Velocity Vector Imaging Research Articles

Effects of different ultrasound power application on left ventricular myocardium 2-dimension strain in in vivo open-chest beagle canines

Objective To evaluate the left ventricular (LV) myocardial mechanical changes with contrast agent and different power irradiation in open-chest beagle canines. Methods The anesthetized open-chest beagle canines were assigned into two groups randomly: group A (n=6) for baseline, diagnostic ultrasound power irradiation (300 mW) 5 min, combined with contrast agent irradiation 5 min and contrast agent 20 min conditions; group B (n=6) for baseline and intensity ultrasound irradiation (1 W, 2 W and 3 W, 5 min respectively) conditions. The peak circumferential strain (CS), longitudinal strain (LS) and radial strain (RS) of LV myocardial wall were measured and analyzed using a dedicated Syngo velocity vector imaging (VVI) method. Results In group A, the peak CS and LS were increased significantly on diagnostic power irradiation, contrast agent irradiation 5 min and contrast agent 20 min (all P 0.05). In group B, the peak CS and LS were higher on power 1 W than on baseline condition (P 0.05); the peak CS, LS, RS were lower on power 2 W than on baseline condition (P>0.05); the peak of CS, LS were lower on power 3 W than on baseline condition (P 0.05). Conclusions These findings indicate potential positive inotropic effects with diagnostic ultrasound power irradiation 5 min, combined with contrast agent irradiation 5 min, contrast agent 20 min conditions, power 1 W and negative inotropic effects with power 3 W on LV myocardial CS, LS deformation. LV myofiber deformation reactions appear no significant differences on LV myocardial RS deformation in same disturbed setting. Key words: Sonication; Microbubbles; Ventricular function, left; Strain

Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction.

BackgroundIn obstructive hypertrophic cardiomyopathy patients with preserved left ventricular (LV) ejection fraction, we sought to determine whether LV global longitudinal strain (LV‐GLS) provided incremental prognostic utility.Methods and ResultsWe studied 1019 patients with documented hypertrophic cardiomyopathy (mean age, 50±12 years; 63% men) evaluated at our center between 2001 and 2011. We excluded age <18 years, maximal LV outflow tract gradient <30 mm Hg, bundle branch block or atrial fibrillation, past pacemaker/cardiac surgery, including myectomy/alcohol ablation, and obstructive coronary artery disease. Average resting LV‐GLS was measured offline on 2‐, 3‐, 4‐chamber views using Velocity Vector Imaging (Siemens, Malvern, PA). Outcome was a composite of cardiac death and appropriate internal defibrillator (implantable cardioverter defibrillator) discharge. Maximal LV thickness, LV ejection fraction, indexed left atrial dimension, rest and maximal LV outflow tract gradient, and LV‐GLS were 2.0±0.2 cm, 62±4%, 2.2±4 cm/m2, 52±42 mm Hg, 103±36 mm Hg, and −13.6±4%. During 9.4±3 years of follow‐up, 668 (66%), 166 (16%), and 122 (20%), respectively, had myectomy, atrial fibrillation, and implantable cardioverter defibrillator implantation, whereas 69 (7%) had composite events (62 cardiac deaths). Multivariable competing risk regression analysis revealed that higher age (subhazard ratio, 1.04 [1.02–1.07]), AF during follow‐up (subhazard ratio, 1.39 [1.11–1.69]), and worsening LV‐GLS (subhazard ratio, 1.11 [1.05–1.22]) were associated with worse outcomes, whereas myectomy (subhazard ratio, 0.44 [0.25–0.72]) was associated with improved outcomes (all P<0.01). Sixty‐one percent of events occurred in patients with LV‐GLS worse than median (−13.7%).ConclusionsIn obstructive hypertrophic cardiomyopathy patients with preserved LV ejection fraction, abnormal LV‐GLS was independently associated with higher events, whereas myectomy was associated with improved outcomes.

