Diastolic Thickness Research Articles

Transthoracic Echocardiography findings in patients with Ankylosing Spondylitis in Kurdistan region

Background and objectives: Ankylosing spondylitis is a chronic inflammatory disorder that affecting axial and non-axial joints leads to a loss of mobility and function over time. The aim of this study is to evaluate the cardiac involvement using transthoracic echocardiography. Methods: A case-control research study took place at Rizgary Teaching Hospital Rheumatology Department between January 2022 and March 2023. Inclusion criteria involved those patients diagnosed with ankylosing spondylitis based on the Assessment of Spondylarthritis International Society criteria for axial spondylarthritis. Transthoracic echocardiography (vivid machine) had been performed for all the participants and parameters such as right and left ventricle dimension, aortic root dimension, left atrium dimension, interventricular septum thickness in diastole and ejection fraction had been documented. Results: This study revealed that transthoracic echocardiography findings of patients with ankylosing spondylitis with diastolic dysfunction in 12%, mitral regurgitation in 8%, mitral prolapse in 10% and 2% of each of anteroseptal hypokinesia, dilated aortic root and aortic regurgitation. The study demonstrated a significant increase in right ventricular, aortic, and left atrium dimensions in patients with ankylosing spondylitis with a p value of 0.0001, 0.001 and 0.001 respectively. In terms of ejection fraction; this study showed a significant decrease in ejection fraction in cases of ankylosing spondylitis with a mean of 64.3% with a p value of 0.004. Conclusion: Tricuspid regurgitation and a drop in ejection fraction are the two significant findings among patients with ankylosing spondylitis.

Assessment of left ventricular systolic function using a non-invasive index of myocardial work in amateur marathon runners.

For non-professionally trained athletes, the hyperphysiological stress response induced by marathon exercise may lead to heart fatigue and even cause organic changes such as abnormal ventricular septal thickening. Early detection of abnormal cardiac function in athletes can help prevent adverse cardiovascular events. The purpose of this study was to analyze the left ventricular systolic function (LVSF) of amateur marathon runners using a novel technique called the left ventricular (LV) pressure-strain loop (PSL). A total of 35 amateur marathon runners and 33 age-matched healthy controls from Hangzhou were enrolled in this cross-sectional study from October 2021 to August 2023. The LV myocardial work (MW) parameters were calculated as the area of the PSL by two-dimensional speckle-tracking echocardiography (2D-STE) and blood pressure. The differences between the structural and functional data of the two groups and the predictive efficacy of each of the MW parameters for LV systolic function were analyzed using receiver operating characteristic (ROC) curves. The correlations between the PSL parameters and conventional echocardiographic parameters were analyzed. Global wasted work (GWW) was higher and global work efficiency (GWE) was lower in the amateur marathon runner group than the control group (P<0.05). The ROC curve analysis showed that the maximum area under the curve (AUC) for GWE was 0.681 [95% confidence interval (CI): 0.551-0.812] with an optimal cut-off value of 96.14%, and a sensitivity and specificity of 75.8% and 62.9%, respectively. The correlation analysis results showed that GCW was associated with increased diastolic interventricular septal thickness (IVSTd) (P<0.05, r=0.379). GWE was related to all conventional echocardiography parameters (P<0.05, r=-0.416, -0.674, -0.393, 0.406, 0.502, and -0.424, respectively). While GWW was correlated with increased IVSTd, LV diastolic posterior wall thickness (LVPWTd), and decreased global longitudinal strain (GLS) (all P<0.05, r=0.352, 0.395, and -0.344, respectively). Amateur marathon runners show potential changes in cardiac structure and systolic function after a period of endurance exercise, which can be assessed using non-invasive MW to evaluate LVSF. LV MW, which incorporates the GLS and afterload conditions, is more sensitive than GLS, and has emerged as a promising parameter for LV systolic functional evaluation.

Abstract 4135531: The Ubiquitin-Specific Protease 30 Inhibitor, MTX652, Attenuates Cardiac Dysfunction And Remodelling In a Murine Model Of Transverse Aortic Constriction

