Systolic Ventricle Research Articles

Children’s heart and prematurity: a current view of the problem

Improved survival of children born with low, extremely low and very low body weight in modern conditions due to increased nursing capabilities, optimization of treatment and increased efficiency of resuscitation measures has led to the need for greater understanding of the importance of assessing the cardiovascular system’s state beyond the neonatal period. With approximately 10% of infants worldwide being born preterm, there is an increasing need for further research into optimal regimens, lifestyle and clinical interventions that can benefit and modify cardiovascular morphology and function in this growing population. Modern theoretical postulates on the physiology and pathophysiology of the child’s heart include ideas about the key process of cardiac biomechanics — diastole, during which the earliest disturbances, that precede the formation of systolic dysfunction, occur. Assessment of the pumping properties of the left ventricle in systole and diastole is a fundamental methodological technique for an in-depth understanding of the pathophysiological mechanisms of cardiovascular system’s emerging diseases, their early diagnosis and assessment of the complex therapy’s effectiveness. However, despite the widespread use of standard echocardiography to assess systolic and diastolic function, its traditional parameters have limitations in terms of diagnostic accuracy and effectiveness in practice. Expanding knowledge about new pathogenetic mechanisms of the cardiac dysfunction formation in conditions of prematurity at the current stage of cardiology development using the “trace spot” technology (two-dimensional speckle tracking echocardiography) will be very useful for scientists studying the mechanics formation of the child’s heart after premature birth, and for doctors of various specialties in early diagnosis of heart diseases.

Abstract 17867: Inward Displacement: A Novel CMR Technique for Quantification of Myocardial Wall Motion in Patients With Myocardial Infarction

Introduction: Inward displacement (InD) is a novel parameter which quantifies myocardial wall motion (WM) by measuring the distance travelled by endocardial tracked points towards their corresponding center of the left ventricle in systole, calculated from 3 LAX views obtained during CMR. Hypothesis: InD using CMR is capable of obtaining global quantifiable measurement of WM abnormalities in patients with myocardial infarction (MI) as defined by Late Gadolinium Enhancement (LGE). Methods: We compared patients with history of MI documented by LGE CMR.Studies were acquired in a 1.5 T Siemens Aera (Siemens, Erlangen Germany) scanner with an 18-channel body array coil; Multi-planar ECG-gated cine CMR was obtained using a balanced steady-state free precession readout and LGE images were acquired using an IR prepped sequence 10 min after Gadolinium contrast injection. Offline analysis using automated endocardial LV contour detection was conducted for each of the LAX series and manual corrections were performed as required. InD was measured in mm and expressed as a percentage. Values were compared between MI patients and normal subjects, and analyzed using a Medis Suite workstation (Medis Medical Imaging BV, Leiden, The Netherlands). Results: We analyzed 646 segments in 38 patients of which 9 had past history of myocardial infarction. Global InD for healthy subjects was 28% vs 19% SEM 0.97, as compared to patients with MI (p:< 0.00001). Conclusions: InD is capable of quantification of abnormal motility in subjects with myocardial infarction, therefore producing an objective measure of LV segmental WM abnormalities, further studies are warranted.

A study of the inter- and intra-operator variability on selected echocardiographic measurements in dogs

Standard transthoracic echocardiography is considered the non-invasive gold standard for the diagnosis of most cardiac diseases. Defining reproducibility, repeatability, and reliability of this exam is imperative to reduce errors in clinical evaluations. The present study aimed at: (1) evaluating the reproducibility and repeatability of 15 echocardiographic parameters in dogs by analyzing measurements obtained from several operators with different levels of experience and comparing them to the ones obtained from two board-certified operators (gold standards - GSs); (2) assessing whether different formative paths have an influence on the variability of the echocardiographic measurements. Fifty-one operators have been included in this study, along with two diplomates of the European College of Veterinary Internal Medicine - Cardiology. Ten dogs were enrolled, 5 Golden Retrievers and 5 Cavalier King Charles Spaniels. Echocardiographic examination was performed on each dog by one GS and several operators on the same day. Results show the highest deviation from the GS and a poor inter-operator reproducibility for the M-mode measurements of the interventricular septum and the left ventricular free wall. Differently, M-mode-obtained internal diameters of the left ventricle in systole and diastole, and measurements of the aortic annulus and root show moderate to excellent intra- and inter-operator reliability and a good concordance with the GSs, demonstrating that all the operators correctly assess left ventricular systolic function and dilation, and evaluate the aortic valve. Furthermore, a specialist clinical activity, more than the acquired theoretical knowledge, affects the reliability of the echocardiographic examination by reducing the difference from the GS’ measurements.

