Systolic Time Research Articles

P166 EXPLORING AGE-ASSOCIATED CHANGES IN HEMODYNAMICS: INSIGHTS FROM 24-HOUR BLOOD PRESSURE MONITORING

Background and Objective: Aging is associated with progressive alterations in the structure and function of the heart and arteries, which can occur independently. This study aims to investigate the hemodynamic changes occurring in aging normotensive subjects concerning heart and arterial function. We employed a novel method based on blood pressure values obtained during 24-hour ambulatory blood pressure monitoring (24-h ABPM). Methods: A cross-sectional study was conducted involving 3,220 non-obese patients referred for 24-h ABPM, who did not have hypertension and were not taking any medications. 24-hour mean hemodynamics was obtained using a non-invasive method based on Ct. Ct was estimated as: Ct/BSA= 38/PPth+ 4/5 × Td/T - 3/7, where BSA: body surface area, Td: diastolic time, T: cardiac period, and PPth: theoretical pulse pressure. The stroke volume (SV) was estimation as: SV= Ct (PP+MSP ×Ts/τ), where PP: pulse pressure, MSP: mean systolic pressure, Ts: systolic time, τ: diastolic pressure decay time constant. Cardiac output (CO) and SVR were obtained using conventional formulas. Results: Among the participants, 64.6% were female, with an average age of 51.0±15.3 years, Ct of 0.96±0.21 mL/mmHg, CO of 5.2±0.68 L/min, and SRV of 1394±178 dyn.s/cm5. An age-related reduction in stroke index and cardiac index are noteworthy, stabilizing from the sixth decade of life onward (41.1±2.0 mL/m2 and 3.0±0.23 L/min/m2, respectively). Conversely, Ct exhibits an early increase from the third to fifth decades of life (1.04±0.18 mL/mmHg), followed by a continuous and gradual decline until the ninth decade (0.71±0.16 mL/mmHg). Meanwhile, SVR demonstrates an upward trend until reaching and maintaining high values from the sixth decade of life (1426±167 dyn.s/cm5) onward with a clear shift in arterial hemodynamics (Analysis of variance [ANOVA]; P value <0.001) (Figure). Conclusions: The current method based on 24-hour ABPM effectively portrays the cardiac and arterial hemodynamics that mirror age-related circulatory alterations. This method offers a valuable pathophysiological basis for understanding the aging blood pressure profile.

Establishment of a hybrid model of atherosclerosis and acute colitis in ApoE-/- mice.

Inflammatory bowel disease (IBD) and atherosclerosis (AS) are both common chronic inflammatory diseases with similar pathophysiological mechanisms. Some studies have shown that IBD patients are at increased risk for early atherosclerosis, myocardial infarction and venous thrombosis. Here we set up a hybrid mouse model associated with atherosclerosis and acute colitis in order to investigate the interplay of the two diseases. We fed ApoE-/- mice with high fat diet to establish atherosclerosis model, and used animal ultrasound machine to detect the artery of mice noninvasively. Then a new hybrid model of atherosclerosis and acute colitis was prepared by drinking water for 7 days. At the end of the experiment, the hybrid model mice showed typically pathological and intuitionistic changes of atherosclerosis and acute colitis. We found the shortened colon length, high histopathological scores of the colon with mucosal erosion and necrosis, hyperlipidemia, a plaque-covered mouse aorta and plaque with foam cells and lipid deposition in the hybrid model group, which proved that the hybrid model was successfully established. At the same time, ultrasonic detection showed that the end-diastolic blood flow velocity and the relative dilation value were decreased, while systolic time / diastolic time, the wall thickness, systolic diameters as well as diastolic diameters were gradually increased, and statistical significance appeared as early as 8 weeks. We clearly described the process of establishing a hybrid model of atherosclerosis and acute colitis, which might provide a repeatable platform for the interaction mechanism exploring and drug screening of atherosclerosis and inflammatory bowel disease in preclinical study.

Investigating the impact of smoking habits through photoplethysmography analysis.

