Pulsed-wave Tissue Doppler Imaging Research Articles

EVALUATION OF THE RELATIONSHIP BETWEEN IRON LOAD, AGE, AND CARDIAC FUNCTION IN CHILDREN AND YOUNG ADULTS WITH THALASSEMIA MAJOR: A PULSED-WAVE DOPPLER AND TISSUE DOPPLER IMAGING STUDY

Objective: To determine the structural and functional cardiac differences in children and young adults with thalassemia major (TM) compared to healthy subjects using pulsed-wave Doppler and tissue Doppler imaging methods and determine the relationship between iron overload and these differences. Materials and Methods: We analyzed the data of pediatric and young adult TM patients (n = 44) aged 4–22 years and an age- and gender-matched control group (n = 40) in our hospital data system between Oct.01.2023 and Oct.01.2024. Height, weight, body mass index (BMI), systolic–diastolic blood pressure measurements, complete blood count, ferritin, cardiac T2* magnetic resonance imaging (MRI) values, and echocardiography results were recorded. In addition to comparisons between the two groups, correlation analysis was performed between ferritin–cardiac T2* MRI results and echocardiographic parameters and age in TM patients. Results: Our study showed growth retardation (low height standard deviation score (SDS), low weight SDS and low BMI SDS), dilatation of the left cavities (high left ventricular internal diameter end diastole (LVIDd)), increased left ventricular muscle mass (high left ventricular mass index (LVMI)), cardiac distinctive diastolic (restrictive pattern: left ventricular (LV) peak early diastolic flow (E)/peak late diastolic flow (A) and E/early diastolic myocardial peak flow (E') high), and subclinical systolic (LV peak systolic flow low and LV Tei index high) dysfunction. In addition, iron load (ferritin and cardiac T2* MRI) was correlated with LVMI, and cardiac diastolic and systolic function indicators. As age increased, ferritin value did not change, but cardiac T2* MRI value decreased and diastolic–systolic parameters worsened. Conclusion: Periodic cardiac T2* MRI and Doppler echocardiography examinations of patients with TM may detect subclinical myocardial dysfunction at an early stage, thus providing a window of opportunity for intervention.

Ultrasonographic assessment of the fetal heart in intrahepatic cholestasis of pregnancy: Pulsed wave Doppler, M-mode, and tissue Doppler imaging prospective study.

To investigate the fetal heart using pulsed wave Doppler, M-mode, and tissue Doppler imaging (TDI) in cases of intrahepatic cholestasis of pregnancy (ICP). This prospective study was conducted at a single tertiary center and included 35 patients with ICP and 70 healthy pregnant women at 28-36 weeks of pregnancy. Among the patients with ICP, 26 had serum bile acid (SBA) levels less than 40 μmol/L and nine had SBA levels of 40 μmol/L or greater. Pulsed wave Doppler, M-mode, and TDI evaluations were performed on the patients to assess fetal cardiac function. The ICP group exhibited significantly higher myocardial performance index (MPI) and isovolumetric relaxation time (IRT), but similar isovolumetric contraction time (ICT). The tricuspid and mitral valve E, A, and E/A ratios were significantly reduced in the ICP group. The TDI parameters showed significantly reduced tricuspid and mitral valve E'/A' ratios in the ICP group compared with the control group (P < 0.001). The E/E' ratio was significantly increased in the ICP group (P < 0.001). According to the M-mode Doppler findings, tricuspid and mitral annular plane systolic excursion values were significantly decreased in the ICP group (P = 0.005 and P = 0.001, respectively). In the subgroup analysis, MPI and IRT were significantly higher in the severe ICP group. ICP might induce changes in the fetal heart during the early systolic and diastolic phases. The detection of these early changes using M-mode and TDI during the antenatal period can provide valuable insights into the condition of the fetus.

