Systole Research Articles

Cardiac motion and its dosimetric impact during radioablation for refractory ventricular tachycardia.

Cardiac radioablation (CR) is a noninvasive treatment option for patients with refractory ventricular tachycardia (VT) during which high doses of radiation, typically 25Gy, are delivered to myocardial scar. In this study, we investigate motion from cardiac cycle and evaluate the dosimetric impact in a cohort of patients treated with CR. This retrospective study included eight patients treated at our institution who had respiratory-correlated and ECG-gated 4DCT scans acquired within 2 weeks of CR. Deformable image registration was applied between maximum systole (SYS) and diastole (DIAS) CTs to assess cardiac motion. The average respiratory-correlated CT (AVGresp ) was deformably registered to the average cardiac (AVGcardiac ), SYS, and DIAS CTs, and contours were propagated using the deformation vector fields (DVFs). Finally, the original treatment plan was recalculated on the deformed AVGresp CT for dosimetric assessment. Motion magnitudes were measured as the mean (SD) value over the DVFs within each structure. Displacement during the cardiac cycle for all chambers was 1.4 (0.9) mm medially/laterally (ML), 1.6 (1.0) mm anteriorly/posteriorly (AP), and 3.0 (2.8) mm superiorly/inferiorly (SI). Displacement for the 12 distinct clinical target volumes (CTVs) was 1.7 (1.5) mm ML, 2.4 (1.1) mm AP, and 2.1 (1.5) SI. Displacements between the AVGresp and AVGcardiac scans were 4.2 (2.0) mm SI and 5.8 (1.4) mm total. Dose recalculations showed that cardiac motion may impact dosimetry, with dose to 95% of the CTV dropping from 27.0 (1.3) Gy on the AVGresp to 20.5 (7.1) Gy as estimated on the AVGcardiac . Cardiac CTV motion in this patient cohort is on average below 3mm, location-dependent, and when not accounted for in treatment planning may impact target coverage. Further study is needed to assess the impact of cardiac motion on clinical outcomes.

PO-706-04 COMPACT REPRESENTATION OF ATRIAL SHAPE FOR THROMBOSIS RISK PREDICTION IN AF

The impact of LA shape on clot formation in AF is yet to be understood To analyze the impact of LA, PVs and LAA orientations on clot formation Pts with history of AF and an indication for LAA closure underwent pre-operative cardiac CT. Those with either a prior history of embolism or a clot detected on arterial and venous-enhanced CT images were categorized as clot positive. On CT images, the LA was segmented and meshed. Automated labelling of PVs and LAA was employed to build a compact skeleton representation of the LA (by registering labels from a template to all cases, and by connecting the center of mass of each labels). LA skeletons were used to train a novel Neural Network model for joint classification of heterogeneous data, such as images taken at different phases of the cardiac cycle. Such model consists of one encoder per dataset followed by a common classifier, enforcing a joint representation of all datasets in the same latent space. This is made possible by writing the task as a variational problem to optimise, we call this model a multi-channel variational classifier. The model was trained to predict clot positive patients and its generalizability was assessed on a test population. 237 pts were included (age 74±8, 70% males, CHA₂DS₂-VASc 4.3±1.2). CTs were acquired during systole in 117 and diastole in 120. 100 (42%) patients were considered clot positive. Segmentation, labeling and skeletization was successfully achieved in all pts. The model was trained using a 10-Fold cross validation. We compared the results after training on diastole and systole cases independently andby jointly training on both datasets. At testing, our model reached a 0.72 overall accuracy for the prediction of LAA clots (0.83 for systole and 0.61 for diastole), while training separately on systole anddiastole was prone to strong overfitting and mode collapse with 0.52 and 0.48 accuracy, respectively. While LA shape, LA size, PV and LAA orientations alone may not be sufficient for robust clot prediction, we introduce a compressed representation of the global anatomy that closely relates to LAA thrombosis, possibly identifying global features related to adverse hemodynamics. The method is reproducible andintroduces a novel approach to accommodate heterogeneous diastole and systole datasets.