GW28-e0412 Evaluation of ventricular function in fetus with Ebstein’s anomaly by velocity vector imaging

GW28-e0412 Evaluation of ventricular function in fetus with Ebstein’s anomaly by velocity vector imaging

Combined 2-D Vector Velocity Imaging and Tracking Doppler for Improved Vascular Blood Velocity Quantification.

Measurement of the maximum blood flow velocity is the primary means for determining the degree of carotid stenosis using ultrasound. The current standard for estimating the maximum velocity is pulsed-wave Doppler with manual angle correction, which is prone to error and interobserver variability. In addition, spectral broadening in the velocity spectra leads to overestimation of maximal velocities. In this paper, we propose to combine two velocity estimation methods to reduce the bias and variability in maximum velocity measurements. First, the direction of the blood flow is estimated using an aliasing-resistant least squares vector Doppler technique. Then, tracking Doppler is performed on the same data, using the direction of the vector Doppler estimate as the tracking direction. Simulations show that the method can estimate a maximum velocity of 2 m/s with accuracy 5% for beam-to-flow angles between 20° and 75°, and that the primary source of error is inaccuracy in the flow direction estimate from vector Doppler. Simulations of complex flow in a carotid bifurcation demonstrated that the combined technique provided spectral velocity profiles corresponding well with the true maximum velocity trace, and that the bias originating from the directional estimate was within 5% for all spatial points. A healthy volunteer and a volunteer with carotid artery stenosis were imaged, showing in vivo feasibility of the method, for high velocities and with beam-to-flow angles varying throughout the cardiac cycle.

Left ventricular torsional parameters before and after atrial fibrillation ablation: a velocity vector imaging study

Background and aimEffects of atrial fibrillation (AF) and its ablative treatment on LV torsion have not yet been fully investigated. This study aimed to examine whether AF patterns of LV contraction and its ablative correction can exert a significant impact on LV torsion by velocity vector imaging (VVI).MethodsThis case-control study conducted in Rajaie Cardiovascular, Medical and Research Center between October 2012 and June 2013. Study participants were 30 consecutive patients with symptomatic paroxysmal AF who met the inclusion criteria. The control group included 24 healthy participants with no history of cardiovascular disease. All individuals were in sinus rhythm at the time of echocardiography before and after the ablation procedure. Two-dimensional (2D) and Doppler echocardiography on a commercially available ultrasound system was performed for all the patients. Scanning was done by a wide-band ultrasound transducer with the frequency range between 2.5–3.5 MHz. The two short-axis views at basal and apical levels were subsequently processed off-line by VVI XStrain software. In order for data analysis, SPSS 16 utilized using paired and independent t-test. p-value ≤0.05 was considered significant.ResultsLV torsion (°/cm) mean ± SD was significantly lower in paroxysmal AF patients before ablation (0.8±0.3) than the control group (1.5±0.4) (p<0.001) and increased significantly after ablation (1.1±0.5) compared with before ablation (p=0.004), but still significantly lower than the control group (p=0.003). LV Twist, twist rate and untwist rate mean ± SD were significantly lower in paroxysmal AF patients before ablation than the control group and increased significantly after ablation compared with before ablation, but still significantly lower than the control group.ConclusionSubclinical LV dysfunction may be detected in paroxysmal AF rhythm by measuring torsional parameters through VVI which improves after AF ablation.

Worsening in Longitudinal Strain and Strain Rate Anticipates Development of Pediatric Transplant Coronary Artery Vasculopathy as Soon as OneYear Following Transplant.