The effect of obesity and subsequent weight reduction on cardiac morphology and function in cats

BackgroundIn people, obesity is a risk factor for cardiovascular disease, associated with systemic hypertension, cardiac remodelling and systolic and diastolic dysfunction. Weight reduction can reverse myocardial remodelling and reduce risk of subsequent cardiovascular disease. In cats, far less is known regarding the effects of obesity and subsequent weight reduction on cardiovascular morphology and function. This prospective study aimed to assess cardiac morphology and function, heart rate variability, cardiac biomarkers and body composition before and after controlled weight reduction in cats with obesity. Body composition analysis (by dual energy x-ray absorptiometry, DEXA) and cardiovascular assessment (echocardiography, systemic arterial systolic blood pressure, electrocardiography, plasma cardiac biomarkers) were performed prior to weight management in twenty cats with obesity. These investigations were repeated in eleven cats that reached target weight.ResultsAt baseline, systemic hypertension was not documented, but the majority of cats with obesity (15 out of 19) showed echocardiographic evidence of diastolic dysfunction. Eleven of 20 cats had increased maximal end-diastolic septal or left ventricular free wall thickness (≥ 6.0 mm) at baseline. Median (interquartile range) percentage of weight lost in the cats reaching target weight was 26% (17–29%), with a median reduction in body fat mass of 45% (26–64%). Both the end-diastolic left ventricular free wall (median magnitude of change -0.85 mm, IQR -0.05 mm to -1.55 mm, P = 0.019; median percentage reduction 14.0%) and end-diastolic interventricular septum (median magnitude of change -0.5 mm, IQR -0.2 mm to -1.225 mm, P = 0.047; median percentage reduction 7.9%) thickness decreased after weight reduction. Following weight reduction, pulsed wave tissue Doppler imaging of the left ventricular free wall was consistent with improved diastolic function in 4 out of 8 cats, however there was no significant difference in overall diastolic function class. Further, there was no change in heart rate variability or cardiac biomarkers with weight reduction.ConclusionAn increase in left ventricular wall thickness and diastolic dysfunction were common echocardiographic features in cats with obesity within our study and may be reversible with successful weight and fat mass loss. Further studies are required to clarify the clinical consequences of these findings.

Longitudinal Strain vs. Conventional Echocardiographic Parameters in the First Week of Life in Healthy Term Newborns.

The first week of life is characterized by substantial alterations in hemodynamic conditions. Changes in myocardial contractility will reflect these changes. We aimed to assess right and left ventricular function on the third and seventh days of life in 50 healthy term newborns. To assess myocardial function, we used speckle tracking echocardiography. Pulsed-wave tissue Doppler imaging, M-mode, Doppler and pulsed-wave Doppler were also used to assess ventricular function. We found a significant increase in both right and left longitudinal strain and an increase in systolic and diastolic tissue Doppler velocities, whereas most other parameters remained unchanged. At both time points, the measured parameters were significantly greater for the right ventricle, but the changes with time were similar for both ventricles. We also found an increase in right ventricular outflow tract acceleration time as an indirect sign of decreasing pulmonary vascular resistance and an increase in systolic blood pressure, pointing to increasing systemic vascular resistance. Together with a decreasing proportion of patients with patent ductus arteriosus, the estimated left ventricular cardiac output decreased and right ventricular cardiac output increased but not to a statistically significant degree. In conclusion, the results of our study show how different echocardiographic techniques capture hemodynamic changes and changes in myocardial contractility and compliance. Both longitudinal strain and tissue Doppler imaging parameters seem to offer greater sensitivity in comparison with conventional echocardiographic parameters.

The reduction of the left ventricular long-axis early diastolic peak velocity (e') evident by early-middle age occurs in the absence of aging-related slowing of active relaxation.

A decrease in the left ventricular (LV) long-axis early diastolic peak velocity (e') is evident by early-middle age, but it is unknown to what extent this decrease is due to slowing of the speed of active relaxation versus a reduction in LV long-axis excursion during early diastole (EDExc). Pulsed-wave tissue Doppler imaging (TDI) signals were acquired from the septal and lateral borders of the mitral annulus in 62 healthy adult subjects of age 18-45years. EDExc and LV systolic excursion (SExc) were measured as the integrals of the respective TDI signals. The speed of active relaxation was indirectly assessed using time interval measurements related to the TDI early diastolic signal, including the isovolumic relaxation time (IVRT'), the acceleration time (EDAT), and the duration (EDDur). Multiple linear regression analyses were performed to identify the relationships between e', age, EDExc, SExc, and time intervals. The findings were similar for both LV walls. Age was negatively correlated with e' and EDExc, but was not correlated with SExc, IVRT', EDAT, or EDDur. The closest correlate of EDExc was SExc, and EDExc was independently correlated with both SExc and age. e' was also positively correlated with SExc, but the closest correlate of e' was EDExc, and when combined with EDExc, EDDur became an independent predictor of e'. The aging-related decrease in e' evident by early-middle age occurs in the absence of aging-related slowing of active relaxation and therefore can be largely attributed to the accompanying reduction in EDExc.

