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Sample records for echocardiographic epicardial fat

  1. Relationship of Echocardiographic Epicardial Fat Thickness and Epicardial Fat Volume by Computed Tomography with Coronary Artery Calcification: Data from the CAESAR Study.

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    Kim, Byung Jin; Kang, Jung Gyu; Lee, Sung Ho; Lee, Jong Young; Sung, Ki Chul; Kim, Bum Soo; Kang, Jin Ho

    2017-05-01

    No study has assessed the association between echocardiographic epicardial fat thickness (EFT) and computed tomography (CT)-based epicardial fat volume (EFV) and coronary artery calcification. The aim of this study is to evaluate the association between EFT and EFV and coronary artery calcification. Among the 2,299 individuals enrolled in the CArdiometabolic risk, Epicardial fat, and Subclinical Atherosclerosis Registry (CAESAR) study, 2,276 (1,851 men; mean age 45 ± 8.9 years) who underwent echocardiographic EFT and CT-based EFV measurements and obtained a coronary artery calcium score (CACS) were included in this study. The overall prevalence of CAC >0 was 19.3%. EFT was significantly correlated with EFV (r = 0.374, p <0.001) but the k statistic showed only slight agreement (k = 0.146, p <0.001). Multivariate regression analyses adjusted for age, sex, body mass index, waist circumference, systolic blood pressure, daily alcohol intake, smoking status, and vigorous exercise and glucose, blood urea nitrogen, uric acid, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, high-sensitivity C reactive protein, and hemoglobinA1c levels revealed that an increase in the absolute values of EFT and EFV was significantly associated with the presence of coronary artery calcium (ORs [95% CIs], 2.023 [1.282-3.193] and 1.785 [1.173-2.716], respectively) and CACS (standardized β values = 0.082 and 0.061, p = 0.001 and 0.042, respectively). These results show that EFT and EFV are associated with coronary artery calcification in Korean adults despite the relatively weak correlation between EFT and EFV. Copyright © 2017 IMSS. Published by Elsevier Inc. All rights reserved.

  2. Epicardial fat thickness and cardiovascular involvements.

    African Journals Online (AJOL)

    E-mail: drsevketb@gmail.com, sevketb@gata.edu.tr. OSA severity. The association of EFT with OSA, both cardiovascular risk factors, is independent of obesity as defined by classical measures5. Echocardiographic epicardial fat measurement in both clinical and research scenarios has several advantages, including its low ...

  3. The relation between total epicardial fat volume assessed by cardiac CT and the presence of atrial fibrillation

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    Mohamed Abdelshafy Tabl

    2016-06-01

    Conclusion: Epicardial fat is associated with the presence of AF and predicts chronicity. These associations are independent to systemic measures of adiposity and sensitive echocardiographic parameters as LA volume index. These findings are consistent with the hypothesis of a local pathogenic effect of epicardial fat on the arrhythmogenic substrate supporting AF.

  4. Epicardial adipose tissue is associated with visceral fat, metabolic syndrome, and insulin resistance in menopausal women.

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    Fernández Muñoz, María J; Basurto Acevedo, Lourdes; Córdova Pérez, Nydia; Vázquez Martínez, Ana Laura; Tepach Gutiérrez, Nayive; Vega García, Sara; Rocha Cruz, Alberto; Díaz Martínez, Alma; Saucedo García, Renata; Zárate Treviño, Arturo; González Escudero, Eduardo Alberto; Degollado Córdova, José Antonio

    2014-06-01

    Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women. A cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis. A positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm(2); P = .03). Epicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  5. Epicardial fat thickness in patients with rheumatoid arthritis | Fatma ...

    African Journals Online (AJOL)

    Background: Epidemiologic data indicates that rheumatoid arthritis is an independent risk factor for cardiovascular disease. Epicardial adipose tissue is a novel cardio-metabolic risk factor. Our aim was to evaluate epicardial fat thickness (EFT) using echocardiography in patients with rheumatoid arthritis compared to healthy ...

  6. The relationship between epicardial fat thickness and gestational diabetes mellitus.

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    Nar, Gökay; Inci, Sinan; Aksan, Gökhan; Unal, Oguz Kağan; Nar, Rukiye; Soylu, Korhan

    2014-01-01

    Gestational diabetes mellitus (GDM) is associated with cardiovascular diseases; however, the relationship between epicardial fat thickness (EFT) and GDM remains unclear. The present study evaluates and compares EFT using transthoracic echocardiography in pregnant women with GDM. This cross-sectional study included 129 pregnant women in the third trimester: 65 with GDM (GDM group) and 64 with uncomplicated pregnancies (control group). As defined by the World Health Organization, the diagnosis of GDM was based on an abnormal 2-h oral glucose tolerance test (OGTT) results. We used echocardiography to measure EFT in blood samples for all the participants. The postprandial blood glucose level was significantly higher in the GDM group than in the control group (P < 0.001). There were no significant differences in BMI, heart rate, systolic and diastolic blood pressure or lipid parameters between the groups. In the GDM group, isovolumic relaxation time (IVRT) parameters were significantly higher than in the control group. EFT was significantly higher in the GDM group (P < 0.001) and was correlated with postprandial glucose, BMI, age, and heart rate in both the groups. Only postprandial glucose and BMI remained significantly associated with EFT after multiple stepwise regression analysis. Echocardiographically measured EFT was significantly higher in the patients with GDM. The findings show that EFT was strongly correlated with postprandial glucose.

  7. Clinical Importance of Epicardial Fat Thickness Defining in Obese Patients

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    Galina A. Chumakova, PhD, ScD¹´³

    2012-09-01

    Full Text Available Obesity is a global epidemic characteristic of the 21st century; therefore, studying the subclinical markers of coronary atherosclerosis in overweight patients is current and relevant. With weight increase, hypertrophy and hyperplasia of adipocytes occur not only in the abdominal area, but also in the ectopic local fat depots, including the epicardial ones. As the myocardium and coronary arteries are anatomically related, hormonally active epicardial fat seems to be a pathologic link between obesity and coronary heart disease (CHD. The objective of this research is to study the relationship between epicardial adiposity and abdominal obesity with metabolic risk factors and visceral fat adipokines. The influence of epicardial fat thickness (EFT and waist circumference (WC on the risk of development of significant coronary atherosclerosis in obese patients with CHD was studied (138 men, 55.47±9.07 years and BMI 35.2±5.2 kg/m². The ROC analysis reveals that EFT is more informative in diagnosing significant stenoses (≥70 %: sensitivity of the given marker constituted 80.4 %, specificity – 67.6 % (cut-off value=6 mm. On comparison of the epicardial and abdominal adiposity as predictors of coronary atherosclerosis, EFT was found to be more significant than WC. In patients with CHD, the increase in EFT is associated with the more serious involvement of the coronary arteries, whereas the WC analysis did not establish similar regularities. Evaluation of EFT in obese patients can be used as a noninvasive marker indicative of the presence of subclinical stenoses of the coronary arteries.

  8. Relationship Between Neck Circumference and Epicardial Fat Thickness in a Healthy Male Population.

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    Küçük, Uğur; Küçük, Hilal Olgun; Cüce, Ferhat; Balta, Sevket

    2016-09-01

    Epicardial fat is an upper body visceral fat depot that may play a significant role in the development of adverse metabolic and cardiovascular risk profiles. There is a significant direct relationship between the amount of epicardial fat and general body adiposity (body mass index, BMI), but data regarding subcutaneous adiposity is limited. We conducted a study to determine the association between neck circumference and epicardial fat thickness in healthy young male individuals, and assess their individual correlations with general body adiposity and cardiometabolic risk factors. One hundred consecutive male patients aged 18 years or older with no known major medical conditions were included in the study. All participants underwent detailed physical examination including measurement of blood pressure, weight, height, waist/hip ratio, and neck circumference. Blood was collected to determine fasting glucose and lipid parameters. A standard echocardiographic examination was performed with additional epicardial fat thickness determination. Among 100 study participants, neck circumference correlated significantly with weight, waist circumference, BMI, blood glucose, serum total cholesterol, low-density (LDL)-cholesterol, and triglycerides levels. No significant correlation was found between neck circumference and high-density lipoprotein (HDL)-cholesterol levels. Neck circumference correlated moderately and positively with echocardiographic epicardial fat thickness. Among patients with low cardiometabolic risk, increased neck circumference was associated with increased epicardial fat thickness. A gordura epicárdica é um depósito de gordura visceral na parte superior do organismo que pode desempenhar um papel importante no desenvolvimento de perfis cardiovasculares e metabólicos adversos. Há uma relação direta significativa entre a quantidade de gordura epicárdica e a adiposidade corporal geral (índice de massa corporal, IMC), mas dados sobre a adiposidade

  9. Quantification of epicardial fat: Which method can predict significant coronary artery disease?

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    Saad, Zizi; El-Rawy, Mohamed; Donkol, Ragab H; Boghattas, Sami

    2015-01-01

    AIM: To compare the predictive value of three methods of epicardial fat (EF) assessment for presence of significant coronary artery disease (CAD) [i.e., epicardial fat volume (EFV), EFV indexed with body surface area (EFV/BSA) and EFV indexed with body mass index (EFV/BMI)].

  10. 70. Epicardial fat quality effect on subclinical atherosclerosis

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    R. Abazid

    2016-07-01

    Full Text Available Epicardial fat quality measured as Hounsfield Unit (HU by computed tomography has significant impact on atherosclerosis. Excessive epicardial adipose tissue (EAT is considered a risk factor for coronary artery disease (CAD. There are limited data, however, about the quality of epicardial fat as a CAD risk factor. We investigated the relation between EAT volume and quality and subclinical CAD defined by positive coronary artery calcification (CAC using computed tomography (CT. We reviewed 609 CT scans to assess the EAT volume, which was measured by manually tracing the parietal pericardial sac on axial images. Fat density was recorded in mean Hounsfield units (HU. Coronary calcium scores were measured using the Agatston method. The patients’ mean age was 50 ± 11 years, and 398 (65.4% were men. The mean EAT volume was 65 ± 27 cm3, and it had a density of 87.0 ± 3.4 HU. Calcium was present in 135 (22% of the patients: 97 (16% of the total were men and 38 (6% were women. There was no difference between the sexes in regard to EAT volume (66 ± 27 vs. 63 ± 26, p = 0.34 or density (87.4 ± 3.2 vs. 87.0 ± 3.6, p = 0.28. Obese patients (body mass index ⩾30 kg/m2 had significantly higher EAT volumes than nonobese patients (73 ± 30 vs. 61 ± 29, p = 0.011, but no difference was seen in CAC (33 ± 97 vs. 27 ± 103, p = 0.34 or fat density (87.7 ± 4.0 vs. 88.0 ± 2.7, p = 0.48. Univariate regression analyses showed that higher fat attenuation (HU was associated with a lower coronary atherosclerosis hazard ratio (HR (0.871, 95% confidence interval [CI] 0.790–0.948, p < 0.0001, and an increased EAT volume was associated with more CAC (HR 1.16, 95% CI 1.078–1.245, p = 0.0001. The quality of EAT, measured as HU on CT, is a strong predictor of subclinical CAD as defined by coronary artery calcifications, with a higher HU associated with a lower incidence of atherosclerosis.

  11. [The role of epicardial fat and obesity parameters in the prediction of coronary heart disease].

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    Prídavková, Dana; Kantárová, Daniela; Lišková, Renáta; Červeň, Peter; Kovář, František; Mokáň, Marián

    2016-04-01

    To assess the relationship of parameters of obesity in relationship to coronary angiography findings with correlation of epicardial fat (EF) thickness in uppermentioned context. There were 80 patients examined (43 males, 37 postmenopausal females) undergoing elective coronary angiography. We examined the regular obesity parameters - BMI, waist circumference (WC), neck circumference (NC), total body fat (TBF), and visceral fat (VF) using bioimpedance. We assessed the echocardiographically measured EF thickness. We added examination of lipidogram, glycaemia, HOMA-IR (insulin resistance index) and AIP (aterogenic index of plasma). The set was divided into group with coronarographically proved stenosis or stenoses (withCS), and a group without finding of quantifiable stenosis or stenoses (withoutCS). The average thickness of EF in withCS group was 6.3 vs 5.6 mm in group withoutCS (p obesity parameters in assessment of pre-clinical stages of coronary atherosclerosis and prediction of risk of coronary heart disease. In adipose parameters, EF thickness was correlated the most by WC. Risk stratification of coronary artery disease is supplemented by increased HOMA-IR and AIP.

  12. Epicardial Fat: Definition, Measurements and Systematic Review of Main Outcomes

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    Bertaso, Angela Gallina [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil); Bertol, Daniela [Programa de Pós-Graduação em Epidemiologia - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil); Duncan, Bruce Bartholow; Foppa, Murilo, E-mail: mfoppa@cardiol.br [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil); Programa de Pós-Graduação em Epidemiologia - Universidade Federal do Rio Grande do Sul, Porto Alegre (Brazil)

    2013-07-15

    Epicardial fat (EF) is a visceral fat deposit, located between the heart and the pericardium, which shares many of the pathophysiological properties of other visceral fat deposits, It also potentially causes local inflammation and likely has direct effects on coronary atherosclerosis. Echocardiography, computed tomography and magnetic resonance imaging have been used to evaluate EF, but variations between methodologies limit the comparability between these modalities. We performed a systematic review of the literature finding associations of EF with metabolic syndrome and coronary artery disease. The summarization of these associations is limited by the heterogeneity of the methods used and the populations studied, where most of the subjects were at high cardiovascular disease risk. EF is also associated with other known factors, such as obesity, diabetes mellitus, age and hypertension, which makes the interpretation of its role as an independent risk marker intricate. Based on these data, we conclude that EF is a visceral fat deposit with potential implications in coronary artery disease. We describe the reference values of EF for the different imaging modalities, even though these have not yet been validated for clinical use. It is still necessary to better define normal reference values and the risk associated with EF to further evaluate its role in cardiovascular and metabolic risk assessment in relation to other criteria currently used.

  13. Echocardiographic epicardial adipose tissue measurements provide information about cardiovascular risk in hemodialysis patients.

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    Ulusal Okyay, Gülay; Okyay, Kaan; Polattaş Solak, Evşen; Sahinarslan, Asife; Paşaoğlu, Özge; Ayerden Ebinç, Fatma; Paşaoğlu, Hatice; Boztepe Derici, Ülver; Sindel, Şükrü; Arınsoy, Turgay

    2015-07-01

    Epicardial adipose tissue (EAT) is a cardiovascular risk predictor in general population. However, its value has not been well validated in maintainance hemodialysis (MHD) patients. We aimed to assess associations of EAT with cardiovascular risk predictors in nondiabetic MHD patients. In this cross-sectional study, we measured EAT thickness by transthoracic echocardiography in 50 MHD patients (45.8 ± 14.6 years of age, 37 male). Antropometric measurements, bioimpedance analysis, left ventricular (LV) mass, carotis intima media thickness, blood tests, homeostasis model assessment for insulin resistance (HOMA-IR) and hemodialysis dose by single-pool urea clearence index (spKt/V) were determined. The mean EAT thickness was 3.28 ± 1.04 mm. There were significant associations of EAT with body mass index (β = 0.590, P body fat mass (β = 0.562, P body fat mass (β = 0.408, P = 0.003), percentage of lean tissue mass (β = -0.421, P = 0.002), LV mass (β = 0.426, P = 0.002), carotis intima media thickness (β = 0.289, P = 0.042), triglyceride/high-density lipoprotein cholesterol ratio (β = 0.529, P  0.05). Body mass index, waist circumference, body fat mass, percentage of lean tissue mass, LV mass, triglyceride/high-density lipoprotein cholesterol ratio, HOMA-IR, and spKt/V appeared as independent predictors of EAT. EAT was significantly associated with body fat measures, cardiovascular risk predictors, and dialysis dose in MHD patients. © 2015 International Society for Hemodialysis.

  14. The Relation of Androgenetic Alopecia Severity with Epicardial Fat Thickness

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    Ede, Huseyin; Erkoc, Mustafa Fatih; Akyuz, Yurdanur; Erbay, Ali Riza

    2016-01-01

    Background Androgenetic alopecia (AGA) is the most commonly encountered baldness pattern in men. Epicardial fat tissue is found on the cardiac surface between the myocardium and visceral pericardium. Both AGA and epicardial fat thickness (EFT) are related to coronary artery disease, which is also reflected by an increase in carotid intima media thickness (CIMT). Objective The purpose of this study was to investigate the relation of AGA severity with EFT. Methods One hundred twenty-six male patients with AGA aged 18 to 55 years without histories of chronic disease were enrolled. Subjects were divided into three groups (mild, moderate, and severe) on the basis of the Hamilton baldness scale as modified by Norwood. Maximum EFT was measured at end-systole on the midventricular free wall of the right ventricle. CIMT was also recorded for all patients. Results The groups did not have statistically significant differences with respect to age, height, weight, body mass index, left ventricular ejection fraction, or left atrial diameter (p>0.05 for all comparisons), but the severe group had a higher EFT compared with the moderate (p<0.001; z score, -7.040) and mild groups (p<0.001; z score, -6.667). The moderate group also had higher EFT than the mild group (p<0.001; z score, -5.931). Mean CIMT value in the severe group was significantly higher compared with the value in the other groups. Conclusion The study showed that subjects in advanced stages of AGA had increased EFT, which was measured via echocardiography. PMID:27081268

  15. Prognostic implications of epicardial fat volume quantification in acute pericarditis.

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    Lazaros, George; Antonopoulos, Alexios S; Oikonomou, Evangelos K; Vasileiou, Panagiotis; Oikonomou, Evangelos; Stroumpouli, Evangelia; Karavidas, Apostolos; Antoniades, Charalambos; Tousoulis, Dimitris

    2017-02-01

    The pathophysiology of acute pericarditis remains largely unknown, and biomarkers are needed to identify patients susceptible to complications. As adipose tissue has a pivotal role in cardiovascular disease pathogenesis, we hypothesized that quantification of epicardial fat volume (EFV) provides prognostic information in patients with acute pericarditis. Fifty (n = 50) patients with first diagnosis of acute pericarditis were enrolled in this study. Patients underwent a cardiac computerized tomography (CT) scan to quantify EFV on a dedicated workstation. Patients were followed up in hospital for atrial fibrillation (AF) development and up to 18 months for the composite clinical endpoint of development of constrictive, recurrent or incessant pericarditis or poor response to nonsteroidal anti-inflammatory drugs. Patients presenting with chest pain had lower EFV vs. patients without chest pain (167·2 ± 21·7 vs. 105·1 ± 11·1 cm3 , respectively, P pericarditis during follow-up (per 20 cm3 increase in EFV: OR = 0·802 [0·656-0·981], P pericarditis. Measurement of EFV by CT may have important prognostic implications in these patients. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  16. Mapping epicardial fat with multi-detector computed tomography to facilitate percutaneous transepicardial arrhythmia ablation

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    Abbara, Suhny [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)]. E-mail: Sabbara@partners.org; Desai, Jay C. [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Cury, Ricardo C. [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Butler, Javed [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Nieman, Koen [Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Reddy, Vivek [Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

    2006-03-15

    A sizable portion of ventricular tachycardia circuits are epicardial, especially in patients with non-ischemic cardiomyopathy, e.g. Chagas disease. Thus there is a growing interest among the electrophysiologists in transepicardial mapping and myocardial ablation for treatment of arrhythmias. However, increased epicardial fat can be a significant hindrance in procedural success as it can mimic infarct during mapping and can also decrease the effectiveness of ablation. Quantitative knowledge of epicardial fat pre-procedure can potentially significantly facilitate the conduct and outcomes of these procedures. In this study we assessed the epicardial fat distribution and thickness in vivo in 59 patients who underwent multi-detector computed tomography (MDCT) for coronary artery assessment using a 16-slice scanner. Multiplanar reconstructions were obtained in the ventricular short axis at the basal, mid ventricular, and near the apex level, and in a four-chamber view. In the short axis slices, we measured epicardial fat diameter in nine segments, and in the four-chamber view, it was measured in five segments. In grooved segments the maximum fat thickness was recorded, while in non-grooved segments thickness at three equally spaced points were averaged. The results were as follows starting clockwise: superior inter-ventricular (IV) groove (all measurements are in mm, in basal, mid ventricular, and apical levels, respectively) (11.2, 8.6, 7.3), left ventricular (LV) superior lateral wall (1.0, 1.5, 1.7), LV inferior lateral wall (1.3, 2.2, 3.5), inferior IV groove (9.2, 6.5, 6.1), right ventricular (RV) diaphragmatic wall (1.4, 0.2, 1.0), acute margin (9.2, 7.3, 7.8), RV anterior free wall inferior (6.8, 4.0, 4.7), RV anterior free wall superior (6.5, 3.2, 3.1), RV superior wall (5.6, 2.7, 4.0), We measured the following four-chamber segments: LV apex (2.8 mm), left atrio-ventricular (AV) groove (12.7), right AV groove (14.8), RV apex (4.8), and anterior IV groove (7

  17. Quantification of epicardial fat: Which method can predict significant coronary artery disease?

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    Saad, Zizi; El-Rawy, Mohamed; Donkol, Ragab H; Boghattas, Sami

    2015-05-26

    To compare the predictive value of three methods of epicardial fat (EF) assessment for presence of significant coronary artery disease (CAD) [i.e., epicardial fat volume (EFV), EFV indexed with body surface area (EFV/BSA) and EFV indexed with body mass index (EFV/BMI)]. The study was performed on 170 patients (85 women and 85 men) with clinical suspicion of CAD. They aged 26-89 years with a median age of 54 years. The patients were classified into three groups: Group 1: 58 patients with normal coronary arteries; group 2: 48 patients with non-significant CAD and group 3: 64 patients with significant CAD. The three methods for assessment of epicardial fat were retrospectively studied to determine the best method to predict the presence of significant CAD. The three methods for epicardial fat quantification and measurements, i.e., EFV, EFV/BSA and EFV/BMI with post- hoc analysis showed a significant difference between patients with significant coronary artery disease compared to the normal group. Receiver operating characteristic curve analysis showed no significant difference between the three methods of epicardial fat measurements, the area under curve ranging between 0.6 and 0.62. The optimal cut-off was 80.3 cm(3) for EFV, 2.4 cm(3)/m(2) for EFV indexed with BMI and 41.7 cm(3)/(kg/m(2)) for EFV indexed with BSA. For this cut-off the sensitivity ranged between 0.92 and 0.94, while specificity varied from 0.31 to 0.35. Any one of the three methods for assessment of epicardial fat can be used to predict significant CAD since all have the same equivalent predictive value.

  18. Epicardial and Pericardial Fat Volume Correlate with the Severity of Coronary Artery Stenosis

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    Aslanabadi Naser

    2014-12-01

    Full Text Available Introduction: Epicardial fat volume (EFV has been reported to correlate with the severity of coronary artery disease (CAD. Pericardial fat volume (PFV has recently been reported to be strongly associated with CAD severity and presence. We aimed to investigate the relationship between EFV and PFV with severity of coronary artery stenosis in patients undergoing 64-slice multi-slice computed tomography (MSCT. Methods: One hundred and fifty one patients undergoing MSCT for suspected CAD were enrolled. Non-enhanced images were acquired to assess calcium score. Contrast enhanced images were used to quantify EFV, PFV and severity of luminal stenosis. Results: Coronary artery stenosis was mild in 25 cases (16.6%, moderate in 58 cases (38.4% and severe in 68 cases (45%. With increase in severity of coronary artery stenosis, there was significant increase in PFV, EFV as well as epicardial fat thickness in right ventricle free wall in basal view and epicardial fat thickness in left ventricle posterior wall in mid and apical view. There was significant linear correlation between PFV with coronary calcification score (r=0.18, P=0.02, between coronary artery stenosis severity and PFV (r=0.75, P<0.001, EFV (r=0.79, P<0.001, apical epicardial fat thickness in right ventricle free wall (r=0.29, P<0.001, Mid (r=0.28, P<0.001 and basal (r=0.23, P=0.004 epicardial fat thickness in left ventricle posterior wall. Conclusion: PFV, EFV and regional epicardial thickness are correlated with severity of CAD and could be used as a reliable marker in predicting CAD severity.

  19. Machine learning in the prediction of cardiac epicardial and mediastinal fat volumes.

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    Rodrigues, É O; Pinheiro, V H A; Liatsis, P; Conci, A

    2017-10-01

    We propose a methodology to predict the cardiac epicardial and mediastinal fat volumes in computed tomography images using regression algorithms. The obtained results indicate that it is feasible to predict these fats with a high degree of correlation, thus alleviating the requirement for manual or automatic segmentation of both fat volumes. Instead, segmenting just one of them suffices, while the volume of the other may be predicted fairly precisely. The correlation coefficient obtained by the Rotation Forest algorithm using MLP Regressor for predicting the mediastinal fat based on the epicardial fat was 0.9876, with a relative absolute error of 14.4% and a root relative squared error of 15.7%. The best correlation coefficient obtained in the prediction of the epicardial fat based on the mediastinal was 0.9683 with a relative absolute error of 19.6% and a relative squared error of 24.9%. Moreover, we analysed the feasibility of using linear regressors, which provide an intuitive interpretation of the underlying approximations. In this case, the obtained correlation coefficient was 0.9534 for predicting the mediastinal fat based on the epicardial, with a relative absolute error of 31.6% and a root relative squared error of 30.1%. On the prediction of the epicardial fat based on the mediastinal fat, the correlation coefficient was 0.8531, with a relative absolute error of 50.43% and a root relative squared error of 52.06%. In summary, it is possible to speed up general medical analyses and some segmentation and quantification methods that are currently employed in the state-of-the-art by using this prediction approach, which consequently reduces costs and therefore enables preventive treatments that may lead to a reduction of health problems. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. An increase in epicardial fat in women is associated with thrombotic risk.

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    Basurto Acevedo, Lourdes; Barrera Hernández, Susana; Fernández Muñoz, María de Jesús; Saucedo García, Renata Patricia; Rodríguez Luna, Ana Karen; Martínez Murillo, Carlos

    2018-01-29

    A decrease in fibrinolytic activity and an increase in the thickness of the epicardial adipose tissue have been observed in patients with coronary artery disease. The aim of this study was to determine the association between epicardial adipose tissue and fibrinolytic activity by measuring the concentration of plasminogen activator inhibitor-1 (PAI-1). A cross-sectional study was conducted on 56 apparently healthy women aged 45 to 60 years. Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Epicardial thickness was assessed by transthoracic echocardiography. The concentration of PAI-1 was directly associated with the thickness of the epicardial adipose tissue (r=0.475, P=.001), body mass index (BMI), visceral adipose tissue, insulin resistance, glucose, and HDL-cholesterol. The multivariate regression analysis indicated that epicardial fat independently predicts the concentrations of PAI-1. Women with thicker epicardial adipose tissue have reduced fibrinolytic activity, and consequently greater thrombotic risk. Copyright © 2017 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Association between endothelial dysfunction, epicardial fat and subclinical atherosclerosis during menopause.

    Science.gov (United States)

    Cabrera-Rego, Julio Oscar; Navarro-Despaigne, Daisy; Staroushik-Morel, Liudmila; Díaz-Reyes, Karel; Lima-Martínez, Marcos M; Iacobellis, Gianluca

    Menopausal transition is critical for the development of early, subclinical vascular damage. Multiple factors, such as atherosclerosis, increased epicardial fat, and endothelial dysfunction can play a role. Hence, the objective of this study was the comparison of epicardial adipose tissue and carotid intima media thickness in order to establish the best predictor of carotid stiffness in middle-aged women with endothelial dysfunction. A total of 43 healthy women aged 40-59 years old with endothelial dysfunction previously demonstrated by flow mediated dilation were recruited to have anthropometric, biochemical, hormonal and ultrasound determinations of carotid intima media thickness and epicardial fat thickness. Carotid arterial stiffness parameters (local pulse wave velocity [4.7±0.7 vs 4.8±0.5 vs 5.6±0.5m/s, respectively, p<0.001], pressure strain elastic modulus [55.2±13.4 vs 59.2±11.8 vs 81.9±15.6kPa, respectively, p<0.001], arterial stiffness index β [4.4±1.4 vs 5.0±1.1 vs 6.4±1.3, respectively, p<0.001]) and epicardial fat thickness (2.98±1.4 vs 3.28±1.9 vs 4.70±1.0mm, respectively, p=0.007) showed a significant and proportional increase in the group of late post-menopausal women when compared to early post-menopausal and pre-menopausal groups, respectively. Among body fat markers, epicardial fat was the strongest predictor of local pulse wave velocity, independent of age. In menopausal women with endothelial dysfunction, menopausal transition is associated with increased carotid arterial stiffness and epicardial fat thickness, independent of age. Ultrasound measured epicardial fat was a better independent predictor of arterial stiffness than carotid intima media thickness in these women. Copyright © 2017 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat

    National Research Council Canada - National Science Library

    Gaborit, B; Kober, F; Jacquier, A; Moro, P J; Cuisset, T; Boullu, S; Dadoun, F; Alessi, M-C; Morange, P; Clément, K; Bernard, M; Dutour, A

    2012-01-01

    To assess epicardial fat volume (EFV), myocardial TG content (MTGC) and metabolic profile in severely obese patients, and to determine whether ectopic fat depots are linked to metabolic disorders or myocardial function...

  3. The Association Between Epicardial Adipose Tissue and Coronary Artery Disease: an Echocardiographic Cut-off Point

    Directory of Open Access Journals (Sweden)

    Mehrnoush Toufan

    2012-09-01

    Full Text Available Introduction: EAT is an independent factor in coronary artery disease (CAD. The objective of the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk. Methods: Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography for measurement of EAT on the right ventricle (RV, RV apex and RV outlet tract. Sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of the EAT cut-off points in the three above-mentioned areas for predicting the severity of CAD were measured. The relation between the EAT and CAD risk factors was evaluated as well. Results: EAT was independent from gender, height, hypertension, diabetes, HDL, total cholesterol, ejection fraction, acute coronary syndrome, and the location of the coronary artery stenosis in the coronary artery in all three anatomical areas. EAT on RV and RV apex had a significant relation with CAD (P ≤ 0.05. Overall, RV EAT≥ 10 mm and RV apex EAT ≥ 8 mm had sensitivity and PPV of more than 70% in predicting coronary stenosis ≥ 50% and acute coronary syndrome (ACS and RVOT EAT ≥ 13 mm is of PPV=83.5% for predicting coronary stenosis ≥ 50%. Conclusion: EAT thickness has an acceptable diagnostic value for predicting severe coronary artery stenosis and ACS. Therefore, non-invasive EAT thickness measurement could be of great assistance to clinicians for detecting the patients at risk and helping them to undergo supplementary evaluations with invasive approaches.

  4. Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content.

    Science.gov (United States)

    Gaborit, Bénédicte; Jacquier, Alexis; Kober, Frank; Abdesselam, Ines; Cuisset, Thomas; Boullu-Ciocca, Sandrine; Emungania, Olivier; Alessi, Marie-Christine; Clément, Karine; Bernard, Monique; Dutour, Anne

    2012-10-09

    This study investigated the effect of bariatric surgery (BS)-induced weight loss on cardiac ectopic fat using 3T magnetic resonance imaging in morbid obesity. Heart disease is one of the leading causes of mortality and morbidity in obese patients. Deposition of cardiac ectopic fat has been related to increased heart risk. Whether sustained weight loss can modulate epicardial fat or myocardial fat is unknown. Twenty-three morbidly obese patients underwent 1H-magnetic resonance spectroscopy to determine myocardial triglyceride content (MTGC), magnetic resonance imaging to assess epicardial fat volume (EFV), cardiac function, and computed tomography visceral abdominal fat (VAF) measurements at baseline and 6 months after BS. The BS reduced body mass index significantly, from 43.1±4.5 kg/m2 to 32.3±4.0 kg/m2, subcutaneous fat from 649±162 cm2 to 442±127 cm2, VAF from 190±83 cm2 to 107±44 cm2, and EFV from 137±37 ml to 98±25 ml (all ploss (ploss in EFV was limited (-27±11%) compared to VAF diminution (-40±19%). The EFV variation was not correlated with percentage of body mass index or VAF loss (p=0.007). The ratio of %EFV to %VAF loss decreased with sleep apnea syndrome (1.34±0.3 vs. 0.52±0.08, pfat deposition, with a significant decrease in epicardial fat and no change in myocardial fat. Epicardial fat volume loss was limited in patients with sleep apnea. (Impact of Bariatric Surgery on Epicardial Adipose Tissue and on Myocardial Function; NCT01284816). Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Prognostic value of epicardial fat volume measurements by computed tomography: a systematic review of the literature.

    Science.gov (United States)

    Spearman, James V; Renker, Matthias; Schoepf, U Joseph; Krazinski, Aleksander W; Herbert, Teri L; De Cecco, Carlo N; Nietert, Paul J; Meinel, Felix G

    2015-11-01

    To perform a systematic review of the growing body of literature evaluating the prognostic value of epicardial fat volume (EFV) quantified by cross-sectional imaging. Two independent reviewers performed systematic searches on both PubMed and Scopus using search terms developed with a medical librarian. Peer-reviewed articles were selected based on the inclusion of outcome data, utilization of epicardial fat volume and sufficient reporting for analysis. A total of 411 studies were evaluated with nine studies meeting the inclusion criteria. In all, the studies evaluated 10,252 patients. All nine studies were based on CT measurements. Seven studies evaluated the prognostic value of EFV unadjusted for calcium score, and six of these studies found a significant association between EFV and clinical outcomes. Seven studies evaluated the incremental value of EFV beyond calcium scoring, and six of these studies found a significant association. The majority of studies suggest that EFV quantification is significantly associated with clinical outcomes and provides incremental prognostic value over coronary artery calcium scoring. Future research should use a binary cutoff of 125 mL for evaluation of EFV to provide consistency with other research. • Epicardial fat volume (EFV) has prognostic value for adverse cardiac events • Establishment of standardized quantitative categories for EFV is needed • Quantification of EFV could improve risk assessment with calcium scoring.

  6. Increased bioactive lipids content in human subcutaneous and epicardial fat tissue correlates with insulin resistance.

    Science.gov (United States)

    Błachnio-Zabielska, Agnieszka U; Baranowski, Marcin; Hirnle, Tomasz; Zabielski, Piotr; Lewczuk, Anna; Dmitruk, Iwona; Górski, Jan

    2012-12-01

    Obesity is a risk factor for metabolic diseases. Intramuscular lipid accumulation of ceramides, diacylglycerols, and long chain acyl-CoA is responsible for the induction of insulin resistance. These lipids are probably implicated in obesity-associated insulin resistance not only in skeletal muscle but also in fat tissue. Only few data are available about ceramide content in human subcutaneous adipose tissue. However, there are no data on DAG and LCACoA content in adipose tissue. The aim of our study was to measure the lipids content in human SAT and epicardial adipose tissue we sought to determine the bioactive lipids content by LC/MS/MS in fat tissue from lean non-diabetic, obese non-diabetic, and obese diabetic subjects and test whether the lipids correlate with HOMA-IR. We found, that total content of measured lipids was markedly higher in OND and OD subjects in both types of fat tissue (for all p lipids content is greater in subcutaneous and epicardial fat tissue and the particular lipids content positively correlates with HOMA-IR.

  7. Increased Epicardial Fat Volume Is Independently Associated with the Presence and Severity of Systemic Sclerosis.

    Science.gov (United States)

    Long, Benjamin D; Stojanovska, Jadranka; Brown, Richard K J; Attili, Anil K; Jackson, Eizabeth A; Ognenovski, Vladimir

    2017-12-01

    The study aimed to determine if intrathoracic fat volumes are associated with the presence and severity of systemic sclerosis (SSc), defined by the presence of pulmonary arterial hypertension (PAH). A total of 265 patients were included in the study, 202 of whom had SSc (134 had SSc with no PAH and 68 had SSc-associated PAH) and who underwent high-resolution computed tomography, and 63 controls who underwent coronary computed tomography angiography with calcium scoring. Intrathoracic and epicardial (EFV) fat volumes were quantified by manual tracing of the mediastinum and the pericardium, the difference of which represents the extrapericardial fat volume. Associations between these three fat volumes and the presence and severity of SSc, adjusted for cardiovascular risk factors and interstitial lung disease, were evaluated by logistic regression analysis. Of the 202 patients with SSc, the mean age was 55 years (ranged from 20 to 86), and 79% (159 of 202) were women. Adjusted EFV (odds ratio [OR]: 1.065; 95% confidence interval [CI]: 1.046-1.084, P = fat volume (OR: 1.028, 95% CI: 1.017-1.038, P = fat volume (OR: 1.033, 95% CI: 1.023-1.043, P = 0.001) were associated with the presence of SSc. Only EFV was associated with SSc severity (adjusted OR: 1.010, 95% CI: 1.003-1.018, P = 0.007). Increased epicardial fat volume is associated with the presence and severity of SSc, independent of cardiovascular risk factors and interstitial lung disease. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  8. Association of systemic inflammation with epicardial fat and coronary artery calcification.

    Science.gov (United States)

    Gauss, Sören; Klinghammer, Lutz; Steinhoff, Alina; Raaz-Schrauder, Dorette; Marwan, Mohamed; Achenbach, Stephan; Garlichs, Christoph D

    2015-05-01

    Increased epicardial fat volume (EFV) has been shown to be associated with coronary atherosclerosis. While it is postulated to be an independent risk factor, a possible mechanism is local or systemic inflammation. We analyzed the relationship between coronary atherosclerosis, quantified by coronary calcium in CT, epicardial fat volume and systemic inflammation. Using non-enhanced dual-source CT, we quantified epicardial fat volume (EFV) and coronary artery calcium (CAC) in 391 patients who underwent coronary computed tomography for suspected coronary artery disease. In addition to traditional risk factors, serum markers of systemic inflammation were measured (IL-1α, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10,IL-12, IL-13, IL-15, IL-17, IFN-γ, TNF-α, hs-CRP, GM-CS, G-CSF, MCP-1, MIP-1, Eotaxin and IP-10). In 94 patients follow-up data were obtained after 1.9 ± 0.5 years. The 391 patients had a mean age of 60 ± 10 years, and 69 % were males. Mean EFV was 116 ± 50 mL. Median CAC was 12 (IQR 0; 152). CAC and EFV showed a significant correlation (ρ = 0.37; P EFV and CAC were significantly correlated with the traditional risk factors like age, male gender, diabetes, smoking and hypertension. With regard to biomarkers, CAC was significantly associated (negatively) to G-CSF and IL-13. EFV (median binned) was significantly associated (positively) with IP-10 (P = 0.002) and MCP-1 (ρ = 0.037). In follow-up, EFV showed a mean annualized progression of 6 mL (IQR 3; 9) (P EFV (P EFV or CAC with systemic inflammation markers. Epicardial fat volume and the baseline extent as well as progression of coronary atherosclerosis-measured by the calcium score-are significantly correlated. While both baseline EFV and CAC displayed significant correlations with systemic inflammation markers, biomarkers were not predictive of the progression of CAC or EFV.

  9. Prognostic value of epicardial fat volume measurements by computed tomography: a systematic review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Spearman, James V.; Krazinski, Aleksander W. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Renker, Matthias [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Giessen University, Department of Internal Medicine I, Cardiology/Angiology, Giessen (Germany); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Herbert, Teri L. [Medical University of South Carolina, Department of Library Science and Informatics, Charleston, SC (United States); De Cecco, Carlo N. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' Sapienza' - Polo Pontino, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Nietert, Paul J. [Medical University of South Carolina, Department of Public Health Sciences, Charleston, SC (United States); Meinel, Felix G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Munich (Germany)

    2015-11-15

    To perform a systematic review of the growing body of literature evaluating the prognostic value of epicardial fat volume (EFV) quantified by cross-sectional imaging. Two independent reviewers performed systematic searches on both PubMed and Scopus using search terms developed with a medical librarian. Peer-reviewed articles were selected based on the inclusion of outcome data, utilization of epicardial fat volume and sufficient reporting for analysis. A total of 411 studies were evaluated with nine studies meeting the inclusion criteria. In all, the studies evaluated 10,252 patients. All nine studies were based on CT measurements. Seven studies evaluated the prognostic value of EFV unadjusted for calcium score, and six of these studies found a significant association between EFV and clinical outcomes. Seven studies evaluated the incremental value of EFV beyond calcium scoring, and six of these studies found a significant association. The majority of studies suggest that EFV quantification is significantly associated with clinical outcomes and provides incremental prognostic value over coronary artery calcium scoring. Future research should use a binary cutoff of 125 mL for evaluation of EFV to provide consistency with other research. (orig.)

  10. Parâmetros ecocardiográficos de deposição de gordura epicárdica e sua relação com doença arterial coronariana Parámetros ecocardiográficos de deposición de grasa epicárdica y su relación con la enfermedad arterial coronaria Echocardiographic parameters of epicardial fat deposition and its relation to coronary artery disease

    Directory of Open Access Journals (Sweden)

    Juan Valiente Mustelier

    2011-08-01

    la infiltración de grasa del ventrículo derecho (VD permanece como algo indeterminado. Ninguno de esos parámetros fue totalmente estudiado en pacientes hispánicos. OBJETIVO: Determinar la asociación entre la grasa epicárdica, la infiltración lipomatosa del septo atrial y la infiltración de grasa del VD en presencia de EAC. MÉTODOS: Doscientos cincuenta pacientes hispánicos (86 mujeres y 164 hombres, con un promedio de edad entre los 61,5 ± 8 vs y 62 ± 10 años respectivamente, fueron sometidos a su primera angiografía coronaria invasiva (ACI y se estudiaron. El día posterior a la ACI, los parámetros de deposición de grasa epicárdica fueron evaluados a través de la ecocardiografía bidimensional. Las variables clínicas como la edad, el sexo, antecedentes personales como el hábito de fumar, la hipertensión y la diabetes mellitus, como también la presentación clínica de la EAC, y antropométricas (circunferencia de la cintura e índice de masa corporal [IMC], también se recolectaron. RESULTADOS: La grasa epicárdica (OR 1,27 p = 0,009, y la infiltración de grasa en el VD (OR 2,94 p = 0,027, presentaron una asociación significativa e independiente con la presencia, pero no con la extensión (p = 0,516 y presentación clínica (p = 0,153 de la EAC. La extensión de la deposición de la grasa epicárdica mostró una asociación proporcional y significativa (p = 0,001 en presencia de EAC. CONCLUSIÓN: La grasa epicárdica y la infiltración de grasa del VD fueron factores significativos e independientes asociados a la presencia de EAC, que estaba proporcionalmente aumentada a tono con la extensión de la deposición de grasa epicárdica.BACKGROUND: Epicardial fat has been associated to the presence of significant coronary artery disease (CAD. However, the association of lipomatous infiltration of the atrial septum and fat infiltration of the right ventricle remains uncertain. None of these parameters has been thoroughly studied in Hispanic

  11. Feasibility of dual gradient-echo in-phase and opposed-phase magnetic resonance imaging for the evaluation of epicardial fat

    Energy Technology Data Exchange (ETDEWEB)

    Okayama, Satoshi; Ayako, Seno; Somekawa, Satoshi; Uemura, Shiro; Saito, Yoshihiko (First Dept. of Internal Medicine, Nara Medical Univ., Nara (Japan)), email: satosi01@naramed-u.ac.jp; Kubota, Yasushi (Radiology, Hirai Hospital, Nara (Japan))

    2011-09-15

    Background: Dual gradient-echo in-phase (IP) and opposed-phase (OP) magnetic resonance imaging (MRI) can evaluate small amounts of fat, and is widely used for imaging abdominal organs. Epicardial fat has recently been revealed as having an important role in the development of heart disease, but IPOP-MRI has not been widely applied in this field, probably because of cardiac motion artifacts. Purpose: To demonstrate the feasibility of IPOP-MRI with electrocardiography (ECG)-gating for evaluation of epicardial fat in the normal human heart, compared to black-blood T1-weighted imaging (T1WI). Material and Methods: Ten healthy volunteers were studied. Epicardial fat volume was quantitatively evaluated on OP-from-IP subtraction images and T1-weighted images. Results: Epicardial fat was clearly visualized on the subtraction images as hyperintense areas that corresponded to regions identified as epicardial fat on the T1-weighted images. Epicardial fat volume correlated well between the two methods (r = 0.93, P <0.0001), and tended to be larger on the subtraction images than on the T1-weighted images (91.4 +- 30.1 vs. 84.1 +- 30.5 mL, P = 0.07). Conclusion: IPOP-MRI with ECG-gating may be a useful alternative method to black-blood T1WI for evaluation of epicardial fat

  12. Comparison of Epicardial Fat Volume by Computed Tomography in Black Versus White Patients With Acute Chest Pain

    NARCIS (Netherlands)

    Apfaltrer, Paul; Schindler, Andreas; Schoepf, U. Joseph; Nance, John W.; Tricarico, Francesco; Ebersberger, Ullrich; McQuiston, Andrew D.; Meyer, Mathias; Henzler, Thomas; Schoenberg, Stefan O.; Bamberg, Fabian; Vliegenthart, Rozemarijn

    2014-01-01

    Disparities in the risk of coronary artery disease (CAD) between races may be influenced by differences in the thoracic adipose tissue. We compared computed tomography (CT)-derived volumes of epicardial adipose tissue (EAT), mediastinal adipose tissue (MAT), and peri-coronary fat thickness (PET) and

  13. Epicardial fat is associated with severity of subclinical coronary atherosclerosis in familial hypercholesterolemia.

    Science.gov (United States)

    Mangili, Leonardo C; Mangili, Otavio C; Bittencourt, Márcio S; Miname, Márcio H; Harada, Paulo H; Lima, Leonardo M; Rochitte, Carlos E; Santos, Raul D

    2016-11-01

    Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated blood cholesterol, increased prevalence of subclinical atherosclerosis and high risk of premature coronary heart disease. However, this risk is not explained solely by elevated LDL-cholesterol concentrations, and other factors may influence atherosclerosis development. There is evidence that increased adiposity may predispose to atherosclerosis in FH. Epicardial fat has been associated with subclinical coronary atherosclerosis in the general population. This study evaluated the association of epicardial fat (EFV) volume with the presence and extent of subclinical coronary atherosclerosis detected by computed tomography angiography in FH patients. Ninety-seven FH subjects (35% male, mean age 45 ± 13 years, LDL-C 281 ± 56 mg/dL, 67% with proven molecular defects) underwent computed tomography angiography and coronary artery calcium (CAC) scoring. EFV was measured in non-contrast images using a semi-automated method. Segment-stenosis score (SSS) and segment-involvement score (SIS) were calculated. Multivariate Poisson regression was utilized to assess an independent association of EFV with coronary atherosclerotic burden. EFV was positively associated with age, body mass index, waist circumference, blood glucose, the presence of the metabolic syndrome components, but not with LDL-C. After adjusting for confounders and abdominal circumference, an independent association (shown as β coefficients and 95% confidence intervals) of EVF with CAC scores [β = 0.263 (0.234; 0.292), p=0.000], SIS [β = 0.304 (0.141; 0.465) p=0.000] and SSS [β = 0.296 (0.121; 0.471), p=0.001] was found. In FH, EFV was independently associated with coronary atherosclerotic presence and severity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Traumatic aortic transection with intraluminal aortic fat: transesophageal echocardiographic characteristics and implications.

    Science.gov (United States)

    Sumner, Andrew D; Bobin, John J; Mehta, Sanjay; Stephenson, Edward R

    2003-11-01

    Aortic transection can be a catastrophic complication of blunt chest trauma. Transesophageal echocardiography is a useful tool for assessing aortic pathology. Presented is a case of traumatic aortic transection in which periaortic fat was found within the aortic lumen. Transesophageal echocardiographic characteristics are reviewed and clinical implications discussed.

  15. Local Production of Fatty Acid–Binding Protein 4 in Epicardial/Perivascular Fat and Macrophages Is Linked to Coronary Atherosclerosis

    National Research Council Canada - National Science Library

    Furuhashi, Masato; Fuseya, Takahiro; Murata, Masaki; Hoshina, Kyoko; Ishimura, Shutaro; Mita, Tomohiro; Watanabe, Yuki; Omori, Akina; Matsumoto, Megumi; Sugaya, Takeshi; Oikawa, Tsuyoshi; Nishida, Junichi; Kokubu, Nobuaki; Tanaka, Marenao; Moniwa, Norihito; Yoshida, Hideaki; Sawada, Norimasa; Shimamoto, Kazuaki; Miura, Tetsuji

    2016-01-01

    .... APPROACH AND RESULTS—First, by immunohistochemical analyses, we found that FABP4 was expressed in macrophages within coronary atherosclerotic plaques and epicardial/perivascular fat in autopsy cases and macrophages within...

  16. Epicardial fat volume is associated with coronary microvascular response in healthy subjects: a pilot study.

    Science.gov (United States)

    Gaborit, Bénédicte; Kober, Frank; Jacquier, Alexis; Moro, Pierre Julien; Flavian, Antonin; Quilici, Jacques; Cuisset, Thomas; Simeoni, Umberto; Cozzone, Patrick; Alessi, Marie-Christine; Clément, Karine; Bernard, Monique; Dutour, Anne

    2012-06-01

    Epicardial fat (EF) is an active ectopic fat depot, which has been associated with coronary atherosclerosis, and which could early influence endothelial function. We thus investigated the relationship between EF and endothelium-dependent vasoreactivity of the coronary microcirculation, in highly selected healthy volunteers. Myocardial blood flow (MBF) was determined by measuring coronary sinus flow with velocity-encoded cine magnetic resonance imaging (MRI) at 3T. We measured MBF at baseline and in response to sympathetic stimulation by cold pressor testing (CPT) in 30 healthy volunteers with normal left ventricular (LV) function (age 22 ± 4 years, BMI = 21.3 ± 2.8 kg/m(2)). EF volume was volumetrically assessed by manual delineation on short-axis views. CPT was applied by immersing one foot in ice water for 4 min. Mean EF volume was 56 ± 26 ml and mean LV mass 100 ± 28 g. CPT significantly increased heart rate (HR) by 32 ± 19%, systolic blood pressure by 14 ± 10%, and rate-pressure product by 45 ± 25%, P glycemic parameters. In multivariate analysis, adiponectin and EF volume remained both independently associated with ΔMBF. A high EF amount is associated with a lower coronary microvascular response, suggesting that EF could early influence endothelial function.

  17. The association of epicardial fat volume with coronary characteristics and clinical outcome.

    Science.gov (United States)

    Iwasaki, Kohichiro; Urabe, Norio; Kitagawa, Atsushi; Nagao, Toshihiko

    2017-08-14

    Recent studies have demonstrated the relationship between epicardial fat volume (EFV) and coronary atherosclerosis, but their association is modest at best. Our purpose is to elucidate the association of epicardial fat with coronary characteristics and clinical outcome. We performed coronary computed tomographic angiography in 651 patients and divided them into three groups according to tertiles of EFV; low-tertile (n = 215), 36-123 ml; middle-tertile (n = 218), 124-165 ml; high-tertile (n = 218), 166-489 ml. The prevalence of coronary calcium score (CCS) >0 (71.6, 73.4, and 83.9% in low-, middle-, and high-tertile group, respectively) and CCS >100 (39.1, 39.9, and 59.2% in each group) was significantly higher in patients with high-tertile EFV compared to the other two groups (p = 0.0047 and p 400 was 17.2, 25.7, and 33.1% in each group, which increased stepwise as EFV increased. The significant stenosis (36.2 vs. 27.0%, p = 0.0383), total coronary occlusion (5.5 vs. 0.9%, p = 0.0156), and high-risk plaque (11.0 vs. 5.6%, p = 0.0368) were more prevalent in patients with high-tertile EFV compared to those with low-tertile EFV. The combined rate of cardiac death and myocardial infarction was 0.9, 2.3, and 6.4% in each patient group, respectively, which was significantly higher in patients with high-tertile EFV compared to those with low-tertile EFV (p = 0.0004). The prevalence of coronary artery calcium, significant stenosis, and high-risk plaque increased sharply in patients with high EFV, which was associated with higher rate of cardiac death and myocardial infarction. Thus, high EFV was associated with advanced coronary atherosclerosis and poor prognosis.

  18. Effect of iterative reconstruction on variability and reproducibility of epicardial fat volume quantification by cardiac CT.

    Science.gov (United States)

    Oda, Seitaro; Utsunomiya, Daisuke; Funama, Yoshinori; Yuki, Hideaki; Kidoh, Masafumi; Nakaura, Takeshi; Takaoka, Hiroko; Matsumura, Masaki; Katahira, Kazuhiro; Noda, Katsuo; Oshima, Shuichi; Tokuyasu, Shinichi; Yamashita, Yasuyuki

    2016-01-01

    The epicardial fat volume (EFV) measured by cardiac CT has emerged as an important parameter for understanding the pathophysiology of coronary atherosclerosis. We investigated the variability and reproducibility of EFV measurements and evaluated the effect of model-based type iterative reconstruction (M-IR) on measurement results. Non-contrast cardiac CT data (tube voltage 120-kVp, tube current time product 32 mAs) of 30 consecutive patients were reconstructed with filtered back projection (FBP), hybrid type iterative reconstruction (H-IR), and M-IR using a slice thickness of 3.0 mm. CT attenuation and image noise was measured for all reconstructions. Two observers independently quantified EFV using semi-automated software and interobserver agreement was evaluated. There was no significant difference in the CT attenuation of the ascending aorta among the three reconstructions. The mean image noise on FBP-, H-IR-, and M-IR images was 48.0 ± 7.9 HU, 29.6 ± 4.8 HU, and 9.3 ± 1.3 HU, respectively; there was a significant difference among all comparison combinations for the three reconstructions (p reconstructions (171.0 ± 54.9 cm(3) [FBP], 153.8 ± 53.1 cm(3) [H-IR], and 134.0 ± 46.4 cm(3) [M-IR]). For all three reconstructions, interobserver correlations were excellent (r = 0.91 [FBP], 0.93 [H-IR], and 0.96 [M-IR]). Interobserver comparisons showed that the lowest Bland-Altman limit of agreement was with M-IR (mean difference 2.0 ± 4.9%, 95% limit of agreement, -24.0 to 28.0%) followed by H-IR (-2.6 ± 7.1%, -39.8 to 34.6%) and FBP (-0.2 ± 8.6%, -45.3- to 45.0%). For the quantification of epicardial fat by cardiac CT, model-based iterative reconstruction can improve the image quality and lessen measurement variability. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  19. Epicardial fat volume and aortic stiffness in healthy individuals. A quantitative cardiac magnetic resonance study

    Energy Technology Data Exchange (ETDEWEB)

    Homsi, R.; Thomas, D.; Meier-Schroers, M.; Dabir, D.; Kuetting, D.; Luetkens, J.A.; Marx, C.; Schild, H.H. [Bonn University Hospital (Germany). Radiology; Gieseke, J. [Philips Healthcare, Hamburg (Germany); Sprinkart, A. [Bonn University Hospital (Germany). Radiology; Bochum Univ. (Germany). Inst. of Medical Engineering

    2016-09-15

    To determine epicardial fat volume (EFV) and aortic stiffness (assessed by aortic pulse wave velocity (PWV)) in healthy individuals, and to investigate the relationship of these parameters, and their association with body mass index (BMI) and age. 58 subjects (29 men, mean age 44.7 ± 13.9 years[y]) underwent a CMR exam at 1.5 Tesla. A 2 D velocity-encoded CMR scan was acquired to determine PWV. The EFV was measured based on a 3 D-mDixon sequence. Group comparisons were made between younger (age < 45y; n=30; mean age 33.4 ± 6.6y) and older (> 45y; n=28; 56.7 ± 8.4y) subjects and between subjects with a BMI < 25 kg/m{sup 2} (n=28; BMI 21.9 ± 2.5 kg/m{sup 2}) and a BMI > 25 kg/m{sup 2} (n=30; 28.7 ± 4.0 kg/m{sup 2}). Associations between the determined parameters were assessed by analyses of covariance (ANCOVAs). The mean values of PWV and EFV (normalized to body surface area) were 6.9 ±1.9 m/s and 44.2 ± 25.0 ml/m{sup 2}, respectively. The PWV and EFV were significantly higher in the older group (PWV=7.9 ± 2.0 m/s vs. 6.0 ± 1.2 m/s; EFV=54.7 ml/m{sup 2} vs. 34.5 ml/m{sup 2}; p < 0.01, each), with no significant differences in BMI or sex. In the overweighted group the EFV was significantly higher than in subjects with a BMI < 25kg/m{sup 2} (EFV=56.1 ± 27.1 ml/m{sup 2} vs. 31.5 ± 14.6 ml/m{sup 2}; p < 0.01) but without a significant difference in PWV. ANCOVA revealed a significant correlation between EFV and PWV, also after adjustment for age (p=0.025). An association was found between age and EFV as well as PWV. EFV and PWV were related to each other also after adjustment for age. The metabolic and pro-inflammatory activity found with increased epicardial fat volume may promote the development of atherosclerosis and aortic stiffness. CMR may be valuable for future studies investigating the relationship between EFV and PWV in patients with increased cardiovascular risk.

  20. Circulating SIRT1 inversely correlates with epicardial fat thickness in patients with obesity.

    Science.gov (United States)

    Mariani, S; Costantini, D; Lubrano, C; Basciani, S; Caldaroni, C; Barbaro, G; Poggiogalle, E; Donini, L M; Lenzi, A; Gnessi, L

    2016-11-01

    Obesity is increasing worldwide and is related to undesirable cardiovascular outcomes. Epicardial fat (EF), the heart visceral fat depot, increases with obesity and correlates with cardiovascular risk. SIRT1, an enzyme regulating metabolic circuits linked with obesity, has a cardioprotective effect and is a predictor of cardiovascular events. We aimed to assess the relationship of EF thickness (EFT) with circulating SIRT1 in patients with obesity. Sixty-two patients affected by obesity and 23 lean controls were studied. Plasma SIRT1 concentration was determined by enzyme-linked immunosorbent assay (ELISA). EFT was measured by echocardiography. Body mass index (BMI), waist circumference, heart rate (HR), blood pressure, and laboratory findings (fasting glucose, insulin, HbA1c, cholesterol, and triglycerides) were assessed. SIRT1 was significantly lower (P = 0.002) and EFT was higher (P obesity compared with lean controls. SIRT1 showed a negative correlation with EFT and HR in the obesity group (ρ = -0.350, P = 0.005; ρ = -0.303, P = 0.008, respectively). After adjustment for obesity-correlated variables, multiple linear regression analysis showed that EFT remained the best correlate of SIRT1 (β = -0.352, P = 0.016). Circulating SIRT1 correlates with the visceral fat content of the heart. Serum SIRT1 levels might provide additional information for risk assessment of coronary artery disease in patients with obesity. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  1. Epicardial fat thickness and oxidative stress parameters in patients with subclinical hypothyroidism.

    Science.gov (United States)

    Aydogdu, Ali; Karakas, Emel Yigit; Erkus, Emre; Altıparmak, İbrahim Halil; Savık, Emin; Ulas, Turgay; Sabuncu, Tevfik

    2017-03-01

    Thyroid disorders are known to be a risk factor for cardiovascular diseases. Epicardial fat thickness (EFT) and oxidative stress are also believed to be major risk factors for cardiovascular events. The aim of this study was to evaluate the possible relationship between oxidative stress parameters and EFT in patients with subclinical hypothyroidism (SCH). A total of 60 individuals (30 patients with SCH and 30 healthy controls) were recruited for the study. The EFT and oxidative stress parameters of all participants were analyzed at baseline; the same were analyzed in SCH patients after achievement of a euthyroid state. Compared to healthy subjects, SCH patients had significantly higher EFT and oxidative stress parameters ( p oxidative stress parameters both decreased after treatment, but only the decrease of EFT levels was statistically significant after thyroid hormone replacement ( p oxidative stress index ( r = 0.141, p = 0.458). Previous studies have demonstrated that visceral adipose tissue and oxidative stress are major risk factors for cardiovascular events; our study demonstrated that EFT, a visceral adipose tissue, and oxidative stress parameters were higher, and could be used as an indicator for cardiovascular diseases in patients with SCH.

  2. Association of epicardial fat volume and nonalcoholic fatty liver disease with metabolic syndrome: From the CAESAR study.

    Science.gov (United States)

    Kim, Byung Jin; Kim, Hak Soo; Kang, Jung Gyu; Kim, Bum Soo; Kang, Jin Ho

    Epicardial adipose tissue or nonalcoholic fatty liver disease (NAFLD) can be one of putative risk factors for metabolic syndrome (MetS). However, there are no data assessing the associations of MetS with epicardial fat and NAFLD. The present study was performed to evaluate the combined effect of epicardial fat volume (EFV) and NAFLD on MetS in Korean adults. Computed tomographic EFV and ultrasonographic fatty liver were measured in 1472 individuals (1242 men: mean age, 44 ± 8.6 years) among a total of 2277 individuals enrolled in the CArdiometabolic risk, Epicardial fat, and Subclinical Atherosclerosis Registry (CAESAR). Subjects were divided into 4 groups according to EFV and NAFLD (group I: low EFV and without NAFLD; group II: low EFV and with NAFLD; group III: high EFV and without NAFLD; and group IV: high EFV and with NAFLD). The overall prevalence of MetS was 24.2%. The EFV levels and prevalence of NAFLD in individuals with MetS was significant higher than those without MetS (81.0 cm3 vs 57.3 cm3, P EFV was associated with MetS (2.03 [1.17-3.52]) but NAFLD was not (1.38 [0.88-2.12]). This study showed that increased EFV and NAFLD are associated with the presence of MetS. However, EFV was more influenced by MetS than NAFLD despite NAFLD having more unfavorable metabolic and lipid profiles. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  3. Increased epicardial fat is independently associated with the presence and chronicity of atrial fibrillation and radiofrequency ablation outcome

    Energy Technology Data Exchange (ETDEWEB)

    Stojanovska, Jadranka; Kazerooni, Ella A.; Gross, Barry H.; Patel, Smita [University of Michigan Health System, Department of Radiology, Division of Cardiothoracic Radiology, UH B1-132 Taubman/Box 0302, Ann Arbor, MI (United States); Sinno, Mohamad; Oral, Hakan [University of Michigan Health System, Department of Internal Medicine, Cardiovascular Medicine, Electrophysiology Laboratory, Cardiovascular Center, Ann Arbor, MI (United States); Watcharotone, Kuanwong [University of Michigan, Michigan Institute for Clinical and Health Research (MICHR), Ann Arbor, MI (United States); Jacobson, Jon A. [University of Michigan Health System, Department of Radiology, Division of Musculoskeletal Radiology, Ann Arbor, MI (United States)

    2015-08-15

    To determine whether intrathoracic fat volumes are associated with presence and chronicity of atrial fibrillation (AF) and radiofrequency ablation (RFA) treatment outcome. IRB approval was obtained and patient consent was waived for this HIPAA-compliant retrospective study. 169 patients with AF (75 non-paroxysmal and 94 paroxysmal) and 62 control patients underwent cardiac CT examination. Extrapericardial (EPFV) and epicardial fat volumes (EFV) were measured on CT, the sum of which is the total intrathoracic fat volume. Associations between these three fat volumes and presence and chronicity of AF, and outcome after RFA, were evaluated using logistic regression analysis. EFV was significantly associated with presence [OR 1.01 (95 % CI 1.003-1.03), p = 0.01], chronicity of AF [1.008 (1.001-1.020), p = 0.03] and AF recurrence after RFA [1.009 (1.001-1.01), p = 0.02] after adjustment for age, gender and BMI. Patients with a larger EFV had a shorter time to AF recurrence (p = 0.017) and a higher rate of recurrence (54 % vs 46 %) (p = 0.002) after RFA. EPFV had no significant associations. Increased epicardial fat is associated with the presence and chronicity of AF, a higher probability of AF recurrence after RFA and a shorter AF-free interval. (orig.)

  4. Epicardial surgical ligation of the left atrial appendage is safe, reproducible, and effective by transesophageal echocardiographic follow-up.

    Science.gov (United States)

    Zapolanski, Alex; Johnson, Christopher K; Dardashti, Omid; O'Keefe, Ryan M; Rioux, Nancy; Ferrari, Giovanni; Shaw, Richard E; Brizzio, Mariano E; Grau, Juan B

    2013-01-01

    The left atrial appendage (LAA) is the source of 90% of thrombi in patients with atrial fibrillation. Our double LAA ligation (LLAA) technique was shown to be 96% successful in a small study. However, the outcomes of these patients have yet to be compared with a set of nonligated patients. From 2005 to 2012, a total of 808 patients received LAA using our double ligation technique using both a polydioxanone (PDS) II endosnare and a running 4-0 Prolene pledgeted suture. The 30-day outcomes of these patients were compared with that of nonligated patients. Fifty-six of the ligated patients had a postoperative transesophageal echocardiography (TEE). An echocardiographer reviewed the follow-up TEEs for LAA remnant and/or residual flow into the LAA using color Doppler imaging. The patients with LAA flow and/or remnant depth of 1 cm or greater were deemed to have an unsuccessful exclusion. The ligated group had a trend of less postoperative atrial fibrillation (19.4% vs 22.9%, P = 0.07) and an overall significantly lower in-hospital mortality (0.7% vs 3.0%, P thrombi perioperatively and in the long-term.

  5. Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography.

    Science.gov (United States)

    Adams, Daniel B; Narayan, Om; Munnur, Ravi Kiran; Cameron, James D; Wong, Dennis T L; Talman, Andrew H; Harper, Richard W; Seneviratne, Sujith K; Meredith, Ian T; Ko, Brian S

    2017-02-01

    Epidemiological studies observed a higher prevalence of coronary atherosclerosis in South Asians when compared to Caucasians, but quantitative computed tomography differences in aggregate plaque volume (APV) and epicardial fat volume (EFV) between South Asians, Southeast or East Asians (SEEAs) and Caucasians remain unknown. We aimed to compare APV and EFV quantified on computed-tomographic-coronary-angiography (CTCA) between South Asian, SEEA and Caucasian populations residing in Australia. Age, gender and body-mass-index matched subjects from three ethnic groups who underwent clinically indicated 320-detector CTCA were retrospectively analysed. Percentage APV in the first 5 cm of the left anterior descending artery (LAD) and EFV were quantified using dedicated software (Vital Images, USA). One-hundred-and-fifty subjects (average age = 57.7 years, 56 % male, n = 50 in each ethnic group) were analysed. Mean LAD percentage APV was highest in South Asians (44.5 ± 8.4 % vs. 37.5 ± 6.5 % in SEEAs and 39.5 ± 6.4 % in Caucasians, P = 0.00001). South Asian ethnicity predicted LAD APV above traditional risk factors on multivariate analysis (P = 0.000002). EFV was significantly higher in both South Asians (103.2 ± 41.7 cm3 vs. 85.8 ± 39.4 cm3, P = 0.035) and SEEAs (110.8 ± 36.9 cm3 vs. 85.8 ± 39.4 cm3, P = 0.001) when compared with Caucasians. In this cohort LAD percentage APV and EFV, as quantified on CTCA, differs between South Asians, SEEA and Caucasian populations, with higher LAD APV observed in South Asians and lower EFV in Caucasians. Atherosclerotic volume in LAD was best predicted by South Asian ethnicity above traditional risk factors and EFV. Further research is required to establish whether APV and EFV quantification can improve cardiac risk prediction in the South Asian population.

  6. The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Rabkin, Simon W

    2014-02-01

    Epicardial fat (epicardial adipose tissue, EAT) has been implicated in the pathogenesis of coronary artery disease (CAD). The objective of this study was to examine the relationship between EAT and generalized obesity, central or visceral adipose tissue (VAT), and the components of the metabolic syndrome--systolic blood pressure (SBP), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG)--that are linked to CAD. A systematic review of the literature, following meta-analysis guidelines, was conducted until May, 2013, using the search strategy "Obesity" OR "abdominal obesity" OR "metabolic syndrome" OR "metabolic syndrome X" AND "epicardial fat". Thirty-eight studies fulfilled the criteria. There was a highly significant (Prelationship of EAT to indices of obesity. The results of multivariate analysis were less consistent but show a relationship between EAT and metabolic syndrome independent of BMI. In summary, the very strong correlation between EAT and VAT suggests a relationship between these two adipose tissue depots. Measurement of EAT can be useful to indicate VAT. Whereas EAT correlates significantly with each of the components of the metabolic syndrome- SBP, TGs, HDL, or FBG-the magnitude of the relationship is considerably and significantly less than the relationship of EAT to BMI. These data show the strong relationship between EAT and BMI but especially with WC and VAT. They also demonstrate the smaller magnitude of the association of EAT with standard coronary risk factors, related to the metabolic syndrome, and suggest that the unique features of this adipose tissue warrant detailed investigation.

  7. Relationship of epicardial fat thickness with endothelial and cardiac functions in children with family history of type 2 diabetes mellitus.

    Science.gov (United States)

    Mahfouz, Ragab A; Alzaiat, Ahmad; Yousry, Ahmad

    2015-01-01

    We hypothesized that many of the pathophysiological mechanisms that cause atherosclerotic disease may be present in early childhood in children with family history of type 2 diabetes. We aimed to investigate the relation of epicardial fat thickness (EFT) with flow-mediated dilatation (FMD) and diastolic function in children with family history of type 2 diabetes mellitus. We measured EFT, FMD, in 209 children (mean age 8.6 + 3.2 years). Children were classified into 2 groups: 109 children with a family history of type 2 diabetes (group at risk) and 100 healthy children with age and body mass index matched and without parental history of diabetes constituted the control group. Epicardial fat thickness was significantly increased in group at risk compared with control children (P history of DM area under the curve (AUC = 0.852) with a specificity of 92.2% and a sensitivity of 77.4%. Our results suggest that children with family history of type 2 diabetes bear considerably impaired FMD% and diastolic dysfunction associated with increased EFT, that reflecting process that promote the development of cardiovascular disease (CVD). © 2014, Wiley Periodicals, Inc.

  8. Changes in arterial stiffness, carotid intima-media thickness, and epicardial fat after L-thyroxine replacement therapy in hypothyroidism.

    Science.gov (United States)

    del Busto-Mesa, Abdel; Cabrera-Rego, Julio Oscar; Carrero-Fernández, Lisván; Hernández-Roca, Cristina Victoria; González-Valdés, Jorge Luis; de la Rosa-Pazos, José Eduardo

    2015-01-01

    To assess the relationship between primary hypothyroidism and subclinical atherosclerosis and its potential changes with L-thyroxine replacement therapy. A prospective cohort study including 101 patients with primary hypothyroidism and 101 euthyroid patients as controls was conducted from July 2011 to December 2013. Clinical, anthropometrical, biochemical, and ultrasonographic parameters were assessed at baseline and after one year of L-thyroxine replacement therapy. At baseline, hypothyroid patients had significantly greater values of blood pressure, total cholesterol, VLDL cholesterol, left ventricular mass, epicardial fat, and carotid intima-media thickness as compared to controls. Total cholesterol, VLDL cholesterol, ventricular diastolic function, epicardial fat, carotid intima-media thickness, carotid local pulse wave velocity, pressure strain elastic modulus, and β arterial stiffness index showed a significant and positive correlation with TSH levels. After one year of replacement therapy, patients with hypothyroidism showed changes in total cholesterol, VLDL cholesterol, TSH, carotid intima-media thickness, and arterial stiffness parameters. Primary hypothyroidism is characterized by an increased cardiovascular risk. In these patients, L-thyroxine replacement therapy for one year is related to decreased dyslipidemia and improvement in markers of subclinical carotid atherosclerosis. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  9. [Association between epicardial fat volume and coronary artery calcification in patients with chronic kidney disease].