Transplant coronary artery vasculopathy (TCAV) following orthotopic heart transplantation (OHT) continues to be the primary reason for late graft failure in children. The current gold standard of diagnosis of TCAV is coronary angiography with or without intravascular ultrasound. This study investigates the longitudinal use of speckle-tracking echocardiographic strain imaging as an early non-invasive marker to screen for development of TCAV. Echocardiograms from patients who underwent OHT between 2006 and 2010 at Children's Hospital Colorado (n=50) were retrospectively assessed. Studies were evaluated at baseline (within a month of transplant), then at each annual clinical follow-up for peak longitudinal (LS) and circumferential (CS) strain, systolic strain rate, and diastolic strain rate using Siemens Velocity Vector Imaging software. Comparisons were made between subjects who did and did not develop TCAV. Mean time to TCAV diagnosis following OHT was 3.2years (range 1-5.1years). One year after transplant, significant differences were seen between groups in LS (non-TCAV mean -19.6%, TCAV mean -17.3%, p=0.03) and longitudinal strain rate (non-TCAV mean -1.7%/s, TCAV mean -1.4%/s, p=0.04). These differences persisted in subsequent years. Differences in LS preceded the catheterization-based diagnosis of TCAV in pediatric heart recipients and were noted as early as one year post transplant. Additionally, within-subject LS changes may have utility as a non-invasive screening tool to predict those patients at increased risk for development of TCAV.

Abstract P521: Relationship Between Carotid Arterial Elastic Properties and Central Aortic Hemodynamics in Patients with Stroke

Objective: Patients with ischemic stroke have more thickened, dilated and stiffer aorta and carotid arteries than patients without. However, there was few data about the relations between the carotid and central aortic elastic properties in those patients. This study aims to investigate the association between carotid artery parameters and central aortic hemodynamics in patients with ischemic stroke. Methods: A total of 101 consecutive patients with ischemic stroke who underwent clinically indicated transesophageal echocardiography (TEE) were performed carotid ultrasonography to assess vascular elastic properties. Using velocity-vector imaging (VVI), instantaneous vessel area (cm 2 ) and deformation as fractional area change (FAC, %) and circumferential strain (%) were obtained in both cross-sectional image of common carotid artery (CA) and descending thoracic aorta (DTA) during TEE. Results: In correlation analysis, elastic properties of DTA including FAC, circumferential strain and vessel area were significantly correlated with the corresponding values of CA, respectively (all p&lt;0.01). Among the vascular parameters, FAC of CA showed independent association with the circumferential strain of DTA adjusting for age, gender, blood pressure, heart rate, intima-media thickness, pulse wave velocity and vessel area (ß=0.14, p=0.002, 95% CI 0.05-0.24) in linear regression analysis. Conclusions: Non-invasively measured elastic properties of CA using VVI showed significant associations with those of DTA and provide valuable information for better understandings of central aortic hemodynamics in patients with ischemic stroke.

OP02.01: Evaluation of ventricular function in fetus with Ebstein's anomaly by velocity vector imaging

OP02.01: Evaluation of ventricular function in fetus with Ebstein's anomaly by velocity vector imaging

Abstract 123: Subtle Changes in Mechanical Properties of Carotid Artery in Overweight and Obese Children

Objective: Obesity in childhood has also been associated with the development of cardiovascular abnormalities. The aim of this study was to investigate the subtle changes of mechanical properties of carotid artery in overweight and obese children. Methods: We prospectively recruited a cohort of overweight (n=25) and obese (n=176) children aged 7 - 17 years and non-obese children with same age and gender (controls, n=31). Overweight is defined as a body mass index (BMI) at or above the 85th percentile and below the 95th percentile and obesity as a BMI at or above the 95th percentile for children of the same age and gender. The mechanical properties of carotid artery were directly measured in a cross-sectional image of common carotid artery using a velocity-vector imaging (VVI) analysis including instantaneous vessel area and deformation parameters as fractional area change (FAC), circumferential strain, and strain rate (SR). Results: Compared to controls, obese children had higher blood pressures and serum glucose and worse lipid profiles than controls, whereas overweight children showed no any difference in blood pressure and laboratory findings. Among vascular properties, there were no differences in carotid intima-media thickness between the three groups. However, obese children showed larger vessel area and higher arterial stiffness as lower FAC, circumferential strain and SR than controls, whereas overweight children showed no difference in vascular properties with obese children and with controls except for circumferential SR. Circumferential SR in overweight children was significantly reduced than controls (0.47±0.19 cm/s, 0.75±0.22 cm/s, respectively, p&lt;0.001) and was the only vascular parameter distinguishing overweight children from controls. In linear regression analysis, age (β=-0.13, p=0.03), BMI (β=- 0.37, p&lt;0.001), and serum triglycerides (β=-0.14, p=0.01) were independent determinants predicting the circumferential SR of carotid artery in this population. Conclusion: A decrease in circumferential SR of carotid artery precedes the changes of other vascular properties as well as blood pressure and laboratory findings in overweight and obese children.

