Systolic Area Research Articles

Cardiac function in a chemical toxin (organophosphate) induced model of gulf war Illness: benefit of exercise training

BackgroundGulf War Illness (GWI) is a debilitating disease characterized by a cadre of neural, immunological and autonomic symptoms. We show that exposure to a sub‐lethal dose of Sarin lead to autonomic imbalance, cardiomyopathy and central nervous system changes. Diisopropyl fluorophosphate (DFP), an analogue of Sarin (GB), can be used as surrogate agent to produce neurotoxicity and neuro‐inflammation. There is limited information on the use of DFP to produce model of GWI with emphasis on the study of cardiovascular‐autonomic dysfunctions. Consideration was given to the inclusion of exercise training (ET) as part of the treatment of cardiac dysfunction induced by organophosphate exposure.ObjectiveThe aim was to determine the effect of chronic exercise training to the response to DFP on autonomic and cardiovascular function.MethodsMale C57BL/6J mice were divided into two groups (n=8/group): Sedentary (S) and trained (T) before and after DFP exposure. ET was performed on an electronic wheel at low intensity for 1 h/day, 5 days/wk. GWI model was induced by corticosterone (CORT) administered for 7 days (200 mg/l) followed by DFP (1.5 mg/kg, s.c). Cardiac function and ECG were assessed by transthoracic echocardiography (echo) under isoflurane anesthesia (2 – 2.5% on 0.8 l/min of O2).ResultsThe low dose of DFP produced left ventricular dilation on sedentary group, specifically, LV dilation of end systolic area (ESA) (S: 10.34±0.86 vs S+DFP: 6.69 ±0.41 cm2). The ET ameliorated DFP induced toxicity (T: 7.99 ±0.40 vs T+DFP 7.66±0.96cm2). Cardiac Output (CO) was reduced in sedentary group after DFP (S: 20.61±2.63 vs S+DFP: 14.78±0.85 ml/min), not change was observed in the ET group, revealing the efficacy of exercise protocol (T: 16.99±1.69 vs T+DFP: 17.90±1.42 ml/min). Myocardial performance index (MPI) and E/A ratio were significantly increased in S group after DFP exposure (MPI: S: 0.52±0.03 vs S+DFP: 0.60±0.02; E/A: S: 1.29±0.09 vs S+DFP: 1.64±0.07) changes that were not observed on T group (MPI: T: 0.50±0.04 vs T+DFP: 0.48±0.03; E/A: S: 1.35±0.09 vs S+DFP: 1.56±0.10) suggesting protection against DFP. Finally sympathetic modulation (LF) was increased in S group compared initial values and T group, as well as LF/HF ratio. Vagal modulation was similar between both groups.ConclusionIn conclusion, results demonstrate that DFP exerts a negative impact on cardiac/autonomic function. Our critical finding is that chronic exercise prevented most of the cardiovascular dysfunctions elicited by DFP, documenting the positive effects of exercise. This treatment protocol maybe equally applicable to other animal models or even humans.Support or Funding InformationThis work was funded under U.S. Department of Defense grant W81XWH‐13‐2‐0085This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Impact of obesity and surgical weight reduction on cardiac remodeling

