Ventricular Free Wall Thickness Research Articles

Factors Predicting Fetal Growth Restriction and Fetal Cardiac Remodeling.

This study aimed to investigate factors influencing fetal growth restriction (FGR) occurrence and assess the clinical significance of fetal cardiac parameters in FGR prediction. Pregnant women with clinically suspected FGR (n=179) and uncomplicated pregnancies (n=53) were included. All had undergone routine obstetric ultrasonography and fetal echocardiography. Umbilical artery flow (UAF) and fetal cardiac parameters (left atrial transverse diameter (LAd), right atrial transverse diameter (RAd), left ventricular transverse diameter (LVd), right ventricular transverse diameter (RVd), foramen ovale width, atrial septum diameter, interventricular septal thickness, left ventricular posterior wall thickness, right ventricular free wall thickness, aortic diameter, pulmonary artery diameter, mitral E velocity, mitral A velocity, tricuspid E velocity, tricuspid A velocity, aortic valve peak flow velocity, and pulmonary valve peak flow velocity) were detected. Follow up was conducted until birth, various fetal clinical parameters were collected: maternal body mass index (BMI), hypertensive disorders complicating pregnancy (HDCP), abnormal umbilical artery flow, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, emergency cesarean delivery, maternal height, maternal age, gestational diabetes mellitus (GDM), hypothyroidism, assisted reproductive technology (ART), parity, and neonatal gender. Participants were categorized into confirmed FGR (n=119) and control (n=113) groups based on neonatal birth weight. Significant differences were observed between groups in maternal BMI, HDCP, abnormal UAF, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, and emergency cesarean delivery. FGR was positively related to abnormal UAF, placental or umbilical cord anomalies, preterm birth and emergency cesarean delivery and negatively to maternal BMI (r=-0.276). Compared to the control group, the FGR group exhibited significantly larger RAd, RVd, RA/LA, and RV/LV. Fetal growth-restricted fetuses have enlarged right heart structures. Fetal cardiac examinations are valuable for early FGR diagnosis, potentially improving neonatal body weight and reducing adverse pregnancy outcomes.

Activation of ALDH2 alleviates hypoxic pulmonary hypertension in mice by upregulating the SIRT1/PGC-1α signaling pathway

To investigate whether activation of mitochondrial acetal dehydrogenase 2 (ALDH2) alleviates hypoxic pulmonary hypertension by regulating the SIRT1/PGC-1α signaling pathway. Thirty 8-week-old C57 BL/6 mice were randomized into control, hypoxia, and hypoxia +Alda-1 (an ALDH2 activator) group (n=10), and the mice in the latter two groups, along with 10 ALDH2 knockout (ALDH2-/-) mice, were exposed to hypoxia (10% O2, 90% N2) with or without daily intraperitoneal injection of Alda-1 for 4 weeks. The changes in right ventricular function and pressure (RVSP) of the mice were evaluated by echocardiography and right ventricular catheter test, and pulmonary artery pressure was estimated based on RVSP. Pulmonary vascular remodeling, right ventricular injury, myocardial α -SMA expression, distal pulmonary arteriole muscle normalization, right ventricular cross-sectional area, myocardial cell hypertrophy, and right cardiac hypertrophy index were assessed with HE staining, immunofluorescence staining and WGA staining, and the expressions of ALDH2, SIRT1, PGC-1α, P16INK4A and P21CIP1 were detected. In pulmonary artery smooth muscle cells with hypoxic exposure, the effect of Alda-1 and EX527 on cell senescence and protein expressions was evaluated using β-galactose staining and Western blotting. The wild-type mice with hypoxic exposure showed significantly increased RVSP, right ventricular free wall thickness and myocardial expressions of P16INK4A and P21CIP1, which were effectively lowered by treatment with Alda-1 but further increased in ALDH2-/- mice. In cultured pulmonary artery smooth muscle cells, hypoxic exposure significantly increased senescent cell percentage and cellular expressions of P16INK4A and P21CIP1, which were all lowered by treatment with Alda-1, but its effect was obviously attenuated by EX527 treatment. ALDH2 alleviates hypoxiainduced senescence of pulmonary artery smooth muscle cells by upregulating the SIRT1/PGC-1α signaling pathway to alleviate pulmonary hypertension in mice.

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.

Multimodal echocardiography for assessing whether left ventricular geometry affects right atrial phasic function in patients with obstructive sleep apnea syndrome: A cross-sectional observational study.

