Ventricular Motion Research Articles

Takotsubo Cardiomyopathy After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for a Recurrent Colon Cancer: A Life-Threatening Complication

(1) Background: Takotsubo cardiomyopathy, or stress cardiomyopathy, is an acute heart failure condition with transient left ventricular (LV) motion abnormalities but no significant coronary artery obstruction. It mimics acute coronary syndrome (ACS), with symptoms like chest pain, dyspnea, and ECG changes. (2) Case Report: We present the case of a 44-year-old female with relapsed colon cancer and peritoneal carcinomatosis. After undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), she experienced cardiac arrest from ventricular fibrillation 18 h postoperatively. Echocardiography revealed a reduced LV ejection fraction (20%) and apical akinesia, suggesting a Takotsubo Cardiomyopathy. Intensive resuscitation and inotropic support led to gradual recovery. Coronary angiography confirmed no coronary artery obstruction. (3) Discussion: This case highlights TTS as a rare but severe complication following major oncological surgeries, possibly triggered by both physical and emotional stressors. TTS should be considered in the differential diagnosis of perioperative cardiac events in cancer patients. (4) Conclusions: Prompt recognition and management of TTS in the perioperative period are crucial to improving outcomes, especially in high-risk oncological patients undergoing extensive surgeries.

Speckle tracking echocardiography for evaluation of myocardial functions before and after mitral valvuloplasty in dogs

BackgroundMyxomatous mitral valve disease (MMVD) is the most common acquired heart disease in dogs. Mitral valvuloplasty (MVP) addresses regurgitation, but the pre- and postoperative changes in myocardial function remain uncertain.ObjectivesThis study evaluated myocardial motion before and after MVP using two-dimensional speckle-tracking echocardiography (2D-STE).AnimalsEight client-owned dogs undergoing MVP for MMVD.MethodsMyocardial deformation was assessed by 2D-STE before surgery and at 1- and 3-months post-surgery. Measurements included left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), cardiac twist, and right ventricular free wall GLS (RVFW-GLS).ResultsPostoperative decreases were observed in left ventricular internal dimensions, left atrial size, and early diastolic myocardial velocity, with an increase in peak late diastolic velocity. LV-GLS decreased at 1 month (−14.4%) and 3 months (−16.3%) compared to preoperative values (−24.4%) (p = 0.0078, p = 0.015). GCS decreased at 1 month (−12.9%) and 3 months (−14.8%) compared to preoperative values (−21.7%) (p = 0.0078). GRS decreased at 1 month (27.7%) and 3 months (32.0%) compared to preoperative values (67.7%) (p = 0.0078). No significant changes were observed in RVFW-GLS. Peak systolic twist increased at 3 months (9.1° vs. 4.9°, p = 0.039). Peak systolic apical rotation showed an upward trend at 3 months (p = 0.109). Left ventricular twist was mildly affected by LVIDd, LVIDDN, and sphericity index (R2 = 0.187, p = 0.034; R2 = 0.33, p = 0.0029; R2 = 0.22, p = 0.019).Conclusions and clinical importancePostoperative myocardial motion approached reference values, indicating significant improvement, particularly in left ventricular twisting motion. These findings highlight the positive impact of surgery on cardiac function in dogs with MMVD.

Clinical analysis of maternal autoantibody-mediated complete left bundle branch block in 9 children