Backgroundthe implication of obessity on cardiometabolic risk factors and incident diabetes has been previously demonstrated, but the impact of weight changes on cardiac structure independent of obesity-related comorbidities has not been extensively studied Aimto study impact of obesity and surgical weight reduction on cardiac structure. Patients and methodsfifty two patients withbody mass index (BMI) ≥40kg/m2, free of previous or overt cardiac risk factors and diseases were included, all patients underwent bariatric surgery; Conventional echocardiography (2D, M-Mode, Doppler), tissue Doppler velocity (TDI), strain and speckle tracking echocardiography for left and right ventricles were performed before and 6m after surgery. Resultsmean age was 38.2±5.6, BMI 42.3±3.4kg/m2, 65% were female and 35% were male. 6 months postopeatively; there was significant increase of left ventricular end systolic volume (LVESV) and left ventricular end diastolic volume (LVEDV) from 66.57±22 to 37.2±12 p<0.001, and 169.4±43.2 to 120.36±19.6ml with p<0.001 respectively and increased ejection fraction (EF%) from 59±8 to 67±7ml p<0.001, significant reduction in left ventricular mass index (LVMI) from 143±11 to 95.5±7gm/m2 p<0.001. Significant increase in right ventricular systolic area (RVSA) from 16.3±4.1 to 10.1±2.7cm2 p<0.001 but was insignificant in right ventricular diastolic area (RVDA) from 30.2±1.5 to 26.7±2cm2 p=0.05, fraction area change (FAC) from 49.5±2.1 to 52±1.2% p=0.7, Tricuspid annular plane systolic exertion (TAPSE) from 20.3±2.8to22.6±3.5mm, p=0.56and pulmonary arterty systolic pressure (PASP) from 32.2±5.2 to 29.2±2.1mmHg, p=0.81.Early tissue Doppler diastolic velocity (Em) of the LV increased from 7.1±2.1 to12±3.5 p<0.001 and that of RV from 6.2±2.8 to 9.2±1.4, p=0.05 and tissue Doppler strain of the LV and RV invrased from −16.1±2.5 to −22.8±3.1, p<0.001, −11.2± 2.6 to −17.3±3.4, p<0.001 respectively. Left ventricular longtiduinal systolic strain (LVLPSS) increased from −17.2±2.1 to −22.7±3.9 p<0.001 and right ventricular longtiduinal systolic strain (RVLPSS) increased from −12.8±1.5 to −18.1±2.7 p<0.001. ConclusionObesity adversely affects cardiac function independent of obesity-related comorbidities .Weight reduction significantly increase the systolic and diastolic function of both ventricles.

Brain Natriuretic Peptide Levels in Acute Inferior Myocardial Infarction.

BackgroundOur objective was to evaluate the relationship between initial serum brain natriuretic peptide (BNP) levels and right ventricular functions in inferior myocardial infarction (MI) with and without right ventricular involvement.MethodsThe study included 61 patients, who presented with acute inferior MI. Twenty-seven patients had right ventricular involvement. Blood samples for BNP were obtained from each patient on admission. Echocardiographic assessments were performed and recorded during the first 12 h. Right ventricular involvement was determined by electrocardiography, conventional and tissue Doppler echocardiography (TDI).ResultsIn inferior MI with right ventricular involvement, tricuspid annulus planimetric systolic excursion (TAPSE) and right ventricular fractional area change were lower, and left ventricular E/E’ ratio was higher. In the group with BNP levels above 400 pg/mL, left ventricular end-diastolic diameter and left ventricular end-systolic diameter were higher, and left ventricular ejection fraction and TAPSE, indicator of right ventricular systolic function, were lower. The elevated BNP levels were negatively correlated with RSm and TAPSE, while they were positively correlated with the E/E’ ratio. The systolic blood pressure and left ventricular end-diastolic diameter during admission were independent predictors of BNP levels.ConclusionsIn acute inferior MI, initially increased BNP levels may be valuable in predicting the right ventricle involvement. Higher rates of hypotension, right ventricular dysfunction and increased left ventricle diameters are observed in patients with BNP levels ≥ 400 pg/mL.

The relationship between systolic vector flow mapping parameters and left ventricular cardiac function in healthy dogs