Recent studies have shown that right atrial (RA) function are important predictors of cardiovascular morbidity and mortality. However, the study data about RA phasic function in obstructive sleep apnea syndrome (OSAS) patients are scarce, especially based on the left ventricular geometry. So, we aimed to assess the influence of left ventricular geometry on RA phasic function in OSAS patients via a multimodal echocardiographic approach. Total of 235 OSAS patients were enrolled in this cross-section study and underwent complete clinical, polysomnography, and echocardiography examinations. The OSAS patients were divided into four groups based on left ventricular mass index (LVMI) and relative wall thickness (RWT): normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). RA phasic function was evaluated via multimodal echocardiography approach (two-dimensional echocardiography biplane method [2DE]; two-dimensional speckle-tracking echocardiography [2D-STE]; and three-dimensional echocardiography [3DE]). The multiple linear regression analysis was used to determine the relationship between left ventricular geometry and RA phasic function. The RA volume and indices increased from NG to CR to EH to CH. RA total emptying fraction and RA strain during systole decreased from NG to CR to EH to CH. RA passive emptying fraction and RA strain during early diastole similarly decreased. RA active emptying fraction and RA strain during late diastole also gradually increased similarly. In analyses that adjusted for gender, age, body mass index, systolic blood pressure, apnea-hypopnea index, LVMI, systolic pulmonary artery pressure, and right ventricular free wall thickness, CH was associated with RA reservoir and conduit function via 2DE area-length method, whereas CH and EH were associated with RA reservoir and conduit function via 2D-STE and 3DE method. Further, CH was associated with RA booster pump function via 2DE area-length method, 2D-STE, and 3DE method. The RA volumes and phasic function varied with left ventricular geometry via multimodal echocardiography approach. CH had the apparent negative effect on RA phasic function.

The effect of obesity and subsequent weight reduction on cardiac morphology and function in cats

BackgroundIn people, obesity is a risk factor for cardiovascular disease, associated with systemic hypertension, cardiac remodelling and systolic and diastolic dysfunction. Weight reduction can reverse myocardial remodelling and reduce risk of subsequent cardiovascular disease. In cats, far less is known regarding the effects of obesity and subsequent weight reduction on cardiovascular morphology and function. This prospective study aimed to assess cardiac morphology and function, heart rate variability, cardiac biomarkers and body composition before and after controlled weight reduction in cats with obesity. Body composition analysis (by dual energy x-ray absorptiometry, DEXA) and cardiovascular assessment (echocardiography, systemic arterial systolic blood pressure, electrocardiography, plasma cardiac biomarkers) were performed prior to weight management in twenty cats with obesity. These investigations were repeated in eleven cats that reached target weight.ResultsAt baseline, systemic hypertension was not documented, but the majority of cats with obesity (15 out of 19) showed echocardiographic evidence of diastolic dysfunction. Eleven of 20 cats had increased maximal end-diastolic septal or left ventricular free wall thickness (≥ 6.0 mm) at baseline. Median (interquartile range) percentage of weight lost in the cats reaching target weight was 26% (17–29%), with a median reduction in body fat mass of 45% (26–64%). Both the end-diastolic left ventricular free wall (median magnitude of change -0.85 mm, IQR -0.05 mm to -1.55 mm, P = 0.019; median percentage reduction 14.0%) and end-diastolic interventricular septum (median magnitude of change -0.5 mm, IQR -0.2 mm to -1.225 mm, P = 0.047; median percentage reduction 7.9%) thickness decreased after weight reduction. Following weight reduction, pulsed wave tissue Doppler imaging of the left ventricular free wall was consistent with improved diastolic function in 4 out of 8 cats, however there was no significant difference in overall diastolic function class. Further, there was no change in heart rate variability or cardiac biomarkers with weight reduction.ConclusionAn increase in left ventricular wall thickness and diastolic dysfunction were common echocardiographic features in cats with obesity within our study and may be reversible with successful weight and fat mass loss. Further studies are required to clarify the clinical consequences of these findings.

Comparison of cardiovascular metrics on computed tomography pulmonary angiography of the updated and old diagnostic criteria for pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension.