Smoking is widely recognized as a significant risk factor in the progression of arterial stiffness and cardiovascular diseases. Valuable information related to cardiac arrhythmias and heart function can be obtained by analyzing biosignals such as the electrocardiogram (ECG) and the photoplethysmogram (PPG). The PPG signal is a non-invasive optical technique that can be used to evaluate the changes in blood volume, and thus it can be linked to the health of the vascular system.Objective. In this study, the impact of three smoking habits-cigarettes, shisha, and electronic cigarettes (e-cigarettes)-on the features of the PPG signal were investigated.Approach. The PPG signals are measured for 45 healthy smokers before, during, and after the smoking session and then processed to extract the morphological features. Quantitative statistical techniques were used to analyze the PPG features and provide the most significant features of the three smoking habits. The impact of smoking is observed through significant changes in the features of the PPG signal, indicating blood volume instability.Main results. The results revealed that the three smoking habits influence the characteristics of the PPG signal significantly, which presentseven after 15 min of smoking. Among them, shisha has the greatest impact on PPG features, particularly on heart rate, systolic time, augmentation index, and peak pulse interval change. In contrast, e-cigarettes have the least effect on PPG features. Interestingly, smoking electronic cigarettes, which many participants use as a substitute for traditional cigarettes when attempting to quit smoking, has nearly a comparable effect to regular smoking.Significance. The findings suggest that individuals who smoke shisha are more likely to develop cardiovascular diseases at an earlier age compared to those who have other smoking habits. Understanding the variations in the PPG signal caused by smoking can aid in the early detection of cardiovascular disorders and provide insight into cardiac conditions. This ultimately contributes to the prevention of the development of cardiovascular diseases and the development of a health screening system.

Evaluating the efficacy and cardiotoxicity of EGFR-TKI AC0010 with a novel multifunctional biosensor

Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality worldwide. Although epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have dramatically improved the life expectancy of patients with NSCLC, concerns about TKI-induced cardiotoxicities have increased. AC0010, a novel third-generation TKI, was developed to overcome drug resistance induced by EGFR-T790M mutation. However, the cardiotoxicity of AC0010 remains unclear. To evaluate the efficacy and cardiotoxicity of AC0010, we designed a novel multifunctional biosensor by integrating microelectrodes (MEs) and interdigital electrodes (IDEs) to comprehensively evaluate cell viability, electrophysiological activity, and morphological changes (beating of cardiomyocytes). The multifunctional biosensor can monitor AC0010-induced NSCLC inhibition and cardiotoxicity in a quantitative, label-free, noninvasive, and real-time manner. AC0010 was found to significantly inhibit NCI-H1975 (EGFR-L858R/T790M mutation), while weak inhibition was found for A549 (wild-type EGFR). Negligible inhibition was found in the viabilities of HFF-1 (normal fibroblasts) and cardiomyocytes. With the multifunctional biosensor, we found that 10 μM AC0010 significantly affected the extracellular field potential (EFP) and mechanical beating of cardiomyocytes. The amplitude of EFP continuously decreased after AC0010 treatment, while the interval decreased first and then increased. We analyzed the change in the systole time (ST) and diastole time (DT) within a beating interval and found that the DT and DT/beating interval rate decreased within 1 h after AC0010 treatment. This result probably indicated that the relaxation of cardiomyocytes was insufficient, which may further aggravate the dysfunction. Here, we found that AC0010 significantly inhibited EGFR-mutant NSCLC cells and impaired cardiomyocyte function at low concentrations (10 μM). This is the first study in which the risk of AC0010-induced cardiotoxicity was evaluated. In addition, novel multifunctional biosensors can comprehensively evaluate the antitumor efficacy and cardiotoxicity of drugs and candidate compounds.

Cardiac cycle timing intervals in university varsity athletes

Cardiac cycle timing events in varsity athletes serve an important function for baseline assessment but are not reported in the literature. The purpose of this study was to characterize the cardiac cycle timing intervals and contractility parameters in university-level varsity athletes. 152 males and 93 females were assessed using a non-invasive seismocardiography cardiac sensor attached to the sternum for 1-minute. Shorter isovolumic relaxation time (IVRT), systolic time, mitral valve open to E-wave (MVO to E) time, rapid ejection period (REP), atrial systole to mitral valve closure (AS to MVC) time, and diastolic performance index (IVRT/systolic time) were found in females, while heart rate was lower in males. Varying differences in timing intervals were found between sports. Systolic times were longer in male and female basketball players, while diastole was shortest in male football players, who also had higher heart rates than the other male sport athletes. These results add reference cardiac cycle timing data to the literature and imply that male and female athletes show different cardiac characteristics. Team differences suggest that different training for different sports can result in unique cardiac function changes, however, these appear to be related to the sex of the participants. The addition of these cardiac cycle timing intervals adds a valuable comparative tool to better understand cardiac physiology in the varsity athletic population.

