Left Ventricular Posterior Wall Research Articles

Peripheral Blood Mononuclear Cells Mitochondrial Respiration and Superoxide Anion after Heart Transplantation.

The mitochondrial function of circulating peripheral blood mononuclear cells (PBMCs) is an interesting new approach to cardiac diseases. Thus, PBMC's mitochondrial respiration decreases in relation to heart failure severity. However, no data are available on heart-transplanted patients (Htx). We determined PBMCs mitochondrial respiration by high-resolution respirometry (Oroboros Instruments) and superoxide anion production using electron paramagnetic resonance (Bruker-Biospin) in 20 healthy subjects and 20 matched Htx and investigated clinical, biological, echocardiographic, coronarography and biopsy characteristics. PBMCs mitochondrial respiratory chain complex II respiration was decreased in Htx (4.69 ± 0.84 vs. 7.69 ± 1.00 pmol/s/million cell in controls and Htx patients, respectively; p = 0.007) and complex IV respiration was increased (24.58 ± 2.57 vs. 15.68 ± 1.67 pmol/s/million cell; p = 0.0035). Superoxide anion production was also increased in Htx (1.47 ± 0.10 vs. 1.15 ± 0.10 µmol/min; p = 0.041). The leucocyte-to-lymphocyte ratio was increased in Htx, whom complex II correlated with leucocyte number (r = 0.51, p = 0.02) and with the left ventricular posterior wall peak early diastolic myocardial velocity (r = -0.62, p = 0.005). Complex IV was increased in the two patients with acute rejection and correlated negatively with Htx's isovolumetric relation time (r = -0.45, p = 0.045). Although presenting with normal systolic function, Htx demonstrated abnormal PBMC's mitochondrial respiration. Unlike immunosuppressive therapies, subclinical diastolic dysfunction might be involved in these changes. Additionally, lymphopenia might reduce complex II, and acute rejection enhances complex IV respirations. PBMC's mitochondrial respiration appears modified in Htx, potentially linked to cellular shift, mild diastolic dysfunction and/or acute rejection.

Cognitive impairment is associated with cardiovascular remodeling in the mouse model of Alzheimer’s disease

AbstractBackgroundDouble‐mutant mice (APPswe/PS1dE9; 2xTg‐AD) represent a model of Alzheimer’s disease (AD). 2xTg‐AD mice develop progressive accumulation of amyloid plaques and cognitive impairment (CI) with age in >12 months old animals. The aim of the present study was to investigate the associations of CI and cardiovascular function in 2xTg‐AD mice.MethodsAortic pulse wave velocity (aPWV), an estimation of aortic stiffness, and cardiac parameters were measured by echocardiography in 16‐mo old male 2xTg‐AD (n=11) and wild type (WT; n=17) mice. Spatial memory (using Morris water maze; MWM) and the anxiety level (using open field test; OFT) were assessed. The relationship between cardiovascular and behavioral parameters were modeled using a linear regression analysis (LRA) with a backward elimination. P‐values <0.05 were considered significant, and 0.05≤P<0.1 were considered near significant and were included in the models.Results2xTg‐AD mice exhibited an increase in aPWV and had a thicker left ventricle (LV) posterior wall in diastole (LVPWd) and narrower LV internal diameter (LVIDd) vs. WT mice (Table 1). 2xTg‐AD mice spent less time in the center of OF vs. WT mice (Table 1). LRA revealed a negative association between time spent in the center of OF and LVPWd, and a positive association with LV volume in diastole (LVvold) in 2xTg‐AD mice (Table 2). In MWM, 2xTg‐AD mice exhibited impaired spatial memory estimated as prolonged average escape latency during their training vs. WT counterparts (Table 1). Although there was no difference between performance in the MWM probe trial, LRA showed a negative association between LVPWd and the mean distance from the platform in the probe trial in 2xTg‐AD mice, and a positive association of LVPWd with number of entries to the platform zone (Table 2). There was a positive association between aPWV and mean distance from the platform in the probe trial in both 2xTg‐AD and WT mice.ConclusionsLRA results indicate that LV remodeling is associated with anxiety‐like behavior in 2xTg‐AD mice, but not with spatial memory impairment. Positive association of aPWV with spatial memory impairment in both groups suggests that aortic stiffness contributes to the age‐associated CI.Supported by the NIH/NIA IRP.

A retrospective study on the clinical significance of cardiac computed tomography in heart failure patients with preserved ejection fraction.