    Science.gov (United States)

    Sheng, Y N; Zhao, D M; Ma, Q L; Gao, Y

    2017-02-24

    Objective: To evaluate whether epicardial fat volume (EFV) is related to coronary artery calcification in patients with chronic kidney disease(CKD). Method: Multi-slice computed tomography was performed in 30 healthy subjects and 120 patients with CKD. Cross-sectional tomographic cardiac slices from base to apex were traced semi-automatically using a Volume Viewer of AW4.3 off-line workstation, and EFV was measured by assigning Hounsfield units ranging from -250 to -30 HU to fat.The coronary artery calcification score was assessed by CaScoring software. High density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C) and collecting the body mass index (BMI), dialysis route, history of diabetes and coronary artery disease were used to analyze the relationship between EFV and other risk factors in patients with CKD. Results: There were 60.8%(73/120) male (mean age 62.8 years) and 39.2%(47/120) female (mean age 66.6 years) in the patients cohort, 73.3%(88/120) patients had coronary artery disease, 55.8%(67/120) had diabetes, 21 patients were on peritoneal dialysis and 9 on hemodialysis. EFV was apparently higher in stage 4-5 D CKD group compared with the control group((140.03±54.71), (145.01±64.56)and (141.45±62.04) cm(3) vs.(92.42±39.56)cm(3), P=0.007, 0.015 and 0.001), was similar between CKD3 and control group, and EFV was significantly higher in peritoneal dialysis group than in hemodialysis group and in coronary artery disease group compared with no coronary artery disease group((140.67±70.31) cm(3) vs.(105.22±61.49) cm(3), P=0.002). EFV was obviously higher in diabetes group than no diabetes group((148.41±65.78) cm(3) vs.(110.53±62.37) cm(3), P=0.007). CACS was apparently increased in stage 3-5 CKD group compared with the control group(140.0 vs.4.3, PEFV was positively associated with CACS(r(s)=0.539, P=0.004) in control group, and the association become more robust in patients with CKD5(r(s)=0.841, PEFV was related to age(r=0

  10. Canagliflozin reduces epicardial fat in patients with type 2 diabetes mellitus

    OpenAIRE

    Yagi, Shusuke; Hirata, Yukina; Ise, Takayuki; Kusunose, Kenya; Yamada, Hirotsugu; Fukuda, Daiju; Salim, Hotimah Masdan; Maimaituxun, Gulinu; Nishio, Susumu; Takagawa, Yuriko; Hama, Saori; Matsuura, Tomomi; Yamaguchi, Koji; Tobiume, Takeshi; Soeki, Takeshi

    2017-01-01

    Background It is unknown whether canagliflozin, a selective sodium glucose co-transporter 2 inhibitor, reduces epicardial adipose tissue (EAT) thickness, which is associated with insulin resistance and is a risk factor for coronary artery disease. Methods and results We administered 100 mg of canagliflozin for 6 months to 13 patients with type 2 diabetes mellitus. We evaluated glycemic control, visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area, and skeletal muscle ...

  11. Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Demircelik, Muhammed Bora; Gurel, Ozgul Malcok; Selcoki, Yusuf; Atar, Inci Asli; Eryonucu, Beyhan, E-mail: drdemircelik@yahoo.com [Turgut Ozal Univercity, Department of Cardiology, Ankara (Turkey); Bozkurt, Alper; Akin, Kayihan [Turgut Ozal Univercity, Department of Radiology, Ankara (Turkey); Yilmaz, Omer Caglar [Ankara Occupational Diseases Hospital, Department of Cardiology, Ankara (Turkey)

    2014-06-15

    Objective: the aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. Methods: the study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing < 50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≧ 50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. Results: the average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. Conclusion: we showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases. (author)

  12. Comparison of epicardial fat volume by computed tomography in black versus white patients with acute chest pain.

    Science.gov (United States)

    Apfaltrer, Paul; Schindler, Andreas; Schoepf, U Joseph; Nance, John W; Tricarico, Francesco; Ebersberger, Ullrich; McQuiston, Andrew D; Meyer, Mathias; Henzler, Thomas; Schoenberg, Stefan O; Bamberg, Fabian; Vliegenthart, Rozemarijn

    2014-02-01

    Disparities in the risk of coronary artery disease (CAD) between races may be influenced by differences in the thoracic adipose tissue. We compared computed tomography (CT)-derived volumes of epicardial adipose tissue (EAT), mediastinal adipose tissue (MAT), and pericoronary fat thickness (PFT) and correlations with CAD between black and white patients. This institutional review board-approved Health Insurance Portability and Accountability Act-compliant study included 372 age- and gender-matched black versus white patients (186 black, 54 ± 11 years, 50% men; 186 white, 54 ± 11 years, 50% men) who underwent CT for chest pain evaluation. EAT, MAT, and PFT were measured. The amount of coronary calcium was quantified as calcium score. CAD was defined as ≥50% coronary artery narrowing. EAT and MAT volumes were significantly lower in black than white patients (59 [twenty-fifth to seventy-fifth percentile 39 to 84] vs 97 [67 to 132] cm(3) and 44 [27 to 77] vs 87 [52 to 157] cm(3), for both p patients was slightly lower than white patients (17.2 ± 3.2 vs 18.1 ± 3.4 mm, p patients (r = 0.19 to 0.26, p patients. In conclusion, CT-derived measurements of thoracic fat differ between symptomatic black and white patients, suggesting a differential relation between thoracic adipose tissue and CAD pathophysiology by race. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Ipragliflozin Reduces Epicardial Fat Accumulation in Non-Obese Type 2 Diabetic Patients with Visceral Obesity: A Pilot Study.

    Science.gov (United States)

    Fukuda, Tatsuya; Bouchi, Ryotaro; Terashima, Masahiro; Sasahara, Yuriko; Asakawa, Masahiro; Takeuchi, Takato; Nakano, Yujiro; Murakami, Masanori; Minami, Isao; Izumiyama, Hajime; Hashimoto, Koshi; Yoshimoto, Takanobu; Ogawa, Yoshihiro

    2017-08-01

    Epicardial fat (EF) was reported to be independently associated with cardiovascular disease regardless of obesity. We have previously reported that a sodium-glucose co-transporter-2 (SGLT2) inhibitor, luseogliflozin, reduces the EF volume (EFV) in parallel with the reduction of body weight in obese patients (BMI ≥25 kg/m2) with type 2 diabetes. However, it is unknown whether SGLT2 inhibitors could reduce EFV in non-obese patients (BMI EFV in non-obese type 2 diabetic patients with visceral obesity in this pilot study. Nine of type 2 diabetic patients (mean age 66 ± 8 years; 33% female) with HbA1c 6.5-9.0%, body mass index (BMI, kg/m2) EFV [median (interquartile range), cm3] was measured by magnetic resonance imaging. Primary endpoint was the change in EFV at 12 weeks. VFA and liver attenuation index (LAI), skeletal muscle index (SMI), and body fat (%) were also assessed at baseline and at 12 weeks. The EFV was significantly reduced from 102 (79-126) cm3 to 89 (66-109) cm3 by ipraglifrozin (p = 0.008). The body weight, BMI, HbA1c, fasting plasma glucose, insulin, homeostasis model assessment-insulin resistance, triglycerides, leptin, body fat, android, gynoid, and VFA were significantly reduced and high-density lipoprotein cholesterol was significantly increased by ipraglifrozin at 12 weeks, whereas SFA and LAI were unchanged. The change in EFV was significantly correlated with the change in BMI. A12-week intervention of ipragliflozin reduced the EFV in non-obese type 2 diabetic patients with visceral adiposity. UMIN Clinical Trial Registry: UMIN000019071. Astellas Pharma Inc. and the Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

  14. Associations of epicardial fat with coronary calcification, insulin resistance, inflammation, and fibroblast growth factor-23 in stage 3-5 chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Kerr Jasmine D

    2013-01-01

    Full Text Available Abstract Background Epicardial fat, quantified in a single multi-slice computed tomography (MSCT slice, is a reliable estimate of total epicardial fat volume (EFV. We sought to determine risk factors for EFV detected in a single-slice MSCT measurement (ssEFV in pre-dialysis chronic kidney disease (CKD patients. Our primary objective was to determine the association between ssEFV and coronary artery calcification (CAC. Methods 94 pre-dialysis stage 3–5 CKD patients underwent MSCT to measure ssEFV and CAC. ssEFV was quantified at the level of the left main coronary artery. Measures of inflammation, traditional and kidney-related cardiovascular disease risk factors were collected. Results Mean age: 63.7 ± 14 years, 56% male, 39% had diabetes, and mean eGFR: 25.1 ± 11.9 mL/min/1.73 m2. Mean ssEFV was 5.03 ± 2.4 cm3. By univariate analysis, body mass index (BMI (r = 0.53; P = r = 0.51; P r = − 0.39; P =  Conclusions In stage 3–5 CKD, coronary calcification and IL-6 and were predictors of ssEFV. Further studies are needed to clarify the mechanism by which epicardial fat may contribute to the pathogenesis of coronary disease, particularly in the CKD population.

  15. Association of epicardial fat thickness with TIMI risk score in NSTEMI/USAP patients.

    Science.gov (United States)

    Ozcan, F; Turak, O; Canpolat, U; Kanat, S; Kadife, I; Avcı, S; Işleyen, A; Cebeci, M; Tok, D; Başar, F N; Aras, D; Topaloğlu, S; Aydoğdu, S

    2014-09-01

    The association of epicardial adipose tissue (EAT) with coronary artery disease has been shown in previous studies. Furthermore, the relationship between EAT and acute coronary syndrome was studied recently. Herein, we investigated the relationship between EAT thickness and the thrombolysis in myocardial infarction (TIMI) risk score for non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). The study included 144 patients with NSTEMI/USAP. The study population was divided into two subgroups according to TIMI risk scores as group I (≤ 4, n = 86) and group II (> 4, n = 58). Stepwise multivariable logistic regression analysis was used to assess the independent association of clinical parameters with TIMI risk score. EAT thickness was higher in group II than in group I (8.2 ± 2.1 vs. 6.2 ± 2.2, p TIMI risk score and Gensini score. Multivariate regression analysis showed that EAT thickness (OR: 1.56, 95 % CI: 1.17-2.08, p = 0.003), LVEF (OR: 0.93, 95 % CI: 0.85-0.98, p = 0.03), and Gensini score (OR: 1.36, 95 % CI: 1.24-1.98, p = 0.002) were independently associated with a higher TIMI risk score. In conclusion, EAT thickness is independently associated with TIMI risk score and may be an emerging risk factor for adverse events in NSTEMI/USAP patients.

  16. Role of galectin 3 and epicardial fat thickness in the development of atrial fibrillation in patients with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    V. A. Ionin

    2015-01-01

    Full Text Available Objective. To evaluate the epicardial fat thickness (EFT in patients with metabolic syndrome (MS, including paroxysmal and persistent atrial fibrillation (AF. To relate EFT to the fibroid heart marker, i.e. galectin 3. Materials and methods. We examined 100 patients with MS (50 with AF, and 50 healthy persons made the control group. Serum galectin 3 was measured by ELISA method. The EFT was measured with echocardiography. Results. EFT in patients with MS was twofold higher than in healthy persons. EFT in patients with MS and AF didn't differ significantly from that in patients with MS without AF. Positive correlation between the levels of EFT and galectin 3 in serum was revealed. Serum galectin 3 and EFT were associated with atrial fibrillation in patients with MS (OR:1,27, 95% CI 1,02-1,58 and OR:1,73, 95% CI 1,37-2,19, correspondingly.Conclusion. Definition of EFT at echocardiography can be used in the assessment of risk AF in patients with MS.

  17. Coronary heart disease risk factors, coronary artery calcification and epicardial fat volume in the Young Finns Study.

    Science.gov (United States)

    Hartiala, Olli; Magnussen, Costan G; Bucci, Marco; Kajander, Sami; Knuuti, Juhani; Ukkonen, Heikki; Saraste, Antti; Rinta-Kiikka, Irina; Kainulainen, Sakari; Kähönen, Mika; Hutri-Kähönen, Nina; Laitinen, Tomi; Lehtimäki, Terho; Viikari, Jorma S A; Hartiala, Jaakko; Juonala, Markus; Raitakari, Olli T

    2015-11-01

    We investigated associations of pre-clinical coronary heart disease (CHD), adolescence and adulthood CHD risk factors, and epicardial fat volume (EFV), which is thought to influence CHD pathology. EFV and coronary calcium scores were quantified using computed tomography imaging for 557 subjects from the Cardiovascular Risk in Young Finns Study in 2007. CHD risk marker levels were assessed repeatedly from 1980 to 2007. Carotid intima-media thickness (cIMT), carotid distensibility, and brachial flow-mediated dilatation were measured by vascular ultrasound in 2007. Increased EFV was cross-sectionally associated with male sex, increased waist circumference, body-mass index (BMI), cIMT, metabolic syndrome prevalence, levels of apolipoprotein B, total cholesterol, low-density lipoprotein cholesterol, triglycerides, C-reactive protein, blood pressure, insulin, and fasting glucose, as well as ever smoking, alcoholic intake, and lower high-density lipoprotein cholesterol (HDL-C), carotid distensibility and physical activity in adulthood. In BMI-adjusted analyses, only apolipoprotein B, ever smoking, alcohol intake and metabolic syndrome prevalence were independently associated with EFV. In adolescence, skinfold thickness, BMI, and insulin levels were higher and HDL-C lower with increasing EFV. Subjects in the lowest vs. highest quarter of EFV had consistently lower BMI across the early life-course. Associations of CHD risk markers with EFV were attenuated after multivariable adjustment. We found no evidence of increased EFV being independently associated with pre-clinical atherosclerosis. EFV was most strongly associated with BMI and waist circumference. Subjects with higher EFV had consistently higher BMI from age 12 suggesting that life-long exposure to higher BMI influences the development of EFV. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  18. Epicardial fat thickness: distribution and association with diabetes mellitus, hypertension and the metabolic syndrome in the ELSA-Brasil study.

    Science.gov (United States)

    Graeff, Daniela Bertol; Foppa, Murilo; Pires, Julio Cesar Gall; Vigo, Alvaro; Schmidt, Maria Ines; Lotufo, Paulo Andrade; Mill, Jose Geraldo; Duncan, Bruce Bartholow

    2016-04-01

    Epicardial fat thickness (EFT) has emerged as a marker of cardiometabolic risk, but its clinical use warrants proper knowledge of its distribution and associations in populations. We aimed to describe the distribution of EFT, its demographic correlates and independent associations with diabetes, hypertension and metabolic syndrome (MS) in free-living Brazilian adults. From the baseline echocardiography of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a cohort study of civil servants aged 35-74 years-EFT was measured from a randomly selected sample of 998 participants as the mean of two paraesternal windows obtained at end systole (EFTsyst) and end diastole (EFTdiast). From the 421 individuals free of diabetes, hypertension and MS, we defined EFT reference values and the EFTsyst 75th percentile cut-off. Median EFTsyst was 1.5 (IQR 0-2.6) mm; a large proportion (84 %) had EFTdiast = 0. EFT was higher in women and lower in blacks, and increased with age and BMI. Although EFT was higher in those with diabetes, hypertension, and MS, EFT associations were reduced when adjusted for age, sex and ethnicity, and were non-significant after adjusting for obesity measures. In conclusion, the amount of EFT in this large multiethnic population is smaller than reported in other populations. EFT reference values varied across demographic and clinical variables, EFT associations with cardiometabolic variables being largely explained by age, sex, ethnicity and central obesity. Although EFT can help identify individuals at increased cardiometabolic risk, it will likely have a limited additional role compared to current risk stratification strategies.

  19. Relationship of epicardial fat volume from noncontrast CT with impaired myocardial flow reserve by positron emission tomography.

    Science.gov (United States)

    Otaki, Yuka; Hell, Michaela; Slomka, Piotr J; Schuhbaeck, Annika; Gransar, Heidi; Huber, Brandi; Nakazato, Ryo; Germano, Guido; Hayes, Sean W; Thomson, Louise E J; Friedman, John D; Achenbach, Stephan; Berman, Daniel S; Dey, Damini

    2015-01-01

    Impaired myocardial flow reserve (MFR) is a marker of coronary vascular dysfunction with prognostic significance. We aimed to investigate the relationship between epicardial fat volume (EFV) measured from noncontrast CT and impaired MFR derived from rest-stress Rb-82 positron emission tomography (PET). We retrospectively studied 85 consecutive patients without known coronary artery disease who underwent rest-stress Rb-82 myocardial PET/CT and were subsequently referred for invasive coronary angiography. EFV was computed from noncontrast CT by validated software and indexed to body surface area (EFVi, cm3/m2). Global stress and rest MFR were automatically derived from PET. Patient age, sex, cardiovascular risk factors, coronary calcium score (CCS), and EFVi were combined by boosted ensemble machine learning algorithm into a novel composite risk score, using 10-fold cross-validation, to predict impaired global MFR (MFR ≤2.0) by PET. Patients with impaired MFR (44 of 85; 52%) were older (71 vs. 65 years; P = .03) and had higher frequency of CCS (≥400; P = .02) with significantly higher EFVi (63.1 ± 20.4 vs. 51.3 ± 14.1 cm3/m2; P = .003). On multivariate logistic regression (with age, sex, number of risk factors, CCS, and EFVi), EFVi was the only independent predictor of impaired MFR (odds ratio, 7.39; P = .02). The machine learning composite risk score significantly improved risk reclassification of impaired MFR compared to CCS or EFVi alone (integrated discrimination improvement = 0.19; P = .007 and IDI = 0.22; P = .002, respectively). Increased EFVi and composite risk score combining EFVi and CCS significantly improve identification of impaired global MFR by PET. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  20. Quantitative analysis of epicardial fat volume: effects of scanning protocol and reproducibility of measurements in non-contrast cardiac CT vs. coronary CT angiography.

    Science.gov (United States)

    D'Errico, Luigia; Salituri, Francesco; Ciardetti, Marco; Favilla, Riccardo; Mazzarisi, Alessandro; Coppini, Giuseppe; Bartolozzi, Carlo; Marraccini, Paoli

    2017-06-01

    Several studies have focused on the role of epicardial fat in the pathogenesis of cardiovascular disease (CVD). The main purpose of the study was to evaluate a computerized method for the quantitative analysis of epicardial fat volume (EFV) by non-contrast cardiac CT (NCT) for coronary calcium scan and coronary CT angiography (coronary CTA). Thirty patients (61±12.5 years, 73% male, body mass index (BMI) =25.9±6.3 kg/m2) referred to our Institution for suspected coronary artery disease (CAD) underwent NCT and coronary CTA. Epicardial boundaries were traced by 2 experienced operators (operator 1, operators 2) on 3 and 6 short-axis (SA) slices. EFV was computed with a semi-automatic method using an in-house developed software based on spherical harmonic representation of the epicardial surface. In order to analyze the inter-observer variability both the Coefficient of Repeatability (CR) and Intra Class Correlation (ICC) were computed. The total EFV was 103.62±50.97 and 94.96±67.91 cc in NCT and coronary CTA with non-significant difference (P=0.292). CR error was 10.22 cc for operator 1 and 11.31 cc for operator 2 in NCT and 7.99 cc for operator 1 and 7.75 cc for operator 2 in coronary CTA. To analyze the inter-observer variability CR and ICC were computed. CR was 8.17 and 8.39 cc with NCT and 7.07 and 7.21 cc with CTA for 6 and 3 SA slices respectively. ICC values >0.99 were obtained in all cases. The right ventricular EFV was 67.23±31.4 and 57.41±34.3 cc for NCT and coronary CTA respectively; the corresponding values for left ventricular EFV were 38.01±19.1 and 35.27±25.9 cc. Both NCT and coronary CTA can be used with low intra- and inter-observer variability for computer-assisted measurements of EFV. Cardiac CT may allow a fast and reliable computation of EFV in clinical setting.

  1. Correlation between reduction of superior interventricular groove epicardial fat thickness and improvement of insulin resistance after weight loss in obese men.

    Science.gov (United States)

    Liang, Kae-Woei; Tsai, I-Chen; Lee, Wen-Jane; Lin, Shih-Yi; Lee, Wen-Lieng; Lee, I-Te; Fu, Chia-Po; Wang, Jun-Sing; Sheu, Wayne H-H

    2014-01-01

    It has been recognized that reduction of abdominal visceral fat and subcutaneous fat are associated with improvement in insulin-resistance (IR) after weight loss. However, few studies have investigated the correlation of reduction in epicardial adipose tissue (EAT) with improvement of IR index after weight loss in obese non-diabetic men with metabolic syndrome (MetS). We prospectively enrolled 32 non-diabetic men with MetS for a 3-month weight reduction program mainly by diet control and exercise. Magnetic resonance imaging (MRI) examinations were used to measure EAT, subcutaneous fat, and abdominal visceral fat. Anthropometric parameters, oral glucose tolerance test (OGTT), and serum adipokines were assessed before and after the weight loss program. After a 3-month weight loss program, 27 obese MetS men had significant weight loss >5% (97 ± 14 to 87 ± 14 kg, with a 10.7 % decrease, p fat area (r = -0.673, p = 0.006) were significantly correlated with improvement of OGTT-derived Matsuda insulin-sensitivity index. The decrement ratio of SIVG EAT correlated with improvement of both HOMA-IR and OGTT-derived Matsuda insulin-sensitivity indexes after weight loss in obese non-diabetic men with MetS. (Multi-faceted Evaluations Following Weight Reduction in Subjects with Metabolic Syndrome NCT 01065753 on Feb 8, 2010).

  2. Epicardial fat, body mass index, and triglyceride are independent contributors of serum fibroblast growth factor 21 level in obese premenopausal women.

    Science.gov (United States)

    Akyildiz, Z I; Polat, S; Yurekli, B S; Kocabas, G U; Tuluce, K; Tuluce, S Y; Kocabas, U; Bozkaya, G; Yuksel, A; Nazli, C

    2015-03-01

    The hormone fibroblast growth factor 21 (FGF-21) regulates carbohydrate and lipid homeostasis. FGF-21 represents an attractive novel therapy for obesity since administration of FGF-21 has been shown to improve metabolic abnormalities in obese animal models. We investigated FGF-21 and its relationship with epicardial fat thickness (EFT), metabolic parameters, and inflammatory markers in premenopausal obese women compared to controls with similar Systematic Coronary Risk Evaluation (SCORE) project risk profiles. Forty-five obese premenopausal women with body mass index (BMI) ≥30 kg/m(2) and 41 control premenopausal women with BMI women compared to controls (p independently contributed to FGF-21 (R(2) = 0.757, p 0.05). EFT, BMI, and TG may play an important role in predicting serum FGF-21 level which may be a potential therapeutic target in cardiometabolic disorders in the future.

  3. Epicardial, pericardial and total cardiac fat and cardiovascular disease in type 2 diabetic patients with elevated urinary albumin excretion rate

    DEFF Research Database (Denmark)

    Christensen, Regitse Hoejgaard; Hansen, Christian S; Heywood, Sarah E

    2017-01-01

    thickness and inflammatory markers were measured at baseline. Cardiac adipose tissue was investigated as continuous and binary variable. Analyses were performed unadjusted (model 1), and adjusted for age, sex (model 2), body mass index, low-density lipoprotein cholesterol, smoking, glycated haemoglobin......, and systolic blood pressure (model 3). Results Patients were followed-up after 6.1 years for non-fatal cardiovascular disease ( n = 29) or mortality ( n = 23). Cardiac adipose tissue ( p = 0.049) and epicardial adipose tissue ( p = 0.029) were associated with cardiovascular disease and mortality in model 1...

  4. Cardiac magnetic resonance based evaluation of aortic stiffness and epicardial fat volume in patients with hypertension, diabetes mellitus, and myocardial infarction.

    Science.gov (United States)

    Homsi, Rami; Sprinkart, Alois M; Gieseke, Juergen; Meier-Schroers, Michael; Yuecel, Seyrani; Fischer, Stefan; Nadal, Jennifer; Dabir, Darius; Luetkens, Julian A; Kuetting, Daniel L; Schild, Hans H; Thomas, Daniel K

    2018-01-01

    Background Aortic stiffness and epicardial fat relate to cardiovascular risk. Their relationship with each other and their role with hypertension, diabetes mellitus (DM), and myocardial infarction (MI) can be evaluated by cardiac magnetic resonance (CMR). Purpose To explore an association between aortic stiffness and epicardial as well as paracardial fat volume (EFV and ParaFV, respectively) in hypertensive patients and to relate the results to the presence of DM and MI. Material and Methods A total of 156 hypertensive and 20 non-hypertensive participants were examined at 1.5 Tesla. A 2D-velocity-encoded sequence was acquired to assess aortic pulse wave velocity (PWV in m/s) as a measure of aortic stiffness. A 3D-Dixon sequence was used to determine EFV and ParaFV. Results PWV correlated with EFV (R = 0.474; P hypertensive controls compared to hypertensive patients. EFV and PWV were significantly higher in diabetic hypertensive patients without MI (n = 19; PWV: 10.4 ± 2.9; EFV: 92.5 ± 19.3) compared to hypertension-only patients (n = 84 [no DM or MI]; EFV: 64.8 ± 25.1, PWV: 9.0 ± 2.6; P hypertensive patients. Both were increased in the presence of DM; however, only EFV was increased in the presence of MI. This may relate to the PWV lowering effect of the antihypertensive medication used by hypertensive patients and underscores the benefit of EFV assessment in this regard.

  5. Epicardial fat accumulation, cardiometabolic profile and cardiovascular events in patients with stages 3-5 chronic kidney disease.

    Science.gov (United States)

    Cordeiro, A C; Amparo, F C; Oliveira, M A C; Amodeo, C; Smanio, P; Pinto, I M F; Lindholm, B; Stenvinkel, P; Carrero, J J

    2015-07-01

    It has been hypothesized that epicardial adipose tissue (EAT) exerts pathogenic effects on cardiac structures. We analysed the associations between EAT and both cardiovascular (CV) disease risk factors and CV events in patients with chronic kidney disease (CKD). We included 277 nondialysed patients [median age 61, interquartile range (IQR) 53-68 years; 63% men] with stages 3-5 CKD in this cross-sectional evaluation. EAT and abdominal visceral adipose tissue (VAT) were assessed by computed tomography. Patients were followed for median 32 (IQR 20-39) months, and the composite of fatal and nonfatal CV events was recorded. With increasing EAT quartiles, patients were older, had higher glomerular filtration rate, body mass index, waist, VAT and coronary calcification, higher levels of haemoglobin, triglycerides, albumin, C-reactive protein and leptin and higher prevalence of left ventricular hypertrophy and myocardial ischaemia; total and high-density lipoprotein cholesterol, 25-hydroxy-vitamin D and 1, 25-dihydroxy-vitamin D progressively decreased. Associations between EAT and cardiac alterations were not independent of VAT. During follow-up, 58 CV events occurred. A 1-SD higher EAT volume was associated with an increased risk of CV events in crude [hazard ratio (HR) 1.41, 95% confidence interval (CI) (1.12-1.78) and adjusted (HR 1.55, 95% CI 1.21-1.99) Cox models. However, adding EAT to a standard CV disease risk prediction model did not result in a clinically relevant improvement in prediction. Epicardial adipose tissue accumulation in patients with CKD increases the risk of CV events independent of general adiposity. This is consistent with the notion of a local pathogenic effect of EAT on the heart or heart vessels, or both. However, EAT adds negligible explanatory power to standard CV disease risk factors. © 2015 The Association for the Publication of the Journal of Internal Medicine.

  6. Local Production of Fatty Acid-Binding Protein 4 in Epicardial/Perivascular Fat and Macrophages Is Linked to Coronary Atherosclerosis.

    Science.gov (United States)

    Furuhashi, Masato; Fuseya, Takahiro; Murata, Masaki; Hoshina, Kyoko; Ishimura, Shutaro; Mita, Tomohiro; Watanabe, Yuki; Omori, Akina; Matsumoto, Megumi; Sugaya, Takeshi; Oikawa, Tsuyoshi; Nishida, Junichi; Kokubu, Nobuaki; Tanaka, Marenao; Moniwa, Norihito; Yoshida, Hideaki; Sawada, Norimasa; Shimamoto, Kazuaki; Miura, Tetsuji

    2016-05-01

    Fatty acid-binding protein 4 (FABP4) is expressed in adipocytes and macrophages, and elevated circulating FABP4 level is associated with obesity-mediated metabolic phenotype. We systematically investigated roles of FABP4 in the development of coronary artery atherosclerosis. First, by immunohistochemical analyses, we found that FABP4 was expressed in macrophages within coronary atherosclerotic plaques and epicardial/perivascular fat in autopsy cases and macrophages within thrombi covering ruptured coronary plaques in thrombectomy samples from patients with acute myocardial infarction. Second, we confirmed that FABP4 was secreted from macrophages and adipocytes cultured in vitro. Third, we investigated the effect of exogenous FABP4 on macrophages and human coronary artery-derived smooth muscle cells and endothelial cells in vitro. Treatment of the cells with recombinant FABP4 significantly increased gene expression of inflammatory markers in a dose-dependent manner. Finally, we measured serum FABP4 level in the aortic root (Ao-FABP4) and coronary sinus (CS-FABP4) of 34 patients with suspected or known coronary artery disease. Coronary stenosis score assessed by the modified Gensini score was weakly correlated with CS-FABP4 but was not correlated with Ao-FABP4. A stronger correlation (r=0.59, Pepicardial/perivascular fat and macrophages in vascular plaques contributes to the development of coronary atherosclerosis. © 2016 American Heart Association, Inc.

  7. Interleukin-15 and soluble interleukin-15 receptor α in coronary artery disease patients: association with epicardial fat and indices of adipose tissue distribution.

    Directory of Open Access Journals (Sweden)

    Elena Dozio

    Full Text Available Interleukin-15 (IL-15 is a pro-inflammatory cytokine which signals via a specific alpha receptor subunit (IL-15Rα. Increased IL-15 level has been observed in cardiovascular patients and IL-15 immunoreactivity has been detected at vulnerable atherosclerotic plaques. Due to the association between adipose tissue distribution, inflammation and coronary artery disease (CAD, we quantified IL-15 and IL-15Rα in CAD patients with different adiposity and adipose tissue distribution and we evaluated whether epicardial adipose tissue (EAT, a visceral fat depot surrounding and infiltrating myocardium, may be a source of both molecules. IL-15 and IL-15Rα proteins were quantified by enzyme-linked immunosorbent assays. Gene expression of IL-15 and IL-15Rα in EAT depots was evaluated by one colour microarray platform. EAT thickness was measured by echocardiography. Plasmatic IL-15 and IL-15Rα levels were higher in CAD than non-CAD patients. After classification according to adipose tissue distribution, IL-15 was higher in CAD patients with increased abdominal adiposity. Increased level of IL-15Rα was observed both in CAD and non-CAD patients with increased abdominal fat. EAT was a source of IL-15 and IL-15Rα and their expression was higher in CAD patients with increased EAT thickness. In conclusion, our data suggest that circulating levels of IL-15 and IL-15Rα seem to reflect visceral distribution of adipose tissue and that EAT may be a potential source of both IL-15 and IL-15Rα. Future studies on the relationship between IL-15, visceral fat and characteristics of atherosclerotic plaques could help to better understand the complex biology of this cytokine.

  8. Assessment of relation between neutrophil lympocyte, platelet lympocyte ratios and epicardial fat thickness in patients with ankylosing spondylitis.

    Science.gov (United States)

    Boyraz, Ismail; Onur Caglar, Sabri; Erdem, Fatma; Yazici, Mehmet; Yazici, Selma; Koc, Bunyamin; Gunduz, Ramazan; Karakoyun, Ahmet

    2016-02-01

    To investigate whether there is a relation between neutrophillymphocyte (N/L) and platelet- lymphocyte (P/L) ratios and epicardial adipose tissue (EAT) thickness in patients with ankylosing spondylitis (AS). Thirty patients diagnosed with ankylosing spondylitis and 25 healthy people (controls) were included in the study. Age, gender, body mass index (BMI), height, hemogram, sedimentation, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, CRP, hepatic and renal function tests, lipid profile of the all patients were recorded. Data related to duration of the disease, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) values of the cases in the patient group were obtained. A cardiologist measured EAT thickness by ECHO in both patient and control groups. In the patient group, mean BASDAI and BASFI scores were 2.48±2.21 and 1.5±2.07, respectively. Age, gender, BMI values did not show statistically significant difference between the patient and the control groups. N/L and P/L ratios did not change significantly in the patient group having higher EAT, BASFI values and taking anti-TNF compared to the control group. In patients with AS, EAT measurements, which are related to inflammatory response increase, can be used for monitoring of the risk of development of cardiac disease. We could not find the relation between EAT and N/L, P/L ratios in terms of evaluation of inflammatory response. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

  9. Cardiac computed tomography-derived epicardial fat volume and attenuation independently distinguish patients with and without myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Amir Abbas Mahabadi

    Full Text Available Epicardial adipose tissue (EAT volume is associated with coronary plaque burden and adverse events. We aimed to determine, whether CT-derived EAT attenuation in addition to EAT volume distinguishes patients with and without myocardial infarction.In 94 patients with confirmed or suspected coronary artery disease (aged 66.9±14.7years, 61%male undergoing cardiac CT imaging as part of clinical workup, EAT volume was retrospectively quantified from non-contrast cardiac CT by delineation of the pericardium in axial images. Mean attenuation of all pixels from EAT volume was calculated. Patients with type-I myocardial infarction (n = 28 had higher EAT volume (132.9 ± 111.9ml vs. 109.7 ± 94.6ml, p = 0.07 and CT-attenuation (-86.8 ± 5.8HU vs. -89.0 ± 3.7HU, p = 0.03 than patients without type-I myocardial infarction, while EAT volume and attenuation were only modestly inversely correlated (r = -0.24, p = 0.02. EAT volume increased per standard deviation of age (18.2 [6.2-30.2] ml, p = 0.003, BMI (29.3 [18.4-40.2] ml, p<0.0001, and with presence of diabetes (44.5 [16.7-72.3] ml, p = 0.0002, while attenuation was higher in patients with lipid-lowering therapy (2.34 [0.08-4.61] HU, p = 0.04. In a model containing volume and attenuation, both measures of EAT were independently associated with the occurrence of type-I myocardial infarction (OR [95% CI]: 1.79 [1.10-2.94], p = 0.02 for volume, 2.04 [1.18-3.53], p = 0.01 for attenuation. Effect sizes remained stable for EAT attenuation after adjustment for risk factors (1.44 [0.77-2.68], p = 0.26 for volume; 1.93 [1.11-3.39], p = 0.02 for attenuation.CT-derived EAT attenuation, in addition to volume, distinguishes patients with vs. without myocardial infarction and is increased in patients with lipid-lowering therapy. Our results suggest that assessment of EAT attenuation could render complementary information to EAT volume regarding coronary risk burden.

  10. Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity.

    Science.gov (United States)

    Fernandes-Cardoso, A; Santos-Furtado, M; Grindler, J; Ferreira, L A; Andrade, J L; Santo, M A

    2017-08-01

    Epicardial fat (EF) is increased in obesity and has important interactions with atrial and ventricular myocardium. Most of the evidence in this scenario can be confused by the presence of comorbidities such as hypertension, diabetes and dyslipidemia, which are very common in this population. The influence of EF on atrial remodeling and cardiac function demands further investigation on morbidly obese without these comorbidities. We prospectively recruited 20 metabolically healthy morbidly obese and 20 normo-weights controls. The maximum P-wave duration (PWD) was analyzed by 12-lead electrocardiogram. Left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and EF thickness (EFT) were evaluated by two-dimensional echocardiography. The mean of maximum PWD and LAD were significantly larger in the obese group as compared to the control group: 109.55 ± 11.52 ms × 89.38 ± 11.19 ms and 36.12 ± 3.46 mm × 31.45 ± 2.64 mm, (p p p p = 0.001) and LAD (r = 0.667; p = 0.001). An inverse correlation was found between EFT and LVEF (r = -0.523; p = 0.001). In a multiple multivariate regression analysis the EFT remains correlated with LAD and LVEF. In a select group of morbidly obese, the excess of EF had a significant impact on atrial remodeling and cardiac function. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  11. Interrelations of Epicardial Fat Volume, Left Ventricular T1-Relaxation Times and Myocardial Strain in Hypertensive Patients: A Cardiac Magnetic Resonance Study.

    Science.gov (United States)

    Homsi, Rami; Kuetting, Daniel; Sprinkart, Alois; Steinfeld, Nina; Meier-Schroers, Michael; Luetkens, Julian; Nadal, Jennifer; Dabir, Darius; Fischer, Stefan; Gieseke, Juergen; Schild, Hans; Thomas, Daniel

    2017-05-01

    This cardiac magnetic resonance study was performed to assess myocardial fibrosis by evaluating T1-relaxation time (T1), to measure left ventricular (LV) strain, and to determine epicardial fat volume (EFV) in hypertensive patients with no history of cardiovascular (CV) events and to relate the results to the presence of coronary atherosclerotic artery disease (CAD) in these patients. A total of 123 subjects were examined at 1.5 T. Of them, 98 were hypertensive patients (58 men; mean age, 62.9±10.7 y; body mass index, 29.0±5.6 kg/m) and 25 were controls without CV risk factors or disease (13 men; 60.1±10.7 y; 28.1±5.4 kg/m). All patients had a well-treated blood pressure. In the hypertensive group, 56 patients had no CAD, whereas 42 patients had CAD. T1 was assessed by a modified Look-Locker inversion recovery sequence. Longitudinal and circumferential peak systolic strain (LS; CS) was determined with dedicated cardiac magnetic resonance software (feature tracking). EFV (normalized to the body surface area) was assessed by a 3D Dixon sequence. T1 (ms) and EFV (mL/m) were higher and CS and LS (%) were lower in hypertensive patients compared with those in nonhypertensive controls (PEFV=58.2±21.1; hypertensive patients overall: T1=991.3±45.5, LS=-21.0±4.5, CS=-25.0±5.9, EFV=71.1±25.3; hypertensive patients without CAD: T1=991.6±48.4, LS=-21.0±4.7, CS=-24.6±6.3, EFV=71.3±26.6; hypertensive patients with CAD: T1=986.7±39.2, LS=-21.1±4.3, CS=-25.5±5.4, EFV=70.9±23.6). There were no significant differences between hypertensive patients with and those without CAD and between patients grouped according to the number of vessels affected (0-vessel disease, 1-vessel disease, 2-vessel disease, or 3-vessel disease). Hypertension is associated with signs of myocardial fibrosis and an impaired LV contractility despite a normal LV ejection fraction, as well as with an increased EFV. However, CAD, in the absence of previous pathologies with consecutive myocardial

  12. Acute and chronic effects of epicardial radiofrequency applications delivered on epicardial coronary arteries.

    Science.gov (United States)

    Viles-Gonzalez, Juan F; de Castro Miranda, Reynaldo; Scanavacca, Mauricio; Sosa, Eduardo; d'Avila, Andre

    2011-08-01

    Epicardial coronary injury is by far the most feared complication of epicardial ablation. Little information is available regarding the chronic effects of delivering radiofrequency in the vicinity of large coronary vessels, and the long-term impact of this approach for mapping and ablation on epicardial vessel integrity is poorly understood. Therefore, the aim of this study was to characterize the acute and chronic histopathologic changes produced by in vivo epicardial pulses of radiofrequency ablation on coronary artery of porcine hearts. Seven pigs underwent a left thoracotomy. The catheter was sutured adjacent to the left anterior descending artery and left circumflex artery, and 20 pulses of radiofrequency energy were applied. Radiofrequency lesions located no more than 1 mm of the vessel were used for this analysis. Three animals were euthanized 20 days (acute phase) after the procedure and 4 animals after 70 days (chronic phase). The following parameters were obtained in each vessel analyzed: (1) internal and external perimeter; (2) vessel wall thickness; (3) tunica media thickness, and (4) tunica intima thickness. The presence of adipose tissue around the coronary arteries, the distance between the artery and the epicardium, and the anatomic relationship of the artery with the coronary vein was also documented for each section. Sixteen of 20 (80%) sections analyzed, showed intimal thickening with a mean of 0.18 ± 0.14 mm compared with 0.13 ± 0.16 mm in the acute phase (P = 0.331). The mean tunica media thickness was 0.25 ± 0.10 mm in the chronic phase animals compared with 0.18 ± 0.03 mm in the acute phase animals (P = 0.021). A clear protective effect of pericardial fat and coronary veins was also present. A positive correlation between depth of radiofrequency lesion and the degree of vessel injury expressed as intimal and media thickening (P = 0.001) was present. A negative correlation was identified (r = -0.83; P = 0.002) between intimal thickening

  13. Catheter ablation of epicardial ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Takumi Yamada, MD, PhD

    2014-08-01

    Full Text Available Ventricular tachycardias (VTs can usually be treated by endocardial catheter ablation. However, some VTs can arise from the epicardial surface, and their substrate can be altered only by epicardial catheter ablation. There are two approaches to epicardial catheter ablation: transvenous and transthoracic. The transvenous approach through the coronary venous system (CVS has been commonly used because it is easily accessible. However, this approach may be limited by the distribution of the CVS and insufficient radiofrequency energy delivery. Transthoracic epicardial catheter ablation has been developed to overcome these limitations of the transvenous approach. It is a useful supplemental or even preferred strategy to eliminate epicardial VTs in the electrophysiology laboratory. This technique has been applied for scar-related VTs secondary to often non-ischemic cardiomyopathy and sometimes ischemic cardiomyopathy, and idiopathic VTs as the epicardial substrates of these VTs have become increasingly recognized. When endocardial ablation and epicardial ablation through the CVS are unsuccessful, transthoracic epicardial ablation should be the next option. Intrapericardial access is usually obtained through a subxiphoidal pericardial puncture. This approach might not be possible in patients with pericardial adhesions caused by prior cardiac surgery or pericarditis. In such cases, a hybrid procedure involving surgical access with a subxiphoid pericardial window and a limited anterior or lateral thoracotomy might be a feasible and safe method of performing an epicardial catheter ablation in the electrophysiology laboratory. Potential complications associated with this technique include bleeding and collateral damage to the coronary arteries and phrenic nerve. Although the risk of these complications is low, electrophysiologists who attempt epicardial catheter ablation should know the complications associated with this technique, how to minimize their

  14. Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia.

    Science.gov (United States)

    Sosa, E; Scanavacca, M; D'Avila, A; Piccioni, J; Sanchez, O; Velarde, J L; Silva, M; Reolão, B

    1998-03-01

    An epicardial site of origin of ventricular tachycardia (VT) may explain unsuccessful endocardial radiofrequency (RF) catheter ablation. A new technique to map the epicardial surface of the heart through pericardial puncture was presented recently and opened the possibility of using epicardial mapping to guide endocardial ablation or epicardial catheter ablation. We report the efficacy and safety of these two approaches to treat 10 consecutive patients with VT and Chagas' disease. Epicardial mapping was carried out with a regular steerable catheter introduced into the pericardial space. An epicardial circuit was found in 14 of 18 mapable VTs induced in 10 patients. Epicardial mapping was used to guide endocardial ablation in 4 patients and epicardial ablation in 6. The epicardial earliest activation site occurred 107+/-60 msec earlier than the onset of the QRS complex. At the epicardial site used to guide endocardial ablation, earliest activation occurred 75+/-55 msec before the QRS complex. Epicardial mid-diastolic potentials and/or continuous electrical activity were seen in 7 patients. After 4.8+/-2.9 seconds of epicardial RF applications, VT was rendered noninducible. Hemopericardium requiring drainage occurred in 1 patient; 3 others developed pericardial friction without hemopericardium. Patients remain asymptomatic 5 to 9 months after the procedure. Interruption during endocardial pulses occurred after 20.2+/-14 seconds (P = 0.004), but VT was always reinducible and the patients experienced a poor outcome. Epicardial mapping does not enhance the effectiveness of endocardial pulses of RF. Epicardial applications of RF energy can safely and effectively treat patients with VT and Chagas' disease.

  15. Fatness

    DEFF Research Database (Denmark)

    Hansen, Anne Katrine Kleberg

    In 1727, the English physician Thomas Short wrote: “I believe no Age did ever afford more instances of Corpulency than our own.” Even in the 18th century, fatness was addressed as an issue of special contemporary concern. This thesis probes concepts and perceptions of fatness in Western European...... Medicine c. 1700–1900. It has been written with particular attention to whether and how fatness has been regarded as a disease during that period in history. One purpose of the thesis is to investigate the immediate period before fatness allegedly became problematized. Another purpose has been to grasp...

  16. Percutaneous epicardial ablation in ventricular arrhythmias.

    Science.gov (United States)

    Galvão Santos, Pedro; Cavaco, Diogo; Adragão, Pedro; Scanavacca, Mauricio; Reis Santos, Katya; Belo Morgado, Francisco; Carmo, Pedro; Costa, Francisco; Bernardo, Ricardo; Nunes, Manuela; Abecasis, Miguel; Neves, José; Mendes, Miguel

    2014-05-01

    Reentrant circuits of ventricular tachycardia may involve not only the endocardium but also the epicardium. Epicardial ablation can be useful in these situations. The aim of this study was to assess efficacy, safety and complications in a series of consecutive patients who underwent ablation of ventricular tachycardia with epicardial mapping. The study included all patients undergoing ventricular tachycardia ablation with epicardial mapping from 2004 to 2012. Of a total of 95 ablations, an epicardial approach was attempted in nine patients, eight male, mean age 58±12 years. Endocardial mapping was performed in all patients previously or simultaneously. The etiology of the arrhythmia was non-ischemic in eight patients and ischemic in one. We compared the number of events in the six months prior to the epicardial procedure and six months after. Percutaneous epicardial access was achieved in eight patients. In one case it was not possible due to the presence of adhesions. In none of the patients was the procedure repeated and there were no major complications during hospitalization. In a mean follow-up of 3.5±1.2 years, one patient suffered stroke; there were no other medium-to-long-term complications and the number of ventricular tachycardia episodes was reduced in all patients after ablation. Epicardial radiofrequency ablation of ventricular tachycardia was effective in reducing morbidity in eight patients, with a low risk of complications in the short and medium-to-long term. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  17. Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes.

    Science.gov (United States)

    González, N; Moreno-Villegas, Z; González-Bris, A; Egido, J; Lorenzo, Ó

    2017-04-04

    Nowadays, obesity is seriously increasing in most of the populations all over the world, and is associated with the development and progression of high-mortality diseases such as type-2 diabetes mellitus (T2DM) and its subsequent cardiovascular pathologies. Recent data suggest that both body fat distribution and adipocyte phenotype, can be more determinant for fatal outcomes in obese patients than increased general adiposity. In particular, visceral adiposity is significantly linked to long term alterations on different cardiac structures, and in developed forms of myocardial diseases such as hypertensive and ischaemic heart diseases, and diabetic cardiomyopathy. Interestingly, this depot may be also related to epicardial fat accumulation through secretion of lipids, adipokines, and pro-inflammatory and oxidative factors from adipocytes. Thus, visceral adiposity and its white single-lipid-like adipocytes, are risk factors for different forms of heart disease and heart failure, mainly in higher degree obese subjects. However, under specific stimuli, some of these adipocytes can transdifferentiate to brown multi-mitochondrial-like adipocytes with anti-inflammatory and anti-apoptotic proprieties. Accordingly, in order to improve potential cardiovascular abnormalities in obese and T2DM patients, several therapeutic strategies have been addressed to modulate the visceral and epicardial fat volume and phenotypes. In addition to lifestyle modifications, specific genetic manipulations in adipose tissue and administration of PPARγ agonists or statins, have improved fat volume and phenotype, and cardiovascular failures. Furthermore, incretin stimulation reduced visceral and epicardial fat thickness whereas increased formation of brown adipocytes, alleviating insulin resistance and associated cardiovascular pathologies.

  18. Transmural mechanics at left ventricular epicardial pacing site

    OpenAIRE

    Ashikaga, Hiroshi; Omens, Jeffrey H.; Ingels, Neil B., Jr.; Covell, James W.

    2004-01-01

    Left ventricular (LV) epicardial pacing acutely reduces wall thickening at the pacing site. Because LV epicardial pacing also reduces transverse shear deformation, which is related to myocardial sheet shear, we hypothesized that impaired end-systolic wall thickening at the pacing site is due to reduction in myocardial sheet shear deformation, resulting in a reduced contribution of sheet shear to wall thickening. We also hypothesized that epicardial pacing would reverse the transmural mechanic...

  19. [Obesity: ectopic fat distribution and the heart].

    Science.gov (United States)

    Müller-Wieland, Dirk; Knebel, Birgit; Haas, Jutta; Merkel, Martin; Kotzka, Jörg

    2010-05-01

    The metabolic syndrome is usually associated with insulin resistance and visceral fat distribution, which appear to play a direct role in the development of clinical criteria of metabolic syndrome, like elevation of arterial blood pressure and dyslipidemia. In this review, the authors will first introduce the concept, that insulin resistance and increased visceral adipose tissue are also regularly associated with an abnormal or ectopic accumulation of lipids in nonadipocytes, like steatosis hepatis. Then, they will provide some evidence that epicardial fat can be associated with insulin resistance in a similar fashion as visceral intraabdominal fat. Furthermore, epicardial fat might directly affect the vessels and function of the heart. Accordingly, ectopic accumulation of fat within cardiac muscle cells can impair their function and possibly be related to heart failure. These new relations between obesity, fat distribution and cardiac function might help to identify and treat individuals at risk earlier and more appropriately.

  20. Epicardial adipose tissue: at the heart of the obesity complications.

    Science.gov (United States)

    Guglielmi, Valeria; Sbraccia, Paolo

    2017-06-29

    In recent years, the anatomic and functional contiguity of epicardial adipose tissue (EAT) to myocardium and coronary arteries has gained increasing interest for its potential pathogenetic role in obesity-related cardiac diseases. Besides its known and attributed biochemical cardioprotective properties, it is becoming evident that, in metabolic disease states, EAT-secreted bioactive molecules may play an important role in the pathogenesis of coronary artery disease and cardiac arrhythmias. EAT-derived inflammatory cytokines and reactive oxidative species may, indeed, play a part in the development of a local proatherogenic milieu by paracrine and vasocrine mechanisms of interaction. In addition, initial clinical and in vitro studies have pointed out that EAT could be a determinant of the substrate of atrial fibrillation by contributing to the structural and electrical remodeling of myocardium. This article reviews the current state of knowledge on the association of EAT with cardiac dysfunction and the potential factors mediating the cross talk between this fat depot and the underlying cardiac structures.

  1. Electrocardiographic patterns during left ventricular epicardial pacing.

    Science.gov (United States)

    Jastrzebski, Marek; Fijorek, Kamil; Czarnecka, Danuta

    2012-11-01

    There is a paucity of data concerning the use of QRS morphology patterns for identifying pacing sites during left ventricle (LV)-only epicardial pacing in patients with a biventricular device. The objective of this study was to identify QRS patterns during LV-only pacing, and to establish their relationship with LV lead position. In addition, to validate the diagnostic performance of such electrocardiogram (ECG) patterns for predicting posterolateral versus anterior and apical versus nonapical LV pacing site. The study retrospectively analyzed data from 376 cardiac resynchronization therapy device patients. Data analyzed included ECGs registered during LV-only VVI pacing, fluoroscopic projections, and lateral chest roentgenograms that documented postimplantation LV lead position. Phase one of the study involved categorization of the ECG patterns of the first 66 study cases. Phase two of the study examined the association between ECG pattern and different LV lead positions. As the LV epicardial pacing site became more anteroapical, the LV-only paced QRS complexes in the precordial leads became more negative. Three ECG patterns were identified (posterolateral, intermediate, and anteroapical), and their distribution was found to be associated with LV lead position (P anteroapical ECG pattern was associated with LV leads in anteroapical segments (specificity of 98.5%, accuracy of 89.1% for predicting an anteroapical pacing site). Posterolateral and anteroapical ECG patterns are highly predictive of LV lead position. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  2. Epicardial Brugada syndrome ablation unmasking inferior J waves.

    Science.gov (United States)

    Lee, Adam; Kohler, Heidi; Wright, Daniel; Haqqani, Haris M

    2017-11-01

    Patients with Brugada syndrome are at risk of life-threatening ventricular arrhythmias. Epicardial substrate ablation for Brugada syndrome has been described as a means of controlling these arrhythmias and recent reports describe elimination of the Brugada phenotype with ablation. We describe a unique case in which a patient developed inferior J waves with an early repolarization-type electrocardiogram following successful epicardial infundibular substrate ablation (which eliminated the Brugada syndrome electrocardiogram on ajmaline challenge). We discuss the likely underlying pathophysiology responsible for this phenomenon, its relationship to the anatomic obstacles encountered during epicardial ablation, and the implications for long-term arrhythmic risk. © 2017 Wiley Periodicals, Inc.

  3. The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation

    Directory of Open Access Journals (Sweden)

    Kimura Takehiro

    2012-11-01

    Full Text Available Abstract Background The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed. Methods Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated. Results The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation. Conclusions Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.

  4. Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy.

    Science.gov (United States)

    Jenni, R; Oechslin, E; Schneider, J; Attenhofer Jost, C; Kaufmann, P A

    2001-12-01

    To determine clear cut echocardiographic criteria for isolated ventricular non-compaction (IVNC), a cardiomyopathy as yet "unclassified" by the World Health Organization. The disease is not widely known and its diagnosis mostly missed. In seven out of a series of 34 patients with IVNC the in vivo echocardiographic characteristics were validated against the anatomical examination of the heart removed after death in four and due to heart transplantation in three patients. Four morphological criteria diagnostic for IVNC were found. (1) Coexisting cardiac abnormalities were absent (by definition). (2) A two layer structure was seen, with a compacted thin epicardial band and a much thicker non-compacted endocardial layer of trabecular meshwork with deep endomyocardial spaces. A maximal end systolic ratio of non-compacted to compacted layers of > 2 is diagnostic. (3) The predominant localisation of the pathology was to mid-lateral (seven of seven patients), apical (six), and mid-inferior (seven) areas. The pathological preparations confirmed the echocardiographic findings. Concomitant regional hypokinesia was not confined to the non-compacted segments. (4) There was colour Doppler evidence of deep perfused intertrabecular recesses. Four clear cut echocardiographic diagnostic criteria were established. It is suggested that the WHO classification of cardiomyopathies be reconsidered to include IVNC as a distinct cardiomyopathy.

  5. Revealing new mouse epicardial cell markers through transcriptomics.

    Directory of Open Access Journals (Sweden)

    Lars Bochmann

    2010-06-01

    Full Text Available The epicardium has key functions during myocardial development, by contributing to the formation of coronary endothelial and smooth muscle cells, cardiac fibroblasts, and potentially cardiomyocytes. The epicardium plays a morphogenetic role by emitting signals to promote and maintain cardiomyocyte proliferation. In a regenerative context, the adult epicardium might comprise a progenitor cell population that can be induced to contribute to cardiac repair. Although some genes involved in epicardial function have been identified, a detailed molecular profile of epicardial gene expression has not been available.Using laser capture microscopy, we isolated the epicardial layer from the adult murine heart before or after cardiac infarction in wildtype mice and mice expressing a transgenic IGF-1 propeptide (mIGF-1 that enhances cardiac repair, and analyzed the transcription profile using DNA microarrays.Expression of epithelial genes such as basonuclin, dermokine, and glycoprotein M6A are highly enriched in the epicardial layer, which maintains expression of selected embryonic genes involved in epicardial development in mIGF-1 transgenic hearts. After myocardial infarct, a subset of differentially expressed genes are down-regulated in the epicardium representing an epicardium-specific signature that responds to injury.This study presents the description of the murine epicardial transcriptome obtained from snap frozen tissues, providing essential information for further analysis of this important cardiac cell layer.

  6. Electrocardiographic And Echocardiographic Findings Of Nigerian ...

    African Journals Online (AJOL)

    ... functions of both categories of athletes were found to be within normal limits and better than the control group. None of the athlete had echocardiographic features suggestive of hypertrophic cardiomyopathy. Key words: Electrocardiography, Echocardiograph in athletes and non athletes. Nigerian Medical Practitioner Vol.

  7. The Epicardial Neural Ganglionated Plexus of the Ovine Heart: Anatomical Basis for Experimental Cardiac Electrophysiology and Nerve Protective Cardiac Surgery

    Science.gov (United States)

    Saburkina, Inga; Rysevaite, Kristina; Pauziene, Neringa; Mischke, Karl; Schauerte, Patrick; Jalife, José; Pauza, Dainius H.

    2011-01-01

    Summary BACKGROUND The sheep is routinely used in experimental cardiac electrophysiology and surgery. OBJECTIVE We aimed at (1) ascertaining the topography and architecture of the ovine epicardial neural plexus (ENP), (2) determining the relationships of the ENP with the vagal and sympathetic cardiac nerves and ganglia, and (3) evaluating gross anatomical differences and similarities among ENPs in humans, sheep and other species. METHODS The ovine ENP, extrinsic sympathetic and vagal nerves were revealed histochemically for acetylcholinesterase on whole heart and/or thorax-dissected preparations from 23 newborn lambs with subsequent examination by a stereomicroscope. RESULTS The intrinsic cardiac nerves extend from the venous part of the ovine heart hilum (HH) along the roots of the cranial (superior) caval and left azygos veins to both atria and ventricles via five epicardial routes; i.e. the dorsal right atrial (DRA), middle (MD), left dorsal (LD), right ventral (VR) and ventral left atrial (VLA) nerve subplexuses. Intrinsic nerves proceeding from the arterial part of the HH along the roots of the aorta and pulmonary trunk extend exclusively into the ventricles as the right and left coronary subplexuses. The DRA, RV, and MD subplexuses receive the main extrinsic neural input from the right cervicothoracic and the right thoracic sympathetic T2, T3 ganglia, as well as from the right vagal nerve. The LD is supplied by sizeable extrinsic nerves from the left thoracic T4-T6 sympathetic ganglia and the left vagal nerve. Sheep hearts contained on average 769±52 epicardial ganglia. Cumulative areas of epicardial ganglia on the root of the cranial vena cava and on the wall of the coronary sinus were the largest of all regions (p<0.05). CONCLUSION Despite substantial interindividual variability in the morphology of the ovine ENP, the right-sided epicardial neural subplexuses supplying the sinuatrial and atrioventricular nodes are mostly concentrated at a fat pad between

  8. Is epicardial adipose tissue, another measure of central obesity, correlated with erectile dysfunction?

    Directory of Open Access Journals (Sweden)

    Chih-Wei Tsao

    2016-01-01

    Full Text Available Background: This study investigated the correlation between epicardial adipose tissue (EAT, a measure of central obesity, and sexual function in males with vasculogenic erectile dysfunction (ED. Materials and Methods: The study was a cross-sectional study of selected males with ED aged <75 years who attended the Urology Outpatient Department of Tri-Service General Hospital. Sixty subjects were included in the study, which employed biochemical data, anthropometric indexes, echocardiography, and questionnaires. Biochemical lipid profiles and associated inflammation markers were recorded. The anthropometric indexes included general and central obesity and bioelectrical impedance analysis. Echocardiography results were assessed by a single experienced cardiologist and included epicardial and pericardial fat thickness measurements. Sexual function was evaluated using the International Index of Erectile Function-5 (IIEF-5 score. Results: According to the analysis of variance and multivariate logistic regression, only the erectile hardness score (EHS was statistically positively correlated with the IIEF-5 score. All other anthropometric indexes and echocardiography parameters, including EAT thickness, pericardial adipose tissue thickness, and ejection fraction (EF, were not significantly associated with sexual function. Conclusions: Only EHS was statistically associated with sexual function in the male subjects with ED. The anthropometric indexes and EAT thickness, a measure of central obesity, were not significantly correlated with sexual function in the male patients with ED.

  9. Epicardial adipose tissue as a metabolic transducer: role in heart failure and coronary artery disease.

    Science.gov (United States)

    Patel, Vaibhav B; Shah, Saumya; Verma, Subodh; Oudit, Gavin Y

    2017-07-31

    Obesity and diabetes are strongly associated with metabolic and cardiovascular disorders including dyslipidemia, coronary artery disease, hypertension, and heart failure. Adipose tissue is identified as a complex endocrine organ, which by exerting a wide array of regulatory functions at the cellular, tissue and systemic levels can have profound effects on the cardiovascular system. Different terms including "epicardial," "pericardial," and "paracardial" have been used to describe adipose tissue deposits surrounding the heart. Epicardial adipose tissue (EAT) is a unique and multifaceted fat depot with local and systemic effects. The functional and anatomic proximity of EAT to the myocardium enables endocrine, paracrine, and vasocrine effects on the heart. EAT displays a large secretosome, which regulates physiological and pathophysiological processes in the heart. Perivascular adipose tissue (PVAT) secretes adipose-derived relaxing factor, which is a "cocktail" of cytokines, adipokines, microRNAs, and cellular mediators, with a potent effect on paracrine regulation of vascular tone, vascular smooth muscle cell proliferation, migration, atherosclerosis-susceptibility, and restenosis. Although there are various physiological functions of the EAT and PVAT, a phenotypic transformation can lead to a major pathogenic role in various cardiovascular diseases. The equilibrium between the physiological and pathophysiological properties of EAT is very delicate and susceptible to the influences of intrinsic and extrinsic factors. Various adipokines secreted from EAT and PVAT have a profound effect on the myocardium and coronary arteries; targeting these adipokines could be an important therapeutic approach to counteract cardiovascular disease.

  10. A Novel Role of CDX1 in Embryonic Epicardial Development

    Science.gov (United States)

    Wang, Huan; Shen, Ting; Yang, Yanqin; Sun, Yun; Tang, Nannan; Ni, Ting; Zhu, Jun; Mailman, Richard B.; Wang, Yuan

    2014-01-01

    The molecular mechanism that regulates epicardial development has yet to be understood. In this study, we explored the function of CDX1, a Caudal-related family member, in epicardial epithelial-to-mesenchymal transition (EMT) and in the migration and the differentiation of epicardium-derived progenitors into vascular smooth muscle cells. We detected a transient expression of CDX1 in murine embryonic hearts at 11.5 days post coitum (dpc). Using a doxycycline-inducible CDX1 mouse model, primary epicardium, and ex vivo heart culture, we further demonstrated that ectopic expression of CDX1 promoted epicardial EMT. In addition, a low-dose CDX1 induction led to enhanced migration and differentiation of epicardium-derived cells into α-SMA+ vascular smooth muscles. In contrast, either continued high-level induction of CDX1 or CDX1 deficiency attenuated the ability of epicardium-derived cells to migrate and to mature into smooth muscles induced by TGF-β1. Further RNA-seq analyses showed that CDX1 induction altered the transcript levels of genes involved in neuronal development, angiogenesis, and cell adhesions required for EMT. Our data have revealed a previously undefined role of CDX1 during epicardial development, and suggest that transient expression of CDX1 promotes epicardial EMT, whereas subsequent down-regulation of CDX1 after 11.5 dpc in mice is necessary for further subepicardial invasion of EPDCs and contribution to coronary vascular endothelium or smooth muscle cells. PMID:25068460

  11. A novel role of CDX1 in embryonic epicardial development.

    Directory of Open Access Journals (Sweden)

    Min Chu

    Full Text Available The molecular mechanism that regulates epicardial development has yet to be understood. In this study, we explored the function of CDX1, a Caudal-related family member, in epicardial epithelial-to-mesenchymal transition (EMT and in the migration and the differentiation of epicardium-derived progenitors into vascular smooth muscle cells. We detected a transient expression of CDX1 in murine embryonic hearts at 11.5 days post coitum (dpc. Using a doxycycline-inducible CDX1 mouse model, primary epicardium, and ex vivo heart culture, we further demonstrated that ectopic expression of CDX1 promoted epicardial EMT. In addition, a low-dose CDX1 induction led to enhanced migration and differentiation of epicardium-derived cells into α-SMA+ vascular smooth muscles. In contrast, either continued high-level induction of CDX1 or CDX1 deficiency attenuated the ability of epicardium-derived cells to migrate and to mature into smooth muscles induced by TGF-β1. Further RNA-seq analyses showed that CDX1 induction altered the transcript levels of genes involved in neuronal development, angiogenesis, and cell adhesions required for EMT. Our data have revealed a previously undefined role of CDX1 during epicardial development, and suggest that transient expression of CDX1 promotes epicardial EMT, whereas subsequent down-regulation of CDX1 after 11.5 dpc in mice is necessary for further subepicardial invasion of EPDCs and contribution to coronary vascular endothelium or smooth muscle cells.

  12. Epicardial and Subcutaneous Adipose Tissue Fatty Acids Profiles in Diabetic and Non-Diabetic Patients Candidate for Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    Masoud Pezeshkian

    2013-01-01

    Full Text Available Introduction: We have recently shown that in high cholesterol-fed rabbits, the sensitivity of epicardial adipose tissue to changes in dietary fat is higher than that of subcutaneous adipose tissue. Although the effects of diabetes on epicardial adipose tissue thickness have been studied, the influence of diabetes on profile of epicardial free fatty acids (FFAs has not been studied. The aim of this study is to investigate the effect of diabetes on the FFAs composition in serum and in the subcutaneous and epicardial adipose tissues in patients undergoing coronary artery bypass graft (CABG. Methods: Forty non-diabetic and twenty eight diabetic patients candidate for CABG with > 75% stenosis participated in this study.Fasting blood sugar (FBS and lipid profiles were assayed by auto analyzer. Phospholipids and non-estrified FFA of serum and the fatty acids profile of epicardial and subcutaneous adipose tissues were determined using gas chromatography method. Results: In the phospholipid fraction of diabetic patients’ serum, the percentage of 16:0, 18:3n-9, 18:2n-6 and monounsaturated fatty acids (MUFAs was lower than the corresponding values of the non-diabetics; whereas, 18:0 value was higher. A 100% increase in the amount of 18:0 and 35% decrease in the level of 18:1n-11 was observed in the diabetic patients’ subcutaneous adipose tissue. In epicardial adipose tissue, the increase of 18:0 and conjugated linolenic acid (CLA and decrease of 18:1n-11, ω3 (20:5n-3 and 22:6n-3 were significant; but, the contents of arachidonic acid and its precursor linoleic acid were not affected by diabetes. Conclusion: The fatty acids’ profile of epicardial and subcutaneous adipose tissues is not equally affected by diabetes. The significant decrease of 16:0 and ω3 fatty acids and increase of trans and conjugated fatty acids in epicardial adipose tissue in the diabetic patients may worsen the formation of atheroma in the related arteries.

  13. [Endomyocardial fibrosis (its clinico-echocardiographic characteristics)].

    Science.gov (United States)

    Bapumiia, M; Solomakhina, N I; Sumarokov, A V

    1996-01-01

    To compare clinical and echocardiographic features in patients with restrictive cardiomyopathy (RCMP), 15 patients (9 males and 6 females, mean age 34.93 +/- 1.03 years, duration of the disease 9 +/- 4.2 months) were examined using complete echocardiographic and doppler echocardiographic investigation in impulse regimen. Endomyocardial fibrosis was not obvious clinically, but should be suspected in dyspnea upon a weak exercise, undue fatiguability, tachycardia in normal arterial pressure and size of the heart. Echocardiographic indications, on the contrary, were rather specific. Endomyocardial fibrosis is characterized by diminished ventricular cavities, thickening of the endocardium and subvalvular structures, changed shape of ventricular cavity, echo-CG signs of passive pulmonary hypertension, diastolic dysfunction of the left and right ventricles.

  14. Transmural mechanics at left ventricular epicardial pacing site.

    Science.gov (United States)

    Ashikaga, Hiroshi; Omens, Jeffrey H; Ingels, Neil B; Covell, James W

    2004-06-01

    Left ventricular (LV) epicardial pacing acutely reduces wall thickening at the pacing site. Because LV epicardial pacing also reduces transverse shear deformation, which is related to myocardial sheet shear, we hypothesized that impaired end-systolic wall thickening at the pacing site is due to reduction in myocardial sheet shear deformation, resulting in a reduced contribution of sheet shear to wall thickening. We also hypothesized that epicardial pacing would reverse the transmural mechanical activation sequence and thereby mitigate normal transmural deformation. To test these hypotheses, we investigated the effects of LV epicardial pacing on transmural fiber-sheet mechanics by determining three-dimensional finite deformation during normal atrioventricular conduction and LV epicardial pacing in the anterior wall of normal dog hearts in vivo. Our measurements indicate that impaired end-systolic wall thickening at the pacing site was not due to selective reduction of sheet shear, but rather resulted from overall depression of fiber-sheet deformation, and relative contributions of sheet strains to wall thickening were maintained. These findings suggest lack of effective end-systolic myocardial deformation at the pacing site, most likely because the pacing site initiates contraction significantly earlier than the rest of the ventricle. Epicardial pacing also induced reversal of the transmural mechanical activation sequence, which depressed sheet extension and wall thickening early in the cardiac cycle, whereas transverse shear and sheet shear deformation were not affected. These findings suggest that normal sheet extension and wall thickening immediately after activation may require normal transmural activation sequence, whereas sheet shear deformation may be determined by local anatomy.

  15. Effects of additional exercise training on epicardial, intra-abdominal and subcutaneous adipose tissue in major depressive disorder: A randomized pilot study.

    Science.gov (United States)

    Kahl, K G; Kerling, A; Tegtbur, U; Gützlaff, E; Herrmann, J; Borchert, L; Ates, Zeynep; Westhoff-Bleck, M; Hueper, K; Hartung, D

    2016-03-01

    Major depressive disorder (MDD) is associated with increased amounts of intra-abdominal and epicardial adipose tissue, risk factors for the development of cardio-metabolic disorders. Exercise has been shown to reduce intra-abdominal fat in different conditions such as obesity and diabetes mellitus, thereby reducing cardio-metabolic risks. Therefore we examined the effects of exercise on adipose tissue compartments in patients with MDD. Of thirty depressed patients included, twenty received supervised exercise training, and ten received no specific training. Volumes of subcutaneous, intra-abdominal and epicardial adipose tissue were measured using magnetic resonance imaging, and factors constituting the metabolic syndrome were determined. Significant effects of the training condition were observed on the amount of epicardial adipose tissue (P=0.017), subcutaneous adipose tissue (P=0.023), weight (P=0.047), body-mass index (P=0.04), high density lipoproteins (P=0.021) and the number of metabolic syndrome factors (P=0.018). The amount of intra-abdominal adipose tissue decreased slightly, although not significantly, in the exercise group. Exercise training reduces the amount of visceral, in particular epicardial adipose tissue, in patients with MDD, and ameliorates factors constituting the metabolic syndrome. Given the high prevalence of cardio-metabolic disorders in major depression, exercise training may be recommended as an additional treatment component. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Video-Assisted Thoracic Placement of Epicardial Leads

    NARCIS (Netherlands)

    Schouwenburg, Jasper J.; Klinkenberg, Theo J.; Maass, Alexander H.; Mariani, Massimo A.