Conventional Echocardiography changes in Children with Diabetes Mellitus Type I with Lipid Profiles the Variation

Introduction: Diabetes mellitus type I (DMTI) is a highlighted endocrine and digestion issue that involved heart organs with more effect when lipid profiles considered. The study aimed to assess the conventional echocardiographic changes in children with diabetes mellitus type I with their lipid profiles variation. Materials and Methods: This analytical and comparison study performed on 96 DMTI and 96 healthy children. The examination run with collaboration of endocrinology and cardiology between March 2018 and April 2019. The DMTI confirmed by the clinical manifestation and laboratory measures. Both groups underwent conventional echocardiography and HbA1c, diabetic duration and lipid profiles measured for the children with diabetes. Data analyzed via SPSS 18.0 and P < 0.05 was considered significant level. Results: About 52.6% and 47.9% were boys in participants and patients respectively. Mean age of participants was 10.82± 3.15 years and 10.87±3.46 and 10.77±2.82 years for patients and controls respectively. Left MPI was higher in patients (p=0.001). Patients with poor controlled had higher LVMI and left DT (p<0.05). Patients with abnormal CHO had higher EF, FS, left E/A, LAd/Aod, LAs/Aos, left ET and PWD when right DT, aortic diameter in diastole, aortic diameter in systole, left MPI and left DT had lower levels. LDL effects on aorta diameter in diastole, right deceleration time, aorta diameter in systole, left MPI and left DT, FS, Left E/A, LAd / Aod, LAs/Aos, and PWD. Patients with abnormal HDL, had higher left MPI and lower left ET. Conclusion: It was concluded that more conventional echocardiography involvement in DMTI children who have abnormal lipids profile as well as abnormal HbA1c and longer diabetes duration.

Diffusion tensor cardiovascular magnetic resonance detects altered myocardial microstructure in patients with acute st-elevation myocardial infarction

Abstract Background Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) can quantify metrics of tissue integrity (mean diffusivity [MD] and fractional anisotropy [FA]) and changes in laminar microstructures (sheetlets), which reorientate from more wall-parallel in diastole (DIA) towards wall-perpendicular in systole (SYS) as the myocardium thickens, quantified by E2 angle [E2A]. Microstructural changes after STEMI may provide new insights into adverse LV remodelling and risk stratification. Methods In vivo DT-CMR was performed 3–5 days after PPCI for first presentation STEMI (N=19, mean age 57±9, 79% male). DT-CMR was acquired in 2 short-axes (SYS &amp; DIA) using a STEAM-EPI sequence. 12 segment analysis of MD, FA, E2A and E2A mobility (ΔE2A = E2ASYS − E2ADIA) was performed. Infarct (INF) segments were defined as &amp;gt;25% LGE, adjacent (ADJ, located contiguous to INF) and remote (REM, all other segments). Wilcoxon signed rank tests were used with threshold P&amp;lt;0.017 (Bonferroni corrected). Results See Table. MD in both SYS and DIA was significantly higher in INF and ADJ regions compared to REM. FA in both SYS and DIA was lower in the INF and ADJ compared to REM. E2ADIA was higher in INF, indicating a more wall-perpendicular orientation of sheetlets, compared to ADJ and REM zones. E2ASYS in INF was significantly reduced, indicating a more wall-parallel orientation of sheetlets, compared to ADJ and REM regions, resulting in significantly reduced sheetlet mobility (ΔE2A). Conclusions Microstructural changes can be detected after acute STEMI by in vivo DT-CMR. Zonal changes in MD and FA may suggest loss of barriers to water diffusion and altered cardiomyocyte organisation, respectively. We provide the first report of reduced sheetlet mobility after acute STEMI in INF. Ongoing work is evaluating the mechanisms and prognostic importance of altered sheetlet mobility after STEMI. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship

Systole and Diastole, Strength and Openness

Systole and Diastole, Strength and Openness

Application of vector flow mapping technique in the assessment of left intraventricular pressure gradients in heart failure patients

