Systolic Dysfunction In Patients Research Articles

Investigation of Cardiomyopathy in Children With Cirrhotic and Noncirrhotic Portal Hypertension

Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT). This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50). Fifty healthy children were also selected for the control group. Electrocardiography and echocardiography were used to evaluate cardiac functions. Corrected QT (QTc) ≥ 0.45 was accepted as prolonged on electrocardiography. The study group was divided into 3 groups: cirrhotic, noncirrhotic, and control. Then, the CCMP group was created according to the diagnostic criteria. Latent CCMP was diagnosed in the presence of prolonged-QTc along with a minor criterion (tachycardia). Manifest CCMP was diagnosed in the presence of at least 2 major criteria (prolonged-QTc along with abnormal echocardiographic findings). Moreover, in this study, the risk factors for CCMP were investigated. The CCMP group included 10 cases (20%). Nine of these cases had latent CCMP (18%), and the remaining one (2%) had manifest CCMP. All of the cases with CCMP had cirrhosis and ascites. None of the patients with CCMP had severe cardiac symptoms, but they were already using some cardioprotective drugs such as propanolol and spironolactone. As risk factors for CCMP, pediatric end-stage liver disease scores, Child-Pugh scores, and ascites grades were found to be significant for the determination of CCMP. The most important risk factor was ascites severity (P = 0.001, odds ratio 9.4). Approximately 20% of children with PHT have CCMP. A detailed cardiac examination should be carried out periodically in children with cirrhotic PHT, especially in the presence of ascites and high Child-Pugh score.

Inflammation and oxidative stress caused by nitric oxide synthase uncoupling might lead to left ventricular diastolic and systolic dysfunction in patients with hypertension.

ObjectiveTo investigate the role of oxidative stress, inflammation, hypercoagulability and neuroendocrine activation in the transition of hypertensive heart disease to heart failure with preserved ejection fraction (HFPEF).MethodsWe performed echocardiography for 112 patients (≥ 60 years old) with normal EF (18 controls and 94 with hypertension), and determined protein carbonylation (PC), and tetrahydrobiopterin (BH4), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), fibrinogen, plasminogen activator inhibitor type-I (PAI-I), von Willebrand factor, chromogranin A (cGA) and B-type natriuretic peptide (BNP) levels from their blood samples.ResultsWe found that 40% (38/94) of the patients with hypertension (HT) had no diastolic dysfunction (HTDD−), and 60% (56/94) had diastolic dysfunction (HTDD+). Compared to the controls, both patient groups had increased PC and BH4, TNF-α, PAI-I and BNP levels, while the HTDD+ group had elevated cGA and CRP levels. Decreased atrial and longitudinal left ventricular (LV) systolic and diastolic myocardial deformation (strain and strain rate) was demonstrated in both patient groups versus the control. Patients whose LV diastolic function deteriorated during the follow-up had elevated PC and IL-6 level compared to their own baseline values, and to the respective values of patients whose LV diastolic function remained unchanged. Oxidative stress, inflammation, BNP and PAI-I levels inversely correlated with LV systolic, diastolic and atrial function.ConclusionsIn patients with HT and normal EF, the most common HFPEF precursor condition, oxidative stress and inflammation may be responsible for LV systolic, diastolic and atrial dysfunction, which are important determinants of the transition of HT to HFPEF.

Abstract 11322: Detection of Subclinical Left Ventricular Systolic Dysfunction by Real-Time 3D Speckle Tracking Echocardiography in Patients With Myocardial Bridge of Left Anterior Descending Coronary Artery

