Ventricular Myocardial Performance Index Research Articles

Association of Plasma B-Type Natriuretic Peptide Levels with Shunt Size in Young Adults with Atrial Septal Defect

This study was designed to investigate the validity of brain natriuretic peptide (BNP) levels for the estimation of the shunt size in young adults with atrial septal defect (ASD), and to determine the relationship between BNP levels and echocardiographic parameters of right heart chambers. Fifty-six patients with ASD (mean age 22.9 ± 2.0 years) were studied. The control group consisted of 31 age-gender matched healthy volunteers (mean age 22.7 ± 1.9 years). Coventional echocardiography, tissue Doppler imaging (TDI) and plasma BNP level measurement was performed in all participants. The ratio of pulmonary to systemic blood flow (Qp/Qs) was measured noninvasively using transthoracic echocardiography. Plasma BNP levels were significantly higher in ASD patients than in controls (42.9 ± 29.4 vs. 8.3 ± 2.6 pg/mL, P < 0.05). Pulmonary artery pressure (PAP) (P = 0.0001), right atrium (RA) volume (P = 0.0001), and right ventricular end-diastolic volume (RVEDV) (P = 0.0001) values were higher in ASD patients. There was a powerful correlation between plasma BNP levels and Qp/Qs ratio (r = 0.71, P < 0.0001). The plasma BNP levels significantly correlated with PAP (r = 0.61, P < 0.0001), RA volume (r = 0.54, P < 0.0001), RVEDV (r = 0.55, P < 0.0001), and right ventricular myocardial performance index (r = 0.50, P < 0.0001). This study shows that there is a significant correlation between right heart echocardiographic parameters and concentrations of BNP in the plasma of young adults with ASD. BNP levels may provide a supplemental data to predict of shunt size in these patients.

Heart Rate Reduction by Ivabradine Reduces Diastolic Dysfunction and Cardiac Fibrosis

Objectives: To determine if heart rate (HR) reduction with ivabradine (IVA), a selective inhibitor of the pacemaker I_f current, prevents cardiac dysfunction associated with dyslipidemia. Methods: New Zealand White rabbits received either a standard diet, a 0.5% cholesterol-enriched diet only (CD), or a 0.5% CD with IVA (17 mg/kg/day) for 12 weeks. HR, left ventricular (LV) systolic function, diastolic function and LV regional myocardial performance index (MPI) were studied using echocardiography. Histological analysis included cardiac interstitial fibrosis and collagen type I fibers. Plasma levels of angiotensin II and aldosterone were quantified by immunoassays. Results: IVA reduced HR by approximately 11%. IVA improved MPI and attenuated LV diastolic dysfunction (DD) (92% mild and 8% moderate DD with IVA vs. 54% mild and 46% moderate DD in CD group). IVA also reduced atrial fibrosis (p = 0.027), ventricular fibrosis (p = 0.0002) and ventricular collagen type I (p = 0.0042). IVA decreased plasma angiotensin II levels (p = 0.042), and both angiotensin II and aldosterone levels were correlated with HR (p = 0.038 and 0.008). Conclusion: Selective HR reduction with IVA reduces DD and cardiac fibrosis in hypercholesterolemic rabbits. These beneficial effects of IVA support testing pure HR reduction in patients with diastolic heart failure.

The association between the spatial QRS‐T angle with cardiac autonomic neuropathy in subjects with Type 2 diabetes mellitus