Objective: To analyze the clinical characteristics, treatment, and outcomes of children with complete left bundle branch block (CLBBB) mediated by maternal autoantibodies. Methods: A retrospective analysis was conducted on nine children diagnosed with maternal autoantibody-mediated CLBBB, treated at Beijing Anzhen Hospital and Fujian Provincial Hospital from March 2015 to August 2023. Their clinical characteristics, electrocardiographic and echocardiographic findings before and after treatment were reviewed. Paired sample t-test was used for inter-group comparison. Results: Among the mothers, 6 had positive antinuclear antibodies (ANA), 5 had anti-Sjogren syndrome antigen A antibodies, and 3 had anti-Ro-52 antibodies. The cohort included one female and eight male children, diagnosed with CLBBB at the age of 1 (2, 13) months. The positive autoantibodies in the infants, consisted with maternal antibodies, were detected within the first 3 months of life among 3 cases. Treatments included anti-heart failure therapy, myocardial nutritional support, intravenous immunoglobulin (IVIG) and glucocorticoids. Before treatment, the levels of troponin I (0.175 (0.060, 10.270) μg/L) and N-terminal pro-B-type natriuretic peptide (420 (327, 12 865) ng/L) were elevated, which normalized in most cases after treatment. Post-treatment, the QRS duration significantly shortened compared to pre-treatment ((137±15) vs.(169±25) ms, t=3.76, P<0.001), and the QTc interval significantly decreased ((433±41) vs. (514±27) ms, t=4.95, P=0.001). Before treatment, varying degrees of mitral and tricuspid regurgitation and marked interventricular septal dyskinesia were observed in echocardiography. After treatment, valve regurgitation and ventricular septum motion significantly improved, with a marked increase in left ventricular ejection fraction ((51±13)% vs. (27±6)%, t=-6.66, P<0.001). Conclusions: Maternal autoantibody-mediated CLBBB in children presents with chronic heart failure in infancy. Early treatment with anti-heart failure medications, IVIG and glucocorticoids can improve clinical symptoms.

Tetralogy of Fallot regurgitation energetics and kinetics: an intracardiac flow analysis of the right ventricle using computational fluid dynamics.

Repaired Tetralogy of Fallot (rTOF) patients suffer from pulmonary regurgitation and may require pulmonary valve replacement (PVR). Cardiac magnetic resonance imaging (cMRI) guides therapy, but conventional measurements do not quantify the intracardiac flow effects from pulmonary regurgitation or PVR. This study investigates intracardiac flow parameters of the right ventricle (RV) of rTOF by computational fluid dynamics (CFD). cMRI of rTOF patients and controls were retrospectively included. Feature-tracking captured RV endocardial contours from long-axis/short-axis cine. Ventricular motion was reconstructed via diffeomorphic mapping, serving as domain boundary for CFD simulations. Vorticity (1/s), viscous energy loss (ELoss, mJ/L) and turbulent kinetic energy (TKE, mJ/L) were quantified in RV outflow tract (RVOT) and RV inflow. These parameters were normalized against total RV kinetic energy (KE) and RV inflow vorticity to derive dimensionless metrics. Vorticity contours by Q-criterion were qualitatively compared. rTOF patients (n = 15) had mean regurgitant fraction 38 ± 12% and RV size 162 ± 35mL/m2. Compared to controls (n = 12), rTOF had increased RVOT vorticity (142.6 ± 75.6/s vs. 40.4 ± 11.8/s, p < 0.0001), Eloss (55.6 ± 42.5 vs. 5.2 ± 4.4mJ/L, p = 0.0004), and TKE (5.7 ± 5.9 vs. 0.84 ± 0.46mJ/L, p = 0.0003). After PVR, there was decrease in normalized RVOT Eloss/TKE (p = 0.0009, p = 0.029) and increase in normalized tricuspid inflow vorticity/KE (p = 0.0136, p = 0.043), corresponding to reorganization of the "donut"-shaped tricuspid ring-vortex. The intracardiac flow in rTOF patients can be simulated to determine the impact of PVR and improve the clinical indications guided by cardiac imaging.

