Simpson's Method Research Articles

Implement the Laplace transform to convert viscoelastic functions of asphalt mixtures

The relaxation modulus of an asphalt mixture is adopted for evaluation of pavement structural soundness. However, it is difficult to perform a strain-controlled relaxation test on an asphalt mixture to obtain the relaxation modulus. The aim of this paper is to obtain the relaxation modulus expression in the Laplace transform domain and then perform a Laplace transform to derive the relaxation modulus from creep compliance. A uniaxial static creep test was conducted on four types of asphalt mixtures at 20 °C, 30 °C, and 40 °C and under a load of 0.3 MPa. The Prony series and power law were used to model creep compliance with good fitting of R2 > 0.95. Because the Laplace transform of the power law was a gamma function, the Prony series was used to simulate creep compliance and then applied to interconverting the viscoelastic functions. The Simpson and Gauss methods were used to convert the relaxation modulus from creep compliance based on a convolution formula and the calculation results from the two methods were shown to be equivalent. Based on the Laplace transform formula for creep compliance and the relaxation modulus, an equation for calculating the relaxation modulus in the Laplace domain was proposed. Numerical inversion of the Laplace transform, using the fixed Talbot method, was implemented to compute the relaxation modulus in the time domain and the results were compared with those derived by using the Gauss method. The average error is less than 10−4 and the computational speed of the fixed Talbot method is a factor of 25 faster than that of the Gauss method, demonstrating the high precision and high efficiency of the Laplace transform method for computing the relaxation modulus. The method developed in this study provides an effective tool for interconverting viscoelastic functions of asphalt mixtures.

Use of a sine cosine algorithm combined with Simpson method for numerical integration

The sine cosine algorithm (SCA) is one of the most recent nature-inspired meta-heuristic optimisation algorithm, which the mathematical model based on sine and cosine functions. SCA has validated excellent performance in solving continuous problems and engineering optimisation problems. In this paper, we propose a new algorithm that encompasses the features of sine cosine algorithm and Simpson method (SCA-SM). The proposed procedure consists of two phases: in the first phase, the of sine cosine algorithm are used to find the optimal segmentation points on the integral interval of an integrand. In the second phase, the approximate integral value of the integrand is then calculated by a Simpson method. Numerical simulation results show that the algorithm offers an effective way to calculate numerical value of definite integrals, and it has a high convergence rate, high accuracy and robustness.

Use of a sine cosine algorithm combined with Simpson method for numerical integration

Use of a sine cosine algorithm combined with Simpson method for numerical integration

Coronary Endarterectomy Improve Left Ventricle Ejection Fraction After Coronary Artery Bypass Grafting Surgery

The diffusely diseased coronary artery is a challenge for cardiac surgeons, although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel. It may assures complete revascularization of myocardium in case of diffusely diseased vessels and prevent residual ischemia but it has not been widely used. recently cardiac surgeons are performing and increasing number of coronary artery endarterectomy and it has evolved as an important adjuvant procedure in coronary artery bypass grafting surgery. we reviewed the early clinical and hemodynamic out comes with echocardiography of 22 patients undergoing coronary artery endarterectomy of left anterior descending artery (LAD) diagonal branches (D1 or D2) and right coronary artery and posterior descending artery (RCA and PDA) with patch plasty method using left internal mammary artery (LIMA) and saphenous vein graft (SVG) between January 2017 and June 2018. mean follow up of all patients were 3-6 months postoperatively, Left internal mammary artery (LIMA) anastomosed to left anterior descending artery (LAD) with endarterectomy and artery patch plasty in 12 (54, 5%) patients, saphenous vein graft (SVG) anastomosed to left anterior descending artery (LAD) with endarterectomy and vein patch plasty in 2 (9%) patients, and saphenous vein graft (SVG) to Right coronary artery (RCA) Diagonal (D1) and posterior descending artery (PDA) with endarterectomy and vein patch plasty in 9 (40.9%) patients. Postoperative mortality was 0% and echocardiographic assessment done by modified Simpson method on outpatient department (OPD) basis, 7 patients had left ventricle ejection fraction of (50-55%) preoperatively with no changes on postoperative period and 7 patients had improvement of left ventricle ejection fraction from (30-35%) preoperatively to (40-45%) in postoperative period. principle goal in coronary artery bypass grafting surgery (CABG) is to achieve complete revascularization of diseased coronary arteries, in particular the left anterior descending artery (LAD) is very important vessel because incomplete revascularization of the LAD has been proven to be a predictor of worse mortality after coronary artery bypass grafting surgery (CABG). Recent publications have revealed that coronary endarterectomy is a safe procedure and demonstrated favorable long term out comes. In our experience coronary endarterectomy has been performed with good clinical and hemodynamic out comes with echocardiography.