The effect of ovariectomy on hemodynamic functions and the level of nitric oxide metabolites in the heart of rats

Background. A higher prevalence of cardiovascular disorders has been observed in women after menopause. This study aimed to determine the long-term effects of ovariectomy on hemodynamic functions and the level of nitric oxide metabolites (NOx) in the heart tissue of ovariectomized rats. Methods. Fourteen female Wistar rats were divided into two groups (n=7 in each group) of control and ovariectomized (OVX). OVX rat model was induced using the two dorsolateral skin incision method. Cardiac hemodynamic function indices, including the left ventricular developed pressure (LVDP), peak rate of positive changes in the left ventricular pressure (+dp/dt), and peak rate of negative changes in the left ventricular pressure (-dp/dt) were measured at the time of systole in hearts after 11 months of the ovariectomy. Serum and left ventricular levels of NOx were measured at the end of the study. Results. At the end of the study, OVX rats had lower LVDP (19%, P=0.001), +dp/dt (30%, P<0.001) and -dp/dt (23%, P=0.004) than control group. In addition, the OVX group had lower serum NOx levels (30%, P=0.021) compared to the control group; heart tissue NOx was also lower by 31% in the OVX rats, but it was not statistically significant (P=0.056). Conclusion. Long-term ovariectomy disrupts cardiac hemodynamic function in ovariectomized rats, which is associated with decreased NOx levels in serum. Practical Implications. Our findings indicated impaired cardiac function following long-term estrogen deficiency in OVX rats. These results can be used to prevent and treat the cardiovascular disease in post-menopausal women. However, these results need to be confirmed in humans.

Non-invasive Assessment Of Elevated Left Ventricular End Diastolic Pressure Using A Small Portable Device: Design For Tele-Monitoring

Background Left ventricular end-diastolic pressure (LVEDP) provides crucial information on the LV operating compliance and is a key marker for congestive heart failure and pulmonary hypertension. The diagnosis and monitoring of the left-sided filling pressure often requiring invasive procedures. HEMOTAG, is a small portable device that uses micro-sensors to capture cardiac vibrations and electrocardiogram (ECG), transduced via thoracic electrodes. It is a viable option to measure cardiac time intervals (CTIs), surrogate markers of hemodynamics and intracardiac pressure. In this study, diastolic-to-systolic time ratio (DSR) and systolic time ratio (STR) along with the patient's age, height, and weight were assessed as valid markers for elevated LVEDP, compared against left heart catheterization LVEDP measurement. Methods In 44 female and 49 male patients, mean LVEDP was measured during cardiac catheterization. Simultaneously, Hemotag generated CTIs: systolic time (ST): mitral valve closure (MVC) to aortic valve closure (AVC), diastolic time (DT): AVC to MVC, STR: Aortic valve opening/(Aortic valve opening to Aortic valve closing), and DSR: DT/ST. The predictability value of non-invasively HEMOTAG-derived CTI ratios - diastolic time normalize by heart rate (DT/HR), DSR, and STR - plus biological information of age, height, and weight were assessed to determine elevated LVEDP (> 15 mmHg). Logistic regression analysis between the markers and LVEDP was performed. Sensitivity, specificity, correlation, and p-values were calculated. Results Mean age for the female (male) patients was 69.41 ± 11.84 (63.12 ± 10.80) and mean LVEDP was 17.20 ± 6.17 (16.57 ± 5.42). Using logistic regression with DSR, STR, age, height, and weight as features, sensitivity of 88.00%, specificity of 94.74%, AUC of 0.94, r = 0.74, p-value = 4.31e-06, were obtained for female patients; using DT/HR, STR, age, height, and weight, a sensitivity of 89.29%, specificity of 71.43%, AUC of 0.79, r = 0.40, and p-value = 0.0419 were obtained in the male patients. Conclusions HEMOTAG detected elevated LVEDP with high sensitivity and high specificity for both female and male patients. This preliminary study has demonstrated the feasibility of estimating LVEDP using a portable, non-invasive device that empowers patients to transmit such data from home instantaneously to providers. Further studies are required to validate HEMOTAG as a point-of-care non-invasive assessment for heart failure and pulmonary hypertension patients. HEMOTAG® development and the clinical study is supported by NIMHD SBIR grant # R44MD009556. Left ventricular end-diastolic pressure (LVEDP) provides crucial information on the LV operating compliance and is a key marker for congestive heart failure and pulmonary hypertension. The diagnosis and monitoring of the left-sided filling pressure often requiring invasive procedures. HEMOTAG, is a small portable device that uses micro-sensors to capture cardiac vibrations and electrocardiogram (ECG), transduced via thoracic electrodes. It is a viable option to measure cardiac time intervals (CTIs), surrogate markers of hemodynamics and intracardiac pressure. In this study, diastolic-to-systolic time ratio (DSR) and systolic time ratio (STR) along with the patient's age, height, and weight were assessed as valid markers for elevated LVEDP, compared against left heart catheterization LVEDP measurement. In 44 female and 49 male patients, mean LVEDP was measured during cardiac catheterization. Simultaneously, Hemotag generated CTIs: systolic time (ST): mitral valve closure (MVC) to aortic valve closure (AVC), diastolic time (DT): AVC to MVC, STR: Aortic valve opening/(Aortic valve opening to Aortic valve closing), and DSR: DT/ST. The predictability value of non-invasively HEMOTAG-derived CTI ratios - diastolic time normalize by heart rate (DT/HR), DSR, and STR - plus biological information of age, height, and weight were assessed to determine elevated LVEDP (> 15 mmHg). Logistic regression analysis between the markers and LVEDP was performed. Sensitivity, specificity, correlation, and p-values were calculated. Mean age for the female (male) patients was 69.41 ± 11.84 (63.12 ± 10.80) and mean LVEDP was 17.20 ± 6.17 (16.57 ± 5.42). Using logistic regression with DSR, STR, age, height, and weight as features, sensitivity of 88.00%, specificity of 94.74%, AUC of 0.94, r = 0.74, p-value = 4.31e-06, were obtained for female patients; using DT/HR, STR, age, height, and weight, a sensitivity of 89.29%, specificity of 71.43%, AUC of 0.79, r = 0.40, and p-value = 0.0419 were obtained in the male patients. HEMOTAG detected elevated LVEDP with high sensitivity and high specificity for both female and male patients. This preliminary study has demonstrated the feasibility of estimating LVEDP using a portable, non-invasive device that empowers patients to transmit such data from home instantaneously to providers. Further studies are required to validate HEMOTAG as a point-of-care non-invasive assessment for heart failure and pulmonary hypertension patients. HEMOTAG® development and the clinical study is supported by NIMHD SBIR grant # R44MD009556.