Abstract 15053: Distinct Effects of Sacubitril/Valsartan on Left Atrial Function Between Heart Failure With Preserved and Reduced Ejection Fraction

Background: Although Sacubitril/Valsartan(S/V) could ameliorate left ventricular (LV) function, it was recently reported that S/V worsened the left atrial (LA) remodeling in pre-heart failure with preserved ejection fraction (pre-HFpEF). However, the effects of S/V on LA function remains controversial in heart failure. Accordingly, this study investigated the effects of S/V on LA function and remodeling in both HFpEF and HFrEF. Methods: This was a single-center retrospective study of patients with HF hospitalized at our hospital. Patients with HF underwent clinical evaluation and echocardiography at baseline and after administration with S/V. LA volume index (LAVI) , LA emptying fraction (LAEF), transmitral peak E wave velocity (E), pulsed-wave TDI e’ velocity (e’), and E/e` were measured by echocardiography. Results: A total of 71 consecutive patients (71 ± 13 years, 70% male) were enrolled in this study. Among them, 29 were patients with HFpEF (LVEF 55 ± 7%), and 42 were HFrEF (LVEF 28 ± 7%). S/V administration significantly reduced the serum brain natriuretic protein level in HFpEF and HFrEF (279 ± 343 to 155 ± 214 pg/ml, 638 ± 642 to. 218 ± 288 pg/ml, p&lt;0.05, respectively). LAVI was also significantly decreased after S/V administration in HFpEF and HFrEF (41 ± 11 to 38 ± 12 ml/m 2 , 50 ± 19 to. 41 ± 21 ml/m 2 , p&lt;0.05, respectively), implicating its effects on LA reverse remodeling. Furthermore, the significant decrease in the velocity of E wave and E/e’ were observed in HFpEF and HFrEF. However, LAEF were significantly improved in HFrEF, but not in HFpEF, while e’ were improved in HFpEF, but not in HFrEF. These results indicated that the effects of S/V might be attributable to LV relaxation in HFpEF and to LA reservoir function in HFrEF. Conclusions: This study demonstrated that treatment with Sacubitril/Valsartan could lead to LA reverse remodeling in both HFpEF and HFrEF, possibly due to the distinct mechanisms of Sacubitril/Valsartan for improving the LA function. Further studies should be needed to be clarified.

Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia.

Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.

Auto left atrial strain by speckle tracking echocardiography and auto left atrial volumes by 3D transthoracic echocardiography after electrical cardioversion for atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction We have evidence that left atrial dysfunction and stunning occur after electric cardioversion for atrial fibrillation (CAF). Additionally, after successful cardioversion to sinus rhythm, a dissociation between electrical and mechanical recovery may be observed. Traditional pulsed Doppler and tissue Doppler imaging parameters demonstrate reduced atrial contractility immediately after cardioversion. Improvement in atrial function occurs within the first 4 weeks after sinus rhythm is restored. Recent advances in the assessment of myocardial function have facilitated the direct measurement of auto left atrial strain using speckle tracking echocardiography, and auto left atrial volumes measurements using dynamic heart model modern 3D transthoracic echo logistics. Purpose Aim of this study was to determine whether auto left atrial strain (auto LAs) by speckle tracking echocardiography, and auto left atrial volumes measurements, auto left atrial volume indices calculations (auto LAVI), could be used to evaluate global left atrial function and when a main improvement occurs after electrical cardioversion for CAF. Methods Auto LAs was measured from transthoracic echocardiography in 25 patients with CAF who had been cardioverted to sinus rhythm and followed up for 4 weeks, and in a cohort of 25 healthy individuals. Left atrial contractile strain (LACTS), conduit strain (LACDS) and reservoir strain (LARSS) were measured. Conventional measures of atrial function derived from transmitral pulsed wave doppler (PW) and tissue doppler imaging (TDI) of lateral mitral annulus were included, such as A wave velocity, A wave velocity time integral, A' wave velocity and A' velocity time integral. Results Immediately after cardioversion all PW, TDI and all three auto LAs parameters were significantly lower than in controls. On the other hand, auto LAVI was significantly higher in patients compared to controls immediately after cardioversion Atrial function was improved over time with maximal change observed 4 weeks after cardioversion and restoration to sinus rhythm. Auto LAs parameters were significantly higher in the group of patients. Auto LA volumes and auto LAVI with dynamic heart model logistics were lower in the same group, but with no statistical significance. Three patients with the lowest auto LAs values immediately after cardioversion, suffered recurrence of atrial fibrillation during the 4 weeks follow up. Conclusions Although left atrial electrical function is immediately restored after cardioversion in CAF patients, a persistent degree of atrial dysfunction remains for up to 4 weeks. This difference could explain the increased propensity for these patients to develop recurrent atrial fibrillation. Additional this dysfunction could indicate the longer-term use of antiarrhythmic and antithrombotic medication in the CAF cohort.