Objective To evaluate the changes of intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) in different phases of cardiac cycle in patients with heart failure(HF) patients by relative pressure imaging based on vector flow imaging(VFM). Methods Forty-nine HF patients with left ventricular ejection fraction (LVEF) lower than 0.50 hospitalized in Qilu Hospital of Shandong University from November 2018 to January 2019, including thirty-three patients with HF with reduced ejection fraction (HFrEF group) and fifteen patients with midrange ejection fraction (HFmrEF group), and forty-three controls were enrolled in this study. Clinical data and echocardiographic images were collected and the conventional left ventricular diameter, mass, volume, and systolic and diastolic function parameters were measured. IVPDs and IVPGs during isovolemic systole (IC), rapid ejection (RE), isovolemic diastole (IR), rapid filling (RF) and atrial systole (AC) phases were obtained by the VFM technique. The changes of IVPDs and IVPGs in different phases between the HF and control groups, and their correlations with conventional ultrasound parameters were analyzed. Results IVPDs and IVPGs in heart failure group were significantly reduced compared with the control group especially in isovolumic relaxation phase(all P<0.001). IVPDs and IVPGs showed a decreasing trend in the control group, HFmrEF group and the HFrEF group(P<0.001). IVPDs and IVPGs were correlated with LVID, LVMI, ESV, LVEF, GLS and E/e′ (all P<0.01), among which IVPD-IR and IVPG-IR were best correlated. IVPD-IR and IVPG-IR had excellent diagnostic efficacy for HF patients with LVEF<0.5, with cut-off values of <0.73 mmHg (AUC=0.915, P<0.001) and <0.103 mmHg/cm (AUC=0.932, P<0.001), respectively. Conclusions Early diastolic hemodynamics are severely impaired when systolic function declines.IVPG-IR, as a marker of left ventricular diastolic function, significantly correlates with left ventricular systolic function, and can be used as a potential indicator for assessing left ventricular systolic and diastolic function in patients with heart failure and identifying patients with heart failure. Key words: Vector flow imaging; Relative pressure imaging; Intraventricular pressure gradients; Heart failure

Assessment of elasticity and viscosity in the human carotid artery using ultrasound shear wave dispersion imaging: a comparison study

Objective To detect the viscoelasticity of carotid artery in healthy volunteers using ultrasonic shear wave dispersion (SWD) technique, and explore the feasibility and influencing factors for SWD parameters. Methods Forty-five healthy volunteers were recruited and divided into elder group (≥50 years old) and younger group (<50 years old) according to the age. The carotid arteries were examined by SWD at systole, axial elastic modulus (SWER) and viscous index (SWDR) were obtained. The pulse wave velocity (PWV), a carotid artery circumferential elastic parameter was obtained and considered as the reference indicator. The difference of SWER, SWDR and PWV were compared between two groups; and the correlation between them were analyzed by Pearson analysis, respectively. Results ①Compared with the younger group, the carotid PWV increased, while SWER and SWDR decreased in the elder group(all P<0.05). ②In all subjects, SWER was negatively correlated with PWV (r=-0.256, P<0.05). In the elder group, SWER was negatively correlated with systolic blood pressure (r=-0.357, P<0.05), and SWDR was negatively correlated with PWV (r=-0.393, P<0.05). In the younger group, SWDR was positively correlated with systolic blood pressure (r=0.366, P<0.05). Conclusions Compared with the elder group, the carotid viscoelasticity was higher in young people, and it is correlated with PWV. SWD can evaluate carotid viscoelasticity, and contribute to better understanding of its tissue characteristics. Key words: Shear wave dispersion; Carotid artery; Pulse wave velocity; Viscoelasticity

Percent Deviation from Midline Coaptation- When to Suspect Bicuspid Aortic Valve

Background: Bicuspid aortic valve (BAV) is typically diagnosed by visualization of aortic valve leaflet opening during systole in parasternal short axis (PSAX) echocardiographic images. The leaflets are often seen poorly in PSAX view due to suboptimal acoustic windows or poor imaging techniques but are usually seen well in parasternal long axis (PLAX) view. Although the eccentric leaflet coaptation in PLAX view has been previously described the degree of eccentricity that should alert clinicians of the presence of BAV is not established in children. The …

Systole and Diastole, Strength and Openness

Systole and Diastole, Strength and Openness

The role of non-invasive fractional flow reserve derived from coronary CT angiography in assessing the hemodynamic relevance of myocardial bridging