A 6-week multidisciplinary tailored Cardiac Rehabilitation Program is able to improve Left-Ventricular Ejection Fraction in patients with Chronic Heart Failure

Background Cardiac rehabilitation (CR) is recommended to patients with chronic heart failure (CHF) and reduced Left-Ventricular ejection fraction (EF) at a class 1 evidence level. Purpose The aim of this prospective study was to assess the effect of a rehabilitation program on EF in patients with CHF. Methods One hundred and five patients (mean age: 5713 years, men: 67%, diabetic patients: 42%) with CHF (EF Reasons of admission were: coronary heart disease artery bypass graft surgery (17%), angioplasty percutaneous coronary interventions and stent (24%), angor pectoris or myocardial infarction (8%), aortic or mitral valve replacement or repair (10%), dilated cardiomyopathy (34%), other (7%). Patients received beta-blocker (96%), conversion enzyme inhibitor or angiotensine II receptor antagonist (42%), sacubitril-valsartan (48%), furosemide (60%), antialdosterone therapy (55%), ivabradine (12%), other (11%). EF assessed by echocardiography using the biplane Simpson's method, peak oxygen consumption (VO2), maximal walking distance (MWD) during 6 min walk test and NT-proBNP were assessed before and after rehabilitation. Results After 6 weeks, there were significantly improvements in EF (35% ± 7.23 vs. 40% ± 8.3 - P Conclusion Our study shows that a 6-week multidisciplinary tailored Cardiac Rehabilitation Program improves significantly Left-Ventricular ejection fraction in patients with Chronic Heart Failure. This should be relevant to improve prognosis.

Impact of Increased Right Atrial Size on Long-Term Mortality in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy

The ability to visualize the right atrium (RA) by echocardiography allows a quantitative, highly reproducible assessment of the RA volume (RAV). The aim of this study is to evaluate the relation between RAV and long-term mortality in a prospective cohort of heart failure and reduced ejection fraction patients in sinus rhythm receiving cardiac resynchronization therapy. 172 patients were included. The right atrium volume index (RAVI) was calculated using Simpson's method from the apical four-chamber view and indexed to body surface area. The relation between RAVI and mortality during follow up was studied. Median follow up was 68 months (interquartile range 62 to 73 months). Mean RAVI was 27 ± 14 mL/m² (IQR 22 to 33 mL/m²). Cumulative 5-year all-cause mortality was 22 ± 6% in patients with RAVI ≤ 19 mL/m², 24 ± 6% for RAVI 19 to 29 mL/m² and 58 ± 7% for RAVI >29 mL/m² (p for trend <0.001). After adjustment on clinical and echocardiographic predictors of outcome including indices of right ventricular function, there was a significant increase in overall mortality risk with increasing RAVI (adjusted hazard ratio 1.02 [95% confidence interval, 1.00 to 1.03], per 1 mL/m2 increment; p = 0.042). Patients in the highest tertile (RAVI >29 mL/m²) had significantly greater risk of death compared with those with RAVI ≤29 mL/m² (adjusted hazard ratio 2.01 [95% confidence interval, 1.15 to 3.50]; p = 0.014). In conclusion, RA enlargement is a powerful and highly reproducible independent predictor of long-term mortality in patients with heart failure and reduced ejection fraction in sinus rhythm receiving cardiac resynchronization therapy.