Vector flow mapping (VFM) is a novel echocardiographic technology that shows blood flow vectors and vortexes, enabled the hydrokinetic evaluation of hemodynamics within the left ventricle. VFM provides several unique parameters: circulation, vorticity, vortex area, and energy loss. The present study aims to reveal a relationship between VFM parameters and cardiac function. Five healthy Beagle dogs were anesthetized and administered with dobutamine (0, 2, 4, 8, 12µg/kg/min). Pressure-volume diagrams were acquired to assess cardiac function using pressure-volume conductance catheter. Systolic maximum circulation, vorticity, vortex area, and energy loss were measured using VFM. The systolic maximum circulation, systolic vorticity, systolic vortex area, and systolic energy loss were increased by dobutamine administration. There was a strongly significant correlation between the systolic maximum circulation and ejection fraction (r=0.76), maximal positive left ventricular (LV) pressure derivatives (dP/dt max) (r=0.80), and end-systolic LV elastance (r=0.73). Systolic vorticity and systolic vortex area were strongly correlated with ejection fraction (r=0.76, 0.68) and dP/dt max (r=0.76, 0.69), and end-systolic LV elastance (r=0.62, 0.74), respectively. Systolic energy loss was strongly correlated with dP/dt max (r=0.78), systolic maximum circulation (r=0.81), and systolic vorticity (r=0.82). The present study revealed that systolic VFM parameters are associated with the LV contractility. Furthermore, systolic energy loss was susceptible to the systolic vortex parameters such as systolic vorticity and systolic maximum circulation. Systolic VFM parameters are new hydrokinetic indices reflecting LV contractility.

Systolic geometry and simplicial complexity for groups

Abstract Twenty years ago Gromov asked about how large is the set of isomorphism classes of groups whose systolic area is bounded from above. This article introduces a new combinatorial invariant for finitely presentable groups called simplicial complexity that allows to obtain a quite satisfactory answer to his question. Using this new complexity, we also derive new results on systolic area for groups that specify its topological behaviour.

Increased Serum Levels of Fetal Tenascin-C Variants in Patients with Pulmonary Hypertension: Novel Biomarkers Reflecting Vascular Remodeling and Right Ventricular Dysfunction?

Pulmonary vascular remodeling is a pathophysiological feature that common to all classes of pulmonary hypertension (PH) and right ventricular dysfunction, which is the major prognosis-limiting factor. Vascular, as well as cardiac tissue remodeling are associated with a re-expression of fetal variants of cellular adhesion proteins, including tenascin-C (Tn-C). We analyzed circulating levels of the fetal Tn-C splicing variants B+ and C+ Tn-C in serum of PH patients to evaluate their potential as novel biomarkers reflecting vascular remodeling and right ventricular dysfunction. Serum concentrations of B+ and C+ Tn-C were determined in 80 PH patients and were compared to 40 healthy controls by enzyme-linked immunosorbent assay. Clinical, laboratory, echocardiographic, and functional data were correlated with Tn-C levels. Serum concentrations of both Tn-C variants were significantly elevated in patients with PH (p < 0.05). Significant correlations could be observed between Tn-C and echocardiographic parameters, including systolic pulmonary artery pressure (B+ Tn-C: r = 0.31, p < 0.001, C+ Tn-C: r = 0.26, p = 0.006) and right atrial area (B+ Tn-C: r = 0.46, p < 0.001, C+ Tn-C: r = 0.49, p < 0.001), and laboratory values like BNP (B+ Tn-C: r = 0.45, p < 0.001, C+ Tn-C: r = 0.42, p < 0.001). An inverse correlation was observed between Tn-C variants and 6-minute walk distance as a functional parameter (B+ Tn-C: r = −0.54, p < 0.001, C+ Tn-C: r = −0.43, p < 0.001). In a multivariate analysis, B+ Tn-C, but not C+ Tn-C, was found to be an independent predictor of pulmonary hypertension. Both fetal Tn-C variants may represent novel biomarkers that are capable of estimating both pulmonary vascular remodeling and right ventricular load. The potential beneficial impact of Tn-C variants for risk stratification in patients with PH needs further investigation.