Subannular repair for functional mitral regurgitation with reduced systolic ventricle function: rationale and design of REFORM-MR registry

BackgroundFunctional mitral regurgitation (FMR) is one of the most common heart valve diseases that is a sequel of left ventricular remodelling. Although mitral valve annuloplasty is a standard treatment of FMR, the recurrence of FMR is a major drawback and occurs in 10–50% of patients. The REFORM-MR registry aims to investigate the effectiveness of standardized papillary muscle relocation and ring annuloplasty and to identify the risk factors associated with recurrent FMR.MethodsREFORM-MR is a prospective, multicenter registry that enrols consecutive FMR patients across five sites in Germany. All patients with FMR and restricted movement of leaflets during systole (i.e., type IIIb mitral regurgitation) undergoing standardized subannular repair in combination with mitral valve annuloplasty are included in the study. The primary objective is to examine the effect of combined papillary muscle relocation and ring annuloplasty on the recurrence of FMR at 2 years postoperatively. The secondary objectives are MACCE rate, reinterventions on the mitral valve and cardiac-related mortality in the study cohort. Echocardiography core-lab and MRI core-lab will provide anonymized analysis of the imaging data in the REFORM-MR registry. Student’s t-test or Mann–Whitney U test for continuous variables and the Chi-Square or Fisher exact test for categorical variables are used for group comparisons. Kaplan–Meier analyses is performed for survival and safety outcomes.ResultsAs of May 2021, a total of 97 patients were enrolled across five sites in Germany.ConclusionsThe results of this study will help define the outcomes of combined papillary muscle relocation and ring annuloplasty in the FMR treatment in a multicentre setting and to improve the understanding of the limitations of subannular repair procedures while treating patients with type III FMR.Trial registration clinicaltrials.gov Identifier: NCT03470155.

Blockade of Stim‐activated TRPC‐ORAI Channels Prevents Vascular Remodeling and Pulmonary Hypertension Induced by Chronic Intermittent Hypoxia

Obstructive sleep apnea (OSA), a sleep breathing disorder featured by chronic intermittent hypoxia (CIH), is associate with mild pulmonary hypertension (PH). Rats exposed to CIH developed pulmonary vascular remodeling and PH, but the pathogenic mechanisms are not well known. In addition, CIH overexpressed Stim‐activated TRPC‐ORAI channels (STOC) in the lung, which paralleled the increase of right systolic ventricle pressure (RVSP) and pulmonary vascular remodeling. Accordingly, we tested weater a treatment with the STOC bloker 2‐Aminoethyl diphenylborinate (2‐APB), started from day 14 days to exposure to CIH may reduce vascular remodelling and PH. Male Sprague‐Dawley rats (~200g) were exposed CIH (5% O2, 12 times/h for 8h). At 14 days, osmotic pumps containing 2‐APB (10 mg/kg/day, n=7) or its vehicle (n=7) were implanted, and rats were keep in CIH for 2 more weeks. At the end of CIH exposure, RVSP was measured in urethane‐chloralose anesthetized rats. Animals were euthanized and lungs were removed to determine vascular remodeling and mRNA levels of the STOC forming subunits TRPC1, TRPC4, TRPC6, ORAI 1 and ORAI 2 by qPCR. CIH‐treated rats were compared with aged‐matched normoxic controls. 2‐APB reduced the increase of RVSP (24.7 ± 1.6 vs. 36.5 ± 1.1 mmHg, 2‐APB vs vehicle, respectively, p < 0.05) and the medial layer thickness of arteries (50‐300 µm) (43.4 ± 1.1 vs. 66.5 ± 2.9 %, 2‐APB vs vehicle, respectively, p < 0.05). In addition, 2‐APB prevented the increase of α‐actin‐ir (8.8 ± 0.4 vs. 14.3 ± 0.6 pixels/μm2, 2‐APB and vehicle respectively, p < 0.05), and to KI67 positive cells (3.9 ± 0.8 vs. 6.3 ± 1.1 %, 2‐APB and vehicle, respectively, p < 0.05). In addition, 2‐APB treatment reverted the increased mRNA levels of TRPC1, TRPC4 and TRPC6, but induced an overexpression of ORAI 1, while ORAI 2 remained unchanged. The present results show that 2‐APB treatment prevented the vascular pulmonary alterations induced by CIH, suggesting that the blockade of STOC may potentially be used to treat the pulmonary hypertension induced by OSA.