Direct calculation formulas for normal depths of four kinds of parabola-shaped channels

Channels with parabola-shaped cross-section are widely used in water conservancy and hydropower engineering, agricultural irrigation and drainage engineering, so it is necessary to determine the accurate normal depth values for design of open channels, operation management and analysis of gradually varied flow. However, the governing equations are nonintegrable for cubic and semi-quintic parabola-shaped channels in terms of the wetted perimeters. In this study, the Simpson's numerical integral method is introduced to approximate the two nonintegrable wetted perimeters for cubic and semi-quintic parabola-shaped channels which can meet the requirements of engineering design well in the commonly using range of engineering. Subsequently, the approximate wetted perimeters are substituted into the uniform flow equation and the uniform flow equation deforms optimal model identically. The optimal model parameters are determined by the 1stOpt software based on Marquardt algorithm and two explicit calculation formulas for the normal depths of cubic and semi-quintic channels are proposed. At the same time, two direct calculation formulas for normal depths of semi-cubic and quadratic parabola-shaped channels are presented as well. Four sets of formulas for normal depths of parabola-shaped channels are presented and their maximum relative errors are 0.52%, − 0.37%, − 0.22% and 0.57%, respectively, which have wide range of application, high precision, concise form and can provide some better guidance for engineering design and operation management.

Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study.

BackgroundHeart failure (HF), is a major public health issue globally. Echocardiography is cost–effective in the diagnosis in expert hands. This study was conducted to estimate the usefulness of Aortic Root Systolic Excursion (ARSE) as a simple and accurate measure to estimate Left Ventricular (LV) function.MethodsThis was a cross-sectional echocardiographic study among adults aged ≥ 18 years, with or without heart failure, in sinus rhythm, and with no LV out–let obstruction. We studied the correlations of ARSE with some selected indices of LV Systolic Functions. We determined optimal cut–offs of ARSE in detecting LV dysfunction. We generated a simple regression equation to best estimate LV ejection fraction according to the modified Simpson method.ResultsOverall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p<0.001), and lowest for the ITV method (r = 0.319, p<0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, with an AUROC of 91.6%.The logarithmic regression equation was best in predicting LV ejection fraction (AUC: 60.2%), followed by the power model (AUC: 56.7%), and the linear model (AUC: 53.6%).ConclusionARSE correlated well with LV systolic function. The cut–off ≤ 6.5 mm suggest LV systolic dysfunction. LV Ejection Fraction was best estimated with the generic equation: LVEF (%) = 29 x In [ARSE].

A Small Disturbance Model for Transonic Flow of Pure Steam With Condensation

A small-disturbance model to study transonic steady condensing flow of pure steam around a thin airfoil is developed. Water vapor thermodynamics is described by the perfect gas model and its dynamics by the compressible inviscid flow equations. Classical nucleation and droplet growth theory for homogeneous and nonequilibrium condensation is used to compute the condensate mass fraction. The model is derived from an asymptotic analysis of the flow and condensation equations in terms of the proximity of upstream flow Mach number to 1, the small thickness ratio of airfoil, the small quantity of condensate, and the small angle-of-attack. The flow field may be described by a nonhomogeneous and nonlinear partial differential equation along with a set of four ordinary differential equations for calculating condensate mass fraction. The analysis provides a list of similarity parameters that describe the flow physics. A numerical scheme, which is composed of Murman and Cole's algorithm for the computation of flow parameters and Simpson's integration method for calculation of condensate mass fraction, is applied. The model is used to analyze the effects of heat release due to condensation on the aerodynamic performance of airfoils operating in steam at high temperatures and pressures near the vapor–liquid saturation dome.

Assessment of left atrial function in dogs with myxomatous mitral valve disease by biplane simpson’s method

ABSTRACT The relationship between the diameter of the left atrium (LA) and aorta (Ao) is considered as a prognostic factor in chronic mitral valve disease. As the left atrium is a three-dimensional structure, methods based on measurement of the chamber volume can be more accurate than linear methods.The aim of this study was to assess the feasibility of measuring LA volume with 2D echocardiography using the biplane modified Simpson (SIMP) method in 33 dogs with various classes of myxomatous mitral valve disease (MMVD), as well as to present values of LA function using the atrial diastolic and systolic volume indices (ADVI and ASVI), cardiac index (ACI) and atrial ejection fraction (AEF). We observed agreement among the LA/Ao ratio and the atrial volume indices (ADVI and ASVI) and the ACI, suggesting that the values of the variables increase as the LA/Ao ratio increases due to atrial remodeling that accompanies MMVD progression. The data demonstrated a good assessment of atrial function, allowing a better understanding of LA's role in the pathophysiology of MMVD.