Objective To evaluate the role of non-invasive fractional flow reserve (FFR) derived from coronary CT angiography (CCTA) in assessing the hemodynamic relevance of myocardial bridging (MB). Methods A total of 60 patients without obstructive coronary artery disease but with CCTA-confirmed MB of the left anterior descending coronary artery and 30 patients with negative CCTA findings as control group were retrospectively included in this study. The 60 patients with MB were divided into 2 groups (superficial and deep MB group) according to the depth of MB. Age and sex were matched among three groups. The location, length, depth, and degree of systolic compression of the MB were measured. The FFRCT values(including systolic and diastolic phases) were measured at three points (segments 1 to 2 cm proximal to a MB, mid-tunneled segment and segments 1 to 2 cm distal to the MB) by cFFR software. Patients with FFRCT<0.75 were deemed to have hemodynamic relevance (abnormal group). χ2 test, ANOVA test, Mann-Whitney U test, Kruskal-Wallis H test and logistic regression model were used for statistical analysis. Results The FFRCT values decreased from diastolic phase to systolic phase in deep MB group [0.90 (0.81-0.94) vs. 0.93 (0.91-0.97), Z=-2.172, P=0.03]. Compared to control group, the FFRCT values decreased in both diastolic phase and systolic phase in superficial MB group as well as deep MB group [systole 0.92 (0.90-0.94) control vs. 0.84 (0.77-0.88) superficial vs. 0.67 (0.50-0.88) deep, H=37.193, P<0.001; diastole 0.93 (0.89-0.94) control vs. 0.85 (0.73-0.92) superficial vs. 0.81 (0.65-0.87) deep, H=26.508, P<0.001]. Abnormal FFRCT values (<0.75) were found in 28 (47.7%) MB patients (9 superficial vs. 19 deep). The length (OR=1.067, 95% CI:1.016-1.122, P=0.010) and depth (OR=2.028, 95%CI:1.129-3.644, P=0.018) of MB were associated with the abnormal FFRCT values. Conclusions The FFRCT values of coronary artery distal to MB were lower than that without MB. Abnormal FFRCT values are more prevalent in deep MB. MB length and depth demonstrate moderate predictive value for an abnormal FFRCT value. Key words: Myocardial bridging; Tomography, X-ray computed; Fractional flow reserve

Reference intervals for transthoracic echocardiographic measurements in adult Dachshunds.

The aim of this study was to establish reference values for 2D and M-mode measurements in Dachshunds. Basic echocardiographic data, including M-mode, 2D and spectral Doppler mea- surements, was collected, analyzed and compared between 41 healthy Dachshunds and 50 other healthy dogs of similar weight. Echocardiographic reference intervals were prepared for Dachs- hunds. Dachshunds had a smaller left ventricular diameter in diastole and systole and a thicker septum than other dog breeds. Male Dachshunds had larger diastolic and systolic left ventricular diameter than females. Reference intervals for 2D and M-mode measurements in healthy Dachs- hunds differ from other dogs of similar weight and should be used for this breed to assess cham- ber enlargement.

Evaluation of diastolic left ventricular energy loss in patients with pregnancy-induced hypertension using vector flow mapping

Objective To quantify the diastolic average energy loss (EL) of left ventricle in patients with pregnancy-induced hypertension (PIH) by vector flow mapping (VFM) technique and explore the clinical significance of EL in evaluating left ventricular diastolic function in patients with PIH. Methods Fifty-seven cases of singletonic PIH in late pregnancy (PIH group) and 38 cases of the third trimester normal singleton pregnancy (control group) were enrolled in this study. VFM were used to analyze the total average energy loss (ELt) and average energy loss at the basal level (ELb), the papillary muscle level (ELp), and the apical level (ELa) in isovolumic relaxation, rapid filling, mid-diastol and atrial systole phases, and the differences between the two groups were compared. The correlation between ELt and E/e in both groups were analyzed. Results In PIH group, ELt, ELb, ELp and ELa in the mid-diastolic and atrial systolic phases were significantly higher than those in control group (all P<0.01); ELt, ELp, ELa in isovolumic diastolic phase and ELt, ELb and ELa in fast filling phase were higher than those in control group (all P<0.05). There was a positive correlation between ELt and E/e in isovolumic diastolic phase, rapid filling phase and atrial systolic phase in PIH group (r=0.326, 0.386, 0.403; all P<0.05). There was a positive correlation between the ELt of fast filling and atrial systolic phases and E/e in control group (r=0.498, 0.371; all P<0.05). Conclusions Increased left ventricular diastolic flow EL in PIH patients reflects the abnormal intraventricular hemodynamic changes, and it is related to left ventricular diastolic function parameters for the quantitatively evaluation of PIH patients, and might be feasible to reveal the extent and mechanism of left ventricular diastolic dysfunction. Key words: Vector flow mapping; Pregnancy-induced hypertension; Ventricular function, left; Energy loss