Prevention of doxorubicin-induced cardiomyopathy using targeted MaFGF mediated by nanoparticles combined with ultrasound-targeted MB destruction.

The present study seeks to observe the preventive effects of doxorubicin-induced cardiomyopathy (DOX-CM) in rats using targeted non-mitogenic acidic fibroblast growth factor (MaFGF) mediated by nanoparticles (NP) combined with ultrasound-targeted MB destruction (UTMD). DOX-CM rats were induced by intraperitoneally injected doxorubicin. Six weeks after intervention, the indices from the transthoracic echocardiography and velocity vector imaging showed that the left ventricular function in the MaFGF-loaded NP (MaFGF-NP) + UTMD group was significantly improved compared with the DOX-CM group. The increased malondialdehyde and decreased superoxide dismutase were observed in the DOX-CM group, while a significant increase in superoxide dismutase and a decrease in malondialdehyde were detected in the groups treated with MaFGF-NP + UTMD. From the Masson staining, the MaFGF-NP + UTMD group showed a significant difference from the DOX-CM group. The cardiac collagen volume fraction and the ratio of the perivascular collagen area to the luminal area number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling positive cells in the MaFGF-NP + UTMD group decreased to 8.9%, 0.55-fold, compared with the DOX-CM group (26.5%, 1.7-fold). From terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling staining, the results showed the strongest inhibition of apoptosis progress in MaFGF-NP + UTMD group. The immunohistochemical staining of the TGF-β1 in MaFGF-NP + UTMD group reached 3.6%, which was much lower than that of the DOX-CM group (12.6%). These results confirmed that the abnormalities, including left ventricular dysfunction, myocardial fibrosis, cardiomyocytes apoptosis and oxidative stress, could be suppressed by twice weekly MaFGF treatments for 6 consecutive weeks (free MaFGF or MaFGF-NP+/UTMD), with the strongest improvements observed in the MaFGF-NP + UTMD group. Western blot analyses of the heart tissue further revealed the highest pAkt levels, highest anti-apoptosis protein (Bcl-2) levels and strongest reduction in proapoptosis protein (Bax) levels in the MaFGF-NP + UTMD group. This study confirmed the preventive effects of DOX-CM in the rats with MaFGF-NP and UTMD by retarding myocardial fibrosis, inhibiting oxidative stress, and decreasing cardiomyocyte apoptosis.

Characteristics of Carotid Artery Structure and Mechanical Function and Their Relationships with Aortopathy in Patients with Bicuspid Aortic Valves.