Evaluation of Fetal Cardiac Functions in Preeclampsia: Does the Severity or Proteinuria Affect Fetal Cardiac Functions?

To compare the fetal cardiac functions in preeclampsia and control group, and determine whether the severity or amount of proteinuria affects fetal cardiac functions. This prospective case-control study involves 48 pregnant women with preeclampsia and 48 healthy women. Pulsed wave Doppler, M-mode, and tissue Doppler imaging were used to measure the cardiac function between the 32 and 34 gestational weeks in each group. All Doppler indices and cardiac function parameters were also compared in subgroups with mild and severe preeclampsia and between subgroups with proteinuria >3 g/24 hours and <3 g/24 hours. Decreased diastolic function (decreased E, A, E', and A' values in mitral/tricuspid valves and increased isovolumetric relaxation time) and decreased systolic functions (decreased mitral and tricuspid annular plane systolic excursion and S' value in mitral/tricuspid valves) were detected in the preeclampsia group. Decreased tricuspid E value in severe preeclampsia compared with mild preeclampsia was shown in the present study. Preeclampsia may cause changes in systolic and diastolic functions in the fetal heart. Subclinical functional changes of these fetuses can be detected earlier and more sensitively with the help of tissue Doppler imaging. Biventricular diastolic functional changes are more prominent in preeclamptic cases with proteinuria >3 g/24 hours.

Left and right ventricular function by echocardiography, tissue doppler imaging, carotid intima media thickness, and asymmetric dimethylarginine levels in female adolescents with vitamin D deficiency.

The aim of our study was to assess left and right ventricle systolic and diastolic functions in female adolescents with vitamin D deficiency using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotid intima media thickness and asymmetric dimethylarginine levels. Sixty-six female adolescents were enrolled in this study. The female adolescents were divided into a vitamin D deficiency group (n: 34) and a control group (n: 32). All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulse, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness. The vitamin D-deficient female adolescent group had normal left and right ventricle systolic and diastolic functions and normal global systolic and diastolic myocardial performance. In the patients with vitamin D deficiency, the carotid intima-media thickness was higher than that in the controls. In the patients within the vitamin D deficiency group, vitamin D was found to be positively correlated with magnesium and negatively correlated with phosphorus and left atrial dimension. The results of this study demonstrate that vitamin D deficiency in female adolescence is associated with normal myocardial geometry and function. Although it has been associated with normal levels of asymmetric dimethyl arginine concentration, high measured carotid intima-media thickness may reflect endothelial dysfunction.

Right Ventricular Function in Patients with Pulmonary Hypertension: Correlation between Myocardial Performance Index measured by Conventional Pulsed Wave Doppler and Tissue Doppler Imaging

Right Ventricular Function in Patients with Pulmonary Hypertension: Correlation between Myocardial Performance Index measured by Conventional Pulsed Wave Doppler and Tissue Doppler Imaging

Assessment of fetal cardiac functions in pregnant women with asthma.