This study investigated the correlation between cardiac function parameters by cardiac computed tomography (CT) and the clinical outcomes of heart failure patients with preserved ejection fraction (HFpEF) to provide experimental data for the diagnosis of HFpEF. A total of 157 HFpEF patients admitted to our hospital from January 2017 to January 2019 were retrospectively analyzed. The patients were divided into event and non-event groups according to the occurrence or absence of adverse events. Cardiac function parameters, such as the left ventricular (LV) end-diastolic volume (LVEDV) and LV end-diastolic volume index (LVEDVI), were obtained via CT scan. Also, the N-terminal-pro hormone b-type natriuretic peptide (NT-proBNP) levels in patients' serum were measured using an enzyme linked immunosorbent assay (ELISA) kit, and echocardiographic parameters such as LV posterior wall thickness (LVPWT) were also recorded. Further, Cox regression was employed to analyze factors associated with the clinical outcomes. Compared with patients in the non-event group, the left ventricular end-diastolic mass (LVM), LVEDVI, left ventricular end-systolic volume index (LVESVI), left atrial end-diastolic volume index (LAEDVI), and left atrial end-systolic volume index (LAESVI) were significantly increased, and the left ventricular total emptying fraction (LVTEF) and left atrial total emptying fraction (LATEF) were markedly decreased in the event group patients. Also, the E/e' and LAEDVI were related factors affecting the clinical outcomes of HFpEF patients. The above indicators displayed a significant predictive for the clinical outcomes of HFpEF patients. Several cardiac function measures, including LAEDVI, are factors associated with the clinical outcomes of HFpEF patients.

The efficacy and safety of Sacubitril/Valsartan on pulmonary hypertension in hemodialysis patients.

Pulmonary hypertension (PH) is a common complication of end-stage renal disease which is associated with adverse outcomes including all-cause mortality and cardiovascular events. Recent studies have demonstrated that Sacubitril/Valsartan (Sac/Val) as an enkephalinase inhibitor and angiotensin II receptor blocker could reduce pulmonary artery systolic pressure (PASP) and improve the prognosis of patients with heart failure. However, whether Sac/Val is effective in hemodialysis (HD) patients with PH is essentially unknown. In this retrospective study, we aimed to evaluate the efficacy and safety of Sac/Val in the treatment of PH in HD patients. A total of 122 HD patients with PH were divided into Sac/Val group (n = 71) and ARBs group (n = 51) based on the treatment regimen. The PASP, other cardiac parameters measured by echocardiography, and cardiac biomarkers including N-terminal fragment of BNP (NT-proBNP) and cardiac troponin I (cTnI) were observed at baseline and 3 months after treatment. There were no significant differences in the baseline characteristics between the two groups. PASP decreased significantly from 45(38, 54) to 28(21, 40) mmHg in Sac/Val group (p < 0.001). PASP reduced from 41(37, 51) to 34(27, 44) mmHg in ARBs group (p < 0.001), and the decrease was more pronounced in the Sac/Val group (p < 0.001). In addition, improvements in the right atrial diameter (RAD), left ventricular diameter (LVD), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), pulmonary artery diameter (PAD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and fractional shortening (FS) were found in Sac/Val group (ps < 0.05). After 3 months, LVD, LAD, LVEDV, LVESV, LVEF, SV, and PASP were significantly improved in Sac/Val group compared with ARBs group (ps <0.05). Significant reduction in NT-proBNP [35,000 (15,000, 70,000) pg/ml vs. 7,042 (3,126, 29,060) pg/ml, p < 0.001] and cTnI [0.056(0.031, 0.085) ng/ml vs. 0.036 (0.012, 0.056) ng/ml, p < 0.001) were observed in Sac/Val group. No significant differences were observed in adverse events between the two groups (ps > 0.05). Sac/Val seems to be an efficacious regimen in PH with favorable safety and has huge prospects for treating PH in HD patients.

Consequences of gestational diabetes mellitus on neonatal cardiovascular health: MySweetHeart Cohort study

BackgroundHyperglycaemic disorders of pregnancy are associated with offspring cardiovascular alterations.MethodsMySweetHeart cohort study aimed to assess the effect of maternal gestational diabetes (GDM) on offsprings’ cardiovascular health. Newborns underwent clinical and echocardiographic examinations between 2016 and 2020.ResultsCompared to mothers without GDM (n = 141), mothers with GDM (n = 123) were more likely to have had GDM in previous pregnancies and had higher weight, BMI, blood glucose, and HbA1c. Newborns of both groups showed similar clinical characteristics. Echocardiography was performed on the 3rd (interquartile range, IQR, 2nd–4th) day of life in 101 offsprings of mothers without and 116 offsprings of mothers with GDM. Left ventricular (LV) mass was similar. Children born to mothers with GDM had a thicker posterior LV wall (z-score +0.15, IQR –0.38/0.62, versus +0.47, IQR –0.11/+1.1, p = 0.004), a smaller end-systolic (1.3 mL, IQR 1.0–1.5 mL, versus 1.4 mL, IQR 1.2–1.8 mL, p = 0.044) but a similar end-diastolic LV volume. They also had shorter tricuspid valve flow duration and aortic valve ejection time, lower tricuspid E-wave and pulmonary valve velocities.ConclusionsNewborns of mothers with or without GDM had similar clinical characteristics and LV mass. However, some echocardiographic differences were detected, suggesting an altered myocardial physiology among infants of mothers with GDM.RegistrationClinicalTrials.gov (NCT02872974).ImpactHyperglycaemic disorders of pregnancy are known to be associated with offspring cardiovascular alterations.Clinical characteristics and estimated left ventricular (LV) mass were similar in children issued from mothers with and without gestational diabetes (GDM).Children born to mothers with GDM had a thicker posterior LV wall and a smaller end-systolic LV volume.Although LV mass is not different, myocardial physiology may be altered in these infants. Further studies should investigate the endothelial function of this population and the cardiovascular evolution of these children over time.

Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis.

Sarcopenia is prevalent and is associated with the occurrence of cardiovascular complications in patients undergoing maintenance hemodialysis (MHD). It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function. This study aimed to evaluate the association between sarcopenia and cardiac structure and function in patients undergoing MHD. We also examined the prognostic role of sarcopenia for mortality and cardiovascular events (CVE) in this population. Participants from a single center underwent bioimpedance body composition analysis to measure skeletal muscle and echocardiography to assess myocardial structure and function. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia criteria. The end points were all-cause mortality and CVE. Of the 158 participants, 46 (29.1%) had sarcopenia, 102 (64.6%) had left ventricular diastolic dysfunction (LVDD), and 106 (67.0%) had left ventricular hypertrophy (LVH). Participants with sarcopenia had smaller right ventricular sizes (2.54 ± 0.77 vs 2.76 ± 0.28; P < 0.01), inter-ventricular thickness (1.07 ± 0.19 vs 1.14 ± 0.20; P = 0.039), and left ventricular posterior wall thickness (0.96, 0.89-1.10 vs 1.06, 0.95-1.20; P = 0.018). Skeletal muscle mass was strongly correlated with left ventricular mass (LVM) (r = 0.577; P < 0.0001). Furthermore, the risk of LVDD (OR: 4.92, 95% confidence interval (CI) [1.73-13.95]) and LVH (OR: 4.88, 95% CI [1.08-21.96]) was much higher in the sarcopenic group than in the non-sarcopenic group. During a follow-up period of 18 months, 11 (6.9%) patients died, of which seven died (4.4%) of CVE, and 36 (22.8%) experienced CVE. The presence of sarcopenia (adjusted hazard ratio (HR), 6.59; 95% CI [1.08-39.91]; P = 0.041) and low skeletal muscle index (HR, 3.41; 95% CI [1.01-11.57]; P = 0.049) and handgrip strength (HR, 0.88; 95% CI [0.78-0.99]; P = 0.037) independently predicted death. Sarcopenia was a significant predictor of CVE (HR, 10.96; 95% CI [1.14-105.10]; P = 0.038). Our findings demonstrated that sarcopenia is associated with LVDD and LVH, and is associated with a higher probability of death and CVE.

The association of dietary glutamine supplementation with the development of high salt-induced hypertension in rats.

Glutamine supplementation has been reported to affect blood pressure (BP). However, its role in the progression of hypertension induced by high salt diet (HSD) has not been elucidated. Male normotensive Wistar rats were exposed to high salt diet and treated with different doses of glutamine supplementation. Rats aged 6 weeks were assigned to five groups: (1) Normal-salt diet (0.3% NaCl, NSD); (2) High-salt diet (8% NaCl, HSD); (3) High-salt + low-dose diet (8% NaCl, 0.5 g of L-glutamine/kg body weight, HSLGD); (4) High-salt + middle-dose diet (8% NaCl, 1.5 g of L-glutamine/kg body weight, HSMGD); and (5) High-salt + high-dose diet (8% NaCl, 2.5 g of L-glutamine/kg body weight, HSHGD). After supplementing different doses of glutamine to male Wistar 6-week-old rats fed with HSD for 7 weeks, we found no difference in body weight among groups. Importantly, we showed that dietary L-glutamine supplementation could prevent the development of hypertension in a dose-dependent manner [dramatically lowering systolic blood pressure (SBP) and slightly reducing diastolic blood pressure (DBP) of hypertensive rats, while the differences of DBP between groups did not reach statistical significance]. Our data further elucidated that dietary glutamine supplementation mildly alleviated the degree of left ventricular hypertrophy, including interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) in hypertensive rats. Together, our results offer evidence that the dietary uptake of glutamine may be associated with attenuating the development of high salt-induced hypertension and slightly alleviating the degree of left ventricular hypertrophy in hypertensive rats. Therefore, glutamine supplementation may act as a prospective dietary intervention for the treatment of hypertension.

The renal function in men with hypertension in conditions of purine and carbohydrate metabolism disorders