Nomograms for echocardiographic right ventricular sub-costal view dimensions in healthy Caucasian children: A new approach to measure the right ventricle

BackgroundThe sub-costal examination of the heart is part of routine examination in pediatric echocardiography, and has the advantage to visualize also the infundibulum part of the right ventricle (RV). Despite this fact, currently nomograms for sub-costal RV dimensions are lacking. MethodsWe prospectively studied healthy Caucasian Italian children by two-dimensional echocardiography. Measurements included: sub-costal end diastolic basal-apical and latero-lateral diameters, end diastolic and end systolic area, 4 chamber end diastolic and end systolic area and length, end diastolic basal (RV1) and mid-cavity (RV2) diameters. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Structured Z scores were then computed. Agreement of RV diameters and areas in subcostal view and 4-chamber view were investigated. Results732 subjects (age 0 days-17 years; 48% female; BSA 0.12-2.12 m2) were studied. The Haycock formula was used when presenting data as predicted values (mean ± 2 SDs) for a given BSA and within equations relating echocardiographic measurements to BSA. The predicted values and Z-score boundaries for all measurements are presented. Excellent correlations were found among two-dimensional diameters and area calculated in sub-costal view with those evaluated in 4-chamber view. ConclusionsWe report echocardiographic nomograms for RV diameters and areas measured in the sub-costal view. Our data may implement normative data for 2D echocardiography evaluation of the RV in children.

An exploratory investigation of echocardiographic parameters and the effects of posture on cardiac structure and function in the Livingstone's fruit bat (Pteropus livingstonii).

There is growing evidence that dilated cardiomyopathy may be a major cause of death in captive Livingstone's fruit bats (Pteropus livingstonii). Therefore, the primary aim of this prospective, exploratory study was to examine whether a systematic cardiac ultrasound protocol is feasible in this critically endangered species and to report basic measures of cardiac structure and function from a cohort of apparently healthy bats. A secondary aim was to test the effect posture (dorsal recumbency vs. roosting) has upon cardiac function in this species. Transthoracic echocardiograms, including 2D, Doppler, and tissue Doppler measures of cardiac structure and function were completed as part of routine health examinations for bats at a single center (n = 19). Bats were then grouped by age and disease status and the mean and range data reported for each group. In healthy adult bats, with the exception of a reduction in heart rate (P ≤0.05), right atrial systolic area (P ≤0.05), and right ventricular velocity during atrial contraction, there were no significant changes in cardiac structure or function in response to the roosting position. However, in the bats presenting with dilated cardiomyopathy the current data suggest that left ventricular ejection fraction is improved while roosting. Further work is required to confirm our initial findings, generate diagnostic reference intervals, and explore the causes of dilated cardiomyopathy in this species.

Regression analysis and transfer function in estimating the parameters of central pulse waves from brachial pulse wave.

This study mainly analyzed the parameters such as ascending branch slope (A_slope), dicrotic notch height (Hn), diastolic area (Ad) and systolic area (As) diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), subendocardial viability ratio (SEVR), waveform parameter (k), stroke volume (SV), cardiac output (CO) and peripheral resistance (RS) of central pulse wave invasively and non-invasively measured. These parameters extracted from the central pulse wave invasively measured were compared with the parameters measured from the brachial pulse waves by a regression model and a transfer function model. The accuracy of the parameters which were estimated by the regression model and the transfer function model was compared too. Our findings showed that in addition to the k value, the above parameters of the central pulse wave and the brachial pulse wave invasively measured had positive correlation. Both the regression model parameters including A_slope, DBP, SEVR and the transfer function model parameters had good consistency with the parameters invasively measured, and they had the same effect of consistency. The regression equations of the three parameters were expressed by Y'=a+bx. The SBP, PP, SV, CO of central pulse wave could be calculated through the regression model, but their accuracies were worse than that of transfer function model.

Hemodynamic changes caused by acupuncture in healthy volunteers: a prospective, single-arm exploratory clinical study