Relationship between left ventricular volume parameters and cardiac function in elderly patients with heart failure

Objective To explore the relationship between left ventricular volume parameters and cardiac function in elderly patients with heart failure. Methods From January 1st, 2012 to December 31st, 2014, five hundred and twenty-eight heart failure elderly patients with coronary heart disease, hypertension, heart valve disease, dilated cardiomyopathy, and hypertrophic cardiomyopathy in Kailuan General Hospital were collected in this study.The left ventricle diastolic end volume (LVEDV), left ventricle end systolic volume (LVESV) and left ventricular ejection fraction of the patients were measured.The concentrations of N type brain natriuretic peptide (NT-proBNP) and related biochemical indexes were detected. Results Among the 528 patients with cardiac insufficiency, 367 were males and 161 were females.Among them, there were 199 cases of heart function I, 163 cases of heart function II, 99 cases of heart function III and 67 cases of heart function IV.Correlation analysis showed that the correlation coefficients of LVEDV, LVESV and age were 0.431(P=0.001), 0.472(P=0.001) and 0.243(P<0.001), respectively.Logistic regression analysis showed that LVEDV (OR=2.654, 95%CI 2.124-3.894, P=0.004), LVESV (OR=2.939, 95%CI 2.539-3.256, P=0.001), LVESV), NT-proBNP (OR=2.921, 95%CI 2.888-3.562, P=0.002) were risk factors for heart failure. Conclusion The correlation between LVESV and cardiac function in elderly patients with heart failure is better than that in LVEDV, and the correlation between the two and cardiac function is better than that of age. Key words: Echocardiography; Left ventricle diastolic end volume; Left ventricle systole end volume; Heart function

Dissipative energy loss within the left ventricle detected by vector flow mapping in dilated cardiomyopathy patients

Objective To quantitatively analyze the energy loss (EL) of the left ventricle in dilated cardiomyopathy (DCM) by vector flow mapping (VFM). Methods Sixty-four DCM patients confirmed by clinical were enrolled and divided into three groups according to the level of left ventricular ejection fraction (LVEF): mild decreased LVEF group(group A, 40%≤LVEF<50%), moderate decreased LVEF group(group B, 30%≤LVEF<40%) and severe decreased LVEF group ( group C, LVEF<30%). Forty healthy volunteers were selected as control group (group D, 53%≤LVEF≤73%) for physical examination. The images of apical four-chamber and three-chamber in color Doppler echocardiography were acquired and EL was analyzed in different phases in a cardiac cycle. Results There was no significant difference of the EL in isovolumic systole and isovolumic diastole between DCM groups and the control group (P>0.05). In rapid and slow ejection period, the EL in group B and C were much lower than those in the control group (P<0.05). In rapid filling phase, the EL in DCM groups were much lower than that in the control group (P<0.05). While in slow filling period and atrial systole the EL in group C was lower than that in the control group (P<0.05). Conclusions VFM provides a new perspective for the cardiac function study of DCM patients. Key words: Echocardiography; Cardiomyopathy, dilated; Ventricular function, left; Vector flow mapping; Energy loss

Postoperative patient-controlled analgesia with butorphanol in puerperants underwent cesarean section