Introduction: Mitochondrial abnormalities are a characteristic of heart failure leading to energy deprivation and disease worsening. The mitochondrial deubiquitinating enzyme USP30, removes ubiquitin and represses PINK1/PARKIN-mediated mitophagy leading to accumulation of dysfunctional mitochondria. In this study we investigated the role of MTX652, a clinical stage USP30 inhibitor, in a mouse model of cardiac hypertrophy using transverse aortic constriction (TAC). Hypothesis: Inhibition of USP30 will promote mitophagy resulting in clearance of dysfunctional mitochondria and improved cellular health leading to cardioprotective effects. Aims: To determine if MTX652 can protect from TAC induced cardiac hypertrophy and remodelling. Methods: Male C57BL/6 mice, 8 weeks old, were subjected to sham surgeries or TAC using a 26G needle to induce cardiac pressure overload. MTX652 (1.5 or 5 mg/kg, n =12-13) or vehicle ( n =11) was administered orally, twice daily, starting 2 days post-surgery. Captopril (30 mg/kg/d, n =13) was also included as a positive control. After 4 weeks, echocardiography assessed left ventricle (LV) function and morphology. Cell based assays assessed MTX652 target engagement and TOM20 ubiquitination in vitro. Results: LV hypertrophy and wall thickening was observed in TAC animals. Treatment with MTX652 decreased systolic LV volume (1.5 mg/kg p&lt;0.05 and 5 mg/kg p&lt;0.01) and diameter (1.5 mg/kg p&lt;0.01 and 5 mg/kg p&lt;0.05,) demonstrating comparable effects to Captopril. A reduction in anterior wall thickness in diastole was also observed with MTX652 (5 mg/kg, p&lt;0.01). Cardiac dysfunction was also evident in TAC animals with MTX652 showing improvements in both ejection fraction (1.5 mg/kg and 5 mg/kg, p&lt;0.0001) and fractional shortening (1.5 mg/kg and 5 mg/kg, p&lt;0.0001). Cellular target engagement for MTX652 was confirmed in HeLa-YFP-Parkin cells with an EC 50 of 2.7 nM ( n =2). Furthermore, the USP30 substrate TOM20 was ubiquitinated following MTX652 treatment in vitro (EC 50 =6.1 nM, n =4) providing evidence of mitophagy activation, a finding also confirmed in mouse heart tissue (MTX652, 5mg/kg). Conclusions: The USP30 inhibitor, MTX652 significantly protected mice from TAC induced cardiac hypertrophy and LV dysfunction. Furthermore, MTX652 potentiates ubiquitylation of TOM20 as a mechanism to promote mitophagy. These data suggest our clinical stage molecule could provide a novel therapeutic approach for the treatment of cardiac hypertrophy and heart failure.

Epidemiological Profile and Correlates for Left Ventricular Diastolic Dysfunction among Patients Attending a Tertiary Health Facility in India

Background: There is an increasing recognition that congestive heart failure (CHF), caused by diastolic dysfunction (DD) (diastolic heart failure), is common and causes significant morbidity and mortality. Methods: The institution-based cross-sectional study was conducted among 119 subjects to determine the epidemiological profile, and regression analysis was used to evaluate the association of clinico-social correlates with the likelihood of developing DD. Result: The mean age of subjects was 51.6(±17.7) years. The mean systolic (SBP) and diastolic blood pressures (DBP) were 130(±18.9) mm Hg and 82.1(±11.1) mm Hg, respectively. Thirty-three (27.7%) subjects were hypertensive. Twelve (10%) were diabetic and experienced heart failure. DD was present in 54 (45.4%) subjects. Age, diabetes, ejection fraction (EF), and interventricular septal thickness in diastole (IVSd) were significant (P &lt; 0.05) correlates of DD. Mean values of age, body mass index (BMI), EF, IVSd, and left ventricular posterior wall thickness in diastole (LVPWD) were higher in subjects with DD. Hypertension contributed to 1.63 times greater odds of developing DD. Conclusion: The prevalence of DD increased with age among hypertensive and diabetic participants. Preventive strategies directed toward identifying subclinical signs of early stage and aggressive blood pressure and blood sugar control are likely to offer the greatest promise for reducing the incidence of DD.

Predictive factors and gender insights into abnormal myocardial flow reserve in non-obstructive coronary artery disease: a CZT-SPECT analysis