BackgroundRadial pressure pulse wave (RPPW) examination has been a key diagnostic component of traditional Chinese medicine. The objective of this study was to investigate the changes in RPPW along with various hemodynamic variables after acupuncture stimulation and to examine the validity of pulse diagnosis as a modern diagnostic tool.MethodsWe conducted acupuncture stimulation at both ST36 acupuncture points in 25 healthy volunteers. We simultaneously assessed the RPPW by pulse tonometry; heart rate variability (HRV) by electrocardiogram; photoplethysmogram (PPG) signals, respiration rate, peripheral blood flow velocity and arterial depth by ultrasonography; and cardiac output by impedance cardiography, before, during and after a session of acupuncture stimulation.ResultsWe observed consistent patterns of increased spectral energy at low frequency (<10 Hz) and pulse power using RPPW examination and in the amplitude and systolic area of the PPG signal during the entire acupuncture session. The low- and high-frequency domains of HRV increased and decreased, respectively, during the acupuncture session. The peripheral blood velocity rose shortly after needle insertion, reached a maximum in the middle of the session and decreased afterwards. The augmentation index (AIX) and pulse transit time (PTT) obtained from RPPW did not change significantly.ConclusionAcupuncture stimulation at ST36 in healthy subjects increased the peripheral pulse amplitudes (pressure pulse wave (PPW) and PPG), blood flow velocity (ultrasonography) and sympathetic nerve activity (HRV). The lack of changes in the AIX and PTT suggests that the increased pulse amplitudes and blood flow velocity may result from increased cardiac output.Trial registrationClinical Research Information Service (KCT0001663).

Maximal systolic excursion of the tricuspid annulus is independent of right atrial size and function in chronic pulmonary hypertension.

Even though the tricuspid annulus (TA) is anatomically and functionally related to right atrioventricular dependence and tricuspid annular plane systolic excursion (TAPSE) is a well-known measure of right ventricular (RV) systolic function, there is paucity of data regarding the potential impact that right atrial (RA) size and function have on TAPSE. Hence, we sought to determine whether RA volumetric and longitudinal measures affect TAPSE in patients with chronic pulmonary hypertension (cPH). In this retrospective study, echocardiographic data from 110 patients were reviewed and the studied population was divided into Group I consisting of 50 patients (50±11years) without PH and Group II that included 60 patients (55±14years) with cPH. Even though RA areas, RA fractional area change, and maximal long-axis length measurements were abnormal in cPH patients, TA tissue Doppler imaging systolic velocity and RV fractional area change were the only useful variables in identifying patients with abnormal TAPSE (P<.0001 and P=.018, respectively). Additionally, TAPSE was independent of all RA measures, left ventricular ejection fraction, and age (P>.05). Based on these results, TAPSE does not appear to be influenced by either RA size or function. Additional studies using strain echocardiography to interrogate RA mechanics might now be very useful to advance our understanding of TA motion in cPH patients given recent data showing that RA function accounts for a significantly greater proportion of total right heart function in patients with cPH than in normal subjects.

Cine-CMR partial voxel segmentation demonstrates increased aortic stiffness among patients with Marfan syndrome.

Standard cine-cardiac magnetic resonance (CMR) imaging is commonly used to evaluate cardiac structure, geometry and function. Prior studies have shown that automated segmentation via partial voxel interpolation (PVI) accurately quantifies phantom-based cardiac chamber volumes and necropsy left ventricular myocardial mass. Despite this, the applicability and usefulness of PVI in the determination of physiologic parameters of the aorta such as aortic stiffness has yet to be investigated. Routine CMR was conducted with a 1.5T (GE) scanner with pulse sequences similar to that of standard CMR (parameters: TR 3.4 msec, TE 1.14 msec, flip angle 60°, temporal resolution ~30-40 msec). Views were obtained in standard cardiac-oriented longitudinal or axial views (2, 3 and 4 chambers). Within non-dilated regions of the descending thoracic aorta, aortic area was quantified via a novel PVI automated process (LV-METRIC), which discerns relative amounts of blood pool in each voxel. Aortic stiffness, as calculated from brachial artery pulse pressure and aortic area at maximal and minimal dimensions, was evaluated in 60 total segments (one segment per patient). All segments were in the descending aorta and were not aneurysmal. Sixty patients in total were studied, including 50 that had genetically-related aortic disorder [35 bicuspid aortic valve (BAV), 15 Marfan syndrome (MFS)]. Ten normal controls without aortic disease were included for comparison purposes. All patients (n=60) had evaluable CMR images for assessment of the descending aorta with use of automated segmentation. Patients with BAV and MFS were similar to controls in age, systolic blood pressure, brachial artery pulse pressure, smoking status or hypercholesterolemia (all P=NS). There were more women (P<0.001), lower body mass index (P=0.008), and greater height (P<0.001) in the MFS cohort compared to BAV and controls. Descending aortic area in either systole (maximal) or diastole (minimal) was similar among all three cohorts. However, change in aortic area (ΔArea) throughout the cardiac cycle was substantially lower in MFS than control subjects (P<0.001). In contrast, change in aortic area throughout the cardiac cycle was not significantly different between BAV vs. controls (P=0.62). Aortic stiffness was increased among MFS patients versus control subjects (P=0.014). When comparing MFS to BAV subjects, a comparable trend was observed (P=0.09). No statistical difference was evident in aortic stiffness in patients with BAV versus control subjects (P=0.29). The application of PVI to standard CMR imaging can assess abnormal descending aorta functional indices in normal caliber segments in MFS subjects. Future prospective studies with larger subject populations are warranted to further determine the overall utility of automated aortic segmentation as a possible early biomarker of aortic dysfunction before overt dilatation.