To examine differences in the spatial QRS-T angle in patients with Type 2 diabetes mellitus with and without cardiac autonomic neuropathy. Two hundred and thirty-two patients with diabetes mellitus (105 with cardiac autonomic neuropathy and 127 without cardiac autonomic neuropathy) and 232 control subjects, matched by gender and age, were studied. Diagnosis of cardiac autonomic neuropathy was based on the classic autonomic function tests. All subjects underwent a digital electrocardiographic recording. Electrocardiographic parameters were measured using the Modular Electrocardiographic Analysis (MEANS) program. Left ventricular mass index (LVMi) and global myocardial performance index (Tei index) of the left ventricle were assessed by ultrasonography. The spatial QRS-T angle was higher in the patients with diabetes in comparison with the control subjects (24.5 ± 10.7 vs. 9.7 ± 4.5°, P < 0.001) and in the patients with diabetes and cardiac autonomic neuropathy than in those without cardiac autonomic neuropathy (30.1 ± 11.3 vs. 19.5 ± 7.1, P < 0.001). No differences were found in the QT interval between the studied groups. Multivariate linear regression analysis in subjects with diabetes after controlling for age, gender, BMI, blood pressure, diabetes duration, HbA(1c) , lipids, microalbuminuria and insulin resistance, demonstrated significant and independent associations between the spatial QRS-T angle with presence and severity of cardiac autonomic neuropathy, all parameters of heart rate variability, LVMi and Tei index. The spatial QRS-T angle is increased in patients with Type 2 diabetes who have cardiac autonomic neuropathy, suggesting increased ventricular arrhythmogenicity, and is associated with the structural and functional properties of the myocardium. Further research is warranted to evaluate its role in cardiovascular risk stratification of patients with diabetes.

Serum fibroblast growth factor-23 (FGF-23) levels are independently associated with left ventricular mass and myocardial performance index in maintenance haemodialysis patients

Fibroblast growth factor-23 (FGF-23) is a phosphorus-regulating substance. Circulating FGF-23 levels increase markedly in dialysis patients and are independently associated with increased risk of mortality. Given the fact that cardiovascular disease is the leading cause of death in dialysis patients, the aim of this study was to test if elevated FGF-23 levels might be associated with left ventricular mass index (LVMI) and left ventricular index of myocardial performance (MPI) in maintenance haemodialysis patients. In this cross-sectional study, plasma FGF-23 concentrations were measured using a C-terminal human enzyme-linked immunosorbent assay kit, and echocardiography was performed in 128 maintenance haemodialysis patients (65 women and 63 men, mean age: 55.5 ± 13 years, mean haemodialysis vintage: 52 ± 10 months, all patients are on haemodialysis thrice a week) and 40 control subjects (21 women and 19 men; mean age: 54 ± 11 years) with normal kidney function (eGFR > 90 mL/min/1.73 m(2)). Serum FGF-23 levels were elevated when compared with age- and gender-matched controls with preserved kidney function [(median 958 RU/mL; interquartile range 106-1894 RU/mL) vs (median 27 RU/mL; interquartile range 11-35), P < 0.0001]. Patients with a history of coronary artery disease and aortic valve calcifications had higher levels of log FGF-23 than those without (3.00 ± 0.22 vs 2.82 ± 0.26, P = 0.002; and 3.06 ± 0.19 vs 2.83 ± 0.26, P = 0.0001, respectively). Patients with MPI > 0.47 had higher serum FGF-23 levels than those with MPI < 0.47 [(median 1156 RU/mL; interquartile range 396-1894 RU/mL) vs (median 657 RU/mL; interquartile range 106-1102 RU/mL), P = 0.0001]. Significant correlations were recorded between log FGF-23 levels and LVMI (r = 0.281, P = 0,007) and MPI (r = 0.555, P = 0.0001). Multivariable-adjusted regression analyses revealed that increased log FGF-23 concentrations were independently associated with increased left ventricular mass index (30% increase per 1-SD increase in log FGF-23 concentration, P = 0.002) and increased MPI (28.5% increase per 1-SD increase in log FGF-23 concentration, P = 0.001). Plasma FGF-23 concentration is independently associated with LVMI and MPI in maintenance haemodialysis patients. Further prospective studies are needed to clarify whether increased serum FGF-23 level is a marker or a potential mechanism for left ventricular involvement in patients with end-stage renal disease.

Long-Term Exposure to Biomass Fuel and Its Relation to Systolic and Diastolic Biventricular Performance in Addition to Obstructive and Restrictive Lung Diseases

Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events.