Background: To understand the impact of myocardial bridge (MB) on left ventricle (LV) function, we evaluate the myocardial function in patients with MB of the left anterior descending coronary artery (LAD), using real-time 3-dimensional speckle tracking echocardiography (RT3D-STE). Methods: The LAD MB was diagnosed by coronary angiography in 82 patients. According to the percentage of systolic compression (SC), patients were divided into 3 groups: SC <50% defined as Group I (n=24), SC 50%-75% as Group II (n=28), and SC >75% as Group III (n=30). Thirty age and gender matched normal subjects were studied as controls. The traditional echocardiography was performed, and LV deformation was estimated by RT3D-STE. Results: The LV ejection fraction was normal in patients with LAD MB. However, the peak longitudinal (LS) and area strain (AS) of the LAD territory were significantly reduced in Group II and III when compared with controls and Group I (p<0.05). The peak circumferential (CS) and radial strain (RS) were significantly reduced only in Group III (p<0.05) (Table). Furthermore, the amplitude of strain variables were significantly reduced in patients with symptom than those without (AS: 17.7±6.4 vs. 25.3±8.4%; LS:-13.0±1.9 vs. -16.2±2.5%; CS:-15.4±3.3 vs. 18.9±3.0 %; RS: 36.6±3.8 vs. 49.4±2.7%; all p<0.0001). The severity of LAD compression correlated the best with with AS at LAD territory (r=–0.90, p<0.0001), although it was also significant in conventional strain variables (LS: r =–0.79, CS: r =–0.69, RS: r =–0.64, all p <0.0001). Conclusions: Despite apparently normal ejection fraction, myocardial strain is abnormal in the LAD territory which had MB. Such abnormality is more pronounced in patients with progressively more severe MB and in those with symptoms. Furthermore, the area strain by RT3D-STE appeared to be most accurate in detection of subclinical systolic dysfunction in patients with LAD MB than conventional 2D strain parameters.

Predictive value of elevated neutrophil-lymphocyte ratio for leftventricular systolic dysfunction in patients with non ST-elevatedacute coronary syndrome.

Objective:We aimed to study the predictive value of the neutrophil-lymphocyte ratio (NLR) for left ventricular systolic dysfunction (LVSD) in patients with non ST-elevated acute coronary syndrome (NST-ACS).Methods:A total of 405 patients (mean age 62 years and 75% male) with NST-ACS were included in the study. The study population was divided into tertiles based on admission NLR values. The low, medium and high tertiles defined as NLR≤1.81 (n=135), 1.81<NLR≤3.2 (n=135) and NLR>3.2 (n=135), respectively.Results:The patients in the high NLR group were older (p<0.001), have higher rate of diabetes mellitus (p=0.028) and non-ST elevated myocardial infarction (NSTEMI) (p<0.001) and have lower left ventricular ejection fraction (LVEF) (p<0.001). Baseline WBC (p=0.02) and neutrophil (p<0.001) levels and NLR (p<0.001) were significantly higher, baseline hemoglobin (p=0.044), hematocrit (p=0.019) and lymphocyte (p<0.001) levels were significantly lower in the high NLR group. NLR was negatively correlated with LVEF in correlation analysis. An NLR >3.2 and age ≥70 were found to be an independent predictor of systolic dysfunction in multivariate analyses.Conclusion:An NLR >3.2 is a useful predictor for LVSD in patients with NST-ACS. The practice of using an NLR count on admission may be useful for identifying high-risk patients and their associated treatment methods.

Combined circumferential and longitudinal left ventricular systolic dysfunction in patients with asymptomatic aortic stenosis.

Early detection of left ventricular (LV) systolic dysfunction is pivotal in the management of patients with aortic stenosis (AS). LV circumferential and/or longitudinal shortening may be impaired in these patients despite LV ejection fraction is preserved. We focused on prevalence and factors associated with combined impairment of circumferential and longitudinal shortening (C&L) in asymptomatic AS patients. Echocardiographic and clinical data from 200 patients with asymptomatic AS of any degree without history of heart failure and normal LV ejection fraction were analyzed. C&L were evaluated by mid-wall shortening (MS) and tissue Doppler mitral annular peak systolic velocity (S'), and classified low if <16.5% and if <8.5 cm/sec, respectively (10th percentiles of controls). Combined C&L dysfunction was detected in 72 patients (36%). The variables associated with this condition were higher LV mass (OR 1.02 [CI 1.01-1.04], P = 0.03), concentric LV geometry (OR 4.30 [CI 1.79-10.34], P = 0.001), increasing pulmonary artery wedge pressure (by E/e' ratio; OR 1.11 [CI 1.04-1.19], P = 0.001). The relation of MS and peak S' was linear and slightly significant in the whole population (r = 0.23; F statistic=0.001), absent in patients with C&L dysfunction (r = 0.04; F = ns), negative (linear model) in the subgroup of patients without C&L dysfunction (r = -0.22; F = 0.02). C&L dysfunction is present in more than one-third of patients with asymptomatic AS and is associated with concentric LV geometry and higher degree of diastolic dysfunction. The relation between MS and peak S' largely varies in the subgroups with different C&L function.