Aim. To assess the condition of renal function in hypertensive men in conditions of disorders of purine and carbohydrate metabolism Material and methods. 60 male patients (aged from 18 to 65 years) with stage I–II of arterial hypertension (AH) and purine and carbohydrate metabolism disorders were examined. In these patients, the level of uric acid (UA) in daily urine, fractional excretion of UA, creatinine in daily urine, microalbumin in urine and the cystatin C level were determined. Hemodynamics was studied by daily blood pressure monitoring. Assessment of kinetics and deformation of the myocardium in offline mode using the Xstrain software package integrated into the ultrasound device (Esaote, Italy) was made. Patients were divided into 2 clinical groups – 1 group of AH with hyperuricemia, 2 – AH without uricemia. Statistical analysis of the results was performed using the Statistica 13.0 software package (Statsoft, USA). Results. Correlation analysis in group 1 showed a positive correlation of cystatin C with the average daytime systolic blood pressure (SBP) (r = 0.408) and the variability of diastolic blood pressure (DBP) at night (r = 0.405), urinary microalbumin with the average SBP at night (r = 0.390) and average pulse blood pressure (r = 0.402), LV posterior wall thickness (r = 0.438), LV myocardial mass index (r = 0.621), end-diastolic index (EDI) (r = 0.492), end-systolic index (ESI) (r = 0.426), LV anterior-posterior size (r = 0.385). A negative correlation was established between blood serum SC and ejection fraction (EF) of the LV (r = -0.410), urinary microalbumin with cardiac index (SI) (r = -0.555) and the speed of movement of the lateral (e’ lat) part of the annulus fibrosus mitral valve (r = -0.453). Conclusions. As a result of the studies, the negative influence of hyperuricemia and hyperglycemia in patients with AH on renal function was established. These changes were evidenced by an increase in microalbuminuria level, a decrease in the fractional excretion of UA, an increasing the serum UA level, remodeling of the myocardium, and worsening of the heart systolic function, worsening of the daily blood pressure profile.

Alterations in diastolic function and cardiac geometry in children: a longitudinal study across the spectrum of dialysis and transplant.

Children with kidney failure have increased risk for cardiovascular morbidities before and after transplantation. Ejection fraction is often preserved, masking cardiac dysfunction until severe. Data on longitudinal changes in diastolic function and cardiac geometry are limited. A prospective study was conducted to investigate longitudinal changes in diastolic function and structure pre- and post-kidney transplant compared with healthy peers. Transplant recipients (n = 41) had echocardiograms pre-transplant, 1, 18, 30, and 42months post-transplant. The controls (n = 26) underwent one echocardiogram. Diastolic function and cardiac geometry were assessed by E/e' lateral, E/A, interventricular septal end diastole diameter, left ventricular internal end diastole diameter, left ventricular posterior wall end diastole diameter, and left atrial dimension. E/e' of patients remained worse than controls until 30months post-transplant, and E/A was impaired at all time points compared to the controls. Left ventricular geometry was abnormal in 46% pre-transplant and remained altered in 44.7%, 32.3%, 30.7%, and 27.2% at 1, 18, 30, and 42months post-transplant. Determinants of diastolic dysfunction included hemodialysis, uncontrolled hypertension, steroid exposure, and metabolic syndrome; abnormal geometry was associated with glomerular diagnosis, dialysis duration, obesity, steroids, and metabolic syndrome. Abnormal diastolic function and structure were associated with left ventricular hypertrophy. Diastolic dysfunction and geometry partially improve after transplant but remain abnormal in a subset of patients compared to healthy peers. Traditional indicators of systolic function are preserved. Modifiable risk factors include dialysis modality and duration, uncontrolled hypertension, corticosteroids, obesity, and metabolic syndrome. Attention to diastolic changes provides opportunity for early intervention. A higher resolution version of the Graphical abstract is available as Supplementary information.

Abstract 14024: Role of Endothelial CXCR4 on the Development of Aortic Valve Stenosis

Background. CXCL12/CXCR4 signaling is essential in cardiac development and repair, however, its contribution to the Aortic valve stenosis (AVS) remains unclear. In this study, we tested the role of endothelial CXCR4 on the development of AVS. Methods. We generated CXCR4 endothelial cell-specific knockout mice (EC CXCR4 KO) by crossing CXCR4 fl/fl mouse with Tie2-Cre mouse to study the role of endothelial cell CXCR4 in AVS. CXCR4 fl/fl mice with no Tie2-Cre gene present were used as control. Echocardiography was used to assess the aortic valve and cardiac function. Heart samples containing the aortic valve were stained using Alizarin Red for detection of calcification. Masson’s Trichrome staining was used for the detection of fibrosis. Apex samples were stained with wheat germ agglutinin to visualize ventricular hypertrophy. Results. Compared with the control group, the deletion of CXCR4 in endothelial cells led to significantly increased aortic valve peak velocity and aortic valve peak pressure gradient, and decreased aortic valve area and ejection fraction. EC CXCR4 KO mice also developed cardiac hypertrophy evidenced by increased left ventricular mass, diastolic and systolic left ventricle posterior wall (LVPW), cardiac myocyte size, and heart weight (HW) to body weight (BW) ratio. Our data also confirmed increased microcalcifications, interstitial fibrosis, and thickened valvular leaflets of the EC CXCR4 KO mice. Conclusions. We found that the deletion of CXCR4 in endothelial cells leads to aortic valve stenosis and left ventricular hypertrophy. This indicates endothelial cell CXCR4 plays a protective role against AVS, and EC CXCR4 KO mice can be used as a novel model for AVS study.