In the 2022 European Society of Cardiology (ESC) and the European Respiratory Society (ERS) guidelines, the diagnostic criteria for pulmonary hypertension (PH) included a reduced mean pulmonary artery pressure (mPAP) of 20 mmHg (mPAP >20 mmHg). This study aimed to reassess cardiovascular metrics on computed tomography pulmonary angiography (CTPA) for chronic thromboembolic pulmonary hypertension (CTEPH) to optimize the timely diagnosis of patients with suspected PH. Patients with suspected CTEPH who underwent CTPA and right heart catheterization (RHC) between January 2019 and December 2022 in China-Japan Friendship Hospital were retrospectively included. They were grouped into CTEPH and non-PH groups according to the new and old criteria (2022 and 2015 ESC/ERS guidelines) for the diagnosis of PH. Cardiovascular metrics including the main pulmonary artery diameter (MPAd), Cobb angle, and right ventricular free wall thickness (RVWT), among others, were measured. The correlation of these metrics with hemodynamic data was analyzed with Spearman rank correlation analysis, while the differences in cardiovascular metrics between the updated (mPAP >20 mmHg) and old PH criteria (mPAP ≥25 mmHg) were compared with independent samples t-test or the Mann-Whitney test. Receiver operator characteristic (ROC) curve analysis was performed for the prediction model. The study enrolled 180 patients (males n=86; age 55.5±12.0 years old). According to the old guidelines, 119 patients were placed into the PH group (mPAP ≥25 mmHg) , while according to the new guidelines, 130 patients were placed into the PH group (mPAP >20 mmHg). Cardiovascular metrics on CTPA between the updated and old guidelines were comparable (P>0.05). Compared to other metrics, an MPAd of 30.4 mm exhibited the highest area under the curve (AUC: 0.934±0.021), with a sensitivity of 0.88 and specificity of 0.90. MPAd [odds ratio (OR) =1.271], transverse diameter of the right ventricle (RVtd; OR =1.176), Cobb angle (OR =1.108), and RVWT (OR =3.655) were independent factors for diagnosing CTEPH (P<0.05). Cobb angle, right and left ventricular transverse diameter ratio, and right and left ventricular area ratio moderately correlated with mPAP (r=0.586, r=0.583, r=0.629) and pulmonary vascular resistance (PVR) (r=0.613, r=0.593, r=0.642). Cardiovascular metrics on CTPA were comparable between the new and old guidelines for CTEPH diagnosis. Cardiovascular metrics on CTPA can noninvasively assess the hemodynamics of patients with CTEPH.

Intratracheally Administered Peptide-Modified Lipid Admixture Containing Fasudil and/or DETA NONOate Ameliorates Various Pathologies of Pulmonary Arterial Hypertension.

This study examined the therapeutic potential of a combination therapy using fasudil, a Rho-kinase inhibitor, and DETA NONOate (DN), a nitric oxide donor, delivered as a lipid admixture modified with a cyclic homing peptide known as CAR (CAR-lipid mixture) for the treatment of pulmonary arterial hypertension (PAH). CAR-lipid mixtures were initially prepared via a thin-film hydration method and then combined with fasudil, DN, or a mixture of both. The therapeutic efficacy of this drug-laden lipid mixture was evaluated in a Sugen/Hypoxia (Su/Hx) rat model of PAH by measuring RV systolic pressure (RVSP), mean pulmonary arterial pressure (mPAP), Fulton indices, and assessing right ventricular (RV) functions, as well as evaluating pulmonary vascular morphology. Rats that received no treatment exhibited increases in RVSP, mPAP, Fulton indices, and changes in RV functional parameters. However, the treatment with the CAR-lipid mixture containing either fasudil or DN or a combination of both led to a decline in mPAP, RVSP, and Fulton indices compared to saline-treated rats. Similarly, rats that received these treatments showed concurrent improvement in various echocardiographic parameters such as pulmonary acceleration time (PAT), tricuspid annular plane systolic excursion (TAPSE), and ventricular free wall thickness (RVFWT). A significant decrease in the wall thickness of pulmonary arteries larger than 100 µm was observed with the combination therapy. The findings reveal that fasudil, DN, and their combination in a CAR-modified lipid mixture improved pulmonary hemodynamics, RV functions, and pathological alterations in the pulmonary vasculature. This study underscores the potential of combination therapy and targeted drug delivery in PAH treatment, laying the groundwork for future investigations into the optimization of these treatments, their long-term safety and efficacy, and the underlying mechanism of action of the proposed therapy.

Cardiovascular metrics on CT pulmonary angiography in patients with pulmonary hypertension — re-evaluation under the updated guidelines of pulmonary hypertension