    Cardiac resynchronization therapy is one of the cornerstones of heart failure treatment. Inability to access the coronary sinus or one of its sidebranches is one of the most common causes of therapeutic failure. We describe a technique using video-assisted thoracic surgery for epicardial placement

  17. Echocardiograph alterations in asthma patients

    Directory of Open Access Journals (Sweden)

    André Luís Mancini

    2008-05-01

    Full Text Available Introduction: Asthma is a chronic inflammatory disease which has increased during the last 20 years, putting a strain on medical resources, particularly severe forms of the disease. Treatment in such cases is inhaled corticosteroids and beta agonist drugs that can produce a range of side effects. The aim of this study is to identify echocardiograph abnormalities and correlate them with severity of disease. Methodology: Eight-seven outpatients were selected at the asthma unit of the Gaffree Guinle University Hospital (HUGG. Each patient underwent spirometry, electrocardiogram (ECG and echocardiogram (ECO during the trial within a month maximum. Echocardiograph abnormalities found related to degree of asthma. Statistical analysis was made by nonparametric tests. Results: We found significant differences (p ≤ 0.05 for age, disease duration and haemoglobin saturation (SaO2 between the moderate and severe groups. In the sample a high prevalence of tricuspid insufficiency (41.4% was identified. Conclusions: ECO identified a series of abnormalities that were not always dependent on severity of disease. ECO can identify pulmonary hypertension through calculation of mean pressure of the pulmonary artery. Resumo: Introdução: A asma é uma doença inflamatória crónica cuja prevalência vem aumentando nos últimos 20 anos. Demanda grande utilização de recursos, principalmente no grupo grave. Neste, há consumo crónico de corticóides inalatórios e de β2-agonistas, que podem produzir uma série de problemas. O objectivo deste trabalho é o de rastrear as alterações electro e ecocardiográficas e relacioná-las ao grau da asma. Metodologia: Selecionámos 87 doentes do ambulatório de asma do HUGG, que, por rotina, possuem uma espirografia, um eletrocardiograma (ECG e um ecocardiograma (ECO feitos com um intervalo máximo de um mês. As alterações ecocardiográficas encontradas

  18. Echocardiographic agreement in the diagnostic evaluation for infective endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Selton-Suty, Christine; Tong, Steven Y C

    2016-01-01

    Echocardiography is essential for the diagnosis and management of infective endocarditis (IE). However, the reproducibility for the echocardiographic assessment of variables relevant to IE is unknown. Objectives of this study were: (1) To define the reproducibility for IE echocardiographic variab...

  19. Increased Epicardial Adipose Tissue Thickness in Type 2 Diabetes Mellitus and Obesity

    Directory of Open Access Journals (Sweden)

    Do Kyeong Song

    2015-10-01

    Full Text Available BackgroundEpicardial adipose tissue (EAT is suggested to play an important role in the progression of metabolic syndrome. We aimed to establish a simple method to measure EAT and examine the differences in EAT thickness according to the presence of type 2 diabetes mellitus or obesity.MethodsA total of 94 patients (42.6% type 2 diabetes mellitus, 53.2% obese, mean age 61±13 who underwent multidetector computed tomography were enrolled. Thickness of EAT was measured on the parasternal short and horizontal long axis view. Epicardial fat area (EFA was measured at the level of left main coronary artery (LMCA.ResultsAll EAT thicknesses were correlated with EFA at the LMCA level (r=0.235 to 0.613, all Ps<0.05, and EAT thickness in the left atrioventricular groove (LAVG had the highest correlation coefficient (r=0.613. EFA, and EAT thicknesses in the LAVG and the left ventricular apex were higher in the group with type 2 diabetes mellitus than in the group without type 2 diabetes mellitus when adjusted only for body mass index. When adjusted only for type 2 diabetes mellitus, EFA, and EAT thicknesses in the LAVG and the right atrioventricular groove were higher in obese group than in nonobese group.ConclusionIn conclusion, EAT thickness can be easily measured and represent EFA. EAT thickness, especially in LAVG, was higher in groups with type 2 diabetes mellitus and obesity independently. These findings implicate that EAT thickness may be a useful indicator for type 2 diabetes mellitus and obesity.

  20. Subtotal pericardectomy and epicardial excision for treatment of coccidioidomycosis-induced effusive-constrictive pericarditis in dogs: 17 cases (1999-2003).

    Science.gov (United States)

    Heinritz, Chris K; Gilson, Stephen D; Soderstrom, Mark J; Robertson, Thomas A; Gorman, Stephanie C; Boston, Ray C

    2005-08-01

    To determine the history, clinicopathologic findings, and results of surgery for effusive-constrictive pericarditis associated with Coccidioides immitis infection in dogs. Retrospective study. 17 client-owned dogs that underwent a subtotal pericardectomy and epicardial excision. Hospital records from May 1999 to June 2003 were reviewed. Data collected included history, clinicopathologic findings, treatments, and outcome. Follow-up information was obtained via recheck examination and by use of standardized telephone interviews with referring veterinarians and owners. All dogs were of large breeds, and most were male (mean age, 4.66 years). Ten dogs had no prior history of C. immitis infection, and 7 dogs had chronic infection with C. immitis. Having a chronic C. immitis infection reduced the odds of survival, compared with no previous infection. All dogs had clinical signs of right-sided heart failure. All dogs had serum titers (range, 1:8 to 1:256) for antibodies against C. immitis prior to surgery, and titers were not significantly associated with outcome. Predominant echocardiographic findings were thickened pericardium, reduced right ventricular filling, and pleural or pericardial effusion. All dogs underwent a subtotal pericardectomy and epicardial excision and had fibrosing pyogranulomatous pericarditis in biopsy specimens obtained during surgery. The perioperative mortality rate was 23.5%, and the 2-year postdischarge survival rate was 82%. Surgical treatment via subtotal pericardectomy and epicardial excision is successful at relieving right-sided heart failure in dogs with effusive-constrictive pericarditis secondary to C. immitis infection, but long-term treatment with antifungal agents may still be required.

  1. [Interventional stroke prophylaxis : endocardial and epicardial left atrial appendage closure].

    Science.gov (United States)

    Rillig, A; Heeger, C H; Kuck, K H; Tilz, R R

    2015-02-01

    Atrial fibrillation (AF) is currently one of the major causes of ischemic stroke with an estimated stroke risk of 5% per year. Oral anticoagulation is an effective treatment for the reduction of stroke risk in patients with AF but is also associated with an increased risk of bleeding. In patients with AF it has been shown that left atrial thrombi can be identified within the left atrial appendage (LAA) in more than 90% of cases. On the basis of these findings LAA closure devices have been developed as an alternative to oral anticoagulation. Besides endocardial LAA occluders, such as the WATCHMAN™ and AMPLATZER™ devices, an epicardial LAA occluder (LARIAT™) has recently been introduced. The following review introduces the various endocardial and epicardial LAA closure devices and assesses the indications, management, advantages and disadvantages of the two approaches according to the current literature.

  2. Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach

    Directory of Open Access Journals (Sweden)

    Aman Makhija

    2009-11-01

    Full Text Available Ventricular tachycardia (VT occurring late after myocardial infarction is often due to reentry circuit in the peri-infarct zone. The circuit is usually located in the sub-endocardium, though subepicardial substrates are known. Activation mapping during VT to identify target regions for ablation can be difficult if VT is non inducible or poorly tolerated. In the latter, a substrate based approach of mapping during sinus rhythm in conjunction with pace mapping helps to define the reentry circuit and select target sites for ablation in majority of patients with hemodynamically unstable VT. Percutaneous epicardial catheter ablation has been attempted as an approach where ablation by a conventional endocardial access has been unsuccessful. We report a case of post myocardial infarction scar VT which could be successfully ablated with a substrate based approach from the epicardial aspect.

  3. Correlation of Electrocardiogram with Echocardiographic left ...

    African Journals Online (AJOL)

    In order to device a method of assessment of LVH that is objective, readily available, affordable and easily operable in the face of soaring cost of the more recent techniques, correlation of electrocardiographic (ECG) LVH parameters was done with echocardiographic (echo) left ventricular mass (LVM). ECG is objective ...

  4. Automated contour detection in echocardiographic images

    NARCIS (Netherlands)

    Bosch, Johannes Gijsbertus

    2006-01-01

    We have developed several methods for automated analysis of echocardiographic images. This thesis describes these methods and their evaluation and use. It is shown that semiautomatic detection based on Dynamic Programming and Pattern Matching provides a useful and reliable way of analyzing 2D

  5. Echocardiographic findings in patients with Wegener granulomatosis.

    Science.gov (United States)

    Oliveira, Guilherme H M; Seward, James B; Tsang, Teresa S M; Specks, Ulrich

    2005-11-01

    To describe the spectrum and clinical implications of echocardiographic findings associated with Wegener granulomatosis. We retrospectively reviewed the clinical records and echocardiographic data of consecutive patients with confirmed Wegener granulomatosis referred to the echocardiography laboratory during the 21-year period from 1976 through 1997. Of the 85 patients Identified as having confirmed Wegener granulomatosis, 73 (86%) were found to have echocardiographic abnormalities. In 26 (36%) of these 73 patients, lesions appeared directly related to Wegener granulomatosis. We found regional wall motion abnormalities in 17 (65%) of these 26 patients. Left ventricular systolic dysfunction with decreased ejection fraction was found in 13 patients (50%) and pericardial effusion in 5 patients (19%). Other findings Included valvulitis, left ventricular aneurysm, and a large intracardlac mass. A significantly increased mortality rate was observed among patients who had cardiac involvement of Wegener granulomatosis found by echocardiography. We found a high frequency of echocardiographic abnormalities that appear to be related to Wegener granulomatosis and associated with Increased mortality. Because cardiac involvement in Wegener granulomatosis often is silent and associated with Increased morbidity and worse prognosis, echocardlographic screening of patients with active Wegener granulomatosis may be of clinical value.

  6. Electrocardiographic And Echocardiographic Findings Of Nigerian ...

    African Journals Online (AJOL)

    Summary In a prospective study spanning over 6 months involving one hundred and nineteen male and female subjects comprising 98 Nigerian athletes and 55 age and sex matched controls all had electrocardiography and echocardiographic assessment of left ventricular dimensions and systolic function. Athletes were ...

  7. Common echocardiographic abnormalities in Nigerians of different ...

    African Journals Online (AJOL)

    2012-09-17

    Sep 17, 2012 ... Degenerative valvular diseases, left ventricular diastolic dysfunction, and atrial septal defects were the commonest abnormalities in the elderly, middle-aged population and children, respectively. Key words: Different age groups, echocardiographic abnormalities, Nigerians. Date of Acceptance: 17-Sep- ...

  8. Decreased adiponectin and increased inflammation expression in epicardial adipose tissue in coronary artery disease

    OpenAIRE

    Sun Zongquan; Du Xinling; Wang Xianguo; Wang Lei; Wei Yutao; Zhou Yuan; Dong Nianguo; Chen Xinzhong

    2011-01-01

    Abstract Background Disorders of endocrine substances in epicardial adipose tissue are known causes of coronary artery disease (CAD). Adiponectin is associated with cardiovascular disease. However, expression of adiponectin in epicardial adipose tissue and its function in CAD pathogenesis is unclear. This study investigates adiponectin expression in epicardial adipose tissue in CAD patients. Methods Vessels or adipose tissue samples collected from CAD patients and non-CAD controls were examin...

  9. [Correlation between epicardial adipose tissue and coronary flow reserve in coronary heart disease patients with no chest pain].

    Science.gov (United States)

    Zhang, M; Li, Z P; Li, W H; Li, D; Liu, L N; Feng, X H; Gao, W

    2014-12-18

    To assess whether epicardial adipose tissue (EAT) thickness is associated with coronary flow reserve (CFR) and could be used to detect coronary microvascular dysfunction. We enrolled 62 nondiabetic patients who underwent computed tomography angiography or invasive coronary angiography and had no obstructive coronary artery disease. CFR and EAT thickness were measured by transthoracic Doppler echocardiography (TTDE). In the study, a total of 62 patients were enrolled, echocardiographic coronary flow reserve were obtained in 61 of the patients with a mean age of (59±10) years. 34 patients (56%) had reduced CFR (CFRmicrovascular dysfunction and 27 patients (44%) had normal CFR (CFR≥3, 3.56±0.52). EAT thickness was significantly increased in the patients with microvascular dysfunction as compared with those without [(3.4±0.8) mm vs. (2.3±0.6) mm, Pcoronary microvascular dysfunction (OR=7.78, 95%CI: 2.44-24.79). EAT thickness>2.9 mm had 82.4% sensitivity and 92.3% specificity to detect CFRcoronary microvascular dysfunction. EAT thickness was independently associated with impaired CFR. EAT>2.9 mm had high sensitivity and specificity to detect coronary microvascular dysfunction.

  10. Left ventricular noncompaction: Clinical-echocardiographic study

    Directory of Open Access Journals (Sweden)

    Nikolić Aleksandra

    2012-01-01

    Full Text Available Background/Aim. Left ventricular noncompaction (LVNC is a disorder in endomyocardial morphogenesis, seen either isolated (in the absence of other cardiac anomalies or in association with congenital heart disease and some neuromuscular diseases. Intrauterine arrest of the compaction of myocardial fibers is postulated to be the reason of LVNC. Recognition of this condition is extremely important due to its high mortality and morbidity that lead to progressive heart failure, ventricular arrhythmias and thromboembolic events. The aim of this study was to determine the prevalence and clinical presentation of LVNC among consecutive outpatients according to clinical and echocardiographyic findings. Methode. A total of 3,854 consecutive patients examined at the Institute for Cardiovascular Diseases within a period January 2006 - January 2007 were included in the study. All the patients underwent echocardiographic examination using the same equipment (Vivid 7, GE Medical System. Echocardiographic parameters and clinical presentation in patients with echocardiographic criteria for LVNC were analyzed. Results. Analyzing 3,854 consecutive outpatients, using two-dimensional Color Doppler echocardiography from January 2006 to January 2007, 12 patients met the criteria for LVNC. Seven of them were male. The mean age at diagnosis was 45 ± 15 years. Analyzing clinical manifestation of LVNC it was found that seven patients had signs of heart failure, six had arrhythmias with no embolic events. Conclusion. Our results suggest that the real prevalence of LVNC may be higher than expected. New studies have to be done to solve this problem.

  11. Echocardiographic evaluation during weaning from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Luciele Medianeira Schifelbain

    2011-01-01

    Full Text Available INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients

  12. Epicardial Ablation of Focal Atrial Tachycardia Arising From Left Atrial Appendage in Children

    Directory of Open Access Journals (Sweden)

    Abdhija Hanumandla

    2014-07-01

    Full Text Available Focal left atrial tachycardia (FLAT although a common cause of supraventricular tachycardia(SVT among children, the one's arising from left atrial appendage (LAA present a unique challenge for successful ablation because of anatomical location. We present two children with FLAT arising from the epicardial LAA, successfully mapped and ablated through percutaneuous epicardial approach.

  13. Pluripotent-stem-cell-derived epicardial cells: a step toward artificial cardiac tissue.

    Science.gov (United States)

    Brenner, Christoph; Franz, Wolfgang-Michael

    2014-11-06

    Epicardial cells are crucial for heart development, function, and regeneration, but methods to study them have been lacking. Using WNT and BMP signaling pathways, Witty et al. (2014) have now developed an elaborate method to generate fully functional epicardial cells from human pluripotent stem cells, allowing their in vitro investigation. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. The relationship between epicardial adipose tissue and malnutrition, inflammation, atherosclerosis/calcification syndrome in ESRD patients.

    Science.gov (United States)

    Turkmen, Kultigin; Kayikcioglu, Hatice; Ozbek, Orhan; Solak, Yalcin; Kayrak, Mehmet; Samur, Cigdem; Anil, Melih; Zeki Tonbul, Halil

    2011-08-01

    Malnutrition, inflammation, atherosclerosis/calcification (MIAC) and endothelial dysfunction are the most commonly encountered risk factors in the pathogenesis of cardiovascular disease in ESRD patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between CAD and EAT was shown in patients with high risk of coronary artery disease. In this study, we aimed to investigate the relationship between EAT and MIAC syndrome in ESRD patients. Eighty ESRD patients and 27 healthy subjects enrolled in this cross-sectional study. EAT and coronary artery calcification score were measured by a multidetector computed tomography (MDCT) scanner. Patients with serum albumin 10 ng/dl (normal range, 0-5 ng/dl) had inflammation; and those with CACS >10 had atheroscleosis/calcification. Total CACS and EAT measurements were significantly higher in ESRD patients when compared with healthy subjects. There was a statistically significant relationship between EAT and CACS in ESRD patients (r = 0.48). EAT measurements were higher in PD patients than HD patients. Twenty-four of the patients had no component, 31 had one component, 17 had two components, and nine had all of the MIAC components. EAT was found to be significantly increased when the presence of MIAC components increased. EAT was positively correlated with age, body mass index, and presence of MIAC. These parameters were also found as independent predictors of increased EAT. We found a relationship between EAT and components of MIAC syndrome in ESRD patients.

  15. Ectopic fat depots and left ventricular function in nondiabetic men with nonalcoholic fatty liver disease.

    Science.gov (United States)

    Granér, Marit; Nyman, Kristofer; Siren, Reijo; Pentikäinen, Markku O; Lundbom, Jesper; Hakkarainen, Antti; Lauerma, Kirsi; Lundbom, Nina; Nieminen, Markku S; Taskinen, Marja-Riitta

    2015-01-01

    Nonalcoholic fatty liver disease has emerged as a novel cardiovascular risk factor. The aim of the study was to assess the effect of different ectopic fat depots on left ventricular (LV) function in subjects with nonalcoholic fatty liver disease. Myocardial and hepatic triglyceride contents were measured with 1.5 T magnetic resonance spectroscopy and LV function, visceral adipose tissue (VAT) and subcutaneous adipose tissue, epicardial and pericardial fat by MRI in 75 nondiabetic men. Subjects were stratified by hepatic triglyceride content into low, moderate, and high liver fat groups. Myocardial triglyceride, epicardial and pericardial fat, VAT, and subcutaneous adipose tissue increased stepwise from low to high liver fat group. Parameters of LV diastolic function showed a stepwise decrease over tertiles of liver fat and VAT, and they were inversely correlated with hepatic triglyceride, VAT, and VAT/subcutaneous adipose tissue ratio. In multivariable analyses, hepatic triglyceride and VAT were independent predictors of LV diastolic function, whereas myocardial triglyceride was not associated with measures of diastolic function. Myocardial triglyceride, epicardial and pericardial fat increased with increasing amount of liver fat and VAT. Hepatic steatosis and VAT associated with significant changes in LV structure and function. The association of LV diastolic function with hepatic triglyceride and VAT may be because of toxic systemic effects. The effects of myocardial triglyceride on LV structure and function seem to be more complex than previously thought and merit further study. © 2014 American Heart Association, Inc.

  16. Echocardiographic study of left atrial myxoma

    Directory of Open Access Journals (Sweden)

    Dalal J

    1979-01-01

    Full Text Available Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio-graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my-xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis-appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma.

  17. Epicardial regeneration is guided by cardiac outflow tract and Hedgehog signalling.

    Science.gov (United States)

    Wang, Jinhu; Cao, Jingli; Dickson, Amy L; Poss, Kenneth D

    2015-06-11

    In response to cardiac damage, a mesothelial tissue layer enveloping the heart called the epicardium is activated to proliferate and accumulate at the injury site. Recent studies have implicated the epicardium in multiple aspects of cardiac repair: as a source of paracrine signals for cardiomyocyte survival or proliferation; a supply of perivascular cells and possibly other cell types such as cardiomyocytes; and as a mediator of inflammation. However, the biology and dynamism of the adult epicardium is poorly understood. To investigate this, we created a transgenic line to ablate the epicardial cell population in adult zebrafish. Here we find that genetic depletion of the epicardium after myocardial loss inhibits cardiomyocyte proliferation and delays muscle regeneration. The epicardium vigorously regenerates after its ablation, through proliferation and migration of spared epicardial cells as a sheet to cover the exposed ventricular surface in a wave from the chamber base towards its apex. By reconstituting epicardial regeneration ex vivo, we show that extirpation of the bulbous arteriosus-a distinct, smooth-muscle-rich tissue structure that distributes outflow from the ventricle-prevents epicardial regeneration. Conversely, experimental repositioning of the bulbous arteriosus by tissue recombination initiates epicardial regeneration and can govern its direction. Hedgehog (Hh) ligand is expressed in the bulbous arteriosus, and treatment with a Hh signalling antagonist arrests epicardial regeneration and blunts the epicardial response to muscle injury. Transplantation of Sonic hedgehog (Shh)-soaked beads at the ventricular base stimulates epicardial regeneration after bulbous arteriosus removal, indicating that Hh signalling can substitute for the influence of the outflow tract. Thus, the ventricular epicardium has pronounced regenerative capacity, regulated by the neighbouring cardiac outflow tract and Hh signalling. These findings extend our understanding of

  18. Echocardiographic screening results in patients with tuberous sclerosis complex.

    NARCIS (Netherlands)

    Adriaensen, M.E.; Cramer, M.J.; Brouha, M.E.; Schaefer-Prokop, C.M.; Prokop, M.; Doevendans, P.A.; Zonnenberg, B.A.; Feringa, H.H.

    2010-01-01

    We sought to examine the frequency of abnormal echocardiographic findings in patients with tuberous sclerosis complex. In a retrospective cohort study, we included all patients with known tuberous sclerosis complex who had been sent to our cardiology department for echocardiographic screening from

  19. Echocardiographic patterns of juvenile rheumatic heart disease at ...

    African Journals Online (AJOL)

    Objective: To describe the echocardiographic features of children with rheumatic heart disease seen at the Kenyatta National Hospital. Design: A retrospective study. Setting: The Kenyatta National Hospital Heart Unit. Subjects: Patients aged 20 years and less with echocardiographic diagnosis of rheumatic heart disease.

  20. The "atrial dancing": echocardiographic diagnosis of electrocardiographic query.

    Science.gov (United States)

    Siniscalchi, Carmine; Gaibazzi, Nicola

    2015-09-14

    The direct observation of the cardiac structure through the echocardiographic exam offers, in some cases, the advantage to resolve difficult diagnostic definition. In this paradigmatic case we emphasize as an accurate observation of the echocardiographic figures and movies can resolve also an electrocardiographic query.

  1. Ebstein's Anomaly: Anatomo-echocardiographic correlation

    Directory of Open Access Journals (Sweden)

    Keirns Candace

    2007-11-01

    Full Text Available Abstract Objective The aim of this investigation is to demonstrate that in Ebstein's Anomaly (EA the right ventricle (RV is affected in its three portions and to establish an anatomoechocardiographic correlation between the anatomic features and the equivalent echocardiographic images. Methods Thirty hearts with EA were studied. The alterations of each portions of the RV were described. Fifty adult patients with this anomaly were studied by echocardiography. Results Anatomy: All hearts had atrial situs solitus, 27 had concordant atrioventricular connection and 3 discordant, of these 2 had transposition of the great arteries (TGA and one double outlet right ventricle (DORV. The degree of tricuspid valve (TV displacement showed a spectrum from I to III. The inlet of the RV was markedly thin in 27. The trabecular portion had multiples muscular bands in all. The outlet portion was dilated in 20 and stenotic in 5. In 25 atrial septal defects were found. Echocardiography: All patients had atrial situs solitus, 42 with concordant atrioventricular connection and 8 with discordant, of these last patients 5 had TGA and 3 DORV. The degree of TV displacement varied from I to III. The inlet of RV was markedly thin in 42. The trabecular portion had muscular bands in 45. The outlet portion was dilated in 31 and stenotic in 11. In 30 atrial septal defects were found. Conclusion The EA affects the whole RV and the anatomoechocardiographic correlation provides an appropriate understanding of echocardiographic images in terms of a precise diagnosis, therapeutic decisions and prognosis.

  2. Facts about polyunsaturated fats

    Science.gov (United States)

    ... polyunsaturated fat; Heart disease - polyunsaturated fat; Peripheral artery disease - polyunsaturated fat; PAD - polyunsaturated fat; Stroke - polyunsaturated fat; CAD - polyunsaturated fat; Heart healthy diet - polyunsaturated fat

  3. Epicardial HIF signaling regulates vascular precursor cell invasion into the myocardium

    Science.gov (United States)

    Tao, Jiayi; Doughman, Yongqiu; Yang, Ke; Ramirez-Bergeron, Diana; Watanabe, Michiko

    2013-01-01

    During cardiogenesis, a subset of epicardial cells undergoes epithelial-mesenchymal-transition (EMT) and the resulting epicardial derived cells (EPDCs) contribute to the formation of coronary vessels. Our previous data showed hypoxia inducible factor-1α (HIF-1α) expression at specific sites within the epicardium and support a link between hypoxia inducible factors (HIFs) and the patterning of coronary vasculogenesis. To better understand the autocrine role of HIFs in the epicardium, we transduced adenovirus mediated expression of constitutively active HIF-1α (AdcaHIF1α) into the embryonic avian epicardium where the vascular precursors reside. We found that introducing caHIF1α into the epicardial mesothelium prevented EPDCs from proper migration into the myocardium. In vitro collagen gel assays and ex vivo organ culture data further confirmed that infection with AdcaHIF1α impaired the ability of EPDCs to invade. However, the proficiency of epicardial cells to undergo EMT was enhanced while the movement of EPDCs within the sub-epicardium and their differentiation into smooth muscle cells were not disrupted by caHIF1α. We also showed that the transcript level of Flt-1 (VEGFR1), which can act as a VEGF signaling inhibitor, increased several fold after introducing caHIF1α into epicardial cells. Blocking the activation of the VEGF pathway in epicardial cells recapitulated the inhibition of EPDC invasion. These results suggest that caHIF1α mediated up-regulation of Flt-1, which blocks the activation of the VEGF pathway, is responsible for the inhibition of EPDC myocardial migration. In conclusion, our studies demonstrate that HIF signaling potentially regulates the degree of epicardial EMT and the extent of EPDC migration into the myocardium, both of which are likely critical in patterning the coronary vasculature during early cardiac vasculogenesis. These signals could explain why the larger coronaries appear and remain on the epicardial surface. PMID:23384563

  4. Epicardial regeneration is guided by cardiac outflow tract and Hh signaling

    Science.gov (United States)

    Dickson, Amy L.; Poss, Kenneth D.

    2015-01-01

    In response to cardiac damage, a mesothelial tissue layer enveloping the heart called the epicardium is activated to proliferate and accumulate at the injury site. Recent studies have implicated the epicardium in multiple aspects of cardiac repair: a source of paracrine signals for cardiomyocyte survival or proliferation; a supply of perivascular cells and possibly other cell types like cardiomyocytes; and, a mediator of inflammation1-9. Yet, the biology and dynamism of the adult epicardium is poorly understood. Here, we created a transgenic line to ablate this cell population in adult zebrafish. We find that genetic depletion of epicardium after myocardial loss inhibits cardiomyocyte proliferation and delays muscle regeneration. The epicardium vigorously regenerates after its ablation, through proliferation and migration of spared epicardial cells as a sheet to cover the exposed ventricular surface in a wave from the chamber base toward its apex. By reconstituting epicardial regeneration ex vivo, we show that extirpation of the bulbous arteriosus (BA), a distinct, smooth muscle-rich tissue structure that distributes outflow from the ventricle, prevents epicardial regeneration. Conversely, experimental repositioning of the BA by tissue recombination initiates epicardial regeneration and can govern its direction. Hedgehog (Hh) ligand is expressed in the BA, and treatment with Hh signaling antagonist arrests epicardial regeneration and blunts the epicardial response to muscle injury. Transplantation of Shh-soaked beads at the ventricular base stimulates epicardial regeneration after BA removal, indicating that Hh signaling can substitute for the BA influence. Thus, the ventricular epicardium has pronounced regenerative capacity, regulated by the neighboring cardiac outflow tract and Hh signaling. These findings extend our understanding of tissue interactions during regeneration and have implications for mobilizing epicardial cells for therapeutic heart repair. PMID

  5. Echocardiographic evaluation of Space Shuttle crewmembers

    Science.gov (United States)

    Bungo, M. W.; Goldwater, D. J.; Popp, R. L.; Sandler, H.

    1987-01-01

    Echocardiographic measurements of left ventricular volume were obtained from 17 members of four Space Shuttle crews before and after 5- to 8-day space flights. Measurements obtained 1 h after landing indicated increases in the heart rate (HR), mean arterial pressure, and systemic vascular resistance values. On the other hand, the end-diastolic volume index (EDVI) fell 17 ml/sq m, and the stroke volume index (SVI) fell 15 ml/sq m. Measurements taken 1-2 weeks later demonstrated that the HR values returned to normal, but the EDVI and SVI values remained significantly below preflight levels, despite the ability of the subjects to ambulate and exercise. The results indicate that a space flight induces significant changes in heart volume affecting the left-ventricle function. It is suggested that the prolonged recovery period is related to the high level of aerobic conditioning in these subjects.

  6. Automated quantification of epicardial adipose tissue using CT angiography: evaluation of a prototype software

    Energy Technology Data Exchange (ETDEWEB)

    Spearman, James V.; Silverman, Justin R.; Krazinski, Aleksander W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Meinel, Felix G.; Geyer, Lucas L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Munich (Germany); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Apfaltrer, Paul [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Canstein, Christian [Siemens Medical Solutions USA, Inc., Malvern, PA (United States); De Cecco, Carlo Nicola [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' - Polo Pontino, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy)

    2014-02-15

    This study evaluated the performance of a novel automated software tool for epicardial fat volume (EFV) quantification compared to a standard manual technique at coronary CT angiography (cCTA). cCTA data sets of 70 patients (58.6 ± 12.9 years, 33 men) were retrospectively analysed using two different post-processing software applications. Observer 1 performed a manual single-plane pericardial border definition and EFV{sub M} segmentation (manual approach). Two observers used a software program with fully automated 3D pericardial border definition and EFV{sub A} calculation (automated approach). EFV and time required for measuring EFV (including software processing time and manual optimization time) for each method were recorded. Intraobserver and interobserver reliability was assessed on the prototype software measurements. T test, Spearman's rho, and Bland-Altman plots were used for statistical analysis. The final EFV{sub A} (with manual border optimization) was strongly correlated with the manual axial segmentation measurement (60.9 ± 33.2 mL vs. 65.8 ± 37.0 mL, rho = 0.970, P < 0.001). A mean of 3.9 ± 1.9 manual border edits were performed to optimize the automated process. The software prototype required significantly less time to perform the measurements (135.6 ± 24.6 s vs. 314.3 ± 76.3 s, P < 0.001) and showed high reliability (ICC > 0.9). Automated EFV{sub A} quantification is an accurate and time-saving method for quantification of EFV compared to established manual axial segmentation methods. (orig.)

  7. Association of epicardial adipose tissue with serum level of cystatin C in type 2 diabetes.

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    Tomomi Murai

    Full Text Available Accumulation of epicardial adipose tissue (EAT is considered to be a cardiovascular risk factor independent from visceral adiposity, obesity, hypertension and diabetes. We explored the parameters related to EAT accumulation, aiming to clarify the novel pathophysiological roles of EAT in subjects with type 2 diabetes (T2DM.We examined the laboratory values, including cystatinC, and surrogate markers used for evaluating atherosclerosis. EAT was measured as the sum of the adipose tissue area, obtained by plain computed tomography scans in 208 subjects with T2DM but no history of coronary artery disease.EAT correlated positively with age, body mass index (BMI, visceral fat area, leptin, cystatin C and C-peptide, while correlating negatively with adiponectin, estimated glomerular filteration rate (eGFR and the liver-to-spleen ratio. Multiple linear regression analysis revealed serum cystatin C (β = 0.175, leptin (β = 0.536, BMI (β = 0.393 and age (β = 0.269 to be the only parameters showing independent statistically significant associations with EAT. When cystatin C was replaced with eGFR, eGFR showed no significant correlation with EAT. In reverse analysis, serum cystatin C was significantly associated with EAT after adjustment in multivariate analysis.EAT accumulation and elevated cystatin C have been independently regarded as risk factors influencing atherosclerosis. The strong association between EAT and cystatin C demonstrated herein indicates that EAT accumulation may play an important role in Cystatin C secretion, possibly contributing to cardiometabolic risk in T2DM patients.

  8. Role of miRNAs in Epicardial Adipose Tissue in CAD Patients with T2DM

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    Yang Liu

    2016-01-01

    Full Text Available Background. Epicardial adipose tissue (EAT is identified as an atypical fat depot surrounding the heart with a putative role in the involvement of metabolic disorders, including obesity, type-2 diabetes mellitus, and atherosclerosis. We profiled miRNAs in EAT of metabolic patients with coronary artery disease (CAD and type-2 diabetes mellitus (T2DM versus metabolically healthy patients by microarray. Compared to metabolically healthy patients, we identified forty-two miRNAs that are differentially expressed in patients with CAD and T2DM from Xinjiang, China. Eleven miRNAs were selected as potential novel miRNAs according to P value and fold change. Then the potential novel miRNAs targeted genes were predicted via TargetScan, PicTar, and miRTarbase, and the function of the target genes was predicted via Gene Ontology (GO analysis while the enriched KEGG pathway analyses of the miRNAs targeted genes were performed by bioinformatics software DAVID. Then protein-protein interaction networks of the targeted gene were conducted by online software STRING. Finally, using microarray, bioinformatics approaches revealed the possible molecular mechanisms pathogenesis of CAD and T2DM. A total of 11 differentially expressed miRNAs were identified and among them, hsa-miR-4687-3p drew specific attention. Bioinformatics analysis revealed that insulin signaling pathway is the central way involved in the progression of metabolic disorders. Conclusions. The current findings support the fact that miRNAs are involved in the pathogenesis of metabolic disorders in EAT of CAD patients with T2DM, and validation of the results of these miRNAs by independent and prospective study is certainly warranted.

  9. Echocardiographic Screening Results in Patients with Tuberous Sclerosis Complex

    Science.gov (United States)

    Adriaensen, Miraude E.A.P.M.; Cramer, Maarten J.M.; Brouha, Madelon E.E.; Schaefer-Prokop, Cornelia M.; Prokop, Mathias; Doevendans, Pieter A.F.M.; Zonnenberg, Bernard A.; Feringa, Harm H.H.

    2010-01-01

    We sought to examine the frequency of abnormal echocardiographic findings in patients with tuberous sclerosis complex. In a retrospective cohort study, we included all patients with known tuberous sclerosis complex who had been sent to our cardiology department for echocardiographic screening from 1995 through August 2003 (n=56). Two research scientists independently reviewed the reports of the echocardiographic screening examinations for abnormal findings. We used descriptive statistics, the Mann-Whitney U test, and the χ2 test. The mean age of patients included in the study was 35 years (range, 12–73 yr); 23 patients were male. Abnormal findings were seen in 22 patients (39%). The most common abnormal findings were focal areas of increased intramyocardial echogenicity, which were seen in 16 patients (29%). The clinical consequence of this finding is still unknown. We conclude that echocardiographic abnormalities are common in patients with tuberous sclerosis complex. PMID:20548802

  10. Echocardiographic predictors of atrial fibrillation after mitral valve replacement

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    Al-Shimaa Mohamed Sabry

    2017-12-01

    Conclusion: LA systolic strain and LV global longitudinal strain were significant predictors of POAF. Echocardiographic parameters can identify patients at greater risk of developing POAF who can benefit from preventive measure and guide the selection of prosthesis.

  11. Echocardiographic Finding in Anabolic Steroids Abuser Athletics

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    B. Haji Moradi

    2006-01-01

    Full Text Available Introduction & Objective: Abuse of anabolic steroids in body builders and competitive sports (doping is common and prevalent in our country. Due to disagreement about cardiovascular side effects of these drugs and existing controversy in published articles, this study was designed to evaluate the echocardiographic finding in athletics who are current user of these drugs. Materials & Methods: Body builders with continues sport for preceding year and at least twice weekly selected and divided into steroid abuser and not abuser and compared with age and BMI matched non athletic healthy volunteers .Results: There was not significant difference in age, body mass index, ejection fraction, ventricular compliance and valve function between three groups. But diastolic size of septum and free wall is significantly thicker in both of athletics in comparison with non athletic volunteer but observed differences were only significant (Pvalue = 0.05 between first and third group. The difference between the above mentioned index was not significant between two groups of athleticConclusion: Observed differences in diastolic size of septum and free wall between first and third group and also absence of difference between two athletic groups is in favor of that long term abuse of anabolic steroid (more than one year results in augmentation of physiologic hypertrophy due to isometric exercise. Furthermore long term abuse and supra pharmacologic dose does not have significant effect in size and left ventricular function.

  12. Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

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    Sepideh Sabouri

    Full Text Available Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes, noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter, and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression, activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa, a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments and 0.96 (simulation between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments and 0.92 (simulation between ATa values. Despite distance (balloon-atrial wall and dimension reduction (64 electrodes, some information about atrial repolarization remained present in noncontact signals.

  13. Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

    Science.gov (United States)

    Sabouri, Sepideh; Matene, Elhacene; Vinet, Alain; Richer, Louis-Philippe; Cardinal, René; Armour, J Andrew; Pagé, Pierre; Kus, Teresa; Jacquemet, Vincent

    2014-01-01

    Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes), noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter), and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression), activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa), a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments) and 0.96 (simulation) between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments) and 0.92 (simulation) between ATa values. Despite distance (balloon-atrial wall) and dimension reduction (64 electrodes), some information about atrial repolarization remained present in noncontact signals.

  14. M-mode echocardiographic reference values in Pantja goats

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    Parul Singh

    2017-01-01

    Full Text Available Aim: The aim of this study was to establish M-mode echocardiographic reference values in Pantja goats and to study the effect of gender and body weight (BW on these parameters. Materials and Methods: A total of 18, clinically healthy, adult Pantja goats of either sex, aged 2-4 years and weighing 10-44 kg were included in the study. Echocardiographic examination was performed in the standing unsedated animal. All measurements were made from the right parasternal long-axis left ventricular outflow tract view of the heart. The following parameters were recorded: Left ventricular internal diameter at diastole and systole, interventricular septal thickness at diastole and systole, left ventricular posterior wall (LVPW thickness at diastole and systole, end diastolic and systolic volumes, stroke volume, fractional shortening, ejection fraction, percent systolic thickening of interventricular septum, percent systolic thickening of LVPW, cardiac output, left atrial (LA diameter at diastole and systole, aortic (AO root diameter at diastole and systole, LA/AO, LA posterior wall thickness at diastole and systole, left ventricular ejection time, DE amplitude, EF slope, AC interval and e-point to septal separation. Results: This study demonstrated specific reference ranges of M-mode echocardiographic parameters and indices in healthy Pantja goats. Normal echocardiographic values obtained in Pantja goats were quite different from other goat breeds. Gender had no influence on echocardiographic parameters, while high correlations were found between most echocardiographic parameters and BW. Conclusion: The echocardiographic values obtained in the study may serve as a reference for future studies in this breed, for cardiovascular disease diagnosis and for utilizing the goat as a model for cardiac disorders in humans.

  15. Comparison of longevity, paging, and sensing characteristics of steroid-eluting epicardial versus conventional endocardial pacing leads in children

    NARCIS (Netherlands)

    Beaufort-Krol, GCM; Mulder, H; Nagelkerke, D; Waterbolk, TW; Bink-Boelkens, MTE

    Objective: Because of either cardiac anatomy or small size, pacing in children often occurs by means of epicardial leads. The disadvantage of epicardial leads is the shorter longevity of these leads compared with endocardial leads. During short-term follow-up, improved stimulation thresholds were

  16. Acute hemodialysis effects on doppler echocardiographic indices

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    Leila Abid

    2014-01-01

    Full Text Available Conventional echocardiographic (ECHO parameters of systolic and diastolic func-tion of the left ventricular (LV have been shown to be load dependent. However, the impact of pre-load reduction on tissue Doppler (TD parameters of LV function is incompletely understood. To evaluate the effect of a single hemodialysis (HD session on LV systolic and diastolic function using pulsed Doppler echocardiography and pulsed tissue Doppler imaging (TDI, we studied 81chronic HD patients (40 males; mean age 52.4 ± 16.4 years with these tools. ECHO parameters were obtained 30 min before and 30 min after HD. Fluid volume removed by HD was 1640 ± 730 cm [3] . HD led to reduction in LV end-diastolic volume (P <0.001, end-systolic volume (P <0.001, left atrium area (P <0.001, peak early (E-wave trans-mitral flow velocity (P <0.001, the ratio of early to late Doppler velocities of diastolic mitral inflow (P <0.001 and aortic time velocity integral (P <0.001. No significant change in peak S velocity of pulmonary vein flow after HD was noted. Early and late diastolic (E′ TDI velocities and the ratio of early to late TDI diastolic velocities (E′/A′ on the lateral side of the mitral annulus decreased signi-ficantly after HD (P = 0.013; P = 0.007 and P = 0.008, respectively. Velocity of flow progres-sion (Vp during diastole was not affected by pre-load reduction. Pulmonary artery systolic pressure and the diameter of the inferior vena cava decreased significantly (P <0.001 and P <0.001, respectively after HD. We conclude that most of the Doppler-derived indices of diastolic function are pre-load-dependent and velocity of flow progression was minimally affected by pre-load reduction in HD patients.

  17. Epicardial Epithelial-to-Mesenchymal Transition in Heart Development and Disease

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    Michael Krainock

    2016-02-01

    Full Text Available The epicardium is an epithelial monolayer that plays a central role in heart development and the myocardial response to injury. Recent developments in our understanding of epicardial cell biology have revealed this layer to be a dynamic participant in fundamental processes underlying the development of the embryonic ventricles, the coronary vasculature, and the cardiac valves. Likewise, recent data have identified the epicardium as an important contributor to reparative and regenerative processes in the injured myocardium. These essential functions of the epicardium rely on both non-cell autonomous and cell-autonomous mechanisms, with the latter featuring the process of epicardial Epithelial-to-Mesenchymal Transition (EMT. This review will focus on the induction and regulation of epicardial EMT, as it pertains to both cardiogenesis and the response of the myocardium to injury.

  18. Decreased adiponectin and increased inflammation expression in epicardial adipose tissue in coronary artery disease.

    Science.gov (United States)

    Zhou, Yuan; Wei, Yutao; Wang, Lei; Wang, Xianguo; Du, Xinling; Sun, Zongquan; Dong, Nianguo; Chen, Xinzhong

    2011-01-12

    Disorders of endocrine substances in epicardial adipose tissue are known causes of coronary artery disease (CAD). Adiponectin is associated with cardiovascular disease. However, expression of adiponectin in epicardial adipose tissue and its function in CAD pathogenesis is unclear. This study investigates adiponectin expression in epicardial adipose tissue in CAD patients. Vessels or adipose tissue samples collected from CAD patients and non-CAD controls were examined after immunochemical staining. Adiponectin, cytokines of interleukin-6 (IL-6) and necrosis factor-α (TNF-α) and toll-like receptor 4 (TLR4) expression level in adipose tissue were measured using real-time quantitative RT-PCR. Adiponectin concentrations in peripheral and coronary sinus vein plasma were measured with enzyme-linked immunosorbent assay. Peripheral vein plasma biochemistries were performed with routine laboratory techniques. Monocytes were collected from blood using lymphocyte separation medium. Expression level of cytokines and transcription factor NF-κB were measured to learn the effect of adiponectin on stearic acid-stimulated monocytes. Percentage of TLR4 positive monocytes was analyzed using flow cytometry. Histological examination revealed increased macrophage infiltration into epicardial adipose tissue of CAD patients. Decreased adiponectin displayed by real-time quantitative RT-PCR was associated with enhanced cytokines of IL-6 and TNF-α or TLR4 expression level in epicardial adipose tissue, suggesting decreased circulating adiponectin may be useful as a more sensitive predictor for coronary atherosclerosis than routine laboratory examinations. Adiponectin suppressed secretion of IL-6 and TNF-α in stimulated monocytes and TLR4 was expressed on cell surfaces. Endocrine disorders in epicardial adipose tissue are strongly linked to CAD, and adiponectin has a protective effect by inhibiting macrophage-mediated inflammation.

  19. Decreased adiponectin and increased inflammation expression in epicardial adipose tissue in coronary artery disease

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    Sun Zongquan

    2011-01-01

    Full Text Available Abstract Background Disorders of endocrine substances in epicardial adipose tissue are known causes of coronary artery disease (CAD. Adiponectin is associated with cardiovascular disease. However, expression of adiponectin in epicardial adipose tissue and its function in CAD pathogenesis is unclear. This study investigates adiponectin expression in epicardial adipose tissue in CAD patients. Methods Vessels or adipose tissue samples collected from CAD patients and non-CAD controls were examined after immunochemical staining. Adiponectin, cytokines of interleukin-6 (IL-6 and necrosis factor-α (TNF-α and toll-like receptor 4 (TLR4 expression level in adipose tissue were measured using real-time quantitative RT-PCR. Adiponectin concentrations in peripheral and coronary sinus vein plasma were measured with enzyme-linked immunosorbent assay. Peripheral vein plasma biochemistries were performed with routine laboratory techniques. Monocytes were collected from blood using lymphocyte separation medium. Expression level of cytokines and transcription factor NF-κB were measured to learn the effect of adiponectin on stearic acid-stimulated monocytes. Percentage of TLR4 positive monocytes was analyzed using flow cytometry. Results Histological examination revealed increased macrophage infiltration into epicardial adipose tissue of CAD patients. Decreased adiponectin displayed by real-time quantitative RT-PCR was associated with enhanced cytokines of IL-6 and TNF-α or TLR4 expression level in epicardial adipose tissue, suggesting decreased circulating adiponectin may be useful as a more sensitive predictor for coronary atherosclerosis than routine laboratory examinations. Adiponectin suppressed secretion of IL-6 and TNF-α in stimulated monocytes and TLR4 was expressed on cell surfaces. Conclusions Endocrine disorders in epicardial adipose tissue are strongly linked to CAD, and adiponectin has a protective effect by inhibiting macrophage

  20. Subxiphoid approach to epicardial implantation of implantable cardioverter defibrillators in children.

    Science.gov (United States)

    Haydin, Sertac; Saygi, Murat; Ergul, Yakup; Ozyilmaz, Isa; Ozturk, Erkut; Akdeniz, Celal; Tuzcu, Volkan

    2013-08-01

    Epicardial implantation of implantable cardioverter defibrillators (ICDs) is considered in the presence of intracardiac shunt, venous access issue, or small body size. We report our experience with epicardial ICD coil implantation using a minimally invasive method. Nine patients who underwent epicardial ICD implantation were included. The median age was 7.4 years (3.9-9.6 years) and the median weight was 15 kg (12-24 kg). Diagnosis at the time of implantation included long QT syndrome (n = 5), catecholaminergic polymorphic ventricular tachycardia (n = 2), hypertrophic cardiomyopathy (n = 1), and fast monomorphic ventricular tachycardia (n = 1). The minimally invasive method involved a subxiphoid incision to place the epicardial pacing leads. The ICD coil was placed in the transverse sinus in four patients using an access path posterior to the heart. The second approach involved a path anterior to the heart to reach the epicardial location posterior to the left atrial appendage in the five remaining patients. No fluoroscopy was used in either approach. The median defibrillation threshold (DFT) at implantation was 7.5 J. Lower DFTs were observed in the anterior approach (10 J vs 5 J). Appropriate ICD shocks were observed in three patients during the median 18-month follow-up period (0.3-28 months). No inappropriate shocks were noted. One patient developed pericardial tamponade 39 days after the procedure and was surgically drained. Minimally invasive epicardial ICD coil implantation in children with low DFT values is possible. The anterior implantation approach appears superior to the posterior approach. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  1. [Optical mapping of chronotopography of excitation of the frog heart ventricle epicardial surface in sinus rhythm].

    Science.gov (United States)

    abramochkin, D V; Rozenshtraukh, L V

    2008-04-01

    Two points of early activation were shown on the surface of the frog Rana temporaria ventricle using optical mapping technique. These points are located on the left and right ventricular surface at equal distance from apex and base of the ventricle. The excitation approaches to epicardial ventricular surface at these points, and then it spreads all over the surface. Such pattern of epicardial activation is also shown in mammals where it is related to conduction system functioning. Thus, the precursor of conduction system seems to exist in the frog ventricle, too.

  2. Myocardial ischemia in the absence of epicardial coronary artery disease in Friedreich's ataxia

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    Dickerson Jennifer A

    2008-04-01

    Full Text Available Abstract We present the first in vivo detection of microvascular abnormality in a patient with Friedreich's ataxia (FA without epicardial coronary artery disease using cardiac magnetic resonance (CMR. The patient had exertional chest pain and dyspnea prompting referral for cardiac evaluation. These symptoms were reproduced during intravenous adenosine infusion, and simultaneous first-pass perfusion imaging showed a significant subendocardial defect; both symptoms and perfusion deficit were absent at rest. Epicardial coronaries were free of disease by invasive angiography; together, these findings support the notion of impaired myocardial perfusion reserve in FA.

  3. Relationship between epicardial adipose tissue and subclinical coronary artery disease in patients with extra-cardiac arterial disease.

    Science.gov (United States)

    den Dekker, M A M; Takashima, R; van den Heuvel, E R; van den Dungen, J J A M; Tio, R A; Oudkerk, M; Vliegenthart, R

    2014-01-01

    Epicardial adipose tissue (EAT) and mediastinal adipose tissue (MAT) are linked to coronary artery disease (CAD). The association between EAT, MAT, and severity of CAD in known extra-cardiac arterial disease was investigated. Sixty-five cardiac asymptomatic patients (mean age 65 ± 8 years, 69% male) with peripheral arterial disease, carotid stenosis, or aortic aneurysm underwent coronary computed tomography angiography. Patients were divided into non-significant (cardiovascular risk factors. Median EAT was 99.5, 98.0, and 112.0 cm(3) (P = 0.38) and median MAT was 66.0, 90.0, and 81.0 cm(3) (P = 0.53) for non-significant, single vessel, and multi-vessel CAD, respectively. In age- and gender-adjusted analysis, only EAT was significantly associated with CAD (odds ratio [OR] 1.12 [95% confidence interval, 1.01-1.25] per 10 cm(3) increase in EAT; P = 0.04). This remained in multivariate-adjusted analysis (OR 1.21 [1.04-1.39]; P = 0.01). In patients with known extra-cardiac arterial disease, CAD is correlated with EAT, but not with MAT. These results suggest that EAT has a local effect on coronary atherosclerosis, apart from the endocrine effect of visceral fat. © 2013 The Obesity Society.

  4. Epicardial Adipose Tissue Thickness in Patients With Subclinical Hypothyroidism and the Relationship Thereof With Visceral Adipose Tissue Thickness.

    Science.gov (United States)

    Arpaci, Dilek; Gurkan Tocoglu, Aysel; Yilmaz, Sabiye; Korkmaz, Sumeyye; Ergenc, Hasan; Gunduz, Huseyin; Keser, Nurgul; Tamer, Ali

    2016-03-01

    Subclinical hypothyroidism (SH) is associated with cardiovascular metabolic syndromes, especially dislipidemia and abdominal obesity. Visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) have the same ontogenic origin and produce many proinflammatory and proatherogenic cytokines. We evaluated EAT and VAAT thickness in patients with SH. Forty-one patients with SH and 35 controls were included in the study. Demographical and anthropometric features of both patients and controls were recorded. Thyroid and metabolic parameters were measured. EAT was measured using 2D-transthoracic echocardiography. The age and gender distributions were similar in the two groups (P = 0.998 and P = 0.121, respectively). Body mass index (BMI), fat mass, waist circumference (WC), hip circumference (HC), the WC/HC ratio, and the thicknesses of VAAT and abdominal subcutaneous adipose tissue were higher in the case group than the control group (all P values 0.05). We found no difference between the two groups in fasting plasma glucose (FPG) level (P = 0.780), but the levels of LDL-C and TG differed significantly (P = 0.002 and P = 0.026, respectively). The serum TSH level was higher and the FT4 level was lower in the case than the control group (both P values <0.01). Increased abdominal adipose tissue thickness in patients with SH is associated with atherosclerosis. To detemine the risk of atherosclerosis in such patients, EAT measurements are valuable; such assessment is simple to perform.

  5. Evaluation of canine congenital heart disease using an echocardiographic algorithm.

    Science.gov (United States)

    Oyama, M A; Sisson, D D

    2001-01-01

    Evaluation of canine congenital heart disease presents a diagnostic challenge to many ultrasonographers. To assist clinicians attempting to examine these patients, an echocardiographic algorithm containing the six most common canine congenital heart diseases (i.e., patent ductus arteriosus, subaortic stenosis, pulmonic stenosis, ventricular septal defect, tricuspid dysplasia, and tetralogy of Fallot) is presented. The algorithm focuses on the underlying disease pathogenesis and the resultant changes in cardiac structure and function that can be readily identified during echocardiographic examination. Use of this algorithm provides a framework from which the ultrasonographer gains both experience and confidence in diagnosing congenital heart disease via echocardiography. This algorithm is supported by a number of still figures within the article as well as real-time echocardiographic images available for viewing at AAHA's website, www.aahanet.org.

  6. Echocardiographic evaluation of ventricular septal defect haemodynamics

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    Miranović Vesna

    2007-01-01

    Full Text Available Introduction Ventricular septal defect (VSD is an opening in the interventricular septum. 30-50% of patients with congenital heart disease have VSD. Objective The aim of the study was to determine the dependence of the left ventricular diastolic dimension (LVD, left ventricular systolic dimension (LVS, shortening fraction (SF, left atrium (LA, pulmonary artery truncus (TPA on the body surface and compare their values among experimental, control and a group of healthy children. Values of maximal systolic gradient pressure (Pvsd of VSD were compared with children from one experimental and control group. Method Children were divided into three groups: experimental (32 children with VSD that were to go to surgery, control (20 children with VSD who did not require surgery and 40 healthy children. Measurements of LVD, LVS, SF, LA, TPA were performed in accordance to recommendations of the American Echocardiographic Association. The value of Pvsd was calculated from the maximal flow velocity (V in VSD using the following formula: Pvsd=4xVІ (mm Hg. Results For children from the experimental group, the relationship between the body surface and the variability of the LVD was explained with 56.85%, LVS with 66.15%, SF with 4.9%, TPA with 58.92%. For children from the control group, the relationship between the body surface and the variability of LVD was explained with 88.8%, LVS with 72.5%, SF with 0.42%, PA with 58.92%. For healthy children, the relationship between the body surface and the variabilitiy of the LVD was explained with 88.8%, LVS with 88.78%, SF with 5.25% and PA with 84.75%. There was a significant statistical difference between average values of Pvsd in the experimental and control group (p<0.02. Conclusion The presence of the large VSD has an influence on the enlargement of LVD, LVS, SF, TPA. The enlargement of the size of the pulmonary artery depends on the presence of VSD and there is a direct variation in the magnitude of the shunt

  7. Echocardiographic evaluation of pre-diagnostic development in young relatives genetically predisposed to hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Jensen, Morten K; Havndrup, Ole; Christiansen, Michael

    2015-01-01

    Identification of the first echocardiographic manifestations of hypertrophic cardiomyopathy may be important for clinical management and our understanding of the pathogenesis. We studied the development of pre-diagnostic echocardiographic changes in young relatives to HCM patients during long...

  8. Epicardial adipose tissue in patients with chronic obstructive pulmonary disease.

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    Jorge Zagaceta

    Full Text Available RATIONALE: Epicardial Adipose Tissue (EAT volume as determined by chest computed tomography (CT is an independent marker of cardiovascular events in the general population. COPD patients have an increased risk of cardiovascular disease, however nothing is known about the EAT volume in this population. OBJECTIVES: To assess EAT volume in COPD and explore its association with clinical and physiological variables of disease severity. METHODS: We measured EAT using low-dose CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI. We determined blood pressure, cholesterol, glucose and HbA1c levels, microalbuminuria, lung function, BODE index, co-morbidity index and coronary artery calcium score (CAC. EAT volume were compared between groups. Uni and multivariate analyses explored the relationship between EAT volume and the COPD related variables. RESULTS: COPD patients had a higher EAT volume [143.7 (P25-75, 108.3-196.6 vs 129.1 (P25-75, 91.3-170.8 cm(3, p = 0.02] and the EAT volume was significantly associated with CAC (r = 0.38, p<0.001 and CRP (r = 0.32, p<0.001 but not with microalbuminuria (r = 0.12, p = 0.13. In COPD patients, EAT volume was associated with: age, pack-years, BMI, gender, FEV1%, 6 MWD, MMRC and HTN. Multivariate analysis showed that only pack-years (B = 0.6, 95% CI: 0.5-1.3, BMI (B = 7.8, 95% CI: 5.7-9.9 and 6 MWD (B = -0.2, 95% CI: -0.3--0.1, predicted EAT volume. CONCLUSIONS: EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular events.

  9. Echocardiographic Assessment of Preload Responsiveness in Critically Ill Patients

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    Alexander Levitov

    2012-01-01

    Full Text Available Fluid challenges are considered the cornerstone of resuscitation in critically ill patients. However, clinical studies have demonstrated that only about 50% of hemodynamically unstable patients are volume responsive. Furthermore, increasing evidence suggests that excess fluid resuscitation is associated with increased mortality. It therefore becomes vital to assess a patient's fluid responsiveness prior to embarking on fluid loading. Static pressure (CVP, PAOP and echocardiographic (IVC diameter, LVEDA parameters fails to predict volume responsiveness. However, a number of dynamic echocardiographic parameters which are based on changes in vena-caval dimensions or cardiac function induce by positive pressure ventilation or passive leg raising appear to be highly predictive of volume responsiveness.

  10. Novel effects of dapagliflozin on epicardial adipose tissue with insulin resistance, high levels of inflammatory chemokines production and low differentiation ability.

    Science.gov (United States)

    Díaz-Rodríguez, Esther; Agra, Rosa M; Fernández, Ángel L; Adrio, B; García-Caballero, Tomás; González-Juanatey, José R; Eiras, Sonia

    2017-09-11

    In patients with cardiovascular disease, epicardial adipose tissue (EAT) is characterized by insulin resistance, high pro-inflammatory chemokines and low differentiation ability. Since dapagliflozin reduces body fat and cardiovascular events in diabetic patients, we wanted to know its effect on EAT and subcutaneous adipose tissue (SAT). Adipose samples were obtained from 52 patients undergoing heart surgery. Sodium-glucose cotransporter 2 (SGLT2) expression was determined by real time PCR (n = 20), Western blot and immunohistochemistry. Fat explants (n = 21) were treated with dapagliflozin and/or insulin. Glucose, free fatty acid, adipokines levels (by array) were measured in their secretomes which were tested on human coronary endothelial cells by wound healing assays. The effect of dapagliflozin effect on levels of glucose transporters in EAT explants was analysed by Western blot. Glucose uptake was also measured by fluorescence glucose (6NBDG) of differentiated stromal vascular cells from fat pads (n = 11). Finally, dapagliflozin-induced adipocytes differentiation was analysed by AdipoRed staining and perilipin levels. Results revealed SGLT2 expression in EAT. Dapagliflozin increased glucose uptake (20.95 ± 4.4 mg/dL vs. 12.97 ± 4.1 mg/dL; p effect on the healing of human coronary artery endothelial cells) and improved the differentiation of EAT cells. These results suggest a new protective pathway for this drug on EAT from patients with cardiovascular disease.

  11. Mitral valve repair: an echocardiographic review: Part 2.

    Science.gov (United States)

    Maslow, Andrew

    2015-04-01

    Echocardiographic imaging of the mitral valve before and immediately after repair is crucial to the immediate and long-term outcome. Prior to mitral valve repair, echocardiographic imaging helps determine the feasibility and method of repair. After the repair, echocardiographic imaging displays the new baseline anatomy, assesses function, and determines whether or not further management is necessary. Three-dimensional imaging has improved the assessment of the mitral valve and facilitates communication with the surgeon by providing the surgeon with an image that he/she might see upon opening up the atrium. Further advancements in imaging will continue to improve the understanding of the function and dysfunction of the mitral valve both before and after repair. This information will improve treatment options, timing of invasive therapies, and advancements of repair techniques to yield better short- and long-term patient outcomes. The purpose of this review was to connect the echocardiographic evaluation with the surgical procedure. Bridging the pre- and post-CPB imaging with the surgical procedure allows a greater understanding of mitral valve repair.

  12. New reference values for echocardiographic dimensions of healthy Dutch children.

    NARCIS (Netherlands)

    Overbeek, L.I.H.; Kapusta, L.; Peer, P.G.M.; Korte, C.L. de; Thijssen, J.M.; Daniëls, O.

    2006-01-01

    AIM: To renew the echocardiographic reference values of heart dimensions in healthy children. METHODS AND RESULTS: Group 1 consisted of 587 children, of which 361 boys and 226 girls, age from birth to 18 years, body weight over 2500 g, who visited the Pediatric Cardiology outclinic during the period

  13. Effect of haematocrit on echocardiographic indices of cardiac ...

    African Journals Online (AJOL)

    Background: Several mechanisms have been put forward to explain myocardial dysfunction in sickle cell anaemia. Aims and objectives: This study was aimed at examining the effect of haematocrit parameters on echocardiographic indices of cardiac dimension in adult sickle cell anaemia patients. Methods: A descriptive ...

  14. Childhood acquired heart disease in Nigeria: an echocardiographic ...

    African Journals Online (AJOL)

    Introduction: Acquired heart diseases (AHD) are not uncommon in children. The current multi-center study aims to provide a more representative data of AHD in Nigeria. Methods: Over 42 months, children referred for echocardiographic evaluation who had confirmed AHD in three centers in Nigeria were recruited. The data ...

  15. Clinical and echocardiographic features of children with rheumatic ...

    African Journals Online (AJOL)

    Clinical and echocardiographic features of children with rheumatic carditis: correlation with high sensitivity C-reactive protein. ... Mitral regurgitation (MR) was found in 65 patients (98%), it was severe in 42 patients (64%), combined with aortic regurgitation (AR) in 27 patients (41%) and with Mitral stenosis (MS) in 3 patients ...

  16. Intravenous carbon dioxide as an echocardiographic contrast agent

    NARCIS (Netherlands)

    R.S. Meltzer (Richard); P.W.J.C. Serruys (Patrick); P.G. Hugenholtz (Paul); J.R.T.C. Roelandt (Jos)

    1981-01-01

    textabstractIntravenous carbon dioxide (CO2) was employed to cause echocardiographic contrast in 40 patients. One to 3 cc of medically pure CO2 were agitated with 5 to 8 cc of 5% dextrose in water and rapidly injected into an upper extremity vein. Contrast was obtained in all patients. In 33

  17. Fat Embolism

    Directory of Open Access Journals (Sweden)

    V. N. Yakovlev

    2013-01-01

    Full Text Available The incidence of fat embolism ranges from 0.5 to 30% in injuries with long and pelvic bone fractures; it also occurs in other diseases and conditions. Moreover, mortality accounts for 3 to 67%. There is still no clear idea on the pathogenesis, prevention, and treatment of fat embolism. This review gives current views on this problem. Key words: fat embolism, poly-trauma.

  18. The Relationship between Endothelial Progenitor Cell Populations and Epicardial and Microvascular Coronary Disease—A Cellular, Angiographic and Physiologic Study

    Science.gov (United States)

    Chan, Kim H.; Simpson, Philippa J. L.; Yong, Andy S.; Dunn, Louise L.; Chawantanpipat, Chirapan; Hsu, Chijen; Yu, Young; Keech, Anthony C.; Celermajer, David S.; Ng, Martin K. C.

    2014-01-01

    Background Endothelial progenitor cells (EPCs) are implicated in protection against vascular disease. However, studies using angiography alone have reported conflicting results when relating EPCs to epicardial coronary artery disease (CAD) severity. Moreover, the relationship between different EPC types and the coronary microcirculation is unknown. We therefore investigated the relationship between EPC populations and coronary epicardial and microvascular disease. Methods Thirty-three patients with a spectrum of isolated left anterior descending artery disease were studied. The coronary epicardial and microcirculation were physiologically interrogated by measurement of fractional flow reserve (FFR), index of microvascular resistance (IMR) and coronary flow reserve (CFR). Two distinct EPC populations (early EPC and late outgrowth endothelial cells [OECs]) were isolated from these patients and studied ex vivo. Results There was a significant inverse relationship between circulating OEC levels and epicardial CAD severity, as assessed by FFR and angiography (r = 0.371, p = 0.04; r = -0.358, p = 0.04; respectively). More severe epicardial CAD was associated with impaired OEC migration and tubulogenesis (r = 0.59, p = 0.005; r = 0.589, p = 0.004; respectively). Patients with significant epicardial CAD (FFRcoronary microvascular disease. PMID:24736282

  19. The relationship between endothelial progenitor cell populations and epicardial and microvascular coronary disease-a cellular, angiographic and physiologic study.

    Science.gov (United States)

    Chan, Kim H; Simpson, Philippa J L; Yong, Andy S; Dunn, Louise L; Chawantanpipat, Chirapan; Hsu, Chijen; Yu, Young; Keech, Anthony C; Celermajer, David S; Ng, Martin K C

    2014-01-01

    Endothelial progenitor cells (EPCs) are implicated in protection against vascular disease. However, studies using angiography alone have reported conflicting results when relating EPCs to epicardial coronary artery disease (CAD) severity. Moreover, the relationship between different EPC types and the coronary microcirculation is unknown. We therefore investigated the relationship between EPC populations and coronary epicardial and microvascular disease. Thirty-three patients with a spectrum of isolated left anterior descending artery disease were studied. The coronary epicardial and microcirculation were physiologically interrogated by measurement of fractional flow reserve (FFR), index of microvascular resistance (IMR) and coronary flow reserve (CFR). Two distinct EPC populations (early EPC and late outgrowth endothelial cells [OECs]) were isolated from these patients and studied ex vivo. There was a significant inverse relationship between circulating OEC levels and epicardial CAD severity, as assessed by FFR and angiography (r=0.371, p=0.04; r=-0.358, p=0.04; respectively). More severe epicardial CAD was associated with impaired OEC migration and tubulogenesis (r=0.59, p=0.005; r=0.589, p=0.004; respectively). Patients with significant epicardial CAD (FFRcoronary microvascular disease.

  20. Clinical and echocardiographic features of aorto-atrial fistulas

    Directory of Open Access Journals (Sweden)

    Ananthasubramaniam Karthik

    2005-01-01

    Full Text Available Abstract Aorto-atrial fistulas (AAF are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.

  1. Echocardiographic Evaluation of Patent Ductus Arteriosus in Preterm Infants

    Directory of Open Access Journals (Sweden)

    Romaine Arlettaz

    2017-06-01

    Full Text Available Patent ductus arteriosus (PDA is part of the typical morbidity profile of the preterm infant, with a high incidence of 80–90% in extremely low birth weight infants born before 26 weeks of gestation. Whereas spontaneous closure of the ductus arteriosus (DA is likely in term infants, it is less so in preterm ones. PDA is associated with increased mortality and various comorbidities including cardiac failure, need for respiratory support, bronchopulmonary dysplasia, pulmonary or intracranial hemorrhage, and necrotizing enterocolitis; however, there is no proven causality between these morbidities and the presence of DA. Thus, the indication to close PDA remains highly controversial. This paper focuses on echocardiographic evaluation of PDA in the preterm infant and particularly on the echocardiographic signs of hemodynamic significance.

  2. Fat heaps

    DEFF Research Database (Denmark)

    Elmasry, Amr Ahmed Abd Elmoneim; Katajainen, Jyrki

    This report is an electronic appendix to our paper \\Fat heaps without regular counters". In that paper we described a new variant of fat heaps that is conceptually simpler and easier to implement than the original version. We also compared the practical performance of this data structure...

  3. Echocardiographic evaluation of coronary arteries in congenital heart disease.

    Science.gov (United States)

    Freire, Grace; Miller, Michelle S

    2015-12-01

    Among populations of patients with the congenital heart disease, there is considerable diversity in the anatomy of the coronary arteries. Understanding these anatomical differences is vitally important in directing interventions and surgical repair. In this report, the authors describe the echocardiographic evaluation of the variants of coronary artery anatomy in the following lesions: transposition of the great arteries, congenitally corrected transposition of the great arteries, double-inlet left ventricle, common arterial trunk, tetralogy of Fallot, and double-outlet right ventricle.

  4. Echocardiographic Assessment of Pulmonary Arterial Hypertension for Pediatricians and Neonatologists

    Directory of Open Access Journals (Sweden)

    Gregory James Skinner

    2017-09-01

    Full Text Available There is a growing awareness of the role that increased pulmonary vascular resistance (PVR plays in many pathologies; therefore, assessment of pulmonary artery pressure (PAP is an increasingly requested investigation in the critical care environment. This article will go through the basic concepts regarding PAP and PVR, then will go on to outline the various echocardiographic parameters which are used to assess them. Finally, an outline of how to undertake this assessment will be presented.

  5. A comparison between brachial and echocardiographic systolic time intervals.

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    Full Text Available Systolic time interval (STI is an established noninvasive technique for the assessment of cardiac function. Brachial STIs can be automatically determined by an ankle-brachial index (ABI-form device. The aims of this study are to evaluate whether the STIs measured from ABI-form device can represent those measured from echocardiography and to compare the diagnostic values of brachial and echocardiographic STIs in the prediction of left ventricular ejection fraction (LVEF <50%. A total of 849 patients were included in the study. Brachial pre-ejection period (bPEP and brachial ejection time (bET were measured using an ABI-form device and pre-ejection period (PEP and ejection time (ET were measured from echocardiography. Agreement was assessed by correlation coefficient and Bland-Altman plot. Brachial STIs had a significant correlation with echocardiographic STIs (r = 0.644, P<0.001 for bPEP and PEP; r  = 0.850, P<0.001 for bET and ET; r = 0.708, P<0.001 for bPEP/bET and PEP/ET. The disagreement between brachial and echocardiographic STIs (brachial STIs minus echocardiographic STIs was 28.55 ms for bPEP and PEP, -4.15 ms for bET and ET and -0.11 for bPEP/bET and PEP/ET. The areas under the curve for bPEP/bET and PEP/ET in the prediction of LVEF <50% were 0.771 and 0.765, respectively. Brachial STIs were good alternatives to STIs obtained from echocardiography and also helpful in prediction of LVEF <50%. Brachial STIs automatically obtained from an ABI-form device may be helpful for evaluation of left ventricular systolic dysfunction.

  6. Echocardiographic Assessment of Pulmonary Arterial Hypertension for Pediatricians and Neonatologists.

    Science.gov (United States)

    Skinner, Gregory James

    2017-01-01

    There is a growing awareness of the role that increased pulmonary vascular resistance (PVR) plays in many pathologies; therefore, assessment of pulmonary artery pressure (PAP) is an increasingly requested investigation in the critical care environment. This article will go through the basic concepts regarding PAP and PVR, then will go on to outline the various echocardiographic parameters which are used to assess them. Finally, an outline of how to undertake this assessment will be presented.

  7. Frame to Frame Diffeomorphic Motion Analysis from Echocardiographic Sequences

    OpenAIRE

    Zhang, Zhijun; Sahn, David; Song, Xubo

    2011-01-01

    International audience; Quantitative motion analysis from echocardiography is an important yet challenging problem. We develop a motion estimation algorithm for echocardiographic image sequences based on diffeomorphic image registration in which the velocity field is spatiotemporally smooth. The novelty of this work is that instead of optimizing a functional of velocity field which consists of similarity metrics between a reference image to each of the following images (\\textitfirst-to-follow...

  8. Association of chemerin mRNA expression in human epicardial adipose tissue with coronary atherosclerosis

    OpenAIRE

    Wang Linjie; Zhang Xiaoxia; Gao Feng; Lai Yongqiang; Gong Fengying; Zhang Fuzhuang; Mi Shuhua; Gao Xiuying; Tao Hong

    2011-01-01

    Abstract Background Growing evidence suggests that epicardial adipose tissue (EAT) may play a key role in the pathogenesis and development of coronary artery disease (CAD) by producing several inflammatory adipokines. Chemerin, a novel adipokine, has been reported to be involved in regulating immune responses and glucolipid metabolism. Given these properties, chemerin may provide an interesting link between obesity, inflammation and atherosclerosis. In this study, we sought to determine the r...