Kiosk 10R-TB-09 - Estimation of Left Ventricular Mass FBom Clinical Parameters and Cardiac Motion Features by Leveraging Machine Learning

Kiosk 10R-TB-09 - Estimation of Left Ventricular Mass FBom Clinical Parameters and Cardiac Motion Features by Leveraging Machine Learning

De novo Biological Coronary Artery Bypass in a Rat Model: Case Report and the Concept of Hybrid Cardiovascular Regeneration

Background: Peripheral blood mononuclear cell-derived progenitor cells (regeneration associated cells: RACs) have been reported to migrate to tissues with inflammation to expedite anti-inflammatory and pro-regeneration actions, but cell sources, administration, timing, dosage, and combined procedures after myocardial ischemia and/or infarction (MI) still remain to be elucidated in preclinical studies. Materials and Methods: Rats with induced MI were treated with intravenous infusion of 5-day culture-primed autologous RACs or control cell transfusion, followed by weekly echocardiography until 4 weeks after MI, at which time pressure-volume relationship (PVR) analyses and histological studies were performed. Results: While most rats treated with autologous RACs infusion after MI developed vascular regeneration from surrounding pericardial tissues and significant functional improvements, one rat developed a de novo coronary artery bypass (φ&lt; 0.3 mm) mimicking surgical bypass grafting (CABG), echocardiography revealed recovered left ventricular (LV) motion, and PVR analyses showed restored LV function as well as histological changes suggesting revascularization and myocardial regeneration. Conclusion: Development of isolated bypass-like structure by RAC therapy after MI led us to consider further surgical as well as biological modifications to expedite biological coronary revascularization and myocardial regeneration. A combination with vascular approaches to provide arterial inflow may increase the rate of complete revascularization and regeneration of cardiomyocytes as hybrid procedure, as they complement each other, to realize cardiovascular regeneration.

Multi-Task Learning for Motion Analysis and Segmentation in 3D Echocardiography.

Characterizing left ventricular deformation and strain using 3D+time echocardiography provides useful insights into cardiac function and can be used to detect and localize myocardial injury. To achieve this, it is imperative to obtain accurate motion estimates of the left ventricle. In many strain analysis pipelines, this step is often accompanied by a separate segmentation step; however, recent works have shown both tasks to be highly related and can be complementary when optimized jointly. In this work, we present a multi-task learning network that can simultaneously segment the left ventricle and track its motion between multiple time frames. Two task-specific networks are trained using a composite loss function. Cross-stitch units combine the activations of these networks by learning shared representations between the tasks at different levels. We also propose a novel shape-consistency unit that encourages motion propagated segmentations to match directly predicted segmentations. Using a combined synthetic and in-vivo 3D echocardiography dataset, we demonstrate that our proposed model can achieve excellent estimates of left ventricular motion displacement and myocardial segmentation. Additionally, we observe strong correlation of our image-based strain measurements with crystal-based strain measurements as well as good correspondence with SPECT perfusion mappings. Finally, we demonstrate the clinical utility of the segmentation masks in estimating ejection fraction and sphericity indices that correspond well with benchmark measurements.

Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study.

Cardiac abnormalities have been reported during ongoing seizures and refractory status epilepticus (RSE). Reduced heart rate variability (HRV) and cardiac arrhythmias may contribute to sudden unexpected death in epilepsy. We sought to explore the utility of electrocardiographic and echocardiographic changes in patients with RSE prognosis and functional outcome. Patients of RSE underwent electrocardiogram (ECG), holter, troponin-I (Trop I), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and 2-dimensional echocardiogram (2D Echo) along with continuous electroencephalogram in first 24 hours and admission. Heart rate changes/arrhythmias, corrected QT interval (QTc) and HRV, ventricular dysfunction or regional motion wall abnormality were studied on 2D Echo. These parameters were also at baseline, at discharge or death and 30 days post discharge. This prospective observational study conducted over 18 months enrolled 20 patients with RSE, fulfilling the inclusion criteria. Mean age was 47.75±17.2 years with male: female ratio of 1:1. Mean time to presentation from seizure onset was 8.80±7.024 hours. Central nervous system infection (35.0%), autoimmune encephalitis (20.0%) and cerebrovascular disease (20.0%) were the common etiologies. Amongst cardiac injury markers, cardiac enzymes and QTc prolongation were the commonest abnormalities in RSE. Both reduced HRV and presence of cardiac injury markers had significant correlation with poor outcome along with poor Glasgow coma scale (GCS) and modified Rankin scale (mRS) at presentation, and presence of non convulsive status epilepticus (NCSE). Presence of poor GCS, poor mRS, markers of cardiac injury, reduced HRV and occurrence of NCSE have a consistent correlation with mortality and poor clinical outcome. Therefore, routine assessment of cardiac abnormalities using affordable, easily accessible and non-invasive tools such as ECG, 2D Echo, holter NT-proBNP and Trop I is recommended in RSE patients.