Impact of Obstructive Sleep Apnea on Global Myocardial Performance in Children Assessed by Tissue Doppler Imaging

This study aimed to assess the impact of obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy (ATH) on the global myocardial performance in children using tissue Doppler imaging (TDI) and to evaluate the reversibility of the disorder after adenotonsillectomy (AT). The study included 42 children with OSA due to ATH (mean age, 5 ± 3.14 years) as the study group and 45 age- and sex-matched healthy children (mean age, 5.2 ± 3.08 years) as the control group. Polysomnography and echocardiography were performed. Indexed left ventricular mass (LVMi), pulmonary artery systolic pressure, mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR) were calculated by echocardiography. Tissue Doppler imaging was used to determine the left ventricular and right ventricular myocardial performance index (MPI) of patients and control subjects before and after AT. The patients were classified into mild OSA (apnea-hypopnea index [AHI] 1-5; n = 18)] and moderate to severe OSA (AHI >5; n = 24) according to polysomnography findings. All the children in the control group had an AHI less than 1. They were treated using AT, then reevaluated by polysomnography and echocardiographic examination 6 to 8 months after surgery. Results are described as mean ± standard deviation. The patients with OSA had higher pulmonary artery systolic pressure, mPAP, PVR, LVMi, and right ventricular diastolic diameter than the control subjects. The patients with moderate to severe OSA showed more prominent changes than the patients with mild OSA, but the latter still differed significantly from the control subjects. The TDI-derived right ventricular MPI and left ventricular MPI measurements of the patients with OSA were higher (mean, 0.40 ± 0.08 vs 0.28 ± 0.01; p < 0.001) than those of the control subjects and (0.45 ± 0.05 vs 0.32 ± 0.05; p < 0.001) and correlated well with AHI and mPAP. In addition, mPAP was significantly correlated with AHI. Postoperatively, relief of OSA was validated by polysomnography, and a repeat of the echocardiographic parameters showed no significant differences between the patients and the control subjects. Tissue Doppler imaging can detect the subtle, subclinical changes in cardiac performance that occur in OSA due to adenotonsillar hypertrophy. Such changes generally are reversible after surgical treatment.

Influence of obstructive sleep apnea on left ventricular mass and global function: sleep apnea and myocardial performance index

Obstructive sleep apnea (OSA) is associated with cardiovascular mortality and morbidity. It may predispose patients to left ventricular hypertrophy and heart failure. The aim of this study was to determine the left ventricular mass (LVM) and myocardial performance index (MPI) reflecting left ventricular global function in uncomplicated OSA patients. Sixty-four subjects without hypertension, diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into three groups: group 1, control subjects with nonapneic snorers (AHI < 5, n = 18); group 2, patients with mild to moderate OSA (AHI: 5-30, n = 25); and group 3, severe OSA (AHI > 30, n = 21). Basic echocardiographic measurements, LVM, and LVM index were measured. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler echocardiography. There were no significant differences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left atrium, interventricular septum, left ventricular posterior wall, left ventricular end-diastolic and end-systolic diameters, LVM mass, and LVM index were not significantly different among the three groups. Left ventricular MPI was significantly higher in severe OSA patients (0.64 +/- 0.18) than in controls (0.49 +/- 0.18; P < 0.05). There was no significant difference between controls (0.49 +/- 0.18) and mild to moderate OSA (0.61 +/- 0.16; P = 0.08) and between mild to moderate OSA (0.61 +/- 0.16) and severe OSA (0.64 +/- 0.18; P = 0.84). The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.

Left atrial volume and N-terminal pro-B type natriuretic peptide are associated with elevated pulmonary artery pressure in patients with systemic sclerosis

Early detection of pulmonary hypertension (PH) in patients with systemic sclerosis (SSc) is essential as it leads to substantial morbidity and mortality irrespective of its etiology. The aim of our study was to determine whether noninvasive biochemical and/or echocardiographic indices can predict the presence of PH in these patients. We prospectively studied 66 patients (mean age of 57.7 +/- 12.1 years, 63 women) with SSc without clinical manifestations of heart failure. All patients underwent standard and tissue Doppler echocardiography. Plasma N-terminal pro-B type natriuretic peptide (NT-proBNP) and asymmetric dimethylarginine (ADMA) levels were also measured. In 24 (36%) patients, the diagnosis of PH was established by echocardiography (systolic pulmonary artery pressure value > or =40 mmHg). Left atrial (LA) volume, NT-proBNP, ADMA, ratio of early transmitral filling velocity to early diastolic velocity of the mitral annulus (mitral E/E (m)), and right ventricular myocardial performance index (MPI) were univariate predictors of PH. In multivariate analysis, NT-proBNP, LA volume, and right ventricular MPI were independent predictors of PH in SSc patients. LA volume and NT-proBNP may be useful noninvasive markers for the prediction of elevated pulmonary artery pressure in patients with SSc. These parameters should be considered when assessing this population for risk stratification and for identification of patients demanding further investigation and institution of specific therapy for the disease at the time when it is most likely to be effective.