Liver stiffness assessed by Fibrosis-4 index predicts mortality in patients with heart failure

ObjectiveLiver dysfunction due to heart failure (HF) is known as congestive hepatopathy. It has recently been reported that liver stiffness assessed by transient elastography reflects increased central venous pressure. The...

Patient-specific blood pressure correction technique for arterial stiffness: evaluation in a cohort on anti-angiogenic medication.

Arterial pulse wave velocity (PWV) depends on blood pressure (BP). Correction of PWV for BP is commonly performed using a statistical approach, requiring a patient cohort. We recently developed a mechanistic, model-predictive approach to assess BP-independent changes in carotid PWV (cPWV) at the level of the individual. The goal of the present study is to compare our novel technique to conventional statistical correction, in the context of anti-cancer therapy using anti-angiogenic drugs (AADs). AADs frequently lead to a PWV increase, but also to hypertension, underlining the need for BP correction of PWV measurements. We obtained carotid artery systolic and diastolic cross-sectional areas (echotracking) and corresponding BPs (tonometry) in 48 patients before starting AAD treatment (sorafenib/sunitinib), and at four follow-up visits spaced 2 weeks apart. For each patient, we derived cPWV and a baseline single-exponential BP cross-sectional area curve. Based on these baseline curves and follow-up BPs, we predicted cPWV at follow-up due to BP. By comparing predicted and measured cPWVs at follow-up, we assessed the BP-independent cPWV increase. In the same way, we assessed whether diastolic cross-sectional area (Ad) changed beyond the BP-induced amount. The AAD-induced BP-independent increase in cPWV was 0.43(0.09,0.77) m s-1 (mean (95%CI), P=0.014, mechanistic approach) and 0.48(0.14,0.82) m s-1 (P=0.006, statistical approach). Ad increased with 1.92(0.93,2.92) mm2 (P<0.001) and 2.14(1.06,3.23) mm2 (P<0.001), respectively. In conclusion, the present study demonstrates the feasibility and potential of our mechanistic, model-predictive approach to quantify BP-independent effects on arterial stiffness at the level of the individual, in a clinically relevant setting of AAD therapy.

IMPACT OF RV DYSFUNCTION AND END-DIASTOLIC PULMONARY ARTERY PRESSURE ESTIMATED FROM ANALYSIS OF TRICUSPID REGURGITANT VELOCITY SPECTRUM IN PATIENTS WITH PRESERVED EJECTION FRACTION

Background: To assess the association between right ventricular (RV) dysfunction, right hemodynamic parameters, and outcomes in patients with preserved ejection fraction. Methods: Analysis of RV functional parameters including RV size (end-diastolic, systolic area), function (qualitative, area

The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus

Background and aimsRight ventricular (RV) functional assessment in premature infants includes basal longitudinal strain (RV BLS), RV systolic tissue Doppler velocity (RV s′), tricuspid annular plane systolic excursion (TAPSE) and...