Abstract 9482: Coronary Spasm in a Patient With Argininosuccinic Aciduria

Case presentation: A 39-year-old male patient was referred for the treatment of hypertension. The patient had been treated for argininosuccinic aciduria (ASA) since eight months of age. Therapeutic drugs including, L-arginine, sodium phenylbutyrate and antiepileptic drugs had been administered. A detailed medical history taking revealed that the patient sometimes complained of chest discomfort under psychological stress. A 12-lead electrocardiogram showed abnormal q waves in lead III and aVF. Transthoracic echocardiography showed hypokinesis of left ventricular posterior wall. Endothelial function was quantified with brachial artery flow-mediated dilatation (FMD). The patient’s FMD value was 2.4% (normal cut off value 7.0%). Coronary computed tomography angiography showed no significant coronary stenosis. Cardiac magnetic resonance revealed transmural late gadolinium enhancement in the mid-ventricular level of the left ventricular posterior wall. The patient was suspected to have prior myocardial infarction. The patient was started on amlodipine and irbesartan, however, he continued to complain of chest discomfort at rest. Cardiac catheterization was performed to make a definitive diagnosis. The acetylcholine spasm provocation test revealed diffuse left and right coronary vasospasm. Transient ST-segment elevation with chest discomfort was observed. The patient was diagnosed as having coronary spastic angina. Chest discomfort was disappeared after additional administration of isosorbide mononitrate. Discussion: ASA is a genetic disorder of the urea cycle, caused by deficiency of argininosuccinate lyase (ASL). Specific laboratory findings are hyperammonemia, argininosuccinic acidemia and low plasma arginine levels. ASL is required to utilize extracellular arginine for NOS-dependent NO synthesis in endothelial cell. Reduction of ASL enzymatic activity leads to decline in NO production even if arginine is supplemented. Efficacy of NO supplementation for treatment of long-term complications in ASA patients has been reported. The precise mechanisms of coronary spasm remain to be elucidated. Our case report might support the significance of endothelial function in the pathogenesis of coronary spasm.

Abstract 14612: The Relationship Between Left Ventricular Geometry and Respiratory Sinus Arrhythmia in Patients With Vasovagal Syncope

Introduction: The study was prompted by our observation that a significant number of patients with vasovagal syncope (VVS) have marked respiratory sinus arrhythmia as well as thin left ventricular (LV) walls. We hypothesized that the geometry of the LV walls may play a role in the pathogenesis of VVS. Hypothesis: The aim of this study was to assess LV geometry in relationship to respiratory sinus arrhythmia in patients with VVS M ethods: We included 191 patients (age 52±20 years, 101 women) with VVS who had either a positive or negative response to tilt table testing TTT (n=64 TTT+, and n=127 TTT-). The VVS group was compared to a group of 75 patients with no syncope (NL) and similar age, sex and BMI distributions. Standard 12-lead electrocardiograms (ECG), vectorcardiograms, and transthoracic echocardiograms were performed to assess electrical activation as well as ventricular geometry and function. The magnitude of respiratory sinus rhythm arrhythmia was measured as the maximum percent change in RR interval on a 10 second 12-lead ECG (dRR) performed before the TTT. Results: When compared to NL group patients with VVS had significantly higher dRR and LV end diastolic diameter (12 ±8% vs 10±8%, p=0.047 and 44±5 vs 46±6mm p=0.006 respectively) The end-diastolic thickness of the interventricular septum (IVS) and that of the LV posterior wall (PWT) in the VVS group were significantly smaller than in the NL group (8.9±1.7mm vs 9.6±1.8mm p value=0.003 and 8.4±1.5mm vs 9.2±1.6mm p value=0.0002). The magnitude of respiratory sinus arrhythmia expressed as dRR correlated inversely and significantly with IVS (r=-0.32; p value=0.042). The was however no significant correlation between dRR and PWT. These results suggest that a more pronounced respiratory sinus arrhythmia could be related to more ample variations in right and left ventricular filling due to increased ventricular interdependence via a thinner and more compliant ventricular septum. Conclusions: The geometry of the LV as well as the cardiovascular impact of respiratory movements may play a role in the pathogenesis of VVS.

A case series of constrictive pericarditis and suggested echocardiographic diagnostic criteria.

The diagnosis of constrictive pericarditis (CP) is challenging as there are currently no standard echocardiographic diagnostic criteria. In this retrospective case series, we analyzed and summarized the features of 25 patients with CP and proposed echocardiographic diagnostic criteria. It is hoped that the suggested criteria help professionals make decisions in their daily practice so that patients receive timely diagnosis and effective treatment. Twenty-five patients with CP were selected for this retrospective study. The clinical and echocardiographic imaging data were analyzed and summarized, and echocardiographic diagnostic criteria for CP were proposed. The main clinical manifestations were fatigue, breathlessness, exertional dyspnea (88%), lower-limb edema (84%), hepatomegaly, and jugular vein filling (84%). Echocardiographic features comprised pericardial thickening (88%) and calcification (60%), pulmonary hypertension (52%), inferior vena cava dilation (80%), left and/or right atrial enlargement (100%), diastolic flattening of the left ventricular (LV) posterior wall (72%), septal shudder and bounce (64%), restrictive LV and right ventricular diastolic filling pattern (100%), early filling changes of mitral and tricuspid flow (80% and 60%, respectively), and mitral annulus reversus (73%). Echocardiography is a simple and valuable examination for CP. The echocardiographic diagnostic criteria are valid and worth promoting.