This study aims to investigate the effects of maternal asthma on fetal cardiac functions. The study was planned with 30 pregnant women who presented to a tertiary health center and were diagnosed with asthma and 60 healthy controls with similar gestational ages. The fetal echocardiographic assessment was assessed between 33 and 35weeks of gestation with pulsed-wave Doppler (PW), M-mode, and tissue Doppler imaging (TDI). Fetal cardiac functions were compared between maternal asthma and the control group. Cardiac functions were assessed according to the duration of maternal asthma diagnosis, as well. Early diastolic function parameters, tricuspid E wave (p=.001), and tricuspid E/A ratio (p=.005) were significantly lower in the group with maternal asthma. Tricuspid annular plane systolic excursion (TAPSE) and measurements of mitral annular plane systolic excursion (MAPSE) values were statistically lower in the study group than in the control group; p=.010 and p=.012, respectively. Parameters assessed with TDI (E', A', S', E/E', and MPI' of tricuspid valves) and global cardiac function parameters assessed with PW like myocardial performance index (MPI) and left cardiac output (LCO) were similar between groups (p>.05). Although, MPI did not change between groups, and the isovolumetric relaxation time (IVRT) value was prolonged in maternal asthma cases (p=.025). We found that maternal asthma disease causes alteration in fetal diastolic and early systolic cardiac functions, but the global fetal cardiac function does not change. Diastolic heart function values also varied with the duration of maternal asthma. Prospective studies are needed to compare fetal cardiac functions with additional patient groups according to disease severity and type of medical treatment.

Prevalence of mitral valve regurgitation in 102 asymptomatic Chinese Crested dogs

IntroductionMitral regurgitation (MR) is one of the main features of myxomatous mitral valve disease (MMVD), which is the most common heart disease in dogs. Myxomatous mitral valve disease affects many small breed dogs, and some breeds such as Cavalier King Charles Spaniels, Dachshunds, Yorkshire terriers, and Miniature Schnauzers have been studied more in detail. Breed-specific information regarding MMVD is valuable for providing appropriate advice on management and breeding. Data, based on insurance statistics in Sweden, show that Chinese Crested dogs (CCD) are twice as likely to visit the veterinarian for a heart-related problem than other breeds. AnimalsOne-hundred two privately owned, healthy CCD were recruited via the Swedish CCD club. Materials and methodsThis was a prospective observational study, in which clinical examinations, blood pressure measurements, and echocardiographic and Doppler examinations were performed in all dogs. Pulsed wave tissue Doppler imaging was performed in 87 dogs. ResultsMitral regurgitation was present in 39 (38%) dogs, whereas a systolic murmur was present in 35 (34%) dogs. Mitral valve prolapse was present in 32 (31%) dogs. Tricuspid regurgitation was found in 29 (28%) dogs. Dogs in the MR group were older (median 9.5 years), and males were overrepresented compared with the non-MR group. Differences were also found between groups regarding left atrial size and transmitral E wave velocity. ConclusionsThe prevalence of MR in CCD is similar to reports in other small breeds. Whether the MR detected in these dogs is a sign of MMVD is unknown.

Assessment of Cardiotoxicity after a Single Dose of Combretastatin A4-Phosphate in Dogs Using Two-Dimensional Speckle-Tracking Echocardiography.

Combretastatin A4-phosphate (CA4P) is a vascular disrupting agent that was recently described for the treatment of solid canine tumors. Conventional echocardiography and pulsed wave tissue Doppler imaging did not reveal cardiotoxicity in dogs, however, the gold standard for assessing myocardial damage in humans receiving cardiotoxic chemotherapeutics is two-dimensional speckle-tracking echocardiography. The current study evaluated the cardiotoxic effect of a single dose of CA4P in dogs using peak systolic strain measurements and the variability of these measurements. Echocardiographic examinations of seven healthy beagles and five canine cancer patients that received CA4P were retrospectively reviewed. Peak systolic regional longitudinal strain (LSt), peak systolic regional circumferential strain (CSt), and peak systolic regional radial strain (RSt) were measured before and 24 h after administration of CA4P. Peak systolic strain measurements were compared to serum cardiac troponin I (cTnI). To quantify intra- and inter-observer measurement variability, seven echocardiographic examinations were selected and each strain parameter was measured by three observers on three consecutive days. After CA4P administration, the median LSt and CSt values decreased by 21.8% (p = 0.0005) and 12.3% (p = 0.002), respectively, whereas the median RSt values were not significantly different (p = 0.70). The decrease in LSt was correlated with increased serum cTnI values (Spearman rho = -0.64, p = 0.02). The intra-observer coefficients of variation (CV) were 9%, 4%, and 13% for LSt, CSt, and RSt, respectively, while the corresponding interobserver CVs were 11%, 12%, and 20%. Our results suggest that regional peak systolic strain measurements may be useful for the early detection of cardiotoxicity that is caused by vascular disrupting agents and that LSt may be promising for the follow-up of canine cancer patients.