Two dimensional speckle tracking echocardiography in detection of subclinical left ventricular systolic dysfunction in patients with severe aortic stenosis

IntroductionSubclinical left ventricular (LV) systolic dysfunction may develop in patients with severe aortic stenosis (AS) despite normal LV ejection fraction (EF%). The aim of the studyTo evaluate the role of two dimensional (2D) speckle tracking echocardiography (STE) in detection of subclinical LV systolic dysfunction in patients with severe AS. Patients and methodThe study included 50 patients with severe AS (mean age: 45 ± 9 years) and 30 age-matched healthy individuals (mean age 43 ± 7 years. Conventional echocardiographic parameters used for the assessment of AS severity were measures and 2D Speckle tracking imaging of the peak systolic strain curves of the Inferior septum and lateral wall in the apical four-chamber view (4C-PLS), the Inferior and anterior wall was in the apical two chamber view (2C-PLS), and the infero lateral and anterior septum in the apical three-chamber view (3C-PLS) were obtained. Left ventricular global longitudinal systolic strain (LV-GLS) was calculated by averaging the peak systolic values of the 6 LV walls. ResultsLV-GLS was significantly reduced in patients with AS compared to controls (<0.001) and negatively correlated with left ventricular mass index (LVMI) (r = −0.47, p = 0.01) irrespective of EF%, maximum velocity, peak pressure gradient and mean pressure gradient across the aortic valve and the aortic valve area. ConclusionPatients with severe AS have evidence of subclinical LV systolic dysfunction despite preserved EF%. 2D speckle tracking appears to be useful in detection of subclinical LV dysfunction in patients with AS.

Detection of subclinical right ventricular systolic dysfunction in patients with mitral stenosis by two dimensional strain and strain rate imaging

Abstract Introduction Right ventricular (RV) systolic dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Conventional echocardiographic techniques have some limitations in the assessment of RV function. Aim of the work To evaluate the role of two dimensional (2D) longitudinal systolic strain and strain rate imaging in detection of subclinical RV systolic dysfunction in patients with moderate-severe MS. Patients and methods Fifty patients with isolated MS (moderate-severe) and 30 healthy control subjects constituted the study population. Conventional echocardiography, pulsed wave tissue Doppler imaging (TDI) of the tricuspid annulus and 2D longitudinal segmental and global RV systolic strain (RV-GLS) and strain rate (RV-GLSr) measurements were obtained. Results Patients with MS had significantly lower RV-GLS and RV-GLSr compared to control subjects (−19.67 ± 6.23 vs. −24.19 ± 3.25, P P = 0.02, respectively). Conclusion Patients with MS had significantly lower 2D RV-GLS and RV-GLSr compared to control group. 2D RV-GLS and RV-GLSr imaging appear to be useful in detection of subclinical RV systolic dysfunction in patients with MS.

Left ventricular systolic dysfunction in patients with ankylosing spondylitis without clinically overt cardiovascular disease by speckle tracking echocardiography.

The aim of this study was to evaluate left ventricular systolic and diastolic function using speckle tracking echocardiography (STE) in order to detect subclinical left ventricular dysfunction in patients with ankylosing spondylitis (AS). Twenty-six AS patients (age 43.7 ± 11.8 years, disease duration 11.83 ± 10.98 years) and 26 healthy controls, matched for age, sex, body mass index, and smoking, were enrolled in this cross-sectional study. All patients underwent two-dimensional, Doppler, tissue Doppler, and speckle tracking echocardiography. The mitral early/late diastolic inflow velocity ratio (1.0 ± 0.4 vs. 1.5 ± 0.5; p < 0.001) and the mitral E-wave velocity (8.1 ± 2 vs. 11.1 ± 3; p < 0.001) were lower in the AS patients than in the controls. The ejection fraction did not differ between the patients and controls (64 ± 4.2 vs. 64.8 ± 2.3; p = 0.402). All segments showed a significant decrease in left ventricular diastolic and systolic strain values in the patients with AS when compared with the healthy controls (p < 0.001). Despite no clinical evidence of cardiovascular disease, patients with AS may have impaired left ventricular systolic function as assessed by STE.

Myocardial Viability and Microvascular Obstruction

Established coronary artery disease has a prevalence of 7% in adult Americans, accounting for 16 million people. As morbidity and mortality rates have risen, research efforts to identify the pathophysiologic mechanisms of systolic dysfunction have risen in parallel. The current goal is to develop new therapeutic strategies with the potential to reverse systolic dysfunction in patients with established coronary artery disease. Cardiac magnetic resonance imaging has gained a key role in cardio vascular medicine. We will comment on the potential pivotal role of cardiac magnetic resonance imaging for the assessment of myocardial viability, including hibernating and stunned myocardium and microvascular obstruction.