Abstract Background Dynamic myocardial perfusion imaging (D-MPI) using cadmium-zinc-telluride (CZT) cardiac-dedicated SPECT has emerged as a valuable method for assessing coronary microcirculation, particularly compared to conventional SPECT. Additionally, gender-specific disparities in microvascular dysfunction require further investigation. Objective This study aims to identify predictive factors for abnormal myocardial flow reserve (MFR) in non-obstructive coronary artery disease (CAD) using CZT-SPECT, with a focus on gender differences in MFR dysfunction. Methods A retrospective analysis was conducted on clinical data from 393 patients presenting with symptoms of "chest pain and/or tightness," all of whom were confirmed to lack obstructive CAD by coronary angiography or CT angiography. MFR was measured using CZT-SPECT, with values ≥2.5 considered normal and values &amp;lt;2.5 considered abnormal. Results Of the patients, 49.1% (193/393) demonstrated abnormal MFR, with females representing 56.7% (223/393). Females with abnormal MFR exhibited higher averages in age, total cholesterol, LDL-C, creatinine, left atrial diameter, left ventricular posterior wall (LVPW) thickness in diastole, and E/e’ ratio (P &amp;lt; 0.05). Additionally, MDRD-eGFR and mitral annular septal velocity e’ were lower in the abnormal MFR cohort (P &amp;lt; 0.05). Multivariate logistic regression analysis identified elevated LDL-C levels (OR = 1.513, 95%CI: 1.122–2.041, P = 0.007) and increased LVPW thickness (OR = 1.717, 95%CI: 1.140–2.585, P = 0.010) as independent predictors of abnormal MFR in females. ROC analysis suggested optimal cutoff for LDL-C at 3.68 mmol/L (sensitivity 31%, specificity 84%, AUC = 0.586; 95%CI: 0.511–0.661) and LVPW thickness at 9.5 mm (sensitivity 62%, specificity 52%, AUC = 0.576; 95%CI: 0.501–0.652). A combined ROC analysis of LDL-C and LVPW thickness showed a sensitivity of 50% and specificity of 73% (AUC = 0.632, 95%CI: 0.559–0.705). In males, greater left ventricular end-diastolic diameter (LVEDD) was significantly associated with abnormal MFR (P = 0.014), with LVEDD identified as a predictor (OR = 1.130, 95%CI: 1.016–1.258, P = 0.025) and an optimal cutoff at 44.5 mm (sensitivity 88%, specificity 37%, AUC = 0.609; 95%CI: 0.524–0.694). No significant gender differences were observed in overall left ventricular resting myocardial blood flow (MBF) among patients with abnormal MFR (P = 0.072); however, female patients exhibited higher resting MBF in specific territories supplied by the left circumflex and right coronary arteries, and higher E/e’ ratios (P &amp;lt; 0.05). Furthermore, a negative correlation was found between resting MBF in the territory supplied by the right coronary artery and E/e’ in females (r = -0.210, P = 0.030). Conclusion Predictors of abnormal MFR in non-obstructive CAD show gender disparities, implicating an association with left ventricular diastolic function.

Echocardiographic Quantitation of Left Ventricular Size and Function in Indian Mongrel Dogs

Background: No published data on two-dimensional echocardiographic quantitation of left ventricular size and function in Indian mongrel dogs is reported till date. Methods: Reference intervals for linear and area measurements of left ventricle size and function was generated in fifty healthy mongrel dogs (25 males, 25 females; mean age=1.59±0.13 yr; mean body weight=16.66±0.73 kg) using two-dimensional echocardiography. Dogs deemed healthy after thorough clinico-physiological, hematological, radiographic, electrocardiographic and echocardiographic evaluation were included in study.Relationship between two-dimensional linear and area measurements of left ventricle and body weight and, between same measurements obtained from different tomographic planes was studied using linear regression analysis. Result: Linear left ventricular measurements, left ventricular internal and external area, mitral valve orifice area showed significant (P less than 0.001) positive correlation with body weight while fractional shortening and ejection fraction showed significant (P less than 0.001) weak negative correlation with body weight. Left ventricular internal length in diastole, interventricular septum thickness and left ventricular internal dimension in systole and left ventricular free wall thickness in diastole were significantly (P less than 0.01) higher in male dogs while mitral valve orifice area was significantly (P less than 0.01) higher in female dogs. All linear measurements of left ventricular size obtained from different tomographic planes displayed significant (P less than 0.001) correlation with each other.

Association between physical activity and cardiovascular parameters in 7-year-old children: a Chinese cross-sectional study

IntroductionPhysical activity (PA) is believed to play an important part in many aspects during childhood and adolescence, especially cardiorespiratory fitness and cardiometabolic health. However, whether different levels of PA in daily life influence the structure or function of heart in school-aged children remains unknown. We aimed to investigate the association between PA and cardiovascular parameters in 7-year-old children.MethodsFollow-up data from the Shanghai Prenatal Cohort Study and the Shanghai Birth Cohort was analyzed. Perinatal information including both maternal and offspring datum was recorded. A refined questionnaire was used to evaluate the frequency and duration of children’s PA levels. Blood pressure, echocardiography, and anthropometry assessment were conducted during the follow-up of 7-year-old children.ResultsOverall, high PA level was associated with higher left ventricle posterior wall thickness in diastole (LVPWd, β coefficient: 0.36, 95% CI: 0.12, 0.61), higher left ventricle mass index (LVMI, β = 0.28, 95% CI: 0.07, 0.48), mitral E/a ratio (β = 0.47, 95% CI: 0.22, 0.71) and slower heart rate (β = -0.32, 95% CI: -0.57, -0.07), compared to low PA level. Medium PA level was associated with lower diastolic blood pressure (DBP, β = -0.18, 95% CI: -0.35, -0.01). In subgroup analysis, increased relative wall thickness (RWT) was found in high PA level boys (β = 0.36, 95% CI: 0.05, 0.67), and systolic blood pressure (SBP) showed a significant decrease in high PA level girls (β = -0.42, 95% CI: -0.78, -0.06).ConclusionsThis study suggested non-athlete children having higher PA level were associated with thicker left ventricle (LV) walls and better LV diastolic function, as well as slower heart rate and DBP at the age of 7. Furthermore, disparity in the association between PA level with morphological heart patterns and blood pressure existed in different sex category.