PurposeTo re-assess cardiovascular metrics on computed tomography pulmonary angiography (CTPA) in predicting pulmonary hypertension (PH) under the 2022 ESC/ERS guidelines.Materials and methodsThis observational study retrospectively included 272 patients (female 143, mean age = 54.9 ± 12.5 years old) with suspected PH. 218 patients were grouped to evaluate cardiovascular metrics on CTPA and develop a binary logistic regression model. The other 54 patients were grouped into the validation group to assess the performance of the prediction model under the updated criteria. Based on mean pulmonary artery pressure (mPAP), patients were divided into three groups: group A consisted of patients with mPAP ≤ 20 mmHg, group B included patients with 20 mmHg < mPAP < 25 mmHg, and group C comprised patients with mPAP ≥ 25 mmHg. Cardiovascular metrics among the three groups were compared, and receiver operating characteristic curves (ROCs) were used to evaluate the performance of cardiovascular metrics in predicting mPAP > 20 mmHg.ResultsThe main pulmonary arterial diameter (MPAd), MPAd/ascending aorta diameter ratio (MPAd/AAd ratio), and right ventricular free wall thickness (RVFWT) showed significant differences among the three groups (p < 0.05). The area under curve (AUC) of MPAd was larger than MPAd/AAd ratio and RVFWT. A MPAd cutoff value of 30.0 mm has a sensitivity of 83.1% and a specificity of 90.4%. The AUC of the binary logistic regression model (Z = − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was 0.938 ± 0.018. In the validation group, the AUC, sensitivity, specificity, and accuracy of the prediction model were 0.878, 92.7%, 76.9%, and 88.9%, respectively.ConclusionUnder the updated criteria, MPAd with a threshold value of 30.0 mm has better sensitivity and specificity in predicting PH. The binary logistic regression model may improve the diagnostic accuracy.Critical relevance statementUnder the updated criteria, the main pulmonary arterial diameter with a threshold value of 30.0 mm has better sensitivity and specificity in predicting pulmonary hypertension. The binary logistic regression model may improve diagnostic accuracy.Key points• According to 2022 ESC/ERS guidelines, a MPAd cutoff value of 30.0 mm has better sensitivity and specificity in predicting mPAP > 20 mmHg• A binary logistic regression model (Z = − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was developed and had a sensitivity, specificity, and accuracy of 92.7%, 76.9%, and 88.9% in predicting mPAP > 20 mmHg.• A binary logistic regression prediction model outperforms MPAd in predicting mPAP > 20 mmHg.Graphical

Echocardiography machine learning based to improve detection of transthyretin cardiac amyloidosis: The R3M Algorithm

Transthyretin cardiac amyloidosis (ATTR-CA) is an emerging cause of heart failure. The screening of ATTR-CA remains difficult since its echocardiographic features are analogous to those observed in patients with age- and hypertension-related cardiac remodeling. We retrospectively included 264 patients (76 ± 13 years old, 59% male) referred for suspected ATTR-CA. A supervised machine learning diagnosis algorithm differentiating patients with (n = 112) and without (n = 152) ATTR-CA was constructed based on echocardiographic data, and subsequently validated in an external multicenter cohort of 455 patients (76 ± 13 years old, 61% male). Patients with ATTR-CA had a lower systolic function (LVEF 47.4 ± 11 vs. 54.3 ± 12%, P < 0.001), left ventricular (LV) global longitudinal strain (GLS) (11.0 ± 3.7 vs. 14.2 ± 4.5%, P < 0.001) and more significant relative apical longitudinal sparing (RALS) (1.5 ± 1.2 vs. 0.9 ± 0.4, P < 0.001) compared to controls. Machine learning identified right ventricular free wall thickness (RVFWT), RALS, relative wall thickness (RWT), and LV mass index as key variables for identifying ATTR-CA (AUC 0.88 [0.84–0.92]; P < 0.001). The diagnostic value of this R3M (RVFWT, RALS, RWT and LV Mass index) algorithm was good in the validation multicenter cohort with an AUC of 0.79 [0.75–0.83] P < 0.001. The R3M algorithm further improved diagnostic accuracy over the IWT (Increased Wall Thickness) guidelines score (increase in C-index of 0.15 [0.10–0.21], P < 0.001). The simple R3M algorithm based on echocardiographic data exploring RVFWT, apical sparing, and concentric hypertrophy displays good diagnostic accuracy for ATTR-CA and could represent an efficient screening tool (Fig. 1).