Preoperative Three-Dimensional Strain Imaging Identifies Reduction in Left Ventricular Function and Predicts Outcomes After Cardiac Surgery.

Echocardiography-based speckle-tracking strain imaging is an emerging modality to assess left ventricular function. The aim of this study was to investigate the change in left ventricular systolic function after cardiac surgery with 3-dimensional (3D) speckle-tracking strain imaging and to determine whether preoperative 3D strain is an independent predictor of acute and long-term clinical outcomes after aortic valve, mitral valve, and coronary artery bypass grafting operations. In total, 163 adult patients undergoing aortic valve, mitral valve, and coronary artery bypass surgeries were enrolled prospectively and had complete data sets. Demographic, operative, and outcome data were collected. 3D transthoracic echocardiograms were preformed preoperatively and on second to fourth postoperative day. Blinded off-line analysis was performed for left ventricular 2-dimensional (2D) ejection fraction (EF2D) and 3D ejection fraction (EF3D) and global peak systolic area, longitudinal, circumferential, and radial strain. 3D global strain correlated well with EF3D. Ventricular function as measured by strain imaging decreased significantly after all types of cardiac surgery. When preoperative EF3D was used, receiver operating characteristic curves identified reference values for 3D global strain corresponding to normal, mildly reduced, and severely reduced ventricular function. Normal ventricular function (EF3D ≥ 50%) corresponded to 3D global area strain -25%, with area under curve = 0.86 (0.81-0.89). Patients with reduced preoperative 3D global area strain had worse postoperative outcomes, including length of intensive care unit stay (4 vs 3 days, P = .001), major adverse events (27% vs 11%, P = .03), and decreased 1-year event-free survival (69% vs 88%, P = .005). After we controlled for baseline preoperative risk models including European System for Cardiac Operative Risk Evaluation score and surgery type, preoperative strain was an independent predictor of both short- and long-term outcomes, including length of intensive care unit stay, postoperative inotrope score, and 1-year event-free survival. This study shows that cardiac surgery was associated with an acute reduction in postoperative left ventricular function, when evaluated with 3D strain imaging. In addition, preoperative 3D strain was demonstrated to be an independent predictor of acute and long-term clinical outcomes after cardiac surgery. The use of noninvasive 3D transthoracic echocardiogram strain imaging before cardiac surgery may provide added information to aid in perioperative risk stratification and management for these high-risk patients.

Accuracy of echocardiographic area-length method in chronic myocardial infarction: comparison with cardiac CT in pigs

BackgroundWe evaluated echocardiographic area-length methods to measure left ventricle (LV) volumes and ejection fraction (EF) in parasternal short axis views in comparison with cardiac computed tomography (CT) in pigs with chronic myocardial infarction (MI).MethodsMale farm pigs with surgical occlusion of the left anterior descending coronary artery (n = 9) or sham operation (n = 5) had transthoracic echocardiography and cardiac-CT 3 months after surgery. We measured length of the LV in parasternal long axis view, and both systolic and diastolic LV areas in parasternal short axis views at the level of mitral valve, papillary muscles and apex. Volumes and EF of the LV were calculated using Simpson’s method of discs (tri-plane area) or Cylinder-hemiellipsoid method (single plane area).ResultsThe pigs with coronary occlusion had anterior MI scars and reduced EF (average EF 42 ± 10%) by CT. Measurements of LV volumes and EF were reproducible by echocardiography. Compared with CT, end-diastolic volume (EDV) measured by echocardiography showed good correlation and agreement using either Simpson’s method (r = 0.90; mean difference −2, 95% CI −47 to 43 mL) or Cylinder-hemiellipsoid method (r = 0.94; mean difference 3, 95% CI −44 to 49 mL). Furthermore, End-systolic volume (ESV) measured by echocardiography showed also good correlation and agreement using either Simpson’s method (r = 0.94; mean difference 12 ml, 95% CI: −16 to 40) or Cylinder-hemiellipsoid method (r = 0.97; mean difference:13 ml, 95% CI: −8 to 33). EF was underestimated using either Simpson’s method (r = 0.78; mean difference −6, 95% CI −11 to 1%) or Cylinder-hemiellipsoid method (r = 0.74; mean difference −4, 95% CI–10 to 2%).ConclusionOur results indicate that measurement of LV volumes may be accurate, but EF is underestimated using either three or single parasternal short axis planes by echocardiography in a large animal model of chronic MI.