Patients with a bicuspid aortic valve (BAV) often have proximal aortic dilatation and systemic vascular dysfunction. We hypothesized that BAV patients would have different carotid artery structural and functional characteristics compared to tricuspid aortic valve (TAV) patients. In 28 patients with surgically confirmed BAV and 27 patients with TAV, intima media thickness (IMT), number of plaques, fractional area change (FAC), global circumferential strain (GCS), and standard deviation of CS (SD-CS) in both common carotid arteries were assessed using duplex ultrasound and velocity vector imaging (VVI). Patients with BAV were younger and had less co-morbidity, but showed a significantly larger ascending aorta (43.3 ± 7.5 vs. 37.0 ± 6.2 mm, p < 0.001) and a higher prevalence of aortopathy (61 vs. 30%, p = 0.021) than those with TAV. BAV patients showed a significantly lower IMT and fewer plaques. Although FAC and GCS were not significantly different between the two groups, they tended to be lower in the BAV group when each group was divided into three subgroups according to age. There was a significant age-dependent increase in IMT and decreases in FAC and GCS in the TAV group (p = 0.005, p = 0.001, p = 0.002, respectively), but this phenomenon was not evident in the BAV group (p = 0.074, p = 0.248, p = 0.394, respectively). BAV patients with aortopathy showed a higher SD-CS than those without aortopathy (p = 0.040), reflecting disordered mechanical function. In conclusion, BAV patients have different carotid artery structure and function compared with TAV patients, suggesting intrinsic vascular abnormalities that are less affected by established cardiovascular risk factors and more strongly related to the presence of aortopathy.

P1435Right ventricular strain assessment by means of velocity vector Imaging echocardiography in heart transplantation recipients: a sensitive tool for detecting acute rejection

P1435Right ventricular strain assessment by means of velocity vector Imaging echocardiography in heart transplantation recipients: a sensitive tool for detecting acute rejection

Sustained Chronic Maternal Hyperoxygenation Increases Myocardial Deformation in Fetuses with a Small Aortic Isthmus at Risk for Coarctation

We aimed to assess differences in myocardial deformation in fetuses at risk for coarctation (CoA) and the effects of maternal hyperoxygenation on deformation. Fetal echocardiography and velocity vector imaging were performed prospectively and serially in 48 fetuses with a small aortic isthmus and 48 gestation age-matched normal fetuses. Fetuses with a small aortic isthmus were randomly divided into two groups: one group with and the other group without maternal supplemental oxygen administration. The strain (S) and strain rate (SR) in the left ventricle (LV) and right ventricle (RV) were measured and compared between the groups. Regression analyses were performed to identify potential factors associated with myocardial deformation. Compared with normal fetuses, fetuses with a small aortic isthmus exhibited a lower S and SR at baseline. A negative correlation was found between aortic isthmus velocity-time integrals and S and SR at baseline (P<.05). In the group that received supplemental oxygen therapy, the S and SR in both the LV and RV increased as a function of time, especially 4weeks after the initiation of oxygen therapy (P<.05). The duration of oxygen therapy and increased combined cardiac index were associated with increased myocardial deformation (P<.05). Myocardial deformation appears abnormal in those at risk for CoA beginning in utero, and chronic oxygen therapy appears to increase deformation measures. These findings may improve patient counseling and perinatal management.

Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Chronic Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction

ObjectivesThis study sought to examine the prognostic utility of left ventricular (LV) global longitudinal strain (GLS) in asymptomatic patients with ≥III+ aortic regurgitation (AR), an indexed LV end-systolic dimension of <2.5 cm/m2, and preserved left ventricular ejection fraction (LVEF). BackgroundManagement of asymptomatic patients with severe chronic AR and preserved LVEF is challenging and is typically based on LV dimensions. MethodsWe studied 1,063 such patients (age 53 ± 16 years; 77% men) seen between 2003 and 2010 (excluding those with symptoms, obstructive coronary artery disease, acute AR/dissection, aortic/mitral stenosis, more than moderate mitral regurgitation, and previous cardiac surgery). Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Average resting LV-GLS was measured offline on 2-, 3-, and 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, Pennsylvania). ResultsMean STS score, LVEF, LV-GLS, and right ventricular systolic pressure were 4.4 ± 5.0%, 57.0 ± 4.0%, −19.5 ± 0.2%, and 31.0 ± 9.0 mm Hg, respectively. In total, 671 patients (63%) underwent aortic valve surgery at a median of 42 days after the initial evaluation. At 6.8 ± 3.0 years, 146 patients (14%) had died. On multivariable Cox survival analysis, LV-GLS (hazard ratio [HR]: 1.11), STS score (HR: 1.51), indexed LV end-systolic dimension (HR: 0.50), right ventricular systolic pressure (HR: 1.33), and aortic valve surgery (HR: 0.35) were associated with longer term mortality (all p < 0.001). Sequential addition of LV-GLS and aortic valve surgery improved the C-statistic for longer term mortality for the clinical model (STS score + right ventricular systolic pressure + indexed LV end-systolic dimension) from 0.61 (95% confidence interval [CI]: 0.51 to 0.72) to 0.67 (95% CI: 0.54 to 0.87) and to 0.77 (95% CI: 0.63 to 0.90), respectively (p < 0.001 for both). A significantly higher proportion (log-rank p = 0.01) of patients with LV-GLS worse than median (−19.5%) died versus those with an LV-GLS better than median (86 of 513 [17%] vs. 60 of 550 [11%]). The risk of death at 5 years significantly increased with an LV-GLS of worse than −19%. ConclusionsIn asymptomatic patients with ≥III+ chronic AR and preserved LVEF, worsening LV-GLS was associated with longer term mortality, providing incremental prognostic value and improved reclassification.

Incremental Prognostic Use of Left Ventricular Global Longitudinal Strain in Asymptomatic/Minimally Symptomatic Patients With Severe Bioprosthetic Aortic Stenosis Undergoing Redo Aortic Valve Replacement.

With improved survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. Timing of redo surgery in asymptomatic/minimally symptomatic patients remains controversial. Left ventricular (LV) global longitudinal strain (GLS) is a marker of subclinical LV dysfunction. In asymptomatic/minimally symptomatic patients with severe PAS undergoing redo AVR, we sought to determine whether LV-GLS provides incremental prognostic use. We studied 191 patients with severe bioprosthetic PAS (63±16 years, 58% men) who underwent redo AVR between 2000 and 2012 (excluding mechanical PAS, severe other valve disease transcatheter AVR, and LV ejection fraction <50%). Society of Thoracic Surgeons score was calculated. Standard echocardiography data were obtained. LV-GLS was measured on 2-, 3-, and 4-chamber views using velocity vector imaging. Severe PAS was defined as aortic valve area <0.8 cm2, mean aortic valve gradient ≥40 mm Hg, and dimensionless index <0.25. A composite outcome of death and congestive heart failure admission was recorded. At baseline, mean Society of Thoracic Surgeons score, LV ejection fraction, mean aortic valve gradients, and right ventricular systolic pressure were 7±6, 58±6%, 54±10 mm Hg and 40±14 mm Hg, whereas 50% had >2+ aortic regurgitation. Median LV-GLS was -14.2% (-11.4, -17.1%). At 4.2±3 years, 41 (22%) patients met the composite end point (2.5% deaths and 1% strokes at 30 days postoperatively). On multivariable Cox survival analysis, LV-GLS was independently associated with longer-term composite events (hazard ratio, 1.21; 95% confidence interval, 1.10-1.33), P<0.01. The C statistic for the clinical model (Society of Thoracic Surgeons score, degree of aortic regurgitation, and right ventricular systolic pressure) was 0.64 (95% confidence interval 0.54-0.79), P<0.001. Addition of LV-GLS to the clinical model increased the C statistic significantly to 0.71 (95% confidence interval 0.58-0.81), P<0.001. In asymptomatic/minimally symptomatic patients with severe bioprosthetic PAS undergoing redo AVR, baseline LV-GLS provides incremental prognostic use over established predictors and could potentially aid in surgical timing and risk stratification.