  9. Longitudinal shortening of sub-epicardial myocytes in severe ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Bjerre, Jenny; Kyhl, Kasper; Gustafsson, Finn

    2017-01-01

    We present two patients with three-vessel disease and severely depressed left ventricular (LV) systolic function where viability analysis by cardiac magnetic resonance imaging demonstrated areas of near-transmural sub-endocardial fibrosis and hence little chance of regaining systolic function as ....... The cases highlight that sub-epicardial, longitudinally oriented myocytes can contribute to overall LV systolic function and suggest taking their 'piston-function' into consideration when analysing viability....

  10. The Relationship Between Epicardial Adipose Tissue Volume and Coronary Plaque Structure in Diabetics

    OpenAIRE

    Gokhan Aksan

    2016-01-01

    Aim: Epicardial adipose tissue (EAT) contributes to the development and progression of coronary artery disease (CAD). We aimed to evaluate the relationship between EAT volume, coronary atherosclerosis, coronary plaque burden, and plaque structure in diabetic patients. Material and Method: 196 DM patients who were evaluated with 128-slice dual- source coronary computed tomography angiography (CCTA) for suspected CAD were included in the study. The CCTA examination was used to assess the total ...

  11. Single-Beat Noninvasive Imaging of Ventricular Endocardial and Epicardial Activation in Patients Undergoing CRT

    Science.gov (United States)

    Berger, Thomas; Pfeifer, Bernhard; Hanser, Friedrich F.; Hintringer, Florian; Fischer, Gerald; Netzer, Michael; Trieb, Thomas; Stuehlinger, Markus; Dichtl, Wolfgang; Baumgartner, Christian; Pachinger, Otmar; Seger, Michael

    2011-01-01

    Background Little is known about the effect of cardiac resynchronization therapy (CRT) on endo- and epicardial ventricular activation. Noninvasive imaging of cardiac electrophysiology (NICE) is a novel imaging tool for visualization of both epi- and endocardial ventricular electrical activation. Methodology/Principal Findings NICE was performed in ten patients with congestive heart failure (CHF) undergoing CRT and in ten patients without structural heart disease (control group). NICE is a fusion of data from high-resolution ECG mapping with a model of the patient's individual cardiothoracic anatomy created from magnetic resonance imaging. Beat-to-beat endocardial and epicardial ventricular activation sequences were computed during native rhythm as well as during ventricular pacing using a bidomain theory-based heart model to solve the related inverse problem. During right ventricular (RV) pacing control patients showed a deterioration of the ventricular activation sequence similar to the intrinsic activation pattern of CHF patients. Left ventricular propagation velocities were significantly decreased in CHF patients as compared to the control group (1.6±0.4 versus 2.1±0.5 m/sec; pCHF patients showed right-to-left septal activation with the latest activation epicardially in the lateral wall of the left ventricle. Biventricular pacing resulted in a resynchronization of the ventricular activation sequence and in a marked decrease of total LV activation duration as compared to intrinsic conduction and RV pacing (129±16 versus 157±28 and 173±25 ms; both p<0.05). Conclusions/Significance Endocardial and epicardial ventricular activation can be visualized noninvasively by NICE. Identification of individual ventricular activation properties may help identify responders to CRT and to further improve response to CRT by facilitating a patient-specific lead placement and device programming. PMID:21298045

  12. Single-beat noninvasive imaging of ventricular endocardial and epicardial activation in patients undergoing CRT.

    Directory of Open Access Journals (Sweden)

    Thomas Berger

    Full Text Available BACKGROUND: Little is known about the effect of cardiac resynchronization therapy (CRT on endo- and epicardial ventricular activation. Noninvasive imaging of cardiac electrophysiology (NICE is a novel imaging tool for visualization of both epi- and endocardial ventricular electrical activation. METHODOLOGY/PRINCIPAL FINDINGS: NICE was performed in ten patients with congestive heart failure (CHF undergoing CRT and in ten patients without structural heart disease (control group. NICE is a fusion of data from high-resolution ECG mapping with a model of the patient's individual cardiothoracic anatomy created from magnetic resonance imaging. Beat-to-beat endocardial and epicardial ventricular activation sequences were computed during native rhythm as well as during ventricular pacing using a bidomain theory-based heart model to solve the related inverse problem. During right ventricular (RV pacing control patients showed a deterioration of the ventricular activation sequence similar to the intrinsic activation pattern of CHF patients. Left ventricular propagation velocities were significantly decreased in CHF patients as compared to the control group (1.6±0.4 versus 2.1±0.5 m/sec; p<0.05. CHF patients showed right-to-left septal activation with the latest activation epicardially in the lateral wall of the left ventricle. Biventricular pacing resulted in a resynchronization of the ventricular activation sequence and in a marked decrease of total LV activation duration as compared to intrinsic conduction and RV pacing (129±16 versus 157±28 and 173±25 ms; both p<0.05. CONCLUSIONS/SIGNIFICANCE: Endocardial and epicardial ventricular activation can be visualized noninvasively by NICE. Identification of individual ventricular activation properties may help identify responders to CRT and to further improve response to CRT by facilitating a patient-specific lead placement and device programming.

  13. Transthoracic echocardiographically-guided interventional cardiac procedures in the dog.

    Science.gov (United States)

    Caivano, Domenico; Birettoni, Francesco; Fruganti, Alessandro; Rishniw, Mark; Knafelz, Patrizia; Moïse, N Sydney; Porciello, Francesco

    2012-09-01

    Interventional cardiac procedures are traditionally performed using fluoroscopy, or, more recently, transesophageal echocardiography (TEE). Neither modality is widely available to practicing cardiologists worldwide. We examined whether balloon valvuloplasty of pulmonic stenosis (PS) and transarterial occlusion of patent ductus arteriosus (PDA) in dogs could be performed safely with transthoracic echocardiography (TTE). A prospective consecutive case series of 26 client-owned dogs with PS (n = 10) and PDA (n = 16). The cardiovascular procedures were performed using TTE. Each dog was positioned on a standard echocardiography table in right lateral recumbency (dogs with PS) or left lateral recumbency (dogs with PDA). Guide wires, balloon catheters, Amplatz(®) Canine Ductal Occluder (ACDO) delivery sheaths, and ACDO were imaged by standard echocardiographic views optimized to allow visualization of the defects and devices. Procedures were performed successfully without major complications in 20 dogs. In 2 dogs (German shepherds) with Type III PDA, ACDO placement was unsuccessful; 2 other German Shepherds were excluded from the procedure because their ductal diameters, measured echocardiographically, exceeded the limits of the maximal ACDO size. Two dogs weighing ≤3.5 kg had suboptimal echocardiographic visualization of the PDA and were considered too small for safe ACDO deployment. All intravascular devices at the level of the heart and great vessels appeared hyperechoic on TTE image and could be clearly monitored and guided in real-time. We have demonstrated that TTE monitoring can guide each step of pulmonic balloon valvuloplasty and PDA occlusion without fluoroscopy. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Drug-refractory ventricular tachycardias after myocarditis: endocardial and epicardial radiofrequency catheter ablation.

    Science.gov (United States)

    Dello Russo, Antonio; Casella, Michela; Pieroni, Maurizio; Pelargonio, Gemma; Bartoletti, Stefano; Santangeli, Pasquale; Zucchetti, Martina; Innocenti, Ester; Di Biase, Luigi; Carbucicchio, Corrado; Bellocci, Fulvio; Fiorentini, Cesare; Natale, Andrea; Tondo, Claudio

    2012-06-01

    Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction≤35%) died of acute heart failure unrelated to ventricular arrhythmias. In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate.

  15. Minimally invasive delivery of a novel direct epicardial assist device in a porcine heart failure model.

    Science.gov (United States)

    McGarvey, Jeremy R; Shimaoka, Toru; Takebayashi, Satoshi; Aoki, Chikashi; Kondo, Norihiro; Takebe, Manabu; Zsido, Gerald A; Jassar, Arminder; Gorman, Joseph H; Pilla, James J; Gorman, Robert C

    2014-01-01

    Despite advances in design, modern ventricular assist device placement involves median sternotomy and cardiopulmonary bypass and is associated with infectious/embolic complications. In this study, we examine the feasibility and function of a novel minimally invasive, non-blood-contacting epicardial assist device in a porcine ischemic cardiomyopathy model. Feasibility was first tested in an ex vivo thoracoscopic trainer box with slaughterhouse hearts. Five male Yorkshire swine underwent selective ligation of the circumflex artery to create a posterolateral infarct Twelve weeks after infarct, all animals underwent left minithoracotomy. A custom inflatable bladder was positioned over the epicardial surface of the infarct and firmly secured to the surrounding border zone myocardium with polypropylene mesh and minimally invasive mesh tacks. An external gas pulsation system actively inflated and deflated the bladder in synchrony with the cardiac cycle. All animals then underwent cardiac magnetic resonance imaging to assess ventricular function. All subjects successfully underwent off-pump placement of the epicardial assist device via minithoracotomy. Ejection fraction significantly improved from 29.1% ± 4.8% to 39.6% ± 4.23% (P porcine ischemic cardiomyopathy model and may provide a safe alternative to currently available ventricular assist device therapies. Further, the technique used for device positioning and fixation suggests that an entirely thoracoscopic approach is possible.

  16. Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.

    Science.gov (United States)

    Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphael; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

    2016-12-01

    Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm2 ) applied to the infarcted anterior wall. Efficacy endpoints were improvement of LVEF and induction of angiogenesis 6 weeks after shock-wave therapy. Safety endpoints were haemodynamic stability during treatment and myocardial damage. Four weeks after LAD ligation, LVEF decreased in both the shock-wave (43 ± 3%, p heart failure exerted a positive effect on LVEF improvement and did not show any adverse effects. Angiogenesis was induced by stimulation of VEGF receptors. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Frequency and characteristics of coronary thrombosis in the epicardial coronary arteries after cardiac transplantation.

    Science.gov (United States)

    Arbustini, E; Dal Bello, B; Morbini, P; Grasso, M; Diegoli, M; Fasani, R; Pilotto, A; Bellini, O; Pellegrini, C; Martinelli, L; Campagna, C; Gavazzi, A; Specchia, G; Viganò, M; Roberts, W C

    1996-10-01

    We investigated at autopsy or at retransplantation the frequency and characteristics of coronary thrombosis in 76 cardiac allografts: 37 in place for 2 to 99 months (late). The 76 allografts were inserted in 69 patients: a single 1 in 56 patients and 2 allografts in 13 patients, 7 of whom subsequently died and had an autopsy. An average of 140 sections from 70 5-mm-long segments of 8 epicardial coronary arteries were examined from each of the 76 allografts with both hematoxylin-eosin and Movat pentachrome stains. Thrombus was found in only 1 coronary artery (3%) (the right one) of the 37 early allografts, and in 24 of 39 late allografts (61%). Of the latter 39 grafts, 29 (79%) had allograft vascular disease (AVD) and 24 (83%) of them had coronary thrombosis. Of the 312 epicardial coronary arteries (4 major and 4 minor) examined in the 39 late cases, 66 arteries (21%) contained thrombus. Of the 24 late cases with thrombus in at least 1 artery, thrombus was present in 66 (34%) of the 192 epicardial coronary arteries examined: in 6 of the 8 arteries in 3 patients; in 5 arteries in 2 patients; in 4 arteries in 1 patient; in 3 arteries in 5 patients; in 2 arteries in 6 patients, and in a single artery in 7 patients. In all 66 arteries with thrombus (24 patients) the thrombus was longer than 5 mm. The thrombus in the late cases was entirely nonocclusive (mural) in 51 (77%) of the 66 epicardial coronary arteries containing thrombus and entirely occlusive in 10 arteries (15%). It consisted exclusively of multiluminal channels in 6 arteries (9%) and combinations in 1 artery (2%). Acute myocardial infarcts were present in 3 patients, all of whom had occlusive thrombi. In all 10 arteries with occlusive thrombi, the thrombus was larger than the underlying plaque and no occlusive thrombi were located over ulcerated plaques. These observations demonstrate that thrombus is common in epicardial coronary arteries >2 months after cardiac transplantation.

  18. Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease.

    Science.gov (United States)

    Lau, Kelvin C; William Gaynor, J; Fuller, Stephanie M; Karen A Smoots; Shah, Maully J

    2015-03-01

    Multiple cardiac operations and resultant myocardial scarring have been implicated in the overall reduced performance of epicardial pacing systems in patients with congenital heart disease (CHD). The aim of the study is to evaluate long-term permanent epicardial pacing lead survival in patients with CHD who had epicardial lead placement in association with surgical repair or palliation. A retrospective review of patients who had implantation of epicardial pacing systems between January 1984 and June 2010 was conducted. Inclusion criteria were as follows: (1) presence of CHD and (2) cardiac operation(s) concomitant with or before initial permanent epicardial lead implantation. Patients were divided into 2 anatomical groups: single ventricle (SV) and biventricle (Bi-V). Epicardial leads were implanted in 663 patients during the study period. One hundred fifty-five patients (76 SV [49%] and 79 Bi-V [51%]) were included, resulting in 259 leads and 946 lead-years of follow-up. There were 2 deaths and 8 infections attributable to pacemaker placement. Overall atrial lead survival at 1, 2, 5, and 10 years (99%, 93%, 83%, and 72%) was comparable with ventricular lead survival (97%, 90%, 74%, and 60%) (P = .540) and was also similar between SV and Bi-V patients. Cox regression analysis demonstrated that SV palliation and an earlier era of lead implantation (1984-1999) was significantly associated with ventricular, but not atrial, lead malfunction. Epicardial leads had acceptable longevity despite cardiac operations for complex CHD, suggesting the long-term reliability of this pacing method. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  19. Bone marrow fat contributes to insulin sensitivity and adiponectin secretion in premenopausal women.

    Science.gov (United States)

    Ermetici, Federica; Briganti, Silvia; Delnevo, Alessandra; Cannaò, Paola; Leo, Giovanni Di; Benedini, Stefano; Terruzzi, Ileana; Sardanelli, Francesco; Luzi, Livio

    2018-02-01

    Bone marrow fat is a functionally distinct adipose tissue that may contribute to systemic metabolism. This study aimed at evaluating a possible association between bone marrow fat and insulin sensitivity indices. Fifty obese (n = 23) and non-obese (n = 27) premenopausal women underwent proton magnetic resonance spectroscopy to measure vertebral bone marrow fat content and unsaturation index at L4 level. Abdominal visceral, subcutaneous fat, and epicardial fat were also measured using magnetic resonance imaging. Bone mineral density was measured by dual-energy X-ray absorptiometry. Body composition was assessed by bioelectrical impedance analysis. Fasting serum glucose, insulin, lipids, adiponectin were measured; the insulin resistance index HOMA (HOMA-IR) was calculated. Bone marrow fat content and unsaturation index were similar in obese and non-obese women (38.5 ± 0.1 vs. 38.6 ± 0.1%, p = 0.994; 0.162 ± 0.065 vs. 0.175 ± 0.048, p = 0.473, respectively). Bone marrow fat content negatively correlated with insulin and HOMA-IR (r = -0.342, r = -0.352, respectively, p = 0.01) and positively with high density lipoprotein cholesterol (r = 0.270, p = 0.043). From a multivariate regression model including lnHOMA-IR as a dependent variable and visceral, subcutaneous, epicardial fat, and bone marrow fat as independent variables, lnHOMA-IR was significantly associated with bone marrow fat (β = -0.008 ± 0.004, p = 0.04) and subcutaneous fat (β = 0.003 ± 0.001, p = 0.04). Bone marrow fat, among the other adipose depots, was a significant predictor of circulating adiponectin (β = 0.147 ± 0.060, p = 0.021). Bone marrow fat unsaturation index negatively correlated with visceral fat (r = -0.316, p = 0.026). There is a relationship between bone marrow fat content and insulin sensitivity in obese and non-obese premenopausal women, possibly mediated by adiponectin secretion

  20. [ECHOCARDIOGRAPHIC PREDICTORS OF THE SEVERITY OF THE EARLY POSTOPERATIVE PERIOD IN PATIENTS AFTER SURGICAL MYOCARDIAL REVASCULARIZATION].

    Science.gov (United States)

    Bockeria, L A; Sokolskaya, N O; Kopylova, N S; Alshibaya, M M

    2015-01-01

    Non-invasive and easily interpretable methods for assessing cardiac hemodynainic parameters including various echocardiographic technologies are highly valuable diagnostic methods in cardiac surgery patients admitting the intensive care unit in the postoperative period. The article presents echocardiographic features of the myocardial functional state in the early period after coronary artery bypass grafting performed in 201 CHD patients. The analysis includes standard echocardiographic parameters and data obtained from tissue Doppler imaging. Tissue Doppler imaging has shown to be informative for diagnosing heart failure. Low left ventricular volumes and restrictive type myocardial diastolic dysfunction have proven to be early echocardiographic predictors of poor prognosis in CAD patients after myocardial revascularization.

  1. Facts about trans fats

    Science.gov (United States)

    ... fat diary with low-fat or nonfat milk, yogurt, and cheese. Alternative Names Trans fatty acids; Partially hydrogenated oils (PHOs); Cholesterol - trans fats; Hyperlipidemia - trans fats; Atherosclerosis - trans fat; ...

  2. Facts about saturated fats

    Science.gov (United States)

    ... fat diary with low-fat or nonfat milk, yogurt, and cheese. Eat more fruits, vegetables, whole grains, and other foods with low or no saturated fat. Alternative Names Cholesterol - saturated fat; Atherosclerosis - saturated fat; Hardening of the ...

  3. Know Your Fats

    Science.gov (United States)

    ... you need. Eating foods containing saturated fat and trans fat causes your body to produce even more, raising ... cholesterol when used in place of saturated and trans fats. Trans Fat Trans fats (or trans fatty acids) ...

  4. Macro fat and micro fat

    DEFF Research Database (Denmark)

    Li, Yanjun; Gaillard, Jonathan R; McLaughlin, Tracey

    2015-01-01

    in the metabolic syndrome. Changes in fat mass can be induced by altered energy intake or even diet composition. These macroscopic changes must manifest themselves as dynamic adipose cell-size distribution alterations at the microscopic level. The dynamic relationship between these 2 independent measurements...... of body fat is unknown. In this study, we investigate adipose tissue dynamics in response to various isocaloric diet compositions, comparing gender- and insulin sensitivity-dependent differences. A body composition model is used to predict fat mass changes in response to changes in diet composition for 28...... the relative change of fat mass for each diet composition, respectively. We find that adipose cell-size dynamics are associated with different modulations dependent on gender and insulin resistance. Larger turnover and growth/shrinkage rates in insulin resistant individuals suggest they may be more sensitive...

  5. Morphological observations in the epicardial coronary arteries and their surroundings late after cardiac transplantation (allograft vascular disease)

    Science.gov (United States)

    Arbustini, E; Roberts, W C

    1996-10-01

    Conclusions from this review, based primarily on study of 39 cardiac allografts in place for >2 months, but also on a study of 37 grafts in place for epicardial coronary arteries and usually the intramural coronary arteries in the outer one-half of the left ventricular wall; (2) the resulting intimal lesion is relatively uniform, consisting mainly of cellular and acellular fibrous tissue; it is diffuse, affecting all segments of the major and minor epicardial coronary arteries; (3) the degree of resulting luminal narrowing is similar in most 5-mm coronary segments, making coronary angiography hazardous in reliably predicting accurately the degree of luminal narrowing; (4) the extensive adventitial fibrosis and the extensive fibrous tissue infiltration of the subepicardial tissues probably inhibit dilation and remodeling of the epicardial coronary arteries and indeed may constrict them; (5) luminal narrowing of the epicardial coronary arteries after transplantation may be the consequence of both intraluminal lesions and exterior compression from the surrounding fibrous tissue; (6) intraluminal and intralesion thrombus is commonly observed as are multiluminal channels in coronary plaques, suggesting that organization of thrombi plays some role in the progression of post-transplant epicardial coronary disease; (7) the coronary lesions developing after cardiac transplantation are morphologically quite different in composition than those occurring in natural (nontransplantation) atherosclerosis; and (8) inflammatory cellular infiltrates are often extensive in the subepicardial tissues and the infiltrates in this area may be extensive even when interstitial myocardial inflammatory infiltrates are minimal or absent.

  6. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    Directory of Open Access Journals (Sweden)

    Tasso Julio Lobo

    2015-01-01

    Full Text Available Background: Heart failure and atrial fibrillation (AF often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class and echocardiographic (EF, left atrial diameter data were compared (McNemar test and t test before and after ablation. Results: 31 patients (6 women, 25 men, aged 37 to 77 years (mean, 59.8±10.6, underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%. During a mean follow-up of 20.3±17 months, 24 patients (77% were in sinus rhythm, 11 (35% being on amiodarone. Eight patients (26% underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures. Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001. The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005 and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026. No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

  7. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    Science.gov (United States)

    Lobo, Tasso Julio; Pachon, Carlos Thiene; Pachon, Jose Carlos; Pachon, Enrique Indalecio; Pachon, Maria Zelia; Pachon, Juan Carlos; Santillana, Tomas Guillermo; Zerpa, Juan Carlos; Albornoz, Remy Nelson; Jatene, Adib Domingos

    2015-01-01

    Background Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement. PMID:25387404

  8. Congenital heart disease in Nigerian children: a multicenter echocardiographic study.

    Science.gov (United States)

    Sadoh, Wilson E; Uzodimma, Chinyere C; Daniels, Queennette

    2013-04-01

    Congenital heart disease (CHD) is among the leading causes of morbidity and mortality in childhood. We report on the spectrum of echocardiographically diagnosed CHD from three different centers across Nigeria. Over a period of 42 months, children who were referred for echocardiographic evaluation in the centers located in three large metropolitan cities were consecutively recruited if they were confirmed to have identifiable CHD. Data were collected on age, gender, and types of CHD and analyzed using SPSS 16 (Chicago, Illinois,). A total of 605 children were recruited, their mean age was 2.1 ± 3.5 (range 0-17) years, and 296 (48.9%) were males. Nearly half (42.5%) had echocardiographic diagnosis of their CHD within the first year of life. Only 17% of the diagnoses were made in the neonatal age group. Acyanotic CHDs were more common than the cyanotic heart diseases (82.8% vs 17.2%). The most common CHD was ventricular septal defect (VSD; 46.6%) followed by patent ductus arteriosus (12.1%), atrial septal defect (8.7%), atrioventricular septal defect (8.2%), and tetralogy of Fallot (7.8%). More than half of the VSDs were perimembranous (55.1%) followed by outlet VSD (23.8%), muscular (10.7%), and inlet VSD (9.6%). Only 42 (6.9%) of the entire study population had definitive intervention. The VSD is the most prevalent CHD in Nigerian children. There is increasing awareness, availability, and use of diagnostic facilities as mirrored in the age distribution of the children. However, access to definitive surgery is poor and draws attention to the urgent need for affordable surgical facilities in the country.

  9. Echocardiographic parameters of captive western lowland gorillas (Gorilla gorilla gorilla).

    Science.gov (United States)

    Murphy, Hayley Weston; Dennis, Patricia; Devlin, William; Meehan, Tom; Kutinsky, Ilana

    2011-12-01

    A total of 163 echocardiographic studies on western lowland gorillas (Gorilla gorilla gorilla) were submitted for evaluation; 140 from 99 animals were suitable for analysis. Of these, 81 studies (42 studies from 35 males ranging in age from 11-41+ yr and 39 studies from 31 females ranging in age from 11-41+ yr) are reported here. Three studies from 3 females and 56 studies from 30 males were excluded from this report due to cardiac abnormalities. Cardiac parameters measured were aortic root (Ao Rt) diameter and left atrial (L atrium) size. Left ventricular (LV) measurements included left ventricular internal diameter in systole (LVID(s)) and diastole (LVID(d)) as well as diastolic septal (IVS) and posterior wall thickness (LVPW). Values considered to be normal in females > 11 yr of age were: Ao Rt 60%. The data from male gorillas show a separation in animals based on three cardiac parameters: systolic function, LV cavity size, and LV wall thickness. Male gorillas > 11 yr of age fall into two groups; unaffected and affected. Unaffected animals are defined as those with no echocardiographic abnormalities and a consistent Ao Rt of 58%. The affected group consisted of male gorillas that exhibited changes in echocardiographic parameters representing the presence of cardiovascular disease. The results determined in this database, gathered from data collected from 1999-2009, suggest a sex-based difference between males and females with predominantly males demonstrating evidence of cardiac disease. The most striking finding seen in this study is that of progressive LV hypertrophy and depressed LV EF in affected adult male gorillas.

  10. Dynamical Segmentation of the Left Ventricle in Echocardiographic Image Sequences

    Science.gov (United States)

    2001-10-25

    1 DYNAMICAL SEGMENTATION OF THE LEFT VENTRICLE IN ECHOCARDIOGRAPHIC IMAGE SEQUENCES A. Bosnjak1,2, V. Burdin 1, V. Torrealba 2, G. Montilla 2, B...V, Bosnjak A, Acuña M, Hernández L, Roux C, Montilla G. “3D Dynamics Echocardiography. Workstation for the Acquisition, Reconstruction and...Torrealba V., Hernández L., Acuña M., Montilla G., Bosnjak A., Roux C. “Interpolación Espacial de Imágenes Médicas 3D basada en movimiento”. Avances

  11. The reliability of echocardiographic left ventricular wall motion index to identify high-risk patients for multicenter studies

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Gadsbøll, Niels; Quinones, Miguel A

    2006-01-01

    OBJECTIVE: To study whether the use of echocardiographic left ventricular (LV) wall motion index (WMI) is a dependable parameter for identifying patients with LV dysfunction to be enrolled in multicenter trials. METHODS: Videotaped echocardiographic examinations from 200 randomly selected patient...

  12. How to prevent echocardiographic misinterpretation of Gerbode type defect as pulmonary arterial hypertension.

    Science.gov (United States)

    Tehrani, Faramarz; Movahed, Mohammad-Reza

    2007-12-01

    We present a rare case of left ventricular to right atrial communication, a Gerbode type defect discovered in an adult female, originally misinterpreted as pulmonary arterial hypertension. The case report will be followed by the review of the literature and a discussion about how to prevent echocardiographic misinterpretation of this defect as pulmonary arterial hypertension using careful echocardiographic examination.

  13. Echocardiographic two-dimensional view of the pulmonary valve in infants: the high transsternal view.

    Science.gov (United States)

    Granados, Miguel A; Albert, Leticia; Toral, Belén

    2016-04-01

    Neonates and small infants have unique characteristics that make it possible to obtain echocardiographic views that are inaccessible in older patients. A high transsternal approach through the cartilaginous sternum and the thymus gland allows visualisation of a short-axis view of the pulmonary valve. This view should be included as part of routine protocols for echocardiographic examinations performed in this age group.

  14. Impact of irrigation flow rate and intrapericardial fluid on cooled-tip epicardial radiofrequency ablation.

    Science.gov (United States)

    Aryana, Arash; O'Neill, Padraig Gearoid; Pujara, Deep K; Singh, Steve K; Bowers, Mark R; Allen, Shelley L; d'Avila, André

    2016-08-01

    The optimal irrigation flow rate (IFR) during epicardial radiofrequency (RF) ablation has not been established. This study specifically examined the impact of IFR and intrapericardial fluid (IPF) accumulation during epicardial RF ablation. Altogether, 452 ex vivo RF applications (10 g for 60 seconds) delivered to the epicardial surface of bovine myocardium using 3 open-irrigated ablation catheters (ThermoCool SmartTouch, ThermoCool SmartTouch-SF, and FlexAbility) and 50 in vivo RF applications delivered (ThermoCool SmartTouch-SF) in 4 healthy adult swine in the presence or absence of IPF were examined. Ex vivo, RF was delivered at low (≤3 mL/min), reduced (5-7 mL/min), and high (≥10 mL/min) IFRs using intermediate (25-35 W) and high (35-45 W) power. In vivo, applications were delivered (at 9.3 ± 2.2 g for 60 seconds at 39 W) using reduced (5 mL/min) and high (15 mL/min) IFRs. Ex vivo, surface lesion diameter inversely correlated with IFR, whereas maximum lesion diameter and depth did not differ. While steam pops occurred more frequently at low IFR using high power (ThermoCool SmartTouch and ThermoCool SmartTouch-SF), tissue disruption was rare and did not vary with IFR. In vivo, charring/steam pop was not detected. Although there were no discernible differences in lesion size with IFR, surface lesion diameter, maximum diameter, depth, and volume were all smaller in the presence of IPF at both IFRs. Cooled-tip epicardial RF ablation created using reduced IFRs (5-7 mL/min) yields lesion sizes similar to those created using high IFRs (≥10 mL/min) without an increase in steam pop/tissue disruption, whereas the presence of IPF significantly reduces the lesion size. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  15. Epicardial Breakthrough Waves During Sinus Rhythm: Depiction of the Arrhythmogenic Substrate?

    Science.gov (United States)

    Mouws, Elisabeth M J P; Lanters, Eva A H; Teuwen, Christophe P; van der Does, Lisette J M E; Kik, Charles; Knops, Paul; Bekkers, Jos A; Bogers, Ad J J C; de Groot, Natasja M S

    2017-09-01

    Epicardial breakthrough waves (EBW) during atrial fibrillation are important elements of the arrhythmogenic substrate and result from endo-epicardial asynchrony, which also occurs to some degree during sinus rhythm (SR). We examined the incidence and characteristics of EBW during SR and its possible value in the detection of the arrhythmogenic substrate associated with atrial fibrillation. Intraoperative epicardial mapping (interelectrode distances 2 mm) of the right atrium, Bachmann's bundle, the left atrioventricular groove, and the pulmonary vein area was performed during SR in 381 patients (289 male, 67±10 years) with ischemic or valvular heart disease. EBW were referred to as sinus node breakthrough waves if they were the earliest right atrial activated site. A total of 218 EBW and 57 sinus node breakthrough waves were observed in 168 patients (44%). EBW mostly occurred at right atrium (N=105, 48%) and left atrioventricular groove (N=67, 31%), followed by Bachmann's bundle (N=27, 12%) and pulmonary vein area (N=19, 9%; P<0.001). EBW occurred most often in ischemic heart disease patients (N=114, 49%) compared with (ischemic and) valvular heart disease patients (N=26, 17%; P<0.001). EBW electrograms most often consisted of double and fractionated potentials (N=137, 63%). In case of single potentials, an R wave was observed in 88% (N=71) of EBW, as opposed to 21% of sinus node breakthrough waves (N=5; P<0.001). Fractionated EBW potentials were more often observed at the right atrium and Bachmann's bundle (P<0.001). During SR, EBW are present in over a third of patients, particularly in thicker parts of the atrial wall. Features of SR EBW indicate that muscular connections between endo- and epicardium underlie EBW and that a slight degree of endo-epicardial asynchrony required for EBW to occur is already present in some areas during SR. Hence, an anatomic substrate is present, which may enhance the occurrence of EBW during atrial fibrillation, thereby promoting

  16. Left ventricular thrombectomy in myocarditis: the epicardial scan & video-assisted transaortic approach.

    Science.gov (United States)

    Gatti, Giuseppe; Poli, Stefano; Benussi, Bernardo; Bussani, Rossana; Iorio, Annamaria; Confalonieri, Marco; Milo, Marco; Tavcar, Irena; Pappalardo, Aniello; Sinagra, Gianfranco

    2017-08-08

    In a 23-year-old man having myocarditis in the context of eosinophilic granulomatosis with polyangiitis, a mobile left ventricular apical thrombus was found with transthoracic echocardiography. Its surgical removal was established because there were no signs of resizing after effective intravascular anticoagulation therapy. Surgery was carried out via a median sternotomy with cardiopulmonary bypass. The site of endocardial implantation of the thrombus was identified with epicardial ultrasonography scan. The trans-aortic approach was adopted to avoid complications such as ventricular dysfunction and arrhythmias secondary to ventricular incision. Real-time imaging of the complete removal was obtained with optical instruments.

  17. Effectiveness of Coenzyme Q10 on echocardiographic parameters of patients with Duchenne muscular dystrophy.

    Science.gov (United States)

    Salehi, Forod; Zeinaloo, Aliakbar; Riasi, Hamid Reza; Shamloo, Alireza Sepehri

    2017-03-01

    Myocardial damage is a common complication in patients with Duchenne muscular dystrophy (DMD) that occurs due to myocardial replacement by fat and fibrosis. In recent years, efforts have been made toward finding new pharmacological agents with fewer complications which can be used as prophylactic before the symptoms. Coenzyme Q10 plays a central role in production of bioenergy in heart muscle and antioxidant in reperfusion condition of myocardial damaged muscle and leads to membrane stability and prevents cell death. This study aimed at comparing the Effectiveness of coenzyme Q10 on echocardiographic parameters of pediatric patients with Duchenne muscular dystrophy. This randomized clinical trial study (RCT) was carried out on 25 pediatric patients with pre-diagnosed DMD who attended the Children's Medical Center (CMC), Tehran, Iran from February 2013 to 2015. The patients were randomly divided into two groups. Group-1; (n=12) was treated with coenzyme Q10 for six months and group-2 ;(n=13) received placebo for the same time. The primary aim was to compare the myocardial performance index (MPI), between the two groups at the end of six months. Data were analyzed by SPSS software (ver-16) and using T-Test. Twenty-five patients under study were divided into two groups of (Q10=12) and (placebo=13). Mean ages were 8.9±1.7 and 8.6±1.4 in Q10 and placebo groups (P=0.66). No significant difference was detected in MPI at all three views of mitral and tricuspid and septum respectively in two groups after the end of treatment (0.41±0.13, and 0.43±0.6; P=0.59), (0.45±0.12, and 0.46±0.1; P=0.05), and (0.45±0.06, and 0.45±0.1; P=0.31). According to the results obtained from this study, coenzyme Q10 had no significant effect on improving the performance of echocardiographic parameters in patients with DMD. The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2015070223018N1. This research has been financially

  18. Extent of myocardial noncompaction: comparison between MRI and echocardiographic evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Alhabshan, Fahad; Smallhorn, Jeffrey F.; Golding, Fraser; Musewe, Norman; Freedom, Robert M. [University of Toronto, Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, Toronto, Ontario (Canada); Yoo, Shi-Joon [University of Toronto, Department of Diagnostic Imaging, Division of Cardiology, Hospital for Sick Children, Toronto, Ontario (Canada)

    2005-11-01

    Noncompaction of the left ventricular myocardium is an important cause of cardiomyopathy. There is no clear consensus about its diagnostic criteria or the diagnostic test of choice. MRI is increasingly used in the pediatric cardiac field because of its superior and objective image quality. To compare the echocardiographic and MRI findings in four patients with recently diagnosed ventricular noncompaction. We compared the extent of myocardial involvement shown at MRI and echocardiography in four individuals, two patients with echocardiographic diagnosis of left ventricular noncompaction, and two family members of one of the patients. In all patients, MRI showed wider area of involvement than echocardiography. A definite diagnosis was entertained in only two patients by echocardiography but in all by MRI. Cine imaging was diagnostic of the disease in all patients. Black-blood pool imaging with double-inversion recovery sequence also helped to visualize the abnormal areas by showing slow flow artifacts in the four- and two-chamber images. MRI provided better delineation of the extent of the abnormal trabeculation in patients with noncompaction of the left ventricular myocardium. It was particularly useful when the myocardial involvement was subtle, as in the asymptomatic family members. (orig.)

  19. [Echocardiographic study of left ventricular geometry in spontaneously hypertensive rats].

    Science.gov (United States)

    Escudero, Eduardo M; Pinilla, Oscar A; Carranza, Verónica B

    2009-01-01

    The purpose of this study was to analyze by echocardiogram left ventricular (LV) geometry in spontaneously hypertensive rats (SHR). Echocardiographic study, systolic blood pressure and heart rate were obtained in 114 male, 4-month old rats, 73 SHR and 41 Wistar (W). Left ventricular mass index (LVMI), relative wall thickness (RWT), stroke volume, and mid ventricular shortening were calculated with echocardiographic parameters. Normal LV was defined considering the mean plus 2 SD of LVMI and RWT in W. Patterns of abnormal LV geometry were: LV concentric remodeling, LVMI 0.71; eccentric, left ventricular hypertrophy (LVH), LVMI > 2.06 mg/g - RWT 2.06 mg/g - RWT > 0.71. Systolic blood pressure (SBP) and cardiac output (CO) were used to obtain total peripheral resistance (TPR). twelve % of SHR had normal LV geometry; 18% LV concentric remodeling; 33% concentric LVH and 37% eccentric LVH. LV concentric remodeling showed the smallest CO and highest TPR of any group. Eccentric LVH presented similar SBP as the other SHR groups and high CO with lower TPR. Our findings in SHR exhibit different patterns of LV geometry like in humans. These results strengthen the similarities between SHR and human essential hypertension.

  20. Balloon atrial septostomy under echocardiographic guide: case series

    Directory of Open Access Journals (Sweden)

    SM Meraji

    2012-12-01

    Full Text Available Background: Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion.Case presentation: In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins.Results: Male sex was predominant (87% and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication.Conclusion: Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.

  1. Packaging of implantable accelerometers to monitor epicardial and endocardial wall motion.

    Science.gov (United States)

    Brancato, Luigi; Weydts, Tristan; Oosterlinck, Wouter; Herijgers, Paul; Puers, Robert

    2017-09-01

    Acceleration signals, collected from the inner and the outer heart wall, offer a mean of assessing cardiac function during surgery. Accelerometric measurements can also provide detailed insights into myocardial motion during exploratory investigations. Two different implantable accelerometers to respectively record endocardial and epicardial vibrations, have been developed by packaging a commercially available capacitive transducer. The same coating materials have been deposited on the two devices to ensure biocompatibility of the implants: Parylene-C, medical epoxy and Polydimethylsiloxane (PDMS). The different position-specific requirements resulted in two very dissimilar sensor assemblies. The endocardial accelerometer, that measures accelerations from the inner surface of the heart during acute animal tests, is a 2 mm-radius hemisphere fixed on a polymethyl methacrylate (PMMA) rod to be inserted through the heart wall. The epicardial accelerometer, that monitors the motion of the outer surface of the heart, is a three-legged structure with a stretchable polytetrafluoroethylene (PTFE) reinforcement. This device can follow the continuous motion of the myocardium (the muscular tissue of the heart) during the cardiac cycle, without hindering its natural movement. Leakage currents lower than 1 μA have been measured during two weeks of continuous operation in saline. Both transducers have been used, during animal tests, to simultaneously record and compare acceleration signals from corresponding locations on the inner and the outer heart wall of a female sheep.

  2. Application of L1-norm regularization to epicardial potential reconstruction based on gradient projection

    Energy Technology Data Exchange (ETDEWEB)

    Wang Liansheng; Qin Jing; Wong, Tien Tsin; Heng, Pheng Ann, E-mail: lswang@cse.cuhk.edu.hk [Department of Computer Science and Engineering, Chinese University of Hong Kong (Hong Kong)

    2011-10-07

    The epicardial potential (EP)-targeted inverse problem of electrocardiography (ECG) has been widely investigated as it is demonstrated that EPs reflect underlying myocardial activity. It is a well-known ill-posed problem as small noises in input data may yield a highly unstable solution. Traditionally, L2-norm regularization methods have been proposed to solve this ill-posed problem. But the L2-norm penalty function inherently leads to considerable smoothing of the solution, which reduces the accuracy of distinguishing abnormalities and locating diseased regions. Directly using the L1-norm penalty function, however, may greatly increase computational complexity due to its non-differentiability. We propose an L1-norm regularization method in order to reduce the computational complexity and make rapid convergence possible. Variable splitting is employed to make the L1-norm penalty function differentiable based on the observation that both positive and negative potentials exist on the epicardial surface. Then, the inverse problem of ECG is further formulated as a bound-constrained quadratic problem, which can be efficiently solved by gradient projection in an iterative manner. Extensive experiments conducted on both synthetic data and real data demonstrate that the proposed method can handle both measurement noise and geometry noise and obtain more accurate results than previous L2- and L1-norm regularization methods, especially when the noises are large.

  3. Implantation of looped epicardial cardioverter defibrillator coil on the surface of the right ventricular outflow tract.

    Science.gov (United States)

    Ozyuksel, Arda; Ersoy, Cihangir; Akdeniz, Celal; Akcevin, Atif; Turkoglu, Halil; Tuzcu, Volkan

    2015-04-01

    We present the early results of looped epicardial cardioverter defibrillator coil implantation on the anterior surface of right ventricular outflow tract in infants and children. Patients with a surgical history of an epicardial implantable cardioverter defibrillator system between 2013 and 2014 were included in the study. Patient age, gender, body weight, indications for a cardioverter defibrillator system implantation, defibrillation threshold values, and defibrillation therapies were retrospectively evaluated. There were eight patients with a mean age of 4.4 ± 2.9 years and a mean body weight of 19.5 ± 11.7 kg. Five of the patients had been diagnosed with long QT syndrome, one patient had been diagnosed with genetic channelopathy and noncompaction of the left ventricle, and two patients had been diagnosed with univentricle physiology. The implantable cardioverter defibrillator system was composed of pace-sense leads, an abdominal active can, and a defibrillation coil placed below the pulmonary valve annulus on the anterior surface of the heart. The mean defibrillation threshold was 6.6 ± 2.3 joules. There were four appropriate therapies in two patients in a mean follow-up of 9 ± 6.5 months. The significantly low defibrillation thresholds with the defibrillation coils located below the pulmonary valve annulus are encouraging. However, a larger patient series will be necessary to evaluate the safety and reliability of this technique. © 2015 Wiley Periodicals, Inc.

  4. Fat Analysis

    Science.gov (United States)

    Min, David B.; Ellefson, Wayne C.

    Lipids, proteins, and carbohydrates constitute the principal structural components of foods. Lipids are a group of substances that, in general, are soluble in ether, chloroform, or other organic solvents but are sparingly soluble in water. However, there exists no clear scientific definition of a lipid, primarily due to the water solubility of certain molecules that fall within one of the variable categories of food lipids (1). Some lipids, such as triacylglycerols, are very hydrophobic. Other lipids, such as di- and monoacylglycerols, have both hydrophobic and hydrophilic moieties in their molecules and are soluble in relatively polar solvents (2). Short-chain fatty acids such as C1-C4 are completely miscible in water and insoluble in nonpolar solvents (1). The most widely accepted definition is based on solubility as previously stated. While most macromolecules are characterized by common structural features, the designation of "lipid" being defined by solubility characteristics is unique to lipids (2). Lipids comprise a broad group of substances that have some common properties and compositional similarities (3). Triacylglycerols are fats and oils that represent the most prevalent category of the group of compounds known as lipids. The terms lipids, fats, and oils are often used interchangeably. The term "lipid" commonly refers to the broad, total collection of food molecules that meet the definition previously stated. Fats generally refer to those lipids that are solid at room temperature and oils generally refer to those lipids that are liquid at room temperature. While there may not be an exact scientific definition, the US Food and Drug Administration (FDA) has established a regulatory definition for nutrition labeling purposes. The FDA has defined total fat as the sum of fatty acids from C4 to C24, calculated as triglycerides. This definition provides a clear path for resolution of any nutrition labeling disputes.

  5. Image-based temporal alignment of echocardiographic sequences

    Science.gov (United States)

    Danudibroto, Adriyana; Bersvendsen, Jørn; Mirea, Oana; Gerard, Olivier; D'hooge, Jan; Samset, Eigil

    2016-04-01

    Temporal alignment of echocardiographic sequences enables fair comparisons of multiple cardiac sequences by showing corresponding frames at given time points in the cardiac cycle. It is also essential for spatial registration of echo volumes where several acquisitions are combined for enhancement of image quality or forming larger field of view. In this study, three different image-based temporal alignment methods were investigated. First, a method based on dynamic time warping (DTW). Second, a spline-based method that optimized the similarity between temporal characteristic curves of the cardiac cycle using 1D cubic B-spline interpolation. Third, a method based on the spline-based method with piecewise modification. These methods were tested on in-vivo data sets of 19 echo sequences. For each sequence, the mitral valve opening (MVO) time was manually annotated. The results showed that the average MVO timing error for all methods are well under the time resolution of the sequences.

  6. Echocardiographic left ventricular masses in distance runners and weight lifters

    Science.gov (United States)

    Longhurst, J. C.; Gonyea, W. J.; Mitchell, J. H.; Kelly, A. R.

    1980-01-01

    The relationships of different forms of exercise training to left ventricular mass and body mass are investigated by echocardiographic studies of weight lifters, long-distance runners, and comparatively sized untrained control subjects. Left ventricular mass determinations by the Penn convention reveal increased absolute left ventricular masses in long-distance runners and competitive weight lifters with respect to controls matched for age, body weight, and body surface area, and a significant correlation between ventricular mass and lean body mass. When normalized to lean body mass, the ventricular masses of distance runners are found to be significantly higher than those of the other groups, suggesting that dynamic training elevates left ventricular mass compared to static training and no training, while static training increases ventricular mass only to the extent that lean body mass is increased.

  7. Differential expression of embryonic epicardial progenitor markers and localization of cardiac fibrosis in adult ischemic injury and hypertensive heart disease.

    Science.gov (United States)

    Braitsch, Caitlin M; Kanisicak, Onur; van Berlo, Jop H; Molkentin, Jeffery D; Yutzey, Katherine E

    2013-12-01

    During embryonic heart development, the transcription factors Tcf21, Wt1, and Tbx18 regulate activation and differentiation of epicardium-derived cells, including fibroblast lineages. Expression of these epicardial progenitor factors and localization of cardiac fibrosis were examined in mouse models of cardiovascular disease and in human diseased hearts. Following ischemic injury in mice, epicardial fibrosis is apparent in the thickened layer of subepicardial cells that express Wt1, Tbx18, and Tcf21. Perivascular fibrosis with predominant expression of Tcf21, but not Wt1 or Tbx18, occurs in mouse models of pressure overload or hypertensive heart disease, but not following ischemic injury. Areas of interstitial fibrosis in ischemic and hypertensive hearts actively express Tcf21, Wt1, and Tbx18. In all areas of fibrosis, cells that express epicardial progenitor factors are distinct from CD45-positive immune cells. In human diseased hearts, differential expression of Tcf21, Wt1, and Tbx18 also is detected with epicardial, perivascular, and interstitial fibrosis, indicating conservation of reactivated developmental mechanisms in cardiac fibrosis in mice and humans. Together, these data provide evidence for distinct fibrogenic mechanisms that include Tcf21, separate from Wt1 and Tbx18, in different fibroblast populations in response to specific types of cardiac injury. © 2013.

  8. VATS-guided epicardial pacemaker implantation. Hand-sutured fixation of atrioventricular leads in an experimental setting.

    Science.gov (United States)

    Furrer, M; Fuhrer, J; Altermatt, H J; Ris, H; Mettler, D; Althaus, U; Carrel, T

    1997-12-01

    In neonates and infants epicardial stimulation may be preferred to endocardial stimulation because of growth-associated lead problems and the risk of vascular complications associated with transvenous electrodes. This study analyzes the feasibility of atrioventricular implantation of a new epicardial lead using the video-assisted thoracic surgical (VATS) technique in an animal model. Bipolar steroid-eluting epicardial leads were implanted in seven young white pigs. In five animals bipolar atrial and ventricular pacing leads (n = 10) were inserted and fixed by the VATS technique, while two animals served as controls and underwent implantation through anterolateral thoracotomy. Surgical feasibility, pacing, and sensing thresholds of the leads as well as hemodynamic parameters during pacing were studied. Histological changes beneath the electrodes were evaluated 1 week after the implantation. All animals survived the pacemaker lead implantation. One animal which underwent thoracotomy died because of irreversible ventricular fibrillation induced by rapid ventricular pacing. One animal in the VATS group exhibited intraoperative herniation of the heart through the pericardial window. All animals with left-sided VATS implantations demonstrated good individual pacing and sensing threshold values. The mean cardiac output was 1.6 times higher during AAI-mode pacing as compared to VVI-mode pacing at a heart rate of 140/min. One animal died postoperatively due to respiratory failure. No displacements of the pacemaker leads were observed in the survivors. While VATS-guided implantation of epicardial, atrial, and ventricular leads is feasible, technical improvements of the system are mandatory for safe clinical application.

  9. Concurrent assessment of epicardial coronary artery stenosis and microvascular dysfunction using diagnostic endpoints derived from fundamental fluid dynamics principles.

    Science.gov (United States)

    Banerjee, Rupak K; Ashtekar, Koustubh D; Effat, Mohamed A; Helmy, Tarek A; Kim, Edward; Schneeberger, Eric W; Sinha, Roy A; Gottliebson, William M; Back, Lloyd H

    2009-10-01

    Simultaneously measured pressure and flow distal to coronary stenoses can be combined, in conjunction with anatomical measurements, to assess the status of both the epicardial and microvascular circulations. Assessments of coronary hemodynamics were performed using fundamental fluid dynamics principles. We hypothesized that the pressure-drop coefficient (CDPe; trans-stenotic pressure drop divided by the dynamic pressure in the distal vessel) correlates linearly with epicardial and microcirculatory resistances concurrently. In 14 pigs, simultaneous measurements of distal coronary arterial pressure and flow were performed using a dual sensor-tipped guidewire in the setting of both normal and disrupted microcirculation, with the presence of epicardial coronary lesions of lt; 50% area stenosis (AS) and > 50% AS. The CDPe progressively increased from lesions of 50% AS and had a higher resolving power (45 +/- 22 to 193 +/- 140 in normal microcirculation; 248 +/- 137 to 351 +/- 140 in disrupted microcirculation) as compared to fractional flow reserve (FFR) and coronary flow reserve (CFR). Strong multiple linear correlation was observed for CDPe with combined FFR and CFR (r = 0.72; p < 0.0001). Further, the ratio of maximum pressure drop coefficient evaluated at the site of stenosis and its theoretical limiting value of minimum cross-sectional area was also able to distinguish different combinations of coronary artery diseases. The CDPe can be readily obtained during routine pressure and flow measurements during cardiac catheterization. It is a promising clinical diagnostic parameter that can independently assess the severity of epicardial stenosis and microvascular impairment.

  10. Alk3 mediated Bmp signaling controls the contribution of epicardially derived cells to the tissues of the atrioventricular junction

    NARCIS (Netherlands)

    Lockhart, Marie M.; Boukens, Bastiaan J. D.; Phelps, Aimee L.; Brown, Christina-Lin M.; Toomer, Katelynn A.; Burns, Tara A.; Mukherjee, Rupak D.; Norris, Russell A.; Trusk, Thomas C.; van den Hoff, Maurice J. B.; Wessels, Andy

    2014-01-01

    Recent studies using mouse models for cell fate tracing of epicardial derived cells (EPDCs) have demonstrated that at the atrioventricular (AV) junction EPDCs contribute to the mesenchyme of the AV sulcus, the annulus fibrosus, and the parietal leaflets of the AV valves. There is little insight,

  11. Echocardiographic chamber quantification in a healthy Dutch population.

    Science.gov (United States)

    van Grootel, R W J; Menting, M E; McGhie, J; Roos-Hesselink, J W; van den Bosch, A E

    2017-12-01

    For accurate interpretation of echocardiographic measurements normative data are required, which are provided by guidelines. For this article, the hypothesis was that these cannot be extrapolated to the Dutch population, since in Dutch clinical practice often higher values are found, which may not be pathological but physiological. Therefore this study aimed to 1) obtain and propose normative values for cardiac chamber quantification in a healthy Dutch population and 2) determine influences of baseline characteristics on these measurements. Prospectively recruited healthy subjects, aged 20-72 years (at least 28 subjects per age decade, equally distributed for gender) underwent physical examination and 2D and 3D echocardiography. Both ventricles and atria were assessed and volumes were calculated. 147 subjects were included (age 44 ± 14 years, 50% female). Overall, feasibility was good for both linear and volumetric measurements. Linear and volumetric parameters were consistently higher than current guidelines recommend, while functional parameters were in line with the guidelines. This was more so in the older population. 3D volumes were higher than 2D volumes. Gender dependency was seen in all body surface area (BSA) corrected volumes and with increasing age, ejection fractions decreased. This study provides 2D and 3D echocardiographic reference ranges for both ventricles and atria derived from a healthy Dutch population. BSA indexed volumes are gender-dependent, age did not influence ventricular volumes and a rise in blood pressure was independently associated with increased right ventricular volumes. The higher volumes found may be indicative for the Dutch population being the tallest in the world.

  12. Comparison of echocardiographic findings in patients with nonfunctioning adrenal incidentalomas

    Directory of Open Access Journals (Sweden)

    Narin Nasıroglu Imga

    2017-06-01

    Full Text Available Adrenal incidentalomas (AIs are usually discovered incidentally after imaging unrelated to adrenal glands. We aimed to evaluate standard risk factors for systemic atherosclerosis and echocardiographic changes in patients with nonfunctioning AIs and compare them with normal subjects. We evaluated 70 patients diagnosed with AIs and 51 healthy controls. Mean levels were determined for HbA1c, LDL, uric acid, fasting plasma insulin, HOMA, and neutrophil-to-lymphocyte ratio (NLR, and these values were found to be significantly higher in the patients than the controls. The mean left atrial diameter, interventricular septum thickness, posterior wall thickness, left ventricular mass, E-wave deceleration time, isovolumetric relaxation time, and the median ratio of the early transmittal flow velocity to the early diastolic tissue velocity (E/Em were higher in patients with AIs compared to controls. The mitral annular early diastolic velocity was lower in patients with AIs. The mean aortic diastolic diameter, stiffness index (SI, and aortic strain were higher, and aortic distensibility was lower in the patients. The mean right ventricular diameter, right atrial major-axis diameter, and right atrial minor-axis diameter were statistically higher in the patient group than the controls. A negative correlation was found between the NLR and aortic strain and aortic distensibility, while a positive correction was found between the NLR and SI. We found altered left ventricular (LV and right ventricular (RV echocardiographic findings in patients with AIs without known cardiovascular disease. Aortic stiffness was also increased. These changes may be related to an increase in cardiovascular risk factors in AI patients.

  13. Electrical storm induced by cardiac resynchronization therapy is determined by pacing on epicardial scar and can be successfully managed by catheter ablation.

    Science.gov (United States)

    Roque, Carla; Trevisi, Nicola; Silberbauer, John; Oloriz, Teresa; Mizuno, Hiroya; Baratto, Francesca; Bisceglia, Caterina; Sora, Nicoleta; Marzi, Alessandra; Radinovic, Andrea; Guarracini, Fabrizio; Vergara, Pasquale; Sala, Simone; Paglino, Gabriele; Gulletta, Simone; Mazzone, Patrizio; Cireddu, Manuela; Maccabelli, Giuseppe; Della Bella, Paolo

    2014-12-01

    The mechanism of cardiac resynchronization therapy (CRT)-induced proarrhythmia remains unknown. We postulated that pacing from a left ventricular (LV) lead positioned on epicardial scar can facilitate re-entrant ventricular tachycardia. The aim of this study was to investigate the relationship between CRT-induced proarrhythmia and LV lead location within scar. Twenty-eight epicardial and 63 endocardial maps, obtained from 64 CRT patients undergoing ventricular tachycardia ablation, were analyzed. A positive LV lead/scar relationship, defined as a lead tip positioned on scar/border zone, was determined by overlaying fluoroscopic projections with LV electroanatomical maps. CRT-induced proarrhythmia occurred in 8 patients (12.5%). They all presented early with electrical storm (100% versus 39% of patients with no proarrhythmia; Pscar was significantly more frequent in the proarrhythmia group (60% versus 9% P=0.03 on epicardial bipolar scar, 80% versus 17% P=0.02 on epicardial unipolar scar, and 80% versus 17% P=0.02 on any-epicardial scar). Ablation was performed within epicardial scar, close to the LV lead, and allowed CRT reactivation in all patients. CRT-induced proarrhythmia presented early with electrical storm and was associated with an LV lead positioning within epicardial scar. Catheter ablation allowed for resumption of biventricular stimulation in all patients. © 2014 American Heart Association, Inc.

  14. Postmyocarditis ventricular tachycardia in patients with epicardial-only scar: a specific entity requiring a specific approach.

    Science.gov (United States)

    Berte, Benjamin; Sacher, Frederic; Cochet, Hubert; Mahida, Saagar; Yamashita, Seigo; Lim, Han; Denis, Arnaud; Derval, Nicolas; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre

    2015-01-01

    Nonischemic cardiomyopathy is a heterogeneous condition providing a favorable substrate for ventricular tachycardia (VT). The purpose of this study is to further characterize the substrate in a subset of postmyocarditis patients with epicardial-only scar. Twelve postmyocarditis patients (11 male, 49 ± 14 years, left ventricular ejection fraction 49 ± 12%) with VT and epicardial-only scar were included for analysis comparing automatic high-amplitude normal activity (HANA) maps to manually adjusted maps of based on local abnormal ventricular activity (LAVA) electrograms when present. A combined endocardial (endo) and epicardial (epi) approach was used in 11/12 with usual bipolar/unipolar voltage thresholds and analyzed using image integration. A delayed enhancement MRI scar area of 52 cm(2) (38, 59) and multidetector CT wall thinning area of 18 cm(2) (14, 35) was found. Bipolar voltage substrate mapping (160 points [101, 239] endo, 553 points [232, 713] epi and LAVA were found only epicardially [443 LAVA points] in all) illustrated a low-voltage area of HANA: 1 cm(2) (0, 10) endo, 25 cm(2) (22, 39) epi and LAVA: 1 cm(2) (0, 10) endo, 39 cm(2) (28, 51) epi. Manual maps performed better than automatic maps for delineating low-voltage area with a higher overlap with scar area on delayed enhancement magnetic resonance imaging (DE-MRI; 76% [66, 94] vs. 45% [35, 62]; P = 0.04). In addition, manual voltage maps also showed a higher overlap with location of LAVA (LAVA in normal voltage area: 3% [0, 9] vs. 35% [32, 41]; P scar, automatic voltage mapping may miss or minimize the electrical VT substrate. DE-MRI and manual LAVA-based voltage mapping are necessary to optimize scar delineation. Epicardial access is critical for mapping and ablation in this condition. © 2014 Wiley Periodicals, Inc.

  15. Epicardial mapping of ventricular fibrillation over the posterior descending artery and left posterior papillary muscle of the swine heart.

    Science.gov (United States)

    Nielsen, Thomas D; Huang, Jian; Rogers, Jack M; Killingsworth, Cheryl R; Ideker, Raymond E

    2009-01-01

    Recent studies suggest that during ventricular fibrillation (VF) epicardial vessels may be a site of conduction block and the posterior papillary muscle (PPM) in the left ventricle (LV) may be the location of a "mother rotor." The goal of this study was to obtain evidence to support or refute these possibilities. Epicardial activation over the posterior LV and right ventricle (RV) was mapped during the first 20 s of electrically induced VF in six open-chest pigs with a 504 electrode plaque covering a 20 cm(2) area centered over the posterior descending artery (PDA). The locations of epicardial breakthrough as well as reentry clustered in time and space during VF. Spatially, reentry occurred significantly more frequently over the LV than the RV in all 48 episodes, and breakthrough clustered near the PPM (p < 0.001). Significant temporal clustering occurred in 79% of breakthrough episodes and 100% of reentry episodes. These temporal clusters occurred at different times so that there was significantly less breakthrough when reentry was present (p < 0.0001). Conduction block occurred significantly more frequently near the PDA than elsewhere. The PDA is a site of epicardial block which may contribute to VF maintenance. Epicardial breakthrough clusters near the PPM. Reentry also clusters in space but at a separate site. The fact that breakthrough and reentry cluster at different locations and at different times supports the possibility of a drifting filament at the PPM so that at times reentry is present on the surface but at other times the reentrant wavefront breaks through to the epicardium.

  16. Epicardial pulmonary vein isolation: a long-term histologic and imaging animal study comparing cryothermy versus radiofrequency.

    Science.gov (United States)

    Rahmanian, Parwis B; Castillo, Javier G; Mehta, Davendra; Adams, David H; Filsoufi, Farzan

    2008-09-01

    Simplifications of the Cox-Maze procedure to treat atrial fibrillation (AF) include epicardial pulmonary vein (PV) isolation using various sources to create lines of conduction block. The creation of transmural lesions has been a concern. The heat-sink effect caused by blood flow has limited the effectiveness of unipolar radiofrequency and linear application of cryothermy, which should be abolished when clamp devices are used for PV isolation. The efficacy and safety of epicardial beating-heart PV isolation with clamp devices using cryothermy or bipolar radiofrequency energy was studied. Twelve domestic pigs underwent beating-heart epicardial PV isolation using cryothermy (n = 6) or radiofrequency (n = 6) energy. Follow-up was 30 days for 3 animals of each group and 90 days for the others. Lesions were assessed by epicardial pacing, cardiac magnetic resonance imaging (MRI), and histologic analysis. Immediate and long-term electrical isolation of PVs was achieved with both energy sources. Histologic analysis showed transmural lesions in all animals at 30 and 90 days. Cardiac MRI showed no evidence of PV stenosis or thrombus formation. Mean left atrial ejection fraction was 0.36 +/- 0.01, 0.36 +/- 0.02, and 0.36 +/- 0.01 at baseline and at 30 and 90 days, respectively (p = 0.360 and 0.230, respectively) and not significantly different with cryothermy or radiofrequency ablations. Beating-heart PV isolation using epicardial cryothermy or radiofrequency ablation produces transmural lesions with complete electrical conduction block, with low or no risk of endocardial thrombosis or PV stenosis. This approach may be useful for PVI in selected patients with AF caused by PV triggers.

  17. Hemodynamic diagnostics of epicardial coronary stenoses: in-vitro experimental and computational study

    Directory of Open Access Journals (Sweden)

    Effat Mohamed A

    2008-08-01

    Full Text Available Abstract Background The severity of epicardial coronary stenosis can be assessed by invasive measurements of trans-stenotic pressure drop and flow. A pressure or flow sensor-tipped guidewire inserted across the coronary stenosis causes an overestimation in true trans-stenotic pressure drop and reduction in coronary flow. This may mask the true severity of coronary stenosis. In order to unmask the true severity of epicardial stenosis, we evaluate a diagnostic parameter, which is obtained from fundamental fluid dynamics principles. This experimental and numerical study focuses on the characterization of the diagnostic parameter, pressure drop coefficient, and also evaluates the pressure recovery downstream of stenoses. Methods Three models of coronary stenosis namely, moderate, intermediate and severe stenosis, were manufactured and tested in the in-vitro set-up simulating the epicardial coronary network. The trans-stenotic pressure drop and flow distal to stenosis models were measured by non-invasive method, using external pressure and flow sensors, and by invasive method, following guidewire insertion across the stenosis. The viscous and momentum-change components of the pressure drop for various flow rates were evaluated from quadratic relation between pressure drop and flow. Finally, the pressure drop coefficient (CDPe was calculated as the ratio of pressure drop and distal dynamic pressure. The pressure recovery factor (η was calculated as the ratio of pressure recovery coefficient and the area blockage. Results The mean pressure drop-flow characteristics before and during guidewire insertion indicated that increasing stenosis causes a shift in dominance from viscous pressure to momentum forces. However, for intermediate (~80% area stenosis, which is between moderate (~65% and severe (~90% area stenoses, both losses were similar in magnitude. Therefore, guidewire insertion plays a critical role in evaluating the hemodynamic severity of

  18. Hemodynamic diagnostics of epicardial coronary stenoses: in-vitro experimental and computational study.

    Science.gov (United States)

    Banerjee, Rupak K; Ashtekar, Koustubh D; Helmy, Tarek A; Effat, Mohamed A; Back, Lloyd H; Khoury, Saeb F

    2008-08-27

    The severity of epicardial coronary stenosis can be assessed by invasive measurements of trans-stenotic pressure drop and flow. A pressure or flow sensor-tipped guidewire inserted across the coronary stenosis causes an overestimation in true trans-stenotic pressure drop and reduction in coronary flow. This may mask the true severity of coronary stenosis. In order to unmask the true severity of epicardial stenosis, we evaluate a diagnostic parameter, which is obtained from fundamental fluid dynamics principles. This experimental and numerical study focuses on the characterization of the diagnostic parameter, pressure drop coefficient, and also evaluates the pressure recovery downstream of stenoses. Three models of coronary stenosis namely, moderate, intermediate and severe stenosis, were manufactured and tested in the in-vitro set-up simulating the epicardial coronary network. The trans-stenotic pressure drop and flow distal to stenosis models were measured by non-invasive method, using external pressure and flow sensors, and by invasive method, following guidewire insertion across the stenosis. The viscous and momentum-change components of the pressure drop for various flow rates were evaluated from quadratic relation between pressure drop and flow. Finally, the pressure drop coefficient (CDPe) was calculated as the ratio of pressure drop and distal dynamic pressure. The pressure recovery factor (eta) was calculated as the ratio of pressure recovery coefficient and the area blockage. The mean pressure drop-flow characteristics before and during guidewire insertion indicated that increasing stenosis causes a shift in dominance from viscous pressure to momentum forces. However, for intermediate (approximately 80%) area stenosis, which is between moderate (approximately 65%) and severe (approximately 90%) area stenoses, both losses were similar in magnitude. Therefore, guidewire insertion plays a critical role in evaluating the hemodynamic severity of coronary

  19. Epicardial cardioverter-defibrillator implantation in a 4-month-old infant bridged to heart transplantation.

    Science.gov (United States)

    Carro, Cristina; Cereda, Alberto Francesco; Annoni, Giuseppe; Marianeschi, Stefano Maria

    2017-11-01

    Implantable cardioverter-defibrillator (ICD) is the gold standard therapy for the prevention of sudden cardiac death. Nevertheless, ICD placement in the paediatric population is still limited because of several technical difficulties. Several implantation techniques have been proposed but experience in infants with very low weight and less than 6 months is very limited. We herein describe a case of a minimally invasive ICD epicardial implantation in a 4-month-old infant weighing 5 kg. A diagnosis of arrhythmic cardiomyopathy with left ventricular non-compaction disease with ventricular tachycardia storms, QT prolongation and Wolff-Parkinson-White pattern was made. Antiarrhythmic drugs, radiofrequency ablation and sympathetic denervation were not effective. ICD implantation was successful allowing the infant to survive and bridging to heart transplantation. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. The Relationship Between Epicardial Adipose Tissue Volume and Coronary Plaque Structure in Diabetics

    Directory of Open Access Journals (Sweden)

    Gokhan Aksan

    2016-09-01

    Full Text Available Aim: Epicardial adipose tissue (EAT contributes to the development and progression of coronary artery disease (CAD. We aimed to evaluate the relationship between EAT volume, coronary atherosclerosis, coronary plaque burden, and plaque structure in diabetic patients. Material and Method: 196 DM patients who were evaluated with 128-slice dual- source coronary computed tomography angiography (CCTA for suspected CAD were included in the study. The CCTA examination was used to assess the total plaque burden, number of diseased segments, plaque characteristics, and EAT volume. The study population was divided into two groups [a CAD group (Group I and non-CAD group (Group II]. The plaque characteristics were analyzed on a per-segment basis. Results: EAT volume was found to be significantly higher among diabetic patients with CAD compared to those without CAD ( 138.7±49.1 ml vs 98.6±34.7 ml, p

  1. Troponin elevation in patients with various tachycardias and normal epicardial coronaries

    Directory of Open Access Journals (Sweden)

    Yousuf Kanjwal

    2008-08-01

    Full Text Available Troponin elevation is usually synonymous with acute coronary syndrome (ACS. Although sensitive for ACS, the elevation of serum troponin, in the absence of clinical evidence of ischemia, should prompt a search for other etiologies of myocardial necrosis. In fact, elevated values of troponin are correlated with myocardial necrosis even though it does not discriminate the mechanism involved. We report a series of seven patients (age range 18-67 years, who presented with complaints of chest discomfort and were found to have regular supraventricular tachycardia (5 patients and one patient each with atrial fibrillation and ventricular tachycardia. All these patients had elevated troponin I and underwent coronary angiography that revealed normal epicardial coronary arteries. This is first case series in which all patients underwent coronary angiography and none of the patients was hemodynamically unstable at the time of presentation. Patients with elevated troponin due to conditions other than ACS can receive inappropriate and delayed definitive diagnosis and treatment.

  2. Late Development of a Bronchocutaneous Fistula due to an Epicardial Cardioverter-Defibrillator Lead

    Directory of Open Access Journals (Sweden)

    Vasileios Patris

    2015-10-01

    Full Text Available Cutaneous complications caused by a pacemaker or defibrillator are widely documented, but the development of a bronchocutaneous fistula has never been described before. We report the case of a 79-year-old man who was admitted to our hospital because of a seemingly superficial cutaneous infection, externalized defibrillator leads, and hemoptysis. Bronchoscopical investigation proved the existence of the fistula, which connected the epicardium, the left main bronchus, and the aforementioned site of skin infection. The patient refused an operation for the complete removal of the epicardial defibrillator and was treated conservatively. This case demonstrated that the long-term presence of foreign bodies in the epicardium may cause serious complications

  3. Atrioesophageal Fistula after Minimally Invasive Video-Assisted Epicardial Ablation for Lone Atrial Fibrillation.

    Science.gov (United States)

    Kik, Charles; van Valen, Richard; Mokhles, Mostafa M; Bekkers, Jos A; Bogers, Ad J J C

    2017-09-01

    Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery. Some caution as to the low-risk character of this procedure seems to be realistic. Georg Thieme Verlag KG Stuttgart · New York.

  4. A preliminary study on atrial epicardial mapping signals based on Graph Theory.

    Science.gov (United States)

    Sun, Liqian; Yang, Cuiwei; Zhang, Lin; Chen, Ying; Wu, Zhong; Shao, Jun

    2014-07-01

    In order to get a better understanding of atrial fibrillation, we introduced a method based on Graph Theory to interpret the relations of different parts of the atria. Atrial electrograms under sinus rhythm and atrial fibrillation were collected from eight living mongrel dogs with cholinergic AF model. These epicardial signals were acquired from 95 unipolar electrodes attached to the surface of the atria and four pulmonary veins. Then, we analyzed the electrode correlations using Graph Theory. The topology, the connectivity and the parameters of graphs during different rhythms were studied. Our results showed that the connectivity of graphs varied from sinus rhythm to atrial fibrillation and there were parameter gradients in various parts of the atria. The results provide spatial insight into the interaction between different parts of the atria and the method may have its potential for studying atrial fibrillation. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  5. "Porcelain heart" cardiomyopathy secondary to hyperparathyroidism: radiographic, echocardiographic, and cardiac CT appearances.

    LENUS (Irish Health Repository)

    Freeman, James

    2010-11-01

    We report the radiographic, echocardiographic and cardiac CT appearances of \\'porcelain heart\\' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure.

  6. "Porcelain heart" cardiomyopathy secondary to hyperparathyroidism: radiographic, echocardiographic, and cardiac CT appearances.

    LENUS (Irish Health Repository)

    Freeman, James

    2012-02-01

    We report the radiographic, echocardiographic and cardiac CT appearances of \\'porcelain heart\\' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure.