Assessment of Indicators of Left Ventricular Performance Obtained by Tissue Doppler Imaging in Prematurely Born Neonates.

Introduction: Tissue Doppler imaging techniques (pulsed-wave TDI (pwTDI) and color-coded TDI (cTDI)) allow for the assessment of myocardial performance during the cardiac cycle. The application of such techniques in neonatology is sporadic and poorly studied. Objective: The objective of the present study was to determine average values of pwTDI indicators of left ventricular performance (maximum systolic velocity of the mitral annulus (s’), maximum velocity in early diastole (e’) and maximum velocity in late diastole (a’)) and to examine their dynamics in prematurely born newborns in the first week of life. Methods: Prematurely born newborns of postnatal age up to 7 days were divided by gestational age into Group1 (<28 weeks) and Group 2 (≥28 weeks). Standard pwTDI parameters (s’, e’ and a’) were measured, compared between the groups and correlated with gestational and postnatal age, as well as application of respiratory support. Results: Fifty subjects were included (Group 1: 24; Group 2: 26). Average values of parameters s’, e’ and a’ were: Group 1: 4.06 ± 0.78 cm/s, 3.71 ± 0.40 cm/s and 3.98 ± 1.06 cm/s, respectively; Group 2: 4.18 ± 1.22 cm/s, 4.68 ± 1.04 cm/s and 4.12 ± 0.94 cm/s, respectively. Values of parameter e’ differed significantly between groups (p = 0.001) and strongly correlated with gestational age (p = 0, Pearson’s R = 0.88). There was no significant difference between groups for parameters s’ and a’ (p = 0.42 and 0.31, respectively). The values of s’, e’ and a’ did not differ between patients with an without respiratory support. Conclusion: Parameter e’ depends on gestational age, whereas parameters s’ and a’ are independent of gestational age. pwTDI indicators do not change during the first week of life, nor are all robust to hemodynamic circumstances caused by invasive/non-invasive respiratory support.

Prevalence of RV dysfunction in patients under cardiotoxic chemoterapy: a preliminary analysis

Abstract Background Chemotherapy-induced cardiotoxicity is a serious complication often leading to heart failure. While the left ventricle (LV) has been thoroughly implicated in this process, data is scarce on right ventricular (RV) function following cardiotoxic chemotherapies. Our goal was to determine the prevalence and clinical significance of RV dysfunction in a cohort of patients who had received these drugs. Methodology Single-center retrospective study of cancer patients performing 2D transthoracic echocardiogram between January 2020 and December 2021. Those previously exposed to anthracyclines and/or anti-HER2 agents (≥6 months prior to echocardiogram) were included. Patients with known coronary artery disease or cardiomyopathy were excluded. LV function was assessed through LV ejection fraction (LVEF) and global longitudinal strain (GLS). LV cardiotoxicity was defined as per 2020 ESMO guidelines. RV function was considered abnormal if the following criteria were met: tricuspid annular plane systolic excursion (TAPSE) &amp;lt;17 mm, peak systolic velocity of the tricuspid annulus by pulsed wave TDI (S'VD) &amp;lt;12 cm/s, fraction area change (FAC) &amp;lt;35% and mean free wall longitudinal strain (FWLS) &amp;gt;−20%. Results Forty patients were included (58±13 years; 95% female; 93% with breast cancer; 30%, 20% and 50% previously treated with anthracyclines, anti-HER2 or both, respectively). Mean LVEF and GLS were 56±7% and −17±3%. Overall, 13 patients had current LV cardiotoxicity. RV dysfunction was documented in 15 (38%) patients (7 [18%] with isolated RV dysfunction), most often detected through FWLS (14 [35%], 7 [18%], 6 [15%] and 5 [13%] patients with abnormal FWLS, TAPSE, FAC and S'VD, respectively) – Figure 1. Seven patients (18%) and one patient (3%) had ≥2 and ≥3 abnormal RV parameters. Those with RV dysfunction were more often symptomatic (NYHA class ≥2: 53% vs. 16%; p=0.013), had higher NT-proBNP levels (516 [204–2400] vs. 66 [46–191] pg/mL; p=0.003) and most often had LV cardiotoxicity (62% vs. 26%, p=0.029); pulmonary artery systolic pressures were similar between both groups. Conclusion In our cohort of patients treated with cardiotoxic anti-neoplastic drugs, RV dysfunction was observed in two out of every five patients, most often detected by RV 2D strain and associated with worse symptoms and higher NT-proBNP levels. This data suggests that RV cardiotoxicity may be common and clinically impactful in those under cardiotoxic chemotherapies. Funding Acknowledgement Type of funding sources: None.