Is It a Residual Ventricular Septal Defect?

A 1-YEAR-OLD BOY (weight, 7.4 kg; height, 67 cm), with Trisomy 21 and a diagnosis of complete atrioventricular septal defect with tetralogy of Fallot, presented to the author's institution for intracardiac repair. Transthoracic echocardiography reported an ostium primum atrial septal defect, a nonrestrictive inlet-type ventricular septal defect, and anterosuperior deviation of the infundibular septum with a severe right ventricular outflow tract obstruction (peak pressure gradient of 75 mmHg). Intraoperative transesophageal echocardiography confirmed the findings (Fig. 1 and 2; Videos 1-3). After completing the repair and separating from cardiopulmonary bypass, a color Doppler blood-flow map in the mid-esophageal aortic short-axis view demonstrated 2 jets (each about 2 mm in diameter) into the right ventricle in systole, with the lower of the 2 jets also persisting during diastole (Fig 3; Video 4). The color Doppler blood-flow map during deep transgastric right ventricular outflow tract interrogation also demonstrated the jet into the right ventricle throughout the cardiac cycle (Fig 4; Video 5). Continuous-wave Doppler interrogation of the lower jet revealed biphasic flow toward the right ventricle (Fig 5; Video 6). What is the diagnosis? Fig. 2Transgastric long-axis right ventricular outflow tract view with Doppler blood-flow map by transesophageal echocardiography showing the turbulence in the right ventricular outflow tract. View Large Image Figure Viewer Download Hi-res image Fig. 3Postoperative aortic short-axis transesophageal echocardiography views showing (A) 2 jets in systole and (B) 1 lower jet during diastole as correlated with the electrocardiogram. View Large Image Figure Viewer Download Hi-res image Fig. 4Postoperative long-axis right ventricular outflow tract view showing 1 jet in diastole as coordinated with the electrocardiogram. View Large Image Figure Viewer Download Hi-res image Fig. 5Postoperative long-axis right ventricular outflow tract view showing the interrogation of the jet opening into the right ventricle with the continuous wave Doppler signal. View Large Image Figure Viewer Download Hi-res image

Effects of long-term high dietary sodium chloride intake on the cardiovascular system of cynomolgus macaques (<i>Macaca fascicularis</i>)

INTRODUCTION . High dietary sodium chloride intake has traditionally been considered an important factor in cardiovascular risk and an increase in blood pressure (BP). However, much remains unclear about the relationship between dietary sodium and cardiovascular health. In particular, it was shown that in rats a high content of salt in the diet can lead to miocardial remodeling/damage without increasing BP. It is possible whether this phenomenon in primates remains unknown. The AIM of the study was to trace the dynamics of BP and some echocardiographic (EchoCG) parameters in cynomolgus macaques ( Macaca fascicularis ), which have been on a high sodium chloride diet for a long time. MATERIAL AND METHODS . 12 male cynomolgus macaques 6-8 years with a body weight of 5,15-9,7 kg were studied. The animals were divided into two groups (six individuals each). The first (control) received a standard diet, the second – a diet high in sodium chloride (8 g NaCl/kg feed). After four and fourteen months, in the animals were measured blood pressure and conducted echocardiographic examination (EchoCG). RESULTS . During the follow-up period in the control group, no significant changes in the studied parameters were recorded. Increased salt intake at four months resulted in a significant decrease in left ventricular end-systolic dimension and an increase in ejection fraction values. After fourteen months, both of these indices returned, practically, to the initial level, but there was a significant increase in the thickness of the posterior wall of the left ventricle in systole and a decrease in systolic excursion of the tricuspid valve annulus compared with the basal data. BP in the salt group also did not change significantly. CONCLUSION . Cynomolgus macaques are able to resist an increase in blood pressure induced by a long stay on a high-salt diet, but in primates under such conditions, the initial manifestations of functional and structural rearrangement of the heart can be observed.

