Postextrasystolic muscle contractions in patients of the 2 nd group had significant potentiation. The amplitude of the muscle strips contractions in patients of both groups was potentiative after short rest periods. However, with an increase in the rest duration, potentiation of contractions was observed only in the group with a higher HbA 1c level. According to the ultrasonography data, it was found that the values of the endsystolic and diastolic volumes, the interventricular septum thickness and the left ventricular (LV) myocardium mass were significantly lower in the patients of the 1 st group compared with the corresponding indicators in the patients of the 2 nd group. The early LV filling velocity (peak E) was significantly lower in the patients of the 1 st group, which indicates a slower LV relaxation. At the same time, the rapid LV filling velocity did not have a significant intergroup difference, but this indicator exceeded the reference values in both groups. CONCLUSIONS : With a moderately increased glycemic level (9,2 [8,0; 10,3]%), the structural and functional heart parameters are preserved both at the level of the isolated myocardial tissue and at the level of the whole heart.