Evaluation of the myocardial performance index and tissue doppler imaging by comparison to near-simultaneous catheter measurements in pediatric cardiac transplant patients

Parameters derived from Doppler echocardiography, such as the myocardial performance index (MPI) and the ratio of peak velocity of early diastolic prograde flow (E) across the atrioventricular valve (AVV) divided by the peak velocity of early diastolic tissue motion at the AVV annulus (E') (E:E' ratio), are routinely used to assess ventricular function. However, they have not been compared with measurements obtained by cardiac catheterization (CC) in children. We prospectively studied post-cardiac transplant children undergoing CC with near-simultaneous echocardiographic imaging for MPI and E:E'. CC data included right atrial pressure (RAp), pulmonary artery wedge pressure (PAWp) and cardiac index (CI). One investigator, who was blinded to the CC data, measured right ventricular (RV) and left ventricular (LV) MPI and E:E' offline. Correlations between echocardiographic and catheter measurements were calculated. Receiver-operating-characteristics (ROC) curves were created to evaluate the utility of echocardiographic measurements that exhibited statistically significant correlations with CC measurements. Twenty-four patients (age range 0.8 to 21 years) underwent 142 CCs during the study period. Of the 12 correlations studied, 3 met statistical significance (p < 0.05) (RV E:E' vs RAp, RV E:E' vs PAWp and LV MPI vs CI). The ROC areas for these correlations were 0.38, 0.42 and 0.68, respectively. There were no cut-off points where both the sensitivity and specificity for any measurement were >0.80. Our data suggest that MPI and E:E' are poor predictors of simultaneously obtained, catheter-derived hemodynamic parameters in post-transplant children. These limitations should be carefully considered before ascribing diagnostic value to these measurements.

A randomized comparison of right ventricular function after on-pump versus off-pump coronary artery bypass graft surgery

Right ventricular dysfunction occurs very soon after conventional coronary bypass surgery with cardiopulmonary bypass and might not recover within 1 year after the operation. It has been postulated that performing coronary surgery without cardiopulmonary bypass might preserve right ventricular function. We hypothesized that right ventricular global and overall systolic functions are better preserved 3 months after off-pump surgery than after conventional coronary bypass surgery. Fifty patients scheduled for elective coronary bypass surgery were randomly assigned to conventional or off-pump surgery. Right ventricular function was assessed by means of transthoracic echocardiographic analysis the day before the operation and 3 months later. Right ventricular myocardial performance index was used as a marker of global right ventricular function, and right ventricular fractional area change was used as a marker of overall right ventricular systolic function. Peak systolic velocities of the lateral tricuspid annulus were studied to assess regional systolic function of the right ventricular free wall. Surgical intervention was completed according to randomization in 48 of 50 patients. Demographic and perioperative characteristics were similar in the 2 groups. Over the study period, right ventricular myocardial performance index and right ventricular fractional area change did not change in comparison with the baseline values in both groups. Peak systolic velocity of the lateral tricuspid annulus was decreased significantly in both groups 3 months after the operation. There were no significant intergroup differences in any echocardiographic marker of right ventricular function. Global right ventricular function was not better preserved 3 months after off-pump surgery than after conventional coronary bypass surgery.

Beneficial Effects of Atorvastatin on Lung Structural Remodeling and Function in Ischemic Heart Failure