Acute and Chronic Pre-Clinical Implants of the CorWave LVAD: Hydraulic, Hemocompatibility and Hemodynamic Results

The CorWave LVAD employs a unique "wave membrane" technology, inspired from the motion of aquatic animals, to generate blood flow. This low shear method of blood propulsion can be rapidly modulated to produce a physiologic pulse. The present study evaluated the hydraulic, hemodynamic and hemocompatibility performance of the device in vitro and in animal implants. The pump membrane, oscillation frequency and magnitude, and blood flow path were simulated by CFD analysis in COMSOL and refined to improve hydraulic efficiency and eliminate areas of flow stagnation. Hydraulic testing in a mock circulatory loop and hemolysis measurements in static and pulsatile conditions were then performed in vitro. Acute and chronic implants of the improved pumps were carried out in sheep. The device was successfully operated in 4 different modes: continuous or fixed (similar to rotary VADs with a constant operating point), synchronous co-pulsation and counter-pulsation, and asynchronous pulsation modes. Sensorless detection of native ventricle systole was developed using a mock circulatory loop, with performance confirmed in acute implants in sheep with induced heart failure. The pump could generate average flow rates of 6+ lpm against physiologic pressure, and instantaneous flow rates exceeding 12 LPM during pulsatile operation. Acute and chronic animal implants (up to 60+ days) demonstrated low hemolysis and an absence of significant thrombus or thromboembolic events. The first long-term chronic animal studies of the CorWave LVAD validated the hemocompatibility and hemodynamic performance of the pump. The ability to restore physiologic pulsatility by sensorless synchronization with the native heart was demonstrated in pre-clinical implants. Extensive computational simulation and bench top testing were used to optimize this unique LVAD, displaying the full flow capacity and adding physiologically relevant pulsatility without excessive shear rates.

The use of Intra Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery

Intra-aortic balloon pump (IABP) is a mechanical device that increases cardiac output by increasing diastolic blood flow to the coronary arteries and lowers the afterload of the left ventricle in systole. IABP is primarily used in acute heart failure, that includes patients that have to undergo coronary artery bypass grafting (CABG). Its usage, however, in cardiac surgery has been declining with ongoing controversy regarding its benefits. The aim of this study was to assess the use and indications and outcome of IABP related to CABG surgery. The study was retrospective and included 2177 patients that underwent CABG at Landspítali during 2001-2018. We compared those who received an IABP with controls, using uni- and multivariate analysis. Long term survival and complications (major adverse cardiovascular and cerebral events, MACCE) was estimated with Kaplan-Meier method. A total of 99 (4.5%) patients received an IABP. The incidence was highest in 2006 (8.9%) and lowest in 2001 (1.7%), but the incidence did not change during the study period (p=0.90). Most patients received the pump before (58.6%) or during (34.3%) CABG, but only 6.1% after surgery. Complication rate was 14.1%, with bleeding from the insertion site in the groin being the most common complication. Thirty day mortality was higher in the IABP group compared with controls (22.2% vs 1.3%, p<0.001) and both 5-year survival (56.4% vs 91.5%, 95% CI: 0.47-0.67) and 5-year MACCE-free survival (46.9% vs 83.0%, 95% CI: 0.38-0.58) were inferior. Less than 5% of patients received IABP in relation to CABG in Iceland and the rate hasn't changed much for the last 18 years. Both the complication rate and 30-day mortality was higher in patients in IABP group and both the long term and MACCE-free survival was much worse, probably mostly related to worse overall clinical condition of the patient that received IABP.

Determination of echocardiographic parameters in spider monkey (Ateles spp.) collectives in captivity sedated with ketamine and midazolam