Mechanism of Kaixin Powder prescriptions Buxin Decoction regulating PI3K/AKT signaling pathway to protect cardiovascular system: based on network pharmacology and experimental verification

This study established the EA.hy926 cell myocardial ischemia model to compare the effects of two Kaixin Powder prescriptions, Buxin Decoction(BXD) and Dingzhi Pills(DZP), at three dosages(500, 200, and 100 μg·mL~(-1)) on the cell viability. Further, the public databases(TCMSP, TCMID, SYMMAP, and STRING) and the network pharmacology methods such as KEGG pathway enrichment were employed to decipher the possible molecular mechanism of BXD in exerting the cardioprotective effect. The pharmacological effect of BXD was evaluated with the rat model of isoprenaline(ISO)-induced myocardial ischemia. The expression levels of proteins involved in the phosphatidylinositol-3-kinase/protein kinase B(PI3 K/AKT) signaling pathway were measured by Western blot. BXD significantly increased the viability of EA.hy926 cells, showing the performance superior to DZP. The network pharmacology analysis predicted that BXD might exert cardiac protection through the PI3 K/AKT signaling pathway. The in vivo experiment on rats showed that BXD treatment significantly increased the cardiac ejection fraction(EF), fractional shortening(FS), diastolic left ventricular anterior wall(LVAWd), systolic left ventricular anterior wall(LVAWs), and diastolic left ventricular posterior wall(LVPWd), significantly decreased the beat per minute(BPM) and diastolic left ventricular internal diameter(LVIDd), and significantly improved the ST segment in the electrocardiogram. The pathological results(Masson staining) showed that BXD restored the myocardial thickness, decreased the collagen fiber, increased the muscle fiber, and reduced the infarct area to alleviate myocardial ischemia. Furthermore, BXD lowered the serum levels of inflammatory cytokines [tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6)] and myocardial enzymes [creatine kinase(CK) and lactate dehydrogenase(LDH)], increased the p-AKT/AKT ratio, up-regulated the protein levels of PI3 K, NF-κB, IKK-α, and Bcl-xl, and down-regulated that of the apoptotic protein Bax. In conclusion, BXD may exert cardiac protection effect by regulating the PI3 K/AKT signaling pathway.

The value of cardiac magnetic resonance imaging in endocardial fibroelastosis.

Endocardial fibroelastosis (EFE), an uncommon congenital heart disorder often occurring in infants, has a poor prognosis. It is of great significance to perform early diagnosis and accurately analyze cardiac function to enable further clinical treatment and prognosis decisions. This study aimed to explore the findings of cardiac magnetic resonance (CMR) in patients with EFE, including morphological changes and cardiac function analyses. Additionally, we compared the difference in the evaluation of the cardiac function between CMR and echocardiography (Echo). Eleven patients with EFE (nine females and two males, aged between 0.3 and 1.9 years), treated in our hospital, were analyzed retrospectively. Left ventricular posterior wall thickness (LVPW), anterior wall thickness (LVAW), fractional shortening (FS), ejection fraction (EF), end-systolic diameter (ESD), end-diastolic diameter (EDD), end-systolic volume (ESV), and end-diastolic volume (EDV) were assessed using both Echo and CMR. The Original Ross classification and the New York Heart Association functional classification were used to grade the patients' cardiac function. The correlations between clinical cardiac function classification and MRI- and Echo-derived imaging data were determined. All patients showed a thickened endocardium and left ventricle globular dilatation on CMR. We observed significant systolic dysfunction and whole or segmental abnormal ventricular movement. Compared with those measured by Echo, the EF, FS, and EDV values were significantly lower when measured using CMR. Compared with Echo measurements, the ESV, ESD, LVAW, and LVPW values were significantly higher when measured using CMR. CMR-measured EF and FS correlated better with the clinical cardiac functional score than those derived from Echo (EF, r = 0.646 > 0.224; FS, r = 0.627 > 0.245, respectively). In patients with EFE, the characteristic morphological changes of the heart could be displayed accurately using CMR. The parameters measured by CMR were more accurate than those of Echo and correlated well with clinical cardiac function scores, mainly because it does not make invalid geometrical assumptions.