Objective To compare the effect of postoperative patient-controlled intravenous analgesia(PCIA) with doses of butorphanol on puerperant after cesarean section. Methods Three hundred ASA Ⅰ or Ⅱ patients underwent cesarean section were randomly divided into 6 groups(n=50) respectively received tramadol 200.0 μg·kg-1·h-1(group T), butorphanol 3.0 μg·kg-1·h-1 (group B1), butorphanol 3.5 μg·kg-1·h-1(group B2), butorphanol 4.0 μg·kg-1·h-1(group B3), butorphanol 4.5 μg·kg-1·h-1(group B4), or butorphanol 5.0 μg·kg-1·h-1(group B5). The loading doses were 50 mg for tramadol in group T, and 0.5 mg for butorphanol in group B1-B5, and PCIA was initiated after operation. VAS and observer's assessment of alertness/sedation(OAA/S) scale were employed to assess the severity of rest pain, motion pain, and uterus systole pain before anesthesia(T0), 0(T1), 30 min(T2), 2 h(T3), 4 h(T4), 24 h(T5) and 48 h(T6) after the initiation of PCIA. The time to flatus, time to breastfeeding, time to lactation, side effects, and satisfaction scores were recorded. Results Compared with group T, VAS scores of rest pain, motion pain, and uterus systole pain at T5 in group B1 were higher(P 0.05). No differences were found in pain scores at T6 among 6 groups(P>0.05). Compared with group T, patients in group B1 need more PCIA bolus during T5-T6(P 0.05). Conclusions PCIA with butorphanol at a dose of 3.5 μg·kg-1·h-1 or 4.0 μg·kg-1·h-1 may provide optimal postoperative analgesia after cesarean section. Key words: Butorphanol; Cesarean section; Patient-controlled intravenous analgesia

Imbalances of both systolic and diastolic hypertension is implicated by a series of causative agents, a cross-sectional health survey

Background and Objectives: Hypertension (HTN) or high blood pressure is a chronic medical condition in which the blood pressure in the arteries is elevated. Blood pressure is summarized by two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). Our survey based study is carried out to estimate the current consequences of HTN among the populations of southern cities in Bangladesh. Methods: We have conducted our research in context on population’s age, gender, family history, addictive probability with type of drug habit, age of onset of respondents. We have compared systolic value with diastolic regarding these parameters by the help of self-designed standard questionnaire relevant with hypertension by manual data collection over six month’s period. Total 350 subject respondents were investigated by majorly visiting at their home, work places and hospitals. Descriptive statistics were applied to the collected data and analyzed using Microsoft Excel software. Results: 52.8% was male respondents and 47.8% was female of which 27.3% was the age range 56-65 years and another top most 23.4% was 46-55 years old. 90-100 mm/Hg diastolic value was noticed for 84.9% participants whereas 101-110mm/Hg was for remaining 9.3%. On the other hand, 140-150 and 151-160mm/Hg systolic pressure measured for 36.1% and 26.8% patients. Although 43.4% respondents answered yes in question for conveying hypertension from their family history but 56.6% was not at all. Narcotics substances immensely do impact in high blood pressure pathogenesis as it has showed almost 54.63% users among them betel & tobacco are experienced at least 71% following for smoking 29%. However, 68% betel & tobacco consumers had diastolic pressure 90-100 mm/Hg and 140-150 mm/Hg systolic value was measured for 37% betel and tobacco addicts followed by 26% chain smokers persist systolic pressure 151-160 mm/Hg range. Interestingly the maximum numbers of 32.2% peoples was first affected by hypertension in their age 36-45 years and 24.9% was the age range of 46-55 in second position. Conclusion: Hypertension is a major public health problem and it is diagnosed on the basis of a persistent high blood pressure. Unfortunately, the tendency to start hypertension in young age is increasing day by day. Everybody should be very conscious about this severe health issue to give up all kind of habit forming narcotic agents.

Left ventricular energy loss during systole in patients with hypertension detected by ultrasonic vector flow mapping

Objective To evaluate the value of left ventricular energy loss (EL) in the systolic left ventricular hemodynamic changes in hypertensive patients by ultrasonic flow vector imaging(VFM). Methods Ninty-eight hypertensive patients were divided into non left ventricular hypertrophy group (NLVH group) and left ventricular hypertrophy group (LVH group) according to the left ventricular mass index(LVMI). Thirty-one healthy adults were erolled as control group. The average total energy loss (EL-T), basal energy loss (EL-B), middle energy loss (EL-M) and apical energy loss (EL-A) of each isovolumic contraction phase, fast ejection phase and slow ejection phase were obtained by VFM, the difference among the three groups were compared. Results ①EL-T and EL-B in isovolumic phase, rapid ejection phase and slow ejection phase in NLVH group were higher than those in control group (P<0.05 or P<0.01); EL-T, EL-B, EL-M and EL-A in isovolumic phase, rapid ejection phase and slow ejection phase in LVH group were all higher than those in control group (P<0.05 or P<0.01); EL-M in isovolumic phase and rapid ejection phase, EL-T, EL-B, EL-M and EL-A in slow ejection phase in LVH group were higher than those in the NLVH group (P<0.05 or P<0.01). ②There was a positive correlation between EL-T and LVMI (r=0.311, P<0.01), EL-B and LVMI (r=0.219, P<0.05), EL-M and LVMI(r=0.207, P<0.05), EL-T and LVEF(r=0.340, P<0.05), EL-B and LVEF(r=0.367, P<0.01) in isovolumic contraction phase. There was a positive correlation between EL-B and LVEF(r=0.359, P<0.01) in rapid ejection phase. There was a positive relation between EL-B and LVEF(r=0.352, P<0.05) in slow ejection phase. Conclusions The EL of systolic peroid in hypertensive patients increased, which suggests that the left ventricular hemodynamic changes abnormally, VFM can accurately evaluate the changes of hemodynamic during systole. Key words: Echocardiography; Hypertension; Ventricular function, left; Vector flow mapping

