Parameters Of Intracardiac Hemodynamics Research Articles

COMPARISON OF THE DISORDERED MECHANICAL FUNCTION OF THE LEFT ATRIUM AFTER ANTRAL ISOLATION OF PULMONARY VEINS BY RADIOFREQUENCY OR CRYOBALLOON ABLATION

Aim. To assess and compare mechanical functioning of the left atrium before and just after cryoballoon or radiofrequency ablation. Material and methods . Totally, 43 patients included, with sympthomatic atrial fibrillation resistant to drug treatment. Of those 21 — for cryoballoon ablation (mean age 57,8±8,7 y. o., 11 males and 10 females) and 22 candidates for radiofrequency ablation, at the age 54,4±11 y. o., 16 males and 6 females. Before procedure, just after and on the 5th day, transthoracal echocardiography was performed, with measurement of Doppler parameters of intracardiac hemodynamics, as mechanical function of the left atrium assessment, including 3D imaging. Results. By the data from transthoracal echocardiography and direct intraoperation manometry, the significant disorders of the left atrium (LA) mechanical function were found in both treatment groups, with some differences. Pulmonary veins (PV) isolation by any method does not influence diastolic and systolic function of the left ventricle, that confirmed by invasive measurements of the end-diastolic pressure in LV, as the changes of volumes and ejection fraction by echocardiography. Therefore transmitral blood flow dynamics, as PV and pulmonary artery flow, related to PV isolation procedure, is a result of the LA functioning disorder due to its passive dilatability and active contractility decrease, dysfunction of the PV sleeves, increase of pulmonary vascular resistance. The significant decrease found in LA pumping function, more prominent in radiofrequency group just after the procedure, with further improvement to the 5th day after procedure. Also, mean pulmonary artery pressure increase, and till the 5th day in radiofrequency group it was significantly higher than in cryoablation group. Conclusion. Both cryo and radio ablation procedures of PV isolation significantly impact on the mechanical functioning of the LA, however cryo ablation leads to less severe disorder at short follow-up.

The investigation of cardioprotective effects of novel necroptosis inhibitors - necrosulfonamide and necrostatin-1s in the rat model of isolated perfused rat heart

Minimization of irreversible myocardial damage after ischemia-reperfusion episode remains valid and unsolved problem. Among of many pharmacological agents have been effective in experimental studies, only a few of them are evidence of its efficacy in clinical trials. This is largely explained by the mechanism of action of these compounds, aimed primarily at preventing reperfusion injury, and do not affect myocardial cells subjected to prolonged ischemia without reperfusion. In recent years, the interest of researchers confined to the mechanisms of programmed necrosis or necroptosis, which morphologically has no different to necrosis, but has molecular targets for suppression. In this paper, on the model of global ischemia-reperfusion in rats we have studied cardioprotective effects of high-activity and low-toxicity necroptosis inhibitors - necrosulfonamide and necrostatin-1s. We demonstrated the infarct-limiting effect of these compounds, as well as the best parameters of intracardiac hemodynamics after an episode of global ischemia-reperfusion. We believe these compounds are interesting for further preclinical studies.

Disorders of Vasoregulative Endothelial Function, Echocardiographic Assessment of Myocardial Dysfunction and Hemodynamics of Pulmonary Circulation in Cirrhosis of the Liver

to study relationship between parameters of intracardiac hemodynamics assessed by Doppler echocardiography and functional activity of endothelium, hepatic blood flow and severity of portal hypertension in patients with cirrhosis of the liver (CL) of different etiology. We found that changes of structural and functional parameters of the heart in LC depended on the stage of compensation of portal hypertension and were accompanied by rearrangement of parameters of intracardiac hemodynamics. Pulmonary arterial hypertension (PAH) was found in 11.1% of patients with LC. PAH was moderate and was more frequent in patients with end-stage disease (Child-Pugh class C) compared with those with initial stage of LC (21.4% and 6.3%, p<0.05, respectively). Disorders of vasoregulating endothelial function in patients with CL were related to parameters of cardiopulmonary hemodynamics and functional state of the right ventricle and were more pronounced in patients with PAH.