Background Studies have suggested some benefit of 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors in congestive heart failure (CHF), although the mechanisms remain uncertain. We hypothesized that statins could improve pulmonary hypertension and right ventricular function in ischemic CHF by reducing lung remodeling. Methods and Results Two weeks after myocardial infarct, rats received atorvastatin (n = 23) or no treatment (n = 23) for 3 weeks and were compared with a sham group (n = 16). Infarct size was similar by echocardiography and pathologic evaluations. Atorvastatin greatly reduced pulmonary hypertension and right ventricular hypertrophy: right ventricular systolic pressure 42 ± 5 vs. 28 ± 2 mm Hg ( P < .01). Atorvastatin did not reduce left ventricular fibrosis and had minimal effects on left ventricular function. Right ventricular myocardial performance index was markedly improved by therapy ( P < .01). CHF caused a restrictive lung syndrome with a downward shift of the respiratory pressure-volume loop, increased dry lung weight, and interstitial fibrosis that were greatly improved by atorvastatin. Reduced lung nitric oxide synthase expression was normalized by treatment. Atorvastatin also reduced isolated lung myofibroblasts proliferation after transforming growth factor–β stimulation (-36 ± 6%, P < 0.01). Conclusions 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibition reduces lung remodeling and dysfunction associated with heart failure with prevention of right ventricular hypertrophy and pulmonary hypertension.

Impact of chronic fluorosis on left ventricular diastolic and global functions

Sixty three patients with endemic fluorosis (36 males/27 females; mean age 33.9 ± 8.6 years) and 45 age, sex and body mass index (BMI) matched healthy controls (30 males/15 females; mean age 32.7 ± 8.8 years) were included in this study. Basic echocardiographic measurements, left ventricular diastolic parameters and left ventricular myocardial performance index (MPI) were measured. The left ventricular MPI was calculated as (isovolumic contraction time + isovolumic relaxation time) / aortic ejection time by Doppler. The urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (1.9 ± 0.1 mg/l vs 0.4 ± 0.1 mg/l respectively; P < 0.001). Isovolumic relaxation time (IVRT) and deceleration time (DT) were significantly higher in fluorosis patients than in controls (for IVRT 106.9 ± 15.6 ms vs 96.7 ± 12.2 ms; P < 0.001 and for DT 211.7 ± 30.7 ms vs 188.0 ± 30.0 ms; P < 0.001, respectively). MPI was significantly higher in fluorosis patients than in controls (0.62 ± 0.15 ms vs 0.49 ± 0.10 ms; P < 0.001, respectively). We have shown that chronic fluorosis patients had left ventricular diastolic and global dysfunctions.

Right Ventricular Function Suffers From Reperfusion Delay: Tissue Doppler Study

In this study, impact of reperfusion delay on adverse cardiac events and right ventricular (RV) function in patients with acute right ventricular myocardial infarction (RVMI) was assessed. In 70 patients with RVMI, RV function was assessed by M-mode tricuspid annular plane systolic excursion (TAPSE) and by pulsed wave tissue Doppler echocardiography (TDE). Right ventricular early (E'(T)) and late diastolic (A'(T)), peak systolic tricuspid annular velocity, (S'(T)) and right ventricular myocardial performance index (RVMPI) were measured. Patients were divided into 2 groups according to the time between the onset of symptoms and percutaneous transluminal coronary angioplasty (PTCA)-group 1 (n = 25), < or =3 hours and group 2 (n = 45), > 3 hours. During 30-day follow-up, we assessed adverse cardiac events like the following: death, cardiogenic shock, need for intra-aortic counterpulsation, temporary transvenous pacing support (PCM), presence of ventricular septal defect (VSD), cardiac tamponade, or free wall rupture. Group 1 had significantly higher values of E'(T), S'(T), and TAPSE than group 2. RVMPI was significantly elevated in group 2. A total of 13 (18.2%) patients had a cardiac event, 5 patients (7.1%) died. We observed an increase of cardiac events in patients with reperfusion delayed more than 3 hours (P = .056). TAPSE-derived and TDE-derived right ventricular systolic and early diastolic velocities were less affected in patients with shorter time from pain onset to opening of the occluded right coronary artery (RCA). Presented initial data show that the tissue Doppler technique may be useful for identification of patients with RV infarction with higher rate of adverse cardiac events including death.