  7. Echocardiographic characteristics of patients with acute heart failure requiring tolvaptan: a retrospective study.

    Science.gov (United States)

    Nakada, Yasuki; Okayama, Satoshi; Nakano, Tomoya; Ueda, Tomoya; Onoue, Kenji; Takeda, Yukiji; Kawakami, Rika; Horii, Manabu; Uemura, Shiro; Fujimoto, Shinichi; Saito, Yoshihiko

    2015-06-08

    No study has investigated the admission echocardiographic characteristics of acute heart failure (AHF) patients who are resistant to conventional diuretics and require tolvaptan. We retrospectively analyzed the echocardiographic characteristics of AHF patients who were resistant to conventional diuretics and took tolvaptan (tolvaptan group: 26 patients), and compared them to those who were sensitive to conventional diuretics (conventional group: 180 patients). The tolvaptan group had a higher left atrial volume index (96.0 ± 85.0 mL/m2 vs. 45.8 ± 25.9 mL/m2, p tolvaptan had no significant echocardiographic differences compared to the non-responders. The admission echocardiographic characteristics of AHF patients requiring tolvaptan included a larger left atrium, inferior vena cava, and more severe tricuspid regurgitation. Echocardiography may provide useful information for the early and appropriate initiation of tolvaptan.

  8. Association of chemerin mRNA expression in human epicardial adipose tissue with coronary atherosclerosis

    Directory of Open Access Journals (Sweden)

    Wang Linjie

    2011-10-01

    Full Text Available Abstract Background Growing evidence suggests that epicardial adipose tissue (EAT may play a key role in the pathogenesis and development of coronary artery disease (CAD by producing several inflammatory adipokines. Chemerin, a novel adipokine, has been reported to be involved in regulating immune responses and glucolipid metabolism. Given these properties, chemerin may provide an interesting link between obesity, inflammation and atherosclerosis. In this study, we sought to determine the relationship of chemerin expression in EAT and the severity of coronary atherosclerosis in Han Chinese patients. Methods Serums and adipose tissue biopsies (epicardial and thoracic subcutaneous were obtained from CAD (n = 37 and NCAD (n = 16 patients undergoing elective cardiac surgery. Gensini score was used to assess the severity of CAD. Serum levels of chemerin, adiponectin and insulin were measured by ELISA. Chemerin protein expression in adipose tissue was detected by immunohistochemistry. The mRNA levels of chemerin, chemR23, adiponectin and TNF-alpha in adipose tissue were detected by RT-PCR. Results We found that EAT of CAD group showed significantly higher levels of chemerin and TNF-alpha mRNA, and significantly lower level of adiponectin mRNA than that of NCAD patients. In CAD group, significantly higher levels of chemerin mRNA and protein were observed in EAT than in paired subcutaneous adipose tissue (SAT, whereas such significant difference was not found in NCAD group. Chemerin mRNA expression in EAT was positively correlated with Gensini score (r = 0.365, P P P P P P P > 0.05. Conclusions The expressions of chemerin mRNA and protein are significantly higher in EAT from patients with CAD in Han Chinese patients. Furthermore, the severity of coronary atherosclerosis is positive correlated with the level of chemerin mRNA in EAT rather than its circulating level.

  9. In vivo epicardial force and strain characterisation in normal and MLP-knockout murine hearts.

    Science.gov (United States)

    Michaelides, M; Georgiadou, S; Constantinides, C

    2015-07-01

    The study's objective is to quantify in vivo epicardial force and strain in the normal and transgenic myocardium using microsensors.Male mice (n = 39), including C57BL/6 (n = 26), 129/Sv (n = 5), wild-type (WT) C57  ×  129Sv (n = 5), and muscle LIM protein (MLP) knock-out (n = 3), were studied under 1.5% isoflurane anaesthesia. Microsurgery allowed the placement of two piezoelectric crystals at longitudinal epicardial loci at the basal, middle, and apical LV regions, and the independent (and/or concurrent) placement of a cantilever force sensor. The findings demonstrate longitudinal contractile and relaxation strains that ranged between 4.8-9.3% in the basal, middle, and apical regions of C57BL/6 mice, and in the mid-ventricular regions of 129/Sv, WT, and MLP mice. Measured forces ranged between 3.1-8.9 mN. The technique's feasibility is also demonstrated in normal mice following afterload, occlusion-reperfusion challenges.Furthermore, the total mid-ventricular forces developed in MLP mice were significantly reduced compared to the WT controls (5.9  ±  0.4 versus 8.9  ±  0.2 mN, p < 0.0001), possibly owing to the fibrotic and stiffer myocardium. No significant strain differences were noted between WT and MLP mice.The possibility of quantifying in vivo force and strain from the normal murine heart is demonstrated with a potential usefulness in the characterisation of transgenic and diseased mice, where regional myocardial function may be significantly altered.

  10. Reference intervals of echocardiographic measurements in healthy adult dairy goats.

    Directory of Open Access Journals (Sweden)

    Olga Szaluś-Jordanow

    Full Text Available To determine references intervals for echocardiographic measurements in adult dairy goats.125 clinically healthy, adult dairy goats aged 2-9 years, belonging to two breeds-Polish Fawn Improved (PFI, n = 64, weight range from 46 to 73, median of 58.5kg and Polish White Improved (PWI, n = 61, weight range from 48 to 80 kg, median of 67.9kg, closely related to French Alpine and Saanen, respectively.Non-invasive transthoracic echocardiography examination was performed in unsedated goats in a standing position. Two-dimensional, M-mode and pulsed wave Doppler measurements were obtained. A non-parametric method was applied for determination of reference intervals. Measurements for the two breeds were compared using an analysis of covariance to control for their body weight. Repeatability was assessed using a between-day coefficient of variation and a coefficient of repeatability.Following reference intervals were determined: aortic diameter in diastole 2.2-3.3, left atrial diameter in systole 2.5-4.3cm cm, the ratio of the left atrial diameter to the aortic diameter 0.96-1.5, right ventricular internal diameter in diastole 0.4-1.7cm, left ventricular internal diameter in systole and diastole 1.8-3.2 and 3.2-5.6 cm, respectively, inter-ventricular septum thickness in systole and diastole 0.7-1.5 and 0.5-1.1cm, respectively, left ventricular posterior-wall in systole and diastole 0.8-1.6 and 0.5-1.2cm, respectively, E-point to septal separation 0.3-0.8cm, left ventricular fractional shortening 28-54%, left ventricular ejection fraction 55-86%, maximum Left and Right Ventricular Outflow Tract velocity 80-140 cm/s and 70-130 cm/s, respectively Left and Right Ventricular Outflow Tract pressure gradient 2.5-8.9mmHg and 1.9-6.5mmHg, respectively. Most of the differences between the two breeds could be attributed to different body weight.The study provides echocardiographic reference intervals determined on the highest sample of apparently healthy goats so far

  11. Reference intervals of echocardiographic measurements in healthy adult dairy goats.

    Science.gov (United States)

    Szaluś-Jordanow, Olga; Czopowicz, Michał; Witkowski, Lucjan; Mickiewicz, Marcin; Frymus, Tadeusz; Markowska-Daniel, Iwona; Bagnicka, Emilia; Kaba, Jarosław

    2017-01-01

    To determine references intervals for echocardiographic measurements in adult dairy goats. 125 clinically healthy, adult dairy goats aged 2-9 years, belonging to two breeds-Polish Fawn Improved (PFI, n = 64, weight range from 46 to 73, median of 58.5kg) and Polish White Improved (PWI, n = 61, weight range from 48 to 80 kg, median of 67.9kg), closely related to French Alpine and Saanen, respectively. Non-invasive transthoracic echocardiography examination was performed in unsedated goats in a standing position. Two-dimensional, M-mode and pulsed wave Doppler measurements were obtained. A non-parametric method was applied for determination of reference intervals. Measurements for the two breeds were compared using an analysis of covariance to control for their body weight. Repeatability was assessed using a between-day coefficient of variation and a coefficient of repeatability. Following reference intervals were determined: aortic diameter in diastole 2.2-3.3, left atrial diameter in systole 2.5-4.3cm cm, the ratio of the left atrial diameter to the aortic diameter 0.96-1.5, right ventricular internal diameter in diastole 0.4-1.7cm, left ventricular internal diameter in systole and diastole 1.8-3.2 and 3.2-5.6 cm, respectively, inter-ventricular septum thickness in systole and diastole 0.7-1.5 and 0.5-1.1cm, respectively, left ventricular posterior-wall in systole and diastole 0.8-1.6 and 0.5-1.2cm, respectively, E-point to septal separation 0.3-0.8cm, left ventricular fractional shortening 28-54%, left ventricular ejection fraction 55-86%, maximum Left and Right Ventricular Outflow Tract velocity 80-140 cm/s and 70-130 cm/s, respectively Left and Right Ventricular Outflow Tract pressure gradient 2.5-8.9mmHg and 1.9-6.5mmHg, respectively. Most of the differences between the two breeds could be attributed to different body weight. The study provides echocardiographic reference intervals determined on the highest sample of apparently healthy goats so far enrolled.

  12. Cardiovascular Fat, Menopause, and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study.

    Science.gov (United States)

    El Khoudary, Samar R; Shields, Kelly J; Janssen, Imke; Hanley, Carrie; Budoff, Matthew J; Barinas-Mitchell, Emma; Everson-Rose, Susan A; Powell, Lynda H; Matthews, Karen A

    2015-09-01

    Cardiovascular risk increases in women after menopause. Mounting evidence demonstrates a role of cardiovascular fat (CF) in the pathogenesis of coronary heart disease, but no research has examined CF in relation to sex hormones or menopausal status in women. The objective was to determine the relationship between CF depots, menopausal status, and endogenous sex hormones. Cross-sectional and longitudinal study designs were used. The setting included the Study of Women's Health Across the Nation (SWAN) Heart and Cardiovascular Fat Ancillary Study. A total of 456 women (mean age, 50.75 y); 62% premenopausal/early perimenopausal, and 38% late peri-/postmenopausal. Menopausal status, endogenous sex hormones measured simultaneously with CF volumes, and circulating estradiol available 4.80 years (median) before CF measures. Volumes of CF (epicardial adipose tissue [EAT], paracardial adipose tissue [PAT], total heart adipose tissue [TAT = EAT + PAT], and aortic perivascular adipose tissue [PVAT]). In final models, late peri-/postmenopausal women had 9.88% more EAT, 20.72% more PAT, and 11.69% more TAT volumes than pre-/early perimenopausal women (P menopausal status. In final models, lower estradiol concentrations were associated with greater volumes of PAT and TAT (P obesity, and other covariates. Endogenous sex hormones are associated with CF. Perhaps CF plays a role in the higher risk of coronary heart disease reported in women after menopause.

  13. Echocardiography of congenital mitral valve disorders: echocardiographic-morphological comparisons.

    Science.gov (United States)

    Silverman, Norman H

    2014-12-01

    I surveyed our echocardiographic database of the years between 1998 and 2012 for congenital abnormalities of the mitral valve in patients over 14 years. A total of 249 patients with mitral valve abnormalities were identified. Abnormalities included clefts in the mitral valve in 58 patients, double orifice of the mitral valve in 19, mitral stenosis with two papillary muscles in 72, and mitral stenosis with one papillary muscle in 51 patients. Supravalvar rings were found in 35 patients with a single papillary muscle, and mitral stenoses with two papillary muscles were found in 22 patients. Mitral prolapse occurred in 44 patients and mitral valvar straddle in five patients. The patients were evaluated by all modalities of ultrasound available over the course of time. Although some lesions were isolated, there were many lesions in which more than one mitral deformity presented in the same patient. The patients are presented showing anatomical correlation with autopsy specimens, some of which came from the patients in this series, and others matched to show correlative anatomy. These lesions remain rare as a group and continue to have high morbidity and mortality.

  14. ECHOCARDIOGRAPHIC AND ERGOMETRIC DISTURBANCES IN DIABETICS WITH MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Ruzica Jankovic

    2003-10-01

    Full Text Available The aim of this study was to examine echocardiographic and ergometric disorders in non-insulin dependent diabetics with myocardial infarction and their correlation with appearing of left ventricular diastolic dysfunction.We examined 80 patients with myocardial infarction (MI treated in Military Hospital in Nis. They were divided into two groups: diabetics and non-diabetics. Doppler echocardiography was used for evaluating left ventricular diastolic function, and ergometric parameters were obtained by bicycle ergometer "Quinton" - Bruce protocol.Diastolic blood pressure and heart rate were higher in diabetics. Double product and power (68.75±13.5 and 50±14.97W were lower in diabetics. They also had frequent appearances of ST depression, dyspnea, palpitation, and rhythm disturbances in rest and after ergo test. Fatigue and pain were more prominent symptoms in non-diabetics. The Doppler mitral E wave was similar between these groups and the A wave was increased in diabetics (0.51 ±0.05 vs. 0.48±0.09, p<0.01. E/A ratio was significantly decreased in diabetics as a sign of worst diastolic dysfunction (1.14±0.09 vs. 1.26±0.17; p<0.01.

  15. Echocardiographic findings in power athletes abusing anabolic androgenic steroids.

    Science.gov (United States)

    Hajimoradi, Behzad; Kazerani, Hashem

    2013-03-01

    Anabolic androgenic steroids (AAS) abuse for improving physical appearance and performance in body builders is common and has been considered responsible for serious cardiovascular effects. Due to disagreement about cardiovascular side effects of these drugs in published articles, this case control study was designed to evaluate the echocardiographic findings in body builder athletes who are current and chronic abusers of these drugs. Body builder athletes with continuous practice for the preceding two years and were training at least twice weekly were selected and divided into AAS abuser and non user and compared with age and BMI matched non athletic healthy volunteers (15 cases in each group). There was no significant difference in left ventricular size or function either systolic or diastolic in comparison to cases and control groups. The only difference was in diastolic size of septum and free wall but observed differences were only significant (P = 0.05) between first (athletic with AAS abuser) and third group (non athletic and nonuser). The difference between the above-mentioned indexes were not significant between two groups of athletes. Observed differences in diastolic size of septum and free wall is in favor of that long term abuse of anabolic steroid results in accentuation of physiologic hypertrophy due to long term sport most probably due to higher rate pressure product. Furthermore long term abuse and supra pharmacologic doses do not have significant effect in size and left ventricular function.

  16. Saturated fat (image)

    Science.gov (United States)

    Saturated fat can raise blood cholesterol and can put you at risk for heart disease and stroke. You should ... limit any foods that are high in saturated fat. Sources of saturated fat include whole-milk dairy ...

  17. Epicardial adipose tissue thickness as a predictor of impaired microvascular function in patients with non-obstructive coronary artery disease.

    Science.gov (United States)

    Alam, Mohammed S; Green, Rachel; de Kemp, Robert; Beanlands, Rob S; Chow, Benjamin J W

    2013-10-01

    To determine if increased epicardial adipose tissue (EAT) measured by cardiac CT could be associated with impaired myocardial flow reserve (MFR) in patients with non-obstructive coronary artery disease (CAD). Studies have shown that EAT volume is related to epicardial obstructive CAD, myocardial ischemia and major adverse cardiac events. However, the association between EAT with coronary microvascular dysfunction and impaired MFR has not been well clarified. Consecutive patients who underwent Rb-82 positron emission tomography (PET), coronary artery calcium (CAC) scoring and non-invasive coronary computed tomography angiography (CCTA) were screened. PET scans were analysed for standard myocardial perfusion (MPI) and MFR. CCTA results were analysed and only patients with non-obstructive CAD ( 5.6 mm was optimal in detecting impaired MFR with a sensitivity and specificity of 81% and 92%, respectively. Increased EAT appears to be associated with impaired MFR. This parameter may help improve detection of patients at risk of microvascular dysfunction.

  18. Ventricular filling slows epicardial conduction and increases action potential duration in an optical mapping study of the isolated rabbit heart

    Science.gov (United States)

    Sung, Derrick; Mills, Robert W.; Schettler, Jan; Narayan, Sanjiv M.; Omens, Jeffrey H.; McCulloch, Andrew D.; McCullough, A. D. (Principal Investigator)

    2003-01-01

    INTRODUCTION: Mechanical stimulation can induce electrophysiologic changes in cardiac myocytes, but how mechanoelectric feedback in the intact heart affects action potential propagation remains unclear. METHODS AND RESULTS: Changes in action potential propagation and repolarization with increased left ventricular end-diastolic pressure from 0 to 30 mmHg were investigated using optical mapping in isolated perfused rabbit hearts. With respect to 0 mmHg, epicardial strain at 30 mmHg in the anterior left ventricle averaged 0.040 +/- 0.004 in the muscle fiber direction and 0.032 +/- 0.006 in the cross-fiber direction. An increase in ventricular loading increased average epicardial activation time by 25%+/- 3% (P action potential duration at 20% repolarization (APD20) but did at 80% repolarization (APD80), from 179 +/- 7 msec to 207 +/- 5 msec (P action potential duration by a load-dependent mechanism that may not involve stretch-activated channels.

  19. Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study

    Science.gov (United States)

    Madhavan, Malini; Venkatachalam, K. L.; Swale, Matthew J.; DeSimone, Christopher V.; Gard, Joseph J.; Johnson, Susan B.; Suddendorf, Scott H.; Mikell, Susan B.; Ladewig, Dorothy J.; Nosbush, Toni Grabinger; Danielsen, Andrew J.; Knudson, Mark; Asirvatham, Samuel J.

    2016-01-01

    Background Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. Methods Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n=10). Phase 2: Percutaneous epicardial ablation of GP was done in 6 dogs using the most efficacious modality identified in phase 1 using 2 novel catheters. Results Phase 1: DC in varying doses [blocking (7 -12μA), electroporation (300-500μA), ablation (3000- 7500μA)], radiofrequency ablation (25–50 W), ultrasound (1.5MHz), and alcohol (2-5ml) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5 and 5/7 GP sites. DC (500–5000μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation (VF) during DC ablation at 5000 μA. Programmed stimulation induced AF in 6 dogs pre-ablation and no atrial arrhythmia in 3, flutter in 1 and AF in 1 post-ablation. Heart rate, blood pressure, effective atrial refractory period and local atrial electrogram amplitude did not change significantly post-ablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. Conclusion Percutaneous epicardial ablation of GP using direct current and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of atrial fibrillation in order to minimize additional atrial myocardial ablation. PMID:26854009

  20. Off-pump epicardial ventricular reconstruction restores left ventricular twist and reverses remodeling in an ovine anteroapical aneurysm model.

    Science.gov (United States)

    Cheng, Yanping; Aboodi, Michael S; Annest, Lon S; Wechsler, Andrew S; Kaluza, Greg L; Granada, Juan F; Yi, Geng-Hua

    2014-07-01

    The loss of normal apical rotation is associated with left ventricular (LV) remodeling and systolic dysfunction in patients with congestive heart failure after myocardial infarction. The objective of the present study was to evaluate the effect of epicardial ventricular reconstruction, an off-pump, less-invasive surgical reshaping technique, on myocardial strain, LV twist, and the potential alteration of myocardial fiber orientation in an ovine model of LV anteroapical aneurysm. LV anteroapical myocardial infarction was induced by coil embolization of the left anterior descending artery. Eight weeks after occlusion, epicardial ventricular reconstruction was performed using left thoracotomy under fluoroscopic guidance in 8 sheep to completely exclude the scar. The peak systolic longitudinal/circumferential strains and LV twist were evaluated using speckle tracking echocardiography before (baseline), after device implantation, and at 6 weeks of follow-up. Epicardial ventricular reconstruction was completed in all sheep without any complications. Immediately after device implantation, LV twist significantly increased (4.18 ± 1.40 vs baseline 1.97 ± 1.92; P = .02). The ejection fraction had increased 17% and LV end-systolic volume had decreased 40%. The global longitudinal strain increased from -5.3% to -9.1% (P anteroapical aneurysm model. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery.

    Science.gov (United States)

    Yu, Yang; Gao, Ming-Xin; Li, Hai-Tao; Zhang, Fan; Gu, Cheng-Xiong

    2012-11-01

    Left ventricular aneurysm (LVA) is one of the serious complications after acute myocardial infarction. We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting (OPCAB). From June 2009 to April 2011, 31 patients with LVA had angina symptoms and ventricular arrhythmia. In all patients, circular and cross-shaped radiofrequency epicardial ablations were performed using unipolar ablation pen along the border between the aneurysm wall and normal cardiac tissue and in the central zone of the aneurysms, followed by a linear placation of ventricular aneurysms on beating heart. All the patients showed complete recovery. The average number of grafted vessels was 2.7 ± 1.3. Intraoperative examinations revealed that the ventricular arrhythmia was effectively controlled by radiofrequency ablation. All cases had been followed up for one year. Holter monitoring revealed a significant reduction in ventricular arrhythmias (P aneurysm and preoperative malignant arrhythmia, aneurysm repair plus epicardial radiofrequency ablation in OPCAB was found to be an effective and feasible therapeutic technique. However, medium- to long-term therapeutic efficacy of this method remains to be determined by future studies and observations.

  2. Association of chemerin mRNA expression in human epicardial adipose tissue with coronary atherosclerosis.

    Science.gov (United States)

    Gao, Xiuying; Mi, Shuhua; Zhang, Fuzhuang; Gong, Fengying; Lai, Yongqiang; Gao, Feng; Zhang, Xiaoxia; Wang, Linjie; Tao, Hong

    2011-10-07

    Growing evidence suggests that epicardial adipose tissue (EAT) may play a key role in the pathogenesis and development of coronary artery disease (CAD) by producing several inflammatory adipokines. Chemerin, a novel adipokine, has been reported to be involved in regulating immune responses and glucolipid metabolism. Given these properties, chemerin may provide an interesting link between obesity, inflammation and atherosclerosis. In this study, we sought to determine the relationship of chemerin expression in EAT and the severity of coronary atherosclerosis in Han Chinese patients. Serums and adipose tissue biopsies (epicardial and thoracic subcutaneous) were obtained from CAD (n = 37) and NCAD (n = 16) patients undergoing elective cardiac surgery. Gensini score was used to assess the severity of CAD. Serum levels of chemerin, adiponectin and insulin were measured by ELISA. Chemerin protein expression in adipose tissue was detected by immunohistochemistry. The mRNA levels of chemerin, chemR23, adiponectin and TNF-alpha in adipose tissue were detected by RT-PCR. We found that EAT of CAD group showed significantly higher levels of chemerin and TNF-alpha mRNA, and significantly lower level of adiponectin mRNA than that of NCAD patients. In CAD group, significantly higher levels of chemerin mRNA and protein were observed in EAT than in paired subcutaneous adipose tissue (SAT), whereas such significant difference was not found in NCAD group. Chemerin mRNA expression in EAT was positively correlated with Gensini score (r = 0.365, P correlation remained statistically significant (r = 0.357, P age, gender, BMI and waist circumference. Chemerin mRNA expression in EAT was also positively correlated with BMI (r = 0.305, P correlated with adiponectin mRNA expression in EAT (r = -0.322, P chemerin or adiponectin between the two groups. Likewise, neither serum chemerin nor serum adiponectin was associated with Gensini score (P > 0.05). The expressions of chemerin mRNA and

  3. Epicardial catheter-based ventricular reconstruction: a novel therapy for ischaemic heart failure with anteroapical aneurysm†

    Science.gov (United States)

    Cheng, Yanping; Aboodi, Michael S.; Wechsler, Andrew S.; Kaluza, Greg L.; Granada, Juan F.; Van Bladel, Kevin; Annest, Lon S.; Yi, Geng-Hua

    2013-01-01

    OBJECTIVES Surgical ventricular reconstruction has been used to treat ischaemic cardiomyopathy with large akinetic or dyskinetic areas. However, application of this approach requires a sternotomy, cardiopulmonary bypass and a left ventriculotomy. This study assessed the feasibility and efficacy of minimally invasive, off-pump, epicardial catheter-based ventricular reconstruction (ECVR) in an anteroapical aneurysm ovine model. METHODS Left ventricular (LV) anteroapical myocardial infarction was induced percutaneously by coil embolization of the left anterior descending coronary artery. Eight weeks after infarction, via mini left thoracotomy and without cardiopulmonary bypass, ECVR was performed in six sheep. The scar was excluded by placing anchor pairs on the LV epicardial anterior wall and the right ventricular side of the interventricular septum under fluoroscopic guidance. LV performance was evaluated before, immediately after device implantation and after 6 weeks by echocardiography. Terminal histopathology was performed. RESULTS ECVR was completed expeditiously in all animals without complications. Parameters obtained 6 weeks after device implantation were compared with baseline (pre-device). End-systolic volume was decreased by 38% (25.6 ± 6.1 ml vs baseline 41.2 ± 7.2 ml, P = 0.02) with preservation of stroke volume. Ejection fraction was significantly increased by 13% (48.5 ± 7% vs baseline 35.8 ± 7%, P = 0.02). The circumferential strain in the anterior septum (−7.67 ± 5.12% vs baseline −0.96 ± 2.22%, P = 0.03) and anterior wall (−9.01 ± 3.51% vs baseline −4.15 ± 1.36%, P = 0.01) were significantly improved. The longitudinal strain in apex was reversed (−3.08 ± 1.53% vs baseline 3.09 ± 3.39%, P = 0.01). Histopathology showed full endocardial healing over the anchors with appreciable reduction of the chronic infarct in the LV. CONCLUSIONS ECVR without cardiopulmonary bypass is a less invasive alternative to current standard therapies

  4. Epicardial catheter-based ventricular reconstruction: a novel therapy for ischaemic heart failure with anteroapical aneurysm.

    Science.gov (United States)

    Cheng, Yanping; Aboodi, Michael S; Wechsler, Andrew S; Kaluza, Greg L; Granada, Juan F; Van Bladel, Kevin; Annest, Lon S; Yi, Geng-Hua

    2013-12-01

    Surgical ventricular reconstruction has been used to treat ischaemic cardiomyopathy with large akinetic or dyskinetic areas. However, application of this approach requires a sternotomy, cardiopulmonary bypass and a left ventriculotomy. This study assessed the feasibility and efficacy of minimally invasive, off-pump, epicardial catheter-based ventricular reconstruction (ECVR) in an anteroapical aneurysm ovine model. Left ventricular (LV) anteroapical myocardial infarction was induced percutaneously by coil embolization of the left anterior descending coronary artery. Eight weeks after infarction, via mini left thoracotomy and without cardiopulmonary bypass, ECVR was performed in six sheep. The scar was excluded by placing anchor pairs on the LV epicardial anterior wall and the right ventricular side of the interventricular septum under fluoroscopic guidance. LV performance was evaluated before, immediately after device implantation and after 6 weeks by echocardiography. Terminal histopathology was performed. ECVR was completed expeditiously in all animals without complications. Parameters obtained 6 weeks after device implantation were compared with baseline (pre-device). End-systolic volume was decreased by 38% (25.6 ± 6.1 ml vs baseline 41.2 ± 7.2 ml, P = 0.02) with preservation of stroke volume. Ejection fraction was significantly increased by 13% (48.5 ± 7% vs baseline 35.8 ± 7%, P = 0.02). The circumferential strain in the anterior septum (-7.67 ± 5.12% vs baseline -0.96 ± 2.22%, P = 0.03) and anterior wall (-9.01 ± 3.51% vs baseline -4.15 ± 1.36%, P = 0.01) were significantly improved. The longitudinal strain in apex was reversed (-3.08 ± 1.53% vs baseline 3.09 ± 3.39%, P = 0.01). Histopathology showed full endocardial healing over the anchors with appreciable reduction of the chronic infarct in the LV. ECVR without cardiopulmonary bypass is a less invasive alternative to current standard therapies, reverses LV remodelling and improves cardiac

  5. Echocardiographic evaluation of wheelchair-bound basketball players.

    Science.gov (United States)

    Karagoz, Tevfik; Ozer, Sema; Bayrakci, Volga; Ergun, Nevin

    2003-08-01

    Cardiopulmonary function in sedentary men whose lower limbs have been immobilized for years has been shown to be markedly lower than normal. However, the cardiopulmonary function of paraplegics who regularly activate their upper limps and trunk has been suggested to be almost normal in a few studies. The purpose of the present study was to evaluate the left ventricular dimensions, left ventricular mass, systolic and diastolic function in adolescent wheelchair-bound basketball players using echocardio-graphy, and to compare the results with those of sedentary adolescents unable to use their lower extremities and the results of able bodied controls. The study group consisted of 22 male adolescent high school students who were unable to use their lower extremities: 11 were members of a high school basketball team who had been regularly playing basketball for at least 2 years, and 11 were sedentary adolescents none of whom was engaged in any kind of routine training program. The control group consisted of 11 healthy able-bodied male adolescents of similar age. There were no significant differences in left ventricular dimensions and wall thickness, aortic root, left atrium diameters, or left ventricular filling characteristics between the three groups. Wheelchair-bound basketball players had increased left ventricular ejection fraction and shortening fraction compared with the sedentary unable-bodied individuals. Although left ventricular ejection fractions were significantly lower than in normal adolescents, all ejection fraction values except one were within the normal limits in the unable-bodied basketball players. The results of the present study suggest that an upper extremity exercise program and sports such as basketball can improve the cardiac functions and additional echocardiographic functions of people unable to use their lower extremities, potentially to normal levels.

  6. Echocardiographic and Hemodynamic Predictors of Mortality in Idiopathic Pulmonary Fibrosis

    Science.gov (United States)

    Rivera-Lebron, Belinda N.; Forfia, Paul R.; Kreider, Maryl; Lee, James C.; Holmes, John H.

    2013-01-01

    Background: Idiopathic pulmonary fibrosis (IPF) can lead to the development of pulmonary hypertension, which is associated with an increased risk of death. In pulmonary arterial hypertension, survival is directly related to the capacity of the right ventricle to adapt to elevated pulmonary vascular load. The relative importance of right ventricular function in IPF is not well understood. Our objective was to evaluate right ventricular echocardiographic and hemodynamic predictors of mortality in a cohort of patients with IPF referred for lung transplant evaluation. Methods: We performed a retrospective cohort study of 135 patients who met 2011 American Thoracic Society/European Respiratory Society criteria for IPF and who were evaluated for lung transplantation at the Hospital of the University of Pennsylvania. Results: Right ventricle:left ventricle diameter ratio (hazard ratio [HR], 4.5; 95% CI, 1.7-11.9), moderate to severe right atrial and right ventricular dilation (HR, 2.9; 95% CI, 1.4-5.9; and HR, 2.7; 95% CI, 1.4-5.4, respectively) and right ventricular dysfunction (HR, 5.5; 95% CI, 2.6-11.5) were associated with an increased risk of death. Higher pulmonary vascular resistance was also associated with increased mortality (HR per 1 Wood unit, 1.3; 95% CI, 1.1-1.5). These risk factors were independent of age, sex, race, height, weight, FVC, and lung transplantation status. Other hemodynamic indices, such as mean pulmonary artery pressure and cardiac index, were not associated with outcome. Conclusions: Right-sided heart size and right ventricular dysfunction measured by echocardiography and higher pulmonary vascular resistance by invasive hemodynamic assessment predict mortality in patients with IPF evaluated for lung transplantation. PMID:23450321

  7. Dietary lipids: less fat or best fat?

    Directory of Open Access Journals (Sweden)

    Chardigny Jean-Michel

    2013-03-01

    Full Text Available Obesity and overweight occurrence is growing around the word. This is often considered as a consequence of high fat diets, and some recommendations encourage ‘‘light’’ diets, including low fat intake. However, most trials with low fat intake do not demonstrate any benefit and could be worse than low carbohydrate diets. The key role of insulin could explain that eating fat do not make body fat. On the other hand, several unbalanced fatty acid intake are reported, i.e. saturated/mononunsaturated fatty acids and w6/w3 polyunsaturated fatty acids. Thus, fat intake could be improved in this respect. Moreover, the molecular and supramolecular structures of fat in food are new challenges to address in order to ameliorate the recommendations for healthy diets.

  8. Epicardial adipose tissue is increased in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Lipson, Aliza; Alexopoulos, Nikolaos; Hartlage, Gregory Randell; Arepalli, Chesnal; Oeser, Annette; Bian, Aihua; Gebretsadik, Tebeb; Shintani, Ayumi; Stillman, Arthur E; Stein, C Michael; Raggi, Paolo

    2012-08-01

    Morbidity and mortality secondary to premature cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) remain significant issues. The pathogenesis of CVD in SLE patients has not been fully explored. Epicardial adipose tissue (EAT) is believed to contribute to atherosclerosis development, through a paracrine and systemic inflammatory effect. We measured EAT volume in 162 SLE patients and 86 matched controls to assess the association of EAT with markers of atherosclerosis, cardiovascular risk and immunoactivation. Clinical and laboratory characteristics collected included anthropomorphic measures, disease activity and damage indices, blood pressure measurement, lipid profile, inflammatory indices, adipokine levels and measures of adiposity. Coronary artery calcium (CAC) and EAT volume were measured using non-contrast cardiac computed tomography. EAT volume was greater in patients with SLE [(mean ± SD) 96.8 ± 45.9 cm(3)] than controls (78.2 ± 40.7 cm(3); P = 0.001). The EAT volume was 31% larger (95% CI, 16.5%-47.4%) in SLE patients than controls (P cardiovascular effects in SLE via an increase in EAT volume, a marker of risk in the general population. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Acute coronary syndrome without critical epicardial coronary disease: prevalence, characteristics, and outcome.

    Science.gov (United States)

    Ohlow, Marc-Alexander; Wong, Vincent; Brunelli, Michele; von Korn, Hubertus; Farah, Ahmed; Memisevic, Nedim; Richter, Stefan; Tukhiashvili, Ketevan; Lauer, Bernward

    2015-02-01

    Absence of significant epicardial coronary artery stenosis in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to retrospectively analyze the clinical characteristics and the outcome of such patients. All patients with myocardial infarction (MI) but without significant coronary artery stenosis (≥50%) on angiography from May 2002 to April 2011 were compared with patients undergoing percutaneous coronary intervention due to non-ST-elevation MI (NSTEMI). Of 4311 consecutive patients with MI, 272 patients (6.3%) did not show significant coronary artery stenosis (group I) and were compared with 253 NSTEMI patients (group II). Younger age (61.9±14.0 vs 65.4±12.0 years; P=.003), female sex (49.3% vs 28.9%; Pcoronary stenosis accounts for a minority of patients presenting with MI and is associated with a better outcome compared to patients with NSTEMI, and the prognosis is inversely related to the troponin level. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Collagen XII Contributes to Epicardial and Connective Tissues in the Zebrafish Heart during Ontogenesis and Regeneration.

    Science.gov (United States)

    Marro, Jan; Pfefferli, Catherine; de Preux Charles, Anne-Sophie; Bise, Thomas; Jaźwińska, Anna

    2016-01-01

    Zebrafish heart regeneration depends on cardiac cell proliferation, epicardium activation and transient reparative tissue deposition. The contribution and the regulation of specific collagen types during the regenerative process, however, remain poorly characterized. Here, we identified that the non-fibrillar type XII collagen, which serves as a matrix-bridging component, is expressed in the epicardium of the zebrafish heart, and is boosted after cryoinjury-induced ventricular damage. During heart regeneration, an intense deposition of Collagen XII covers the outer epicardial cap and the interstitial reparative tissue. Analysis of the activated epicardium and fibroblast markers revealed a heterogeneous cellular origin of Collagen XII. Interestingly, this matrix-bridging collagen co-localized with fibrillar type I collagen and several glycoproteins in the post-injury zone, suggesting its role in tissue cohesion. Using SB431542, a selective inhibitor of the TGF-β receptor, we showed that while the inhibitor treatment did not affect the expression of collagen 12 and collagen 1a2 in the epicardium, it completely suppressed the induction of both genes in the fibrotic tissue. This suggests that distinct mechanisms might regulate collagen expression in the outer heart layer and the inner injury zone. On the basis of this study, we postulate that the TGF-β signaling pathway induces and coordinates formation of a transient collagenous network that comprises fibril-forming Collagen I and fiber-associated Collagen XII, both of which contribute to the reparative matrix of the regenerating zebrafish heart.

  11. Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants.

    Science.gov (United States)

    Silvetti, Massimo Stefano; Drago, Fabrizio; De Santis, Antonella; Grutter, Giorgia; Ravà, Lucilla; Monti, Lidia; Fruhwirth, Rodolfo

    2007-06-01

    Endocardial (ENDO) or epicardial (EPI) pacing systems are implanted in infants but it remains unclear which system should be preferred. We evaluated the results of children AAIR) in 2 (all EPI). Follow-up (FU) was 4.5 +/- 3.5 (range 0.3-13) years: 15 pacing system failures occurred among the 56 patients (26%) after 4.5 +/- 3.2 years, with a significantly reduced success rate for EPI (21-fold increase of the risk of failure) and complex CHD. Also in patients without surgery for CHD, EPI showed a worse outcome. Among the 91 leads implanted, failures occurred more significantly in EPI (18% of atrial, 24% of ventricular leads) than in ENDO (5% of ventricular leads). No venous occlusion was found at FU. Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.

  12. Knockdown of Zebrafish Blood Vessel Epicardial Substance Results in Incomplete Retinal Lamination

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    Yu-Ching Wu

    2014-01-01

    Full Text Available Cell polarity during eye development determines the normal retinal lamination and differentiation of photoreceptor cells in the retina. In vertebrates, blood vessel epicardial substance (Bves is known to play an important role in the formation and maintenance of the tight junctions essential for epithelial cell polarity. In the current study, we generated a transgenic zebrafish Bves (zbves promoter-EGFP zebrafish line to investigate the expression pattern of Bves in the retina and to study the role of zbves in retinal lamination. Immunostaining with different specific antibodies from retinal cells and transmission electron microscopy were used to identify the morphological defects in normal and Bves knockdown zebrafish. In normal zebrafish, Bves is located at the apical junctions of embryonic retinal neuroepithelia during retinogenesis; later, it is strongly expressed around inner plexiform layer (IPL and retinal pigment epithelium (RPE. In contrast, a loss of normal retinal lamination and cellular polarity was found with undifferentiated photoreceptor cells in Bves knockdown zebrafish. Herein, our results indicated that disruption of Bves will result in a loss of normal retinal lamination.

  13. Echocardiographic-Fluoroscopic Fusion Imaging in Transseptal Puncture: A New Technology for an Old Procedure.

    Science.gov (United States)

    Faletra, Francesco F; Biasco, Luigi; Pedrazzini, Giovanni; Moccetti, Marco; Pasotti, Elena; Leo, Laura Anna; Cautilli, Giorgio; Moccetti, Tiziano; Monaghan, Mark J

    2017-09-01

    In an era of catheter-based structural heart disease and left-side electrophysiologic interventions, transseptal puncture (TSP) is probably the most common transcatheter procedure. Experienced interventional cardiologists and electrophysiologists may safely perform TSP using fluoroscopic guidance alone. However, at present TSP is usually the first step in complex percutaneous catheter-based structural heart disease procedures and necessitate a precise site-specific TSP. Thus, in these procedures most interventional cardiologists perform TSP under fluoroscopic and two- or three-dimensional transesophageal echocardiographic guidance. The EchoNavigator system may provide a solution by fusing fluoroscopic and transesophageal echocardiographic images. In this review, the authors describe advantages and limitations of this new imaging system in guiding TSP and suggest specific echocardiographic-fluoroscopic fusion imaging perspectives that may facilitate TSP, making it potentially easier and safer. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  14. Echocardiographic evaluation of patients with subacute sclerosing panencephalitis

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    Derya Çimen

    2014-03-01

    Full Text Available Objective: Subacute sclerosing panencephalitis is a slowly progressive, inflammatory and neurodegenerative disease caused by virus infection in the central nervous system. Since there are a limited number of studies in the literature evaluating the cardiovascular functions of patients with SSPE, the present study evaluates the patients with SSPE using tissue Doppler echocardiography and compares them between the control group in order to shed some light on the subject. Methods: The study is a prospective observational study. 49 patients (17 female, 32 male with SSPE were included in the study. Patients were divided into two groups: Stage 2 (n=29 and Stage 3 (n=20. Echocardiographic data were compared with a control group of 26 which is the same average age. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. Results: Sinus tachycardia ( >100 beats/min in children was detected in nineteen (38.7% patients. There were not significant differences between parameters of systolic and diastolic function of the heart. Stage 2 group, EF: 69.9±6.4; SF: 39.2±5.58; and MPI (mitral: 0.38±0.03 and MPI (tricuspid: 0.39±0.10. And in the Stage 3 group, EF: 68.5±7.0, SF: 37.8±5.34, MPI (mitral: 0.37±0.09 and MPI (tricuspid: 0.38±0.12. In the control group EF:70.96±5.54; SF:39.96±5.05 and MPI(mitral: 0.35±0.06 MPI (tricuspid:0.36±0.04 and statistically meaningful differences were not found between patients and control groups (p >0.05. Conclusion: Cardiac functions may be preserved and cardiac functions constitute no significant risks of mortality in the advanced stages of patients with Subacute sclerosing panencephalitis, which is a group of chronic and bedridden patients.

  15. Echocardiographic Monitoring of Intracardiac Hemodynamics in Neonatal Respiratory Distress Syndrome

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    S. A. Perepelitsa

    2010-01-01

    Full Text Available Objective: to perform an early neonatal ultrasound study of intracardiac hemodynamics in premature neonates with respiratory distress syndrome (RDS during mechanical ventilation. Subjects and methods. The paper presents the results of ultrasound study of intracardiac hemodynamics in 51 premature neonates. Two patient groups were identified. Group 1 comprised 34 infants with severe RDS who received the exogenous surfactant Curosurf and Group 2 consisted of 17 apparently healthy premature newborn infants. Results. Functional tension of the cardiovascular system was characterized for premature neonates with RDS. There were signs of left ventricular systolic dysfunction within the first 24 hours of life and those of right ventricular dysfunction by day 5 of postnatal age. Within 5 days of life, there were echocardiographic signs of pump dysfunction of both ventricles: stroke volume, cardiac index, and blood minute volume. Analysis of changes in peak blood flow velocity and peak pressure gradient across the atrioventricular valves of the right and left ventricles indicated that 17.6% of the children showed increases in peak blood flow velocity and tricuspid valve pressure gradient in the systolic phase. The greatest peak blood flow velocity changes were recorded in the pulmonary artery trunk. By day 5 of life, signs of pulmonary hypertension concurrent with hydropericardium remained in 29.4% of cases. RDS – was shown to be accompanied by higher Qp/Qs ratio in premature neonates. The lower index was attended by the alleviated signs of respiratory failure. In RDS, mainly left-to-right blood shunt was accomplished through the open oval window, but the shunt intensity decreased when the pathological process was resolved in the lung. The functioning patent ductus arteriosus was hemodynami-cally significant in none case. Conclusion. The premature neonates with RDS were found to have intracardiac hemo-dynamic changes. By day 5 of postnatal age, there was

  16. Exercise Training Reduces Intrathoracic Fat Regardless of Defective Glucose Tolerance.

    Science.gov (United States)

    Honkala, Sanna M; Motiani, Kumail K; Eskelinen, Jari-Joonas; Savolainen, Anna; Saunavaara, Virva; Virtanen, Kirsi A; Löyttyniemi, Eliisa; Kapanen, Jukka; Knuuti, Juhani; Kalliokoski, Kari K; Hannukainen, Jarna C

    2017-07-01

    Epicardial (EAT) and pericardial (PAT) fat masses and myocardial triglyceride content (MTC) are enlarged in obesity and insulin resistance. We studied whether the high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) similarly decrease ectopic fat in and around the heart and whether the decrease is similar in healthy subjects and subjects with defective glucose tolerance (DGT). A total of 28 healthy men (body mass index = 20.7-30.0 kg·m, age = 40-55 yr) and 16 men with DGT (body mass index = 23.8-33.5 kg·m, age = 43-53 yr) were randomized into HIIT and MICT interventions for 2 wk. EAT and PAT were determined by computed tomography and MTC by H-MRS. At baseline, DGT subjects had impaired aerobic capacity and insulin sensitivity and higher levels of whole body fat, visceral fat, PAT, and EAT (P HIIT increased aerobic capacity (HIIT = 6%, MICT = 0.3%; time × training P = 0.007) and tended to improve insulin sensitivity (HIIT = 24%, MICT = 8%) as well as reduce MTC (HIIT = -42%, MICT = +23%) (time × training P = 0.06, both) more efficiently compared with MICT, and without differences in the training response between the healthy and the DGT subjects. However, both training modes decreased EAT (-5%) and PAT (-6%) fat (time P HIIT and MICT effectively reduce EAT and PAT in healthy and DGT subjects, whereas HIIT seems to be superior as regards improving aerobic capacity, whole-body insulin sensitivity, and MTC.

  17. Echocardiographic predictors of mortality in patients with pulmonary hypertension and cardiopulmonary comorbidities.

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    Johannes Steiner

    Full Text Available We aimed to identify the echocardiographic measures associated with survival in a patient population with a high prevalence of co-morbid cardiovascular and pulmonary disease that have significantly elevated estimated pulmonary artery systolic pressures (ePASP.Pulmonary hypertension (PH is a clinical feature of several cardiopulmonary diseases that are prevalent among elderly. While certain echocardiographic parameters have been shown to be important in the prognosis in specific PH groups, the prognostic relevance of echocardiographic characteristics in a cohort with multiple cardiopulmonary comorbidities is unclear.We retrospectively identified 152 patients with ePASP > 60 mmHg by echocardiography over a five year period (6/2006-11/2011 and followed until 4/2013. Candidate clinical and echocardiographic characteristics suggestive of PH severity were compared between deceased and surviving subpopulations. Cox proportional hazard modeling was used to identify echocardiographic predictors of death adjusted for age and clinical characteristics.This was a predominantly elderly (age 78.8 ± 10.2 years, male (98.7% cohort with several cardiopulmonary comorbidities. Overall mortality was high (69.7%, median survival 129 days. After adjusting for age and clinical characteristics, decreased right ventricular (RV systolic function assessed by tricuspid annular plane systolic excursion (HR 0.56, 95% CI 0.33-0.96, p = 0.034 and increased RV thickness (HR: 4.34, 95% CI: 1.49-12.59, p = 0.007 were independently associated with mortality. In contrast, left ventricular systolic function, left ventricular diastolic parameters, ePASP, or echo-derived pulmonary vascular resistance (PVR were not associated with increased mortality.In a cohort of patients with PH and high prevalence of cardio-pulmonary comorbidities, RV systolic function and hypertrophy are associated with mortality and may be the most relevant echocardiographic markers for prognosis.

  18. Correlation between echocardiographic and morphological investigations of lesions of the tricuspid valve diagnosed during fetal life

    Science.gov (United States)

    Oberhoffer, Renate; Cook, Andrew C; Lang, Dieter; Sharland, Gurleen; Allan, Lindsey D; Fagg, Nuala L K; Anderson, Robert H

    1992-01-01

    Objective—To assess the degree of agreement between the fetal echocardiographic and postmortem examination of hearts from fetuses with severe malformations of the tricuspid valve. Design—A retrospective study to analyse echocardiographic recordings and make comparisons with postmortem findings. Setting—Tertiary referral centre for fetal echocardiography. Institute for cardiac morphology. Patients—19 cases shown to have severe malformation of the tricuspid valve by fetal echocardiography that died in the prenatal or neonatal period. Main outcome measures—Correlations between morphology and measurements made at echocardiography and necropsy. Results—The echocardiographic diagnosis was Ebstein's malformation in seven and tricuspid valvar dysplasia in 12 fetuses. These findings were confirmed in six and eight cases at necropsy. In one false positive diagnosis of Ebstein's malformation, necropsy showed dysplasia of the leaflets of the tricuspid valve without displacement. In four cases with the echocardiographic diagnosis of valvar dysplasia, necropsy showed displacement, the hallmark of Ebstein's malformation. Associated malformations that are known to worsen prognosis were predicted correctly by echocardiography. Taking the mean duration of four weeks between echocardiographic and postmortem investigations, both methods showed cardiomegaly causing lung hypoplasia, right atrial dilatation, and relative hypoplasia of the pulmonary trunk, morphometric factors that may be responsible for the poor outcome. Mostly good agreement existed between the echocardiographic and postmortem measurements if cases with an interval of more than eight weeks between the measurements were excluded. Conclusion Fetal echocardiography was proved to be a reliable technique in differentiating the variants of tricuspid valvar disease, in diagnosing associated cardiac lesions, and in predicting quantitative factors that can define the subsequent outcome. PMID:1467052

  19. Comparative integromics on FAT1, FAT2, FAT3 and FAT4.

    Science.gov (United States)

    Katoh, Yuriko; Katoh, Masaru

    2006-09-01

    WNT5A, WNT5B, WNT11, FZD3, FZD6, VANGL1, VANGL2, DVL1, DVL2, DVL3, PRICKLE1, PRICKLE2, ANKRD6, NKD1, NKD2, DAAM1, DAAM2, CELSR1, CELSR2, CELSR3, ROR1 and ROR2 are planar cell polarity (PCP) signaling molecules implicated in the regulation of cellular polarity, convergent extension, and invasion. FAT1, FAT2, FAT3 and FAT4 are Cadherin superfamily members homologous to Drosophila Fat, functioning as a positive regulator of PCP in the Drosophila wing. Complete coding sequence (CDS) for human FAT1 (NM_005245.3) and FAT2 (NM_001447.1) are available, while artificial CDS for human FAT3 (XM_926199 and XM_936538) and partial CDS for FAT4 (NM_024582.2). Here, complete CDS of human FAT3 and FAT4 were determined by using bioinformatics and human intelligence (Humint). FAT3 gene, consisting of 26 exons, encoded a 4557-aa protein with extracellular 33 Cadherin repeats, one Laminin G (LamG) domain and two EGF domains. FAT4 gene encoded a 4924-aa protein with extracellular 34 Cadherin repeats, two LamG domains and three EGF domains. Cytoplasmic VCSVxPxLP and SDYxS motifs were identified as novel motifs conserved among FAT1, FAT2 and FAT3 orthologs. Domain architecture comparison and phylogenetic analysis revealed that FAT1, FAT2 and FAR3 were divergent from FAT4. FAT1-MTNR1A locus at 4q35.2 and FAT3-MTNR1B locus at 11q14.3-q21 were paralogous regions within the human genome. FAT1 mRNA was expressed in embryonic stem (ES) cells, neural tissues, gastric cancer, pancreatic cancer, colorectal cancer, breast cancer, lung cancer and brain tumors. FAT2 mRNA was expressed in infant brain, cerebellum, gastric cancer, pancreatic cancer, ovarian cancer, esophageal cancer, skin squamous cell carcinoma, head and neck cancer. FAT3 mRNA was expressed in ES cells, primitive neuroectoderm, fetal brain, infant brain, adult neural tissues and prostate. FAT4 mRNA was expressed in fetal brain, infant brain, brain tumor and colorectal cancer. FAT family members were revealed to be targets of systems

  20. Prosthetic mitral inflow mimicking severe aortic regurgitation (revisited). An echocardiographic challenge.

    Science.gov (United States)

    Battisha, Ayman; Abdelhaleem, Ahmed; Srialluri, Swetha; Arisha, Mohammed J; Farhoud, Adel A; Kamel, Hassan; Mahmoud, Mohamed S; Tageldin, Omar; Salama, Ahmed Y; Ibeche, Bashar; Nanda, Navin C

    2017-10-01

    Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame-by-frame analysis of two-dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR. © 2017, Wiley Periodicals, Inc.

  1. Enhanced Electrical Integration of Engineered Human Myocardium via Intramyocardial versus Epicardial Delivery in Infarcted Rat Hearts.

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    Kaytlyn A Gerbin

    Full Text Available Cardiac tissue engineering is a promising approach to provide large-scale tissues for transplantation to regenerate the heart after ischemic injury, however, integration with the host myocardium will be required to achieve electromechanical benefits. To test the ability of engineered heart tissues to electrically integrate with the host, 10 million human embryonic stem cell (hESC-derived cardiomyocytes were used to form either scaffold-free tissue patches implanted on the epicardium or micro-tissue particles (~1000 cells/particle delivered by intramyocardial injection into the left ventricular wall of the ischemia/reperfusion injured athymic rat heart. Results were compared to intramyocardial injection of 10 million dispersed hESC-cardiomyocytes. Graft size was not significantly different between treatment groups and correlated inversely with infarct size. After implantation on the epicardial surface, hESC-cardiac tissue patches were electromechanically active, but they beat slowly and were not electrically coupled to the host at 4 weeks based on ex vivo fluorescent imaging of their graft-autonomous GCaMP3 calcium reporter. Histologically, scar tissue physically separated the patch graft and host myocardium. In contrast, following intramyocardial injection of micro-tissue particles and suspended cardiomyocytes, 100% of the grafts detected by fluorescent GCaMP3 imaging were electrically coupled to the host heart at spontaneous rate and could follow host pacing up to a maximum of 300-390 beats per minute (5-6.5 Hz. Gap junctions between intramyocardial graft and host tissue were identified histologically. The extensive coupling and rapid response rate of the human myocardial grafts after intramyocardial delivery suggest electrophysiological adaptation of hESC-derived cardiomyocytes to the rat heart's pacemaking activity. These data support the use of the rat model for studying electromechanical integration of human cardiomyocytes, and they

  2. Lagrangian displacement tracking using a polar grid between endocardial and epicardial contours for cardiac strain imaging.

    Science.gov (United States)

    Ma, Chi; Varghese, Tomy

    2012-04-01

    Accurate cardiac deformation analysis for cardiac displacement and strain imaging over time requires Lagrangian description of deformation of myocardial tissue structures. Failure to couple the estimated displacement and strain information with the correct myocardial tissue structures will lead to erroneous result in the displacement and strain distribution over time. Lagrangian based tracking in this paper divides the tissue structure into a fixed number of pixels whose deformation is tracked over the cardiac cycle. An algorithm that utilizes a polar-grid generated between the estimated endocardial and epicardial contours for cardiac short axis images is proposed to ensure Lagrangian description of the pixels. Displacement estimates from consecutive radiofrequency frames were then mapped onto the polar grid to obtain a distribution of the actual displacement that is mapped to the polar grid over time. A finite element based canine heart model coupled with an ultrasound simulation program was used to verify this approach. Segmental analysis of the accumulated displacement and strain over a cardiac cycle demonstrate excellent agreement between the ideal result obtained directly from the finite element model and our Lagrangian approach to strain estimation. Traditional Eulerian based estimation results, on the other hand, show significant deviation from the ideal result. An in vivo comparison of the displacement and strain estimated using parasternal short axis views is also presented. Lagrangian displacement tracking using a polar grid provides accurate tracking of myocardial deformation demonstrated using both finite element and in vivo radiofrequency data acquired on a volunteer. In addition to the cardiac application, this approach can also be utilized for transverse scans of arteries, where a polar grid can be generated between the contours delineating the outer and inner wall of the vessels from the blood flowing though the vessel.

  3. Comparison of outcomes of percutaneous coronary intervention of ostial versus nonostial narrowing of the major epicardial coronary arteries.

    Science.gov (United States)

    Mavromatis, Kreton; Ghazzal, Ziyad; Veledar, Emir; Diamandopoulos, Laura; Weintraub, William S; Douglas, John S; Kalynych, Anna M

    2004-09-01

    Outcomes of percutaneous coronary intervention (PCI) of the ostia of the major epicardial coronary arteries in the modern era of stenting have not been clearly defined. We evaluated data from all PCIs performed from 1998 to 2001 in the proximal segments of the major epicardial coronary arteries entered into a large cardiac database and compared ostial with nonostial PCI outcomes. Of 2,484 patients who underwent PCI of a proximal coronary artery (left anterior descending, left circumflex, or right coronary), 223 patients had ostial narrowing and 2,261 patients had proximal, nonostial narrowing. Baseline characteristics were similar between the 2 groups, except that patients with ostial narrowing tended to be older and have shorter narrowings than did patients with nonostial narrowings. Stenting occurred in 89% of all patients and was similar in patients with ostial or nonostial narrowings. Procedural success was the same for ostial and nonostial PCI (96% vs 95%, p = 0.95). One-year event-free survival rate was lower in patients who underwent ostial PCI (69% vs 80%, p = 0.0019), largely due to a greater need for repeat PCI (19% vs 10%, p <0.0001). Multivariate analysis showed that ostial location, age, angina class, and number of diseased vessels were independent predictors of the occurrence of cardiac events. PCI of ostial narrowings of the major epicardial coronary arteries was relatively safe. However, at 1 year, patients who underwent ostial PCI had an increased rate of repeat revascularization compared with patients who underwent nonostial, proximal PCI. Copyright 2004 Excerpta Medica, Inc.

  4. Facts about monounsaturated fats

    Science.gov (United States)

    ... health. How Monounsaturated Fats Affect Your Health Monounsaturated fats are good for your health in several ways: They can help lower your LDL (bad) cholesterol level. Cholesterol is a soft, waxy substance ...

  5. Dietary fat and children

    Science.gov (United States)

    Some fat in the diet is needed for normal growth and development. However, many conditions such as obesity, heart disease, and diabetes are linked to eating too much fat or eating the wrong types of ...

  6. Segmentation of the heart muscle in 3-D pediatric echocardiographic images.

    NARCIS (Netherlands)

    Nillesen, M.M.; Lopata, R.G.P.; Gerrits, I.H.; Kapusta, L.; Huisman, H.J.; Thijssen, J.M.; Korte, C.L. de

    2007-01-01

    This study aimed to show segmentation of the heart muscle in pediatric echocardiographic images as a preprocessing step for tissue analysis. Transthoracic image sequences (2-D and 3-D volume data, both derived in radiofrequency format, directly after beam forming) were registered in real time from

  7. Echocardiographic Applications in the Diagnosis and Management of Patients with ARVC

    NARCIS (Netherlands)

    Mast, Thomas P.|info:eu-repo/dai/nl/41396664X; Teske, Arco J.|info:eu-repo/dai/nl/314003231; Doevendans, Pieter A.|info:eu-repo/dai/nl/164248366; Cramer, Maarten J.|info:eu-repo/dai/nl/155240706

    2016-01-01

    Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a genetically determined myocardial disease predominantly affecting the right ventricle (RV). There is no single gold standard for the diagnosis of ARVC/D. New echocardiographic tools such as tissue deformation imaging allow

  8. Bedside percutaneous transseptal mitral commissurotomy under sole transthoracic echocardiographic guidance in a critically ill patient.

    Science.gov (United States)

    Trehan, Vijay K; Nigam, Arima; Mukhopadhyay, Saibal; Yusuf, Jamal; UmaMahesh, C R; Gupta, Mohit D; Girish, Menahalli Palleda; Sharma, Manish

    2006-04-01

    Percutaneous transvenous mitral commissurotomy is an effective and safe alternative to surgical treatment, in selected patients of rheumatic mitral stenosis. It is usually performed under fluoroscopic guidance in the catheterization laboratory. We report the successful performance of emergency mitral commissurotomy by the Inoue balloon at bedside under sole transthoracic echocardiographic guidance in a critically ill patient.

  9. Sequence of echocardiographic changes during development of right ventricular failure in rat

    NARCIS (Netherlands)

    Hardziyenka, Maxim; Campian, Maria E.; de Bruin-Bon, H. A. C. M. Rianne; Michel, Martin C.; Tan, Hanno L.

    2006-01-01

    BACKGROUND: The temporal relations between the onset of echocardiographic changes and clinical diagnosis of right ventricular (RV) failure are unresolved. We have characterized such relations in a rat monocrotaline (MCT) model of RV failure. METHODS: Eight-week-old male Wistar rats were injected

  10. Sequence of echocardiographic changes during development of right ventricular failure in rat.

    Science.gov (United States)

    Hardziyenka, Maxim; Campian, Maria E; de Bruin-Bon, H A C M Rianne; Michel, Martin C; Tan, Hanno L

    2006-10-01

    The temporal relations between the onset of echocardiographic changes and clinical diagnosis of right ventricular (RV) failure are unresolved. We have characterized such relations in a rat monocrotaline (MCT) model of RV failure. Eight-week-old male Wistar rats were injected with MCT (60 mg/kg) or vehicle and underwent serial echocardiography. RV free-wall thickness (RVWT), pulmonary artery acceleration time normalized to cycle length (PAAT/CL), RV end-diastolic diameter (RVEDD), and tricuspid annular plane systolic excursion (TAPSE) were measured. Significant differences in echocardiographic parameters between MCT-treated and control rats were found as early as 14 days before RV failure for RVWT, 10 days for PAAT/CL, and 7 days for RVEDD and TAPSE. The time intervals between the onset of changes in RVWT, PAAT/CL, RVEDD, and TAPSE and diagnosis of RV failure were 11.3 +/- 0.8, 10.9 +/- 0.7, 6.5 +/- 0.5, and 5.4 +/- 0.7 days, respectively. The sequence of echocardiographic changes was consistent in all animals during development of RV failure. Pulmonary hypertension (assessed by PAAT/CL) and RV free-wall thickening (characterized by RVWT) precede RV dilation and RV systolic dysfunction (measured by RVEDD and TAPSE, respectively). Echocardiographic analysis permits accurate determination of the stage of disease development in MCT-induced RV failure.

  11. Echocardiographic findings in haemodialysis patients according to their state of hydration

    Directory of Open Access Journals (Sweden)

    María Cristina Di Gioia

    2017-01-01

    Conclusions: We found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO, and not with FO/ECW.

  12. Modeling envelope statistics of blood and myocardium for segmentation of echocardiographic images.

    NARCIS (Netherlands)

    Nillesen, M.M.; Lopata, R.G.P.; Gerrits, I.H.; Kapusta, L.; Thijssen, J.M.; Korte, C.L. de

    2008-01-01

    The objective of this study was to investigate the use of speckle statistics as a preprocessing step for segmentation of the myocardium in echocardiographic images. Three-dimensional (3D) and biplane image sequences of the left ventricle of two healthy children and one dog (beagle) were acquired.

  13. Reference values of M-mode echocardiographic parameters and indices in conscious Labrador Retriever dogs.

    Science.gov (United States)

    Gugjoo, M B; Hoque, M; Saxena, A C; Shamsuz Zama, M M; Dey, S

    2014-01-01

    Breed-wise standard echocardiographic values in dogs have been reported as there is variation in body and chest conformation which limits the application of data of one breed for other breed. Labrador Retrievers being originated from hunting dogs, might have different echocardiographic values from standard normal range of other dog breeds. So, the present study was aimed to determine the M-mode echocardiographic reference ranges in Labrador Retriever dogs and to evaluate the effect of body weight and gender on these parameters. The data obtained were also compared with that of the other dog breeds. Conscious clinically healthy Labrador Retriever dogs (n=24) of both sexes were made the subject of the study. All the measurements were made from a right parasternal long axis left ventricular outflow tract view and the parameters measured were: left ventricular dimensions, left ventricular function, left ventricular volumes, left atrial and aortic root diameter and mitral valve parameters. Data obtained were also compared with that available for other dog breeds. Significant correlation (P0.5); moderate for LVPWd, LVPWs, EPSS, EF Slope and SV (r=0.3 to 0.5); weak for EDV and ESV (r<0.3). Non-significant effect of gender was seen on all the echocardiographic parameters. However, some of the parameters had a significant breed effect. It is expected that the obtained data will be valuable for the progress of studies on small animal cardiology.

  14. Effects of epicardial versus transvenous left ventricular lead placement on left ventricular function and cardiac perfusion in cardiac resynchronization therapy: A randomized clinical trial.

    Science.gov (United States)

    van Dijk, Vincent F; Fanggiday, Jim; Balt, Jippe C; Wijffels, Maurits C E F; Daeter, Edgar J; Kelder, Johannes C; Boersma, Lucas V A

    2017-08-01

    Optimal left ventricular (LV) lead position in patients undergoing cardiac resynchronization therapy (CRT) is crucial to achieve an optimal effect on hemodynamics. Due to various difficulties, up to 30% of transvenous LV lead placements fail, or a suboptimal position is achieved. Surgical epicardial LV lead placement could be performed at a position anticipated to be the optimal site. This could have a more favorable effect, which may be expressed by increased improvement in left ventricular ejection fraction (LVEF) and cardiac perfusion. The objective of this trial is to compare transvenous versus epicardial LV lead placement in CRT in a randomized fashion METHODS AND RESULTS: Fifty-two patients were randomized to either epicardial or transvenous approach. All patients received an ICD with CRT. Patients were followed for 6 months after device implant. Primary endpoint was the degree of change in cardiac perfusion measured by myocardial perfusion scintigraphy. LVEF equally improved in both groups, from 24% to 36% in the transvenous group versus 25% to 35% in the epicardial group (P = 0.797). Cardiac perfusion, expressed as summed stress score, improved in both groups without a significant difference as well (P = 0.727). Complication rate was similar, respectively 6 and 7 patients had any complication. Admission time was significantly longer in the epicardial group with 2 (2-7) versus 3 (2-32) days (P <0.001). Epicardial LV lead placement does not result in additional improvement of LVF or myocardial perfusion compared to the conventional transvenous in CRT. © 2017 Wiley Periodicals, Inc.

  15. Trans Fat Now Listed With Saturated Fat and Cholesterol

    Science.gov (United States)

    ... Trans Fat Now Listed With Saturated Fat and Cholesterol Share Tweet Linkedin Pin it More sharing options ... I Do About Saturated Fat, Trans Fat, and Cholesterol? When comparing foods, look at the Nutrition Facts ...

  16. Quantification of mitral regurgitation on cardiac computed tomography: comparison with qualitative and quantitative echocardiographic parameters.

    LENUS (Irish Health Repository)

    Arnous, Samer

    2012-02-01

    PURPOSE: To assess whether cardiac computed tomographic angiography (CCTA) can quantify the severity of chronic mitral regurgitation (MR) compared to qualitative and quantitative echocardiographic parameters. MATERIALS AND METHODS: Cardiac computed tomographic angiography was performed in 23 patients (mean +\\/- SD age, 63 +\\/- 16 years; range, 24-86 years) with MR and 20 patients without MR (controls) as determined by transthoracic echocardiography. Multiphasic reconstructions (20 data sets reconstructed at 5% increments of the electrocardiographic gated R-R interval) were used to analyze the mitral valve. Using CCTA planimetry, 2 readers measured the regurgitant mitral orifice area (CCTA ROA) during systole. A qualitative echocardiographic assessment of severity of MR was made by visual assessment of the length of the regurgitant jet. Quantitative echocardiographic measurements included the vena contracta, proximal isovelocity surface area, regurgitant volume, and estimated regurgitant orifice (ERO). Comparisons were performed using the independent t test, and correlations were assessed using the Spearman rank test. RESULTS: All controls and the patients with MR were correctly identified by CCTA. For patients with mild, moderate, or severe MR, mean +\\/- SD EROs were 0.16 +\\/- 0.03, 0.31 +\\/- 0.08, and 0.52 +\\/- 0.03 cm(2) (P < 0.0001) compared with mean +\\/- SD CCTA ROAs 0.09 +\\/- 0.05, 0.30 +\\/- 0.04, and 0.97 +\\/- 0.26 cm(2) (P < 0.0001), respectively. When echocardiographic measurements were graded qualitatively as mild, moderate, or severe, strong correlations were seen with CCTA ROA (R = 0.89; P < 0.001). When echocardiographic measurements were graded quantitatively, the vena contracta and the ERO showed modest correlations with CCTA ROA (0.48 and 0.50; P < 0.05 for both). Neither the proximal isovelocity surface area nor the regurgitant volume demonstrated significant correlations with CCTA ROA. CONCLUSIONS: Single-source 64-slice CCTA provides a

  17. Dietary fats explained

    Science.gov (United States)

    ... and fatty meats. Some vegetable oils, such as coconut, palm, and palm kernel oil, also contain saturated fats. These fats are solid at room temperature. A diet high in saturated fat increases cholesterol buildup in your arteries (blood vessels). Cholesterol is ...

  18. Fats and Your Child

    Science.gov (United States)

    ... Healthy fats are a vital part of a child’s diet, and they should not be excessively limited or banned. For young kids, especially, fat and cholesterol play important roles in brain development. And for those under 2 years old, fat ...

  19. Effect of volume reduction on diastolic echocardiographic parameters in hemodialyzed patients

    Directory of Open Access Journals (Sweden)

    Hekmat R

    2007-09-01

    Full Text Available Background: Cardiovascular problems including arterial hypertension, coronary artery diseases, congestive heart failure are prevalent among chronic hemodialyzed patients. Ultrafiltration of hemodialyzed patient's serum, which culminating in intravascular volume reduction, is frequently used during hemodialysis. One of the restrictions of the echocardiographic evaluation of the diastolic heart function is the intravascular volume dependency of some echocardiographic parameters. In this study we have evaluated the volume dependency of certain echocardiography parameters in chronically hemodialyzed patients. Methods: Thirteen patients undergoing chronic hemodialysis in Ghaem Hospital Hemodialysis Center in Mashhad, Iran, were evaluated one hour before and immediately after hemodialysis for the following: all diastolic echocardiographic parameters, left ventricular function, left ventricular systolic function, inferior vena cava (IVC diameter and IVC collapsibility with inspiration, and systolic and diastolic blood pressure. The echocardiographic parameters were analyzed using the paired Student's t-test. Results: With hemodialysis, there was no significant change in left ventricular function, A wave amplitude and E/F slope, however, there was a significant reduction of the E wave amplitude, increment in E wave deceleration time (p= 0.001, t=-4.14 and a decrease in the E/A ratio (p=0.03, t=2.46. Tissue Doppler echocardiography showed no significant change in mitral annular diastolic motion, E'/A' waves, with hemodialysis (p=0.728, t= - 0.356, although there was a reduction of the E/E' ratio. Conclusion: Tissue Doppler imaging and color M-mode echocardiographic parameters are independent of the intravascular value status. With no change associated with hemodialysis, these parameters can be used as reliable criteria for evaluating ventricular diastolic function even when the volume status varies.     Hekmat R. *1"nTalebi S

  20. Diastolic dysfunction revisited: A new, feasible, and unambiguous echocardiographic classification predicts major cardiovascular events.

    Science.gov (United States)

    Johansen, Niklas Dyrby; Biering-Sørensen, Tor; Jensen, Jan Skov; Mogelvang, Rasmus

    2017-06-01

    Echocardiographic classification of DDF has been widely discussed. The aim of this study was to investigate the independent prognostic value of established echocardiographic measures in a community-based population and create a new classification of DDF. Within the Copenhagen City Heart Study, a prospective, community-based study, 1851 participants were examined by echocardiography including Tissue Doppler Imaging (TDI) in 2001 to 2003 and followed with regard to MACE (median, 10.9 years). We found that persons with impaired myocardial relaxation as defined by low peak early diastolic mitral annular velocity e' by TDI had higher incidence of clinical and echocardiographic markers of cardiac dysfunction and increased risk of MACE. Among persons with impaired relaxation, only echocardiographic indices of increased filling pressures such as LAVi≥34 mL/m(2) (HR 1.97 (1.13-3.45, P=.017), E/e' ≥ 17 (HR 1.89 (1.34-2.65), P2 (HR 5.24 (1.91-14.42), P=.001) provided additional and independent prognostic information on MACE. Based on these findings, we created a new classification of DDF where all grades were significant predictors of MACE independently of age, sex, and cardiac clinical risk markers (Mild DDF: HR 1.99 (1.23-3.21), P=.005; Moderate DDF: HR 3.11 (1.81-5.34), PDDF: HR 4.20 (1.81-9.73), PDDF was linearly associated with increasing plasma proBNP concentrations. In the general population, the presence of echocardiographic markers of elevated filling pressures in persons with impaired relaxation increased the risk of MACE significantly. Based on this, we present a new, feasible, and unambiguous classification of DDF capable of accurate risk prediction in the community. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Echocardiographic methods, quality review, and measurement accuracy in a randomized multicenter clinical trial of Marfan syndrome.