Echocardiographic Characteristics of Left and Right Ventricular Longitudinal Function in Patients With a History of Cardiac Surgery

Previous studies have indicated a reduction in right ventricular (RV) longitudinal motion following cardiac surgery. However, the long-term effect of cardiac surgery on longitudinal motion and the involvement of left ventricular (LV) motion remain unclear. Therefore, this study aimed to comprehensively investigate the longitudinal function of the right ventricle and left ventricle in patients who had undergone cardiac surgery. The study included patients who underwent comprehensive transthoracic echocardiography (TTE) with three-dimensional RV data sets. By propensity score matching of clinical and echocardiographic variables, including LV and RV ejection fraction, the echocardiographic parameters were compared between patients with and without a history of cardiac surgery (the surgery and nonsurgery groups, respectively). In this study, the surgery group had significantly lower LV global longitudinal strain values than the nonsurgery group, despite having similar LV ejection fraction. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular velocity, and RV free wall longitudinal strain were also significantly smaller in the surgery group, whereas the RV ejection fraction was comparable between the 2 groups. Additionally, a subgroup analysis based on the time from previous surgery to TTE (≤1 and >1 year) revealed that TAPSE was reduced in both postoperative phases. In conclusion, LV and RV longitudinal parameters were reduced after cardiac surgery, despite preserved LV and RV global functions. Moreover, TAPSE was reduced even a long time following cardiac surgery. These findings emphasize the need for careful interpretation of biventricular longitudinal motion in patients with a history of cardiac surgery.

Antagonism of contractile forces in left ventricular hypertrophy: a diagnostic challenge for better pathophysiological and clinical understanding

Cardiac function is characterised by haemodynamic parameters in the clinical scenario. Due to recent development in imaging techniques, the clinicians focus on the quantitative assessment of left ventricular size, shape...

Effect of pulmonary regurgitation on cardiac functions based on a human bi-ventricle model

Background and objective: Assessing the severity of pulmonary regurgitation (PR) and identifying optimal clinically relevant indicators for its treatment is crucial, yet standards for quantifying PR remain unclear in clinical practice. Computational modelling of the heart is in the process of providing valuable insights and information for cardiovascular physiology research. However, the advancements of finite element computational models have not been widely applied to simulate cardiac outputs in patients with PR. Furthermore, a computational model that incorporates both the left ventricle (LV) and right ventricle (RV) can be valuable in assessing the relationship between left and right ventricular morphometry and septal motion in PR patients. To enhance our understanding of the effect of PR on cardiac functions and mechanical behaviour, we developed a human bi-ventricle model to simulate five cases with varying degrees of PR severity. Methods: This bi-ventricle model was built using a patient-specific geometry and a widely used myofibre architecture. The myocardial material properties were described by a hyperelastic passive constitutive law and a modified time-varying elastance active tension model. To simulate realistic cardiac functions and the dysfunction of the pulmonary valve in PR disease cases, open-loop lumped parameter models representing systemic and pulmonary circulatory systems were designed. Results: In the baseline case, pressures in the aorta and main pulmonary artery and ejection fractions of both the LV and RV were within normal physiological ranges reported in the literature. The end-diastolic volume (EDV) of the RV under varying degrees of PR was comparable to the reported cardiac magnetic resonance imaging data. Moreover, RV dilation and interventricular septum motion from the baseline to the PR cases were clearly observed through the long-axis and short-axis views of the bi-ventricle geometry. The RV EDV in the severe PR case increased by 50.3% compared to the baseline case, while the LV EDV decreased by 18.1%. The motion of the interventricular septum was consistent with the literature. Furthermore, ejection fractions of both the LV and RV decreased as PR became severe, with LV ejection fraction decreasing from 60.5% at baseline to 56.3% in the severe case and RV ejection fraction decreasing from 51.8% to 46.8%. Additionally, the average myofibre stress of the RV wall at end-diastole significantly increased due to PR, from 2.7±12.1 kPa at baseline to 10.9±26.5 kPa in the severe case. The average myofibre stress of the LV wall at end-diastole increased from 3.7±18.1 kPa to 4.3±20.3 kPa. Conclusions: This study established a foundation for the computational modelling of PR. The simulated results showed that severe PR leads to reduced cardiac outputs in both the LV and RV, clearly observable septum motion, and a significant increase in the average myofibre stress in the RV wall. These findings demonstrate the potential of the model for further exploration of PR.