Nonhuman primates have long been studied and managed in research centers, zoos, and farms, but there is still a lack of information regarding their illnesses. The present study aimed to establish the echocardiographic parameters of normality among primates of the genus Ateles (spider monkey) that are housed at the Zoo of the City of Rio de Janeiro – RIOZOO Foundation. Nine specimens of the same species were used, 5 females and 4 males, that were clinically healthy, young adults, with an approximate captive age of 2 to 3 years, and an average weight of 8.5 kg. The animals were physically restrained with a net and soon after, chemical containment was carried out by means of an association of ketamine hydrochloride at a dose of 8 mg per kg and midazolam at 0.5 mg per kg, intramuscularly. The animals were submitted to chemical restraint to establish the clinical evaluation, blood collection for complete blood count and biochemical measurements, urine collection for urinalysis, chest X-ray in the ventro-dorsal and latero-lateral positions, and electrocardiographic exams, with all the parameters within the normal range, in addition to echocardiographic examination, which became the means by which the study parameters were acquired. During this examination, the following values were evaluated: cardiac output, ejection fraction, final cardiac volume, heart rate, left atrial diameter, aorta diameter, ratio between the diameters of the left atrium and aorta artery, thickness of the interventricular septum in diastole, diameter of the left ventricle in diastole, thickness of the free wall of the left ventricle in diastole, thickness of the interventricular septum in systole, diameter of the left ventricle in systole, thickness of the free wall of the left ventricle in the systole, left ventricular end systolic volume, left ventricular end diastolic volume, septum bending fraction, fraction of curving of the posterior wall, septal separation, and shortening fraction. With the data obtained, tables were drawn with the echocardiographic values of the species studied under sedation.

Statistical Analysis of M-Mode Echocardiographic Normal Reference Values in South Indian Adults

Background: Normal values for echocardiographic measurements are derived from American Society of echocardiography and European Society of Cardiology/European Association of Cardio-Vascular Imaging and their publications. Indians have smaller cardiac chamber dimensions than the Europeans. However, it has been long felt that reference range from western data cannot be fully applied in our scenario. Aim: The objective of this study was to develop age and gender-specific normative reference range values for echocardiography measurements. Methodology: This was a retrospective cross-sectional single-center study conduct on 111 healthy Indian adults who were selected out of the 336 patients aged from 18– 76 years, who visited the cardiac medical check-up unit in a tertiary hospital. Echocardiograms were done in participants free of cardiovascular diseases, hypertension, diabetes, high blood pressure or other clinical evident disorders. M-mode Echocardiography in the left parasternal long-axis view was used to measure aorta, left atrium, left ventricle in systole and diastole,right ventricle, interventricular septum, and posterior wall thickness. The 95% reference range of the echocardiographic parameters calculated as a mean±2 “standard deviation for overall and genders specific”. Results: This study provides a set of data with reference ranges for normal M-mode parameters according to age and gender. Around 58 males and 53 females were classified into the age group from 18-76 years as exclusive class intervals. Age group above of 38 years Indians had higher volume in all the echocardiographic measurements are observed in this study. On examining all our healthy participants, we found that the reference range of most echocardiographic parameters is a highly statistically significant difference as compared with those used in western studies. Conclusion: The normal reference values for echocardiographic measurements derived from this study could be used for future reference in our local population.

P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG

Abstract Introduction In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies. Purpose To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG). Methods The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed. Results Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p&gt;0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029). Conclusion Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.