Sonographic Assessment of the Effects of Mechanical Ventilation on Carotid Flow Time and Volume.

BackgroundCorrected carotid flow time (CFTc) and carotid blood flow (CBF) are sonographic measurements used to assess fluid responsiveness in hypotension. We investigated the impacts of mechanical ventilation on CFTc and CBF.Materials and methodsNormotensive patients undergoing cardiac surgery were prospectively enrolled. Carotid ultrasound (US) was performed pre and post-intubation. Post-intubation measurements took place after the initiation of mechanical ventilation. To measure CFTc and CBF, a sagittal carotid view was obtained with pulse wave-Doppler (maximum angle 60°). CFTc was calculated with the Bazett formula (CFTc = systolic time/√cycle time). CBF was calculated using CBF (mL/min) = area (cm 2 ) x time average mean velocity (TAMEAN) (cm/sec) x 60 (sec/min). The maximum carotid diameter was measured at the level of the thyroid.ResultsTwenty patients were enrolled. Mean CFTc pre-intubation was 328 ms (SD 43.9 ms) compared to CFTc post-intubation 336 ms (SD 36 ms). There was no significant difference between pre and post-intubation CFTc (mean differences=-0.008; t(19)=-0.71, p=.49). Mean CBF pre-intubation was 487 mL/min (SD 176 mL/min) compared to CBF post-intubation 447 mL/min (SD 187 mL/min). There was no significant difference between pre and post-intubation CBF (mean differences= 40; t(19)=1.24, p=.23).ConclusionsIn this study of normotensive patients, there were no detected differences in CFTc or CBF pre and post-intubation with mechanical ventilation.

Abstract 9604: Pulmonary Artery Systolic Blood Pressure Predicted From Cardiac MR Image Data Without Requiring Calibration; A Virtual RHC?

Introduction: Despite decades of initiatives, assessment of absolute pulmonary arterial pressures (PAP) by CMR has remained an elusive goal. We introduce a means to predict the PAP from routine image data easily obtained by CMR. The image data is directly used to calculate the impedance between the LV and the aorta (IMP LV ) and between the RV and the main PA (IMP RV ) which are combined to predict PAP. Methods: Patients (n=33, 82% F), 51 ±12 yrs) with a diagnosis of (PHTN) underwent evaluation by CMR to assess the blood flow through the aorta and PA at the interface to the LV and RV, respectively. Phase velocity mapping flow data at single plane (acquisition time 2min) was used to calculate the previously described and validated impedance for the LV and RV: IMP LV and IMP RV . IMP was calculated using the formula:IMP = (end systolic ejection time) x (mean blood velocity) / (vessel diameter). Systolic PAP was measured during a right heart cath examination performed within one week of the CMR. A multiple linear regression model was generated to predict systolic PAP, with parameters retained with a significance <0.05. Results: The parameters that best predicted the systolic PAP were IMP LV , IMP RV and the distance of the measured IMP LV from the center position of the data range of IMP LV (r = 0.69, p<0.001), Fig 1. The standard major-axis line was fitted to the data (p<0.001). Conclusions: This is the first demonstration of the utility of a CMR-measured left and right ventricular impedance value to directly predict systolic PAP. Critically, the correlation coefficient, identical to Echo, holds over a very wide physiologic range, and has never been demonstrated before by CMR. Of central importance is the distinguishing feature that no calibration of the data is required, thus, unlike typical Echo-derived estimates of PAP or newer implanted pressure monitors, no estimate of CVP or RAP is required. Thus, this is the first-in-man CMR demonstration of a virtual RHC.