P90 CAMPYLOBACTER JEJUNI–ASSOCIATED MYOCARDITIS: A RARE BACTERIAL TRIGGER OF ACUTE MYOCARDITIS

Abstract Introduction Acute myocarditis is an important cause of chest pain in the young, with potential acute arrhythmic and hemodynamic complications and possible evolution into chronic inflammatory cardiomyopathy. Even though multiple triggers can be recognized, bacterial infections are rarely associated with myocarditis in immunocompetent patients. Case report A 22–year–old Caucasian woman presented to the Emergency Department with stabbing chest pain exacerbated by breathing, for several hours, without fever. She experienced diarrhea and gastroenteric symptoms for 4 days. One year prior she experienced identical pain during an acute myocarditis episode, with no clear trigger. The patient’s father too suffered from myocarditis a few months earlier. She underwent routine blood tests with evidence of elevated troponin HS (peak 8000 ng/L) and PCR (82mg/L). ECG showed sinus rhythm and anterolateral concave ST elevation of a maximum of 2 mm. Echocardiography showed normal bi–ventricular dimensions, thickness, regional motion, and absence of pericardial effusion. MRI exhibited inferolateral subepicardial edema and late gadolinium enhancement (LGE). The previous MRI performed 6 months after the resolution of the previous myocarditis did not show any LGE or edema. We began empirical anti–inflammatory therapy with swift benefit. Due to the persistence of gastroenteric symptoms, fecal film array and coproculture were performed and resulted positive for Campylobacter Jejuni, treated with Azithromycin 500 mg/day for 3 days. Finally, considering the recurrent event and the family history of myocarditis in the father, a genetic test was planned to exclude a “hot phase” in the context of arrhythmogenic cardiomyopathy. Discussion Up to 80% of acute myocarditis has an infectious trigger. The recent 2020 consensus advises against routine serology unless specific pathogens are suspected. In the literature, Campylobacter Jejuni is reported as a trigger of various inflammatory diseases, including acute myocarditis. We suggest investigating the presence of this bacterium in stool in case of active gastroenteric symptoms and adding targeted antibiotic therapy in case of active bacterial infection. Previous case reports excluded viral in myocarditis patients positive for Campylobacter. This may support C. Jejuni’s causal role and not as an innocent bystander.