    Science.gov (United States)

    Selamet Tierney, Elif Seda; Levine, Jami C; Chen, Shan; Bradley, Timothy J; Pearson, Gail D; Colan, Steven D; Sleeper, Lynn A; Campbell, M Jay; Cohen, Meryl S; De Backer, Julie; Guey, Lin T; Heydarian, Haleh; Lai, Wyman W; Lewin, Mark B; Marcus, Edward; Mart, Christopher R; Pignatelli, Ricardo H; Printz, Beth F; Sharkey, Angela M; Shirali, Girish S; Srivastava, Shubhika; Lacro, Ronald V

    2013-06-01

    The Pediatric Heart Network is conducting a large international randomized trial to compare aortic root growth and other cardiovascular outcomes in 608 subjects with Marfan syndrome randomized to receive atenolol or losartan for 3 years. The authors report here the echocardiographic methods and baseline echocardiographic characteristics of the randomized subjects, describe the interobserver agreement of aortic measurements, and identify factors influencing agreement. Individuals aged 6 months to 25 years who met the original Ghent criteria and had body surface area-adjusted maximum aortic root diameter (ROOTmax) Z scores > 3 were eligible for inclusion. The primary outcome measure for the trial is the change over time in ROOTmaxZ score. A detailed echocardiographic protocol was established and implemented across 22 centers, with an extensive training and quality review process. Interobserver agreement for the aortic measurements was excellent, with intraclass correlation coefficients ranging from 0.921 to 0.989. Lower interobserver percentage error in ROOTmax measurements was independently associated (model R(2) = 0.15) with better image quality (P = .002) and later study reading date (P < .001). Echocardiographic characteristics of the randomized subjects did not differ by treatment arm. Subjects with ROOTmaxZ scores ≥ 4.5 (36%) were more likely to have mitral valve prolapse and dilation of the main pulmonary artery and left ventricle, but there were no differences in aortic regurgitation, aortic stiffness indices, mitral regurgitation, or left ventricular function compared with subjects with ROOTmaxZ scores < 4.5. The echocardiographic methodology, training, and quality review process resulted in a robust evaluation of aortic root dimensions, with excellent reproducibility. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  2. Low value of simple echocardiographic indices of ventricular dyssynchrony in predicting the response to cardiac resynchronization therapy.

    Science.gov (United States)

    Bordachar, Pierre; Lafitte, Stéphane; Réant, Patricia; Reuter, Sylvain; Clementy, Jacques; Mletzko, Ralph-Uwe; Siegel, Robert M; Goscinska-Bis, Kinga; Bowes, Robert; Morgan, John; Bénard, Sandrine; Leclercq, Christophe

    2010-06-01

    A recent study suggested that no single echocardiographic index of cardiac dyssynchrony can reliably identify candidates for cardiac resynchronization therapy (CRT). We examined the value of three simple echocardiographic indices for predicting the 6-month clinical and echocardiographic responses to CRT. We analysed data from 75 CRT-D system recipients. Standard echocardiography was used to measure aortic pre-ejection delay (APED), interventricular mechanical delay (IVMD), and delayed activation of the left ventricular (LV) infero-lateral wall (OVERLAP). Clinical responders were defined as patients who had an improved status, based on rehospitalization for heart failure, NYHA class, and peak oxygen consumption. Echocardiographic responders had a > or =10% decrease in LV end-systolic volume. During the study, one patient died and five were lost to follow-up. Of the remaining 69 analysable patients, 50 (72.5%) were classed as clinical responders and 41 (59.4%) as echocardiographic responders to CRT. Before CRT implantation, APED, IVMD, and OVERLAP were similar in responders and non-responders. The value of these indices of dyssynchrony as single or combined predictors of the clinical or echocardiographic response to CRT was low, with sensitivities ranging between 4 and 63%, and specificities between 37 and 100%. Simple echocardiographic indices of dyssynchrony were poor predictors of response to CRT.

  3. Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study.

    Science.gov (United States)

    Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Yi, Li; Marinovic Gutierrez, Carolina; Di Tullio, Marco R; Farrell, Mary Beth; Burgess, Pamela; Gornik, Heather L; Hamburg, Naomi M; Needleman, Laurence; Orsinelli, David; Robison, Susana; Rundek, Tatjana

    2017-08-08

    Accreditation of echocardiographic testing facilities by the Intersocietal Accreditation Commission (IAC) is supported by the American College of Cardiology and American Society of Echocardiography. However, limited information exists on the accreditation status and geographic distribution of echocardiographic facilities in the United States. Our study aimed to identify (1) the proportion of outpatient echocardiography facilities used by Medicare beneficiaries that are IAC accredited, (2) their geographic distribution, and (3) variations in procedure type and volume by accreditation status. As part of the VALUE-ECHO (Value of Accreditation, Location, and Utilization Evaluation-Echocardiography) study, we examined the proportion of IAC-accredited echocardiographic facilities performing outpatient echocardiography in the 2013 Centers for Medicare and Medicaid Services outpatient limited data set (100% sample) and their geographic distribution using geocoding in ArcGIS (ESRI, Redlands, CA). Among 4573 outpatient facilities billing Medicare for echocardiographic testing in 2013, 99.6% (n = 4554) were IAC accredited (99.7% in the 50 US states and 86.2% in Puerto Rico). The proportion IAC-accredited echocardiographic facilities varied by region, with 98.7%, 99.9%, 99.9%, 99.5%, and 86.2% of facilities accredited in the Northeast, South, Midwest, West, and Puerto Rico, respectively (P < .01, Fisher exact test). Of all echocardiographic outpatient procedures conducted (n = 1,890,156), 99.8% (n = 1,885,382) were performed in IAC-accredited echocardiographic facilities. Most procedures (90.9%) were transthoracic echocardiograms, of which 99.7% were conducted in IAC-accredited echocardiographic facilities. Almost all outpatient echocardiographic facilities billed by Medicare are IAC accredited. This accreditation rate is substantially higher than previously reported for US outpatient vascular testing facilities (13% IAC accredited). The uniformity of imaging

  4. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

    Directory of Open Access Journals (Sweden)

    Sorin Giusca

    2017-01-01

    Full Text Available Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.

  5. Impact on diabetes mellitus on the epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count.

    Science.gov (United States)

    Soylu, Ahmet; Ozdemir, Kurtulus; Duzenli, Mehmet Akif; Yazici, Mehmet; Tokac, Mehmet

    2009-01-01

    The aim of this study is to evaluate the effect of type 2 diabetes mellitus on epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count. The thrombolysis in myocardial infarction frame count was measured in 272 coronary arteries from 101 patients with type 2 diabetes mellitus and in 271 coronary arteries from 104 age- and gender-matched patients without type 2 diabetes mellitus referred for coronary angiography. The thrombolysis in myocardial infarction frame count was measured only in normal arteries or in arteries without significant lesion. By both univariate and multivariate analysis, the thrombolysis in myocardial infarction frame count was not related with either type 2 diabetes mellitus or the duration and glycated hemoglobin levels in the patients with type 2 diabetes mellitus. The thrombolysis in myocardial infarction frame count was significantly associated with body surface area, heart rate, and proximal coronary artery diameter. Type 2 diabetes mellitus did not affect epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count.

  6. Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: the Heinz Nixdorf Recall Study.

    Science.gov (United States)

    Mahabadi, Amir A; Lehmann, Nils; Kälsch, Hagen; Bauer, Marcus; Dykun, Iryna; Kara, Kaffer; Moebus, Susanne; Jöckel, Karl-Heinz; Erbel, Raimund; Möhlenkamp, Stefan

    2014-08-01

    Epicardial adipose tissue (EAT) is increased in subjects with atrial fibrillation (AF). Likewise, EAT is associated with left atrial (LA) size, as itself is a strong predictor of AF. We aimed to determine the association of EAT and LA size as computed tomography (CT)-derived measures with prevalent and incident AF and investigated whether both measures independently predict AF. Participants from the Heinz Nixdorf Recall study without known cardiovascular disease were included. At baseline, EAT, defined as fat volume inside the pericardial sac, and LA size, defined as an axial area at the level of the mitral valve, were quantified from non-contrast enhanced cardiac CT. AF was determined from electrocardiogram at baseline and also at 5-year follow-up examination. Overall, 3467 participants (age: 58.9 ± 7.6 years, 47% male) were included. Ninety-six subjects had AF (46 prevalent and 50 incident). A 1-standard deviation (SD) change of EAT was associated with nearly two-fold increased prevalence of AF in univariate analysis, which persisted after adjustment for AF risk factors [odds ratio (OR) (95% confidence interval, 95% CI): 1.38 (1.11-1.72), P = 0.003]. Ancillary adjusting for LA reduced the effect [1.26 (0.996-1.60), P = 0.054]. For incident AF, no relevant effect was observed for EAT when adjusting for risk factors [1.19 (0.88-1.61), P = 0.26]. In contrast, a 1-SD chance of LA was strongly associated with AF independently of EAT and risk factors [2.70 (2.22-2.20), P < 0.0001]. LA but not EAT as non-contrast CT-derived measures improved the prediction of AF over risk factors (receiver operating characteristics: 0.810-0.845, P = 0.025). LA size from non-contrast CT is strongly associated with prevalent and incident AF and ultimately diminishes the link of EAT with AF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  7. Effect of type 2 diabetes mellitus on epicardial adipose tissue volume and coronary vasomotor function.

    Science.gov (United States)

    Chen, Weena J Y; Danad, Ibrahim; Raijmakers, Pieter G; Halbmeijer, Rick; Harms, Hendrik J; Lammertsma, Adriaan A; van Rossum, Albert C; Diamant, Michaela; Knaapen, Paul

    2014-01-01

    Patients with coronary artery disease and/or type 2 diabetes mellitus (DM) generally exhibit more epicardial adipose tissue (EAT) than healthy controls. Recently, it has been proposed that EAT affects vascular function and structure by secreting proinflammatory and vasoactive substances, thereby potentially contributing to the development of cardiovascular disease. In the present study, the interrelation of EAT, coronary vasomotor function, and coronary artery calcium was investigated in patients with and without DM, who were evaluated for coronary artery disease. Myocardial blood flow (MBF) was assessed at rest and during adenosine-induced hyperemia using [(15)O]-water positron emission tomography combined with computed tomography to quantify coronary artery calcium and EAT in 199 patients (46 with DM). In this cohort (mean age 58 ± 10 years), the patients with DM had a greater body mass index, heart rate, and systolic blood pressure at rest (all p <0.05). Coronary artery calcium and the EAT volumes were comparable between those with and without DM. Both patient groups showed comparable MBF at rest and coronary vascular resistance. A lower hyperemic MBF and coronary flow reserve (CFR) and greater hyperemic coronary vascular resistance (all p <0.05) was observed in the patients with DM. A pooled analysis showed a positive association of EAT volume with hyperemic coronary vascular resistance but not with the MBF at rest, hyperemic MBF, or coronary vascular resistance at rest. In the group analysis, the EAT volume was inversely associated with hyperemic MBF (r = -0.16, p = 0.05) and CFR (r = -0.17, p = 0.04) and positively with hyperemic coronary vascular resistance (r = 0.26, p = 0.002) only in patients without DM. Multivariate regression analysis, adjusted for age, gender, and body mass index, showed an independent association between the EAT volume and hyperemic MBF (β = -0.16, p = 0.02), CFR (β = -0.16, p = 0.04), and hyperemic coronary vascular resistance (

  8. Myopotential oversensing notified by Lead Integrity Alert in a patient with implantable cardioverter defibrillator with a dedicated bipolar epicardial sensing lead

    OpenAIRE

    Yazaki, Kyoichiro; Ajiro, Yoichi; Hasegawa, Shun; Watanabe, Masahiro; Tsukamoto, Kei; Mizobuchi, Keiko; Saito, Takashi; Mori, Fumiaki; Iwade, Kazunori

    2016-01-01

    Key Clinical Message Although myopotential oversensing by a dedicated bipolar lead is rare, an epicardial lead on a dilated ventricle might contribute to its sensitivity. Myopotential oversensing was notified by the Lead Integrity Alert in this case. We should be aware of this possibility for the management of such patients.

  9. Echocardiographic findings predict in-hospital and 1-year mortality in left-sided native valve Staphylococcus aureus endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine K.; Park, Lawrence; Tong, Steven Y C

    2015-01-01

    BACKGROUND: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS: Consec...

  10. Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Mogensen, Ulrik M; Jhund, Pardeep S

    2017-01-01

    structural and functional echocardiographic abnormalities. Further investigation is needed to determine the mediators of the adverse impact of diabetes mellitus on outcomes in heart failure with preserved ejection fraction and whether they are modifiable. CLINICAL TRIAL REGISTRATION: URL: http...

  11. Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy

    OpenAIRE

    Jenni, R; Oechslin, E; Schneider, J; Jost, C; Kaufmann, P

    2001-01-01

    AIM—To determine clear cut echocardiographic criteria for isolated ventricular non-compaction (IVNC), a cardiomyopathy as yet "unclassified" by the World Health Organization. The disease is not widely known and its diagnosis mostly missed.
METHODS AND RESULTS—In seven out of a series of 34 patients with IVNC the in vivo echocardiographic characteristics were validated against the anatomical examination of the heart removed after death in four and due to heart transplantation in three patients...

  12. Association between echocardiographic structural parameters and body weight in Wistar rats.

    Science.gov (United States)

    Oliveira-Junior, Silvio A; Martinez, Paula F; Fan, William Y C; Nakatani, Bruno T; Pagan, Luana U; Padovani, Carlos R; Cicogna, Antonio C; Okoshi, Marina P; Okoshi, Katashi

    2017-04-18

    The association between echocardiographic structural parameters and body weight (BW) during rat development has been poorly addressed. We evaluated echocardiographic variables: left ventricular (LV) end-diastolic (LVDD) and end-systolic (LVSD) diameters, LV diastolic posterior wall thickness (PWT), left atrial diameter (LA), and aortic diameter (AO) in function of BW during development.Results/Materials and Methods: Male Wistar rats (n = 328, BW: 302-702 g) were retrospectively used to construct regression models and 95% confidence intervals relating to cardiac structural parameters and BW. Adjusted indexes were significant to all relationships; the regression model for predicting LVDD (R2 = 0.678; p cardiac structures is associated with BW gain during rat growth. LA and AO can be correctly predicted using regression models; prediction of PWT and LV diameters is not accurate.

  13. Updated standards and processes for accreditation of echocardiographic laboratories from The European Association of Cardiovascular Imaging.

    Science.gov (United States)

    Popescu, Bogdan A; Stefanidis, Alexandros; Nihoyannopoulos, Petros; Fox, Kevin F; Ray, Simon; Cardim, Nuno; Rigo, Fausto; Badano, Luigi P; Fraser, Alan G; Pinto, Fausto; Zamorano, Jose Luis; Habib, Gilbert; Maurer, Gerald; Lancellotti, Patrizio; Andrade, Maria Joao; Donal, Erwan; Edvardsen, Thor; Varga, Albert

    2014-07-01

    Standards for echocardiographic laboratories were proposed by the European Association of Echocardiography (now the European Association of Cardiovascular Imaging) 7 years ago in order to raise standards of practice and improve the quality of care. Criteria and requirements were published at that time for transthoracic, transoesophageal, and stress echocardiography. This paper reassesses and updates the quality standards to take account of experience and the technical developments of modern echocardiographic practice. It also discusses quality control, the incentives for laboratories to apply for accreditation, the reaccreditation criteria, and the current status and future prospects of the laboratory accreditation process. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  14. Cholinergic stimulation with pyridostigmine, hemodynamic and echocardiographic analysis in healthy subjects

    Directory of Open Access Journals (Sweden)

    Paulo Vasconcellos de Pontes

    1999-03-01

    Full Text Available OBJECTIVE: Growing evidence suggests that sudden death after an acute myocardial infarction (AMI correlates with autonomic nervous system imbalance. Parasympathomimetic drugs have been tested to reverse these changes. However, their effects on ventricular function need specific evaluation. Our objective was to analyze pyridostigmine's (PYR effect on hemodynamic and echocardiographic variables of ventricular function. METHODS: Twenty healthy volunteers underwent Doppler echocardiographic evaluations, blood pressure (BP, and heart rate (HR assessment at rest, before and 120 min after ingestion of 30 mg PYR or placebo, according to a double-blind, placebo-controlled, crossed and randomized protocol, on different days. RESULTS: PYR was well tolerated and did not cause alterations in BP or in ventricular systolic function. A reduction in HR of 10.9±1.3% occurred (p0.05. CONCLUSION: PYR reduces HR and increases E/A ratio, without hemodynamic impairment or ventricular function change.

  15. Echocardiographic assessment of cardiac valvular regurgitation with lorcaserin from analysis of 3 phase 3 clinical trials.

    Science.gov (United States)

    Weissman, Neil J; Sanchez, Matilde; Koch, Gary G; Smith, Steven R; Shanahan, William R; Anderson, Christen M

    2013-07-01

    Lorcaserin is a selective 5-HT2C agonist evaluated for weight management in clinical trials. Echocardiographic monitoring was conducted to test the hypothesis that selective 5-HT2C agonism would avoid valvular heart disease. Echocardiographic and weight change data from 5249 obese and overweight patients in 3 phase 3 trials were integrated. Treatment duration with 10 mg lorcaserin twice daily or placebo was 52 weeks. The proportions of patients who developed Food and Drug Administration-defined valvulopathy (≥ mild aortic or ≥ moderate mitral regurgitation) and changes in regurgitant grade at each heart valve were evaluated. Possible associations between weight or body mass index change and valvulopathy were explored. New valvulopathy was present in 2.04% of placebo and 2.37% of lorcaserin recipients at 52 weeks (risk difference, 0.33%; 95% confidence interval, -0.46 to 1.13; risk ratio, 1.16 [all patients with sufficient echocardiographic data, last-observation-carried-forward imputation] or 1.03 [patients who completed 52 weeks]). Changes in weight and body mass index were negatively associated with presence of valvulopathy at week 52 (P=0.02 and P=0.04, respectively); a 5% decrease in weight was associated with an odds ratio of 1.15 for Food and Drug Administration-defined valvulopathy. Most changes in regurgitation were ±1 grade in both treatment groups at all heart valves. In 3 prospective placebo-controlled trials with integrated data for 5249 patients, the rate of echocardiographic valvulopathy was similar with lorcaserin and placebo. Point estimates for risk ratios ranged from 1.03 to 1.16 and may be at least partially influenced by greater weight loss in the lorcaserin group than in the placebo group. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00395135, NCT00603291, NCT00603902.

  16. Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes.

    Science.gov (United States)

    Vranian, Michael N; Sperry, Brett W; Hanna, Mazen; Hachamovitch, Rory; Ikram, Asad; Brunken, Richard C; Jaber, Wael A

    2017-01-03

    Quantitative uptake of Technetium 99 m-pyrophosphate (TcPYP) is sensitive and specific for diagnosing transthyretin cardiac amyloidosis (ATTR). We sought to examine the association between TcPYP uptake intensity and echocardiographic measures of disease severity and clinical outcomes. A retrospective analysis was performed of 75 patients who underwent TcPYP scintigraphy. Planar images were evaluated semiquantitatively and using heart-to-contralateral lung (H/CL) ratio. The associations between H/CL ratio and echocardiographic parameters and outcomes were evaluated using linear regression and Cox models, respectively. There were 48 patients diagnosed with ATTR with mean H/CL ratio 1.58 ± 0.22 (vs 1.08 ± 0.09 if semiquantitative score = 0). The H/CL ratio was not associated with any measured echocardiographic parameter. Both semiquantitative uptake grade and H/CL ratio were associated with all-cause mortality (P = 0.009 and 0.007, respectively) and all-cause mortality or heart failure hospitalization (P = 0.001 and 0.020, respectively); however, neither were associated with outcomes when limited to patients with confirmed ATTR (P = 0.18 and 0.465, respectively). In patients with suspected ATTR, quantitative and semiquantitative uptake intensity of TcPYP is associated with all-cause mortality as well as all-cause mortality or heart failure hospitalization. However, in those with confirmed ATTR, there is no association with echocardiographic disease severity or outcomes.

  17. Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise--the Australian Ironman Triathlon.

    Science.gov (United States)

    Tulloh, L; Robinson, D; Patel, A; Ware, A; Prendergast, C; Sullivan, D; Pressley, L

    2006-07-01

    There is concern about whether cardiac damage occurs as a result of prolonged strenuous exercise. To investigate whether competing in a triathlon is associated with cardiac damage based on a sustained increase in cardiac troponin T (cTnT), and whether such an increase correlates with echocardiographic changes cTnT and echocardiographic measurements were made in 38 participants in the 2001 Australian ironman triathlon. cTnT was measured the day before, immediately after, and the day following the race. Echocardiography was done the day before, immediately after, and two to six weeks later for measurement of ejection fraction, stroke volume, cardiac output, wall motion analysis, and global left ventricular function (LVF). No subject had detectable cTnT in the pre-race sample. Following the race, 32 subjects (86.5%) had detectable levels of cTnT (>0.01 ng/ml), with six (16.2%) having >0.10 ng/ml. The day after the race, nine subjects (23.7%) still had detectable cTnT, with two recording a level >0.10 ng/ml. Previously described echocardiographic changes of "cardiac fatigue" were observed in the whole cohort. There was a modest but significant correlation between change in ejection fraction and peak cTnT level (p = 0.02, r = 0.39). Athletes with a post-race cTnT >0.10 ng/ml had a greater decrease in global LVF (p = 0.02) and a trend toward a greater fall in ejection fraction and stroke volume than athletes with cTnT levels 0.10 ng/ml (p>0.05). Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function. The clinical significance and long term sequelae of such damage remains to be determined.

  18. Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF.

    Science.gov (United States)

    Sani, Mahmoud U; Davison, Beth A; Cotter, Gad; Damasceno, Albertino; Mayosi, Bongani M; Ogah, Okechukwu S; Mondo, Charles; Dzudie, Anastase; Ojji, Dike B; Kouam, Charles Kouam; Suliman, Ahmed; Yonga, Gerald; Ba, Sergine Abdou; Maru, Fikru; Alemayehu, Bekele; Edwards, Christopher; Sliwa, Karen

    The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure. Out of the 1 006 patients in the THESUS-HF registry, 954 had had an echocardiogram performed within a few weeks of admission. Echocardiographic measurements were performed according to the American Society of Echocardiography guidelines. We examined the associations between each echocardiographic predictor and outcome using regression models. Heart rate and left atrial size predicted death within 60 days or re-admission. Heart rate, left ventricular posterior wall thickness in diastole (PWTd), and presence of aortic stenosis were associated with the risk of death within 180 days. PTWd added to clinical variables in predicting 180-day mortality rates. Echocardiographic variables, especially those of left ventricular size and function, were not found to have additional predictive value in patients admitted for acute HF. Left atrial size, aortic stenosis, heart rate and measures of hypertrophy (LV PWTd) had some predictive value, suggesting the importance of early treatment of hypertension and severe valvular heart disease.

  19. Reversal of echocardiographic right-sided heart pathology in a dog with severe pulmonary hypertension: a case report

    Directory of Open Access Journals (Sweden)

    McMahon P

    2015-06-01

    Full Text Available Peggy McMahon,1 Carley Saelinger 2  1Emergency and Critical Care Department, 2Cardiology Department, Animal Specialty and Emergency Center, Los Angeles, CA, USA Abstract: Pathologic right-sided heart changes are a common echocardiographic finding in patients with pulmonary hypertension (PH. Canines with PH may have right heart pathology documented via echocardiographic color Doppler interrogation including tricuspid valve regurgitation, pulmonic valve insufficiency, elevated pulmonary arterial systolic pressure, elevated pulmonary arterial diastolic pressure, and alterations in ejection profiles. Two-dimensional echocardiographic findings may include right ventricular hypertrophy, interventricular septal flattening, paradoxical interventricular septal motion, pulmonary artery dilation, and potentially abnormal left heart dimensions. In veterinary medicine, much confidence is given to the measurement of pulmonary arterial systolic pressure estimated from tricuspid valve regurgitation to grade the severity of PH and monitor its improvement with little emphasis placed on the integration of two-dimensional echocardiographic right and left heart pathology in conjunction with Doppler findings. To the authors’ knowledge, marked improvement and/or resolution of echocardiographic-documented right heart pathology have not been previously reported in the veterinary literature. This case report documents profound echocardiographic improvement of right-sided heart disease in a dog with severe PH. Keywords: canine, pulmonary hypertension, tricuspid valve regurgitation, right heart hypertrophy, sildenafil  

  20. The Relationship Between Hemodialysis and the Echocardiographic Findings in Patients with Chronic Kidney Disease.

    Science.gov (United States)

    Omrani, Hamidreza; Golshani, Sanam; Sharifi, Vahid; Almasi, Afshin; Sadeghi, Masoud

    2016-10-01

    The incidence of cardiac morbidity and mortality is high in patients treated with hemodialysis (HD). The aim of this study was to evaluate the relationship between HD and the echocardiographic findings in patients with chronic kidney disease (CKD). Between 2012 and 2014, 150 patients with CKD. The echocardiographic data were done based on American Society of Cardiology (ASE). Measurement method for Ejection Fraction was E balling and for Diastolic Function was Tissue Doppler. Anemia, thyroid conditions and dialysis through an arteriovenous fistula or permanent catheter of dialysis for the patients are not considered. The mean age at diagnosis for the patients was 57.8 years, 52.7% were males. Out of 150 patients, 112 patients (74.7%) had diabetes and 117 patients (78%) had a history of hypertension. The prevalence of all echocardiographic findings was more after the first dialysis compared with before the first dialysis in diabetic patients (Pdiabetic patients, was not for the tricuspid valve stenosis, impaired right ventricular volume, systolic dysfunction and pulmonary hypertension (P>0.05). According to the findings of this study, seems that more accurate selection of patients for dialysis, paying special attention to hemodynamic change during dialysis, patient education about diet and better control of uremia and diabetes is essential.

  1. Mucocutaneous lymph node syndrome. A cross-sectional echocardiographic diagnosis of coronary aneurysms.

    Science.gov (United States)

    Yoshida, H; Funabashi, T; Nakaya, S; Taniguchi, N

    1979-12-01

    The cross-sectional echocardiographic technique for detecting coronary artery aneurysms of mucocutaneous lymph node syndrome (MLNS) was examined. When cutting the aortic root in round slices by the echocardiographic scanner, each of the right and left coronary arteries was imaged as a linear echo-free structure arising from the aortic root. Of 22 normal subjects, the left main coronary artery was imaged in all, the anterior descending branch in 18, the circumflex branch in six, and the right coronary artery in 18. Of 41 patients with MLNS, coronary artery aneurysms were detected as large echo-free spaces in four patients who were proved later to have these lesions by coronary angiography or autopsy. In addition, in four patients, whose echocardiograms demonstrated the coronary arteries to be normal, the angiographic studies showed that the coronary arteries were intact. These results suggest that the cross-sectional echocardiographic technique is a useful noninvasive diagnostic method for imaging the coronary arteries and the aneurysms in MLNS.

  2. A STUDY OF ECHOCARDIOGRAPHIC CHANGES IN CKD PATIENTS ON MAINTENANCE HEMODIALYSIS : A SINGLE CENTRE STUDY

    Directory of Open Access Journals (Sweden)

    Rajaram

    2015-09-01

    Full Text Available OBJECTIVES : The Aim of this study to assess and analyze the echocardiographic changes in chronic kidney disease patients on maintenance hemodialysis. MATERIAL AND METHODS : We Performed Prospective study of echocardiographic changes in chronic kidney disease (CKD patients undergoing on maintenance hemodialysis at our institute. We performed M - mode echocardiography in 100 CKD patients without obvious clinical evidence of cor onary artery disease, Valvular heart disease, congenital heart disease. RESULTS: 100 Patients Undergoing Hemodialysis were included in our study. Of them Echocardiography finding shown LV dilation and diastolic dysfunction in 49(49%, left ventricular hype rtrophy (LVH in 57 (57%, systolic dysfunction and pericardial effusion in 28(28% and 13(13% patients respectively. RWMA was present in 10% and Valvular calcification was seen in 5 patient. In sub - group of patients with Hb 140/90mmhg, LVH Was Present in 64.47 % ( 49 vs 33.33 % ( 8 in patients group with BP< 140/90 mm hg (p=0.02. In both sub group p value for systolic dysf unction, RWMA & pericardial effusion is statistically not significant. CONCLUSION: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anemia and presence of LVH and positive correlation between presence of hypertension and LVH

  3. [Echocardiographic diagnosis of anomalous origin of one pulmonary artery from the ascending aorta].

    Science.gov (United States)

    Reyes de la Cruz, Lorenzo; Vizcaíno Alarcón, Alfredo; Arévalo Salas, Alexis; Espinosa Islas, Gonzalo; Bolio Cerdán, Alejandro; Arteaga Martínez, Manuel

    2003-01-01

    To present our experience in the echocardiographic diagnosis of anomalous origin of one pulmonary artery from the ascending aorta (AOPA). To analyze its clinical presentation, treatment and outcomes with special emphasis in the echocardiographic data. We reviewed restrospectively the clinical, hemodynamic data, and surgical findings of patients with an echocardiographic diagnosis of AOPA studied in the Hospital Infantil of Mexico "Federico Gomez" from 1991 to 2002. The study includes 12 children with AOPA; Seven were males. The average age at diagnosis was two months; 4 in neonatal period, 3 under 1 year and 5 older than 1 year. The diagnosis was established prospectively by echocardiography in all patients and it was confirmed by angiography in 8 and at surgery in 9. Ten had anomalous origin of right pulmonary artery. The associated anomalies were patent ductus arteriosus in 6, ventricular septal defect in 2 and aortopulmonary window, atrioventricular discordance, double outlet right ventricle and tetralogy of Fallot in one case each. Nine underwent corrective surgery of all the anomalies. One patient died on the sixth postoperative day; the remaining are in good condition without stenosis at the site of the anastomosis. Surgery was refused in one. One patient was not candidate to surgery due to advanced obstructive pulmonary vascular disease (OPVD) and one case is awaiting surgery. The diagnosis of AOPA may be established with precision through echocardiography. Cardiac catheterization is seldom needed to confirm morphology but is mandatory in older children with suspected of OPVD.

  4. Echocardiographic measurement of cart horses in the metropolitan region of Curitiba-PR

    Directory of Open Access Journals (Sweden)

    Amália Turner Giannico

    2015-04-01

    Full Text Available In order to maintain the horses’ performance during the exercise, their hearts adapt to the variations on metabolic activity, resulting in muscular adaptation. Thus, echocardiography allows to assess on both eventual adaptations of heart tissue and impairment of the ability to pump blood. Little is yet known about echocardiography in cart horses, whose general conditions of health and treatment are often inappropriate to the type of exercise they are submitted to. The goal of this study was to establish echocardiographic numbers for cart horses. Nineteen mongrel horses were submitted for echocardiographic examination, and values of the distance from E point (maximum opening mitral valve to the interventricular septum; diameter of left ventricle cavity, interventricular septum thickness and thickness of left ventricle free wall during systole and diastole, fractional shortening and ejection fraction were obtained by M-mode. In the 2D images, diameter of the aortic valve and left atrium were evaluated, and their relationship. The velocities of the blood flow were evaluated in aorta and pulmonary artery and the mitral valve by means of Doppler, and possible insufficiency was detected through the color Doppler. Mean values for echocardiographic parameters were established considering 19 traction horses that worked pulling cart loads. There were no significant values that indicated either an inappropriate cardiac remodeling, a left ventricular dysfunction – with consequent decrease in exercises performance – or diseases that affect the animal’s performance at work.

  5. Echocardiographic screening of schoolchildren in American Samoa to detect rheumatic heart disease: a feasibility study

    Directory of Open Access Journals (Sweden)

    Shawn S Barnes

    2011-02-01

    Full Text Available Shawn S Barnes1 James Sim2 James R Marrone3 Venudhar D Reddy2 Darragh C O’Carroll1 Lauren Sumida1 Guliz Erdem21John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA; 2Department of Pediatrics, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA; 3Department of Pediatrics, Lyndon Baines Johnson Tropical Medical Center, Pago Pago, American SamoaBackground: We report a practical and affordable pilot echocardiographic screening model for the detection of rheumatic heart disease (RHD in Samoan children.Materials and methods: Following a brief training period, three medical students recruited and screened 58.3% (N = 140 of schoolchildren aged 7–18 years on the remote Pacific island of Ta’u, American Samoa, performing echocardiography with a SonoSite® portable ultrasound machine.Results: None of the echocardiographic images obtained showed significant abnormality consistent with RHD on their review by two pediatric cardiologists on Oahu, Hawaii.Conclusions: The implementation of echocardiographic screening in resource-poor regions with high rates of acute rheumatic fever and RHD, such as American Samoa, is feasible with limited training of personnel.Keywords: pediatric, RHD, Samoa, schoolchildren, screening

  6. Echocardiographic diagnosis of rare pathological patterns of sinus of Valsalva aneurysm.

    Directory of Open Access Journals (Sweden)

    Yali Yang

    Full Text Available To evaluate the value and improve the diagnostic accuracy of echocardiography in the diagnosis of a sinus of Valsalva aneurysm (SVA with rare pathological patterns.Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995-2013 at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns.The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation (16, obstruction of the ventricular outflow tract or valvular orifice (3, and conduction disturbance (3. The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed.We could accurately diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features. However, for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, we recommend combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.

  7. Weighing in on Dietary Fats

    Science.gov (United States)

    ... lower-fat ingredients. “Low-fat and fat-free yogurt and milk still contain the important proteins and minerals found in the full-fat versions, but you’re getting less saturated fat and cholesterol,” McDowell says. “In some recipes, you can use ...

  8. Low-energy defibrillation research using a rabbit ventricular model: optimizing the potential gradient distribution using multiple epicardial electrodes.

    Science.gov (United States)

    Jianfei Wang; Lian Jin; Xiaomei Wu; Biao Song; Li Qian; Weiqi Wang

    2016-08-01

    Cardiac potential gradient distribution directly affects defibrillation efficacy, and the electrode configuration that ensures optimal distribution is yet to be determined. In this study, a rabbit ventricular finite element conductor model containing blood perfusion in ventricular cavities was developed. The electric field was solved on the model by using 95% myocardial volume potential gradient higher than 5 V/cm as the successful defibrillation threshold (DFT). Multiple epicardial electrodes (MEE) protocols and a SCAN protocol were used to identify the optimum defibrillation method. Results showed that when using the SCAN protocol, DFT energy reduced to 4.3% that of the control group which had the traditional implantable cardioverter defibrillator current path. Rapidly switching scanning stimuli generated using MEE pairs is a promising low-energy defibrillation method. For multiple electrodes defibrillation, the distribution of the electrode pairs determine the defibrillation efficacy, and the counteraction effect has negative effect on defibrillation. These findings can provide suggestions for clinical applications.

  9. Value of epicardial potential maps in localizing pre-excitation sites for radiofrequency ablation. A simulation study

    Science.gov (United States)

    Hren, Rok

    1998-06-01

    Using computer simulations, we systematically investigated the limitations of an inverse solution that employs the potential distribution on the epicardial surface as an equivalent source model in localizing pre-excitation sites in Wolff-Parkinson-White syndrome. A model of the human ventricular myocardium that features an anatomically accurate geometry, an intramural rotating anisotropy and a computational implementation of the excitation process based on electrotonic interactions among cells, was used to simulate body surface potential maps (BSPMs) for 35 pre-excitation sites positioned along the atrioventricular ring. Two individualized torso models were used to account for variations in torso boundaries. Epicardial potential maps (EPMs) were computed using the L-curve inverse solution. The measure for accuracy of the localization was the distance between a position of the minimum in the inverse EPMs and the actual site of pre-excitation in the ventricular model. When the volume conductor properties and lead positions of the torso were precisely known and the measurement noise was added to the simulated BSPMs, the minimum in the inverse EPMs was at 12 ms after the onset on average within images/0031-9155/43/6/006/img1.gif" ALIGN="MIDDLE"/> cm of the pre-excitation site. When the standard torso model was used to localize the sites of onset of the pre-excitation sequence initiated in individualized male and female torso models, the mean distance between the minimum and the pre-excitation site was images/0031-9155/43/6/006/img2.gif" ALIGN="MIDDLE"/> cm for the male torso and images/0031-9155/43/6/006/img3.gif" ALIGN="MIDDLE"/> cm for the female torso. The findings of our study indicate that a location of the minimum in EPMs computed using the inverse solution can offer non-invasive means for pre-interventional planning of the ablative treatment.

  10. Outcomes after endocarditis or device infection in patients with left ventricular epicardial leads versus coronary sinus leads.

    Science.gov (United States)

    Karim, Saima; Hussein, Ayman; Batal, Omar; Karim, Mohammad M; Tarakji, Khaldoun; Saliba, Walid; Martin, David; Wazni, Oussama; Kanj, Mohammed; Wilkoff, Bruce L; Callahan, Thomas

    2014-04-01

    There is scant data about outcomes in patients with left ventricular epicardial (LVE) leads who develop endocarditis or device-related infection. This retrospective study evaluated mortality and recurrence of infection among patients with LVE leads in comparison to patients with endovascular coronary sinus (CS) leads after the development of endocarditis or device-related infection. Patients with cardiac resynchronization therapy (CRT) devices who developed endocarditis or pocket infection over 5 years at Cleveland Clinic were included in the study. The groups were all patients with LVE leads versus CRT devices without epicardial leads that developed endocarditis or pocket infection. Mortality was assessed using the Social Security Death Index and re-infection was assessed by reviews of the medical record. Prospective extraction of the CRT device and leads occurred among all 50 patients with CS leads and 8 of the 14 patients with LVE leads. The survival rate was 92.9 versus 92 % and freedom from re-infection rate was 64.3 versus 80 % in the patients with LVE leads versus CS leads, respectively, over 1 year (P value = 0.918 and 0.226, respectively). At 3 years, the survival rate in LVE lead group was 92.9 % and freedom from re-infection rate was 64.3 % in comparison to survival rate of 90 % and freedom from re-infection rate of 68 % in the CS group (P value = 0.751 and 0.798, respectively). After development of endocarditis or pocket infection, no statistically significant differences were seen in mortality, or recurrent infection between patients with LVE leads and those with CS leads.

  11. [Echocardiographic examination of cardiac structure and function in male athletes of static and dynamic disciplines].

    Science.gov (United States)

    Kamiński, Leszek; Płońska, Edyta; Szyszka, Andrzej; Peregud, Małgorzata; Olszewski, Robert

    2006-03-01

    Practising a record-seeking sport may in consequence lead to morphological and functional changes in a heart muscle. The physiological changes which are result of heart's adaptation to a greater physical effort are called "sportsman's heart". AIM OF THE THESIS: The value of echocardiographic tests in detecting and designating frequency of occurrence of heart abnormalities in sportsmen. The comparison of echocardiographic, functional and morphological adaptation changes in a group of sportsmen of both static and dynamic disciplines. The safety of practising football and bodybuilding. The influence of length of time when the sport is practised on the quantity of echocardiographic parameters. The material analysed in the doctor's thesis consists of a group of 40 men practising a static sport and a group of 40 men subjected to dynamic effort, as well as a control group of 30 men who do not practise any sport. In all the examined men the analysis comprises echocardiographic examination. The analysis deals with morphology and function of heart's structures: the left and the right ventricles, atrium and valves, on the basis of echocardiography The data is evaluated in each group of sportsmen (frequency of occurrence of heart abnormalities in sportsmen) and compared both between the record-seekers practising two kinds of training, and between the record-seekers and the control group. Adaptation changes of the left ventricle in the sportsmen practising static disciplines showed thickening of walls of the left ventricle with the lessening of its inner size, so called concentric hypertrophy. Thickness of walls of the left ventricle did not exceed 12 mm in diastole in 97% of the examined. In the dynamic group a slight growth in thickness of the walls with the delatation of the left ventricle's cavity was observed in relation to the sportsmen of the static group (p parameters of the right ventricle's morphology differed significantly statistically in both groups of sportsmen

  12. Dietary fat and carcinogenesis

    NARCIS (Netherlands)

    Woutersen, R.A.; Appel, M.J.; Garderen-Hoetmer, A. van; Wijnands, M.V.W.

    1999-01-01

    Epidemiologic investigations have suggested a relationship between dietary fat intake and various types of cancer incidences. Furthermore, epidemiologic studies as well as studies with animal models have demonstrated that not only the amount but also the type of fat consumed is important. At

  13. Trans-polar-fat

    DEFF Research Database (Denmark)

    Counil, Emilie; Dewailly, Eric; Bjerregaard, Peter

    2008-01-01

    As part of the rapid socio-cultural transition observed in Arctic populations, the Inuit diet is changing. We present original data derived from the baseline Inuit Health in Transition cohort study regarding biological levels of n-3 fatty acids and trans-fatty acids (TFA), lipids with opposite he...... of 2 g/100 g fat on industrially produced trans-fats in 2003....

  14. Dietary fats and cancer

    NARCIS (Netherlands)

    Zock, P.L.

    2001-01-01

    The present review addresses the evidence for a possible link between dietary fat and cancer. International comparisons suggest that a high-fat diet may increase cancer risk, and this hypothesis is supported by animal experiments. However, epidemiological studies within populations show little or

  15. Learning about Fats

    Science.gov (United States)

    ... and other animal products, such as butter and cheese. Saturated fats are also in palm and coconut oils, which are often used in baked goods you buy at the store. Eating too much saturated fat can raise blood cholesterol levels and increase the chance of getting heart ...

  16. Fat and bone interactions.

    Science.gov (United States)

    Bermeo, Sandra; Gunaratnam, Krishanthi; Duque, Gustavo

    2014-06-01

    Fat and bone have a complicated relationship. Although obesity has been associated with low fracture risk, there is increasing evidence that some of the factors that are released by peripheral fat into the circulation may also have a deleterious effect on bone mass, thus, predisposing to fractures. More importantly, the local interaction between fat and bone within the bone marrow seems to play a significant role in the pathogenesis of age-related bone loss and osteoporosis. This "local interaction" occurs inside the bone marrow and is associated with the autocrine and paracrine release of fatty acids and adipokines, which affect the cells in their vicinity including the osteoblasts, reducing their function and survival. In this review, we explore the particularities of the fat and bone cell interactions within the bone marrow, their significance in the pathogenesis of osteoporosis, and the potential therapeutic applications that regulating marrow fat may have in the near future as a novel pharmacologic treatment for osteoporosis.

  17. Differential fat harvesting

    Directory of Open Access Journals (Sweden)

    Sebastian Torres Farr

    2014-12-01

    Full Text Available Aim: Volume replacement with fillers is regularly performed with the use of diverse volumetric materials to correct different structures around the face, depending on the volume enhancement required and the thickness of the soft tissue envelope. Differential fat harvesting and posterior grafting is performed to place the correct fat parcel size for each target area, expanding the potential applications of fat. Methods: Sixty patients consecutively recruited on a first come basis undergone a facial fat grafting procedure, in private practice setting between March 2012 and October 2013. Fat grafting quantity and quality was predicted for each case. Differential harvesting was performed, with 2 fat parcels size. Processing was performed through washing. Fat infiltration was carried out through small cannulas or needles depending on the treated area. Outcomes were analysed both by the physicians and the patients at 7 days, 1 month, 3 months and 6 months through a perceived satisfaction questionnaire. Parameters considered were downtime or discomfort, skin benefits, volume restoration, reabsorption rate estimated and overall improvement. Results: Full facial differential fat grafting procedure lasted an average of 1.5-2.5 h. Average downtime was 3-4 days. Follow-up was performed to a minimum of 6 months. Both patient and physician overall satisfaction rates were mostly excellent. Adverse events like lumps or irregularities were not encountered. Conclusion: Differential fat harvesting and posterior grafting is a valid alternative, to expand the repertoire of fat use, allow a more homogeneous effect, reduce the potential complications, speed up the process, improve graft survival, and to enhance overall aesthetic outcome.

  18. Abdominal wall fat pad biopsy

    Science.gov (United States)

    Amyloidosis - abdominal wall fat pad biopsy; Abdominal wall biopsy; Biopsy - abdominal wall fat pad ... method of taking an abdominal wall fat pad biopsy . The health care provider cleans the skin on ...

  19. Face the Fats Quiz 2

    Science.gov (United States)

    Face the Fats Quiz II Do you know your fats by heart? Ready to make informed choices about the foods you ... to fried chicken, test your knowledge about the fats in some familiar foods. Welcome to Face the ...

  20. Performance of steroid eluting bipolar epicardial leads in pediatric and congenital heart disease patients: 15 years of single center experience.

    Science.gov (United States)

    Paech, Christian; Kostelka, Martin; Dähnert, Ingo; Flosdorff, Patrick; Riede, Frank Thomas; Gebauer, Roman Antonin

    2014-05-12

    Cardiac pacing is sometimes required for patients with congenital heart disease for various reasons. Because of complex anatomy, repetitive previous heart surgery and patient size, epicardial leads are of special importance in these patients. Using epicardial leads has been discussed controversly regarding pacing performance and lead survival. The aim of this study was to review the long-term data on pacing performance as well as lead survival of epicardial leads implanted in our center. Retrospective chart review and review of the literature. 82 consecutive pediatric patients or adult patients with congenital heart disease with 158 epicardial leads (Medtronic 4968, bipolar, steroid - eluting) were included. We found 1.2% pacemaker-related early postoperative complications. The incidence of lead dysfunction was 7.5% (12/158) for primary (i.e. directly related to the lead itself) lead dysfunction and 3.2% (5/158) of lead abandonment for reasons not directly related to the lead itself. Primary lead dysfunction occured after a median of 3.83 years. Lead survival at 2, 5 and 10 years was 98.7%, 93% and 92.4%. There were no infections reported. Stable median measurements for impedance (RA/RV/LV of 577/483/610 Ohm), sensing threshold (RA/RV/LV of 2.0/11.0/10.0 mV) and pacing threshold (RA/RV/LV of 0.75 V at 0.4 ms/1.0 V at 0.49 ms/1.0 V at 0.45 ms) indicated a good mid- to longterm performance. The only risk factor for primary lead dysfunction was young age at implantation. The use of epicardial leads in pediatric and adult patients with congenital heart disease shows good longterm outcomes in terms of pacing performance and lead survival. The authors encourage using epicardial leads in patients with congenital heart disease based on the patient's individual characteristics.

  1. High-resolution 3D coronary vessel wall imaging with near 100% respiratory efficiency using epicardial fat tracking: reproducibility and comparison with standard methods.

    Science.gov (United States)

    Scott, Andrew D; Keegan, Jennifer; Firmin, David N

    2011-01-01

    To quantitatively assess the performance and reproducibility of 3D spiral coronary artery wall imaging with beat-to-beat respiratory-motion-correction (B2B-RMC) compared to navigator gated 2D spiral and turbo-spin-echo (TSE) acquisitions. High-resolution (0.7 × 0.7 mm) cross-sectional right coronary wall acquisitions were performed in 10 subjects using four techniques (B2B-RMC 3D spiral with alternate (2RR) and single (1RR) R-wave gating, navigator-gated 2D spiral (2RR) and navigator-gated 2D TSE (2RR)) on two occasions. Wall thickness measurements were compared with repeated measures analysis of variance (ANOVA). Reproducibility was assessed with the intraclass correlation coefficient (ICC). In all, 91% (73/80) of acquisitions were successful (failures: four TSE, two 3D spiral (1RR) and one 3D spiral (2RR)). Respiratory efficiency of the B2B-RMC was less variable and substantially higher than for navigator gating (99.6 ± 1.2% vs. 39.0 ± 7.5%, P B2B-RMC permits coronary vessel wall assessment over multiple thin contiguous slices in a clinically feasible duration. Excellent reproducibility of the technique potentially enables studies of disease progression/regression. Copyright © 2010 Wiley-Liss, Inc.

  2. The Rendu-Osler-Weber Disease Revealed by a Refractory Hypoxemia and Severe Cerebral Fat Embolism

    Directory of Open Access Journals (Sweden)

    Leonel Barreto

    2013-01-01

    Full Text Available The Rendu-Osler-Weber disease is a genetic disease which may lead to severe hemorrhage and less frequently to severe organ dysfunction. We report the case of a 22-year-old patient with no personal medical history who was involved in a motorcycle accident and exhibited severe complications related to large arteriovenous pulmonary shunts during his ICU stay. The patient developed an unexplained severe hypoxemia which was attributed to several arteriovenous shunts of the pulmonary vasculature by a contrast study during a transesophageal echocardiographic examination. The course was subsequently complicated by a prolonged coma associated with hemiplegia which was attributed to a massive paradoxical fat embolism in the setting of an untreated femoral fracture. In addition to hemorrhagic complications which may lead to intractable shock, arteriovenous malformations associated with the Rendu-Osler-Weber disease may involve the pulmonary vasculature and result in unexpected complications, such as hypoxemia or severe cerebral fat embolism in high-risk patients.

  3. Atrial epicardial pacing with long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis.

    Science.gov (United States)

    Kazmierczak, J; Kornacewicz-Jach, Z; Wojtarowicz, A

    1999-07-01

    Atrial epicardial pacing with a long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis is discussed. Arrhythmogenic right ventricular dysplasia (ARVD) is associated with a high incidence of malignant ventricular arrhythmias. Most patients with ARVD need antiarrhythmic drugs, catheter ablation, or an implantable cardioverter defibrillator. We report a patient with ARVD in whom effective treatment with sotalol caused severe, symptomatic sinus bradycardia requiring permanent pacing. Due to leftward displacement of the right ventricle and the presence of two thrombi in the right atrium, an epicardial atrial lead and AAI pacemaker were implanted. A long stimulus to P wave interval caused by severe dilatation of the right atrium was recorded. During a 6 months of follow-up on sotalol treatment there were neither ventricular tachycardia (VT) attacks nor pacing problems.

  4. Epicardial Adipose Tissue Is Associated with Plaque Burden and Composition and Provides Incremental Value for the Prediction of Cardiac Outcome. A Clinical Cardiac Computed Tomography Angiography Study.

    Directory of Open Access Journals (Sweden)

    Gitsios Gitsioudis

    Full Text Available We sought to investigate the association of epicardial adipose tissue (eCAT volume with plaque burden, circulating biomarkers and cardiac outcomes in patients with intermediate risk for coronary artery disease (CAD.177 consecutive outpatients at intermediate risk for CAD and completed biomarker analysis including high-sensitive Troponin T (hs-TnT and hs-CRP underwent 256-slice cardiac computed tomography angiography (CCTA between June 2008 and October 2011. Patients with lumen narrowing ≥50% exhibited significantly higher eCAT volume than patients without any CAD or lumen narrowing 3 risk factors, presence of CAD, hs-CRP and hs-TnT.Epicardial adipose tissue volume is independently associated with plaque burden and maximum luminal narrowing by CCTA and may serve as an independent predictor for cardiac outcomes in patients at intermediate risk for CAD.

  5. Dietary Fat Overload Reprograms Brown Fat Mitochondria

    Directory of Open Access Journals (Sweden)

    DANIELE eLETTIERI BARBATO

    2015-09-01

    Full Text Available Chronic nutrient overload accelerates the onset of several aging-related diseases reducing life expectancy. Although the mechanisms by which overnutrition affects metabolic processes in many tissues are known, its role on BAT physiology is still unclear. Herein, we investigated the mitochondrial responses in BAT of female mice exposed to high fat diet (HFD at different steps of life. Although adult mice showed an unchanged mitochondrial amount, both respiration and OxPHOS subunits were strongly affected. Differently, offspring pups exposed to HFD during pregnancy and lactation displayed reduced mitochondrial mass but high oxidative efficiency that, however, resulted in increased bioenergetics state of BAT rather than augmented uncoupling respiration. Interestingly, the metabolic responses triggered by HFD were accompanied by changes in mitochondrial dynamics characterized by decreased content of the fragmentation marker Drp1 both in mothers and offspring pups. HFD-induced inactivation of the FoxO1 transcription factor seemed to be the up-stream modulator of Drp1 levels in brown fat cells. Furthermore, HFD offspring pups weaned with normal diet only partially reverted the mitochondrial dysfunctions caused by HFD. Finally these mice failed in activating the thermogenic program upon cold exposure. Collectively our findings suggest that maternal dietary fat overload irreversibly commits BAT unresponsiveness to physiological stimuli such as cool temperature and this dysfunction in the early stage of life might negatively modulates health and lifespan.

  6. Fecal Fat: The Test

    Science.gov (United States)

    ... weeks to delivery) Prostate Cancer Protein in Urine (Proteinuria) Reactive Arthritis Rheumatoid Arthritis Sarcoidosis Scleroderma Sepsis Septic ... healthcare practitioner's instructions; this may include consuming 50-150 grams of fat a day in your diet ...

  7. Fecal Fat: The Test

    Science.gov (United States)

    ... Pregnancy hCG Tumor Marker HDL Cholesterol Heavy Metals Helicobacter pylori Testing Hematocrit Hemoglobin Hemoglobin A1c Hemoglobinopathy Evaluation ... 150 grams of fat a day in your diet for 2-3 days prior to and during ...

  8. Drink Water, Fight Fat?

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_165714.html Drink Water, Fight Fat? When you have it in place ... HealthDay News) -- If you choose a glass of water instead of a beer or a sugar-sweetened ...

  9. What Are Solid Fats?

    Science.gov (United States)

    ... TIPS: Vary Your Veggies Beans and Peas Are Unique Foods Food Gallery Take the Vegetable Quiz Grains ... Foods and Beverages Saturated, Unsaturated, and Trans Fats Sodium Added Sugars Others Everything You Eat and Drink ...

  10. Alternative fat sources to animal fat for pigs

    DEFF Research Database (Denmark)

    Lauridsen, Charlotte; Christensen, Thomas Bruun; Halekoh, Ulrich

    2007-01-01

    % of either animal fat, palm oil mix, palm oil, vegetable oil mix, coconut oil, or rapeseed oil were tested in weaned and growing pigs. It was concluded that several vegetable fat sources (palm oil mix, palm oil, coconut oil, rapeseed oil) could be used as alternatives to animal fat in pig feed, whereas fat......The use of fats and oils in diets for pigs is of great importance due to their high energy value. As a consequence of the BSE-crisis in the European Union, the amount of animal fat available for animal feeds has been reduced, and alternative fat sources are of increasing importance. In this paper...

  11. ECG and echocardiographic findings in 10-15-year-old elite athletes.

    Science.gov (United States)

    Koch, Sarah; Cassel, Michael; Linné, Karsten; Mayer, Frank; Scharhag, Jürgen

    2014-06-01

    Data on electrocardiographic and echocardiographic pre-participation screening findings in paediatric athletes are limited. 10--15 year-old athletes (n = 343) were screened using electro- and echocardiography. The electrocardiogram (ECG) was normal in 220 (64%), mildly abnormal in 108 (31%), and distinctly abnormal in 15 (4%) athletes. Echocardiographic upper reference limits (URL, 97.5 percentile) for the left ventricular (LV) wall thickness in 10-11-year-old boys and girls were 9-10 mm and 8-9 mm, respectively; in 12-13-year-old boys and girls 9-10 mm; and in 14-15-year-old boys and girls 10-11 mm and 9-10 mm, respectively. Three athletes were excluded from competitive sports: one for symptomatic Wolff-Parkinson-White syndrome with a normal echocardiogram; one for negative T-waves in V1-V4 and a dilated right ventricle by echocardiography suggestive of (arrhythmogenic) right ventricular disease; and one for normal ECG and biscupid aortic valve including an aneurysm of the ascending aorta detected by echocardiography. Related to echocardiographic findings, the sensitivity and specificity of the ECG to identify cardiovascular abnormalities was 38% and 64%, respectively. The ECG's positive-predictive and negative-predictive values were 13% and 88%, respectively. The numbers needed to screen and calculated costs were 172 for ECG (€7049), 172 for echocardiography (€11,530), and 114 combining ECG and echocardiography (€9323). Compared to adults, paediatric athletes presented with fewer distinctly abnormal ECGs, and there was no gender difference in paediatric athletes' ECG-pattern distribution. A combination of ECG and echocardiography for pre-participation screening of paediatric athletes is superior to ECG alone but 30% more costly. © The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Clinical and echocardiographic diagnosis, follow up and management of right-sided cardiac thrombi.

    Science.gov (United States)

    Mohan, Bishav; Chhabra, Shibba Takkar; Gulati, Amarpal; Mohan Mittal, Chander; Mohan, Gaurav; Tandon, Rohit; Kumbkarni, S; Aslam, Naved; Sood, Naresh K; Wander, Gurpreet Singh

    2013-01-01

    Right-sided cardiac masses are infrequent and have varied clinical presentation. The present study describes the clinical features, echocardiographic findings and management of 19 patients presenting with right-sided cardiac thrombi in a tertiary care center in north India. This is a retrospective, single center observational study of consecutive patients over the period January 2003-2008 admitted in our emergency intensive care unit (EICU). We identified 38 patients with right-sided cardiac masses admitted to EICU diagnosed by transthoracic echocardiography of which 19 patients had right-sided thrombus. The echocardiographic findings were reviewed by two cardiologists in all patients. Treatment was not standardized and choice of therapy was based on judgment of attending physician. The mean age of patients with cardiac thrombus was 36.6 ± 11.8 years. Right atrial (n = 17) and right ventricle (n = 2) thrombi were associated with deep vein thrombosis (DVT) in 7 (36.8%) and pulmonary embolism in 3 (15%) patients. 13 (68.4%) patients appeared to have in situ mural thrombus. 12 patients were managed with oral anticoagulants, 3 patients underwent surgery and 4 patients were thrombolysed. All the survivors had a mean follow-up of 40 ± 6 months (range--18-50 months). Prompt echocardiographic examination in an appropriate clinical setting facilitates faster diagnosis and management of patients with right-sided cardiac thrombi. High incidence of in situ mural thrombus and varied comorbidities predisposing to right-sided cardiac thrombi besides DVT and pulmonary embolism need to be recognized. Oral anticoagulation and thrombolysis appear to be the mainstay of treatment with surgery limited for selected patients. Copyright © 2013. Published by Elsevier B.V.

  13. Three-Dimensional Echocardiographic Assessment of Changes in Mitral Valve Geometry After Valve Repair

    Science.gov (United States)

    Mahmood, Feroze; Subramaniam, Balachundhar; Gorman, Joseph H.; Levine, Robert M.; Gorman, Robert C.; Maslow, Andrew; Panzica, Peter J.; Hagberg, Robert M.; Karthik, Swaminathan; Khabbaz, Kamal R.

    2011-01-01

    Background Application of annuloplasty rings during mitral valve (MV) repair has been shown to significantly change the mitral annular geometry. Until recently, a comprehensive two-dimensional echocardiographic evaluation of annular geometric changes was difficult owing to its nonplanar orientation. In this study, an analysis of the three-dimensional intraoperative transesophageal echocardiographic evaluation of the MV annulus is presented before and immediately after repair. Methods We performed three-dimensional geometric analysis on 75 patients undergoing MV repair during coronary artery bypass graft surgery for mitral regurgitation or myxomatous mitral valve disease. Geometric analysis of the MV was performed before and immediately after valve repair with full rings and annuloplasty bands. The acquired three-dimensional volumetric data were analyzed in the operating room. Specific measurements included annular diameter, leaflet lengths, the nonplanarity angle, and the circularity index. Before and after repair data were compared. Results Complete echocardiographic assessment of the MV was feasible in 69 of 75 patients (92%) within 2 to 3 minutes of acquisition. Placement of full rings resulted in an increase in the nonplanarity angle or a less saddle shape of the native mitral annulus (137 ±14 versus 146 ± 14; p = 0.002. By contrast, the nonplanarity angle did not change significantly after placement of partial rings. Conclusions Mitral annular nonplanarity can be assessed in the operating room. Application of full annuloplasty rings resulted in the mitral annulus becoming more planar. Partial annuloplasty bands did not significantly change the nonplanarity angle. Neither of the two types of rings restored the native annular planarity. PMID:19932245

  14. Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study

    Directory of Open Access Journals (Sweden)

    Guilherme Ferreira Gazzoni

    2017-11-01

    Full Text Available Abstract Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT, thus, appropriate patient selection is critical to the success of CRT in heart failure. Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario. Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS. Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant. Results: A total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027, previous acute myocardial infarction (AMI (HR of 2.17, p = 0.049 and chronic obstructive pulmonary disease (COPD (HR of 3.13, p = 0.015. The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048. The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation. Conclusion: Mortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response.

  15. Reference intervals and allometric scaling of echocardiographic measurements in Bengal cats.

    Science.gov (United States)

    Scansen, Brian A; Morgan, Kyla L

    2015-12-01

    The Bengal is a relatively new hybrid breed, reported to develop hypertrophic cardiomyopathy. The aim of this study was to determine reference intervals for echocardiographic measurements in Bengal cats. Sixty-six apparently healthy Bengal cats. The study included a retrospective review of echocardiograms from 39 Bengal cats evaluated from March 2004 to June 2012 and reported to be normal by a board-certified cardiologist. An additional 27 cats were enrolled prospectively from June 2012 to June 2013. The effects of sex and body weight on linear cardiac dimensions were evaluated by regression analysis. Reference intervals were determined by the robust method with bootstrapping. Allometric equations scaled to body weight were derived for each echocardiographic variable. Intra- and interobserver variability were evaluated by coefficient of variation from 6 of the prospective studies. Reference intervals were determined from all 66 Bengal cats as no significant differences were observed between the retrospective and prospective data. An effect of sex, separate from body weight, was suggested and unique reference intervals for male and female cats were determined. Body weight was a significant co-variate and 95% prediction intervals for linear dimensions were determined by allometric scaling. Coefficients of variation were less than 10% for 2-dimensional variables and less than 18% for M-mode variables. These data provide reference intervals and weight-based 95% prediction intervals for echocardiographic measurements in the Bengal cat, potentially aiding cardiologists who screen this breed in detecting pathologic variants from normal dimensions. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Feasibility, Reproducibility, and Agreement between Different Speckle Tracking Echocardiographic Techniques for the Assessment of Longitudinal Deformation

    Directory of Open Access Journals (Sweden)

    Sergio Buccheri

    2013-01-01

    Full Text Available Background. Left ventricular (LV longitudinal deformation can be assessed with new echocardiographic techniques like triplane echocardiography (3PE and four-dimensional echocardiography (4DE. We aimed to assess the feasibility, reproducibility, and agreement between these different speckle-tracking techniques for the assessment of longitudinal deformation. Methods. 101 consecutive subjects underwent echocardiographic examination. 2D cine loops from the apical views, a triplane view, and an LV 4D full volume were acquired in all subjects. LV longitudinal strain was obtained for each imaging modality. Results. 2DE analysis of LV strain was feasible in 90/101 subjects, 3PE strain in 89/101, and 4DE strain in 90/101. The mean value of 2DE and 3PE longitudinal strains was significantly higher with respect to 4DE. The relationship between 2DE and 3PE derived strains (r=0.782 was significantly higher (z=3.72, P<0.001 than that between 2DE and 4DE (r=0.429 and that between 3PE and 4DE (r=0.510; z=3.09, P=0.001. The mean bias between 2DE and 4DE strains was -6.61±7.31% while -6.42±6.81% between 3PE and 4DE strains; the bias between 2DE and 3PE strain was of 0.21±4.16%. Intraobserver and interobserver variabilities were acceptable among the techniques. Conclusions. Echocardiographic techniques for the assessment of longitudinal deformation are not interchangeable, and further studies are needed to assess specific reference values.

  17. Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Rassi, Daniela do Carmo, E-mail: dani.rassi@hotmail.com [Faculdade de Medicina e Hospital das Clínicas da Universidade Federal de Goiás (UFG), Goiânia, GO (Brazil); Vieira, Marcelo Luiz Campos [Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Arruda, Ana Lúcia Martins [Instituto de Radiologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Hotta, Viviane Tiemi [Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador [Faculdade de Medicina e Hospital das Clínicas da Universidade Federal de Goiás (UFG), Goiânia, GO (Brazil)

    2014-03-15

    Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m{sup 2} were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

  18. Saturated and trans fats

    National Research Council Canada - National Science Library

    Shader, Richard I

    2014-01-01

    ... Original Pancake Mix plus ingredients suggested by the recipe: 2 g saturated fat (SF) and no trans fatty acids or trans fat (TFA); bacon, Oscar Mayer Lower Sodium Bacon: 2.5 g SF and no TFA; sausages, Jimmy Dean Original Pork Sausage Links: 8 g SF and no TFA; potatoes, Ore-Ida Mini Tater Tots: 2 g SF and no TFA; and nondairy creamer, Nestlé Coffee-...

  19. Visceral and subcutaneous fat have different origins and evidence supports a mesothelial source.

    Science.gov (United States)

    Chau, You-Ying; Bandiera, Roberto; Serrels, Alan; Martínez-Estrada, Ofelia M; Qing, Wei; Lee, Martin; Slight, Joan; Thornburn, Anna; Berry, Rachel; McHaffie, Sophie; Stimson, Roland H; Walker, Brian R; Chapuli, Ramon Muñoz; Schedl, Andreas; Hastie, Nick

    2014-04-01

    Fuelled by the obesity epidemic, there is considerable interest in the developmental origins of white adipose tissue (WAT) and the stem and progenitor cells from which it arises. Whereas increased visceral fat mass is associated with metabolic dysfunction, increased subcutaneous WAT is protective. There are six visceral fat depots: perirenal, gonadal, epicardial, retroperitoneal, omental and mesenteric, and it is a subject of much debate whether these have a common developmental origin and whether this differs from that for subcutaneous WAT. Here we show that all six visceral WAT depots receive a significant contribution from cells expressing Wt1 late in gestation. Conversely, no subcutaneous WAT or brown adipose tissue arises from Wt1-expressing cells. Postnatally, a subset of visceral WAT continues to arise from Wt1-expressing cells, consistent with the finding that Wt1 marks a proportion of cell populations enriched in WAT progenitors. We show that all visceral fat depots have a mesothelial layer like the visceral organs with which they are associated, and provide several lines of evidence that Wt1-expressing mesothelium can produce adipocytes. These results reveal a major ontogenetic difference between visceral and subcutaneous WAT, and pinpoint the lateral plate mesoderm as a major source of visceral WAT. They also support the notion that visceral WAT progenitors are heterogeneous, and suggest that mesothelium is a source of adipocytes.

  20. Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: first long-term results from a prospective device trial

    OpenAIRE

    Emmert, Maximilian Y.; Puippe, Gilbert; Baumüller, Stephan; Alkadhi, Hatem; Landmesser, Ulf; Plass, Andre; Bettex, Dominique; Scherman, Jacques; Grünenfelder, Jürg; Genoni, Michele; Falk, Volkmar; Salzberg, Sacha P.

    2017-01-01

    OBJECTIVES Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). This is the first report of long-term safety and efficacy data on LAA closure using a novel epicardial LAA clip device in patients undergoing cardiac surgery. METHODS Forty patients with AF were enrolled in this prospective ‘first-in-man' trial. The inclusion criterion was elective cardiac surgery in adult patients with AF for which a concomitant ablation proce...

  1. Endocardial-epicardial distribution of myocardial perfusion reserve assessed by multidetector computed tomography in symptomatic patients without significant coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, Jørgen Tobias; George, Richard T; Mehra, Vishal C

    2016-01-01

    (MPR) in humans. We aimed to test the hypothesis that MPR in all myocardial layers is determined by age, gender, and cardiovascular risk profile in patients with ischaemic symptoms or equivalent but without obstructive coronary artery disease (CAD). METHODS AND RESULTS: A total of 149 patients enrolled...... in endocardial-epicardial distribution of perfusion reserve may be demonstrated with static CT perfusion. Low MPR in all myocardial layers was observed specifically in obese patients....

  2. Comparison of four echocardiographic methods to determine left atrial size in dogs

    DEFF Research Database (Denmark)

    Höllmer, Miriam; Willesen, Jakob; Tolver, Anders

    2016-01-01

    OBJECTIVES: To compare a linear and three volume-based two-dimensional echocardiographic methods for measuring LA size: left atrium to aorta ratio (LA/Ao ratio), biplane area-length, biplane modified Simpson and monoplane area-length. ANIMALS: One hundred seventy-six client-owned dogs of different...... breeds, 88 healthy dogs and 88 dogs with myxomatous mitral valve disease of different disease severity. METHODS: The left apical four- and two-chamber views were used to measure LA volumes. The right parasternal short-axis view at the level of the heart base was used to measure the LA/Ao ratio. RESULTS...

  3. The role of biomedical knowledge in echocardiographic interpretation expertise development: a correlation study

    DEFF Research Database (Denmark)

    Nielsen, Dorte Guldbrand; Gøtzsche, Ole; Eika, Berit

    2010-01-01

    Purpose: Little is known about factors of relevance for achieving knowledge of echocardiography (TTE); one of the essential skills defined by the European Society of Cardiology Core Curriculum. Recent research in other fields suggests that biomedical knowledge plays a more prominent role...... in professional practice than previously assumed. This study investigates the role of biomedical knowledge represented by physiology knowledge in the development of echocardiographic expertise. Methods: Forty-five physicians (15 novices, 15 intermediates and 15 experts) were evaluated on echocardiography...... of echocardiography relevant physiology knowledge. Results: A strong and significant correlation between expertise level and scores on the TTE interpretation checklist was found (r = 0.70, p

  4. Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise—the Australian Ironman Triathlon

    Science.gov (United States)

    Tulloh, L; Robinson, D; Patel, A; Ware, A; Prendergast, C; Sullivan, D; Pressley, L

    2006-01-01

    Background There is concern about whether cardiac damage occurs as a result of prolonged strenuous exercise. Objective To investigate whether competing in a triathlon is associated with cardiac damage based on a sustained increase in cardiac troponin T (cTnT), and whether such an increase correlates with echocardiographic changes Methods cTnT and echocardiographic measurements were made in 38 participants in the 2001 Australian ironman triathlon. cTnT was measured the day before, immediately after, and the day following the race. Echocardiography was done the day before, immediately after, and two to six weeks later for measurement of ejection fraction, stroke volume, cardiac output, wall motion analysis, and global left ventricular function (LVF). Results No subject had detectable cTnT in the pre‐race sample. Following the race, 32 subjects (86.5%) had detectable levels of cTnT (>0.01 ng/ml), with six (16.2%) having >0.10 ng/ml. The day after the race, nine subjects (23.7%) still had detectable cTnT, with two recording a level >0.10 ng/ml. Previously described echocardiographic changes of “cardiac fatigue” were observed in the whole cohort. There was a modest but significant correlation between change in ejection fraction and peak cTnT level (p = 0.02, r = 0.39). Athletes with a post‐race cTnT >0.10 ng/ml had a greater decrease in global LVF (p = 0.02) and a trend toward a greater fall in ejection fraction and stroke volume than athletes with cTnT levels 0.10 ng/ml (p>0.05). Conclusions Participation in ironman triathlon often resulted in persistently raised cTnT levels, and the troponin rise was associated with echocardiographic evidence of abnormal left ventricular function. The clinical significance and long term sequelae of such damage remains to be determined. PMID:16611724

  5. NT-proBNP, echocardiographic abnormalities and subclinical coronary artery disease in high risk type 2 diabetic patients

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Hansen, Peter R; Wiinberg, Niels

    2012-01-01

    Intensive multifactorial treatment aimed at prevention of cardiovascular (CV) disease may reduce left ventricular (LV) echocardiographic abnormalities in diabetic subjects. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the association between P-NT-proBNP and the put......Intensive multifactorial treatment aimed at prevention of cardiovascular (CV) disease may reduce left ventricular (LV) echocardiographic abnormalities in diabetic subjects. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the association between P......-NT-proBNP and the putative residual abnormalities in such patients are not well described. This study examined echocardiographic measurements of LV hypertrophy, atrial dilatation and LV dysfunction and their relation to P-NT-proBNP levels or subclinical coronary artery disease (CAD) in type 2 diabetic patients...