Role of two dimensional strain and strain rate imaging in assessment of left ventricular systolic function in patients with rheumatic mitral stenosis and normal ejection fraction

Abstract Introduction Conventional echocardiographic parameters are not able to detect subclinical left ventricular (LV) systolic dysfunction in patients with mitral stenosis (MS). Two-dimensional (2D) longitudinal strain (S) and strain rate (Sr) imaging is a new technique which evaluates global LV systolic function with high reproducibility. The aim of the study was to assess LV systolic function, in patients with moderate–severe MS and normal ejection fraction (EF%), by 2D longitudinal systolic S and Sr imaging. Patients and method The study included 50 patients with an established diagnosis of MS (mean age: 32 ± 8 years) and 30 age-matched healthy individuals (mean age 34 ± 7 years). The mitral valve area (MVA) was measured by planimetry and pressure half time (PHT) methods. 2D longitudinal systolic S and Sr imaging was performed for each participant from the apical long axis (LAX), 4 chamber (4C) and 2 chamber (2C) views. Global longitudinal systolic S and Sr were calculated by averaging the three apical views. Results There were no significant differences in LV EF%, LV end-systolic and end-diastolic dimensions between the two groups. Patients with MS had significantly lower 2D longitudinal LV systolic S and Sr compared to the control group ( Conclusion Patients with MS and preserved EF% had lower 2D longitudinal LV systolic S and Sr compared to the control group. 2D longitudinal LV systolic S and Sr imaging appears to be useful in the detection of subclinical LV systolic dysfunction in patients with MS and preserved EF%.

Frequent premature ventricular complex is associated with left atrial enlargement in patients with normal left ventricular ejection fraction.

Premature ventricular complex (PVC) has been regarded as benign; however, when frequent, the arrhythmia can induce left ventricular (LV) systolic dysfunction. Meanwhile, the influence of PVCs on cardiac structural remodeling and functional change before occurrence of overt systolic heart failure has not been fully described. In this study, we attempted to identify early cardiac structural/functional manifestations of frequent PVCs in patients with normal LV systolic function. A total of 146 patients (age: 55 ± 15 years, 48 males) with frequent PVCs observed on 24-hour Holter monitoring (>10/h) and normal LV ejection fraction (LV EF ≥ 55% on echocardiography) were enrolled. Clinical characteristics and echocardiographic parameters of the patients were compared with those of an age-/sex-matched control group (n = 292, age: 55 ± 15 years, 96 males). Patients with frequent PVCs had significantly larger left atrial volume index (LAVI [28 ± 9 mL/m(2) vs. 24 ± 7 mL/m(2) ]), along with larger LV end-diastolic dimension (49.4 ± 4.4 mm vs. 48.5 ± 3.9 mm), lower LV EF (63 ± 7% vs. 66 ± 6%), and lower peak systolic mitral annular velocity (7 ± 2 cm/s vs. 8 ± 2 cm/s; P < 0.05 for all), whereas other clinical characteristics were similar. In particular, in patients with frequent PVCs, LAVI showed linear correlation with PVC burden (R = 0.30, P < 0.001), and, in a multiple regression model, PVC burden independently estimated LAVI, even after controlling for age, sex, comorbidities, and systolic function (β = 0.309, P < 0.001). Frequent PVC is associated with LA enlargement in patients with normal LV EF. Atrial anatomical remodeling may precede LV geometry change and systolic dysfunction in patients with frequent PVCs.

HUMORAL MARKERS, CONVENTIONAL DOPPLER ECHOCARDIOGRAM AND BIDIMENSIONAL STRAIN IN THE DETECTION OF MYOCARDIAL TOXIC EFFECT SECONDARY TO CHEMOTHERAPY

Aim: Analyze the usefulness of humoral markers (quantitative troponin T (TT), BNP, NT pro-BNP), conventional and the two-dimensional longitudinal strain (LS), and radial strain (RS) in the prediction of ventricular systolic dysfunction in patients treated with cardiotoxic chemotherapy. Thirty six

PP-263 Elevated Platelet-Lymphocyte Ratio Predicts Left Ventricular Systolic Dysfunction in Patients Non ST-Elevated Acute Coronary Syndrome

The prognostic value of high platelet–lymphocyte ratio (PLR) have been reported in patients with non-ST elevated myocardial infarction (NSTEMI) and different oncologic disorders. We aimed to evaluate the predictive value of the PLR for left ventricular systolic dysfunction (LVSD) in patients with non ST-elevated acute coronary syndrome (NST-ACS).