Динамика показателей внутрисердечной гемодинамики в ходе реабилитации больных артериальной гипертензией

Динамика показателей внутрисердечной гемодинамики в ходе реабилитации больных артериальной гипертензией

THE INFLUENCE OF DYNAMIC AND STATIC PHYSICAL EXERCISES ON THE PARAMETERS OF INTRACARDIAC HEMODYNAMICS AND PHYSICAL ENDURANCE IN HIGHER-LEVEL SPORTSMEN

Aim. To assess the influence of dynamic and static exercises on the parameters of intracardiac hemodynamics and physical endurance in higher-level sportsmen. Material and methods. Totally, 136 sportsmen studied all males. Higher- level (qualified) sportsmen (groups of sports perfection and higher sports mastery) — 116 persons (mean age 22,07±4,10 y.; sports experience 5-15 years) depending on the type of activity were selected into groups as following: I (n=30) — wrestling, judo, II (n=27) — ski racing, biathlon, III (n=33) — powerlifting, IV (n=26)—volleyball. Group V (n=20) — controls (age 17,95±1,55 y.), with the experience not higher than 3 years. Investigation methods: electrocardiography, echocardiography (EchoCG), veloergometry. Results. By the data of ECG the parameters of intracardiac hemodynamics in sportsmen of all groups were in the normal range. There were significant differences found for the geometry of the heart between control group and higher-level sportsmen, and the controls had lower morphostructural parameters. In highly dynamic kinds of sports (ski racing, biathlon) the morphostructural changes are related to the increase of volumetric parameters of the left ventricle. Intensive static and low dynamic load in power kinds of sports (powerlifting) lead to the increase of myocardial mass, caused by thickness of the left ventricle walls. The highest values of the level of physical endurance and maximum oxygen consumption were in biathlon and ski racing sportsmen who train endurance. Conclusion. Study of the influence of dynamic and static physical exertion on the parameters of intracardiac hemodynamic, morphostructure of the heart and physical endurance is of definitive importance for the evaluation of cardiovascular adaptation potential in higher-level sportsmen. Depending on the type and intensity of the exertion adaptation mechanisms have their specifics. The obtained data can be used for on-time correction of the training regimens and for management of training-competition process in sportsmen of various kinds. That means, EchoCG and veloergometry must be included into the list of obligatory diagnostic methods that fulfill systemic dynamic control of cardiovascular system parameters in the highest achievement sportsmen, that has special significance for revealing of the signs of desadaptation and overtraining in longtime sports involvement.

Dronedarone does not affect infarct volume as assessed by magnetic resonance imaging in a porcine model of myocardial infarction.

Dronedarone has been demonstrated to be harmful in patients with recent decompensated heart failure. Furthermore, a PALLAS study reported that dronedarone therapy increases mortality rates in patients with permanent atrial fibrillation. Although a pathophysiological explanation for these finding remains to be elucidated, the long term effects of dronedarone on myocardial structure and stability have been suggested. The aim of the present study was to determine whether dronedarone therapy affects left ventricular (LV) function in a chronic model of myocardial infarction (MI). An anterior MI was induced in 16 pigs. Of these animals, eight pigs were then treated with dronedarone for 1 week prior to, and 4 weeks following MI, the remaining pigs served as controls. LV angiography was performed 4 weeks after MI to determine the LV ejection fraction (LVEF). A post‑mortem magnetic resonance imaging scan of the LV was then performed on the two groups (n=6) to determine the volume and size of the induced MI. Dronedarone therapy did not affect systemic and intracardiac hemodynamic parameters or LVEF during the follow‑up assessment. Of note, dronedarone had no negative effect on the total infarct volume and size and did not induce lethal proarrhythmic effects following the induced anterior MI. Therefore, the results suggested that dronedarone did not increase the volume or size of induced anterior MI and did not affect LV performance. Thus, dronedarone therapy was observed to be safe in a porcine model of anterior MI.

Optimization of cardiac resynchronization therapy according to the surface ECG

Background: Atrioventricular and interventricular delay (VVD) optimization is an important part of CRT correction. The lack of this procedure or incorrect performance may reduce the positive effect of cardiac resynchronization and enhance Heart Failure (HF). Widely used selection of VVD methods with different ways of echocardiography requires special skills and time-consuming. Aim: To assess the impact of VVD optimization in CRT devices based on changes in the width of the QRS complex using ECG on intracardiac hemodynamic parameters in the long-term period. Materials and methods: 96 patients after CRT implantation were divided into 2 groups (I - with selection of VVD, n=48, II - without selection of VVD, n=48) with sinus rhythm, complete left bundle branch block, ejection fraction (EF) ≤35%.QRS complex was measured before CRT implantation (QRSown), then every 6 months: QRS measurement in the temporary device suppression mode (QRSno-st), measuring the width of the stimulated QRS complex (QRSst) during the VVD optimization process. VVD selection was implemented by gradual change the delay time of stimulation of the right/left ventricle (from 0 to 40 ms) and simultaneous measurement of the stimulated QRS width on ECG. The final VVD result was assumed to the narrowest QRS. Echocardiography was performed in all patients before CRT implantation and then every 6 months. Observation period was 2 years. Results: For 24 month follow-up there was significant reducion in the QRSst width in Group I, p = 0.042. Final values of the QRSst and QRSno-st width were lower in Group I, p = 0.015 and p = 0.001 respectively. There are no significant differences in baseline QRS and QRSst between the groups. End-systolic and end-diastolic LV volume significantly decreased in both groups; reduction in the end-systolic volume was greater in Group I compared to Group II, p = 0.039. EF increased in both groups; percentage increase in EF was significantly higher in Group I, p = 0.048. Functional class (FC) of HF decreased in both groups; the final FC value was significantly lower in Group I, 2.12 versus 2.64 in Group II, p = 0.001. Conclusions: VVD optimization in CRT devices using ECG influences on hemodynamic parameters in the long-term period. The narrowest QRS can be the sign of optimal cardiac synchronization. This safe and reproducible method improves the electrical systole of the myocardium and can adjust the conduction system of ventricles that leads subsequently to a decrease in FC of HF.