  6. Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern.

    Science.gov (United States)

    Nagase, Satoshi; Tanaka, Masamichi; Morita, Hiroshi; Nakagawa, Koji; Wada, Tadashi; Murakami, Masato; Nishii, Nobuhiro; Nakamura, Kazufumi; Ito, Hiroshi; Ohe, Tohru; Kusano, Kengo F

    2017-01-01

    Background: Brugada syndrome (BrS) is characterized by J-point or ST-segment elevation on electrocardiograms (ECGs) and increased risk of ventricular fibrillation (VF). In BrS, epicardial depolarization abnormality with delayed potential on the right ventricular outflow tract is reportedly the predominant mechanism underlying VF. Yet VF occurrence is also associated with early repolarization (ER) pattern in the inferolateral ECG leads, which may represent the inferior and/or left lateral ventricular myocardium. The aim of this study was to examine epicardial electrograms recorded directly at the left ventricle (LV) in BrS patients after VF episodes. Methods: In 12 BrS patients who had experienced VF episodes and 17 control subjects, a multipolar catheter was introduced into the left lateral coronary vein for unipolar and bipolar electrogram recordings at the LV epicardium. Both inferior and lateral ER patterns on ECG were observed in three BrS patients and six control subjects. Results: In the epicardium, prominent J waves were detected using unipolar recording, and potentials after the QRS complex were detected using bipolar recording in three of the 12 BrS patients. These three patients also showed both inferior and lateral ER patterns on ECG. Neither prominent J waves nor potentials after the QRS complex were recorded at the endocardium of the LV in any of these three patients; nor were they seen at the epicardium in any of the control subjects. These features were accentuated on pilsicainide administration (n = 2) but diminished on constant atrial pacing (n = 3) and isoproterenol administration (n = 1). The J waves observed through unipolar recording coincided with the potentials after QRS complex observed through bipolar recording and with the inferolateral ER patterns on ECG. Conclusions: We recorded prominent J waves in unipolar electrogram and potentials after QRS complex in bipolar electrogram at the LV epicardium in BrS patients with global ER pattern

  7. Assessment of muscular ventricular septal defect closure by transcatheter or surgical approach: a three-dimensional echocardiographic study.

    Science.gov (United States)

    Acar, P; Abdel-Massih, T; Douste-Blazy, M-Y; Dulac, Y; Bonhoeffer, P; Sidi, D

    2002-09-01

    Previous classification of muscular ventricular septal defects (VSDs) visualized on two-dimensional echocardiography relied on artificial divisions of the septum. New visualization of the ventricular septum integrating the third dimension would facilitate communication between cardiologists and surgeons. The objectives of this study were (1) to assess in patients with muscular ventricular septal defects the accuracy of left ventricular three-dimensional echocardiographic reconstructions in demonstrating the position, the size and the tissue rims of the defects; (2) to compare findings by three-dimensional echocardiography with those obtained by surgical and transcatheter approaches. Twenty-six patients, aged from one month to 40 years, with muscular ventricular septal defects underwent three-dimensional echocardiographic study. From the left ventricular three-dimensional echocardiographic reconstructions, the localization, the maximal diameter and the tissue rim of the defect were analysed and compared with surgical or transcatheter findings. Optimal three-dimensional echocardiographic reconstructions were obtained in 22 patients. Nineteen had a single muscular ventricular septal defect and three had multiple muscular ventricular septal defects. The muscular ventricular septal defect localizations were the inlet septum in three, the outlet septum in three, the mid-muscular septum in 14 and the apex in eighth. In 10 patients who underwent surgical closure, the correlation between three-dimensional echocardiography and surgery for muscular ventricular septal defect maximal diameter was y=0 x 95 x +0.13 (r=0.98; Pventricular septal defect localization were complete. In five patients who underwent transcatheter closure, the mean difference between three-dimensional echocardiographic maximal diameter and stretched diameter was 1 x 8+/-0 x 5 mm. The three-dimensional echocardiographic left ventricular views provide a new and easily communicated visualization of various

  8. Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: first long-term results from a prospective device trial.

    Science.gov (United States)

    Emmert, Maximilian Y; Puippe, Gilbert; Baumüller, Stephan; Alkadhi, Hatem; Landmesser, Ulf; Plass, Andre; Bettex, Dominique; Scherman, Jacques; Grünenfelder, Jürg; Genoni, Michele; Falk, Volkmar; Salzberg, Sacha P

    2014-01-01

    Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). This is the first report of long-term safety and efficacy data on LAA closure using a novel epicardial LAA clip device in patients undergoing cardiac surgery. Forty patients with AF were enrolled in this prospective 'first-in-man' trial. The inclusion criterion was elective cardiac surgery in adult patients with AF for which a concomitant ablation procedure was planned. Intraoperative transoesophageal echocardiography (TEE) was used to exclude LAA thrombus at baseline and evaluate LAA perfusion after the procedure, while computed tomography (CT) was used for serial imagery workup at baseline, 3-, 12-, 24- and 36-month follow-up. Early mortality was 10% due to non-device-related reasons, and thus 36 patients were included in the follow-up consisting of 1285 patient-days and mean duration of 3.5 ± 0.5 years. On CT, clips were found to be stable, showing no secondary dislocation 36 months after surgery. No intracardial thrombi were seen, none of the LAA was reperfused and in regard to LAA stump, none of the patients demonstrated a residual neck >1 cm. Apart from one unrelated transient ischaemic attack (TIA) that occurred 2 years after surgery in a patient with carotid plaque, no other strokes and/or neurological events demonstrated in any of the studied patients during follow-up. This is the first prospective trial in which concomitant epicardial LAA occlusion using this novel epicardial LAA clip device is 100% effective, safe and durable in the long term. Closure of the LAA by epicardial clipping is applicable to all-comers regardless of LAA morphology. Minimal access epicardial LAA clip closure may become an interesting therapeutic option for patients in AF who are not amenable to anticoagulation and/or catheter closure. Further data are necessary to establish LAA occlusion as a true and viable therapy for stroke prevention. The trial is

  9. Changes in Mitral Annular Ascent with Worsening Echocardiographic Parameters of Left Ventricular Diastolic Function

    Directory of Open Access Journals (Sweden)

    Paula M. Hernández Burgos

    2016-01-01

    Full Text Available Background. While the mitral annular plane systolic excursion (MAPSE has been suggested as a surrogate measurement of left ventricular ejection fraction, less is known about the relative value of mitral annular ascent (MAa. Methods. Our database was queried for complete transthoracic echocardiograms performed for any clinical indication. Baseline echocardiographic measurements were compared to determine any correlation between MAa and traditional Echo-Doppler echocardiographic measures to characterize left ventricular diastolic dysfunction (LVDD. Results. Patients with normal LV diastolic function were younger (41±13 years than patients with LVDD (stage 1: 61±13 years; stage 2: 57±14 years; and stage 3: 66±17 years; p=0.156. LV ejection fraction decreased in patients with stage 2 LVDD (63±17% and was further reduced in patients with stage 3 LVDD (28±21; p=0.003. Discussion. While a vigorous MAa excursion was seen in patients with stage 1 LVDD, MAa significantly decreased in stage 2 and stage 3 LVDD patients. Our results highlight the importance of atrioventricular coupling, as MAa motion seems to reflect changes in left atrial pressure. Additional studies are now required to better examine atrioventricular interactions and electromechanical coupling that might improve our assessment of LV diastolic function.

  10. Rationale and Design of the Echocardiographic Study of Hispanics/Latinos (ECHO-SOL).

    Science.gov (United States)

    Rodriguez, Carlos J; Dharod, Ajay; Allison, Matthew A; Shah, Sanjiv J; Hurwitz, Barry; Bangdiwala, Shrikant I; Gonzalez, Franklyn; Kitzman, Dalane; Gillam, Linda; Spevack, Daniel; Dadhania, Rupal; Langdon, Sarah; Kaplan, Robert

    2015-01-01

    Information regarding the prevalence and determinants of cardiac structure and function (systolic and diastolic) among the various Hispanic background groups in the United States is limited. The Echocardiographic Study of Latinos (ECHO-SOL) ancillary study recruited 1,824 participants through a stratified-sampling process representative of the population-based Hispanic Communities Health Study - Study of Latinos (HCHS-SOL) across four sites (Bronx, NY; Chicago, Ill; San Diego, Calif; Miami, Fla). The HCHS-SOL baseline cohort did not include an echo exam. ECHO-SOL added the echocardiographic assessment of cardiac structure and function to an array of existing HCHS-SOL baseline clinical, psychosocial, and socioeconomic data and provides sufficient statistical power for comparisons among the Hispanic subgroups. Standard two-dimensional (2D) echocardiography protocol, including M-mode, spectral, color and tissue Doppler study was performed. The main objectives were to: 1) characterize cardiac structure and function and its determinants among Hispanics and Hispanic subgroups; and 2) determine the contributions of specific psychosocial factors (acculturation and familismo) to cardiac structure and function among Hispanics. We describe the design, methods and rationale of currently the largest and most comprehensive study of cardiac structure and function exclusively among US Hispanics. ECHO-SOL aims to enhance our understanding of Hispanic cardiovascular health as well as help untangle the relative importance of Hispanic subgroup heterogeneity and sociocultural factors on cardiac structure and function.

  11. Chagas' heart disease: evolutive evaluation of electrocardiographic and echocardiographic parameters in patients with the indeterminate form

    Directory of Open Access Journals (Sweden)

    Ianni Barbara Maria

    2001-01-01

    Full Text Available OBJECTIVE: To identify and associate potential electrocardiographic and echocardiographic changes in patients with the indeterminate form of Chagas' disease during long-term follow-up. METHODS: One hundred sixty patients underwent standard electrocardiography and two-dimensional guided M-mode echocardiography for left ventricular ejection fraction determination. Patients were followed up for 98.6±30.4 months, undergoing repeat electrocardiographic studies at 6-month intervals and echocardiographic studies at 12-month intervals. RESULTS: Based on the electrocardiographic findings, the patients were divided into group I, 125 patients (78.6% with normal electrocardiograms throughout follow-up, and group II, 34 patients (21.3% who developed electrocardiographic changes. Group II was further divided into group IIA (9 patients, 5.6% with permanent electrocardiographic changes, group IIB (14 patients, 8.8% with transitory electrocardiographic changes, and group IIC (11 patients, 6.9% with changes appearing only on the final electrocardiogram. Left ventricular ejection fractions remained normal in the entire population studied and did not differ among groups. CONCLUSION: The indeterminate form of Chagas' disease clearly represents a benign condition with a favorable long-term prognosis. Although some patients develop electrocardiographic changes, left ventricular systolic function is well preserved.

  12. Do baseline diastolic echocardiographic parameters predict outcome after resynchronization therapy? Results from the PROSPECT trial.

    Science.gov (United States)

    Sullivan, Renee M; Murillo, Jaime; Gerritse, Bart; Chung, Eugene; Orlov, Michael V; Stegemann, Berthold; Fedewa, Michelle; Peterson, Brett J; Sun, Jing Ping; Olshansky, Brian

    2013-02-01

    Cardiac resynchronization therapy (CRT) can improve clinical and cardiac structural status in heart failure patients. The role of baseline diastolic echocardiographic parameters to characterize the likelihood of positive outcomes is not well known. We explored relationships between diastolic parameters and outcomes 6 months after CRT implant in the Predictors of Response to CRT (PROSPECT) Trial. We hypothesized that diastolic echocardiographic parameters were associated with clinical and structural outcomes in CRT patients. For 426 patients in PROSPECT, a prospective observational trial of CRT, baseline E/A ratio, left atrial (LA) area, isovolumic relaxation time, left ventricular inflow deceleration time, E' velocity, and E/E' ratio were evaluated and related to 6-month clinical composite score (CCS) and left ventricular end-systolic volume (LVESV) reduction using Spearman rank-order correlations. Parameters associated with outcomes were analyzed further by discrete categorization. As continuous variables, only E/A ratio and LA area correlated with CCSs (P = 0.017, P = 0.045, respectively) and relative change in LVESV at 6 months (P discrete variables, E/A ratio and LA area also correlated with CCSs and LVESV. Diastolic echo parameters E/A ratio and LA area were associated with clinical and structural outcomes in CRT patients at 6 months. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  13. Atrioventricular valve abnormalities in infancy: two-dimensional echocardiographic and angiocardiographic comparison.

    Science.gov (United States)

    Gutgesell, H P; Cheatham, J; Latson, L A; Nihill, M R; Mullins, C E

    1983-09-01

    The results of two-dimensional echocardiography and biplane angiocardiography from 47 infants with congenital atrioventricular (AV) valve abnormalities were compared. Eleven patients had atresia of the right AV valve, 10 had atresia of the left AV valve, 4 had hypoplasia of the right AV valve and 5 had hypoplasia of the left AV valve. Twelve patients had endocardial cushion defect, three had single ventricle and two had straddling of the left AV valve. There was agreement between the two techniques as to the number of AV valves present in each patient. The echocardiographic estimate of valve anular diameter was below normal in seven of the eight patients thought to have a hypoplastic anulus by angiocardiography. In 10 of the 12 patients with endocardial cushion defect, there was agreement between the two techniques as to the presence or absence of atrial and ventricular septal defect. The chordal attachments of straddling valves were better visualized by echocardiography; flow patterns and effective orifice size were better demonstrated by angiocardiography. The subcostal four chamber echocardiographic views and cranially angulated oblique angiocardiographic views were comparable and provided the best images for determination of the size and number of AV valves and their relation to the atrial and ventricular septa.

  14. Allometric scaling of echocardiographic measurements in healthy Spanish foals with different body weight.

    Science.gov (United States)

    Rovira, S; Muñoz, A; Rodilla, V

    2009-04-01

    Scaling in biology is usually allometric, and therefore, the size of the heart may be expressed as a power function of body weight (BW). The present research analyses the echocardiographic measurements in 68 healthy Spanish foals weighed between 70 and 347kg in order to determine the correct scaling exponent for the allometric equation. The echocardiographic parameters measured were: left ventricular internal dimensions (LVID), free wall thickness (LVFWT), interventricular septum thickness (IVST) at systole (s) and diastole (d), EPSS (distance between the point E of the mitral valve and the interventricular septum), and aorta diameters at the level of the aortic valve (AOD), base of valve leaflets (ABS), sinus of Valsalva (ASV) and sino-tubular junction (AJT). Indices of left ventricular performance were calculated. It was found that LVIDd, IVSTs, AOD, and ASV have a relationship to BW raised to 0.300-0.368 power, whereas left ventricular end-diastolic volume and stroke volume scaled to BW raised to 0.731-0.712 power. With these data, appropriate values can be calculated for normal Spanish foals.

  15. Effects of arteriovenous fistula on clinical, laboratory and echocardiographic findings in renal allograft recipients.

    Science.gov (United States)

    Gorgulu, Numan; Caliskan, Yasar; Yelken, Berna; Akturk, Faruk; Turkmen, Aydin

    2011-10-01

    Left ventricular hypertrophy (LVH) is frequently observed in patients with end-stage renal disease and renal allograft recipients, and is an independent and strong predictor of morbidity and mortality. Presence of a patent arteriovenous fistula (AVF) after renal transplantation may contribute to the persistent LVH. We investigated the clinical, laboratory, and echocardiographic findings in patients with renal transplants with or without AVF. A total of 130 renal transplant recipients were included in this study: 60 hemodialysis patients whose fistulas were still functional, 49 hemodialysis patients whose fistulas were spontaneous stopped or closed, and 21 peritoneal dialysis patients who had never had fistulas created. Laboratory parameters were measured and echocardiographic measurements were performed. There were no significant differences regarding smoking status, blood pressures, or NT-proBNP, hs-CRP, iPTH, and TSH levels between the study groups. Left atrial, right atrial diameters, left ventricle end-diastolic diameter, left ventricle end-systolic diameter, interventricular septum thickness (IVST), left ventricle mass index (LVMI), pulmonary artery pressure (PAP), and ejection fraction were similar in the three groups. In correlation analysis, PAP was significantly correlated with serum uric acid and NT-proBNP levels. Also, there were positive and moderate correlations between the serum uric acid and the IVST. Patent AVFs have not affected cardiovascular abnormalities such as LVH and LV mass index in patients with renal transplant. Hyperuricemia may be associated with increased PAP and high LVMI.

  16. Echocardiographic findings in infants with presumed congenital Zika syndrome: Retrospective case series study.

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    Danielle Di Cavalcanti

    Full Text Available To report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome.An observational retrospective study was performed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP, Recife, Brazil. 103 infants with presumed congenital Zika syndrome. All infants had microcephaly and head computed tomography findings compatible with congenital Zika syndrome. Zika IgM antibody was detected in cerebrospinal fluid samples of 23 infants. In 80 infants, the test was not performed because it was not available at that time. All infants had negative serology for HIV, syphilis, rubella, cytomegalovirus and toxoplasmosis. A complete transthoracic two-dimensional, M-mode, continuous wave and pulsed wave Doppler and color Doppler echocardiographic (PHILIPS HD11XE or HD15 examination was performed on all infants.14/103 (13.5% echocardiograms were compatible with congenital heart disease: 5 with an ostium secundum atrial septal defect, 8 had a hemodynamically insignificant small apical muscular ventricular septal defect and one infant with dyspnea had a large membranous ventricular septal defect. The echocardiograms considered normal included 45 infants with a persistent foramen ovale and 16 with a minimum patent ductus arteriosus.Preliminarily this study suggests that congenital Zika syndrome may be associated with an increase prevalence of congenital heart disease. However the types of defects noted were septal defects, a proportion of which would not be hemodynamically significant.

  17. Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.

    Science.gov (United States)

    Sohmer, Benjamin; Hudson, Christopher; Hudson, Jordan; Posner, Glenn D; Naik, Viren

    2014-03-01

    Performance of transesophageal echocardiography (TEE) requires the psychomotor ability to obtain interpretable echocardiographic images. The purpose of this study was to determine the effectiveness of a simulation-based curriculum in which a TEE simulator is used to teach the psychomotor skills to novice echocardiographers and to compare instructor-guided with self-directed online delivery of the curriculum. After institutional review board approval, subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator. Subjects were randomized to two groups. The first group received an instructor-guided lesson of TEE psychomotor skills with the simulator. The second group received a self-directed slide presentation of TEE psychomotor skills with the simulator. Both lessons delivered identical information. Following their respective training sessions, all subjects performed a post-test of their TEE psychomotor skills using the simulator. Two assessors rated the TEE performances using a validated scoring system for acquisition of images. Pre-test TEE simulator scores were similar between the two instruction groups (9.0 vs 5.0; P = 0.28). The scores in both groups improved significantly following training, regardless of the method of instruction (P psychomotor skills. There was no difference in improvement between the different modalities of instruction. Further research will examine the need for a faculty resource for a curriculum in which a simulator is used as an adjunct.

  18. Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction.

    Science.gov (United States)

    Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Arruda, Ana Lúcia Martins; Hotta, Viviane Tiemi; Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador

    2014-03-01

    Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

  19. Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues.

    Science.gov (United States)

    Louw, Jacoba; Brown, Stephen; Thewissen, Liesbeth; Smits, Anne; Eyskens, Benedicte; Heying, Ruth; Cools, Bjorn; Levtchenko, Elena; Allegaert, Karel; Gewillig, Marc

    2013-04-01

    Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis. Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified. Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors. Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.

  20. Echocardiographic assessment of left atrial size in patients with end-stage renal disease.

    Science.gov (United States)

    Koçinaj, Dardan; Gashi, Masar; Berisha, Merita; Koçinaj, Allma; Ramadani, Naser; Korça, Hajrije

    2009-01-01

    Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischaemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, annular mitral and aortic valve calcification, and enlargement of the left atrium, than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study, we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. We analysed data from 123 patients who were on regular haemodialysis, by means of traditional transthoracic echocardiographic examination. The usual statistical parameters, correlations and the Student's t-test were performed, with levels of significance of p < 0.01 and p < 0.05. The most presented age group was 60 to 69 years old, with a predomination of females (56.1%). We found dilated left atrium in 26.02% of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Evaluation of left atrial size should be determined by several different measurements, and left atrial enlargement should be seen as a risk factor for advancing disease.

  1. Echocardiographic evaluation of right ventricular function in preterm infants with bronchopulmonary dysplasia.

    Science.gov (United States)

    Bokiniec, Renata; Własienko, Paweł; Borszewska-Kornacka, Maria; Szymkiewicz-Dangel, Joanna

    2017-04-01

    To evaluate right ventricular function in preterm infants with and without bronchopulmonary dysplasia. Eighty-nine preterm infants (bronchopulmonary dysplasia (n=32); (2) mild-bronchopulmonary dysplasia (n=35); (3) severe-bronchopulmonary dysplasia (n=15). Right ventricular echocardiographic parameters included the following: (1) pulsed-wave Doppler through the tricuspid valve (E/A ratio), pulmonary artery acceleration time, right ventricular ejection time, right ventricular velocity-time integral; (2) tissue Doppler measurements of myocardial velocities and atrioventricular conduction times; (3) pulsed-wave Doppler and tissue Doppler evaluation of myocardial performance index and E/E' ratio; and (4) M-mode detection of right ventricular end-diastolic wall diameter. The severe-bronchopulmonary dysplasia group had higher mean right ventricular myocardial performance index (on the 28th day of life by pulsed-wave Doppler) than the no-bronchopulmonary dysplasia (P=.014) or mild-bronchopulmonary dysplasia (P=.031) groups; no differences were found between no-bronchopulmonary dysplasia and mild-bronchopulmonary dysplasia groups (P=.919). A reduction in right ventricular myocardial performance index at later time points was observed in all three groups (Pbronchopulmonary dysplasia severity in other right ventricular echocardiographic parameters. Right ventricular myocardial performance index measured by pulsed-wave Doppler indicates impaired right ventricular function in preterm infants with severe bronchopulmonary dysplasia. © 2017, Wiley Periodicals, Inc.

  2. A Clinical and Echocardiographic Score to Identify Pulmonary Hypertension Due to HFpEF.

    Science.gov (United States)

    Berthelot, Emmanuelle; Montani, David; Algalarrondo, Vincent; Dreyfuss, Céline; Rifai, Raed; Benmalek, Anouar; Jais, Xavier; Bouchachi, Amir; Savale, Laurent; Simonneau, Gerald; Chemla, Denis; Humbert, Marc; Sitbon, Olivier; Assayag, Patrick

    2017-01-01

    Heart failure with preserved ejection fraction (HFpEF) is a frequent cause of pulmonary hypertension (PH) that is not easy to differentiate from precapillary PH. We aimed to determine whether the characteristic features of the patients may help differentiate between HFpEF and precapillary PH. Clinical and echocardiographic parameters were analyzed in 156 patients referred to our PH referral center. Right heart catheterization identified 78 PH-HFpEF patients and 78 with precapillary PH. Compared with precapillary PH, PH-HFpEF patients were older, with a smaller proportion of women, a higher proportion of hypertension, diabetes mellitus, atrial fibrillation and sleep apnea syndrome, and a higher body mass index. On echocardiography, PH-HFpEF patients had higher left ventricular mass index, higher left atrial area, and smaller right ventricular end-diastolic area. Following multivariate analysis, a model predicting the probability of PH-HFpEF was built with history of diabetes mellitus, presence of atrial fibrillation, left atrial area, right ventricular end-diastolic area, and left ventricular mass index. The score was internally validated using bootstrap method (area under the curve 0.93 [95% confidence interval 0.918-0.938]). A score <5 ruled out PH-HFpEF. A score including clinical and echocardiographic criteria may help physicians to identify PH-HFpEF from precapillary PH. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Infective endocarditis following patch closure of ventricular septal defect: a cross-sectional Doppler echocardiographic study.

    Science.gov (United States)

    Shrivastava, S; Radhakrishnan, S

    1989-10-01

    Cross-sectional and Doppler echocardiographic characteristics of infective endocarditis are described in six cases following patch closure of a ventricular septal defect. The patients presented to us with fever one to five months after surgery. Five of them also had congestive cardiac failure. Cross-sectional echocardiography showed large masses over the patch in all cases. Dehiscence of the lower end of the patch was identified in three of them, and, in two cases, the right sinus of Valsalva had ruptured into the right ventricle. Doppler detected turbulent flow in the right ventricle in five cases, and a continuous signal indicating an aorto-right ventricular communication in two cases. A signal indicative of aortic regurgitation was also found in the latter two cases. Staphylococcus aureus was cultured from the blood in three cases and Aspergillus was identified at autopsy in one. The echocardiographic findings were confirmed in three cases (one during surgery and two at autopsy). Dehiscence of the patch and large masses were associated with a poor prognosis.

  4. Robust multipoint water-fat separation using fat likelihood analysis.

    Science.gov (United States)

    Yu, Huanzhou; Reeder, Scott B; Shimakawa, Ann; McKenzie, Charles A; Brittain, Jean H

    2012-04-01

    Fat suppression is an essential part of routine MRI scanning. Multiecho chemical-shift based water-fat separation methods estimate and correct for Bo field inhomogeneity. However, they must contend with the intrinsic challenge of water-fat ambiguity that can result in water-fat swapping. This problem arises because the signals from two chemical species, when both are modeled as a single discrete spectral peak, may appear indistinguishable in the presence of Bo off-resonance. In conventional methods, the water-fat ambiguity is typically removed by enforcing field map smoothness using region growing based algorithms. In reality, the fat spectrum has multiple spectral peaks. Using this spectral complexity, we introduce a novel concept that identifies water and fat for multiecho acquisitions by exploiting the spectral differences between water and fat. A fat likelihood map is produced to indicate if a pixel is likely to be water-dominant or fat-dominant by comparing the fitting residuals of two different signal models. The fat likelihood analysis and field map smoothness provide complementary information, and we designed an algorithm (Fat Likelihood Analysis for Multiecho Signals) to exploit both mechanisms. It is demonstrated in a wide variety of data that the Fat Likelihood Analysis for Multiecho Signals algorithm offers highly robust water-fat separation for 6-echo acquisitions, particularly in some previously challenging applications. Copyright © 2011 Wiley-Liss, Inc.

  5. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function.

    Science.gov (United States)

    Bakkum, M J; Danad, I; Romijn, M A J; Stuijfzand, W J A; Leonora, R M; Tulevski, I I; Somsen, G A; Lammertsma, A A; van Kuijk, C; van Rossum, A C; Raijmakers, P G; Knaapen, P

    2015-09-01

    Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [(15)O]H2O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p coronary artery calcium score were independent predictors of CMVR. EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors.

  6. Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient: A pilot outcome study.

    Science.gov (United States)

    Hebbar, Ullhas Udaya; Effat, Mohamed A; Peelukhana, Srikara V; Arif, Imran; Banerjee, Rupak K

    2017-12-26

    To investigate the patient-outcomes of newly developed pressure drop coefficient (CDP) in diagnosing epicardial stenosis (ES) in the presence of concomitant microvascular disease (MVD). Patients from our clinical trial were divided into two subgroups with: (1) cut-off of coronary flow reserve (CFR) 27.9 groups for assessing major adverse cardiac events (MACE: Primary outcome). Comparisons were also made between the survival curves for FFR 27.9 groups. Two tailed chi-squared and Fischer's exact tests were performed for comparison of the primary outcomes, and the log-rank test was used to compare the Kaplan-Meier survival curves. P 27.9 group (7.7%, 2/26) was lower than FFR 27.9 group (12.5%, 2/16) was lower than FFR 27.9 group ( n = 26) when compared with FFR 27.9 group ( n = 16) showed higher survival times compared to FFR group ( n = 11); P = 0.58. CDP correlated significantly with HMR and resulted in better %MACE as well as survival rates in comparison to FFR. These positive trends demonstrate that CDP could be a potential diagnostic endpoint for delineating MVD with or without ES.

  7. Sea cucumbers with an anti-inflammatory effect on endothelial cells and subcutaneous but not on epicardial adipose tissue.

    Science.gov (United States)

    Mena-Bueno, Sara; Atanasova, Miroslava; Fernández-Trasancos, Ángel; Paradela-Dobarro, Beatriz; Bravo, Susana B; Álvarez, Ezequiel; Fernández, Ángel L; Carrera, Iván; González-Juanatey, José R; Eiras, Sonia

    2016-02-01

    epicardial adipose tissue (EAT) from patients with coronary artery disease (CAD) contains higher levels of inflammatory proteins and lower adiponectin levels than subcutaneous adipose tissue (SAT), enhancing the progression of atherosclerosis. Since products from sea cucumber have anti-inflammatory properties, we investigated its effect on EAT, SAT and endothelial cells. stromal cells or explants from EAT and SAT were obtained from patients with cardiovascular disease. Extracts were obtained after hydrolysis by food-grade enzymes at different times. Proteins were identified by LC-MALDI mass spectrometry. Adipogenesis and adiponectin induction were determined on stromal cells in the presence/absence of extracts. The bioavailability of the extracts was tested on a Caco-2 cell culture model in vitro. The bioavailable fraction was probed on endothelial cells and EAT or SAT explants. Vascular cell adhesion protein (VCAM-1), intercellular adhesion molecule (ICAM-1), IL-6 and adiponectin were determined by real time polymerase chain reaction (RT-PCR). our results showed that H. forskali and P. tremulus extracts contained compounds with anti-oxidant and anti-inflammatory properties. The bioavailable fraction of P. tremulus reduced VCAM-1 (p effect was observed on EAT. these results suggest that sea cucumber extracts might be used for the prevention of endothelial cells and SAT inflammation.

  8. The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries.

    Science.gov (United States)

    Topuz, Mustafa; Dogan, Ali

    2017-01-01

    The aim of this study is to evaluate the effect of epicardial adipose tissue (EAT) thickness on left ventricular diastolic functions in patients with normal coronary arteries (NCA) proven by angiography. We selected study patients who were referred to coronary angiography due to typical chest pain or atypical chest pain with a positive pre-test result for coronary artery disease (CAD). After coronary angiography, 85 patients with significant coronary lesion (≥ 50% stenosis) served as the CAD group, 82 patients with non-significant coronary lesion (thickness and left ventricular diastolic properties. Gensini score, total cholesterol, and C-reactive protein were significantly higher in the CAD group compared to the non-significant CAD group and the NCA group. The average of EAT thickness was 7.3 ± 2.4 mm in all groups. It was 5.8 ± 2.3 mm in the NCA group, 6.4 ± 2.4 mm in the non-significant CAD group, and 7.8 ± 2.2 mm in the CAD group (p thickness was significantly correlated with E/e' ratio in the NCA group. In multivariate analysis, average of EAT thickness was significantly associated with left ventricular diastolic dysfunction in subjects with NCA (OR 1.019, 95% CI 1.012-1.027, p thickness may have an effect on left ventricular diastolic functions. This independent relationship showed us the clinical importance of measuring of EAT thickness.

  9. Measurement of visceral fat: should we include retroperitoneal fat?

    Directory of Open Access Journals (Sweden)

    Chi-Sheng Hung

    Full Text Available OBJECTIVE: Whether retroperitoneal fat should be included in the measurement of visceral fat remains controversial. We compared the relationships of fat areas in peritoneal, retroperitoneal, and subcutaneous compartments to metabolic syndrome, adipokines, and incident hypertension and diabetes. METHODS: We enrolled 432 adult participants (153 men and 279 women in a community-based cohort study. Computed tomography at the umbilicus level was used to measure the fat areas. RESULTS: Retroperitoneal fat correlated significantly with metabolic syndrome (adjusted odds ratio (OR, 5.651, p<0.05 and the number of metabolic abnormalities (p<0.05. Retroperitoneal fat area was significantly associated with blood pressure, plasma glycemic indices, lipid profile, C-reactive protein, adiponectin (r =  -0.244, P<0.05, and leptin (r = 0.323, p<0.05, but not plasma renin or aldosterone concentrations. During the 2.94 ± 0.84 years of follow-up, 32 participants developed incident hypertension. Retroperitoneal fat area (hazard ration (HR 1.62, p = 0.003 and peritoneal fat area (HR 1.62, p = 0.009, but not subcutaneous fat area (p = 0.14 were associated with incident hypertension. Neither retroperitoneal fat area, peritoneal fat area, nor subcutaneous fat areas was associated with incident diabetes after adjustment. CONCLUSIONS: Retroperitoneal fat is similar to peritoneal fat, but differs from subcutaneous fat, in terms of its relationship with metabolic syndrome and incident hypertension. Retroperitoneal fat area should be included in the measurement of visceral fat for cardio-metabolic studies in human.

  10. Fat Grams: How to Track Your Dietary Fat

    Science.gov (United States)

    Healthy Lifestyle Nutrition and healthy eating To track how much fat I eat each day, should I focus on ... 30, 2016 Original article: http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/fat-grams/faq- ...

  11. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Science.gov (United States)

    Nillesen, M. M.; Lopata, R. G. P.; de Boode, W. P.; Gerrits, I. H.; Huisman, H. J.; Thijssen, J. M.; Kapusta, L.; de Korte, C. L.

    2009-04-01

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  12. Doppler echocardiographic evaluation of midventricular obstruction in cats with hypertrophic cardiomyopathy.

    Science.gov (United States)

    MacLea, H B; Boon, J A; Bright, J M

    2013-01-01

    Hypertrophic cardiomyopathy (HCM) is heterogeneous in both people and cats, with variability in the distribution of hypertrophy, hemodynamic characteristics, and Doppler echocardiographic findings. To document the Doppler echocardiographic characteristics of midventricular obstruction in some cats with HCM. Eight cats with hypertrophic cardiomyopathy. Retrospective case series. The medical records of cats presenting to the cardiology service at Colorado State University between February 2009 and January 2012 were reviewed. All cats had a physical examination; Doppler systolic blood pressure measurement; and transthoracic two-dimensional (2D), M-mode, and Doppler echocardiography were performed. A more thorough evaluation of the echocardiographic images and measurements was performed. Cats included in this study had echocardiograms of adequate quality to confirm the diagnosis of midventricular obstruction by documentation of left midventricular concentric hypertrophy; a midventricular turbulent Doppler color flow pattern; and high velocity, late-peaking flow at the area of turbulence. Cats with evidence of systemic hypertension defined as a systolic Doppler blood pressure of greater than 170 mmHg were excluded. All 8 cats had left ventricular hypertrophy at the level of the papillary muscles; left, midventricular hypertrophy; and in 4/8 cats there was apical hypertrophy or basilar hypertrophy of the interventricular septum. Color flow Doppler revealed turbulent flow in 8/8 cats and spectral Doppler (continuous and pulsed wave) revealed increased flow velocities and late-peaking flow profiles at the level of the left midventricle. Two of 8 cats had a bifid midventricular flow profile in which there was a midsystolic decline in left ventricular velocities with elevated velocities extending into early diastole. The peak left ventricular outflow velocity in all 8 cats was normal. A variant of HCM characterized by hypertrophy at the level of the papillary muscles with

  13. Fat utilization during exercise

    DEFF Research Database (Denmark)

    Helge, Jørn Wulff; Watt, Peter W.; Richter, Erik

    2001-01-01

    % carbohydrate) and six consumed a carbohydrate-rich diet (20 % fat, 65 % carbohydrate). After 7 weeks of training and diet, 60 min of bicycle exercise was performed at 68 +/- 1 % of maximum oxygen uptake. During exercise [1-(13)C]palmitate was infused, arterial and venous femoral blood samples were collected......, and blood flow was determined by the thermodilution technique. Muscle biopsy samples were taken from the vastus lateralis muscle before and after exercise. 3. During exercise, the respiratory exchange ratio was significantly lower in subjects consuming the fat-rich diet (0.86 +/- 0.01, mean +/- S.E.M.) than...... the fat-rich diet. Whole-body plasma FA oxidation (determined by comparison of (13)CO(2) production and blood palmitate labelling) was 55-65 % of total lipid oxidation, and was higher after the fat-rich diet than after the carbohydrate-rich diet (13.5 +/- 1.2 vs. 8.9 +/- 1.1 micromol min(-1) kg(-1); P

  14. Subcutaneous encapsulated fat necrosis

    DEFF Research Database (Denmark)

    Aydin, Dogu; Berg, Jais O

    2016-01-01

    We have described subcutaneous encapsulated fat necrosis, which is benign, usually asymptomatic and underreported. Images have only been published on two earlier occasions, in which the necrotic nodules appear "pearly" than the cloudy yellow surface in present case. The presented image may help...

  15. Fats for diabetics. (Letter).

    NARCIS (Netherlands)

    Katan, M.B.

    1994-01-01

    Opinion. Comments on the treatment of type 2 diabetes from the interaction between nature and nurture. Effective form of treatment for type 2 diabetes; Composition of the diet for diabetics; Identification of unsaturated fats in the diabetic diet; Risks faced by diabetic patients.

  16. That Fat Cat

    Science.gov (United States)

    Lambert, Phyllis Gilchrist

    2012-01-01

    This activity began with a picture book, Nurit Karlin's "Fat Cat On a Mat" (HarperCollins; 1998). The author and her students started their project with a 5-inch circular template for the head of their cats. They reviewed shapes as they drew the head and then added the ears and nose, which were triangles. Details to the face were added when…

  17. Intra-abdominal fat: Comparison of computed tomography fat ...

    African Journals Online (AJOL)

    Background: Intra-abdominal fat is an important factor in determining the metabolic syndrome/insulin resistance, and thus the risk of diabetes and ischaemic heart disease. Computed Tomography (CT) fat segmentation represents a defined method of quantifying intra-abdominal fat, with attendant radiation risks.

  18. Effect Of Fat Source And Vitamin E Supplimentation On Fat ...

    African Journals Online (AJOL)

    The effect of different sources of fat on carcass characteristics, fatty acid composition of broilers and the interactive effect of fat source and vitamin E on keeping quality of broiler thigh meat were evaluated. The four dietary treatments were the control (No fat inclusion); palm oil; groundnut oil and palm kernel oil. The diets ...

  19. Figuring Out Fat and Calories

    Science.gov (United States)

    ... our growth and activities — everything from solving a math problem to racing up and down the soccer ... saturated fat and trans fat raise blood cholesterol levels, increasing a person's chances of developing heart disease, ...

  20. [Echocardiographic indices of the right heart in patients with coronary artery disease in different age groups].

    Science.gov (United States)

    Gajfulin, R A; Sumin, A N; Arhipov, O G

    2016-01-01

    The aim of study was to examine echocardiographic indices of right heart chambers in patients with coronary artery disease in different age groups. On 678 patients aged 38-85 years, who underwent echocardiography, are including with the use of spectral tissue Doppler. Obtained 2 age groups: 1st - patients up to 60 years (n=282) and group 2nd - patients 60 years and older (n=396). In the analysis the obtained results in patients with coronary heart disease in older age groups showed an increase in right ventricular wall thickness, systolic and average pressure in the pulmonary artery. These changes were accompanied by deterioration in left ventricular diastolic function, while the systolic function of the left and right ventricle were independent of age. Thus, the results can be recommended for assessment of right ventricular dysfunction in patients of older age groups.

  1. Prognostic implications of fasting plasma glucose in subjects with echocardiographic abnormalities

    DEFF Research Database (Denmark)

    Pareek, Manan; Vaduganathan, Muthiah; Bhatt, Deepak L

    2017-01-01

    AIMS: To examine whether baseline fasting plasma glucose (FPG) modifies the prognostic role of left ventricular (LV) mass, geometric pattern, and diastolic function, for prediction of cardiovascular morbidity and mortality. METHODS: Population-based cohort study comprising of 1047 men and 456 women...... proportional-hazards regression with interaction analysis was used to evaluate the risk associated with FPG and LV structure and function. RESULTS: Median age was 67years, and 31% had impaired fasting glucose, 31% diabetes, 17% LV hypertrophy, and 40% diastolic dysfunction. During a median follow-up duration.......001), and with the association between diastolic dysfunction and event risk (P=0.02), including grade 2 or 3 dysfunction (P=0.04). CONCLUSIONS: Echocardiographic abnormalities were more strongly associated with an adverse prognosis among subjects with impaired fasting glucose or diabetes....

  2. A NEW, OTHER THAN ACOUSTIC, QUANTIFICATION METHOD FOR ENDOCARDIUM DETECTION IN ECHOCARDIOGRAPHIC IMAGES

    Directory of Open Access Journals (Sweden)

    Leszek Wojnar

    2011-05-01

    Full Text Available A new, semiautomatic algorithm for tracing outlines of endocardium of newborns that are detectable in echocardiographic images is presented. The main advantage of the method proposed is its low sensitivity to operator errors. Moreover, in contrast to the acoustic quantification method (AQ, an analysis of archive and low quality images is available, as well as the traces obtained are smooth and free of artefacts. Thus, the new solution allows for further, fully automatic, quantitative characterization of the shape and size of the ventricle. The results are compared with manual tracings in order to demonstrate the advantage of the newly developed method. Some results from massive research on newborns with various heart defects are also presented.

  3. ASSOCIATION OF ECHOCARDIOGRAPHIC CHARACTERISTICS WITH CARDIOVASCULAR RISK FACTORS IN ADULTS WITHOUT CLINICAL MANIFESTATION OF HEART FAILURE.

    Science.gov (United States)

    Rukhadze, E; Bregvadze-Tabagari, N; Tvildiani, L

    2016-10-01

    The objective the study was to assess the association between echocardiographic parameters and established cardiovascular risk factors in adults without clinical manifestation of heart failure (HF). A cross-sectional study was conducted between (September 2008 - December 2010) Consecutive sample of 177 participants were enrolled in the study. We performed routine Transthoracic Echocardiography and evaluated several well established cardiovascular risk factors. The data was analyzed using SPSS, version 16. LA was significantly correlated with age (r 0.396, prisk factors for Heart Failure development and progression and as most of them are correlated the age and obesity variables it should be appropriate to conduct routine echocardiography in aged and obese patients even in low CVD risk group. This statement particularly relevant for Georgia as the frequency of obesity is very high in the Georgian population.

  4. Echocardiographic evaluation of TASER X26 probe deployment into the chests of human volunteers.

    Science.gov (United States)

    Dawes, Donald M; Ho, Jeffrey D; Reardon, Robert F; Miner, James R

    2010-01-01

    Several animal studies have shown that the TASER X26 (TASER International, Scottsdale, Ariz) conducted electrical weapon can electrically capture the myocardium when discharged on the thorax. These results have not been reproduced in human echocardiographic studies. A primary limitation of those human studies is that the TASER device was connected by taping the wires into conductive gel on the skin surface of the thorax. This study overcomes those limitations. In this study, a training instructor discharged a TASER X26 into the chests of 10 subjects from a distance of 7 ft so that a 5-second discharge could be administered through the probes as in field exposures. Limited echocardiography was performed before, during, and after discharge. In agreement with 2 prior studies by these authors, the TASER X26 did not electrically capture the human myocardium when used with probe deployment. These data are contrary to animal studies in which capture occurred.

  5. Phased-array intracardiac echocardiographic imaging of acute cardiovascular emergencies: Experimental studies in dogs.

    Science.gov (United States)

    Yamada, Elina; Zhang, Yi; Davies, Ray; Coddington, William; Kerber, Richard E

    2002-10-01

    We evaluated a newly developed phased-array intracardiac echocardiographic catheter. Our aim was to evaluate the imaging capability of this new ICE catheter in an animal model simulating acute cardiovascular abnormalities. ICE images were obtained from the right atrium during (1) acute left ventricular dysfunction; (2) acute coronary occlusion; (3) pericardial effusion and tamponade; and (4) pulmonary embolism. Left ventricular dysfunction, induced experimentally by halothane inhalation, resulted in a fall in echocardiography-calculated ejection fraction from 47% +/- 11% to 25% +/- 10%, P small as 15 mL. Right ventricular and atrial compression and respiratory variation in right ventricular inflow during tamponade were demonstrated. After injection of intravenous thrombin to create venous thromboembolism, we demonstrated right ventricular dilatation and dysfunction and thrombi attached to the tricuspid and pulmonary valves and in the pulmonary artery. This new phased-array ICE catheter may be a useful clinical tool for the diagnosis of heart failure, ischemia, tamponade, and pulmonary embolism.

  6. Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography

    DEFF Research Database (Denmark)

    de Knegt, Martina Chantal; Fuchs, A; Weeke, P

    2016-01-01

    Current echocardiographic assessments of coronary vascular territories use the 17-segment model and are based on general assumptions of coronary vascular distribution. Fusion of 3D echocardiography (3DE) with multidetector computed tomography (MDCT) derived coronary anatomy may provide a more...... accurate assessment of left ventricular (LV) territorial function. We aimed to test the feasibility of MDCT and 3DE fusion and to compare territorial longitudinal strain (LS) using the 17-segment model and a MDCT-guided vascular model. 28 patients underwent 320-slice MDCT and transthoracic 3DE on the same...... day followed by invasive coronary angiography. MDCT (Aquilion ONE, ViSION Edition, Toshiba Medical Systems) and 3DE apical full-volume images (Artida, Toshiba Medical Systems) were fused offline using a dedicated workstation (prototype fusion software, Toshiba Medical Systems). 3DE/MDCT image...

  7. Echocardiographic Findings Suggestive of Infective Endocarditis in Asymptomatic Danish Injection Drug Users Attending Urban Injection Facilities

    DEFF Research Database (Denmark)

    Axelsson, Anna; Søholm, Helle; Dalsgaard, Morten

    2014-01-01

    of 206, 7%, 95% confidence interval [CI] 4% to 11%) had a previous history of IE. IDUs with a history of IE were significantly older than IDUs without a history of IE (48 ± 8 vs 42 ± 9 years, respectively, p = 0.03) and had a longer duration of injection drug use (27 [18 to 36] vs 17 years [10 to 25], p......Injection drug users (IDUs) account for a considerable number of the hospitalizations for infective endocarditis (IE), but the prevalence of diagnosed and unrecognized IE in IDUs is unknown. The aim of the present study was to assess the prevalence of valvular abnormalities suggestive of IE in IDUs...... attending a supervised injection facility. We performed transthoracic echocardiographic examinations on-site in the injection facilities. A total of 206 IDUs (mean age 43 ± 9 years, 23% women) with a median injection drug abuse of 18 years (interquartile range 10 to 26) were included. Fourteen IDUs (14...

  8. Electrocardiographic, echocardiographic, and indirect blood pressure evaluation in dogs subjected to different sedation protocols

    Directory of Open Access Journals (Sweden)

    Helena Mondardo Cardoso

    Full Text Available ABSTRACT: The present study aimed to evaluate the effects of different sedation protocols on blood pressure and echocardiographic and electrocardiographic parameters in dogs. In total, 24 male mixed-breed dogs with a mean weight of 9.87±3.0kg were used.Animals were randomly divided into four groups (n=6, which were subjected to sedation using the following protocols: acepromazine (0.05mgkg-1 and butorphanol (0.3mgkg-1 (AB; acepromazine (0.05mgkg-1and methadone (0.5mgkg-1 (AM; acepromazine (0.03mgkg-1, methadone (0.5mgkg-1, and midazolam (0.3mgkg-1(MAM; and methadone only (0.5mgkg-1 (M. Indirect blood pressure (BP measurements and computerized electrocardiography (ECG and echocardiography (ECO were performed immediately before the application of the sedation protocol (baseline, and the same evaluations were repeated after 15 minutes. BP decreased in groups AB, MAM, and AM compared to baseline values. Electrocardiographic measurements showed decreased heart rates (HRs after sedation in all groups, and bradycardia was observed after sedation in two dogs from group M and one animal from group AM. The P-wave duration increased after sedation in groups AM and M. After sedation, no changes in cardiac dimensions were revealed byECO.Fractional shortening (FS decreased after sedation in the AM group, and dogs from group AB exhibited a smaller decrease in FS compared with the other groups. The cardiac index (CI was lower in groups AM and M than in the other groups. Animals from group AB were less resistant to examination and exhibited the most favorable sedation scores. It was concluded that the combination of acepromazine and butorphanol was the best sedation protocol for performing echocardiogram measurementsbecause dogs were less resistant to examinations and echocardiographic parameters of FS and CI remained stable.

  9. Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

    Science.gov (United States)

    Mahmood, Feroze; Warraich, Haider J.; Gorman, Joseph H.; Gorman, Robert C.; Chen, Tzong-Huei; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal

    2014-01-01

    Background and aim of the study Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR). Methods A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec® Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters. Results Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p <0.001), circumference (-8.9% p <0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p <0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 62%, p <0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter. Conclusion The mitral annulus undergoes significant geometric changes immediately after AVR Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve. PMID:23409347

  10. A STUDY OF AETIOLOGY, CLINICAL FEATURES, ECG, ECHOCARDIOGRAPHIC FEATURES OF CARDIAC TAMPONADE

    Directory of Open Access Journals (Sweden)

    Y. V. Subba Reddy

    2017-01-01

    Full Text Available BACKGROUND Cardiac tamponade is a life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, blood, because of effusion, trauma or rupture of the heart. It was an observational study and included 40 patients with cardiac tamponade. We looked for incidence of Beck’s triad and pulsus paradoxus, electrocardiographic presence of electrical alternans, echocardiographic evidence of cardiac tamponade and aetiology of cardiac tamponade. MATERIALS AND METHODS This was a single-centre observational study that included 40 patients diagnosed with cardiac tamponade between January 2014 and January 2015. All patients were assessed concerning the clinical features, aetiology, electrocardiographic details and echocardiographic findings and quantification. RESULTS Total 25 patients were females; 34 (85.0% patients presented with pulsus paradoxus. Malignancy (42.5% was the most common aetiology for cardiac tamponade. Paradoxical hypertension was noted among five patients. Cardiac tamponade due to hypothyroidism was present in 7 patients. 39 patients presented with electrical alternans on ECG. Most of the patients had large pericardial effusion (50.0%. All patients were treated with pericardiocentesis and there was no in-hospital complication or mortality. CONCLUSION It can be concluded that malignancy is increasing as an aetiology for cardiac tamponade (42.5% followed by tuberculosis. Hypothyroidism as an aetiology for cardiac tamponade is not that rare (17.5%. Beck’s triad is not seen in all cases. JVP is raised in all patients. Hypertension at the time of presentation doesn’t rule out cardiac tamponade. Both ECG and echocardiography can be efficiently used in the diagnosis of cardiac tamponade. Pericardiocentesis is a noteworthy method for treatment of cardiac tamponade.

  11. Correlation-based discrimination between cardiac tissue and blood for segmentation of 3D echocardiographic images

    Science.gov (United States)

    Saris, Anne E. C. M.; Nillesen, Maartje M.; Lopata, Richard G. P.; de Korte, Chris L.

    2013-03-01

    Automated segmentation of 3D echocardiographic images in patients with congenital heart disease is challenging, because the boundary between blood and cardiac tissue is poorly defined in some regions. Cardiologists mentally incorporate movement of the heart, using temporal coherence of structures to resolve ambiguities. Therefore, we investigated the merit of temporal cross-correlation for automated segmentation over the entire cardiac cycle. Optimal settings for maximum cross-correlation (MCC) calculation, based on a 3D cross-correlation based displacement estimation algorithm, were determined to obtain the best contrast between blood and myocardial tissue over the entire cardiac cycle. Resulting envelope-based as well as RF-based MCC values were used as additional external force in a deformable model approach, to segment the left-ventricular cavity in entire systolic phase. MCC values were tested against, and combined with, adaptive filtered, demodulated RF-data. Segmentation results were compared with manually segmented volumes using a 3D Dice Similarity Index (3DSI). Results in 3D pediatric echocardiographic images sequences (n = 4) demonstrate that incorporation of temporal information improves segmentation. The use of MCC values, either alone or in combination with adaptive filtered, demodulated RF-data, resulted in an increase of the 3DSI in 75% of the cases (average 3DSI increase: 0.71 to 0.82). Results might be further improved by optimizing MCC-contrast locally, in regions with low blood-tissue contrast. Reducing underestimation of the endocardial volume due to MCC processing scheme (choice of window size) and consequential border-misalignment, could also lead to more accurate segmentations. Furthermore, increasing the frame rate will also increase MCC-contrast and thus improve segmentation.

  12. Congenital Heart Diseases in the Newborns of Diabetic Mothers: an Echocardiographic Study

    Directory of Open Access Journals (Sweden)

    S Rahimpour

    2011-10-01

    Full Text Available Introduction: Despite the discovery of insulin and current improvement in diabetics care, congenital malformations in diabetics are still more frequent than in the general population. The aim of this study was to identify congenital heart dieases (CHD in the newborns of diabetic mothers (IDMS. Methods: In our prospective study, color doppler echocardiography was performed in 75 consecutive full- term newborns of diabetic mothers by GE Vivid3 echocardiographic device. Newborns were classified into two subgroups according to the type of the mothers’ diabetes: pre-gestational and gestational. They were also those were classified into three subgroups according to their birth weight: appropriate, large and small for gestational age. Data analysis was made by Fisher exact test and Chi-Square test. Results: Forty nine (65% and thirty six (35% of subjects were infants of gestational (IGDM and pre-gestational diabetic mothers (IPDM, respectively. Fifty five Newborns (73% were apropriate, fourteen (19% were large and six (8% were small for gestational age. The most common echocardiographic findings included: patent ductus arteriosus (PDA: 54.7%, hypertrophic cardiomyopathy (HCMP: 24%, ventricular septal defect (VSD: 4%, atrial septal defect (ASD: 2.7%, transposition of great arteries (TGA: 1.3% and coarctation of the Aorta (COA: 1.3%. Overall incidence of congenital heart diseases was 9.3 after exclusion of PDA and HCMP cases. The incidence of congenital heart diseases was higher in macrosomic than nonmacrosomic infants of diabetic mothers (P<0.001. Congenital heart diseases were more common in infants of pre-gestational than gestational diabetic mothers (P=0.004. Conclusion: Our results showed that diabetic mothers are at increased risk of giving birth to a newborn with congenital heart disease, and transthoracic echocardiography is recommended for all infants of diabetic mothers.

  13. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

    2000-01-01

    The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress {sup 99m}Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest {sup 123}I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and {sup 123}I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by {sup 123}I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in {sup 123}I-BMIPP). Eighteen normotensive patients with apical defect by {sup 123}I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by {sup 123}I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by {sup 123}I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and {sup 123}I-BMIPP imaging are useful for the identification of these patients. (author)

  14. Canine pulmonary vein-to-pulmonary artery ratio: echocardiographic technique and reference intervals.

    Science.gov (United States)

    Birettoni, F; Caivano, D; Patata, V; Moïse, N S; Guglielmini, C; Rishniw, M; Porciello, F

    2016-12-01

    The size of the pulmonary veins (PVs) and pulmonary arteries (PAs) changes in response to hemodynamic alterations caused by physiological events and disease. We sought to create standardized echocardiographic methods for imaging the right ostium of the pulmonary veins (RPVs) and the right pulmonary artery (RPA) using specific landmarks and timing to quantify vessel diameters and phasic changes during the cardiac cycle. Fifty client-owned healthy dogs prospectively recruited. M-mode and 2-dimensional images were obtained from modified right parasternal long and short axis views. Right ostium of the pulmonary veins and RPA measurements were timed with electrical [peak of the QRS complex (RPVQRS and RPAQRS) and end of T wave (RPVT and RPAT)] or mechanical events [RPV and RPA vessels at their respective maximal (RPVMAX; RPAMAX) and minimal (RPVMIN; RPAMIN) diameters]. Right ostium of the pulmonary veins and RPA measurements were also indexed to the aorta. In normal dogs regardless of the echocardiographic view or time in the cardiac cycle, the RPV/RPA ratio approximated 1.0. Mechanically timed fractional changes (distensibility indices) in RPV and RPA diameters did not differ (p=0.99; 36.9% and 36.8%, respectively). ECG-timed fractional changes (distensibility indices) in RPV and RPA diameter were at least 50% smaller than mechanically timed changes (p<0.05). RPV:Ao and RPA:Ao ranged between 0.3 and 0.6, with lower values obtained in diastole and larger values in systole (p<0.0001). Multiple positive and negative deflections were identified on the RPV and RPA M-mode tracings. This study provides detailed methodology and 2D and M-mode reference intervals for the RPV and RPA dimensions and the phasic changes during the cardiac cycle of the dog using echocardiography. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. An Echocardiographic Study of Heart in a Group of Male Adult Elite Athletes

    Directory of Open Access Journals (Sweden)

    Ahmad Mohebi

    2008-08-01

    Full Text Available Background: Severe and prolonged physical training is associated with morphological and physiological cardiac changes, often termed as the “athlete’s heart”. Echocardiographic features peculiar to elite Iranian athletes have not been previously described. The aim was to examine the echocardiographic characteristics of highly trained Iranian athletes involved in three different sports. Methods: We studied cardiac morphology and function as assessed by rest echocardiography in 50 elite adult male athletes referring to a university hospital in Tehran between February 2001 and March 2006. Resting ejection fraction, interventricular septal wall thickness (IVSWT, left ventricular posterior wall thickness (LVPWT, left ventricular internal end diastolic dimension (LVEdD, left ventricular internal systolic dimension (LVIsD, left ventricular (LV mass, and relative wall thickness (RWT were measured. The control group consisted of 50 age- and weight-matched normal healthy men. Results: Of the athletes, 38 were engaged in predominantly dynamic (running and soccer and 12 in predominantly static (weightlifting sports. The overall mean LVEdD (51.06±5.49mm and IVSWT (10.24±1.43mm were higher in the athletes than those in the normal subjects. The mean of IVSWT in the 38 endurance-trained athletes was significantly more than that of the 12 strength-trained athletes (11.1 mm vs. 10.3 mm, P<0.05. LVEdD was also greater in the endurance-trained athletes, but the difference was not statistically significant (51.2 mm vs. 50.6 mm. Conclusion: Our results of higher LVEdD and IVSWT in Iranian male athletes are in line with previous reports. To generalize the results, we require more studies with larger sample sizes (with female athletes included.

  16. Contractile reserve of valvular heart diseases echocardiographically evaluated by epinephrine loading before and after cardiac surgery.

    Science.gov (United States)

    Yamazaki, Y; Matsuzawa, H; Otani, S; Sato, Y; Hayashi, J; Yazawa, M; Imaizumi, K; Okazaki, H; Eguchi, S

    1985-10-01

    In order to evaluate cardiac contractile reserve, echocardiographic studies were performed on 59 patients with acquired valvular heart disease and 13 patients with atrial septal defect. After epinephrine loading, the 59 patients were classified into three groups. In group I, echocardiographically-obtained left ventricular posterior wall excursion (PWE) remained below 10 mm after the administration of 2 microgram/min epinephrine. This group included patients with PWE below 10 mm after 1 microgram/min epinephrine loading but who could not endure the 2 microgram/min infusion because of significant adverse effects. In group II, PWE was less than 10 mm before the loading, but exceeded 10 mm after the administration of 1 or 2 microgram/min epinephrine loading. In group III, PWE exceeded 10 mm without stress. The conclusions derived from our data are as follows: The PWE and mean left ventricular posterior wall velocity (mPWV) obtained by echocardiography reflect the stroke volume derived from the thermodilution technique. It is possible to estimate the cardiac contractile force in patients who have a paradoxical motion of the interventricular septum, in the preoperative and even in the early postoperative periods. Patients whose PWE and mPWV are less than 10 mm and 35 mm/sec, respectively, after 2 microgram/min loading of epinephrine (group I), are likely to have severe cardiac failure after surgery. Inotropic stimulation is considered to be a very useful indicator for prediction of cardiac contractile reserve. Patients having decreased PWE, mPWV, mVcf and EF before surgery may have arrested recovery in both short- or long-term follow-up. However, surgical treatment is recommended for these patients with low cardiac function, because some improvement can be expected after surgery.

  17. Right ventricular function in children with bronchial asthma: a tissue Doppler echocardiographic study.

    Science.gov (United States)

    Shedeed, Soad A

    2010-10-01

    Asthma is the most common cause of respiratory disability among children. Patients with severe bronchial asthma can experience cor pulmonale later in life, but little is known about the function of the right ventricle early in the disease. This study aimed to investigate the right ventricular function in children with bronchial asthma as detected by tissue Doppler echocardiography. This case-control study compared 60 asthmatic children ages 5 to 15 years between attacks (study group) with 60 apparently healthy children (control group). All the children were subjected to full history-taking, complete physical examination, measurement of peak expiratory flow rate (PEFR), chest x-ray, electrocardiography (ECG), echocardiographic examination, and both conventional and tissue Doppler study. The results of the tissue Doppler study examining the right ventricular diastolic function showed that peak E' velocity (10.08 ± 2.8 cm/s), peak A' velocity (5.7 ± 2.5 cm/s), E'/A' ratio (1.77 ± 0.58 m/s), and isovolumetric relaxation time (IVRT) of the lateral tricuspid annulus (138.9 ± 30.7 m/s) among the asthmatic patients differed significantly from those among the control subjects (12.4 ± 2.3, 7.8 ± 2.1 cm/s; 1.58 ± 0.32, and 91.1 ± 32.6 m/s, respectively). In addition, the E' velocity and IVRT of the lateral tricuspid annulus were significantly different among the mild, moderate, and severe cases (P children were apparently normal, the tissue Doppler echocardiographic study showed right ventricular dysfunction that is positively correlated with the severity of asthma. These findings signify the diagnostic value of tissue Doppler echocardiography for the early detection and monitoring of such deleterious effects among asthmatic patients.

  18. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function

    Energy Technology Data Exchange (ETDEWEB)

    Bakkum, M.J.; Danad, I.; Romijn, M.A.J.; Stuijfzand, W.J.A.; Leonora, R.M.; Rossum, A.C. van; Knaapen, P. [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Tulevski, I.I.; Somsen, G.A. [Cardiology Centers of the Netherlands, Amsterdam (Netherlands); Lammertsma, A.A.; Kuijk, C. van; Raijmakers, P.G. [VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam (Netherlands)

    2015-09-15

    Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [{sup 15}O]H{sub 2}O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg x ml{sup -1} x min{sup -1} x g{sup -1}, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. (orig.)

  19. Protect Your Heart: Choose Healthy Fats

    Science.gov (United States)

    ... by eating less trans fat, saturated fat and cholesterol. Sources of saturated fat • bacon and bacon grease • high-fat dairy products, • butter such as cheese, cream, • chitterlings ice cream, whole milk, 2% milk, ...

  20. Fat and bone.

    Science.gov (United States)

    Reid, Ian R

    2010-11-01

    Body weight is a principal determinant of bone density and fracture risk, and adipose tissue mass is a major contributor to this relationship. In contrast, some recent studies have argued that "fat mass after adjustment for body weight" actually has a deleterious effect on bone, but these analyses are confounded by the co-linearity between the variables studied, and therefore have produced misleading results. Mechanistically, fat and bone are linked by a multitude of pathways, which ultimately serve the function of providing a skeleton appropriate to the mass of adipose tissue it is carrying. Adiponectin, insulin/amylin/preptin, leptin and adipocytic estrogens are all likely to be involved in this connection. In the clinic, the key issues are that obesity is protective against osteoporosis, but underweight is a major preventable risk factor for fractures. Copyright © 2010 Elsevier Inc. All rights reserved.

  1. Brown Fat Cell Isolation

    OpenAIRE

    sprotocols

    2014-01-01

    Author: C.R. Kahn ### 1.) ISOLATION AND PRIMARY CULTURE OF BROWN FAT PREADIPOCYTES ### Rationale: To prepare primary brown preadipocytes for immortalization: useful for metabolic studies from knockout mice. This consists of the following five protocols. References: Fasshauer, M., J. Klein, K M. Kriauciunas, K. Ueki, M.Benito, and C.R. Kahn. 2001. Essential role of insulin substrate 1 in differentiation of brown adipocytes. *Mol Cell Biol* 21: 319-329. Fasshauer, M....

  2. Fat transfer and fatal macroembolization.

    Science.gov (United States)

    Astarita, Denis C; Scheinin, Lisa A; Sathyavagiswaran, Lakshmanan

    2015-03-01

    Fat embolism is usually associated with long bone fractures or other trauma. The diagnosis is usually clinical, and in most cases, emboli are not fatal and not usually seen on gross examination. At the Los Angeles County Coroner's Office, we autopsied the victim of fatal macroscopic fat embolization to the lungs. The patient died during buttock enhancement surgery when fat from liposuction was injected into her buttocks. Fat embolism from liposuction and fat injection is reportedly rare, and macroscopic embolization is rarer still. Varicose veins can occur in the area of the sciatic notch and are known to cause painful sciatica symptoms. We suggest them as a potential conduit for macroscopic fat to reach the lungs. Simple pre-operative questioning for sciatica symptoms and possible radiologic study to rule out sciatic varices seem prudent before undertaking buttock-enhancing surgery. Careful fat injection with pre-aspiration is always advised. © 2015 American Academy of Forensic Sciences.

  3. Fat Quality Influences the Obesogenic Effect of High Fat Diets

    Science.gov (United States)

    Crescenzo, Raffaella; Bianco, Francesca; Mazzoli, Arianna; Giacco, Antonia; Cancelliere, Rosa; di Fabio, Giovanni; Zarrelli, Armando; Liverini, Giovanna; Iossa, Susanna

    2015-01-01

    High fat and/or carbohydrate intake are associated with an elevated risk for obesity and chronic diseases such as diabetes and cardiovascular diseases. The harmful effects of a high fat diet could be different, depending on dietary fat quality. In fact, high fat diets rich in unsaturated fatty acids are considered less deleterious for human health than those rich in saturated fat. In our previous studies, we have shown that rats fed a high fat diet developed obesity and exhibited a decrease in oxidative capacity and an increase in oxidative stress in liver mitochondria. To investigate whether polyunsaturated fats could attenuate the above deleterious effects of high fat diets, energy balance and body composition were assessed after two weeks in rats fed isocaloric amounts of a high-fat diet (58.2% by energy) rich either in lard or safflower/linseed oil. Hepatic functionality, plasma parameters, and oxidative status were also measured. The results show that feeding on safflower/linseed oil diet attenuates the obesogenic effect of high fat diets and ameliorates the blood lipid profile. Conversely, hepatic steatosis and mitochondrial oxidative stress appear to be negatively affected by a diet rich in unsaturated fatty acids. PMID:26580650

  4. Fat Quality Influences the Obesogenic Effect of High Fat Diets

    Directory of Open Access Journals (Sweden)

    Raffaella Crescenzo

    2015-11-01

    Full Text Available High fat and/or carbohydrate intake are associated with an elevated risk for obesity and chronic diseases such as diabetes and cardiovascular diseases. The harmful effects of a high fat diet could be different, depending on dietary fat quality. In fact, high fat diets rich in unsaturated fatty acids are considered less deleterious for human health than those rich in saturated fat. In our previous studies, we have shown that rats fed a high fat diet developed obesity and exhibited a decrease in oxidative capacity and an increase in oxidative stress in liver mitochondria. To investigate whether polyunsaturated fats could attenuate the above deleterious effects of high fat diets, energy balance and body composition were assessed after two weeks in rats fed isocaloric amounts of a high-fat diet (58.2% by energy rich either in lard or safflower/linseed oil. Hepatic functionality, plasma parameters, and oxidative status were also measured. The results show that feeding on safflower/linseed oil diet attenuates the obesogenic effect of high fat diets and ameliorates the blood lipid profile. Conversely, hepatic steatosis and mitochondrial oxidative stress appear to be negatively affected by a diet rich in unsaturated fatty acids.

  5. Body fat, abdominal fat and body fat distribution related to VO(2PEAK) in young children

    DEFF Research Database (Denmark)

    Dencker, Magnus; Wollmer, Per; Karlsson, Magnus K

    2011-01-01

    Abstract Objective. Aerobic fitness, defined as maximum oxygen uptake (VO(2PEAK)), and body fat measurements represent two known risk factors for disease. The purpose of this study was to investigate the relationship between VO(2PEAK) and body fat measurements in young children at a population......-based level. Methods. Cross-sectional study of 225 children (128 boys and 97 girls) aged 8-11 years, recruited from a population-based cohort. Total lean body mass (LBM), total fat mass (TBF), and abdominal fat mass (AFM) were measured by dual-energy x-ray absorptiometry. Body fat was also calculated...... as a percentage of body mass (BF%) and body fat distribution as AFM/TBF. VO(2PEAK) was assessed by indirect calorimetry during maximal exercise test. Results. Significant relationships existed between body fat measurements and VO(2PEAK) in both boys and girls, with Pearson correlation coefficients for absolute...

  6. A meta-analysis of echocardiographic measurements of the left heart for the development of normative reference ranges in a large international cohort

    DEFF Research Database (Denmark)

    Møgelvang, Rasmus

    2014-01-01

    AIM: To develop age-, sex-, and ethnic-appropriate normative reference ranges for standard echocardiographic measurements of the left heart by combining echocardiographic measurements obtained from adult volunteers without clinical cardiovascular disease or significant cardiovascular risk factors......, from multiple studies around the world. METHODS AND RESULTS: The Echocardiographic Normal Ranges Meta-Analysis of the Left heart (EchoNoRMAL) collaboration was established and population-based data sets of echocardiographic measurements combined to perform an individual person data meta-analysis. Data...... and 95th centile of each measurement against age. CONCLUSION: This unique data set represents a large, multi-ethnic cohort of subjects resident in a wide range of countries. The resultant reference ranges will have wide applicability for normative data based on age, sex, and ethnicity....

  7. Self-assembling peptide hydrogel enables instant epicardial coating of the heart with mesenchymal stromal cells for the treatment of heart failure.

    Science.gov (United States)

    Ichihara, Yuki; Kaneko, Masahiro; Yamahara, Kenichi; Koulouroudias, Marinos; Sato, Nobuhiko; Uppal, Rakesh; Yamazaki, Kenji; Saito, Satoshi; Suzuki, Ken

    2018-02-01

    Transplantation of mesenchymal stromal cells (MSCs) is an emerging therapy for the treatment of heart failure. However, the delivery method of MSC is currently suboptimal. The use of self-assembling peptide hydrogels, including PuraMatrix ® (PM; 3-D Matrix, Ltd), has been reported for clinical hemostasis and in research models. This study demonstrates the feasibility and efficacy of an advanced approach for MSC-therapy, that is coating of the epicardium with the instantly-produced PM hydrogel incorporating MSCs (epicardial PM-MSC therapy). We optimized the conditions/procedure to produce "instant" 2PM-MSC complexes. After spreading on the epicardium by easy pipetting, the PM-MSC complex promptly and stably adhere to the beating heart. Of note, this treatment achieved more extensive improvement of cardiac function, with greater initial retention and survival of donor MSCs, compared to intramyocardial MSC injection in rat heart failure models. This enhanced efficacy was underpinned by amplified myocardial upregulation of a group of tissue repair-related genes, which led to enhanced repair of the damaged myocardium, i.e. augmented microvascular formation and reduced interstitial fibrosis. These data suggest a potential for epicardial PM-MSC therapy to be a widely-adopted treatment of heart failure. This approach may also be useful for treating diseases in other organs than the heart. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Facial Fat Necrosis Following Autologous Fat Transfer and its Management

    OpenAIRE

    Sweta Rai; Alexander M Marsland; Vishal Madan

    2014-01-01

    Autologous fat transfer (AFT) is an increasingly popular cosmetic procedure practiced by dermatologic surgeons worldwide. As this is an office based procedure performed under local or tumescent anaesthesia with fat transferred within the same individual and limited associated down time its is considered relatively safe and risk free in the cosmetic surgery arena. We describe a case of AFT related fat necrosis causing significant facial dysmorphia and psychosocial distress. We also discuss the...