Association between serum total antioxidant status and coronary microvascular function in idiopathic dilated cardiomyopathy

Coronary microvascular impairment may cause myocardial ischemia and systolic dysfunction in patients with idiopathic dilated cardiomyopathy (IDC). The study included 41 patients with IDC and 33 healthy control subjects. Serum total antioxidant status (TAS), serum interleukin (IL)-6 levels, and tumor necrosis factor (TNF)-α levels were assayed and coronary flow reserve (CFR) was measured in all subjects via echocardiography. High-sensitivity C-reactive protein (hsCRP) levels were significantly higher in patients with IDC than in the control group (3.42 ± 2.14 vs. 1.91± 1.40, p = 0.001). Serum TAS was statistically lower in patients with IDC than in controls (1.23 ± 0.16 vs. 1.77 ± 0.12, p < 0.001). CFR was statistically and significantly lower in the IDC group (2.10 ± 0.39 vs. 3.09 ± 0.49, p < 0.001). The IDC group was subsequently subdivided into two groups according to CFR values, as CFR ≥ 2 and CFR < 2. HsCRP (4.30 ± 2.42 vs. 2.58 ± 1.42, p = 0.01), TNF-α (16.67 ± 8.08 vs. 10.97 ± 1.63, p = 0.01), and IL-6 (7.54 ± 6.16 vs. 3.14 ± 1.10, p = 0.05) values were significantly higher in the CFR < 2 group compared with the higher CFR group. TAS (1.3 ± 0.16 vs. 1.14 ± 0.10, p < 0.001) was significantly lower in the CFR < 2 group. CFR correlated significantly with hsCRP, TAS, red cell distribution width (RDW), IL-6, and TNF-α. Plasma proinflammatory cytokine levels are increased in patients with IDC. CFR was impaired as a reflection of impaired coronary microvascular dysfunction in association with increasing plasma proinflammatory cytokine levels and hsCRP levels.

Multidirectional Global Left Ventricular Systolic Function in Normal Subjects and Patients with Hypertension: Multicenter Evaluation

The aim of this multicenter study was to determine the normal ranges and the clinical relevance of multidirectional systolic parameters to evaluate global left ventricular (LV) systolic function. Three hundred twenty-three healthy adult subjects prospectively included at 10 centers and a cohort of 310 patients with hypertension were analyzed. Multidirectional global LV systolic function was analyzed using two-dimensional speckle-tracking echocardiography by means of two indices: longitudinal-circumferential systolic index (the average of longitudinal and circumferential global systolic strain) and global systolic index (the average of longitudinal, circumferential, and radial global systolic strain). The ranges of values of the multidirectional systolic parameters in healthy subjects were -21.22 ± 2.22% for longitudinal-circumferential systolic index and 29.71 ± 5.28% for global systolic index. In addition, the lowest expected values of these multidirectional indices were determined in this population (calculated as -1.96 SDs from the mean): -16.86% for longitudinal-circumferential systolic index and 19.36% for global systolic index. Concerning the clinical relevance of these measurements, these indices indicated the presence of subtle LV global systolic dysfunction in patients with hypertension, even though LV global longitudinal systolic strain and LV ejection fraction were normal. Moreover, in these patients, functional class (dyspnea [New York Heart Association classification]) was inversely related to both the longitudinal-circumferential index and the global systolic index. In the present multicenter study analyzing a large cohort of healthy subjects and patients with hypertension, the normal range and the clinical relevance of multidirectional systolic parameters to evaluate global LV systolic function have been determined.