Fatty liver as a risk factor for cardiovascular diseases: retrospective analysis of data from patients of the Geriatrics Clinic of University Clinical Hospital in Wrocław

Non-alcoholic fatty liver disease (NAFLD) is currently the most common liver disorder affecting about 25% of the global population. The causes of its development include poor diet, low physical activity, overweight, obesity, older age, diabetes, and lipid disorders. Non-alcoholic fatty liver disease is identified by some researchers as a hepatic manifestation of metabolic syndrome. It has been observed that patients with NAFLD have an increased risk of cardiovascular events, as well as a higher number of deaths from myocardial infarction compared to the general population. A retrospective analysis was conducted on the data of 237 patients diagnosed with hepatic steatosis, treated in the Department of Geriatrics at the University Clinical Hospital in Wrocław from 2019 to 2022, focusing on coexisting overweight, obesity, and concomitant diseases. Laboratory results and the degree of left ventricular muscle hypertrophy were analyzed. Parameters assessed by echocardiography, including interventricular septal thickness in diastole (IVSd), left ventricular posterior wall thickness in diastole (LVPWd), and IVSd + LVPWd/2, were used to evaluate left ventricular hypertrophy. Data from 237 patients were analyzed: 79 men (age: 77.2±7.1 years) and 158 women (age: 78.4±7.7 years). Body mass index (BMI) values for men and women were 30.5±5.0 kg/m² and 31.9±5.6 kg/m², respectively. There was a positive correlation between BMI and the degree of left ventricular hypertrophy for the parameters IVSd (ρ = 0.36, p < 0.001), LVPWd (ρ = 0.36, p < 0.001), and IVSd + LVPWd/2 (ρ = 0.38, p < 0.001). The study demonstrated a moderate positive correlation between BMI and the degree of left ventricular hypertrophy in patients diagnosed with hepatic steatosis. These findings indicate the necessity of actively searching for cardiovascular risk factors, including the evaluation of echocardiographic parameters in patients with NAFLD. Med Pr Work Health Saf. 2024;75(3):223-231.

Association between the atherogenic index of plasma and left ventricular hypertrophy in patients with obstructive sleep apnea: a retrospective cross-sectional study

BackgroundThe atherogenic index of plasma (AIP) is a simple and reliable marker of insulin resistance and is closely associated with various cardiovascular diseases (CVDs). However, the relationships between AIP and left ventricular (LV) geometric indicators have not been adequately assessed. This study was carried out to investigate the association between AIP and LV geometric abnormalities in obstructive sleep apnea (OSA) patients.MethodsThis retrospective cross-sectional study included a total of 618 OSA patients (57.3 ± 12.4 years, 73.1% males, BMI 28.1 ± 4.2 kg/m2) who underwent echocardiography. Patients with OSA were diagnosed with clinical symptoms and an apnea-hypopnea index ≥ 5.0. LV hypertrophy (LVH) was defined as left ventricular mass index (LVMIh2.7) ≥ 50.0 g/m2.7 for men and 47.0 g/m2.7 for women. AIP was calculated as log10 (TG/HDL-C).ResultsCompared with the non-LVH group, AIP was significantly higher in the LVH group (0.19 ± 0.29 vs 0.24 ± 0.28, P = 0.024) and the concentric LVH group (0.18 ± 0.29, 0.19 ± 0.30, 0.20 ± 0.26 and 0.29 ± 0.29 in the control, concentric remodeling, eccentric hypertrophy and concentric hypertrophy groups, respectively, P = 0.021). Meanwhile, in the group of patients with the highest AIP tertile, the levels of LVMIh2.7 (42.8 ± 10.5, 43.2 ± 9.3 and 46.1 ± 12.1 in the T1, T2 and T3 groups, respectively, P = 0.003), and the prevalence of LVH (25.2%, 24.0% and 34.6% in the T1, T2 and T3 groups, respectively, P = 0.032) and concentric LVH (10.7%, 9.8% and 20.2% in the T1, T2 and T3 groups, respectively, P = 0.053) were higher compared with those in the other groups. Positive correlations between AIP and LV geometric indicators including the LVMIh2.7, LVMIBSA, LV mass (LVM), diastolic left ventricular inner diameter (LVIDd), diastolic left ventricular posterior wall thickness (PWTd) and diastolic interventricular septal thickness (IVSTd), were revealed according to correlation analysis (P < 0.05). Furthermore, AIP was independently associated with LVMIh2.7 according to multivariate linear regression model (β = 0.125, P = 0.001). Notably, AIP remained independently associated with an elevated risk of LVH [odds ratio (OR) = 1.317 per 1 standard deviation (SD) increment, 95% confidence interval (CI): 1.058 - 1.639, P = 0.014) and concentric LVH (OR = 1.545 per 1 SD increment, 95% CI: 1.173 - 2.035, P = 0.002) after fully adjusting for all confounding risk factors by multivariate logistic regression analyses.ConclusionsAIP was independently associated with an increased risk of LVH and concentric LVH in OSA patients. Therefore, AIP, as a practical and cost-effective test, might be useful in monitoring hypertrophic remodeling of the heart and improving CVDs risk stratification in clinical management of OSA.