Corwave LVAD Development Update

Purpose The Corwave Neptune LVAD is being developed to employ gentle oscillation of a membrane to propel blood, based on the wave motion of swimming fish. The pump output can be readily tuned by adjusting membrane oscillation frequency and magnitude. The purpose of this project was increase the hydraulic efficiency, implement a physiologic pulsatility control algorithm, and confirm performance in animal implants. Methods The fluid path of the pump was simulated by Fluid-Structure-Interaction (FSI) computational fluid dynamic analysis in COMSOL. Membrane size, oscillation frequency, oscillation magnitude, and the blood flow path were modeled and refined to improve hydraulic performance and eliminate areas of flow stagnation. Pumps were then tested in blood analogs and blood in mock circulation loops and in vitro hemolysis testing. Non-hermetic pumps were implanted in a total of 25 sheep for acute and chronic implants. Results Design simulations and individual component testing resulted in a pump which can generate 6+ LPM of blood flow against physiologic pressures with maximum shear rates orders of magnitude lower that those of rotary blood pumps. Mock loop testing demonstrated the pumps have “flat” HQ (pressure vs. flow) curves. Three control methods were developed: fixed, asynchronous pulsatile, and synchronous pulsatile. Pulsatile modes generated dP/dt>400 mmHg/sec using sensorless detection of native ventricle systole. Animal implants demonstrated low hemolysis and an absence of renal infarcts, but were limited to about a week in duration due to the non-hermetic sealing of the pumps. Conclusion Application of robust computational simulation and bench top testing have produced a unique new kind of VAD, offering the flow capacity and reliability of rotary pumps, but adding physiologically relevant pulsatility without excessive shear rates. Future efforts will implement full hermeticity to extend animal study durations and confirm von Willebrand Factor compatibility. The Corwave Neptune LVAD is being developed to employ gentle oscillation of a membrane to propel blood, based on the wave motion of swimming fish. The pump output can be readily tuned by adjusting membrane oscillation frequency and magnitude. The purpose of this project was increase the hydraulic efficiency, implement a physiologic pulsatility control algorithm, and confirm performance in animal implants. The fluid path of the pump was simulated by Fluid-Structure-Interaction (FSI) computational fluid dynamic analysis in COMSOL. Membrane size, oscillation frequency, oscillation magnitude, and the blood flow path were modeled and refined to improve hydraulic performance and eliminate areas of flow stagnation. Pumps were then tested in blood analogs and blood in mock circulation loops and in vitro hemolysis testing. Non-hermetic pumps were implanted in a total of 25 sheep for acute and chronic implants. Design simulations and individual component testing resulted in a pump which can generate 6+ LPM of blood flow against physiologic pressures with maximum shear rates orders of magnitude lower that those of rotary blood pumps. Mock loop testing demonstrated the pumps have “flat” HQ (pressure vs. flow) curves. Three control methods were developed: fixed, asynchronous pulsatile, and synchronous pulsatile. Pulsatile modes generated dP/dt>400 mmHg/sec using sensorless detection of native ventricle systole. Animal implants demonstrated low hemolysis and an absence of renal infarcts, but were limited to about a week in duration due to the non-hermetic sealing of the pumps. Application of robust computational simulation and bench top testing have produced a unique new kind of VAD, offering the flow capacity and reliability of rotary pumps, but adding physiologically relevant pulsatility without excessive shear rates. Future efforts will implement full hermeticity to extend animal study durations and confirm von Willebrand Factor compatibility.

M-mode echocardiography measurements of healthy Brazilian random bred cats

To determine the M-mode echocardiography reference measurements for Brazilian random bred cats in Rio de Janeiro, Brazil, Cats presenting for routine care were examined by M-mode echocardiography. Animals with free wall values ​​of the left ventricle and/or interventricular septum above 5 mm were not included. A total of 125 cats were included in the study. The correlation of the body score condition (BSC) with the echocardiography measurements was positive for left ventricle wall in systole (LVWs) and left ventricular wall in diastole (LVWd) . The LVWd values of BSCs 3 and 4 were different , and those of BSCs 3 and 5 were also different. The LVWs values of BSCs 3 and 5 were different . The correlated effect between BSC and the echocardiography measurements was true for the left atrium , left atrium/aorta ratio, ventricular septum in diastole, ventricular septum in systole, LVWs, LVWd, left ventricle in diastole, left ventricle in systole, ejection fraction and shortening fraction. The M-mode echocardiography evaluation of cats is impacted by the animal’s body mass; therefore, the BSC must be taken into consideration when interpreting echocardiography measurements.

Relationship between left ventricular volume parameters and cardiac function in elderly patients with heart failure

Objective To explore the relationship between left ventricular volume parameters and cardiac function in elderly patients with heart failure. Methods From January 1st, 2012 to December 31st, 2014, five hundred and twenty-eight heart failure elderly patients with coronary heart disease, hypertension, heart valve disease, dilated cardiomyopathy, and hypertrophic cardiomyopathy in Kailuan General Hospital were collected in this study.The left ventricle diastolic end volume (LVEDV), left ventricle end systolic volume (LVESV) and left ventricular ejection fraction of the patients were measured.The concentrations of N type brain natriuretic peptide (NT-proBNP) and related biochemical indexes were detected. Results Among the 528 patients with cardiac insufficiency, 367 were males and 161 were females.Among them, there were 199 cases of heart function I, 163 cases of heart function II, 99 cases of heart function III and 67 cases of heart function IV.Correlation analysis showed that the correlation coefficients of LVEDV, LVESV and age were 0.431(P=0.001), 0.472(P=0.001) and 0.243(P<0.001), respectively.Logistic regression analysis showed that LVEDV (OR=2.654, 95%CI 2.124-3.894, P=0.004), LVESV (OR=2.939, 95%CI 2.539-3.256, P=0.001), LVESV), NT-proBNP (OR=2.921, 95%CI 2.888-3.562, P=0.002) were risk factors for heart failure. Conclusion The correlation between LVESV and cardiac function in elderly patients with heart failure is better than that in LVEDV, and the correlation between the two and cardiac function is better than that of age. Key words: Echocardiography; Left ventricle diastolic end volume; Left ventricle systole end volume; Heart function

The cardiovascular system in patients with functional and inflammatory bowel diseases.