Assessment Of Myocardial Mechanics In Renal Transplant Recipients Using Speckle Tracking Echocardiography

PURPOSE: Renal transplant recipients (RTR) have an high risk of cardiovascular mortality, despite surgical treatment and physical exercise is normally allowed to reduce the global morbility risk. Quantitation of myocardial function by Global Longitudinal Strain (GLS)from 2-dimensional images based on speckle tracking echocardiography plays an important role in detecting the early myocardial disfunction in many diseases. The aim of this study was to analyze the changes in myocardial strain during 12 months of exercise as prescription model. MATERIALS AND METHODS: We studied 17 renal transplant recipients, mean age 56 ± 8 y, submited to the exercise prescription model followed ACSM guidelines.Longitudinal peak systolic strain were determined by velocity vector imaging from apical 4- and 2-chamber views (MyLab seven -Esaote).All the other standard 2D echo parameters (LVDd, LVSd, CMI, IVS, PW ; EF) and the diastolic parameters were evaluated. RESULTS: Mean heart rate and systolic and diastolic blood pressure and the LV sistolic and diastolic parameters maintain normals during the follow up. After training, GLS and Longitudinal peak systolic strain at basal and mid-segments of the lateral wall were significantly higher after 6 months(GLS TO -20,7±4% vs GLS T6 :- 23,7±4,1% with p<0.05) and after 12 months of exercise (GLS: -24,4±3%) in RTR with respect of the values of the onset of the protocol (p<0.01). Average longitudinal systolic strain from the 4-chamber view and GLS was normal in controls (-22.3±2.6 % T0; -21.8±3.6 T6; -23.4±4.2 T12) and not significantly different if compared to RTR during all the time of the protocol. CONCLUSIONS: Differences in myocardial function in patients renal transplant recipients submitted to the esercise prescription can be found and it can be quantified by strain imaging. Any possible other differences comparing subjects with end-stage renal or before the transplantation and RTR will need further studies.Figure

Velocity vector imaging shows normal cardiac systolic function in survivors of severe bronchopulmonary dysplasia at six to 16 years of age

This study evaluated global myocardial function and associations between cardiac function and lung function in very low birth weight (VLBW) children, with and without severe radiographic bronchopulmonary dysplasia (BPD), at six to 14 years of age. We studied 34 VLBW and 19 term-born controls, and the VLBW group was further divided into a BPD group with severe radiographic BPD and those without radiographic BPD in infancy. Detailed right and left ventricular myocardial functions were analysed by velocity vector imaging, and the left ventricular mass was calculated. The associations between cardiac function and lung function were assessed by impulse oscillometry. The right and left ventricular myocardial systolic functions and the left ventricular mass were similar in the three groups. Lung function was not associated with cardiac systolic function. Neonatal exposure to dexamethasone treatment was negatively associated with right ventricular function, as measured by the automated fractional area change, with an odds ratio of 7.9 and 95% confidence interval of 1.9-33.5 (p = 0.005). Lung function measurements were not associated with cardiac systolic function in preterm infants at six to 14 years of age. Neonatal exposure to dexamethasone, used for weaning from the ventilator, was negatively associated with right ventricular function.

Initial shunt type at the Norwood operation impacts myocardial function in hypoplastic left heart syndrome.

We investigated the impact of initial shunt type, a Blalock-Taussig (BT) shunt versus a right ventricle to pulmonary artery conduit (RV-PA) on myocardial function at different stages of surgical palliation in patients with hypoplastic left heart syndrome (HLHS). A population-based cohort of 63 Finnish children with HLHS (BT n = 23, RV-PA n = 40) born between 2003 and 2010 were studied retrospectively by echocardiography prior to Stages 1, 2 and 3 palliation and 0.5-3 years after Stage 3. For comparison of systolic myocardial function, we evaluated the RV fractional area change (FAC), strain, strain rate and mechanical synchrony from the apical 4-chamber view by velocity vector imaging. There were no intergroup differences in demographics during the study period. At baseline, no intergroup differences were detected in RV systolic myocardial function. Before Stage 2, RV FAC was higher ( P = 0.03) in the RV-PA conduit group. At Stage 3, an increase in all systolic myocardial functional parameters was observed in the BT shunt group. After Stage 3, the BT shunt group had better RV systolic function. In multiple regression analysis, the shunt type and the stage of palliation had an impact on myocardial function. Although patients with HLHS initially palliated with a BT shunt demonstrate lower RV FAC after Stage I, RV FAC improves after Stage 2 with better systolic performance after Stage 3 compared with those initially palliated with an RV-PA conduit.

Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial

Corticosteroids can improve the hemodynamic status of neonates with postoperative low cardiac output syndrome after cardiac operations. This study compared a prophylactically administered stress-dose corticosteroid (SDC) regimen against placebo on inflammation, adrenocortical function, and hemodynamic outcome. Forty neonates undergoing elective open heart operations were randomized into two groups. The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6 hours after the operation, a hydrocortisone infusion (0.2 mg/kg/h) was started with tapering doses for 5 days. Placebo was administered in a similar fashion. An adrenocorticotropic hormone stimulation test was performed after the therapy. The primary endpoint of the study was plasma concentration of interleukin (IL-6). Secondary clinical outcomes included plasma cortisol, IL-10, C-reactive protein, echocardiographic systemic ventricle contractility evaluated by the Velocity Vector Imaging program, the inotropic score, and time of delayed sternal closure. The IL-6 values of the SDC group were significantly lower postoperatively than in the placebo group. Significantly lower inotropic scores (p < 0.05), earlier sternal closure (p= 0.03), and less deterioration in the systemic ventricle mean delta strain values between the preoperative and the first postoperative assessment (p= 0.01) were detected for the SDC group. The SDC therapy did not suppress the hypothalamic-pituitary-adrenal axis more than placebo. The mean plasma cortisol level did not decline in the placebo group after the operation. The SDC regimen for 5 days postoperatively in neonates was safe and did not cause suppression of the hypothalamic-pituitary-adrenal axis. Furthermore, the open heart operation per se did not lead to adrenal insufficiency in neonates.

Right Atrial Dysfunction in the Fetus with Severely Regurgitant Tricuspid Valve Disease: A Potential Source of Cardiovascular Compromise

In severe right heart obstruction (RHO), redistribution of cardiac output to the left ventricle (LV) is well tolerated by the fetal circulation. Although the same should be true of severely regurgitant tricuspid valve disease (rTVD) with reduced or no output from the right ventricle, affected fetuses more frequently develop hydrops or suffer intrauterine demise. We hypothesized that right atrium (RA) function is altered in rTVD but not in RHO, which could contribute to differences in outcomes. Multi-institutional retrospective review of fetal echocardiograms performed over a 10-year period on fetuses with rTVD (Ebstein's anomaly, tricuspid valve dysplasia) or RHO (pulmonary atresia/intact ventricular septum, tricuspid atresia) and a healthy fetal control group. Offline velocity vector imaging and Doppler measurements of RA size and function and LV function were made. Thirty-four fetuses with rTVD, 40 with RHO, and 79 controls were compared. The rTVD fetuses had thelargest RA size and lowest RA expansion index, fractional area of change, and RA indexed filling and emptying rates compared with fetuses with RHO and controls. The rTVD fetuses had the shortest LV ejection time and increased Tei index with a normal LV ejection fraction. RA dilation (odds ratio, 1.27; 95% CI, 1.05-1.54) and reduced indexed emptying rate (odds ratio, 2.49; 95% CI, 1.07-5.81) were associated with fetal or neonatal demise. Fetal rTVD is characterized by more severe RA dilation and dysfunction compared with fetal RHO and control groups. RA dysfunction may be an important contributor to reduced ventricular filling and output, potentially playing a critical role in the worsened outcomes observed in fetal rTVD.