The Relationship between Neutrophil/Lymphocyte Ratio and Calcific Aortic Stenosis

The role of inflammation in fibrotic and calcific processes of atherosclerosis and aortic stenosis (AS) is similar. Furthermore, a relationship between systemic inflammation and heart failure has been well demonstrated. Recently, neutrophil/lymphocyte ratio (NLR) has been proposed as a predictive marker of systemic inflammation. We investigated the association of NLR with the severity of calcific AS and left ventricular (LV) systolic dysfunction in patients with severe calcific AS. A total of 96 patients with calcific AS were included in this retrospective study from 2011 to 2013. The severity of AS was graded according to the transaortic mean pressure gradient. The patients were divided into 3 groups as mild-to-moderate AS, severe AS with normal left ventricular ejection fraction (LVEF), and severe AS with reduced LVEF (mean gradient >40mmHg and LVEF <50%). Neutrophil/lymphocyte ratio was significantly higher in severe calcific AS with reduced LVEF group than the other 2 groups (3.94±0.88, P<0.001). In addition, NLR was higher in severe AS with normal LVEF group than mild-to-moderate AS group (2.69±1.00 vs. 2.05±0.64, P=0.008). There was a statistically significant correlation between NLR and both transaortic mean pressure gradient and aortic valve peak velocity in patients with mild-to-severe AS with normal LVEF (n=81; r=0.369, P<0.001; r=0.290, P=0.004; respectively). Increased NLR is related to the severity of calcific AS and LV systolic dysfunction in patients with severe calcific AS.

Association of LOX-1 and CX3CR1 with coronary artery stenosis disease and its outcomes

Objective To explore the association of lectin-like oxidized low-density lipoprotein (ox-LDL) receptor -1 (LOX-1), CX3C chemokine receptor 1 (CX3CR1) with coronary artery stenosis disease and its outcomes. Methods A case-control study was conducted.A total of 176 cases of coronary artery stenosis which were confirmed coronary artery stenosis ≥ 50% by coronary angiography(CAG) were served as case group from department of cardiology of TEDA International Cardiovascular Hospital of Tianjin from May 2011 to April 2013.A total of 129 patients without coronary artery lesion by CAG from this hospital in the same period were served as control group, which has no history of heart disease, liver and kidney dysfuction, brain disease, hematological disease, other disorders that could bring out atherosclerosis and thrombosis.General information and laboratory parameters, LOX-1, CX3CR1, uric acid (UA) and creatinine (CREA) were measured in 2 groups.These parameters of each group were compared,the levels of LOX-1 and CX3CR1 in one-vessel stenosis were compared than that in multi-vessels stenosis in case group, the correlations between LOX-1,CX3CR1 and Gensini score and other variables were analyzed.Comparison of the levels of LOX-1 and CX3CR1 between major adverse cardiovascular events (MACEs) group and non-major adverse cardiovascular event (MACE) group was made during follow up 1.5 years.MACEs in patients with different levels of LOX-1 and CX3CR1 were compared during 1.5-year follow up.All of the data were analyzed by SPSS 16.0 software.The independent-samples T test, Mann-Whitney U test, Chi-square test, Spearman correlation, Binary Logistic Regression and Kaplan-Meier probability were adopted for data analysis. Results Comparison between case group and control group, LOX-1:3.72(1.44，8.15) μg/L vs 0.75(0.50，1.19) μg/L，z=11.072，P 0.05).LOX-1 was negatively related to left ventricular ejection fraction(LVEF) (R=-0.272，P<0.01), but positively related to left ventricular end-diastolic diameter (LVDD)(R=0.190，P<0.05), positively related to UA (R=0.121，P<0.05).Comparison between MACE group and non-MACE group, LOX-1：7.38（4.97,11.88）μg/L vs 3.52(1.45,7.75) μg/L, z=2.762，P<0.01；CX3CR1：（4.02±2.90） μg/L vs （2.67±1.48) μg/L，t=3.086，P<0.01.LOX-1 and TG were independent risk effects of coronary artery stenosis disease.MACEs were increased in patients with high levels of LOX-1 after PCI during following up 1.5 years (comparison between high-LOX-1 group and low-LOX-1 group, the probability of non-MACE was 87.1% (115/132) vs 97.7%(43/44), Log-ranK test, χ2=6.957, P<0.01). Conclusions LOX-1 and CX3CR1 may be involved in the process of coronary artery stenosis, and a high level of LOX-1 may be associated with left ventricular systolic dysfunction in patients with coronary artery stenosis.Elevated LOX-1 level are closely related to afterwards MACE incidence after PCI in patients with coronary artery stenosis.（Chin J Lab Med,2014,37:66-71） Key words: Coronary stenosis; Scavenger receptors, class E; Receptors, chemokine; Prognosis

The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in patient with metabolic syndrome.