Abstract 10130: Immediate Changes of Transesophageal Echocardiographic Findings in Percutaneous Closure of Atrial Septal Defects

Introduction: Atrial septal defects (ASD) are treated with percutaneous closures that subsequently increase the left ventricular volume load. This retrospective study aimed to assess the change in transesophageal ultrasound indices and to determine the search associated post-closure left diastolic index. Subjects: We enrolled 62 patients who underwent percutaneous closure of ASD in our hospital between January 2018 and November 2020. Method: Percutaneous ASD closure was performed under general anesthesia. We measured left ventricular inflow (early diastolic flow velocity, E; atrial contraction flow velocity, A; E-wave deceleration time, DT), mitral annulus velocity by tissue doppler imaging at lateral annulus (early diastolic myocardial velocity, E'; atrial contraction velocity, A'), and pulmonary venous blood flow velocity (peak systolic velocity, S; diastolic velocity, D; atrial systolic regurgitation velocity, AR; atrial systolic regurgitation time, AD) using transesophageal echocardiography (TEE). The ratio of E and E' (E/E') was calculated for and compared between before (pre) and after (post) ASD closure. Statistical analysis was performed using the EZR software. Wilcoxon's code order test was used for comparison, and multivariate correlation analysis was performed with post-occlusion E/E' as the objective variable. Statistical significance was set at p<0.05. Results: Significant changes were seen in A', E', E, S, D, AD, and E/E'. Multivariate correlation analyses revealed a significant association of post E/E’ with the pre E/E’ and pre AR. Conclusion: In this study, the pulmonary venous flow velocity was found to decrease during systole and diastole following ASD closure. The DT did not change; thus, there was no change in the stiffness of the left ventricle. We concluded that the increased left ventricular volume load caused the increase in the left end-diastolic pressure.

Preservation of left ventricle peak and mean pulse flow blood velocity despite progressive deterioration of cardiac function in a chronic heart failure murine model.

The goal of this study was to assess the alterations in left ventricle (LV) blood flow velocity patterns in relation to progressive impairment of cardiac function in the course of heart failure (HF) in a unique murine model of chronic HF in Tgαq*44 mice. Doppler- and MRI-based assessments of blood velocity and cardiac performance, respectively, were performed in Tgαq*44 mice at the age of 1, 2, 4, 6, 8 and 12 months as compared with age-matched FVB control mice. One-month-old Tgαq*44 mice displayed elongated early diastolic phase with fully preserved cardiac function that, however, progressively deteriorated in older Tgαq*44 mice. As early as in 2-month-old Tgαq*44 mice, the filling rate (FR), max. radial strain and end-systolic volume increased; in 4-month-old Tgαq*44 mice, the ejection fraction, max. circ. strain and ventriculo-arterial coupling decreased, and the ejection time was prolonged; in 6 - 8-month-old Tgαq*44 mice, the stroke volume, max. (both) strains decreased, end-systolic volume, FR and end-diastolic volume increased, and finally, in 12-month-old Tgαq*44 mice, the ejection fraction, cardiac output and stroke volume were all severely impaired. In the early phase of HF development, no differences were observed in Tgαq*44 mice versus FVB mice regarding systolic LV flow pattern, but indices of mitral diastolic flow were considerably increased in 1-month-old Tgαq*44 mice versus FVB mice. In the late phase of HF, despite progressive deterioration of cardiac function, LV pulse flow blood velocity was not altered in Tgαq*44 mice up to the age of 8 months. Systolic peak velocity and mean acceleration time deteriorated only in 12-month-old Tgαq*44 mice, with peak acceleration and mean velocity values still preserved. We demonstrated that the cardiac mitral diastolic flow pattern displayed adaptive changes in the very early phase of HF development in Tgαq*44 mice and that these changes preceded early alterations in LV haemodynamics. Then, despite the progressive deterioration of cardiac haemodynamics, peak and mean in- and out-flow velocities remained unchanged for a relatively long time and deteriorated only at the end-stage HF. Altogether, we revealed that in addition to cardiac performance, adaptive vascular performance represents an important factor determining LV mitral inflow and ejection flow phenotype during the progression of chronic HF in Tgαq*44 mice.

Fish oil replacement prevents, while docosahexaenoic acid-derived protectin DX mitigates end-stage-renal-disease in atherosclerotic diabetic mice.