Pathological significance of retrograde flow in fetal aortic arch

Objective To summarize the pathological significance of retrograde flow in fetal aortic arch by analyzing the associated diseases and hemodynamic characteristics. Methods A retrospective study on retrograde flow in fetal aortic arch was conducted on fetuses with intra- or extra-cardiac abnormality. All data were collected from the database of Fetal Heart Disease Maternal Fetal Medicine Research Important Laboratories in Beijing from January 2013 to October 2016. Fetuses with normal cardiac structure and without extra-cardiac abnormality in late pregnancy were excluded from this study. Ultrasound images with description of retrograde flow in fetal aortic arch in report or presenting retrograde flow signal during scanning were recruited. All selected cases were reviewed and the diagnosis was reconfirmed. The signal of retrograde flow in the aortic arch was that the direction of blood flow in the aortic arch was inconsistent with that of the ductus arteriosus. Spectral Doppler was used to define systolic or diastolic retrograde flow and all cases were divided into four groups accordingly: middle-late systole, systole, diastole, systole+diastole for analysis. The etiology of retrograde flow in the aortic arch was analyzed based on cardiac structure abnormality and extra-cardiac abnormality. Clinical outcomes were followed up. Descriptive statistics was used to analyze all the data. Results (1) Among 21 607 cases reviewed, 62 (0.29%) were recruited with the mean gestational age of (29.5±4.6) weeks and and average age of (26.1±2.9) years, respectively. (2) Fifty-eight (93.5%) of the 62 cases were diagnosed with cardiac structure and/or cardiac function abnormality, including 44 of left ventricular outflow abnormality and 14 of significantly reduced left ventricular volume with normal left ventricular function. The other four cases (6.5%) with extra-cardiac abnormality were all complicated with abnormal peripheral circulation resistance in fetal systemic circulation, which included intrauterine growth restriction resulting from placental insufficiency (three cases) and cerebral arteriovenous fistula (one case). (3) Retrograde flow filling the whole aortic arch was found in 32 cases (51.6%) with severe aortic stenosis or atresia, one (1.6%) with severe aortic regurgitation caused by absence of aortic valve and one (1.6%) with cerebral arteriovenous fistula. Retrograde flow with other causes mainly presented in the middle part and the distal isthmus of the aortic arch. (4) Retrograde flow presented in the middle and late systole was observed in 24 cases (38.7%) of significantly reduced left ventricular volume with normal left ventricular function, while those presented in the diastole were found in cases with severe aortic regurgitation, large coronary fistula, or abnormal peripheral circulation resistance (six cases, 9.7%). Thirty-two fetuses (51.6%), diagnosed with left ventricular outflow tract obstruction, showed retrograde flow in both systole and diastole. (5) Among the 62 pregnancies, 46 (74.2%) were terminated, one (1.6%) ended due to fetal intrauterine death, and the other 15 (24.2%) continued to delivery (13 of term pregnancy, and two of preterm pregnancy). Autopsies were performed on 26 out of the 46 terminated fetuses, and the results were consistent with the fetal echocardiography. Of the 15 newborns, one died due to extra-cardiac abnormality, and the other 14 (four underwent operation) remained well in development and heart function during follow-up until March, 2017. Conclusions The retrograde flow signal in the aortic arch is commonly seen in fetal cardiac structural and/or functional abnormality. Hemodynamic characteristics of the retrograde flow may vary depending on the etiology. Therefore, clinicians should pay attention to analyze the hemodynamics in combination with ultrasound findings to identify the etiology and to improve the accuracy of fetal echocardiography. Key words: Fetal diseases; Aortic valve insufficiency; Hemodynamics