Hemodynamic Patterns for Symptomatic Presentations of Severe Aortic Stenosis

The aim of this study was to investigate intracardiac hemodynamic idiosyncrasies responsible for various presentations of severe aortic stenosis (AS). Syncope, dyspnea, and chest pain are well-established indications for aortic valve replacement in patients with severe AS. Patients' survival is limited once they develop symptoms from AS, and survival depends on what type of symptoms a patient develops. We hypothesized that there would be a relationship between the type of AS symptoms and intracardiac hemodynamics as well as AS severity. We analyzed 498 patients (men: 58.4%, 66 ± 12 years of age) with severe AS and normal left ventricular ejection fraction from 2003 to 2009 who had comprehensive echocardiography examination for AS. The study population was divided into 4 groups based on presenting symptom(s) (341 in group I, asymptomatic; 15 in group II, syncope; 110 in group III, dyspnea; 32 in group IV, chest pain). Echocardiographic measurements for cardiac structure, function, and intracardiac hemodynamic parameters were compared among these 4 groups. Mean aortic valve pressure gradient and aortic valve area were 57.1 ± 15.2 mm Hg and 0.74 ± 0.19 cm(2), respectively. AS severity based on mean gradient and aortic valve area was similar among 4 groups. Compared with the asymptomatic group, symptomatic patients were older and had lower cardiac output, and higher E/e' ratio while having a similar aortic valve area and gradient. Group II (syncope) displayed smaller LV dimension, stroke volume, cardiac output, left atrial volume index, and E/e' ratio. Conversely, group III (dyspnea) was found to have the worst diastolic function with largest left atrial volume index and highest E/e' ratio. Among patients with severe AS, their symptoms are often linked to specific hemodynamic patterns associated with AS: smaller left ventricular cavity and reduced output for syncope versus more advanced diastolic dysfunction for dyspnea. Hence, comprehensive intracardiac hemodynamics including diastolic function and stroke volume need to be evaluated in addition to aortic valve area and pressure gradient for assessment of AS.

In Vivo Toll-Like Receptor 4 Antagonism Restores Cardiac Function During Endotoxemia

Severe sepsis and septic shock are often accompanied by acute cardiovascular depression. Lipopolysaccharide (LPS) signaling via Toll-like receptor 4 (TLR4) can induce septic organ dysfunction. The aim of this study was to elucidate the in vivo impact of pharmacological TLR4 antagonism on LPS-induced cardiovascular depression using eritoran tetrasodium (E5564). To simulate sepsis, C3H/HeN mice were challenged i.p. with 2 mg/kg body weight LPS. With the intent to antagonize the LPS effects, eritoran was administered i.v. (4 mg/kg body weight). Physical activity, peripheral blood pressure, and heart frequency were recorded before and after LPS and eritoran injection. In addition, intracardiac hemodynamic parameters were analyzed with a pressure conductance catheter. After 2 and 6 h of LPS stimulation ± eritoran treatment, the hearts and aortae were harvested, and TLR as well as inflammatory mediator expression was measured using reverse transcription-quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. Lipopolysaccharide significantly decreased arterial blood pressure over time. Administration of eritoran partially prevented the LPS-dependent reduction in blood pressure and preserved cardiac function. In addition, LPS increased the expression of CD14 and TLR2 in cardiac and aortic tissue. In aortic tissue, eritoran attenuated this increase, whereas no significant reduction was observed in the heart. Furthermore, cardiac and aortic inducible nitric oxide synthetase mRNA levels were significantly increased 6 h after LPS application. This effect was reduced in the presence of eritoran. In summary, the beneficial influence of eritoran on cardiovascular function in vivo seems to rely mainly on reduction of LPS-induced inducible nitric oxide synthetase expression as well as on attenuated cytokine expression in the vascular wall.