Diabetic nephropathy (DN) remains the major cause of end-stage renal disease (ESRD). We used high-fat/high-sucrose (HFHS)-fed LDLr-/- /ApoB100/100 mice with transgenic overexpression of IGFII in pancreatic β-cells (LRKOB100/IGFII) as a model of ESRD to test whether dietary long chain omega-3 polyunsaturated fatty acids LCω3FA-rich fish oil (FO) could prevent ESRD development. We further evaluated the potential of docosahexaenoic acid (DHA)-derived pro-resolving lipid mediators, 17-hydroxy-DHA (17-HDHA) and Protectin DX (PDX), to reverse established ESRD damage. HFHS-fed vehicle-treated LRKOB100/IGFII mice developed severe kidney dysfunction leading to ESRD, as revealed by advanced glomerular fibrosis and mesangial expansion along with reduced percent survival. The kidney failure outcome was associated with cardiac dysfunction, revealed by reduced heart rate and prolonged diastolic and systolic time. Dietary FO prevented kidney damage, lean mass loss, cardiac dysfunction, and death. 17-HDHA reduced podocyte foot process effacement while PDX treatment alleviated kidney fibrosis and mesangial expansion as compared to vehicle treatment. Only PDX therapy was effective at preserving the heart function and survival rate. These results show that dietary LCω3FA intake can prevent ESRD and cardiac dysfunction in LRKOB100/IGFII diabetic mice. Our data further reveals that PDX can protect against renal failure and cardiac dysfunction, offering a potential new therapeutic strategy against ESRD.

Clinical and instrumental profile of patients with stage II essential hypertension with different forms of extrasystoles according to the level of apelin-13

Annotation. Essential hypertension (EH) is one of the leading causes of disability and mortality among cardiovascular diseases, so today new metabolic markers of cardiovascular risk are being actively studied. One of them is apelin-13. Objective – to evaluate the clinical and instrumental profile of patients with stage II hypertension with different forms of extrasystoles and different neurohumoral background – conditionally high/low serum apelin-13 levels. 156 patients with stage II essential hypertension were examined. 124 of them had frequent symptomatic extrasystoles, 32 patients had no arrhythmias and were considered to the comparison group. 30 practically healthy normotensive persons were considered to the control group. All patients underwent a complete clinical and anthropometric examination, blood pressure measurement, automatic daily blood pressure monitoring, daily electrocardiogram monitoring, echocardiography and the assessment of serum apelin-13 level. For statistical analysis, the procedure of non-linear data estimation was chosen, namely logistic regression or logit model. To form the basic statistical matrix of the analysis, we used clinical-instrumental and laboratory indicators, which passed a preliminary correlation analysis of Spearman with the level of apelin-13 serum and found a significant correlation (p<0.05). In the course of the logistic analysis at the final model, which allowed to predict “background of apelin” in patients with stage II EH entered 4 independent factors that revealed statistically significant (p<0.05) correlations with the initial parameter: the value of the systolic arterial pressure time index in%, the index of the left atrium in mm/m2, the average number of ventricular extrasystoles for 1 hour and the level of total cholesterol in plasma in mmol/l. The last indicator showed the least informativeness in predicting of the apelin-13 serum level. Interpreting the data of the obtained logit regression model, it should be said that in patients with EH of increasing the value of the systolic arterial pressure time index, the index of the left atrium and the average value of ventricular extrasystoles during 1 hour and decrease total cholesterol level in plasma increase the probability of determining relatively low (<920 pg/ml) and at the same time reduce the probability of determining a relatively high (≥920 pg/ml) level of apelin serum. These data also show that the highest informativeness in predicting the level of apelin-13 in patients with EH was the total number of ventricular extrasystole per hour. So, a high “apelin background” (≥920 pg/ml) in patients with EH will be accompanied by a benign course of the disease, so an increase serum apelin-13 in patients with EH should be considered as positive neurohumoral changes that promote cardioprotection, improve prognosis course of the disease and reduce cardiovascular risk.