P175 PARADOXICAL RESPONSE DURING DOBUTAMINE STRESS ECHOCARDIOGRAPHY: A CASE REPORT

Abstract Background Dobutamine Stress Echo (DSE) is a test widely used in the diagnosis of ischemic heart disease. The purpose of the following work is to describe a clinical case with uncommon behaviour. Case Description: 63–year–old female with dyspnoea on mild exertion, and history of NSTEMI–ACS 5 years prior with Coronary Angiography (CA) finding of 3–vessel coronary artery disease, treated with PCI + stent (DES) of right coronary artery (CDX), untreated disease sub–occlusion of the first marginal obtuse (OM1), and chronic occlusion of the anterior interventricular artery (IVA). We decide for DSE. During 20 mcg/kg/min infusion, the patient reported dyspnoea and paradoxical bradycardia (BP) was documented on the ECG, in the absence of ST changes, with the appearance of akinesia of the basal and mid posterolateral segments and worsening of the inferior hypokinesia, present in basal conditions on Echocardiograms (EC). The BP and the alterations of the ventricular motion (VCA) did not respond to the administration of Atropine (1+1 mg) while the administration of 240 mg of Aminophylline (AM) restored the HR and the VCA to baseline values. The CA demonstrated patency of the CDX with the presence of collateral circulation for IVA and occluded OM1. Discussion This case is characterized by the presence of a double paradox: the BP and the Atropine–Resistance (AR). BP during DEB, as demonstrated in previous studies, occurred in 8% of cases, with signs of significant coronary artery disease in 57% of cases. The BP is an expression of ischemia only in just over half of the patients, in the rest of the cases it appeared referable to the Bezold–Jarish reflex, a vagal reflex determined by the stimulation of the intracardiac mechanoreceptors. In our case, the presence of AR seems to exclude the possibility that bradycardia is due to this reflex. The appearance of paradoxical bradycardia during DSE is a rare complication and can lead to premature termination of the test with inconclusive results. In our case, the BP and the AR confirm the positivity of the test also in consideration of the response to the AM antagonist of Adenosine, which accumulates during ischemia. Conclusions This uncommon response to DSE, where AR and AM response in addition to BP could identify patients with severe coronary artery disease in whom the ischemic response is driven by adenosine accumulation, rather than a vagal reflex responding to atropine administration.

P139 RETURN TO THE ORIGINS: WHEN THE THROMBOLYSIS SAVES THE ANGIOPLASTY

Abstract A 62 year old man arrived in PS for typical chest pain radiating to the jugular and associated with sweating for about three hours. History of arterial hypertension and untreated dyslipidemia, family history of CVD. ECG: sinus rithm at rate of 50 bpm with first degree AVB. Inferior ST elevation in inferior leads and ST depression in V2–V3. Echocardiogram: depressed systolic function (EF 48%) in relation to hypo–akinesia of the mid–basal segments of the inferior–posterior–lateral wall. Diagnosed with STEMI inferior–posterior, was sent to the cath lab to undergo to emergency coronary angiography, with findings of non–significant atheromas on IVA and Cx. Multiple unsuccessful attempts to search for the right coronary artery and failure to visualize the aortography in two complementary projections. During the procedure hemodynamic and electrical instability, worsening angor, marked hypotension and extreme bradycardia up to complete AVB with asystole phases. Inotropics and atropine were started, which proved ineffective, and it was therefore decided to proceed with the implantation of a temporary pacemaker. During the placement, the patient presented cardiac arrest from VF (likely an irritating effect from the passage of the lead through the tricuspid) treated with effective DC–shock. Given the technical difficulties in proceeding with mechanical revascularization and given the patient‘s instability, the decision was made to postpone PCI by attempting systemic thrombolysis. Early efficacy of thrombolysis with disappearance of precordial pain, improvement of echo motion and reduction &amp;gt; 50% of the ST–segment elevation to the rare spontaneous QRS displayed at the transient shutdown of the temporary PM. Subsequent emergence of AF at rate of 116 bpm. Approximately 12 hours after thrombolysis: complete ST resolution in absence of Q waves. AngioTC of the coronaries was performed which showed regularl origin of Cdx from the right coronary sinus but higher up and lateralized to the left, with severe lesion in the first segment. So the patient underwent falicitated PCI with detection of ostio–proximal Cdx thrombotic lesion effectively treated with PTCA and drug–eluting stent placement with good final angiographic result. Control echo: preserved global left ventricular motion (FE 55%), hypokinesia of the basal segment of the inferior wall. The remaining stay decurred without any complications and the patient was discharged with indications for a close follow–up.

Left ventricular myocardial motion tracking in cardiac cine magnetic resonance images based on a biomechanical model.