Evaluation of Biventricular Functions With Tissue Doppler Imaging in Patients With Myotonic Dystrophy

Myotonic dystrophy (MD) is characterized by myotonia with dystrophic involvement of the muscles. Cardiac involvement is usually not evident in the early stages of MD. We investigated biventricular functions by tissue Doppler imaging (TDI) in MD patients with no overt cardiac involvement to explore the value of TDI in the early detection of myocardial dysfunction. A total of 21 MD patients (15 male, age: 32.2 +/- 12.3 yrs) and 21 healthy controls (13 male, age: 32.2 +/- 7.8 yrs) were included. In addition to conventional echocardiography, pulsed Doppler and TDI were performed including measurement of myocardial performance index (MPI); peak systolic (Sm) and early (Em) and atrial (Am) diastolic myocardial velocities at the basal mitral and tricuspid annulus. All patients and controls had normal ejection fraction. Transmitral E peak velocity was significantly lower while both deceleration time of E velocity and isovolumic relaxation time were significantly longer in MD patients (P = 0.007, P = 0.001, and P < 0.001, respectively). Sm, Em and Am peak velocities were significantly lower in MD patients in all segments except for Em of the mitral anterior annulus and Am of the tricuspid lateral annulus. Both left and right ventricular MPI were significantly higher in MD patients (P < 0.001 and P = 0.013, respectively). There are changes in myocardial systolic and diastolic functions in MD patients although they have no overt heart failure. Myocardial tissue velocities and MPI are useful in identifying subclinical biventricular involvement in these patients.

Intradialytic exercise training reduces oxidative stress and epicardial fat: a pilot study

Cardiovascular disease (CVD) mortality rates are greatly elevated in chronic kidney disease patients receiving maintenance haemodialysis therapy. The purpose of this study was to evaluate the efficacy of intradialytic endurance exercise training on novel risk factors that may contribute to this excessive CVD risk. Seventeen haemodialysis patients were randomized to either an intradialytic exercise training (cycling) group (EX; n = 8) or a non-exercising control group (CON; n = 9) for 4 months. At baseline and following the intervention, we measured serum parameters related to CVD risk and renal function, used echocardiography to measure variables related to cardiac structure and function and assessed physical performance by a validated shuttle walk test. Performance on the shuttle walk test increased by 17% in EX (P < 0.05), but did not change in CON. There was no change in serum lipids or inflammatory markers (C-reactive protein, interleukin-6) in either group. Serum thiobarbituric acid reactive substances, a marker of oxidative stress, were reduced by 38% in EX (P < 0.05), but did not change in CON. In addition, serum alkaline phosphatase (ALP), a putative risk factor for vascular calcification, was reduced by 27% in EX (P < 0.05), but did not change in CON. There was no change in left atrial volume, left ventricular mass or myocardial performance index in either group. However, the thickness of the epicardial fat layer was reduced by 11% in EX (P < 0.05), but did not change in CON. Furthermore, the change in physical performance was inversely correlated to the change in epicardial fat (r = -0.63; P = 0.03). These results suggest that endurance exercise training may improve CVD risk in haemodialysis patients by decreasing novel risk factors including serum oxidative stress, ALP and epicardial fat.

CARDIAC FUNCTIONS EVALUATED WITH TISSUE DOPPLER IMAGING IN CHILDHOOD CANCERS TREATED WITH ANTHRACYCLINES

Aim: The aim of this study was to assess the cardiac functions using conventional echocardiography and tissue Doppler imaging in childhood cancers treated with anthracyclines. Methods: The study group was selected from the patients admitted to the pediatric oncology department for a treatment protocol that included doxorubicin. Body surface area was calculated and complete 2-dimensional, M-mode, pulse wave Doppler and pulse wave tissue Doppler echocardiographic examinations were performed just before the first treatment and at least 6 months after the last treatment. Results: This study included 20 patients (12 males and 8 females). Mean cumulative antracycline dose was 189 ± 102.90 mg/m2. There were no significant differences between the pre- and post-treatment groups regarding systolic and diastolic blood pressures, heart rates, left ventricular ejection fraction and fractional shortening, right and left ventricular conventional and tissue Doppler diastolic parameters (E and A waves, E/A ratio, E′ and A′ waves, E′/A′ ratio), but there were significant differences between the pre- and post-treatment groups regarding body surface area, right and left ventricular myocardial performance index observed by conventional pulse wave and pulse wave tissue Doppler methods. Conclusion: Tissue Doppler imaging provided additional information on cardiac functions. While systolic and diastolic functions were in normal range, myocardial performance index observed by tissue Doopler method was impaired in children who were treated with anthracyclines.