Identification of subclinical and metamanifests state changes of cardiovascular system in patients with functional and inflammatory bow- el diseases (IBD) without a background of cardiac pathology. Was examined 79 patients with colon diseases, 20 patients were diagnosed with irritable bowel syndrome (IBS) with diarrhea, a 37 - undifferentiated colitis (UdC) and 22 patients with ulcerative colitis (UC). As a control group were examined in 50 healthy subjects. All patients received treatment in accordance with international and national guidelines. Prescribed medications had effect on the function of the cardiovascular system. Patients with contacting the hospital and against the onset of remission was performed ultrasound of the heart. Determines the size of the left atrium, heart rate, end-diastolic volume, end-systolic volume, ejection fraction (EF), cardiac index (CI), to- tal peripheral vascular resistance, the presence of right heart failure, blood flow, the area of the right atrium and right ventricle in systole and diastole, and calculated the proportion of contractility of the right atrium and right ventricle. Determined systolic pressure in PA (SPPA), the average pressure in PA (SPPA). Clinical manifestations of cardiac syndrome was identified in 75,0% of patients with IBS, 54,1% of patients NK and 68,2% patients with UC. When performing correlation analysis in the patients with UdC and UC was noted the relationship of hemodynamic parameters and disease severity was more pronounced in UC. So, when comparing the duration of the disease and levels of the MLC - r=0,52 and r=0,73 (p&lt;0,05), EF - r=-0,51 and r=-0,71 (p&lt;0,05), CI - r=0,49 and r=0,70 (p&lt;0,05), heart rate - r=0,47, r=0,68 (p&lt;0,05); duration of stay in hospi- tal and the magnitudes of MLC - r=0,54 and r=0,77 (p&lt;0,05), EF - r=-0,51 and r=-0,71 (p&lt;0.05), CI - r=0,55 and r=0,73 (p&lt;0,05), heart rate - r=0,47, r=0,63 (p&lt;0,05). For patients with UC, we noted the presence of correlation when the average frequency of exacerbations per year and the values of the MLC - r=0,53 (p&lt;0,05), EF - r=-0,55 (p&lt;0,05), heart rate: r=0,54 (p&lt;0,05); severity of UC and EF (r=-0,67; p&lt;0,05). A statistically significant correlation of changes in EF and value SPPA and APPA, aggravated by the deepening severity of the disease. So, for IBS - r=-0,46, and r=-0,48 (p&lt;0,05); for NK - r=-0,51 and r=-0,59 (p&lt;0,05); for the UC - r=-0,62, and r=-0,67 (p&lt;0,05). In the analysis of duration of hospitalization, and values SPPA and APPA for patients with IBS - r=0.48 and r=0.46 (p&lt;0,05); with UdC - r=0,50 and r=0,53 (p&lt;0,05); with UC - r=0,59 and r=0,62 (p&lt;0,05). Sick UC was characterized by the greatest dilatation of RA and RV with access from outside the variations of the norms of 90.9 and 68.2 per cent, a significant decrease dRA and dRV. Discovered correlation of the squares of PP and SDL - r=0,48, r=0,54 and r=0,61 (p&lt;0,05); APPA - r=0,50, r=0,56 and r=0,63 (p&lt;0,05); RV areas and levels SPPA - r=0,45, r=0,50 and r=0.52 (p&lt;0,05); and APPA - r=0,46, r=0,47 r=0,53 (p&lt;0,05). When analyzing the values of the squares of the pancreas and MLC - r=0,47 r=0,54 and r=0,61 (p&lt;0,05), levels of EF and dRV - r=0,41, r=0,50 and r=0,56 (p&lt;0,05). Cardiac syndrome in patients with IBS and IBD without a background of cardiac pathology can occur in the form of subclinical or manifested weakly, but persistent changes that may not be recognized, but in the future may complicate the course of the underlying dis- ease, necessitating research to develop tactics to correct them.