Left Ventricular Function After Repair of Totally Anomalous Pulmonary Venous Connection

Poor left ventricular (LV) growth and diastolic dysfunction long after simple total anomalous pulmonary venous connection (TAPVC) repair has been well documented and is believed to originate from insufficient preoperative volume preload. The objective of the study was to confirm these findings. Of 61 patients undergoing simple TAPVC repair between 1996 and 2016, 42 patients undergoing postoperative catheter examinations were enrolled. The mean age at the time of repair was 39 ± 117 days. Postoperative catheter examinations were conducted at a mean duration of 1.1 years after the repair. LV end-diastolic volume (LVEDV) was calculated by biplane cineangiography with the use of Simpson's method as a Graham modification. LV ejection fraction, LV end-diastolic pressure (LVEDP), and cardiac index were 72% ± 5%, 10.3 ± 2.7 mm Hg, and 4.0 ± 0.7 L •·min-1 • m-2, respectively. LVEDV was 102% ± 16% of the predictive normal value, and it strongly correlated with the predictive normal value of LV end-diastolic diameter (LVEDd) calculated by two-dimensional echocardiography (R2= 0.29, p= 0.005). LVEDd maintained a normal range thereafter during the entire follow-up period. LVEDP correlated linearly with age at the time of TAPVC repair (R2= 0.18, p= 0.007) but not with LVEDV (p= 0.67). LV size maintained a normal range after the repair of simple TAPVC. High LVEDP was frequently observed a year after repair; it did not correlate with LV size but had a strong negative correlation with age at the time of repair.

Echocardiographic variables in healthy North American Salukis

IntroductionTo report normal echocardiographic variables from a population of healthy Salukis in North America. AnimalsThe study included 83 healthy adult Salukis from North America with structurally normal hearts. MethodsAll animals underwent a full physical examination and two-dimensional, M-mode, and Doppler echocardiography using the right parasternal and left apical views with the left ventricular volumes calculated using the Simpson's method of discs. Echocardiographic variables were compared among sex, body surface area, and body weight (BW) using linear regression. The 95% predictive intervals were calculated for both unadjusted and BW-adjusted data. ResultsNo relationship between sex and the echocardiographic variables was noted. Predictive intervals for echocardiographic variables are presented for 22 echocardiographic variables. Linear regression suggested that 16 of those variables were associated with BW. The 95% predictive intervals of echocardiographic variables adjusted for BW are reported. ConclusionsThe data from this study provide breed-specific echocardiographic reference values for Salukis.

Measurement of Left Ventricular Volumes and Ejection Fraction in Patients with Regional Wall Motion Abnormalities Using an Automated 3D Quantification Algorithm

Accurate and rapid left ventricular (LV) ejection fraction (EF) measurement is crucial for patients with wall motion abnormalities (WMAs). Conventional 2D echocardiographic imaging has limitations. The recently developed software HeartModel (HM, Philips Healthcare, Andover, MA, USA) has shown promise in automated 3D quantification. However, the accuracy and detailed features of HM in measurements of LV volume and EF in patients with regional WMAs have not been carefully investigated. In the present study, echocardiographic imaging (EPIQ, X5-1, Philips Healthcare) was performed in 72 patients with WMAs. The LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF were measured by HM in three modes: without editing and with global and regional endocardial border editing (Auto 3D-NE, Auto 3D-GE and Auto 3D-RE, respectively). The conventional 2D Simpson's biplane method and manual 3D quantification (QLAB-3DQA software, Philips Healthcare), as the standard method, were used for comparison. Among the three HM modalities, Auto 3D-RE exhibited the best correlation with manual 3D in assessing EDV, ESV and EF (r = 0.88, 0.93 and 0.91, respectively), although it took slightly longer (67.3 ± 13.0 s). Auto 3D-RE also exhibited a small degree of bias for the measurements (EDV: 11.7mL, ESV: 8.45mL, EF: –1.57%) and narrow limits of agreement. Heterogeneity of LV wall motion was defined to indicate the dispersion degree of WMAs. It associated with the difference in EF measurement between Auto 3D-RE and manual 3D (p = 0.014, hazard ratio = 5.19). In patients with WMAs, HM with regional contour editing enables accurate and efficient evaluation of LV volume and EF.

Effect of transcatheter aortic valve replacement on left atrial function.