Cardiac structural and functional remodeling in the fetuses associated with maternal hypothyroidism during pregnancy

Objectives We sought to investigate the effect of maternal hypothyroidism during pregnancy on fetal cardiac structural and functional remodeling using fetal echocardiography. Methods A total of 59 pregnant women with history of hypothyroidism were prospectively enrolled as the study group, and 74 normal fetuses as the control group. Fetal echocardiography was performed on each subject. Demographic, clinical, and fetal echocardiographic variables were measured, including left ventricular (LV) and right ventricular (RV) free wall and ventricular septal thickness, fractional shortening (FS), stroke volume (SV), cardiac output (CO), combined cardiac output (CCO), cardiac index (CI), combined cardiac index (CCI), aortic and pulmonary artery velocity, ductus venosus (DV) and pulmonary vein (PV) spectral Doppler, and Tei index. Results The incidence of echogenic intracardiac foci (EIF) was higher in the study group than that in the control group (18.6% vs. 6.8%, p = .036). The thickness of LV free wall and interventricular septum was reduced, the pulmonary velocities and CCI, RV FS, CO, and CI were lower, the S, D, S/A, and pulsatility index (PI) of DV were higher, and LV Tei index was higher in the study group compared with the control group. There was no significant difference in other variables between the two groups. Conclusions There is cardiac remodeling, and systolic, diastolic functional alterations in fetuses with maternal hypothyroidism. Further investigation is warranted to develop strategies to optimize the outcome of these fetuses.

Echocardiographic findings in subjects with an amyloidogenic apolipoprotein A1 pathogenic variant

Background Very small case series of patients with apolipoprotein A1 (ApoA1) amyloidosis are available. Methods We described the clinical and echocardiographic characteristics of individuals with the pathogenic APOA1 variant Leu75Pro (p. Leu99Pro), referred for cardiac screening. Results We enrolled 189 subjects, 54% men, median age 55 years (interquartile range 42–67), 39% with concomitant renal disease and 31% with liver disease. Median left ventricular ejection fraction was 60% (55–66). Overall, these subjects did not show overt diastolic dysfunction nor left ventricular (LV) hypertrophy. Age correlated with interventricular septal (IVS) thickness (r = 0.484), LV mass index (r = 0.459), E/e’ (r = 0.501), and right ventricular free wall thickness (r = 0.594) (all p < 0.001). Some individuals displayed red flags for cardiac amyloidosis (CA), and 14% met non-invasive criteria for CA. Twenty-nine subjects died over 5.8 years (4.1–8.0), with 10 deaths for cardiovascular causes. Individuals meeting echocardiographic criteria for CA had a much higher risk of all-cause death (p = 0.009), cardiovascular death (p = 0.001), cardiovascular death or heart failure (HF) hospitalisation (p < 0.001). Subjects with both renal and liver involvement had a more prominent cardiac involvement, and shortest survival. Conclusions Subjects with the APOA1 Leu75Pro variant displayed minor echocardiographic signs of cardiac involvement, but 14% met echocardiographic criteria for CA. Subjects with suspected CA had a worse outcome.

Echocardiographic evaluation of right heart pressure changes in healthy newborns and its follow-up till 12 weeks of life

Background: Right ventricular (RV) pressure undergoes a series of changes from foetal to neonatal period on both left and right heart. Pulmonary velocity acceleration time (PVAccT) measured by trans-thoracic echocardiography has been established as a reliable indicator of RV pressure measurement in neonates. This study aims to throw some light into the changes in the RV pressure by serial PVAccT measurements in the initial 12 weeks of life. Materials and Methods: A cross sectional study was carried out among term new-borns until 12 weeks of age and serial changes in the PVAccT values were recorded, reflecting the mean pulmonary artery pressure (MPAP), and the left ventricular internal diastolic diameter (LVIDD), left atrial diameter (LAD), right ventricular outflow tract (RVOT), right ventricular free wall thickness (RVFWT). Results: There was gradual increase in the mean value of PVAccT with age from birth i.e., 1-3 days (70.08±18.62ms) to 3 months (86.23±17.31ms) (p=&lt;0.05). Mean value of right ventricular outflow tract proximal diameter was also seen to have an increase from day 1-3 (0.92±0.19cm) to 3 months of age (1.09±0.01cm) (p= &lt;0.001). There was an overall decrease in the mean value of the RVFWT from day 1-3 (0.37±.07 cm) to 3 months (0.27±0.07cm) of age after an increase at 1 month (p=&lt;0.05). Statistically significant increase in mean LAD from 1.18±0.29cm to 1.40±0.35 cm and LVIDD from 1.54±0.31cm to1.96±0.27 was seen from birth to 3 months of age. Conclusion: Changes in PVAcct and RV pressure with time from birth to 3 months of age will aid in early diagnosis of persistent pulmonary artery hypertension of new-born (PPHN) or pulmonary arterial hypertension (PAH).