Echocardiographic Monitoring of Intracardiac Hemodynamics in Neonatal Respiratory Distress Syndrome

Objective: to perform an early neonatal ultrasound study of intracardiac hemodynamics in premature neonates with respiratory distress syndrome (RDS) during mechanical ventilation. Subjects and methods. The paper presents the results of ultrasound study of intracardiac hemodynamics in 51 premature neonates. Two patient groups were identified. Group 1 comprised 34 infants with severe RDS who received the exogenous surfactant Curosurf and Group 2 consisted of 17 apparently healthy premature newborn infants. Results. Functional tension of the cardiovascular system was characterized for premature neonates with RDS. There were signs of left ventricular systolic dysfunction within the first 24 hours of life and those of right ventricular dysfunction by day 5 of postnatal age. Within 5 days of life, there were echocardiographic signs of pump dysfunction of both ventricles: stroke volume, cardiac index, and blood minute volume. Analysis of changes in peak blood flow velocity and peak pressure gradient across the atrioventricular valves of the right and left ventricles indicated that 17.6% of the children showed increases in peak blood flow velocity and tricuspid valve pressure gradient in the systolic phase. The greatest peak blood flow velocity changes were recorded in the pulmonary artery trunk. By day 5 of life, signs of pulmonary hypertension concurrent with hydropericardium remained in 29.4% of cases. RDS &#8211; was shown to be accompanied by higher Qp/Qs ratio in premature neonates. The lower index was attended by the alleviated signs of respiratory failure. In RDS, mainly left-to-right blood shunt was accomplished through the open oval window, but the shunt intensity decreased when the pathological process was resolved in the lung. The functioning patent ductus arteriosus was hemodynami-cally significant in none case. Conclusion. The premature neonates with RDS were found to have intracardiac hemo-dynamic changes. By day 5 of postnatal age, there was no normalization of major intracardiac hemodynamic parameters although respiratory failure resolved in most neonates. Key words: premature neonates, respiratory distress syndrome, mechanical ventilation, intracardiac hemodynamics, echocardiography.

Monitoring the Function of the Right Ventricle of the Heart When Correcting an Interventricular Septal Defect

A clinical study of intracardiac hemodynamics was conducted on 46 patients with an interventricular septal defect. The practical significance of determining the contractile state of the right ventricular myocardium was confirmed based on information obtained during the long-term catheterization of the right chambers of the heart, when constructing the right ventricular function curves, and analyzing the pressure–volume diagrams. This approach to the analysis of intracardiac hemodynamic parameters versus conventional hemodynamic monitoring allows the cardiac function to be assessed on a real-time basis, the causes of the development of a low cardiac output to be revealed, and optimal ways of the regulation of myocardial contractility to be elaborated.

Initial experience with an implantable hemodynamic monitor.

Measurement of intracardiac hemodynamic parameters has been limited to brief periods in the acute care setting. We developed and evaluated an implantable hemodynamic monitor that is capable of measuring chronic right ventricular oxygen saturation and pulmonary artery pressure. The device consists of an electronic controller placed subcutaneously and two transvenous leads placed in the right ventricle (reflectance oximeter) and pulmonary artery (variable capacitance pressure sensor). Implantation was performed in 10 patients with severe left ventricular dysfunction. Average implant pulmonary artery pressures were systolic, 52 +/- 16 mm Hg; diastolic, 29 +/- 11 mm Hg; and mean, 40 +/- 12 mm Hg. The mean right ventricular oxygen saturation at implant was 51%. Provocative maneuvers, including postural changes, sublingual nitroglycerin, and bicycle exercise, demonstrated expected changes in measured oxygen saturation and pulmonary artery pressures over time. At follow-up of 0.5 to 15.5 months, there were no significant differences between pulmonary artery pressures or oxygen saturation values transmitted from the device and simultaneous measurement with balloon flotation catheters. Four of the pulmonary artery leads dislodged and three demonstrated sensor drift, whereas two of the oxygen saturation sensors failed. Four patients died and four received transplants. Pathological study did not demonstrate injury to the right ventricular outflow tract or pulmonic valve. Chronic measurement of hemodynamic parameters in the outpatient setting with implantable sensor technology appears to be feasible. The devices are well tolerated without significant untoward effects, and the sensors generally function well over time, providing reliable information. Clinical usefulness remains to be established.

Hemodynamic parameters and exercise tolerance in insulin- dependent diabetes mellitus

The problem of development of diabetic myocardiodystrophy is analyzed. Thirty-seven patients with type 1 diabetes running a grave course with various disease duration were examined. The major parameters of intracardiac hemodynamics were examined by echolocation; exercise tolerance was studied by bicycle ergometry. The data indicate the development of diastolic rigidity, reduced volume of leftventricular myocardium, and decreased stroke and minute output at the early stages of the disease. Bicycle ergometry showed reduced exercise tolerance. These changes were in direct proportion to disease duration, presence of microangiopathy, and compensation status. These parameters may appreciably improve in recovery of the disturbed metabolic processes with restoration of the age-specific norm in patients with not long disease standing. Hence, echolocation of the heart and bicycle ergometry may be regarded among the criteria of diabetes mellitus compensation.