To investigate the effect of transcatheter aortic valve replacement on left atrial volumetric function and left atrial volume for the prediction of adverse outcomes. This is a retrospective analysis of 121 patients in sinus rhythm who underwent TAVR for severe AS. Maximum LA volume index (LAVI max), minimum LA volume index (LAVI min), and "pre-A" volume index (LAVIpre-A, the volume before atrial contraction) were measured by biplane Simpson's method at baseline, 1month, and 1year. The reservoir function, conduit function, booster pump function were calculated. All patients were followed for new-onset of atrial fibrillation, hospitalization and all-cause mortality. The reservoir function, conduit function and booster function before TAVR were 46%, 21%, 32%, respectively. LA volumetric function assessment demonstrated that reservoir function, conduit function increased over the time (all P<0.01). There was no difference in booster function after TAVR (P=0.18). Baseline markedly enlarged LA was significantly increased for AF (HR: 4.72; 95% CI, 1.11-20.13, P=0.04). In addition, There was a progressive decrease in LAVI max (P=0.02) and RVSP (P=0.03) over the time in non-AF group but not in AF group (P=0.62 and P=0.65, respectively). Although, the proportion of high left ventricular filling pressure decreased in both groups but a marked decrease was noted in non AF group in compared with AF group. Reservoir function, conduit function increased over time. Lack of negative LA remodeling post TAVR was associated with higher incidence of AF.

Semi-automated estimation of left ventricular ejection fraction by two-dimensional and three-dimensional echocardiography is feasible, time-efficient, and reproducible.

To compare two-dimensional (2D) and three-dimensional (3D) methods to estimate left ventricular ejection fraction (LVEF) with respect to feasibility, time consumption, and retest reproducibility. A total of 100 patients planned to undergo coronary artery bypass grafting and/or aortic valve replacement were included consecutively. 2D and 3D echocardiography was performed on all patients. Acquisition and analysis time as well as intra- and inter-examiner variability were assessed in 50 consecutive patients with 3 repeated echocardiographic examinations and analyses. LVEF was estimated by five different methods: uniplane, biplane, and single-beat triplane (SB3P), as well as semi-automated biplane (AutoEF) and 3D volumetric tracings (4D Auto LVQ). All methods were compared to Simpson's biplane method and feasibility was determined. Feasibility of Simpson's uniplane method, Simpson's biplane method, AutoEF, SB3P, and 4D Auto LVQ was 97%, 92%, 86%, 70%, and 89%, respectively. All methods evaluated were 18%-33% faster (P<0.001) than Simpson's biplane method (115seconds, standard deviation 15seconds). Compared to Simpson's biplane method mean LVEF was slightly underestimated by 4D Auto LVQ (-2±8%, P=0.02), but not significantly different when assessed by the other methods. AutoEF and 4D Auto LVQ showed the lowest test variability (intra-examiner coefficient of variation (CV) 10%-11%; inter-examiner CV 10%-12% vs intra-examiner CV 12%-18%; inter-examiner CV 12%-20%). Estimation of LVEF by modern semi-automated 2D and 3D echocardiographic modalities is feasible, time-efficient, and reproducible.

19 ISOLATED SYSTOLIC HYPERTENSION AS A RISK FACTOR FOR LEFT VENTRICULAR HYPERTOPHY IN HEART FAILURE PATIENT AT SAIFUL ANWAR HOSPITAL

Background: Left ventricular hypertrophy (LVH) is a maladaptive response to chronic pressure overload and an important risk factor sudden death in patients with heart failure. Previous studies show that LVH is a risk factor for systolic heart failure. It's interesting to examine whether Isolated Systolic Hypertension (ISH) in the presence of LVH contribute to clinical outcome. Objective: The aims of this study to examined association of ISH with cardiovascular outcomes and to examined associations of ISH and LVH in Heart failure registry patient Methods: A total of 120 subject's were collected from Saiful Anwar Heart Failure Registry from January 2017 to December 2017. All participants were individually interviewed with a structured questionnaire for collecting baseline characteristic. Subject were classified into 2 group of hypertension (ISH and Systolic Diastolic Hypertension (SDH)). ISH based on the criteria of SBP ≥ 140 and DBP < 90 mmHg and SDH based on SBP ≥ 140 and DBP ≥ 90 mmHg. The EF and volumes were measured with 2D-biplane Simpson's method by measured as a standart manner Results: ISH commonly found among older hypertensive patients than SDH (Mean age 61,23 ± 11,2 yo vs 53,52 ± 11,1 yo, respectively, p < 0,04). LVH was more prevalence among ISH than SDH. No difference in clinical outcome such as in hospital mortality, Rehospitalization, and Lengt of stay were observed in both groups. Complication of hypertension was similar in both groups such as stroke, Myocardial Infarct, and Chronic Kidney Disease. Intrestingly, no difference also observe in compliance to the drug between ISH and SDH. We also examined subgroup analysis of subject's with ISH. There was no statistically significant difference in clinical outcome between ISH with LVH and ISH without LVH. Conclusion: In this study, we suggest that ISH more common in older patient with HF than SDH but had similar associations with cardiovascular mortality and rehospitalization. ISH was associated with a higher prevalence of left ventricular hypertrophy than SDH.