Research on gradual change of ascending aorta diameter

Objective To study the changes in the diameter of the ascending aorta at different levels. Methods A total of 287 patients were enrolled in this study from November 2016 to January 2017 at the Chinese People′s Liberation Army General Hospital in Beijing. Each patient had undergone enhanced computerized tomography scanning, and the systolic and diastolic images were reconstructed for each patient. Ten times distance accounts for percentage was calculated per 10% unit of ascending aorta. The maximal diameters of each level were measured by 3 mensio Vascular 8.1 software with curved planar reformation. Generalized additive mixed model with smoothing function and threshold saturation effect analysis with generalized estimating equations were used to analysis the changing regularity of ascending aortic diameters and its consistency using stratified analysis. Furthermore, stratified analyses were conducted aauording to sex, age, BMI, smoking status and history of chronic diseases. Results A nonlinear relationship between the maximal diameters and distance was observed. With the increase of distance, the maximal diameters of ascending aorta presented an inverted U shape. In the first half, the ascending aortic maximal diameter increased 1.16 mm while the distance increased ten percent of the ascending aortic length (P<0.001). In the second half, the ascending aortic maximal diameter reduced 0.47 mm while the distance increased ten percent of the ascending aortic length (P<0.001). The results showed that the changing regularity of ascending aortic diameter has no significant difference between systolic and diastolic periods. Conclusions With the increase of distance, the maximal diameters of ascending aorta increase and then decrease. The regularity of ascending aortic diameter between systole and diastole is consistent. In each subgroup, the regularity of ascending aortic diameter is not completely consistent, but the difference has not clinical significance. Key words: Aorta; Blood vessels; Periodicity, heart; Computer tomography

Xinfuli Granule improves post-myocardial infarction ventricular remodeling and myocardial fibrosis in rats by regulating TGF-β/Smads signaling pathway.

BackgroundRecent clinical and experimental studies have confirmed the effects of Xinfuli Granule (XG), a compound Chinese medicine in the prevention and treatment of heart failure (HF). This study aimed to investigate the effects and the mechanisms of XG on ventricular reconstruction in rats with acute myocardial infarction (AMI).MethodsSprague-Dawley rats were subjected to left anterior descending branch ligation. The rats that survived 24 h were randomly assigned to five groups: medium-dose of XG group (MI+XGM), high-dose of XG group (MI+XGH), carvedilol group (MI+C), medium-dose of XG + carvedilol group (MI+C+XGM). Fourteen rats underwent identical surgical procedures without artery ligation, serving as sham controls. At 28 days, left ventricular weight to body weight (LVW/BW) and heart weight to body weight (HW/BW) were calculated; left ventricular ejection fraction (LVEF), left ventricular shortening fraction (LVFS), left ventricular internal diameter at systole (LVIDS) were measured by ultrasound; HE staining, Masson staining, and Sirius red staining were used to assess the myocardial pathological and physiological changes as well as myocardial fibrosis area and non-infarct zone I/III collagen ratio. Expression of Smad3 were detected and analyzed by Western blot, immunohistochemistry and immunofluorescence. P-Smad3, Smad2 and Smad7 in the TGF-β/Smads signaling pathway were also analyzed by Western blot.ResultsThe LVIDS (P < 0.01), HW/BW (P < 0.05), type I/III collagen ratio (P < 0.01) and myocardial collagen (P < 0.01) decreased significantly while the LVW/BW, LVFS (P < 0.05) increased significantly in MI+XGM group as compared with those in other groups. The expression of key signal molecules of the TGF-β/Smads signaling pathway, including Smad3, P-Smad3 and Smad2 protein were decreased, while the expression of Smad7 increased in both XG and carvedilol treatment groups as compared to those of the MI group (all P < 0.01). Immunohistochemistry and immunofluorescence further confirmed the down-regulated Smad3 expression.ConclusionXG can improve ventricular reconstruction and inhibit myocardial fibrosis in rats with AMI by regulating TGF-β/Smads signaling pathway.