Variations in regional strain under different afterload conditions may help to identify ischemic myocardium

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute coronary syndromes are a major health problem worldwide. The Speckle Tracking Imaging has been proposed as adjunctive for diagnosis and prognosis purposes in the context of NSTE-ACS. Purpose We sought to determine the regional myocardial strain in ischemic versus non-ischemic segments in subjects with NSTE-ACS, before and during acute pressure overload. Methods Data from 2D-echocardiography were obtained from 21 patients (mean age, 50 ± 10 years) undergoing cinecoronariography for NSTE-ACS indications. A blinded observer performed an offline analysis to obtain the Systolic Positive Peak (P), Systolic Peak Strain (S), Peak Strain (G) and Time to Peak Strain (TTP) of each segment acquired before and during pressure overload-induced by left hand-grip (42± 8 Kg) combined with simultaneous pneumatic constriction of the right arm and both lower limbs. Moreover, LVEF and GLS were also calculated. A second blinded observer labelled the ischemic regions according to AHA-16 Bull’s eye using data from cinecoronariography. Results The handgrip manuever caused mild reductions in the median LVEF (56 %; IQR 48 -58% vs 54%; IQR 51-56%) as well as the median GLS (-17%; IQR-19%-15% vs -16%; IQR -19-15%). For the analysis of regional myocardial function, we obtained 360 segments (29% labelled as ischemic) with optimal tracking quality. Mean regional strain changes during pressure overload were significantly different in ischemic vs non-ischemic segments for Peak S ( 1,07% x -0.5%; p-value <0,01) and Peak G (0.85% x -0.65%; p-value < 0.01)(Table). Notably, however, we found marked increases in the systolic deformation, restricted to the apical ischemic segments during pressure overload (Figure). Conclusions Our data point to a distinct increase in the systolic deformation of the apical segments in contrast to the overall reductions in the GLS and EF in the ischemic left ventricle. Non- Ischemic segments N = 256 Ischemic segments N = 104 Baseline Handgrip Variation (%) Baseline Handgrip Variation (%) p-value* Peak P 0.33(0.57) 0.36(0.7) 0.03(0.7) 0.50(0.7) 0.57(0.8) 0.07(0.8) 0.32 Peak S -17.9(4.4) -16.8(5.3) 1.07(4.1) -16.6 (5.2) -17.2(5.6) -0.5(4.8) 0.0006 Peak G -18.5 (4.2) -17.68 (4.6) 0.85 (3.7) -17.3 (4.5) -18 (4.6) -0.65(4.2) 0.0005 TTP 377(62) 384(66) 6.5(52) 387(65_ 388(62) 1.15(46) 0.17 * t- test comparing the variations baseline-handgrip between the two groups (ischemic versus non-ischemic. Peak P= positive systolic peak; Peak S= systolic peak; Peak G= peak strain; TTP= time to peak Abstract Figure

The impact of magnesium on psycho-emotional stress and functional activity of the cardiovascular system in students from African countries

The objective of the study is investigation of the impact of magnesium on psycho-emotional stress and functional activity of the cardiovascular system in foreign male students of African origin. A total of 33 male first course students were involved in the study. The examinees were supplemented with 150 mg/day of magnesium. Evaluation of serum and urinary Mg levels was performed using inductively-coupled plasma mass-spectrometry, whereas functional activity of the cardiovascular system and psycho-emotional stress were assessed using Angioscan-01 diagnostic complex both before and after a course of magnesium supplementation. It has been demonstrated that magnesium supplementation resulted in a significant 3% increase in serum Mg levels as compared to baseline. The observed increase in circulating magnesium levels was associated with a significant 26% decrease in stress index, whereas arterial stiffness index significantly reduced by 3%. A significant increase in absolute systole duration and time from the start of the pulse wave to a maximum of the early systolic wave was also observed. The results of the study demonstrate a significant decrease in stress index and arterial stiffness in response to magnesium intake, being in agreement with the existing data on protective effects of magnesium. Therefore, monitoring of magnesium supply and its improvement may be considered as a valuable tool supporting somatic and psychic health of students thus improving their academic performance.

Portable, non-invasive video imaging of retinal blood flow dynamics

Retinal blood flow (RBF) information has the potential to offer insight into ophthalmic health and disease that is complementary to traditional anatomical biomarkers as well as to retinal perfusion information provided by fluorescence or optical coherence tomography angiography (OCT-A). The present study was performed to test the functional attributes and performance of the XyCAM RI, a non-invasive imager that obtains and assesses RBF information. The XyCAM RI was installed and used in two different settings to obtain video recordings of the blood flow in the optic nerve head region in eyes of healthy subjects. The mean blood flow velocity index (BFVi) in the optic disc and in each of multiple arterial and venous segments was obtained and shown to reveal a temporal waveform with a peak and trough that correlates with a cardiac cycle as revealed by a reference pulse oximeter (correlation between respective peak-to-peak distances was 0.977). The intra-session repeatability of the XyCAM RI was high with a coefficient of variation (CV) of 1.84 ± 1.13% across both sites. Artery-vein comparisons were made by estimating, in a pair of adjacent arterial and venous segments, various temporal waveform metrics such as pulsatility index, percent time in systole and diastole, and change in vascular blood volume over a cardiac cycle. All arterial metrics were shown to have significant differences with venous metrics (p < 0.001). The XyCAM RI, therefore, by obtaining repeatable blood flow measurements with high temporal resolution, permits the differential assessment of arterial and venous blood flow patterns in the retina that may facilitate research into disease pathophysiology and biomarker development for diagnostics.