Cardiac cine magnetic resonance (CCMR) imaging plays an important role in the clinical cardiovascular disease (CVD) examination and evaluation. To accurately reconstruct the displacement field and describe the motion of the left ventricular myocardium (LVM), this study proposes and tests a new approach for tracking myocardial motion of the left ventricle based on a biomechanical model. CCMR imaging data acquired from 103 patients are enrolled, including two simulated and 101 clinical data. A non-rigid image registration method with a combination of a thin-plate spline function and random sample consensus is used to recover the observed displacement field of LVM. Next, a biomechanical model and a material matrix are introduced to solve the dense displacement field of LVM using a finite element framework. Then, the tracking precision and error of results for the two groups are analyzed. Displacement results of the simulated data show correlation coefficient≥0.876 and mean square error≤0.159, while displacement results of the clinical data show Dice≥0.97 and mean contour distance≤0.464. Additionally, the strain results show correlation coefficient≥0.717. This study demonstrates that the proposed new method enables to accurately track the motion of the LVM and evaluate strain, which has clinical auxiliary value in the diagnosis of CVD.

Dobutamine effects on systolic and diastolic left ventricular long-axis excursion and timing – significance for the interpretation of s′ and e′

Background Dobutamine effects on the relationships of the peak velocity of left ventricular (LV) long-axis systolic motion (s′) with systolic excursion (SExc), systolic duration (SDur) and heart rate, of LV long-axis early diastolic excursion (EDExc) with SExc, and of the peak velocity of LV long-axis early diastolic motion (e′) with EDExc, early diastolic duration (EDDur) and isovolumic relaxation time (IVRT') are unknown. Methods Two groups of adult subjects, one young and healthy (n = 10), and one with impaired LV long-axis function (n = 10), were studied, with the aim of identifying consistent findings for the two groups and for the septal and lateral walls. Dobutamine was infused at doses of 5 and 10 µg/kg/min. The relationships between tissue Doppler imaging (TDI) variables acquired before and during dobutamine infusion were analysed using mixed effect multivariate regression modelling. Results In both groups, heart rate increased and SDur decreased during dobutamine infusion, and there were independent inverse correlations of SDur with heart rate and dobutamine dose. In contrast, there was no change in EDDur during dobutamine infusion, and no consistent changes in IVRT' independent of heart rate. s′ was positively correlated with SExc and inversely correlated with SDur, and there were positive correlations between EDExc and SExc and between e′ and EDExc. Conclusion Dobutamine increases s′ due to effects on both systolic excursion and duration and it increases e′ due to the associated increases in systolic and early diastolic excursion. A lack of effect on diastolic times does not support the presence of a lusitropic effect of dobutamine.

Simulating hyperelasticity and fractional viscoelasticity in the human heart

Biomechanics plays an important role in the diagnosis and treatment of pathological conditions of the heart. Computational models are paving the way for personalized therapeutic treatment but they rely on accurate constitutive equations for predicting their biomechanical behavior. Even so, viscoelasticity remains under-explored in computational modeling despite experimental observations. To facilitate the viscoelastic modeling of cardiovascular soft tissues, we previously developed a fractional viscoelastic modeling approach, which extends existing hyperelastic models. This has comparable computational costs to the conventional hyperelastic model and only requires two additional material parameters for the viscoelastic response. This approach was demonstrated to be able to accurately capture the viscoelastic response of the human myocardium. However, the numerical properties of this fractional viscoelastic approach have not yet been examined. In this work, we present its implementation in Finite Element Analysis, examine its numerical properties in uniaxial extension and 2D inflation test examples, and examine its physiological implication in a computational model of an idealized left ventricle in a fully idealized circulatory system. Optimal convergence properties were observed and the importance of viscoelasticity during passive filling, ventricular motion, and regional fiber strain and stresses were explained.

A Case Report of Spinal Anesthesia for Cerclage Placement in the Setting of Severe Hypertrophic Obstructive Cardiomyopathy.