Assessment of left ventricular systolic function by tissue Doppler imaging in controlled versus uncontrolled type 2 diabetic patients.

AimTo detect and quantify early subtle left ventricular (LV) systolic dysfunction using Tissue Doppler Imaging in type 2 diabetic patients with apparently normal LV ejection fraction.MethodsNinety age and sex matched subjects were enrolled in the study, sixty of them were suffering from type 2 diabetes mellitus (DM) whom were divided according to HbAlc into 2 groups, 30 uncontrolled diabetic patients with HbAlc > 8% and 30 controlled diabetic patients with HbAlc < 8% and a third group of 30 normal subjects served as controls. We excluded patients with inadequate Doppler signal, all structural heart diseases, systemic disorders with cardiac involvement and patients with false positive HbAlc. Assessment of diastolic function was done by Pulsed Doppler through mitral flow and by propagation flow velocity. Assessment of left ventricular systolic function was done by conventional echocardiography by 2D Simpson method and by Tissue Doppler Imaging (TDI) through detection of mitral annular peak systolic velocities.ResultsLeft ventricular diastolic function was compared between the studied groups and showed that the mean peak early mitral inflow velocity E wave and the color M-mode flow propagation velocity of early diastolic flow (Vp) were significantly lower, and the mean peak late mitral inflow velocity A wave was significantly higher in uncontrolled diabetics versus controlled diabetic patients and control group with highly significant statistical difference (p < 0.001). Assessment of global systolic function by conventional Simpson’s modified biplane method didn’t show significant difference between uncontrolled diabetic patients, controlled diabetic patients and normal individuals. However, evaluation of systolic function by Tissue Doppler Imaging showed that the mean peak longitudinal systolic velocity was significantly decreased in uncontrolled diabetic patients when compared to controlled diabetic patients and normal individuals, with highly significant statistical difference (p < 0.001). A cut-off value for systolic dysfunction detected by TDI in uncontrolled diabetic patients was calculated. The peak systolic velocities < 7 cm/s for medial mitral annulus and < 8.2 cm/s for lateral mitral annulus indicated systolic dysfunction in diabetic patients with sensitivity and specificity of 96% and 67% respectively for medial mitral annulus while 98% and 71% respectively for lateral annulus.ConclusionTDI is a simple and effective method for detection of subtle LV systolic dysfunction in type 2 uncontrolled diabetic patients.

Greater nighttime blood pressure variability is associated with left atrial enlargement in atrial fibrillation patients with preserved ejection fraction.

Left atrial enlargement is an independent risk factor for ischemic stroke in patients with atrial fibrillation. Little is known regarding the association between nighttime blood pressure variability and left atrial enlargement in patients with atrial fibrillation and preserved ejection fraction. The study population consisted of 140 consecutive patients with atrial fibrillation (mean age 64 ± 10 years) with preserved ejection fraction (≥50%). Nighttime blood pressure was measured at hourly intervals, using a home blood pressure monitoring device. Nighttime blood pressure variability was expressed as the standard deviation of all readings. Left atrial volume index was measured using the modified Simpson's biplane method with transthoracic echocardiography. Multiple regression analysis indicated that nighttime mean systolic/diastolic blood pressure and its variability remained independently associated with left atrial enlargement after adjustment for age, sex, anti-hypertensive medication class, and left ventricular mass index (P < 0.01). When patients were divided into four groups according to nighttime blood pressure and its variability, the group with higher nighttime blood pressure and its variability had significantly larger left atrial volume than the group with lower nighttime blood pressure and its variability (46.6 ml/m2 vs. 35.0 ml/m2, P < 0.0001). Higher nighttime blood pressure and its variability are associated with left atrial enlargement. The combination of nighttime blood pressure and its variability has additional predictive value for left atrial enlargement. Intensive intervention for these high-risk patients may avoid or delay progression of left atrial enlargement and reduce the risk of stroke.