Influence of Dorper lamb development from birth to 120 days of age on clinical and echocardiographic parameters

The expansion of the sheep model in research represents an attractive and economically beneficial academic reason for investigations in sheep echocardiography. The present study aimed to evaluate the clinical and echocardiographic parameters in Dorper lambs during the developmental period. Emphasis was placed on the use of the species in translational research for the echocardiographic diagnosis of congenital heart diseases, which can contribute to improvements in interventionist techniques. Ten Dorper lambs were evaluated at the following time points: 24 h after birth and 7, 14, 21, 30, 60, 90 and 120 days of age. Clinical parameters were compiled, and echocardiogram records were obtained without sedation. Rectal temperature was lower on the first day compared to the others. From 21 days of life, there was a reduction in HR, with differences between time points. Mean and systolic blood pressure differed, with the highest values at 90 and 120 days of age. The thickness of the interventricular septum in diastole (IVSd) increased as age progressed, with the highest value at 120 days of age, and the same occurred for LVIDd (left ventricle internal diameter in diastole), LVFWd (left ventricular free wall thickness in diastole), IVSs (interventricular septum thickness in systole), LVIDs (left ventricle internal diameter in systole) and LVFWs (left ventricular free wall thickness in systole). There were differences in the size of the LA, Ao and LA/Ao ratio, which were greater at 90 days and 120 days of age. Echocardiographic changes accompany the development of lambs, where changes in echocardiographic parameters are evident with advancing age. The echocardiographic measurements in lambs obtained in the present study are similar to those in newborns.

Assessment of right ventricular functions in acromegaly: comparison of active disease with remission.

Aim Cardiac involvement in acromegaly is defined as acromegalic cardiomyopathy, an insidious and chronic disease. Previous research on acromegalic cardiomyopathy was largely focused on morphological and functional assessment of the left heart. Since the literature data regarding right heart function in acromegalic patients are limited, we aimed to evaluate the structure and function of the right heart in such patients.Material and Methods We included 43 adult participants as the acromegaly group and 42 individuals as the control group. All patients underwent echocardiographic evaluation. The results were compared between acromegaly and control groups and between active and controlled acromegaly groups.Results The acromegaly group had increased interventricular septum thickness, right ventricular (RV) free wall thickness, right atrium (RA) minor diameter, RV basal and longitudinal diameters, RV end-diastolic and end-systolic areas, E / E' ratio, isovolumetric relaxation time, and RV ejection time. The E / A ratio and E' velocity were reduced. GH and IGF-1 were positively correlated with RV longitudinal diameter, indexed RA minor-axis dimension, and indexed RV end-diastolic area. Patients with active acromegaly had increased RV index of myocardial performance (RVIMP) and isovolumetric contraction time and shortened RV ejection time compared to patients in remission. A RVIMP value of 0.435 predicted active acromegaly with a sensitivity and specificity of 0.83 and 0.64, respectively (p=0.002).Conclusions Increases in the size and diameters of the right heart chambers along with RV free wall thickness may be attributed to acromegalic cardiomyopathy. RVIMP, isovolumetric contraction time, and ejection time are parameters that can be used in the evaluation of active acromegaly disease.

Cardiovascular changes in horses with atrial fibrillation and high thyroid hormone concentration: a case–control study

IntroductionHyperthyroidism is a predisposing factor for atrial fibrillation (AF) in humans. The relationship between high thyroid hormone (TH) and AF in horses has not been evaluated. ObjectivesThe aim of this study is to identify whether (1) high TH concentrations were present in horses with AF, (2) other cardiovascular effects were observed in horses with high TH and AF, and (3) TH status affected recurrence rate. AnimalsTwenty-three horses presented with naturally occurring AF. MethodsProspective case–control clinical study. Thyroid hormone concentration was measured in horses presenting with AF. Heart rate, electrocardiogram, blood pressure, and an echocardiogram were recorded as part of their clinical workup. Recurrence rate was determined by owner/veterinarian follow-up. ResultsHigh TH concentration was found in 60% of horses with AF. Horses in the high TH group had a higher heart rate (P=0.001), systolic blood pressure (P=0.019), left ventricular free wall thickness (P=0.026), relative wall thickness (P=0.041) and were more likely to have periods of AF with a rapid ventricular response rate (P=0.022). All horses were successfully converted to normal sinus rhythm. The likelihood of recurrence was not different between groups. ConclusionElevated TH concentration can be found in horses with AF. Other cardiovascular effects of high TH concentrations in other species were also present in horses with AF and elevated TH concentrations. This study recommends measuring TH concentrations in horses presenting for AF with a history of thyroid or iodine supplementation. This study also cautions against TH or iodine supplementation in healthy performance horses.