Risk factors and major adverse cardiovascular events of isolated coronary artery ectasia: An observational study.

To evaluate the cardiac index and major adverse cardiovascular events (MACE) events between isolated coronary artery ectasia (CAE) and control groups over 1 year period from diagnosis. A total of 18 patients who were diagnosed with isolated CAE in the Second Hospital of Hebei Medical University from December 2020 to December 2021 were included in CAE group. About 36 patients with non-obstructive coronary artery lesions were included in the control group. All patients in 2 groups completed dobutamine stress echocardiography (DSE) during hospitalization. The chamber size, wall thickness, left ventricular ejection fraction, and left ventricular diastolic function indicators (including E/A ratio, e', and E/e' ratio) were measured. MACE and all-cause death were measured during follow-up after discharge. Interventricular septum thickness (IVSd), left ventricular posterior wall (LVPW) thickness in diastole and E/e' in CAE group were significantly higher than control group (P < .05). No significant differences were found in prognosis including angina, myocardial ischemia (MI), patient readmission and cardiovascular death (P > .05). In CAE group, coronary angiography showed dilation of left anterior descending (LAD) in 1 case, left circumflex (LCX) in 3 cases and right coronary artery (RCA) in 14 cases. Multivariate logistic regression analysis showed that BMI and IVSd were independent risk factors for CAE. IVSd, LVPW thickness in diastole and E/e' in CAE group were significantly higher than control group. BMI and IVSd were independent risk factors for isolated CAE, and had a good predictive value for isolated CAE.

Evaluation of Left Ventricular Function in Patients With Severe Aortic Stenosis Utilizing Automated Cardiac Motion Quantitation Techniques

ObjectiveThe objective of this study is to explore the patterns of alteration in left ventricular systolic function among patients with severe aortic stenosis (SAS) through the application of automatic myocardial motion quantification (aCMQ) techniques. Furthermore, we seek to ascertain dependable quantitative markers for the assessment of impaired left ventricular function in patients with SAS and an ejection fraction (EF) ≥ 60%. MethodsSeventy patients who underwent echocardiography and received a diagnosis of severe aortic stenosis (SAS) in the hospital from November 2021 to August 2022 were selected for the SAS group and categorized into three subgroups based on ejection fraction (EF)—SAS group with EF ≥ 60%, SAS group with EF ranging from 50% to 59%, and SAS group with EF < 50%. Concurrently, 30 healthy individuals were recruited at the hospital during the same timeframe to serve as the control group. Participants from both groups underwent standard transthoracic echocardiography to assess conventional echocardiographic parameters. Dynamic images were examined using automatic myocardial motion quantification (aCMQ) software to derive longitudinal peak strain (LPS) parameters, which were then subjected to statistical analysis. ResultsIn comparison to the control group participants, the measurements of ascending aorta diameter (AoD), left atrium diameter (LAD), interventricular septal end diastolic thickness (IVSd), left ventricular posterior wall end diastolic thickness (LVPWd), peak systolic velocity (Vmax), and mean pressure gradient (MPG) were significantly higher in the SAS groups (p < 0.05). When compared to participants in the SAS group with an EF ≥ 60%, the values of IVSd, LVPWd, Vmax, and MPG in the SAS group with EF ranging from 50% to 59% were significantly elevated (p < 0.05). Similarly, left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e'), and the ratio of early to late diastolic mitral inflow velocities (E/A) in the SAS group with EF < 50% were significantly elevated (p < 0.05). The absolute values of longitudinal peak strain (LPS) in the SAS groups were significantly lower in comparison to those in the control group (p < 0.05). Furthermore, all measurements of left ventricular global longitudinal systolic peak strain (GLPS) showed a positive correlation with MPG, a moderate negative correlation with aortic valve area index (AVAI), and a moderate positive correlation with E/A. ConclusionsPatients with SAS and an EF < 50% exhibited the most profound impairment in left ventricular myocardial function. Utilizing the aCMQ technique enables the precise and quantitative evaluation of the severity of impaired left ventricular systolic function in patients within the SAS group with an EF ≥ 60%.