Clinical research Myocardial performance index after surgical correction of ventricular septal defects

IntroductionThe myocardial performance index (MPI) has been described as a non-invasive Doppler measurement of ventricular function. The aim of this study was to assess MPI following surgical correction of ventricular septal defect (VSD) and to evaluate its impact on postoperative recovery.Material and methodsThis is a prospective study involving 30 children (16 girls and 14 boys) operated on for VSD (group I). The control group (group II) consisted of 30 healthy children (age and sex matched).ResultsWe found that both the right and left ventricular (RV and LV) MPI correlated significantly with the ejection fraction (EF) (r = –0.49, p = 0.006, r = –0.51, p = 0.004, respectively). The LV EF and the LV FS were negatively correlated, while the left and right ventricular MPI was positively correlated with the: LVEDD (p = 0.000), the VSD size (p = 0.000), and the postoperative course of the patients in terms of the duration of ventilation (p = 0.000), the duration of use of inotropics (p = 0.000) and the duration of staying in the ICU (p = 0.000). By linear regression, the factors that correlated with the postoperative course of VSD surgery were the RV MPI pre-surgery, MPI 2 days after surgery and the ejection fraction (p = 0.000).ConclusionsMyocardial performance index is a useful index for measurement of the left and right ventricular function. It correlates significantly with the ejection fraction, fractional shortening, VSD size, and the left ventricular size. It also significantly predicts the outcome of VSD surgery.

Feasibility of Measuring Myocardial Performance Index of the Right Ventricle in Anesthetized Patients

Myocardial performance index, the sum of the 2 isovolumic times divided by the ejection time, contains information on global systolic and diastolic function. This study was performed to determine the feasibility of right ventricular myocardial performance index measurements if measured by transesophageal echocardiography in patients under general anesthesia and positive-pressure ventilation. A prospective cohort study. A tertiary care university hospital. Twenty patients undergoing elective coronary artery bypass graft surgery. None. The feasibility of the right ventricular myocardial performance index measurements was assessed in awake patients by using transthoracic echocardiography and reassessed in the same patients under general anesthesia and positive-pressure ventilation using transesophageal echocardiography. The time from the cessation to the onset of 2 consecutive right ventricular inflows was measured as time A; the time from the onset to the cessation of right ventricular ejection was measured as time B. Myocardial performance index was calculated as follows: (time A-time B)/time B. A first reader independently measured all recordings twice to assess intrareader variability and a second reader once to assess interreader variability. Variability (%) was calculated as the mean absolute difference between 2 readings divided by their mean. The myocardial performance index could be measured for all patients. The point estimates of inter- and intraobserver variability of the right ventricular myocardial performance index measurements were 4.3% to 5% in awake patients and 17.8% to 19.6% in anesthetized patients. This finding questions the use of right ventricular myocardial performance index measurements in anesthetized patients under positive-pressure ventilation.

Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect

Right ventricular (RV) volume overload is a well-known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three-dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. We found that: (1) the right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) (respectively 106.54+/-25.97 vs 69.78+/-10.46 mL, P < 0.05; 59.73+/-17.59 vs 33.84+/-7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%+/-4.51% vs 54.11%+/-5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61+/-16.49] ms vs (64.09+/-11.82) ms, P < 0.05; [28.04+/-9.57] ms vs [20.45+/-6.53] ms, P < 0.05) were prolonged and ejection time ([250.02+/-24.21] ms vs [272.73+/-20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41+/-0.07 vs 0.31+/-0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function.

Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome

The objective of the study was to determine whether cardiac troponin T (cTnT) and natriuretic peptides can be isolated from the amniotic fluid (AF) of pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) and whether they correlate with fetal echocardiographic findings and recipient survival. AF samples from the recipient sac were obtained in 52 TTTS cases and 16 controls. Samples were assayed for cTnT and natriuretic peptides. Prior to fetoscopic laser therapy, 34 recipient twins underwent assessment of atrioventricular flow patterns, myocardial performance index (MPI), and precordial venous Dopplers. Fetal survival was assessed 48 hours postoperatively. AF B-type natriuretic peptide and cTnT levels were elevated in TTTS and correlated with functional echocardiographic findings. Postoperative recipient survival was 72% when both AF-cTnT and left ventricular MPI were increased. If 1 of both markers was normal, survival was 100% (P = .046). Combining ultrasound and AF-cTnT measurements allows the identification of fetuses at risk of postoperative demise.