Effects of acute oxygen supplementation on functional capacity and heart rate recovery in Eisenmenger syndrome

BackgroundEisenmenger syndrome (ES) precipitates the extreme manifestation of pulmonary hypertension, which leads to severe functional limitation and poor quality of life. The propose of the current study was: 1) examined the acute effects of 40% oxygen supplementation during the 6-minute walk test (6MWT); and 2) evaluate the relation between exercise capacity and clinical cardiac parameters in patients with ES. MethodsThirty subjects were prospectively included; all were submitted to a 6MWT with compressed air and with 40% of oxygen. Heart rate recovery at the first minute (HRR1) and perceived effort Borg scale for dyspnea and lower limb fatigue were recorded in both tests scenarios. ResultsThe 6MWT distance was modestly, negatively associated with pulmonary vascular resistance (PVR) [r=0.46, p=0.02]. Patients improved 6MWT distance (p<0.001) and exhibited a faster HRR1 (p<0.001) with 40% supplemental oxygen compared to compressed air. With 40% supplemental oxygen, subjects revealed lower dyspnea and lower limb fatigue compared to 6MWT without oxygen supplementation (p<0.001). The amount of change in the 6MWT distance from air to oxygen was moderate, positively associated with tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) [r=0.50, p=0.03; r=0.64, p<0.001, respectively]. ConclusionAcute 40% oxygen supplementation in patients with Eisenmenger syndrome led to an improvement in 6MWT distance, faster HRR1 and lower dyspnea and lower limb fatigue perception. Moreover, functional capacity was positively associated with right ventricular parameters.

Diagnostic value of invasive cardiac catheterization for constrictive pericarditis and restrictive cardiomyopathy

Objective To evaluate the diagnostic value of invasive cardiac catheterization for restrictive cardiomyopathy (RCM) and constrictive pericarditis (CP). Methods Twenty-seven children with CP or RCM hospita-lized in Department of Cardiology, Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiaotong University from February 2002 to December 2015, were selected, including 10 patients who had been surgically documented CP and 17 patients with RCM who underwent cardiac catheterization.Intracardiac pressure waveforms were recorded and all the measurement indexes of pressure of all the patients were analyzed.The changes of cardiac pressure under deep breathing in 9 patients with local anesthesia was recorded. Results There were significant differences in pulmonary artery pressure, difference between left ventricular end-diastolic pressure (LVEDP) and right ventricular end-diastolic pressure (RVEDP), and the ratio of RVEDP/right ventricular systolic pressure between group RCM and group CP [(50.2±12.0) mmHg(1 mmHg=0.133 kPa) vs.(38.1±6.8) mmHg, (7.8±5.5) mmHg vs.(1.8±4.7) mmHg, 0.27±0.10 vs.0.45±0.20, respectively; t=2.912, 2.787, 2.418, all P<0.05]. However, there was overlapping for these criteria, and the predictive sensitivity of any of the criteria was less than 66.7%.In patients with CP, reciprocal changes in the filling between right ventricle and left ventricle occurred during respiration.In patients with RCM, the right ventricle and left ventricle pressures moved concordantly with respiration.The systolic area index was greater in group CP than that in group RCM (1.20±0.03 vs.0.70±0.14), and the difference was significant (t=6.152, P<0.01). The systolic area index had a sensitivity of 100.0% and a predictive accuracy of 100.0% for the identification of patients with surgically proven CP. Conclusions Measurements in catheterization, especially the ratio of right ventricular to left ventricular systolic area during inspiration and expiration is a reliable catheterization criterion for differentiating CP from RCM. Key words: Restrictive cardiomyopathy; Constrictive pericarditis; Catheterization; Hemodynamics