Fractal Diagnostic Generalization of the Left Ventricular Cardiac Morphology: Moderate and Severe Abnormalities from Ventriculogram

Introduction: Cardiac irregularity is adequately described by means of fractal geometry, which was the basis for the development of a diagnosis of the left ventriculogram. Methods: All possible permutations of similarity degrees from fractal dimensions were simulated for the ventricle in systole, diastole and the totality. Permutations were defined between the previously established minimum and maximum values of similarity degrees for moderate and severe abnormality. Results: The total number of ventricular prototypes between moderate and severe abnormality was established. The total number of possible ventricular structure prototypes is 1614: 794 ventricles with moderate abnormality and 820 with severe abnormality. Previous measurements of ventricles with a diagnosis of moderate and severe abnormality were found within the generalization. Conclusions: An objective geometric methodology was developed, which is of diagnostic aid in the clinical practice. It determined all possible left ventricular structures with moderate and severe abnormality, independently of clinical classifications.

Modification of Aortic Cannula With an Inlet Chamber to Induce Spiral Flow and Improve Outlet Flow.

Physiologically, blood ejected from the left ventricle in systole exhibited spiral flow characteristics. This spiral flow has been proven to have several advantages such as lateral reduction of directed forces and thrombus formation, while it also appears to be clinically beneficial in suppressing neurological complications. In order to deliver spiral flow characteristics during cardiopulmonary bypass operation, several modifications have been made on an aortic cannula either at the internal or at the outflow tip; these modifications have proven to yield better hemodynamic performances compared to standard cannula. However, there is no modification done at the inlet part of the aortic cannula for inducing spiral flow so far. This study was carried out by attaching a spiral inducer at the inlet of an aortic cannula. Then, the hemodynamic performances of the new cannula were compared with the standard straight tip end-hole cannula. This is achieved by modeling the cannula and attaching the cannula at a patient-specific aorta model. Numerical approach was utilized to evaluate the hemodynamic performance, and a water jet impact experiment was used to demonstrate the jet force generated by the cannula. The new spiral flow aortic cannula has shown some improvements by reducing approximately 21% of impinging velocity near to the aortic wall, and more than 58% reduction on total force generated as compared to standard cannula.

Cardiac imaging in patients with cardiac syncope.

Syncope is a common symptom with a possibly unfavorable prognosis, especially when the cause is a cardiac disease. Often diagnostic workup requires multiple and challenging investigations to determine whether the patient has a structural heart disease. Cardiac imaging tests should be used when baseline clinical findings raise the suspicion of a cardiac syncope. Transthoracic echocardiography is the first line imaging examination as it helps establish the cause of syncope and supplies useful information for prognostic stratification by evaluating systolic ventricle function. Advanced imaging techniques such as multidetector computed tomography and cardiac magnetic resonance imaging should be reserved for selected cases when echocardiography is inconclusive. With this review we aim to report the main information obtainable with cardiac imaging tests in patients with suspected or known cardiac syncope. We summarize the most common as well as rarer heart structural diseases which may cause syncope and briefly state the possible physio-pathologic mechanism. For each heart disease we describe the role of the various imaging techniques and the possible diagnostic and prognostic information provided by these techniques.

Crista Supraventricularis Purkinje Network and Its Relation to Intraseptal Purkinje Network.

Using transparent specimens with a dual color injection, microscopy, and computer tomography, this report shows that the right and left ventricular subendocardial Purkinje networks are connected by an extensive septal network in the bovine heart. The septal network is present along the entire septum except at a free zone below ventricular valves. Being the only communication of the basal right septum with the right free wall, the supraventricular crest is an enigmatic but not, by any means, hidden muscular structure. It is one of the last structures to be activated in human heart. It is shown here that the supraventricular crest Purkinje network connects the anterosuperior right ventricular basal free wall Purkinje network to anterior right ventricular basal septal Purkinje network. It is suggested that the stimulus initiated at middle left ventricular endocardium will activate the supraventricular crest. The intraseptal connection found between the basal left ventricular subendocardial septal Purkinje network and the right ventricular basal septal Purkinje network is, probably, the pathway for the stimulus. An anatomic basis is provided to explain why the inflow tract contracts earlier than the outflow tract in the right ventricle systole. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:1793-1801, 2017. © 2017 Wiley Periodicals, Inc.