Predictors of mitral annulus enlargement? A real-time three-dimensional transesophageal study

BackgroundMitral annulus (MA) enlargement can be observed in various cardiac conditions but respective influence of left atrial (LA) and left ventricle (LV) size remained unclear. MethodsIn 120 patients who underwent a clinically indicated 3D-transesophageal-echocardiography, 30 atrial fibrillation (AF), 30 secondary mitral regurgitation (SMR), 30 primary myxomatous mitral regurgitation (PMR) and 30 mitral stenosis (MS), we evaluated the association between MA area (MA-area) and LA volume (LAvol) measured using the biplane area-length method, end-diastolic (LVEDV) and end-systolic (LVESV) volumes measured using the biplane Simpson method. MA-area was measured based on 3D datasets using QLab10. ResultsMA-area was correlated to LVEDV (r = 0.42, p < 0.0001), LVESV (r = 0.29, p = 0.001) but more markedly to LAvol (r = 0.62, p < 0.0001). Correlation between MA-area and LAvol was sustained in all subsets whereas MA-area was not correlated to LVEDV and LVESV in patients with SMR and with PMR (all p > 0.10). In multivariate analysis main predictors of MA-area were LAvol (p < 0.0001) and myxomatous etiology of MR (p = 0.0003) followed by LVEDV (p = 0.006) and LVESV (p = 0.02). ConclusionIn a population of patients with a wide range of LA/LV size related to various conditions, LA volume and myxomatous MR etiology appeared as main predictors of MA size whereas LV size had a more modest influence.

CARDIOTOXICITY IN PATIENTS WITH TRIPLE NEGATIVE BREAST CANCER UNDERGOING ANTHRACYCLINE CHEMOTHERAPY DEPENDING ON BLOOD PRESSURE LEVEL

Objective: to study the risk of cardiotoxicity in patients with triple negative breast cancer with arterial hypertension (AH) during anthracycline chemotherapy. Design and method: 70 women [48.6 ± 13.3 yrs] with breast cancer were enrolled. In all patients office blood pleasure (BP) was thrice measured. Echocardiography, including 2D STE, was performed before and after 8 courses of antitumor therapy. Left ventricular ejection fraction (LVEF) measured with the biplane Simpson's method and global longitudinal strain (GLS) [normal GLS – 22.1 ± 1.8 for women] were analyzed. Patients depending on blood pressure level were divided into 2 groups: group 1 - with AH (n = 18) and group 2 – without AH (n = 52). Results: The average level of office BP in group 1 was 130.8 ± 2.3 / 79.5 ± 2.7 mm Hg. After chemotherapy target BP level was maintained in 10 patients. There was a significant LVEF reduction after chemotherapy (from 68.9 ± 5.8% to 63.7 ± 6.7%, p < 0.05). Initially in group 1 GLS was lower than normal range (−19.1 ± 2.8%, p < 0.05), after chemotherapy further GLS decrease was recorded (from −19.1 ± 2.8% to −16.4 ± 3.8% [p < 0.05]). There was a further progression of AH (mean systolic BP (sBP) 162.2 ± 11.2 mmHg, mean diastolic BP (dBP) −98.3 ± 4.9 mmHg) in 8 patients (44.4%) in spite of antihypertensive therapy during chemotherapy. After chemotherapy reduction in LVEF was observed (from 65.9 ± 3.4% to 62.0 ± 2.0% (n.s.)). GLS before chemotherapy was below the normal values (−18.0 ± 1.5%), after chemotherapy GLS values were 15.6 ± 1.3% (n.s.). Also there was an increase in BP in 7 patients (13.4%) without initial AH during chemotherapy (mean sBP -148.3 ± 5.8 mmHg, mean dBP - 94.1 ± 3.7 mmHg). Before and after chemotherapy the LVEF was 68.9 ± 1.7% and 67.9 ± 1.5%, consequently. There were practically no changes in initially normal GLS before (21.8 ± 0.4%) and after chemotherapy GLS (21.4 ± 0.5%, (n.s)). Conclusions: Patients with AH already have a subclinical impairment in cardiac function, which makes them more vulnerable to cardiotoxic effects of chemotherapy.