Neuraxial anesthesia is preferred over general anesthesia in obstetric patients to avoid airway manipulation, aspiration, and maternal-fetal transfer of medications; however, a sudden sympathetic block is generally avoided in patients with hypertrophic obstructive cardiomyopathy (HOCM). The case of a 31-year-old G2P0010 with HOCM with severe resting left ventricular outflow tract (LVOT) obstruction and systolic anterior motion of the mitral valve undergoing a cerclage under choroprocaine spinal anesthesia is presented. Risks and benefits of general versus neuraxial anesthesia, and epidural versus spinal anesthesia, in this specific setting are reviewed.

Contribution of Ventricular Motion and Sampling Location to Discrepancies in Two-Dimensional Versus Three-Dimensional Fetal Ventricular Strain Measures

Echocardiographic quantification of fetal cardiac strain is important to evaluate function and the need for intervention, with both two-dimensional (2D) and three-dimensional (3D) strain measurements currently feasible. However, discrepancies between 2D and 3D measurements have been reported, the etiologies of which are unclear. This study sought to determine the etiologies of the differences between 2D and 3D strain measurements. A validated cardiac motion-tracking algorithm was used on 3D cine ultrasound images acquired in 26 healthy fetuses. Both 2D and 3D myocardial strain quantifications were performed on each image set for controlled comparisons. Finite element modeling of 2 left ventricle (LV) models with minor geometrical differences were performed with various helix angle configurations for validating image processing results. Three-dimensional longitudinal strain (LS) was significantly lower than 2D LS for the LV free wall and septum but not for the right ventricular (RV) free wall, while 3D circumferential strain (CS) was significantly higher than 2D CS for the LV, RV, and septum. The LS discrepancy was due to 2D long-axis imaging not capturing the out-of-plane motions associated with LV twist, while the CS discrepancy was due to the systolic motion of the heart toward the apex that caused out-of-plane motions in 2D short-axis imaging. A timing mismatch between the occurrences of peak longitudinal and circumferential dimensions caused a deviation in zero-strain referencing between 2D and 3D strain measurements, contributing to further discrepancies between the2. Mechanisms for discrepancies between 2D and 3D strain measurements in fetal echocardiography were identified, and inaccuracies associated with 2D strains were highlighted. Understanding of this mechanism is useful and important for future standardization of fetal cardiac strain measurements, which we propose to be important in view of large discrepancies in measured values in the literature.

Takotsubo cardiomyopathy – review of current literature

Takotsubo syndrome (TTS) also known as broken heart syndrome is acute cardiac disease, which is characterized by reversible ventricular motion abnormalities, in the absence of justifying coronary artery disease. The clinical entity was first described in Japan in 1991. The word “Takotsubo” is a container used by the Japanese to catch octopus, which has a narrow neck and a relatively wide base, which resembles the heart's shape in TTS. The cardiomiopathy predominantly affects postmenopausal women and is often preceded by emotional (death of close family member, domestic abuse) or physical (external injury, severe pain) stress. The exact pathophysiological mechanism has not yet been fully clarified. Inordinate amount of catecholamines released into bloodstream after stress attack plays a crucial role in the pathogenesis of TTS. Symptoms of Takotsubo cardiomyopathy such as chest pain and dyspnea are similar to acute myocardial infarction due to it TTS requires careful diagnosis. The main tools for making diagnosis are echocardiography, coronary angiography, ECG, cardiac biomarkers and cardiac magnetic resonance. The syndrome is usually reversible, nevertheless number of patients may develop complications such as cardiogenic shock, arrhythmias, heart failure. Treatment is mostly supportive including Angiotensin-converting enzyme (ACEi) inhibitors and angiotensin receptor blockers (ARBs), which may reduce the likelihood of recurrent episodes. Generally patients with TSS have favourable prognosis, although some deaths are reported. This article is a review of current medical knowledge about Takotsubo syndrome based on available publications in Pubmed and Google Scholar databases.