Objective:The aim of this study was to assess subclinical left (LV) and right ventricular (RV) dysfunction novel load-independent isovolumic myocardial acceleration (IVA) derived from tissue Doppler imaging (TDI) in patient with metabolic syndrome (MetS).Methods:This study had an observational case-control design. The study included 133 subjects which were divided into two groups: 75 patients with MetS and 58 controls without MetS. MetS was defined by the presence of ≥3 criteria according to ATP-NCEP III guidelines. All the subjects underwent laboratory blood tests and complete conventional echocardiography and TDI. Student’s t, Mann-Whitney U, Pearson’s, and multiple regression analysis were used for statistical analysis.Results:There were no significant difference between two groups in terms of traditional echocardiographic parameters. The diastolic and global functions of both ventricles were significantly impaired in MetS group. The TDI-derived IVA of the LV and the RV was significantly lower in patients with MetS (3.2±0.9 vs. 4.0±1.4, p<0.001 and 2.6±0.7 vs. 3.1±0.9, p=0.001, respectively). Whereas, TDI derived systolic velocity (Sa), and peak myocardial velocity during isovolumic contraction (IVV) of both ventricles were similar between the two groups. In the multiple regression analysis, waist circumference and diastolic blood pressure were found to be an independent determinant of IVA of LV (β=-.223, 95% CI=-.034 -.002, p=0.004) and RV (β=-.527, 95% CI=-.085 -.020, p=0.002) respectively.Conclusion:MetS affects global, diastolic, and systolic functions of two ventricles. This disruption lead to decreased function of heart was related with raised risk factors of MetS

Echocardiographic Assessment of Left Ventricular Systolic Dysfunction in Chronic Kidney Disease Patients of a Rural Tertiary Medical Care Centre in West Bengal

Objective: To evaluate the prevalence of LV systolic dysfunction in patients with CKD (Hemodialysis naive patients) & assess the severity of dysfunction in respect to stages of CKD. Methodology: This is a cross sectional study conducted at the Medicine Department, B.S. Medical College, West Bengal during the period of one year from 1st May 2012 to 30th April 2013. 50 patients of both sexes and ages above 18 years and below 65 years presenting with chronic kidney disease who did not underwent dialysis, were included in the study. A proforma was designed to collect data containing basic information, history & physical examination and the relevant hematological, biochemical and radiological investigations like Electrocardiography and Echocardiography (2D & M mode). Based on the eGFR value (by Cockroft-Gault equation), Patients were divided in two categories - mild/moderate Chronic Kidney Disease [those with eGFR >30ml/min/1.73m 2 = CKD stages 1-3] (N = 27) and severe Chronic Kidney Disease [those with eGFR <30ml/min/1.73m 2 =CKD stages 4 - 5] (N = 23). And echocardiographic LV systolic parameters were analysed and compared between the two groups. Result: 15% of mild/moderate CKD patients showed low EF & 48% of severe CKD had evidence of low EF. 22% patients with mild/moderate CKD, and 26% with severe CKD had impaired fractional shortening. LVH was 58% among total study population, & it was 33% and 87% among two groups. Among all LVH, 31% was concentric and 69% was eccentric type. Conclusion: Chronic Kidney Disease patients has higher prevalence of left ventricular hypertrophy (LVH) and higher prevalence of systolic dysfunction, which was more pronounced in CKD stage 4-5.

Biventricular strain analysis at 1.5T cardiac MR imaging: preliminary results in volunteers using an iterative SENSE reconstruction with L1 regularization

Background Changes in myocardial strain have been shown to precede onset of systolic dysfunction in patients with cardiomyopathy. Traditionally performed with echocardiography, acoustic windows can limit strain evaluation. Preliminary work has shown good agreement between myocardial strain derived from deformation field analysis at balanced steady-state free-precession (bSSFP) cine MRI and speckle tracking echocardiography. The application of a novel prototype iterative SENSE reconstruction with L1 regularization (IRSENSE) to highly accelerated segmented bSSFP cine acquisitions can maintain or improve the effective temporal resolution with a shorter breath-hold. The purpose of this study is to evaluate left- and right-ventricular stain analysis from bSSFP cine acquisitions using conventional GRAPPA and highly accelerated T-PAT with IR-SENSE. We hypothesize that myocardial strain parameters derived from accelerated T-PAT cine acquisitions with IR-SENSE are similar to those obtained using conventional segmented bSSFP with comparable effective temporal resolutions.