Investigating the Relationship Between Cardiac Function and Insulin Sensitivity in Horses: A Pilot Study.

Metabolic syndrome in humans is commonly associated with cardiovascular dysfunction, including atrial fibrillation and left ventricular diastolic dysfunction. Although many differences exist between human and equine metabolic syndrome, both of these conditions share some degree of insulin resistance. The aims of this pilot study were to investigate the relationship between insulin sensitivity and cardiac function. Seven horses (five mares, two geldings, aged 17.2 ± 4.2 years, weight 524 ± 73 kg) underwent insulin-modified frequently sampled intravenous glucose tolerance testing to determine insulin sensitivity (mean 2.21 ± 0.03 × 10−4 L/min/mU). Standard echocardiograms were performed on each horse, including two-dimensional, M-mode, and pulse-wave tissue Doppler imaging. Pearson and Spearman correlation analyses were used to determine the association of insulin sensitivity with echocardiographic measures of cardiac function in 5 horses. Insulin sensitivity was found to be significantly correlated with peak myocardial velocity during late diastole (r = 0.89, P = 0.0419), ratio between peak myocardial velocity in early and late diastole (r = −0.92, P = 0.0263), isovolumetric relaxation time (r = −0.97, P = 0.0072), and isovolumetric contraction time (ρ = −0.90, P = 0.0374). These preliminary data suggest that decreased insulin sensitivity is correlated with alterations in both systolic and diastolic function, as measured with tissue Doppler imaging (TDI). Due to the small sample size of this study, the relationship between insulin sensitivity and myocardial function in horses requires further investigation.

The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients

Objective: Cardiac dysfunction has been reported in both cirrhotic and alcoholic patients. Our aim was to determine the relation of serum N-terminal pro-B-type natriuretic peptide (Nt-proBNP) levels to myocardial performance index (MPI) and disease severity in nonalcoholic cirrhotic patients. Patients and Methods: In this prospective study including 25 cirrhotic patients and 27 healthy controls, MPI was assessed by pulsed-wave tissue Doppler imaging (PW-TDI). The disease severity was determined by Child–Turcotte–Pugh (CTP ) and model for end-stage liver disease (MELD) scores. Results: There were no statistically significant differences in MPI levels between patients and controls (p&amp;lt; 0.246). Nt-proBNP levels (p&amp;lt; 0.0003), cardiac output (CO) (p&amp;lt; 0.0002), left ventricular end-systolic (LVES) volume (p&amp;lt; 0.031) and QT interval (p&amp;lt; 0.0001) increased. Left ventricular systolic function was normal in all cirrhotic patients when compared to controls. Nt-proBNP levels were positively correlated with MELD scores (p&amp;lt; 0.0001, r= 0.59), QT duration (p&amp;lt; 0.0001, r= 0.59), CO (p= 0,001, r= 0.44), right atrial (RA) area (p= 0.026, r= 0.31) and negatively correlated with diastolic BP (p= 0.015, r= -0.34). Conclusion: We conclude that in nonalcoholic cirrhotic patients, left ventricular MPI and systolic function were normal. Nt-proBNP levels were correlated with the disease severity and hyperdynamic circulation.

Early myocardial functional abnormalities in primary dyslipidemia: clinical and echocardiographic observations in young children from a highly consanguineous population.