Effect of Maximal Exercise on the Heart Rate, Blood Pressure and Level of Cardiac Remolding in Elite Athletes

Aim / Objective: The purpose of this study was to determine how intense exercise effect the blood pressure, heart rate and the extent upto, which the cardiac remolding may occur in elite athletes. Location of Study: This study was conducted in the Department of Physiology, Army Medical College, along with the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Methodology: There were 40 control participants and 40 elite endurance athletes. Clinical tests were performed on all the subjects to rule out an underlying medical condition or disease. Auscultatory method was used to measure the heart rate before exercise and immediately after exercise, Similarly the blood pressure was examined before and within 3 minutes after the physical activity. The left ventricular end-diastolic internal diameter (LVIDd), diastolic posterior wall thickness (PWTd), diastolic interventricular septal thickness (IVSTd), and left ventricular mass (LVM) were measured by echocardiography and determined using the Devereux formula. Before breakfast, the participants engaged in maximum physical activity on an electronic ergometer cycle until they were exhausted. Results: It was observed that when compared to the control group, the heart rates and blood pressure of athletes were noticeably lower. In contrast, LVIDd, IVSTd, PWTd, and LVM were higher in athletes than in healthy controls... Conclusion: The long term athletic training causes remodeling of the heart with increased dimensions of the left ventricle which reduces the heart rate and blood pressure in endurance trained athletes.

Prefrontal-medullary Circuitry Impacts Sex-specific Microvascular Function Following Chronic Stress

Vascular dysfunction is a prominent factor underlying cardiovascular disease, the leading cause of death worldwide. Additionally, chronic stress contributes to cardiovascular pathologies in a sex-dependent manner. However, the neurobiological mechanisms mediating the sex-specific impact of chronic stress on vascular function are not known. Our previous studies found that the prefrontal infralimbic cortex (IL)-rostral ventrolateral medulla (RVLM) circuit inhibits sympathetic and endocrine responses to stress; therefore, the current study tested the hypothesis that the IL-RVLM circuit is necessary to mitigate microvascular dysfunction following chronic stress. To this end, an intersectional genetic approach was used to induce Cre-dependent expression of tetanus toxin light chain and inhibit neurotransmitter release from RVLM-projecting IL neurons in male and female rats. Rats were then exposed to 2 weeks of chronic variable stress (CVS) or remained unstressed. Left ventricle structure was assessed by echocardiography and microvascular function was subsequently assessed by resistance arteriole pressure myography. Arteriole myogenic tone, endothelial-independent vasoconstriction, as well as endothelial-dependent vasodilation and vasoconstriction were determined at both normotensive (70 mmHg) and hypertensive (120 mmHg) pressures. Our results indicate that heart size and ventricular thickness were impacted in a sex-dependent manner. Circuit inhibition increased heart index in females regardless of stress. In males, circuit inhibition reduced ventricular wall thickness in diastole. Microvasculature also exhibited sex-dependent function. Following CVS, males had increased myogenic tone compared to females. Circuit inhibition also differentially impacted vasodilation in males and females. In chronically stressed females, circuit inhibition increased endothelial-dependent vasodilation at both normotensive and hypertensive pressures and normotensive endothelial-independent relaxation. These changes indicate that chronic stress leads to female microvascular dysfunction that is exacerbated by IL-RVLM inhibition. Chronically stressed males had no changes in normotensive vasodilation. However, with elevated pressure, circuit-inhibited CVS males had increased endothelial-dependent vasodilation. In contrast, unstressed males with circuit inhibition had decreased endothelial-dependent vasodilation at 120 mmHg, indicating that the male IL-RVLM circuit may be necessary for vascular function during acute hypertensive events. Broadly, these results support the hypothesis that the IL-RVLM circuit is necessary for appropriate vascular function and that circuit inhibition and chronic stress lead to sex-specific responses that may differentially impact the progression of cardiovascular disease. NIH R01 HL150559 (B.Myers) NIH F30 OD032120 (C. Dearing). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Evaluation of cardiac function in paediatric Wilson's disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography).

In Wilson's disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography). Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children's Hospital were included in the study between 2022 and 2023. The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e', mitral septal e' and tricuspid lateral e' velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002). Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.

Association between left ventricular remodeling and lipid profiles in obese children: an observational study.