Systolic modified Look-Locker inversion recovery myocardial T1 mapping improves the accuracy of T1 and extracellular volume fraction measurements of patients with high heart rate or atrial fibrillation.

Image data for T1 mapping are generally acquired during mid-diastole period. However, T1 mapping tends to fail for patients with high heart rate or atrial fibrillation because of short or irregular R-R interval. Focusing on the evidence that the timing of systole is more stable than that of diastole from the R wave, we compared systolic T1 mapping with conventional diastolic T1 mapping for all participants (n = 58) by visual scoring of T1 calculation error. The systolic scores were significantly better than the diastolic scores (p < 0.05). This advantage of the systolic scores was confirmed selectively for patients with atrial fibrillation (p < 0.05, n = 19). The successful number of nonrigid image registration alignment for extracellular volume fraction (ECV) analysis also increased significantly for systolic images compared with diastolic images (p < 0.05). Thus, systolic T1 mapping improves the accuracy of T1 values and ECV analysis.

The prognostic value of myocardial deformational patterns is reduced in patients with heart failure

Abstract Background Early systolic lengthening (ESL) and postsystolic shortening are considered highly specific for myocardial ischemia. We aimed to investigate the prognostic potential of both deformational patterns in patients with heart failure (HF) and to determine if a history of ischemic heart disease modified this relationship. Method A total of 884 patients with systolic HF (66±12 years, male 73%, mean ejection fraction 28±9%) underwent speckle tracking echocardiography. Of these, 61% suffered from ischemic cardiomyopathy (ICM). Patients were followed for all-cause mortality. We assessed the ESL index: [−100x (peak positive strain/maximal strain)] and the postsystolic index (PSI): [100x (postsystolic strain/maximal strain)]. Both parameters were averaged across 18 myocardial segments. Results During a median follow-up of 3.4 years [interquartile range 1.9 to 4.8], 132 patients (15%) died. In multivariable survival analyses adjusted for potential confounders (age, sex, BMI, mean arterial pressure, cholesterol, heart rate, CABG/PCI, left ventricular ejection fraction and mass index, left atrial volume index, tricuspid annular plane systolic excursion, E-wave, E/e', deceleration time, and global longitudinal strain) neither the ESL index (HR 1.02 per 1% increase [0.97 to 1.08], P=0.40) nor PSI (HR 1.00 per 1% increase [0.98 to 1.01], P=0.69) were associated with all-cause mortality. ICM modified the relationship (P interaction unadjusted/adjusted=0.001/0.008; Figure) such that per 1% increase in ESL index in patients with ICM was significantly associated with all-cause mortality (unadjusted: HR 1.09 [1.04 to 1.15], P&amp;lt;0.001 and adjusted: HR 1.06 [1.00 to 1.13], P=0.045) but not in those without (unadjusted: HR 1.02 [1.01 to 1.03], P=0.002 and adjusted: HR 0.99 [0.90 to 1.09], P=0.086). ICM did not modify the relationship between PSI and all-cause mortality (P interaction unadjusted/adjusted=0.15/0.13). Conclusion Our results indicate that in this cohort of undifferentiated HF patients with reduced ejection fraction the prognostic value of deformational patterns was reduced. However, the ESL index may provide some information on prognosis in patients with ICM. ESL and interaction with ICM Funding Acknowledgement Type of funding source: None

Arterial spectral waveform analysis in the prediction of diabetic foot ulcer healing.

Objective:We assessed the association between (1) severity of vessel wall calcification, (2) number of patent vessels at the ankle and (3) arterial spectral waveform features, as assessed on a focused ankle Duplex ultrasound (DUS), and healing at 12-months in a cohort of patients who had their diabetic foot ulcers conservatively managed.Research design and methods:Scans performed on 50 limbs in 48 patients were included for analysis. Patient health records were prospectively reviewed for 12-months to assess for the outcome of ulcer healing.Results:We identified that the number of waveform components, peak systolic velocity, systolic rise time and long forward flow as well as the number of vessels patent at the ankle on DUS, may be useful independent predictors of healing, as noted by the trend towards statistical significance.Conclusion:Arterial spectral waveform features may be useful in predicting the chance of diabetic foot ulcer healing.

PERSONALIZED INTENSIVE CARE OF CARDIOVASCULAR DISORDERS IN CHILDREN WITH RESPIRATORY FAILURE

PERSONALIZED INTENSIVE CARE OF CARDIOVASCULAR DISORDERS IN CHILDREN WITH RESPIRATORY FAILURE