PSUN52 Patients with Left Ventricular Hypertrophy on Echocardiography are Frequently Evaluated with Renin and Aldosterone

Abstract Background Increased left ventricular (LV) mass is an independent predictor of cardiovascular morbidity and mortality. Primary aldosteronism (PA) is associated with increased LV mass regardless of concomitant essential hypertension. Therefore, we hypothesize that the findings of increased LV mass approximated by left-ventricular hypertrophy (LVH) on echocardiogram relate to renin-independent hyperaldosteronism. Methods We performed a retrospective review of patients who underwent echocardiography at our institution between April of 2013 and September of 2017 (n=98,007 individuals). Of this population, we identified patients who underwent transthoracic echocardiography who met criteria for LVH based on current American Society of Echocardiography guidelines using the interventricular septal thickness in diastole (IVSd) and left ventricular posterior wall thickness in diastole (LVPWd). We excluded patients who underwent isolated transesophageal imaging as well as those who had significant structural cardiac abnormalities other than LVH. This cohort was analyzed with an internal self-service data tool to determine if patients had undergone biochemical evaluation with serum aldosterone and renin, which defined the final analytical cohort. Results We identified 19,664 patients with LVH of whom 5.8% (n = 1132) underwent biochemical evaluation with serum aldosterone and corresponding plasma renin activity (PRA) or direct renin concentration (DRC). In all patients with LVH, the mean IVSd was 11.7 ± 1.2mm in those who underwent biochemical testing and 11.5 ± 1.2 mm in those who did not (p &amp;lt;0.001); the mean LVPWd was 11.4 ± 1.1 mm mm in those who underwent biochemical testing and 11.3 ± 1.1 mm in those who did not (p &amp;lt;0.001). Of African American patients with LVH, 9.8% underwent biochemical testing; 5.0% of Caucasian patients with LVH underwent testing. The median PRA was 0.9 ng/mL/h with a median aldosterone to renin activty ratio (ARR) of 8.9 ng/dL-ng/mL/h. . The majority (54.4%) of individuals who underwent testing with plasma renin activity had a PRA ≤ 1.0 ng/mL/h. Conclusion Patients with LVH are being evaluated with renin and aldosterone at a higher frequency than patients with resistant hypertension and other guideline based indications for PA screening. Individuals evaluated with renin and aldosterone had increased IVSD and LVPWd, suggestive of more extensive LVH, compared with other individuals with LVH. LVH may be a sensitive screening criterion for PA. Additional prospective studies are necessary. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Attenuation of Myocardial Dysfunction in Hypertensive Cardiomyopathy Using Non-R-Wave-Synchronized Cardiac Shock Wave Therapy.

Cardiac shock wave therapy (CSWT) is a novel therapeutic procedure for patients with angina that is refractory to conventional therapy. We investigated the potential mechanism and therapeutic efficacy of non-R-wave-triggered CSWT to attenuate myocardial dysfunction in a large animal model of hypertensive cardiomyopathy. Sustained elevated blood pressure (BP) was induced in adult pigs using a combination of angiotensin-II and deoxycorticosterone acetate (DOCA). Two sessions of non-R-wave-triggered CSWT were performed at 11 and 16 weeks. At 10 weeks, systolic and diastolic blood pressure, LV posterior wall thickness and intraventricular septum thickness significantly increased in both the hypertension and CSWT groups. At 20 weeks, +dP/dt and end-systolic pressure-volume relationship (ESPVR) decreased significantly in the hypertension group but not the CSWT group, as compared with week 10. A significant improvement in end-diastolic pressure-volume relationship (EDPVR) was observed in the CSWT group. The CSWT group exhibited significantly increased microvascular density and vascular endothelial growth factor (VEGF) expression in the myocardium. Cytokine array demonstrated that the CSWT group had significantly reduced inflammation compared with the hypertension group. Our results demonstrate that non-R-wave-triggered CSWT is safe and can attenuate LV systolic and diastolic dysfunction via enhancement of myocardial neovascularization and anti-inflammatory effect in a large animal model of hypertensive cardiomyopathy.

Effective Echocardiography Parameters to Identify Radiation-Induced Heart Disease in the Mouse Model

<h3>Purpose/Objective(s)</h3> Radiation-induced heart disease (RIHD) may occur after excessive radiotherapy to thoracic cancer. However, the effect of cardiac irradiation on left ventricle (LV) function is still controversial and no previous studies has evaluated the importance of stroke volume (SV) in RIHD. The hypothesis is that diastolic dysfunction with decreased SV could be potentially effective echocardiography parameters to identify RIHD in the mouse model. <h3>Materials/Methods</h3> C57 mice (n=5-10 per group) were treated with a single heart X-ray radiation for 20Gy or 0Gy. Echocardiography was performed to evaluate changes in LV dimensions and function before radiation and after radiation 4, 8 weeks. Elisa kits were used to detect the level of serum BNP and cTnI. HE, Masson's trichrome and Sirius red staining was utilized to assess cardiomyocytes size and myocardial fibrosis. Data are expressed as mean values (means±SEM). Statistical analyses were performed using the two-way repeated measures ANOVA or one-way ANOVA for multiple comparisons and student's t-test for unpaired two groups. In all statistical analyses, significance was defined as P < 0.05. <h3>Results</h3> The Myocardial histopathology indicated a markably increased cardiac fibrosis area and cardiomyocytes size at 8 weeks after radiation. Echocardiography analyses revealed that SV (27.02±1.131 vs. 41.64±2.021ul, P<0.0001), the LV end-diastolic volume (45.64±5.054 vs. 72.24±3.758ul, P=0.0018), and cardiac output (12.58±0.6669 vs. 19.16±0.9942ml/min, P<0.0002) of the 20Gy-mice have significantly decreased than the 0Gy-mice at 8 weeks. The dead 20Gy-mice had lower SV (22.40±0.6110 vs. 30.48±0.1827ul, P=0.0153) as compared to the survival 20Gy-mice. Moreover, the LV diastolic anterior (1.042±0.05123 vs. 0.8456±0.02860mm, P=0.0398) and posterior (0.8745±0.02558 vs. 0.7701±0.02551mm, P=0.0290) wall thickness of 20Gy-mice also had significantly increased than the 0Gy-mice. However, there were no significant difference of the EF (P>0.05), fraction shortening (P>0.05), heart rate (P>0.05), and LV end-systolic volume (P>0.05) between two groups at all the time points. In addition, the result of Elisa kits showed that serum BNP level (427.3±34.05 vs. 279.8±24.84ng/ml, P=0.0127) of 20Gy-mice was significantly higher than the 0Gy-mice at 8 weeks while cTnI was not significantly changed. <h3>Conclusion</h3> Diastolic dysfunction and decreased SV instead of systolic dysfunction occurs firstly in radiation-induced heart disease, which could be effective indexes to detect cardiac toxicity induced by irradiation.