Childhood obesity has become a prominent issue in the society, which can lead to left ventricular remodeling and severe cardiovascular complications in adulthood. It is beneficial to identify the causes of left ventricular remodeling so that targeted measures can be taken to prevent the cardiovascular disease. Therefore, this study aimed to explore the relationship between left ventricular remodeling and changes in blood lipid indexes in obese children. This study was conducted on 40 healthy non-obese children and 140 obese children diagnosed in the pediatric health department of our hospital. Clinical data collected from the two groups were compared. Echocardiography was performed to examine left ventricular configuration and cardiac function. Multiple linear regression analysis was conducted to assess the independent effects of blood lipid levels on echocardiographic parameters. Blood lipid indicators among different left ventricular structural patterns which were classified according to left ventricular mass indexes and relative wall thickness were compared. Obese children exhibited significantly increased height, weight, body mass index (BMI), body fat percentage (BFP), blood pressure, triglycerides, total cholesterol, left ventricular internal diameter (LVIDd), interventricular septum (IVSd), left ventricular posterior wall diastolic thickness (LVPWd), myocardial mass (LVM) and relative wall thickness (RWT), as well as lower high-density lipoprotein cholesterol (HDL-C) and left ventricular ejection fraction (LVEF) compared to the non-obese children (P < 0.05). Multiple linear correlation analysis showed LVM had a significantly positive correlation with BMI (r = 3.21, P = 0.002) and SBP (r = 2.61, P = 0.01); LVMI had a significantly negative correlation with HDL-C (r = -2.45, P = 0.015); RWT had a significantly positive correlation with SBP (r = 2.50, P = 0.013) but a significantly negative correlation with HDL-C (r = -2.35, P = 0.02). Furthermore, there were significant differences in HDL-C values among children with different ventricular configurations (P < 0.05), with the lowest HDL-C value recorded in the concentric hypertrophy group. Obese children will develop left ventricular remodeling. The left ventricular configuration indexes are most significantly associated with serum HDL-C. Lower HDL-C level contributes to severer left ventricular hypertrophy, indicating a concentric hypertrophy pattern.

Accuracy of Pediatric Interventricular Septal Thickness Measurement Obtained Via Point-of-Care Ultrasound: A Prospective Study.

Hypertrophic cardiomyopathy is a genetic, life-threatening cardiovascular disease that often goes unidentified in pediatric patients. Patients are often asymptomatic and neither history or physical examination are reliable to detect the disease. The only reliable method to diagnose hypertrophic cardiomyopathy is with echocardiography to look at interventricular septal thickness. Emerging literature has shown that cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians is as effective and accurate compared with cardiac echocardiography performed by pediatric cardiologists. The objective of the study was to determine the diagnostic accuracy of POCUS performed by ultrasound-trained PEM physicians in measuring the interventricular septum end diastole (IVSd) thickness in the pediatric emergency department. We conducted a prospective, single-center, observational, diagnostic accuracy study to examine the diagnostic accuracy of POCUS in measuring IVSd thickness in pediatric patients who presented to the pediatric emergency department with symptoms that prompted a cardiac POCUS. Cardiac POCUS findings were interpreted by a PEM physician at the bedside and retrospectively by a pediatric cardiologist. Diagnostic concordance of the measurements obtained by the PEM physician and cardiologist was assessed. Forty-eight patients were enrolled. Median patient age was 13.4 years. There was excellent diagnostic agreement on the measurement of the IVSd thickness between PEM physicians and the pediatric cardiologist (81.25% of cases; 39/48). Disagreement was seen in 18.75% of the cases (9/48). The mean error of disagreement was -0.32, with a 95% confidence interval of -0.37 to -0.28. Overall, the mean error of both agreement and disagreement was -0.046, with 95% confidence interval of -0.08 to -0.01 and P value of 0.008. Point-of-care ultrasound performed by ultrasound-trained PEM physicians to measure pediatric IVSd thickness has a high diagnostic accuracy with excellent agreement with a pediatric cardiologist.

Artemisinin Attenuates Isoproterenol-induced Cardiac Hypertrophy via the ERK1/2 and p38 MAPK Signaling Pathways.

Artemisinin (ART) is mainly derived from Artemisia annua, a traditional Chinese medicinal plant, and has been found to affect cellular biochemical processes, such as proliferation, angiogenesis, and apoptosis, in addition to its antimalarial properties. However, its effect on cardiac hypertrophy and the underlying mechanisms remain unclear. This study aimed to investigate the effect of ART on cardiac hypertrophy and explore its possible mechanisms. A rat model was established by intraperitoneal injection of isoproterenol (ISO) for 3 days, and the degree of myocardial hypertrophy was compared among 5 groups: a control (CON) group, an ISO group, and groups treated with different doses of ART (7 mg/kg/d, 35 mg/kg/d, and 75 mg/kg/d). Echocardiography was used to evaluate cardiac function and structure. The cross-sectional area of cardiomyocytes was measured by hematoxylin and eosin (H&E) staining. The heart weight (HW), body weight (BW), and tail length were measured, and the HW/tail length ratio and the HW/BW ratio were calculated. H9c2 rat cardiomyocytes were cultured, and different amounts of ART were added 2 hours before ISO stimulation. Phalloidin staining was used to evaluate the degree of cell hypertrophy. The levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were quantified in rat plasma and cell supernatant using enzyme-linked immunosorbent assay (ELISA), while the expression levels of p- ERK1/2, p-JNK, and p-p38 MAPK were assessed in the myocardium and H9c2 cells via western blot analysis. Intragastric administration of ART at a dosage of 35 mg/kg/d or over mitigated the early-stage cardiac hypertrophy induced by ISO in rats led to a reduction in left ventricular posterior wall diastolic thickness, interventricular septal thickness at diastole, lowered ANP and BNP levels, as well as a decrease in HW/tail length and HW/BW ratio. In vitro studies demonstrated that ART at a concentration of 100 μM inhibited ISO-mediated hypertrophy of H9c2 cells. The ISO group showed a higher p-ERK/GAPDH ratio and p-p38 MAPK/GAPDH ratio than the control group both in vivo and in vitro. Although the p-JNK/GAPDH ratio was increased in the ISO group, there was no statistical difference. The p-ERK/GAPDH and p-p38/GAPDH ratios were significantly lower in the ART group than in the ISO group. The mechanism of ART against cardiac hypertrophy was related to inhibition of the ERK1/2 and p38 MAPK signaling pathways.