Background Dyslipidemia is a major health problem among children and adolescents worldwide due to its significant association with cardiovascular disease. Primary dyslipidemias are commonly familial syndromes that can be completely asymptomatic.Purpose Apart from the risk of coronary artery disease (CAD), limited data are currently available on the direct effects of dyslipidemia on myocardial function in children.Methods We recruited 25 children with primary dyslipidemia (14 with isolated hypercholesterolemia, 4 with isolated hypertriglyceridemia, and 7 with combined dyslipidemia). Relevant clinical manifestations and laboratory and radiological investigations were evaluated. Pulsed-wave Doppler and tissue Doppler imaging echocardiography were performed for all recruited patients and the results were compared with those of 15 age- and sex-matched healthy children.Results The median age of the dyslipidemic children was 8 years (range, 1.5–16 years). A family history was documented in 13 cases (52%), while 18 (72%) had consanguineous parents. None of the dyslipidemic children had a personal history or clinical manifestations of CAD. In contrast, echocardiographic findings differed in several diastolic function parameters of both right and left ventricles in dyslipidemic children compared to controls. Based on normalized z scores, aortic valve narrowing was detected in 7 patients (28%), while narrowing of the aortic sinus (sinus of Valsalva) was detected in 15 patients (60%).Conclusion Different types of primary dyslipidemia produce functional myocardial abnormalities early in childhood. Biochemical and echocardiographic screening of high-risk children is advised to minimize the incidence of serious cardiovascular complications.

Correlation Between Left Ventricular Electromechanical Delay and Body Mass Index

Abstract Aim To evaluate effect of body mass index on left ventricle electromechanical delay among adults with no history of cardiac disease. Obesity is a complex disorder involving an excessive amount of body fat. Being extremely obese increases the risk of diseases and health problems, such as heart disease, type 2 diabetes mellitus, hypertension and premature death. The assessment of LV dyssynchrony has been gaining interest because it is increasingly considered to indicate the risk of progression to heart failure in various populations. Ventricular electromechanical delay can be measured from the onset of the QRS complex on electrocardiogram to the onset or peak of ventricular contraction determined by tissue Doppler imaging. Methods 66 subjects divided into three groups with 22 subjects for each group with age range (≥18 years and &amp;lt; 60 years old) of either sex with no history of cardiac disease were classified according to BMI into three group; Group A: subjects with normal BMI (18.5 – 24.9 kg/m2|), Group B: overweight subjects with BMI (25-29.9 kg/m2), Group C: obese subjects with BMI (≥ 30 kg/m2). The study groups were age, gender and risk factors matched. The time from the beginning of the QRS complex (on electrocardiogram) to the onset of systolic velocities in the septum and lateral wall were assessed and the time from the beginning of the QRS complex (on electrocardiogram) to the peak of systolic velocities in the septum and lateral wall were assessed using the pulsed wave Tissue Doppler Imaging (PW-TDI) by placing the sample volume in the middle of the basal portions of the LV septal and lateral walls in the apical four-chamber view at end-expiratory at a sweep speed of 100 mm/s, The difference between time recorded from septal and that recorded from lateral walls was referred as the lateral-to-septal delay. Results There was significant difference between the three groups regarding (lateral to septal delay) from onset of QRS to onset of S'(23.36±7.6 ms vs. 24.05±5.9ms vs. 35.18±9.3ms respectively, P &amp;lt; 0.0001), also there was a significant difference between study groups regarding (lateral to septal delay) from onset of QRS to peak of S'(39.41±9 ms vs. 48±10.4ms vs. 62.82±15.3ms respectively, P &amp;lt; 0.0001). There was a direct correlation between BMI and (lateral to septal delay) onset of QRS to peak of S' (r = 0.633, P &amp;lt; 0.0001) as well as (lateral to septal delay) onset of QRS to onset of S'(r = 0.64, P &amp;lt; 0.0001). Conclusion We present an interesting finding of left ventricular electromechanical delay in asymptomatic obese subjects with sinus rhythm and no history of cardiac disease. It would be speculative to say that the intraventricular dyssynchrony seen in asymptomatic obese individuals is related to cardiac electrical remodeling occurs with obesity and gives a proposal to understand pathophysiology of heart failure occurring in obese patients.