Comparative study of feline arterial thromboembolism treated with the combination of atenolol-clopidogrel and single clopidogrel

Feline Arterial Thromboembolism (FATE) is one of the most devastating consequences of cardiac disease in cats, characterized by a thrombosis that leads to an obstruction in the blood vessel. This disease predominantly occurs with Hypertrophic Cardiomyopathy (HCM) condition. The purpose of this case study is to corroborate the comparison of therapy between two FATE cases treated with a combination of atenolol and clopidogrel compared to clopidogrel only. Two cats were brought by the owner to the clinic with the same conditions including paraparesis, hypothermia, and pale hind paws. Physical examination revealed that both cats got hypothermic, had no femoral pulse, and pale hind legs. The blood test result showed an increase in lactate from the femoral vein and hyperkalemia in the body. Echocardiographic found HCM characterized by thickening of the left ventricular posterior wall and interventricular septum. The first cat was given the combination of atenolol (beta-blocker) and clopidogrel (antiplatelet), with supportive medications such as analgesic, omega 3, and diuretic. On the other hand, the second cat was given the same exact medications, but without atenolol (beta-blocker). After 9 days of treatment and hospitalization, the first cat that was administered a combination of atenolol and clopidogrel died after got hypotension and dyspnea. While the second cat that was given single clopidogrel survived with good clinical conditions and recovered from the lameness

Two-dimensional speckle tracking echocardiography, a powerful method for the evaluation of anthracyclines induced left ventricular insufficiency.

Anthracyclines have been one of the most important therapeutic methods in breast cancer therapy for decades. However, serious long-term toxicities, especially cardiotoxicity limits the continuous usage of anthracyclines, hence affects long term prognosis. Early detection of myocardial dysfunction during treatment is critical but challenging. Two-dimensional speckle tracking echocardiography (2D-STE) is a non-Doppler technique that can assess deformation and strain by tracking displacement of acoustic markers in the myocardium. This study aims to compare the sensitivity and precision between 2D-STE and traditional echocardiography on monitoring the left ventricular function in patients with breast cancer after anthracyclines therapy, which is the key indicator for evaluating myocardial changes. Thirty-three patients with breast cancer were recruited from February 2019 to December 2019. All patients were treated with 4 cycles anthracycline. 2D-STE and conventional echocardiography were performed on each patient. Two-dimensional echocardiographic examination was used to collect data interventricular septum diameter (IVSD), end-diastolic left ventricular posterior wall diameter (LVPWD), left ventricular end-diastolic diameter (LVEDD) and left ventricular systole on the parasternal left ventricular long axis view. The final diameter (left ventricular end-systolic diameter [LVESD]) and the left ventricular short axis shortening rate (LVFS) was measured by M-type. The two-plane Simpson’s method was used to measure left ventricular end-diastolic volume (LVEDV) and end-systolic volume (left ventricular end-systolic volume [LVESV]) to obtain left ventricular ejection fraction (LVEF). Two-dimensional speckle tracking imaging technical indicator includes left ventricular global longitudinal strain (LVGLS), subendocardial myocardial longitudinal strain (LVGLS-Endo) and epicardial myocardial longitudinal strain (LVGLS-Epi). The correlation between 2-dimensional speckle tracking imaging and conventional ultrasound parameters were analyzed. Compared with baseline (T0), the systolic function parameter LVEF was significantly changed after four cycle chemotherapy (T4) (P < .05). However, the conventional echocardiographic parameters including IVSD, LVPWD, LVEDD, LVESD, LVEDV, and LVESV were not statistically significant (P > .05). Meanwhile, the two-dimensional strain parameters LVGLS, LVGLS-Endo, and LVGLS-Epi were statistically significant after T2 and T4 cycle chemotherapy (P < .01).The two-dimensional strain parameter GLS has higher accuracy and sensitivity for monitoring left ventricular insufficiency caused by anthracycline therapy when compared with traditional echocardiography.