Echocardiographic Evaluation of Infants Born to Mothers with Gestational Diabetes Mellitus: A Cross-sectional Analytical Study

Introduction: Gestational Diabetes Mellitus (GDM) is a chronic and progressive disease characterised by changes in the metabolism of carbohydrates, lipids, and proteins, leading to glucose intolerance. The foetal heart in GDM is affected throughout the gestational period, which may result in hyperplasia and hypertrophy of myocardial cells. Aim: To determine the cardiac function and structural changes in infants of gestational diabetic mothers using Dopplerechocardiographic data. Materials and Methods: A cross-sectional analytical study was conducted on 30 infants of mothers with GDM and 30 infants of non diabetic mothers at the Department of Physiology, R.G. Kar Medical College and Hospital, in collaboration with the Departments of Paediatric Medicine and Cardiology from January 2023 to August 2023. Neonatal screening echocardiography was performed by a cardiologist using a Philips Echocardiograph machine, Model: EPIQ 7C, Software Version: 4.0.2, with a linear convex probe of S8-3 MHz frequency to assess cardiac structure and function using 2D, M mode, and Conventional Doppler. The parameters studied included aortic root diameter (mm), left atrial diameter (mm), Interventricular Septal (IVS) in diastole (mm), left ventricular posterior wall thickness in diastole (mm), left ventricular internal diameter in diastole (mm), left ventricular internal diameter in end systole (mm), left ventricular fractional shortening (%), and left ventricular ejection fraction (%). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version-20.0 with an Independent Student’s t-test. Results: The mean gestational age for the cases was 38.50±2.57 weeks and 39.30±1.97 weeks for controls. The mean maternal age for cases was 25±4.37 years and for controls was 27±5.03 years. The left atrial diameter in cases (12.83±2.14 mm) was significantly smaller than that of the control (14.20±0.55 mm). The left ventricular posterior wall diameter in diastole was significantly increased in cases (4.53±0.50 mm) compared to controls (3.87±0.35 mm). Significant differences were observed in the interventricular septum in diastole {cases: 4.73±0.45 mm, control: 3.97±0.32 mm} and in the left ventricular internal diameter in end systole {cases: 12.30±1.84 mm, control: 13.83±1.02 mm} between cases and controls. Aortic root diameter was increased in 13.3% of cases. The percentage of left ventricular fractional shortening (cases: 35.47±3.74 %, Control: 38.53±2.43 %), Left Ventricular Ejection fraction (cases: 67.63±4.52 %, control: 72.17±4.89 %) were significantly decreased in cases compared to control. Conclusion: The present study demonstrated the development of ventricular hypertrophy and compromised myocardial contractility in infants of diabetic mothers.

Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions

BackgroundRenovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin–angiotensin–aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention.MethodsAll patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention.ResultsOne hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z-scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal (z-score reduction 0.25, p < 0.001) and severely abnormal (z-score reduction 0.23, p < 0.001) z-scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy.ConclusionsOur study reports improvement in cardiac outcomes after endovascular + / − surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information.Supplementary information

Prevalence of papillary muscle hypertrophy in fabry disease

Background and aimsFabry disease (FD) is an X-linked genetic lysosomal disease, in which a deficit in the alpha-galactosidase A enzyme results in lysosomal build-up of globotriaosylceramide in several organs, causing cardiac, renal and cerebrovascular complications. The aim of this study was to assess the prevalence of papillary muscle hypertrophy (PMH) in patients with FD.MethodsA group of 63 patients with FD and a positive genetic diagnosis were studied and were divided into two groups: one included 24 patients with FD and LVH and another group included 39 patients with FD and without LVH. Papillary muscles were measured from the left parasternal short axis view, defining PMH as a diastolic thickness greater than 11 mm in any diameter.ResultsPatients with FD and LVH had a high prevalence of anterolateral PMH (66.6%), and such prevalence was lower for the posteromedial PMH (33.3%). However, patients who had not yet developed LVH had a high prevalence of anterolateral PMH (33.3%).ConclusionsPatients with FD in the pre-clinical stage (without LVH) have a high prevalence of PMH, especially involving the anterolateral papillary muscle. This finding could be an early marker for the development of LVH, allowing to suspect the disease during its early stages, and begin enzyme replacement therapy in the appropriate patients.