Assessment of cardiac dimensions in children diagnosed with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is an inherited autosomal dominant heart disease, characterized by increased left ventricular wall thickness and abnormal loading conditions. Imaging modalities are the first choice for diagnosis and risk stratification. Although heart dimensions have been characterized widely in HCM adults from cardiac imaging, there is limited information about children affected by HCM. The aim of this study is to evaluate left ventricular function and left heart dimensions in a small population of children diagnosed with HCM. A total of 16 (seven male, nine female) pediatric patients with an average age of 14.0±2.5 years diagnosed with HCM at Great Ormond Street Hospital for Children were included in this study. Cardiac magnetic resonance (CMR) images were used to measure left and right ventricular dimensions, and septal and left ventricular free wall thicknesses in Simpleware ScanIP. The gender groups were compared using student t-test or non-parametric Mann-Whitney U-test depending on the sample distribution. Differences in heart rate, left ventricular end-diastolic volume and end-diastolic volume index, left ventricular stroke volume and stroke volume index, left ventricular end-systolic long axis length, left ventricular end-systolic long axis length index, left ventricular end-diastolic mid-cavity diameter, left ventricular end-diastolic free wall thickness, left ventricular end-diastolic free wall thickness index, right ventricular end-diastolic long axis length were statistically significant in males and females. Left ventricular wall and intraventricular septal thickness increase affecting left ventricle cavity dimensions and there may be differences in anatomical and physiological parameters in males and females affected by HCM.

P286 ECHOCARDIOGRAPHIC FINDINGS IN SUBJECTS WITH AN AMYLOIDOGENIC APOLIPOPROTEIN A1 MUTATION

Abstract Background The APOA1 gene encodes the precursor of apolipoprotein AI (ApoAI), whose mature form is the major component of high–density lipoproteins. APOA1 mutations may cause a form of hereditary amyloidosis (AApoAI). Only very small case series of patients with AApoAI are available. Methods We examined 189 consecutive subjects with the heterozygous APOA1 Leu75Pro mutation referred for cardiac screening over a 10–year timespan at the Spedali Civili of Brescia (Italy). Results Subjects (men 54%, median age 55 years, renal disease 39%, liver disease 31%) had a median left ventricular ejection fraction (LVEF) of 60% (55–66), did not display a prominent diastolic dysfunction (E/e’ ratio 7 [6–10]) nor LV hypertrophy (LV mass index [LVMI] 92 g/m2 [74–111]). LV global longitudinal strain (GLS) (–19% [–21 to –17]), and mass to strain ratio (MSR) (10.0 [6.8–12.1]) were within normal limits. Age correlated with several echocardiographic parameters, including interventricular septal (IVS) thickness (r = 0.484), LVMI (r = 0.459), E/e’ (r = 0.501), and right ventricular free wall thickness (r = 0.459) (all p &amp;lt; 0.001). Some individuals displayed echocardiographic red flags of cardiac amyloidosis (CA; “granular sparkling” of the IVS, 19%; pericardial effusion, 11%; apical sparing, 10%; thickened atrioventricular valves, 8%). Thirteen out of 96 (14%) fulfilled non–invasive criteria for CA. Twenty–nine subjects died over 5.8 years (4.1–8.0), with 10 deaths for cardiovascular causes; 14 out of 182 (8%) were hospitalized because of HF, and 17 (9%) died for cardiovascular causes or were hospitalized for HF. Individuals with suspected CA had a much higher risk of all–cause death (p = 0.009), cardiovascular death (p &amp;lt; 0.001), cardiovascular death or HF hospitalization (p &amp;lt; 0.001), and HF hospitalization alone (p &amp;lt; 0.001). Furthermore, subjects with either renal or liver involvement had a higher risk of events and a worse outcome. Conclusions In subjects with an amyloidogenic APOA1 mutation, transthoracic echocardiography showed only minor signs of cardiac disease. The correlations between age and echocardiographic findings suggested a progressive increase in wall thickness, a decline in systolic and diastolic function, and a greater uncoupling between LV mass and contractility over time. Subjects with both renal and liver disease displayed the most evident signs of biventricular involvement and had a worse outcome.

Lack of right ventricular hypertrophy is associated with right heart failure in patients with left ventricular failure.

Presence of right heart failure (RHF) is associated with a worse prognosis in patients with left ventricular failure (LVF). While the cause of RHF secondary to LVF is multifactorial, an increased right ventricular (RV) afterload is believed as the major cause of RHF. However, data are scarce on the adaptive responses of the RV in patients with LVF. Our aim was to understand the relationship of right ventricular hypertrophy (RVH) with RHF and RV systolic and diastolic properties in patients with LVF. 55 patients with a left ventricular ejection fraction of 40% or less were included in the present study. A comprehensive two-dimensional transthoracic echocardiographic examination was done to all participants. 12 patients (21.8%) had RHF, and patients with RHF had a significantly lower right ventricular free wall thickness (RVFWT) as compared to patients without RHF (5.3 ± 1.7mm vs. 6.6 ± 0.9mm, p = 0.02) and the difference remained statistically significant after adjusting for confounders (Δx̅:1.34mm, p = 0.002). RVFWT had a statistically significant correlation with tricuspid annular plane systolic excursion (r = 0.479, p < 0.001) and tricuspid annular lateral systolic velocity (r = 0.360, p = 0.007), but not with the indices of the RV diastolic function. None of the patients with concentric RVH had RHF, while 22.2% of patients with eccentric RVH and 66.7% of patients without RVH had RHF (p < 0.01 as compared to patients with concentric RVH). In patients with left ventricular systolic dysfunction, absence of RVH was associated with worse RV systolic performance and a significantly higher incidence of RHF.

Congestive Hepatopathy Secondary to Right Ventricular Hypertrophy Related to Monocrotaline-Induced Pulmonary Arterial Hypertension.

Heart dysfunction and liver disease often coexist. Among the types of cardiohepatic syndrome, Type 2 is characterized by the chronic impairment of cardiac function, leading to chronic liver injury, referred to as congestive hepatopathy (CH). In this study, we aimed to establish a rat model of CH secondary to right ventricular hypertrophy (RVH) related to monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Fifty male Wistar rats were divided into four groups and randomly assigned to control and experimental groups. Three experimental groups were submitted to intraperitoneal MCT inoculation (60 mg/kg) and were under its effect for 15, 30 and 37 days. The animals were then sacrificed, obtaining cardiac and hepatic tissues for anatomopathological and morphometric analysis. At macroscopic examination, the livers in the MCT groups presented a nutmeg-like appearance. PAH produced marked RVH and dilatation in the MCT groups, characterized by a significant increase in right ventricular free wall thickness (RVFWT) and chamber area. At histological evaluation, centrilobular congestion was the earliest manifestation, with preservation of the hepatocytes. Centrilobular hemorrhagic necrosis was observed in the groups exposed to prolonged MCT. Sinusoidal dilatation was markedly increased in the MCT groups, quantified by the Sinusoidal Lumen Ratio (SLR). The Congestive Hepatic Fibrosis Score and the Centrilobular Fibrosis Ratio (CFR) were also significantly increased in the MCT30 group. Hepatic atrophy, steatosis, apoptotic bodies and, rarely, hydropic swelling were also observed. SLR correlated strongly with CFR and RVFWT, and CFR correlated moderately with RVFWT. Our rat model was able to cause CH, related to monocrotaline-induced PAH and RVH; it was feasible, reproducible, and safe.

An Echocardiographic Study of Right Ventricular Morphology and Function in Systemic Hypertension.

Background and Aims: Hypertension is a common medical condition that leads to increased risk of cardiovascular conditions including coronary artery disease, heart failure, stroke, renal diseases, blindness and cardiovascular death. Long term hypertension will affect left ventricle by hypertrophy and several functional derangements. Since heart works as a unit, right heart changes are expected. Right ventricular dysfunction has a strong prognostic significance and we aim to study right ventricular parameters in hypertensive patients.&#x0D; Methods: We studied 71 hypertensive subjects and 66 matched control without hypertension in echocardiography laboratory for chamber dimensions and right ventricular systolic and diastolic parameters.&#x0D; Results: The right ventricular free wall thickness (5.46±1.97mm vs 4.77±0.81mm; P=0.01) and interventricular septal thickness (11.62±2.64mm vs 9.10±1.16mm; P&lt;0.01) were significantly higher among hypertensive patients. Right ventricular dimensions namely basal diameter (26.41±4.97mm vs 29.16±5.22mm; P&lt;0.01), mid-ventricular diameter (25.83±4.40mmvs 27.44±5.05mm; P=0.05) and right ventricular long-axis length (69.54±7.08 mm vs 73.28±7.08mm; P&lt;0.01) were significantly low among hypertensive patients. Tricuspid Annular Plane Systolic Excursion (TAPSE) was significantly lower among hypertensive patients (18.84±1.85mm vs control 20.54±2.65mm; P&lt;0.01). A significant statistical correlation was found between mitral E/A ratio and tricuspid E/A ratio (R2 linear=0.78, P=0.01).&#x0D; Conclusion: The effect of hypertension in right ventricular structure and function are found to be subtle but definite as seen in diastolic wave velocities, right ventricular wall thickness, internal chamber dimensions and TAPSE. Assessment of hypertensive effect on heart will help to control hypertension in stringent way.