  9. Temporary epicardial cardiac resynchronisation versus conventional right ventricular pacing after cardiac surgery: study protocol for a randomised control trial

    Directory of Open Access Journals (Sweden)

    Russell Stuart J

    2012-02-01

    Full Text Available Abstract Background Heart failure patients with stable angina, acute coronary syndromes and valvular heart disease may benefit from revascularisation and/or valve surgery. However, the mortality rate is increased- 5-30%. Biventricular pacing using temporary epicardial wires after surgery is a potential mechanism to improve cardiac function and clinical endpoints. Method/design A multi-centred, prospective, randomised, single-blinded, intervention-control trial of temporary biventricular pacing versus standard pacing. Patients with ischaemic cardiomyopathy, valvular heart disease or both, an ejection fraction ≤ 35% and a conventional indication for cardiac surgery will be recruited from 2 cardiac centres. Baseline investigations will include: an electrocardiogram to confirm sinus rhythm and measure QRS duration; echocardiogram to evaluate left ventricular function and markers of mechanical dyssynchrony; dobutamine echocardiogram for viability and blood tests for renal function and biomarkers of myocardial injury- troponin T and brain naturetic peptide. Blood tests will be repeated at 18, 48 and 72 hours. The principal exclusions will be subjects with permanent atrial arrhythmias, permanent pacemakers, infective endocarditis or end-stage renal disease. After surgery, temporary pacing wires will be attached to the postero-lateral wall of the left ventricle, the right atrium and right ventricle and connected to a triple chamber temporary pacemaker. Subjects will be randomised to receive either temporary biventricular pacing or standard pacing (atrial inhibited pacing or atrial-synchronous right ventricular pacing for 48 hours. The primary endpoint will be the duration of level 3 care. In brief, this is the requirement for invasive ventilation, multi-organ support or more than one inotrope/vasoconstrictor. Haemodynamic studies will be performed at baseline, 6, 18 and 24 hours after surgery using a pulmonary arterial catheter. Measurements will be

  10. Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation.

    Science.gov (United States)

    Jiang, Zhaolei; Yin, Hang; He, Yi; Ma, Nan; Tang, Min; Liu, Hao; Ding, Fangbao; Mei, Ju

    2015-09-01

    The aim of this study was to examine the efficacy and safety of this novel epicardial circumferential left atrial ablation (CLAA) with pulmonary vein isolation (PVI) in sustained atrial fibrillation (AF). Thirty domestic pigs were divided equally into 3 groups: AF without ablation (AF group), AF with PVI (PVI group), and AF with CLAA and PVI (CLAA + PVI group). AF was induced by rapid atrial pacing. After AF was induced, CLAA and PVI were performed for pigs in CLAA + PVI group, and PVI was performed for pigs in PVI group. AF vulnerability, AF duration, and histology were performed in all groups. All pigs developed sustained AF after 6.27 ± 0.69 weeks of rapid atrial pacing. All pigs successfully underwent isolated PVI or CLAA with PVI on the beating heart in PVI group or CLAA + PVI group. Isolated PVI terminated AF in 3 of 20 pigs (15 %), and CLAA with PVI terminated AF in 5 of 8 pigs (62.5 %, P = 0.022). Compared with AF group (10/10), the incidence of sustained AF by burst pacing was significantly decreased in PVI group (3/10, P = 0.003) or CLAA + PVI group (0/10, P CLAA + PVI group (P = 0.211). AF duration was significantly decreased in CLAA + PVI group (734.70 ± 177.81 s, 95 % CI 607.51-861.89) compared with PVI group (1217.90 ± 444.10 s, 95 % CI 900.21-1535.59, P = 0.008). Also, AF duration was significantly decreased in PVI group (P = 0.003) or CLAA + PVI group (P CLAA could ablate the left atrial roof and posterior wall together safely and reliably. Compared with PVI alone, CLAA with PVI may be able to improve the rate of acute termination of persistent AF. It may be useful in selecting the best ablation approaches for patients with persistent AF.

  11. Epicardial Adipose Tissue (EAT Thickness Is Associated with Cardiovascular and Liver Damage in Nonalcoholic Fatty Liver Disease.

    Directory of Open Access Journals (Sweden)

    Anna Ludovica Fracanzani

    Full Text Available Epicardial adipose tissue (EAT has been proposed as a cardiometabolic and hepatic fibrosis risk factor in patients with non alcoholic fatty liver disease (NAFLD. Aim of this study was to evaluate the role of EAT in NAFLD by analyzing 1 the association between EAT, the other metabolic parameters and the severity of steatosis 2 the relationship between cardiovascular (cIMT, cplaques, E/A, liver (presence of NASH and significant fibrosis damage and metabolic risk factors including EAT 3 the relationship between EAT and genetic factors strongly influencing liver steatosis.In a cross-sectional study, we considered 512 consecutive patients with NAFLD (confirmed by biopsy in 100. EAT, severity of steatosis, carotid intima-media thickness (cIMT and plaques were evaluated by ultrasonography and results analysed by multiple linear and logistic regression models. Variables independently associated with EAT (mm were female gender (p = 0.003, age (p = 0.001, BMI (p = 0.01, diastolic blood pressure (p = 0.009, steatosis grade 2 (p = 0.01 and 3 (p = 0.04, fatty liver index (p = 0.001 and statin use (p = 0.03. Variables independently associated with carotid IMT were age (p = 0.0001, hypertension (p = 0.009, diabetes (p = 0.04, smoking habits (p = 0.04 and fatty liver index (p = 0.02, with carotid plaques age (p = 0.0001, BMI (p = 0.03, EAT (p = 0.02, and hypertension (p = 0.02, and with E/A age (p = 0.0001, diabetes (p = 0.005, hypertension (p = 0.04 and fatty liver index (p = 0.004. In the 100 patients with available liver histology non alcoholic steatohepatitis (NASH was independently associated with EAT (p = 0.04 and diabetes (p = 0.054 while significant fibrosis with EAT (p = 0.02, diabetes (p = 0.01 and waist circumference (p = 0.05. No association between EAT and PNPLA3 and TM6SF2 polymorphisms was found.In patients with NAFLD, EAT is associated with the severity of liver and vascular damage besides with the known metabolic risk factors.

  12. Epicardial-endocardial breakthrough during stable atrial macroreentry: Evidence from ultra-high-resolution 3-dimensional mapping.

    Science.gov (United States)

    Pathik, Bhupesh; Lee, Geoffrey; Sacher, Frédéric; Haïssaguerre, Michel; Jaïs, Pierre; Massoullié, Grégoire; Derval, Nicolas; Sanders, Prashanthan; Kistler, Peter; Kalman, Jonathan M

    2017-08-01

    Evidence for epicardial-endocardial breakthrough (EEB) is derived from mapping inferences in patients with atrial fibrillation who may also have focal activations. The purpose of this study was to investigate whether EEB could be discerned during stable right atrial (RA) macroreentry using high-density high-spatial resolution 3-dimensional mapping. Macroreentry was diagnosed using 3-dimensional mapping and entrainment. Bipolar maps were reviewed for EEB defined as (1) presence of focal endocardial activation with radial spread unaccounted for by an endocardial wavefront and (2) present with the same timing on every tachycardia cycle. The EEB site was always in proximity to a line of endocardial conduction slowing or block. Distance and conduction velocity from the line of block to the EEB site was calculated. Electrograms at EEB sites were individually analyzed for morphology and to confirm direction of activation. Entrainment was performed at EEB sites. Twenty-six patients were studied. Fourteen examples of EEB were seen: 11 at the posterior RA (4 at the superior portion of the posterior wall and 7 at the inferior section) and 1 each at the cavotricuspid isthmus postablation, RA septum, and inferolateral RA. The mean area of the EEB site was 0.6 ± 0.2 cm2. A mean of 79.5% ± 18.6% of unipolar electrograms at the EEB site demonstrated an rS morphology. The mean distance and conduction velocity from the line of endocardial block to the EEB site at the posterior RA was 13.6 ± 2.3 mm and 59.3 ± 12.3 cm/s, respectively. In 4 patients, entrainment demonstrated that EEB sites were within the circuit and in 1 of these patients critical to arrhythmia maintenance. Activation maps during tachycardia and coronary sinus pacing demonstrated EEB at the same anatomic site. EEB sites were demonstrated in stable atrial macroreentry supported by systematic entrainment confirmation and demonstration of the same phenomenon during pacing. Copyright © 2017 Heart Rhythm Society

  13. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne Krarup; Høst, Nis

    2016-01-01

    Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal...... AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...... of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p

  14. Facial fat necrosis following autologous fat transfer and its management

    Directory of Open Access Journals (Sweden)

    Sweta Rai

    2014-01-01

    Full Text Available Autologous fat transfer (AFT is an increasingly popular cosmetic procedure practiced by dermatologic surgeons worldwide. As this is an office based procedure performed under local or tumescent anaesthesia with fat transferred within the same individual and limited associated down time its is considered relatively safe and risk free in the cosmetic surgery arena. We describe a case of AFT related fat necrosis causing significant facial dysmorphia and psychosocial distress. We also discuss the benefits and risks of AFT highlighting common causes of fat graft failure.

  15. Five-year clinical and echocardiographic evaluation of the Das AngelWings atrial septal occluder.

    Science.gov (United States)

    Kay, Joseph D; O'Laughlin, Martin P; Ito, Kristin; Wang, Andrew; Bashore, Thomas M; Harrison, J Kevin

    2004-02-01

    The late outcome of patients treated with atrial septal occluder devices remains incompletely defined. The purpose of this study was to assess the late outcome (range 4-7 years postprocedure) of patients in whom the Das AngelWings septal occluder device was implanted in the atrial septum. We report the clinical and echocardiographic outcome, at an average of 5 years following the procedure, of patients treated with the Das AngelWings device used to close either a secundum atrial septal defect (ASD) or a patent foramen ovale (PFO). Thirty-two patients underwent successful percutaneous closure of an atrial septal closure, patent foramen ovale, or fenestration in the lateral tunnel of their Fontan with the Das AngelWings device between June 1995 and March 1998 at Duke University Medical Center. Two of the 32 patients were lost to follow-up. The remaining 30 patients were divided into 3 groups based on indication for device implantation. Group 1 consisted of 14 patients with a secundum ASD and predominantly left-to-right atrial shunting. Group 2 consisted of 8 patients who had a PFO and who suffered a thromboembolic event. Group 3 (compassionate use) consisted of 10 patients with multiple comorbid medical problems with predominantly right-to-left shunting at the atrial level causing hypoxemia. Eight of the patients in group 3 were severely ill at the time of device implantation. The 2 remaining patients in group 3 underwent AngelWings implantation for closure of right-to-left shunting through a Fontan fenestration. Mean follow-up was 59 months. There was no device embolization. No patient in the ASD or PFO/stroke group had a clinical complication. By radiographic examination, 2 of 27 patients had evidence of fracture of the nitinol framework at 2-year follow-up. Residual shunting was present in 44% at 24 hours, 20% at 1 year, and 18.8% at 2 years by use of Doppler color flow imaging and/or microcavitation echocardiographic studies. Mild mitral regurgitation caused by

  16. Fractional order integration and fuzzy logic based filter for denoising of echocardiographic image.

    Science.gov (United States)

    Saadia, Ayesha; Rashdi, Adnan

    2016-12-01

    Ultrasound is widely used for imaging due to its cost effectiveness and safety feature. However, ultrasound images are inherently corrupted with speckle noise which severely affects the quality of these images and create difficulty for physicians in diagnosis. To get maximum benefit from ultrasound imaging, image denoising is an essential requirement. To perform image denoising, a two stage methodology using fuzzy weighted mean and fractional integration filter has been proposed in this research work. In stage-1, image pixels are processed by applying a 3 × 3 window around each pixel and fuzzy logic is used to assign weights to the pixels in each window, replacing central pixel of the window with weighted mean of all neighboring pixels present in the same window. Noise suppression is achieved by assigning weights to the pixels while preserving edges and other important features of an image. In stage-2, the resultant image is further improved by fractional order integration filter. Effectiveness of the proposed methodology has been analyzed for standard test images artificially corrupted with speckle noise and real ultrasound B-mode images. Results of the proposed technique have been compared with different state-of-the-art techniques including Lsmv, Wiener, Geometric filter, Bilateral, Non-local means, Wavelet, Perona et al., Total variation (TV), Global Adaptive Fractional Integral Algorithm (GAFIA) and Improved Fractional Order Differential (IFD) model. Comparison has been done on quantitative and qualitative basis. For quantitative analysis different metrics like Peak Signal to Noise Ratio (PSNR), Speckle Suppression Index (SSI), Structural Similarity (SSIM), Edge Preservation Index (β) and Correlation Coefficient (ρ) have been used. Simulations have been done using Matlab. Simulation results of artificially corrupted standard test images and two real Echocardiographic images reveal that the proposed method outperforms existing image denoising techniques

  17. Clinical and Echocardiographic Evaluation of Regional Systolic Function Detected by Tissue Doppler Imaging in Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    A Sadeghpour

    2009-09-01

    Full Text Available Background: Hypertrophic cardiomyopathy (HCM is the most common type of the genetic cardiovasculardiseases. Regarding to tremendous heterogeneity in the phenotypic expression of HCM, which is generally unrelatedto genotype, we aimed to study, clinical and echocardiographic parameters such as Tissue Doppler Imaging(TDI in various subtypes of HCM patients and evaluate the influence of race and gender in Iranian patients.Methods: Patients with HCM underwent a complete clinical and echocardiographic study including TDI toassess regional systolic contraction( in the 12 segments and early diastolic annular velocity (Em from theseptal mitral annulus.Results: The study comprised 41 patients (20 women, mean age = 41 ± 15 years with mean LVEF 55%±4.8%and mean maximal septal thickness 2.07cm. Considering LVOT gradient>30mmHg, hypertrophic obstructivecardiomyopathy (HOCM was found in 18 (45%. Asymmetric septal hypertrophy (ASH existed in 27 patients(67%, systolic anterior motion of anterior mitral leaflet (SAM in 25 persons (64%. Nineteen patients (46.3%were included in NYHA function class (FC II and 6 (14.7% in FC III or higher. We found syncope in 10(24.4%, chest pain in 4 (9.8%, atrial fibrilation in 14.6 % and ventricular arrhythmias in (17.1% of patients.History of ICD was seen in 7 (17.1% and PPM in 9 cases. Mean E’ velocity was 5.44± 1.65 cm/sec and S velocity5.70± 1.49 cm/sec with significant lower S velocity and E’ in syncope patients. Overall, HOCM patients hadgrade II diastolic dysfunction with E/É >15(17.54±7.46. Majority (25 of cases (61% were categorized in typeIII of HCM. RV involvement was observed in 11 patients (28.2%.No significant differences existed betweenprevalence of syncope and dysrhythmia among HCM and HOCM patients.Conclusion: In our study, we found lower detection of latent HOCM, compared to other studies, suggestive ofinadequate use of appropriate provocative maneuvers such as exercise stress echocardiography and amyl

  18. P1033Echocardiographic predictive model of new-onset postoperative atrial fibrillation after abdominal surgery.

    Science.gov (United States)

    Demirevska, L; Gotchev, D

    2016-12-01

    and purpose: Postoperative atrial fibrillation (POAF) is a frequent complication post high-risk abdominal surgery in elderly patients. This study aimed to develop a predictive model of POAF based on preoperative transthoracic echocardiography (TTE) findings in these patients. We conducted a prospective study of 300 consecutive patients, age ≥ 65 years (mean age 72±6 years, 61% men), who underwent high-risk abdominal surgery under general anesthesia. Preoperative TTE was performed in all patients, including tissue Doppler imaging (TDI). We measured the time interval between the onset of the P-wave on ECG and a point of the peak-A wave on TDI from the lateral mitral annulus (PA lateral) and septal mitral annulus (PA septal). Left atrial (LA) dyssynchrony was measured by subtracting the PA septal from PA lateral. Right ventricular systolic pressure was estimated by using the tricuspid regurgitation jet (TRJ) Doppler velocity method. The primary endpoint was the occurance of new-onset POAF. Thirty-seven (12%) patients developed POAF. Multiple echocardiographic parameters were measured and tested in different combinations. The final model included the following variables with cutoff points predictive of POAF: PA lateral > 139 ms (69% sensitivity, 92% specificity), LA dyssynchrony > 35 ms (78% sensitivity, 89% specificity), and TRJ Doppler velocity >2.6 m/s (89% sensitivity, 64% specificity). A value of 0 was assigned when the result was below the cutoff point and a value of 1 if above the cutoff point. Coding of these three variables in the following order: PA lateral- TRJ Doppler- left atrial dyssynchrony can predict the probability of POAF. The model showed a postive predictive value of 79% and a negative predictive value of 95%. A model using three echocardiographic variables: PA lateral, LA dyssynchrony and TRJ Doppler velocity, can predict the incidence of POAF after high-risk abdominal surgery. The model can be used preoperatively to identify high-risk patients

  19. Four-tiered echocardiographic analysis approach for congenital mitral valve malformations: Four years of experience.

    Science.gov (United States)

    Sun, Feifei; Chen, Yixin; Ren, Weidong; Zhang, Ying; Wu, Dan; Chen, Xin; Ma, Chunyan; Li, Dongyu

    2017-01-15

    Traditional methods of describing and classifying congenital mitral valve malformations (CMVMs) often lack specificity and scientificity. Thus, documentation is incomplete, especially in terms of ultrasound findings. Data were collected from 436 patients (mean age, 36.6±26.8years; male 47.9%), each subjected to echocardiographic evaluation of CMVM. Valvar characteristics were studied and analyzed via a four-tiered echocardiographic analysis (FTEA) approach: (1) supravalvular region and annulus, (2) valvar leaflets and commissures, (3) chordae tendineae, and (4) papillary muscles. A clinical random ultrasonic reading controlled trial was designed to the compare conventional diagnostic method and FTEA in patients with CMVMs. From a total of 246,507 echocardiograms, CMVMs were methodically investigated in 436 (0.18%) patients. Of these, 16 (3.7%) had multi-level malformations; and in 133 (30.5%), CVCMs were associated with other cardiac defects. Using a FTEA approach, involvement was distributed as follows: (1) supravalvular region and annulus (n=7 [1.6%]; excessive supravalvular tissue, 3; abnormal annulus, 4 [overriding, 1; shifted, 2; bridging/cord-like accessory tissue, 1]); (2) valvar leaflets and commissures (n=421 [96.3%]; lengthy or excessive, 210; underdeveloped, 35; contracture,12; atretic, 3; anomalously connected, 1; loose or billowy, 63; clefts, 57; dual orifice, 5; localized bulging, 6; accessory tissue element, 4; fibrotic, 18; fused leaflet cusps, 3; abnormal commissures, 4 [fused, 1; clefts, 3]); (3) chordae tendineae (n=14 [3.2%]; confined to single papillary muscle, 4; excessive, 2; thickened and fused, 2; shortened, 2; fibrotic, 2; accessory tissue element, 1; straddling, 1); and (4) papillary muscles (n=13 [3.0%]; absent, 2; single, 5; asymmetric, 2; abnormally located, 3; fibrotic, 1). According to the report comparing one by one each section among the inexperienced (groups A and B) and experienced (group C) groups out of 100 patients with CMVMs

  20. Fat circadian biology.

    Science.gov (United States)

    Gimble, Jeffrey M; Floyd, Z Elizabeth

    2009-11-01

    While adipose tissue has long been recognized for its major role in metabolism, it is now appreciated as an endocrine organ. A growing body of literature has emerged that identifies circadian mechanisms as a critical regulator of adipose tissue differentiation, metabolism, and adipokine secretory function in both health and disease. This concise review focuses on recent data from murine and human models that highlights the interplay between the core circadian regulatory proteins and adipose tissue in the context of energy, fat, and glucose metabolism. It will be important to integrate circadian mechanisms and networks into future descriptions of adipose tissue physiology.

  1. Correlation analysis of the relationship between B-type natriuretic peptide and selected echocardiographic parameters in patients with permanent pacemakers

    Directory of Open Access Journals (Sweden)

    Janusz Sielski

    2016-01-01

    Full Text Available Introduction: The present study was undertaken to evaluate the practical value of BNP measurements and echocardiographic left ventricular volume index in patients with permanent pacemakers because there are no such reports in the literature. Aim of the research: The aim of the study was to reveal multiple correlations between BNP levels and selected echocardiographic parameters of the left atrium in patients with permanent pacemakers. In the literature there are reports on the significance of BNP values and left atrial size in patients with permanent pacemakers. The results of the present study appear to be of value in the outpatient assessment of these patients. Material and methods: We analysed a group of 117 patients with permanent pacemakers (AAI/R 21 patients, DDD/R 59 patients, VVI/R 37 patients and 48 healthy volunteers serving as the control group. BNP measurements were performed on venous blood samples using Triage meters. The Simpson method and the ellipse method were used to assess the left atrium on echocardiography. Results: There was a significant correlation between BNP and maximum left atrial volume, minimum left atrial volume, and left atrial volume index in patients with AAI/R, DDD/R, and VVI/R pacemakers at 3 and 6 months after the implantation. Conclusions : In patients after implantation of permanent pacemakers there are correlations between BNP values and echocardiographic left atrial parameters, especially in patients with DDD/R pacemakers. Left atrial function improves in patients with DDD/R pacemakers. Pacemaker check-up should be extended to include BNP measurements and echocardiographic assessment of the left atrium.

  2. Echocardiographic measurements in normal chinese adults focusing on cardiac chambers and great arteries: a prospective, nationwide, and multicenter study.

    Science.gov (United States)

    Yao, Gui-Hua; Deng, Yan; Liu, Yan; Xu, Ming-Jun; Zhang, Cheng; Deng, You-Bin; Ren, Wei-Dong; Li, Zhi-An; Tang, Hong; Zhang, Quan-Bin; Mu, Yu-Ming; Fang, Li-Gang; Zhang, Mei; Yin, Li-Xue; Zhang, Yun

    2015-05-01

    Currently available echocardiographic reference values are derived mainly from North American and European population studies, and no echocardiographic reference values are available for the Chinese population. The aim of this study was to establish normal values of echocardiographic measurements of the cardiac chambers and great arteries in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1,586 healthy Han Chinese volunteers aged 18 to 79 years were screened at 43 collaborating laboratories throughout China. Standard M-mode and two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries. The impacts of gender and age on all echocardiographic measurements were analyzed. A total of 1,394 qualified healthy subjects (mean age, 47.3 ± 16.0 years; 678 men) were ultimately enrolled. Except for left ventricular ejection fraction, values of cardiac chamber and great arterial dimensions were significantly higher in men than in women. Most measurements of the atrial and great arterial dimensions, left ventricular wall thickness, and left ventricular mass increased with age in both men and women. Normal reference values of cardiac dimensional parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Because most of these parameters were found to vary with gender and age, reference values stratified for gender and age should be used in clinical practice. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  3. Fusion of morphological data obtained by coronary computed tomography angiography with quantitative echocardiographic data on regional myocardial function.

    Science.gov (United States)

    Lipiec, Piotr; Wejner-Mik, Paulina; Wdowiak-Okrojek, Katarzyna; Szymczyk, Ewa; Skurski, Adam; Napieralski, Andrzej; Kamiński, Marek; Szymczyk, Konrad; Kasprzak, Jarosław D

    2016-01-01

    Three-dimensional (3D) fusion of morphological data obtained by coronary computed tomography angiography (CCTA) with functional data from resting and stress echocardiography could potentially provide additional information compared to examination results analyzed separately and increase the diagnostic and prognostic value of non-invasive imaging in patients with suspected coronary artery disease (CAD). Using vendor-independent software developed in our institution, we aimed to assess the feasibility and reproducibility of 3D fusion of morphological CCTA data with echocardiographic data regarding regional myocardial function. Thirty patients with suspected CAD underwent CCTA and resting transthoracic echocardiography. From CCTA we obtained 3D reconstructions of coronary arteries and left ventricle (LV). Offline speckle-tracking analysis of the echocardiographic images provided parametric maps depicting myocardial longitudinal strain in 17 segments of the LV. Using our software, 3 independent investigators fused echocardiographic maps with CCTA reconstruc-tions in all patients. Based on the obtained fused models, each segment of the LV was assigned to one of the major coronary artery branches. Mean time necessary for data fusion was 65 ± 7 s. Complete agreement between independent investigators in assignment of LV segments to coronary branches was obtained in 94% of the segments. The average coefficient of agreement (kappa) between the investigators was 0.950 and the intra-class correlation coefficient was 0.9329 (95% CI 0.9227-0.9420). Three-dimensional fusion of morphological CCTA data with quantitative echocardiographic data on regional myocardial function is feasible and allows highly repro-ducible assignment of myocardial segments to coronary artery branches.

  4. Use of Simpson's method of disc to detect early echocardiographic changes in Doberman Pinschers with dilated cardiomyopathy.

    Science.gov (United States)

    Wess, G; Mäurer, J; Simak, J; Hartmann, K

    2010-01-01

    M-mode is the echocardiographic gold standard to diagnose dilated cardiomyopathy (DCM) in dogs, whereas Simpson's method of discs (SMOD) is the preferred method to detect echocardiographic evidence of disease in humans. To establish reference values for SMOD and to compare those with M-mode measurements. Nine hundred and sixty-nine examinations of 471 Doberman Pinschers. Using a prospective longitudinal study design. Reference values for SMOD were established using 75 healthy Doberman Pinschers >8 years old with 95mL/m(2) ) and end-systolic volume (LVESV/BSA > 55mL/m(2) ) to detect echocardiographic changes in Doberman Pinschers with DCM was compared with currently recommended M-mode values. Dogs with elevated SMOD values but normal M-mode measurements were followed-up using a prospective longitudinal study design. At the final examination 175 dogs were diagnosed with DCM according to both methods (M-mode and SMOD). At previous examinations, M-mode values were abnormal in 142 examinations only, whereas all 175 SMOD already had detected changes. Additionally, 19 of 154 dogs with >100 VPCs/24 hours and normal M-mode values had abnormal SMOD measurement. Six dogs with increased SMOD measurements remained healthy at several follow-up examinations (classified as false positive); in 24 dogs with increased SMOD measurements, no follow-up examinations were available (classified as unclear). SMOD measurements are superior to M-mode to detect early echocardiographic changes in Dobermans with occult DCM. Copyright © 2010 by the American College of Veterinary Internal Medicine.

  5. Reference values of two-dimensional and M-mode echocardiographic measurements as a function of body size in various equine breeds and in ponies.

    Science.gov (United States)

    Al-Haidar, A; Moula, N; Leroux, A; Farnir, F; Deleuze, S; Sandersen, C; Amory, H

    2017-12-01

    The aim of this study was to establish echocardiographic reference values for the equine species using allometric regression equations based on body weight (BW) and thoracic circumference (TC). A total of 239 horses or ponies were studied, including 65 warmbloods, 33 Standardbreds, 41 Thoroughbreds, 32 Arabian horses, 28 draft horses, and 40 ponies aged from 1 day to 30 years, weighing from 18 to 890 kg, with no evidence of cardiac disease. For each horse or pony, a two-dimensional and M-mode echocardiography was performed. Within each breed, the relationships between BW or TC and echocardiographic dimensions were examined using power regression equations. Predictions and their 95% prediction intervals were calculated for the echocardiographic measurements. Within each breed, all echocardiographic measurements showed a significant and positive relationship with a high coefficient of determination for the estimation of the regression equations using BW and TC as the main explanatory variables. Breed-specific power regression equations as well as the 95% prediction intervals were calculated for each echocardiographic measurement as a function of BW and TC. In the future, the body size-corrected and breed-specific echocardiographic reference values calculated in the present study could be used to discriminate between normal and abnormal values in a given animal. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Fat sensing and metabolic syndrome.

    Science.gov (United States)

    Youn, Jang H

    2014-12-01

    Overconsumption of dietary fat contributes to the development of obesity and metabolic syndrome. Recent evidence suggests that high dietary fat may promote these metabolic states not only by providing calories but also by inducing impaired control of energy balance. In normal metabolic states, fat interacts with various organs or receptors to generate signals for the regulation of energy balance. Many of these interactions are impaired by high-fat diets or in obesity, contributing to the development or maintenance of obesity. These impairments may arise largely from fundamental alterations in the hypothalamus where all peripheral signals are integrated to regulate energy balance. This review focuses on various mechanisms by which fat is sensed at different stages of ingestion, circulation, storage, and utilization to regulate food intake, and how these individual mechanisms are altered by high-fat diets or in obesity.

  7. Echocardiographic estimation of right ventricular stroke work in children with pulmonary arterial hypertension: comparison with invasive measurements.

    Science.gov (United States)

    Di Maria, Michael V; Burkett, Dale A; Younoszai, Adel K; Landeck, Bruce F; Mertens, Luc; Ivy, D Dunbar; Friedberg, Mark K; Hunter, Kendall S

    2015-11-01

    Right ventricular (RV) failure is a key determinant of mortality in children with pulmonary arterial hypertension (PAH). RV stroke work (RVSW) can be estimated as the product of RV systolic pressure and stroke volume. The authors have shown that RVSW predicts adverse outcomes in this population when derived from hemodynamic data; noninvasive assessment of RVSW may be advantageous but has not been assessed. There are few data validating noninvasive versus invasive measurements in children with PAH. The aim of this study was to compare echocardiographically derived RVSW with RVSW determined from hemodynamic data. This was a retrospective study, including subjects with idiopathic PAH and minor or repaired congenital heart disease. Forty-nine subjects were included, in whom cardiac catheterization and echocardiography were performed within 1 month. Fourteen additional patients were included in a separate cohort, in whom catheterization and echocardiography were performed simultaneously. Catheterization-derived RVSW was calculated as RV systolic pressure × (cardiac output/heart rate). Echocardiographically derived RVSW was calculated as 4 × (peak tricuspid regurgitant jet velocity)(2) × (pulmonary valve area × velocity-time integral). Statistics included the intraclass correlation coefficient and Bland-Altman analysis. Echocardiographically derived RVSW was linearly correlated with invasively derived RVSW (r = 0.74, P rights reserved.

  8. [Body fat distribution: anthropometric indicators].

    Science.gov (United States)

    Yáñez, M; Albala, C

    1995-12-01

    There are two types of fat distribution in obese subjects. The abdominal, superior, android or apple shaped and the gluteo-femoral, gynecoid, inferior or pear shaped. In the former, fat is accumulated in the abdomen and in the latter, in the gluteal region. The superior distribution is associated with a higher risk of cardiovascular diseases. Among anthropometric measurements of fat distribution, the ratio between waist circumference measured at the level of the navel and hip circumference, measured at the level of greater trochanters, is the best indicator. Using the cutoff points of 0.8 for women and 1 for men, it has a good correlation with visceral fat.

  9. Clinical and Echocardiographic Predictors of Mortality in Chagasic Cardiomyopathy - Systematic Review

    Science.gov (United States)

    Pereira, Clodoval de Barros; Markman, Brivaldo

    2014-01-01

    Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease. PMID:25004422

  10. Segmentation of the heart muscle in 3-D pediatric echocardiographic images.

    Science.gov (United States)

    Nillesen, Maartje M; Lopata, Richard G P; Gerrits, Inge H; Kapusta, Livia; Huisman, Henkjan J; Thijssen, Johan M; de Korte, Chris L

    2007-09-01

    This study aimed to show segmentation of the heart muscle in pediatric echocardiographic images as a preprocessing step for tissue analysis. Transthoracic image sequences (2-D and 3-D volume data, both derived in radiofrequency format, directly after beam forming) were registered in real time from four healthy children over three heart cycles. Three preprocessing methods, based on adaptive filtering, were used to reduce the speckle noise for optimizing the distinction between blood and myocardium, while preserving the sharpness of edges between anatomical structures. The filtering kernel size was linked to the local speckle size and the speckle noise characteristics were considered to define the optimal filter in one of the methods. The filtered 2-D images were thresholded automatically as a first step of segmentation of the endocardial wall. The final segmentation step was achieved by applying a deformable contour algorithm. This segmentation of each 2-D image of the 3-D+time (i.e., 4-D) datasets was related to that of the neighboring images in both time and space. By thus incorporating spatial and temporal information of 3-D ultrasound image sequences, an automated method using image statistics was developed to perform 3-D segmentation of the heart muscle.

  11. Echocardiographic assessment of the right ventricle in the current era: Application in clinical practice.

    Science.gov (United States)

    Venkatachalam, Sridhar; Wu, Geru; Ahmad, Masood

    2017-12-01

    The right ventricle has unique structural and functional characteristics. It is now well recognized that the so-called forgotten ventricle is a key player in cardiovascular physiology. Furthermore, there is accumulating evidence that demonstrates right ventricular dysfunction as an important marker of morbidity and mortality in several commonly encountered clinical situations such as heart failure, pulmonary hypertension, pulmonary embolism, right ventricular myocardial infarction, and adult congenital heart disease. In contrast to the left ventricle, echocardiographic assessment of right ventricular function is more challenging as volume estimations are not possible without the use of three-dimensional (3D) echocardiography. Guidelines on chamber quantification provide a standardized approach to assessment of the right ventricle. The technique and limitations of each of the parameters for RV size and function need to be fully understood. In this era of multimodality imaging, echocardiography continues to remain a useful tool for the initial assessment and follow-up of patients with right heart pathology. Several novel approaches such as 3D and strain imaging of the right ventricle have expanded the usefulness of this indispensable modality. © 2017, Wiley Periodicals, Inc.

  12. Clinical and echocardiographic predictors of mortality in chagasic cardiomyopathy - systematic review

    Directory of Open Access Journals (Sweden)

    Clodoval de Barros Pereira Júnior

    2014-07-01

    Full Text Available Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed, LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.

  13. Effects of Acute Carbon Monoxide Poisoning on ECG and Echocardiographic Parameters in Children.

    Science.gov (United States)

    Ozyurt, Abdullah; Karpuz, Derya; Yucel, Aydin; Tosun, Mehtap Durukan; Kibar, Ayse Esin; Hallioglu, Olgu

    2017-07-01

    The aim of the current study is to investigate the effects of CO (carbon monoxide) on the cardiovascular system via electrocardiographic, echocardiographic and biochemical findings in children. This prospective study included 22 children with CO poisoning and 24 healthy children as a control group. The CO-intoxicated children were evaluated via electrocardiography and echocardiography 1 h after admission to the emergency department and daily until their discharge from the hospital. Blood gasses, complete blood account, troponin I and creatinine kinase-MB(CK-MB) were assessed daily. Tpeak-end (p:0.001), QTc durations (p:0.02), Tpeak-end dispersion (p:0.001) and Tpeak-end/QT ratio (p:0.001) of CO-intoxicated patients were significantly higher than those in the control group. Mitral E duration (p:0.001), mitral E/A ratio (p:0.001) and left ventricle contractile fraction (p:0.023) at admission were significantly lower, and left ventricle myocardial performance index was higher (p:0.001) in the CO poisoning group. Troponin I and CK-MB levels were higher at admission in 6 (27 %) and 4 (18 %) patients, respectively. The heart is the most critical organ in pediatric CO poisoning. These children present subclinical systolic and diastolic left ventricle dysfunction even in mild cases. Although, in children with acute CO-intoxication ventricular repolarization is impaired, it seems to be reversible like other findings.

  14. Interictal electrocardiographic and echocardiographic changes in patients with generalized tonic-clonic seizures.

    Science.gov (United States)

    M Ramadan, Mahmoud; El-Shahat, Nader; A Omar, Ashraf; Gomaa, Mohamed; Belal, Tamer; A Sakr, Sherif; Abu-Hegazy, Mohammad; Hakim, Hazem; A Selim, Heba; Omar, Sabry; A Omar, Sabry

    2013-01-01

    Partial and generalized seizures often affect autonomic functions during seizures, and interictal and postictal periods. We investigated possible interictal electrocardiographic abnormalities in patients with generalized tonic-clonic seizures (GTCS), together with evaluating any structural heart changes by echocardiography in these patients in comparison with healthy controls. We studied 120 definite GTCS patients (76 males and 44 females) who are neither diabetic nor under any medical treatment, and 60 healthy controls with a mean age of 25.2 ± 9.3 and 27.3 ± 7.5 years; respectively. Resting systolic and diastolic arterial blood pressures were measured, and standard 12-lead electrocardiograms and a 2-dimensional echocardiographic examination were performed. In univariate analysis, GTCS patients (compared to controls) had significantly lower means of PR interval (147.2 ± 18.6 versus 153.8 ± 22.6 msec; P = 0.037), QT interval (362.8 ± 22.9 versus 379.9 ± 29.3 msec; P seizures on cardiac microstructure. Further work is needed to stratify the risk of sudden unexplained cardiac death (SUDEP) on the basis of interictal autonomic parameters to improve prognosis.

  15. Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach.

    Science.gov (United States)

    Smolarek, Dorota; Gruchała, Marcin; Sobiczewski, Wojciech

    2017-01-01

    Estimation of right ventricular (RV) performance still remains technically challenging due to its anatomical and functional distinctiveness. The current guidelines for the echocardiographic quantification of RV function recommend using multiple indices to describe the RV in a thorough and comprehensive manner, such as RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'-wave), three-dimensional RV ejection fraction (3D RVEF), RV longitudinal strain (RVLS)/strain rate by speckle- tracking echocardiography (STE). Among these, the last one mentioned here is an innovative and a particularly promising tool that yields more precise information about complex regional and global RV mechanics. STE was initially designed to evaluate left ventricular function, but recently it has been introduced to assess RV performance, which is difficult due to its unique structure and physiology. Many studies have shown that both free wall and 6-segment RVLS present a stronger correlation with the RVEF assessed by cardiac magnetic resonance than conventional parameters and seem to be more sensitive in detecting myocardial dysfunction at an earlier, subclinical stage.

  16. [Effect of rapid digitalization on the left-ventricular myocardial function according to the echocardiographic data].

    Science.gov (United States)

    Belenkov, Iu N; At'kov, O Iu; Tsibekmakher, T D

    1977-09-01

    The article deals with the data of echocardiographic examination of 61 patients (37 with rheumatic heart disease and 17 with atherosclerotic cardiosclerosis) subjected to rapid stage-by-stage digitalization by intravenous administration of various rapidly acting glycosides. In 10 patients with ischemic heart disease echocardiography was performed following a single strophanthin injection. Decrease in the volumes of the left ventricle and increase in the indices of central hemodynamics were noted as a result of rapid stage-by-stage saturation with strophanthin. The maximum inotropic effect of strophanthin does not coincide in time with the maximum chronotropic effect. The increase in the stroke volume noted in maximum deceleration of cardiac contractions is probably realized due to the Frank-Starling mechanism. Strophanthin increases the rate of myocardial contractions without changing the duration of the systole. The rate of diastolic relaxation grows, the phase of rapid filling becomes shorter and the phase of slow filling longer, which creates favourable conditions for the next contraction.

  17. Echocardiographic anatomy of the mitral valve in healthy dogs and dogs with myxomatous mitral valve disease.

    Science.gov (United States)

    Wesselowski, S; Borgarelli, M; Menciotti, G; Abbott, J

    2015-06-01

    To further characterize the echocardiographic anatomy of the canine mitral valve apparatus in normal dogs and in dogs affected by myxomatous mitral valve disease (MMVD). Twenty-two normal dogs and 60 dogs with MMVD were prospectively studied. The length (AMVL), width (AMVW) and area (AMVA) of the anterior mitral valve leaflet were measured in the control group and the affected group, as were the diameters of the mitral valve annulus in diastole (MVAd) and systole (MVAs). The dogs with MMVD were staged based on American College of Veterinary Internal Medicine (ACVIM) guidelines and separated into groups B1 and B2/C. All measurements were indexed to body weight based on empirically defined allometric relationships. There was a statistically significant relationship between all log10 transformed mitral valve dimensions and body weight. The AMVL, AMVW, AMVA, MVAd and MVAs were all significantly greater in the B2/C group compared to the B1 and control groups. The AMVW was also significantly greater in the B1 group compared to the control group. Interobserver % coefficient of variation (% CV) was mitral valve leaflet and the mitral valve annulus in the dog can be indexed to body weight based on allometric relationships. Preliminary reference intervals have been proposed over a range of body sizes. Relative to normal dogs, AMVL, AMVW, AMVA, MVAd and MVAs are greater in patients with advanced MMVD. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Clinical and echocardiographic predictors of mortality in chagasic cardiomyopathy--systematic review.

    Science.gov (United States)

    Pereira Júnior, Clodoval de Barros; Markman Filho, Brivaldo

    2014-06-01

    Diagnosis, prognosis and evaluation of death risk in Chagas cardiomyopathy still constitute a challenge due to the diversity of manifestations, which determine the importance of using echocardiography, tissue Doppler and biomarkers. To evaluate, within a systematic review, clinical and echocardiographic profiles of patients with chronic chagasic cardiomyopathy, which may be related to worse prognosis and major mortality risk. To perform the systematic review, we used Medline (via PubMed), LILACS and SciELO databases to identify 82 articles published from 1991 to 2012, with the following descriptors: echocardiography, mortality and Chagas disease. We selected 31 original articles, involving diagnostic and prognostic methods. The importance of Chagas disease has increased due to its emergence in Europe and United States, but most evidence came from Brazil. Among the predictors of worse prognosis and higher mortality risk are morphological and functional alterations in the left and right ventricles, evaluated by conventional echocardiography and tissue Doppler, as well as the increase in brain natriuretic peptide and troponin I concentrations. Recently, the evaluations of dyssynchrony, dysautonomia, as well as strain, strain rate and myocardial twisting were added to the diagnostic arsenal for the early differentiation of Chagas cardiomyopathy. Developments in imaging and biochemical diagnostic procedures have enabled more detailed cardiac evaluations, which demonstrate the early involvement of both ventricles, allowing a more accurate assessment of the mortality risk in Chagas disease.

  19. Electrocardiographic intricacies clarified by echocardiography--should the electrocardiogram be interpreted echocardiographically?

    Science.gov (United States)

    Ker, James

    2012-07-12

    During the past century the electrocardiogram (ECG) has established itself as an integral part of the cardiovascular examination. Since the first direct recordings of cardiac potentials by Waller in 1887, to the invention of the string galvanometer by Willem Einthoven in 1901, to use in the clinic by 1910, the electrocardiogram has become the most widely used clinical tool in the diagnosis of virtually every type of heart disease. Currently up to 20 million ECGs are performed annually in the United States alone. However, in this era of readily available echocardiography, an important caveat in the interpretation of the electrocardiogram has emerged: variants of intracardiac structures which might mimic disease on the ECG. In this perspective various structural variants of intracardiac structures, specifically variants of papillary muscles and subaortic muscular bands, will be shown, together with their associated electrocardiographic changes, mimicking disease. It is concluded that in this era of readily available echocardiography, the electrocardiogram should be interpreted echocardiographically in instances where intricate variations are seen on the surface electrocardiogram. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Echocardiographic analysis of valvular heart diseases over one decade in Nigeria.

    Science.gov (United States)

    Ike, S O

    2008-12-01

    This was a hospital-based study designed to determine the prevalence and pattern of valvular heart diseases (VHD) seen at the echocardiographic laboratory of the University of Nigeria Teaching Hospital, Enugu, Nigeria. It was also aimed at evaluating the age and gender distribution, as well as the aetiological diagnosis, of these disease presentations. All the 2527 patients referred for echocardiography over the 10 year period from February 1991 to January 2001 were consecutively studied. VHDs were diagnosed in 957 (38%) of the patients. There were 529 males and 428 females, with an age range of 6 months to 89 years. One hundred and forty-eight (16%) of them presented in the first two decades of life. Mitral valve diseases accounted for 654 (68%), aortic valve diseases 233 (25%), tricuspid valve diseases 51 (5%) and pulmonary valve diseases 19 (2%) of the cases. All four valves were involved in 15 (2%) patients. Rheumatic aetiology was the most common presumptive diagnosis, with 568 (59%) patients. The frequency pattern of VHDs in this study was high. This poses a number of challenges, one of which is the need for availability of interventions, such as non-invasive and minimally invasive surgeries.

  1. Obesity, ultrasound indexes of fat depots and lipid goal attainment in patients with high and very high cardiovascular risk: A novel approach towards better risk reduction.

    Science.gov (United States)

    Haberka, M; Okopień, B; Gąsior, Z

    2016-02-01

    Our aim was to assess the attainment of primary (low density lipoprotein cholesterol; LDL-C) and secondary (non-high density lipoprotein cholesterol; non-HDL-C) lipid therapeutic goals in relation to obesity, clinical measures of adiposity and ultrasound indexes of fat depots, including the novel index of periarterial adipose tissue (PAT): carotid artery extra media thickness (EMT). High and very high cardiovascular (CV) risk patients (n = 420; F/M: 34/66%; age: 61.2 ± 7 years) with prior statin treatment (≥ 18 months) were enrolled into this cross-sectional study. All patients had a detailed assessment with several anthropometric measures and ultrasound indexes of fat depots indexed to BMI: abdominal (Intra-abdominal Fat Thickness; IAT and Pre-peritoneal Fat Thickness; PreFT), paracardial (Epicardial Fat Thickness; EFT and Pericardial Fat Thickness; PFT) and the new index corresponding to PAT (carotid EMT). Lipid goals attainment in the study group was as follows: 34% (LDL-C goal), 39% (non-HDL-C goal) and 35% (both LDL and non-HDL-C goals). Among ultrasound indexes, patients with both lipid goals attainment revealed significantly lower carotid EMT/BMI (LDL-C goal: 25.2 ± 4.2 vs 27.5 ± 4.1, p obesity and most clinical measures of adiposity, carotid EMT and abdominal IAT, but not other ultrasound indexes of fat depots revealed associations independent from BMI with lipid goal attainment and may help identify patients requiring more aggressive lipid management. Copyright © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  2. Body fat, abdominal fat and body fat distribution related to cardiovascular risk factors in prepubertal children

    DEFF Research Database (Denmark)

    Dencker, Magnus; Wollmer, Per; Karlsson, Magnus K

    2012-01-01

    Aim:  We analysed whether total body fat (TBF), abdominal fat and body fat distribution are associated with higher composite risk factor scores for cardiovascular disease (CVD) in young children. Methods:  Cross-sectional study of 238 children aged 8-11 years. TBF and abdominal fat mass (AFM) were......, separately, and used as composite risk factor score. Results:  Pearson correlations between ln BF%, ln AFM and AFM/TBF versus composite risk factor score for boys were r = 0.56, r = 0.59 and r = 0.48, all p ...

  3. Oil and fat absorbing polymers

    Science.gov (United States)

    Marsh, H. E., Jr. (Inventor)

    1977-01-01

    A method is described for forming a solid network polymer having a minimal amount of crosslinking for use in absorbing fats and oils. The polymer remains solid at a swelling ratio in oil or fat of at least ten and provides an oil absorption greater than 900 weight percent.

  4. Fats and oils: An overview

    Science.gov (United States)

    Dietary fat is a macronutrient that has historically engendered considerable controversy and continues to do so. Contentious areas include optimal amount and type for cardiovascular disease risk reduction, and role in body weight regulation. Dietary fats and oils are unique in modern times in that ...

  5. Fat burners: nutrition supplements that increase fat metabolism.

    Science.gov (United States)

    Jeukendrup, A E; Randell, R

    2011-10-01

    The term 'fat burner' is used to describe nutrition supplements that are claimed to acutely increase fat metabolism or energy expenditure, impair fat absorption, increase weight loss, increase fat oxidation during exercise, or somehow cause long-term adaptations that promote fat metabolism. Often, these supplements contain a number of ingredients, each with its own proposed mechanism of action and it is often claimed that the combination of these substances will have additive effects. The list of supplements that are claimed to increase or improve fat metabolism is long; the most popular supplements include caffeine, carnitine, green tea, conjugated linoleic acid, forskolin, chromium, kelp and fucoxanthin. In this review the evidence for some of these supplements is briefly summarized. Based on the available literature, caffeine and green tea have data to back up its fat metabolism-enhancing properties. For many other supplements, although some show some promise, evidence is lacking. The list of supplements is industry-driven and is likely to grow at a rate that is not matched by a similar increase in scientific underpinning. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

  6. Omega-3 fats: Good for your heart

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000767.htm Omega-3 fats: Good for your heart To use the sharing ... 3 fatty acids are a type of polyunsaturated fat . We need these fats to build brain cells ...

  7. Idiopathic Premature Ventricular Contraction Originating from Left Epicardial Outflow Tract —Effects of Antiarrhythmic Drugs, Autonomic Provocation and Radiofrequency Catheter Ablation—

    Directory of Open Access Journals (Sweden)

    Kotaro Miyaji, MD

    2006-01-01

    Full Text Available We present a patient with frequent episodes of palpitation who had idiopathic premature ventricular contraction (PVC. with QRS morphology exhibiting a right bundle branch block pattern with an inferior axis. Neither administration of procainamide, propranolol, lidocaine or verapamil could inhibit PVC, whereas administration of adenosine triphosphate, carotid sinus massage and Valsalva maneuver could effectively eliminate PVC. The earliest activation preceding the QRS complex by 25 msec at occurrence of the PVC was recorded at the distal site of the coronary sinus and within the left coronary cusp. Pacemapping in the supravalvular site during sinus rhythm produced a QRS complex more similar to PVC than that produced in the infravalvular site of the left ventricular outflow tract (LVOT. Radiofrequency catheter ablation was performed at the supravalvular site close to the epicardial LVOT, which resulted in successful elimination of PVCs.

  8. History of fat grafting: from ram fat to stem cells.

    Science.gov (United States)

    Mazzola, Riccardo F; Mazzola, Isabella C

    2015-04-01

    Fat injection empirically started 100 years ago to correct contour deformities mainly on the face and breast. The German surgeon Eugene Hollaender (1867-1932) proposed a cocktail of human and ram fat, to avoid reabsorption. Nowadays, fat injection has evolved, and it ranks among the most popular procedures, for it provides the physician with a range of aesthetic and reconstructive clinical applications with regenerative effects on the surrounding tissues. New research from all over the world has demonstrated the role of adipose-derived stem cells, present in the adipose tissue, in the repair of damaged or missing tissues. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Diagnostic Utility of High Sensitivity Troponins for Echocardiographic Markers of Structural Heart Disease.

    Science.gov (United States)

    Wang, Tom Kai Ming; Dugo, Clementina; Gillian, Yvonne; Yvonne, Wynne; Heather, Semple; Kevin, Smith; Peter, Cleave; Jonathan, Christiansen; Andrew, To; Nezar, Amir; Scott, Tony; Ross, Boswell; Patrick, Gladding

    2018-02-15

    The conventional use of high-sensitivity troponins (hs-troponins) is for diagnosing myocardial infarction however they also have a role in chronic disease management. This pilot study assessed the relationship of hs-troponins with echocardiographic markers of left ventricular hypertrophy (LVH) and structural heart disease (SHD). Patients undergoing computer gomography (CT) coronary angiogram for low-intermediate risk chest pain and healthy volunteers were recruited. Hs-troponins Singulex I, Abbott I and Roche T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were evaluated in relation to SHD parameters including left ventricular hypertrophy (LVH Echo ) and left atrial enlargement (LAE Echo ) on echocardiography. 78 subjects who underwent echocardiography were included in this study. C-statistics (95% confidence interval) of the four biomarkers for predicting LVH Echo were 0.84 (0.72-0.92), 0.84 (0.73-0.92), 0.75 (0.63-0.85) and 0.62 (0.49-0.74); for LAE Echo 0.74 (0.6-0.85), 0.78 (0.66-0.88), 0.55 (0.42-0.67) and 0.68 (0.62-0.85); and composite SHD 0.79 (0.66-0.88), 0.87 (0.75-0.94), 0.62 (0.49-0.73) and 0.74 (0.62-0.84) respectively. Optimal cut points for SHD were >1.2 ng/L, >1.6 ng/L, >8 ng/L and >18 pmol/L respectively. These results advocate the potential role of hs-troponins as screening tools for structural heart disease with theranostic implications.

  10. Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Silvio Henrique Barberato

    2016-01-01

    Full Text Available Abstract Background: Sudden cardiac death (SCD is the leading cause of death in maintenance hemodialysis (HD patients, but there is little information about underlying risk factors. Objectives: Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. Methods: Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. Results: We followed 153 patients (50 ± 15 years, 58% men for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023 and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028 showed independent association with SCD events. Conclusions: HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.

  11. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results

    Science.gov (United States)

    da Costa, Francisco Diniz Affonso; Colatusso, Daniele de Fátima Fornazari; da Costa, Ana Claudia Brenner Affonso; Balbi Filho, Eduardo Mendel; Cavicchioli, Vinicius Nesi; Lopes, Sergio Augusto Veiga; Ferreira, Andrea Dumsch de Aragon; Collatusso, Claudinei

    2016-01-01

    Introduction Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95% - 68%-95%) at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95% - 66%-97%) and 91% (CI 95% - 69%-97%) at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results. PMID:27556321

  12. Prognostic meaning of coronary microvascular disease in type 2 diabetes mellitus: a transthoracic Doppler echocardiographic study.

    Science.gov (United States)

    Cortigiani, Lauro; Rigo, Fausto; Gherardi, Sonia; Galderisi, Maurizio; Bovenzi, Francesco; Sicari, Rosa

    2014-07-01

    The prognostic value of Doppler-derived coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery in patients with type 2 diabetes with preserved left ventricular systolic function and without flow-limiting stenoses on angiography remains undetermined. The study sample consisted of 144 patients with type 2 diabetes (82 men; mean age 62 ± 10 years) with chest pain or angina-equivalent symptoms, no histories of coronary artery disease, and echocardiographic ejection fractions ≥ 50%. All patients underwent dipyridamole stress echocardiography with CFVR assessment of the left anterior descending coronary artery by transthoracic Doppler echocardiography and coronary angiography showing normal coronary arteries or nonobstructive coronary artery disease. Mean CFVR was 2.44 ± 0.57. On individual patient analysis, 109 patients (76%) had CFVR > 2, and 35 (24%) had CFVR ≤ 2. During a median follow-up period of 29 months (interquartile range, 14-44 months), 17 hard events (five deaths, 12 nonfatal myocardial infarctions) occurred. The annual hard-event rate was 13.9% in subjects with CFVR ≤ 2 and 2.0% in those with CFVR > 2. The annual event rate associated with CFVR ≤ 2 was significantly higher both in patients with left ventricular hypertrophy (P coronary artery disease was not an independent predictor of outcomes. Microvascular dysfunction before the occurrence of coronary artery involvement is a strong and independent predictor of outcomes in patients with type 2 diabetes. Vasodilator stress CFVR is a suitable tool to assess microvascular dysfunction in routine clinical practice. Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  13. Echocardiographic and biochemical analysis of cardiac function and injury among female amateur runners post-marathon.

    Science.gov (United States)

    Montiel, G; Horn, T; Vafa, R; Solera, A; Hollmann, W; Predel, H G; Brinkmann, C

    2016-03-01

    Numerous studies with male amateur runners have determined negative changes in their cardiac function/of their myocard following long endurance loads. This study aims to examine such potential changes in women, specifically, after running a marathon. A total of 18 female amateur runners (39.5 ± 10.5 years) were examined before (T1), immediately after (T2) and 24 h post-marathon (T3). An echocardiography was performed using Tissue Doppler (TD) imaging. In addition, the concentration of cardiac troponin T (cTnT) and the activity of the myocardial muscle creatine kinase (CK-MB) were determined at T1 and T2. The echocardiographic parameters revealed impairment of the diastolic function, without, however, documenting a diastolic dysfunction (in accordance with the classification of Nagueh (J Am Soc Echocardiogr, 22:107-33, 2009)). The ratio of blood flow velocity through the mitral valve during early versus late diastole (MV E/A ratio), for example, decreased. The values measured at T3 were similar to those measured at T1. The ratio of early transmitral diastolic filling velocity and of the transmitral diastolic filling velocity by TD imaging (MV E/E') did not indicate any change from T1 to T2, but a significant increase at T3 (in comparison with T1). The systolic function (measured by the left ventricular ejection fraction) did not change significantly. The cTnT concentration and CK-MB activity were significantly higher in T2 than in T1. The data collected does not provide any solid evidence of pathological changes in the cardiac function of female amateur runners post-marathon, although the lab values indicate a strongly increased myocardial stimulation.

  14. Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis.

    Science.gov (United States)

    Minners, Jan; Allgeier, Martin; Gohlke-Baerwolf, Christa; Kienzle, Rolf-Peter; Neumann, Franz-Josef; Jander, Nikolaus

    2008-04-01

    The present study tests the consistency of echocardiographic criteria for the grading of aortic valve stenosis. Current guidelines/recommendations define severe stenosis as an aortic valve area (AVA) 40 mmHg, or peak flow velocity (Vmax) >4 m/s. We tested the consistency of the three criteria for the grading of aortic valve stenosis in 3483 echocardiography studies performed in 2427 patients with normal left ventricular (LV) systolic function and a calculated AVA of equation and between AVA and Vmax based on the continuity equation for our study population. An AVA of 1.0 cm2 correlated to a DeltaPm of 21 mmHg and a Vmax of 3.3 m/s. Conversely, a DeltaPm of 40 mmHg corresponds to an AVA of 0.75 cm2 and a Vmax of 4.0 m/s to an AVA of 0.82 cm2. Consequently, severe stenosis was diagnosed in 69% of patients based on AVA, 45% on Vmax, and 40% on DeltaPm. Stroke volume was lower in inconsistently graded patients (65 +/- 11 mL vs. consistently graded: 70 +/- 14 mL, P < 0.001). The criteria for the grading of aortic stenosis are inconsistent in patients with normal systolic LV function. On the basis of AVA, a higher proportion of patients is classified as having severe aortic valve stenosis compared with mean pressure gradient and peak flow velocity. Discrepant grading in these patients may be partly due to reduced stroke volume.

  15. Serum Uric Acid Correlation with Echocardiographic Indices in Children with Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Shahrokh Rajaei

    2009-12-01

    Full Text Available Background: Dilated cardiomyopathy (DCMP is a myocardial disease characterized by dilated left ventricle or both ventricles and reduced contractility of the myocardium. In patients suffering from DCMP, the serum level of uric acid may increase. This research was designed to evaluate the effect of the serum level of uric acid on systolic and diastolic functions in patients with DCMP.Methods: This case-control study was performed on 30 patients with DCMP aged between 1 month and 12 years who were consistent with a control group in terms of age and gender. Patients suffering from congenital and acquired cardiac, renal, metabolic, endocrine, musculoskeletal, neurologic, vascular, and hematologic diseases were excluded. After physical examination, chest X-ray, and electrocardiography, systolic and diastolic parameters were measured via echocardiography, and fasting serum uric acid level was measured. The data were analyzed using the t-test and Pearson correlation coefficient.Results: The average age of the patients in the case and control groups was 7.28 and 7.13 years, respectively. There were 15 boys, and the rest were girls. The serum uric acid level in the case and control groups was 6.22 and 3.31 mg/dl, respectively; the difference was statistically significant (P value <0.01. There was a significant correlation between serum uric acid level and left ventricular isovolumic contraction, interventricular septal diameter, left ventricular septal diameter in diastole, and fractional shortening (P value <0.05.Conclusion: In children with DCMP, the serum level of uric acid increases significantly and this increase is significantly correlated with some of left heart echocardiographic parameters. This test is of predictive value for disease progression.

  16. Echocardiographic Wall Motion Abnormality in Posterior Myocardial Infarction: The Diagnostic Value of Posterior Leads

    Directory of Open Access Journals (Sweden)

    A Darehzereshki

    2008-06-01

    Full Text Available Background: For the purpose of ascertaining myocardial infarction (MI and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9 was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.Results: Of a total 79 patients enrolled, 48 (60.8% were men, and the mean age was 57.35±8.22 years. Smoking (54.4% and diabetes (48% were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1% had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

  17. The effects of hormone replacement therapy on echocardiographic basic cardiac functions in postmenopausal women.

    Science.gov (United States)

    Taskin, O; Gökdeniz, R; Muderrisoglu, H; Korkmaz, M E; Uryan, I; Atmaca, R; Kafkasli, A

    1998-09-01

    This prospective study was designed to investigate the effects of hormone replacement therapy (HRT) on systolic and diastolic functions. Twenty-eight non-smoking, healthy postmenopausal women who had not received any kind of HRT for at least three years within the onset of menopause were included in the study. All patients received 0.625 mg conjugated oestrogens and 2.5 mg medroxyprogesterone acetate as daily HRT regimen. Their basic systolic and diastolic functions were investigated echocardiographically using standard positions and windows before and 6 months after initiation of HRT. The means of age, weight and length of postmenopausal period were 49.3 +/- 5.8 years, 63.5 +/- 8.7 kg and 46.3 +/- 7.1 months, respectively. Heart rate and systolic and diastolic pressures were similar during the pre- and post-treatment periods. After 6 months of HRT, the mean left ventricular end-systolic and end-diastolic volumes were decreased significantly (71.3 +/- 16.4 versus 56.3 +/- 22.8 ml, 144.5 +/- 26.1 versus 111.7 +/- 24.0 ml, respectively, P function was significant compared with the pretreatment period (E/A 0.90 +/- 0.2 versus 1.10 +/- 0.4, deceleration time 238 +/- 36.8 versus 201 +/- 24.2 ms, respectively, P < 0.05). Based on our preliminary results, we conclude that besides the known favourable effects on women's lives, HRT may also improve cardiac performance and age-related dysfunctions. The present results further suggest that oestrogens exert many direct effects on the cardiovascular system, other than the metabolic changes related to lipoproteins.

  18. Cardiac troponin I levels and its relation to echocardiographic findings in infants of diabetic mothers

    Directory of Open Access Journals (Sweden)

    Korraa Afaf

    2012-09-01

    Full Text Available Abstract Background Cardiomyopathy is noted in up to 40% of infants of diabetic mothers, and the exact mechanisms responsible for it are unknown. The aim of this study was to compare between infants of diabetic mothers (IDM and infants of non- diabetic mothers (INDM as regards cardiac troponin I (cTnI levels (as a marker of cardiac dysfunction and to examine the relationship between this marker and neonatal echocardiographic changes (cardiac structure and function. Methods A prospective, comparative study included eighty full term neonates during the first three days of life, during the period from April 2008 to June 2011. They were divided into 2 groups, group I: included 40 infants of diabetic mothers (IDMsand group II: included 40 infants of non diabetic healthy mothers as a control group. Results 37.5% of the IDMs were large for gestational age and demonstrated a significantly lower blood glucose level than the control group (34.6 ± 11.3mg/dl Vs 77.2 ± 19.8 mg/dl respectively , respiratory distress and cyanosis were the presenting signs in 67.5% of IDMs. Cardiac TnI on the second day of life increased significantly in infants of diabetic mothers in comparison to INDM (p (P-value = 0.002*. Cardiac TnI was significantly increased in IDMs with respiratory distress (P –value  Conclusions This study demonstrated a highly significant positive correlation between cTnI level on the second day of life and the left ventricular end diastolic diameter (LVED and interventricular septum diameter (IVSD. Cardiac troponin I (cTnI is a useful biochemical marker for monitoring myocardial injury in infants of diabetic mothers. An elevated cTnI concentration in infants of diabetic mothers with respiratory distress was a good predictor for hypertrophic cardiomyopathy and/or left ventricular dysfunction.

  19. Echocardiographic Evidence of Early Diastolic Dysfunction in Asymptomatic Children with Osteogenesis Imperfecta

    Directory of Open Access Journals (Sweden)

    Khalfan S. Al-Senaidi

    2015-11-01

    Full Text Available Objectives: Structural and functional cardiovascular abnormalities have been reported in adults with osteogenesis imperfecta (OI; however, there is a lack of paediatric literature on this topic. This study aimed to investigate cardiovascular abnormalities in children with OI in comparison to a control group. Methods: This case-control study was conducted at the Sultan Qaboos University Hospital in Muscat, Oman, between May 2013 and August 2014. Data from eight patients with OI and 24 healthy controls were compared using conventional and tissue Doppler echocardiography (TDE. Results: The OI group had significantly lower peak early mitral valve flow velocity (P = 0.027, peak a-wave reversal in the pulmonary vein (P = 0.030 and peak early diastolic velocity of the mitral valve and upper septum (P = 0.001 each. The peak late diastolic velocities of the mitral valve (P = 0.002 and the upper septum (P = 0.037 were significantly higher in the OI group; however, the peak early/late diastolic velocity ratios of the mitral valve (P = 0.002 and upper septum (P = 0.001 were significantly lower. Left ventricular dimensions and aortic and pulmonary artery diameters were larger in the OI group when indexed for body surface area. Both groups had normal systolic cardiac function. Conclusion: Children with OI had normal systolic cardiac function. However, changes in myocardial tissue Doppler velocities were suggestive of early diastolic cardiac dysfunction. They also had increased left ventricular dimensions and greater vessel diameters. These findings indicate the need for early and detailed structural and functional echocardiographic assessment and follow-up of young patients with OI.

  20. Development and Validation of a Teaching Module for Echocardiographic Scoring of Rheumatic Mitral Stenosis.

    Science.gov (United States)

    Stehouwer, Nathan; Okello, Emmy; Gupta, Vedant; Bailey, Alison L; Josephson, Richard; Madan Mohan, Sri Krishna; Osman, Mohammed N; Longenecker, Chris T

    2017-08-31

    The Wilkins score and commissural calcification scores predict outcomes after percutaneous balloon mitral valvuloplasty. However, many cardiologists are inadequately trained in their application-both in the United States where the incidence of rheumatic heart disease has fallen and in rheumatic heart disease endemic countries where training infrastructure is weak. This study sought to develop a computer-based educational module teaching 2 scoring systems for rheumatic mitral stenosis and to validate the module among cardiology fellows in the United States and Uganda. We developed a module organized into 3 sets of 10 echocardiograms each. The module was completed by 13 cardiology fellows from 2 academic centers in the United States and 1 in Uganda. Subject answers were compared with a score assigned by 2 experts in echocardiography. The primary outcome was change in subjects' accuracy from set 1 to set 3, measured by mean absolute deviation from expert scores. Secondary outcomes included change in interoperator variability and individual subject bias from set 1 to set 3. The mean absolute deviations from expert scores in sets 1 and 3 were 2.09 and 1.82 for the Wilkins score (possible score range 0 to 16) and 1.13 and 0.94 for the commissural calcification score (possible score range 0 to 4). The change from set 1 to set 3 was statistically significant only for 1 of the Wilkins component scores (leaflet calcification, p < 0.001.) No change was seen in the interoperator variability. Individual subject bias in assigning the total Wilkins score was reduced from set 1 to set 3. Use of this module has the potential to enhance the training of cardiologists in the echocardiographic assessment of mitral stenosis. Modified versions of this module or similar ones should be tested in targeted populations of cardiology trainees with the most exposure to mitral stenosis interventions. Copyright © 2017 World Heart Federation (Geneva). Published by Elsevier B.V. All rights

  1. Intramyocardial Dissecting Hematoma after Acute Myocardial Infarction-Echocardiographic Features and Clinical Outcome.

    Science.gov (United States)

    Zhao, Ying; He, Yi Hua; Liu, Wen Xu; Sun, Lin; Han, Jian Cheng; Man, Ting Ting; Gu, Xiao Yan; Chen, Zhuo; Wen, Zhao Ying; Henein, Michael Y

    2016-07-01

    Intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI) is a rare form of subacute cardiac rupture and hence management uncertainties. The objective of this study was to describe the clinical course of a small series of IDH patients and to review the available evidence for managing similar cases. Eight IDH patients from our center had echocardiographic, coronary angiographic and clinical outcome data reviewed. PubMed was also searched for IDH following MI. Cases were divided into three groups and compared according to the dissection location. In our 8 patients, 3 had septal, 1 right ventricular (RV), and 4 left ventricular (LV) dissection. Five were medically treated and 3 surgically repaired. Reviewing the literature revealed 68 IDH patients, of mean age 66 ± 10 years, 43 males. The percentage of IDH involving the LV free wall, septal, and RV free wall were 47%, 26.5%, and 26.5%, respectively. In the cohort as a whole, mortality was not different between surgically and medically treated patients (33.3% vs. 54.3%, P = 0.08), neither based on the IDH location (P = 0.49). While surgical and medical treatment of the LV free wall (20.0% vs. 40.9%, P = 0.25) and septal (46.2% vs. 60.0%, P = 0.60) were not different, surgical repair of RV free wall had significantly better survival (30.0% vs. 87.5%, P = 0.015). The LVEF (P = 0.82), mitral regurgitation (P = 0.49) failed to predict mortality. While survival following medical and surgical treatment of LV IDH is not different, patients with RV free wall dissection benefit significantly from surgical repair. © 2016, Wiley Periodicals, Inc.

  2. Haemodynamic effects of remifentanil in children with and without intravenous atropine. An echocardiographic study.

    Science.gov (United States)

    Chanavaz, C; Tirel, O; Wodey, E; Bansard, J Y; Senhadji, L; Robert, J C; Ecoffey, C

    2005-01-01

    Remifentanil is known to cause bradycardia and hypotension. We aimed to characterize the haemodynamic profile of remifentanil during sevoflurane anaesthesia in children with or without atropine. Forty children who required elective surgery received inhalational induction of anaesthesia using 8% sevoflurane. They were allocated randomly to receive either atropine, 20 microg kg(-1) (atropine group) or Ringer's lactate (control group) after 10 min of steady-state 1 MAC sevoflurane anaesthesia (baseline). Three minutes later (T0), all children received remifentanil 1 microg kg(-1) injected over a 60 s period, followed by an infusion of 0.25 microg kg(-1) min(-1) for 10 min then 0.5 microg kg(-1) min(-1) for 10 min. Haemodynamic variables and echocardiographic data were determined at baseline, T0, T5, T10, T15 and T20 min. Remifentanil caused a significant decrease in heart rate compared with the T0 value, which was greater at T20 than T10 in the two groups: however, the values at T10 and T20 were not significantly different from baseline in the atropine group. In comparison with T0, there was a significant fall in blood pressure in the two groups. Remifentanil caused a significant decrease in the cardiac index with or without atropine. Remifentanil did not cause variation in stroke volume (SV). In both groups, a significant increase in systemic vascular resistance occurred after administration of remifentanil. Contractility decreased significantly in the two groups, but this decrease remained moderate (between -2 and +2 sd). Remifentanil produced a fall in blood pressure and cardiac index, mainly as a result of a fall in heart rate. Although atropine was able to reduce the fall in heart rate, it did not completely prevent the reduction in cardiac index.

  3. AAIR versus DDDR pacing in patients with impaired sinus node chronotropy: an echocardiographic and cardiopulmonary study.

    Science.gov (United States)

    Vardas, P E; Simantirakis, E N; Parthenakis, F I; Chrysostomakis, S I; Skalidis, E I; Zuridakis, E G

    1997-07-01

    The aim of this study was to compare AAIR and DDDR pacing at rest and during exercise. We studied 15 patients (10 men, age 65 +/- 6 years) who had been paced for at least 3 months with activity sensor rate modulated dual chamber pacemakers. All had sick sinus syndrome (SSS) with impaired sinus node chronotropy. The patients underwent a resting echocardiographic evaluation of systolic and diastolic LV function at 60 beats/min during AAIR and DDDR pacing with an AV delay, which ensured complete ventricular activation capture. Cardiac output (CO) was also measured during pacing at 100 beats/min in both pacing modes. Subsequently, the oxygen consumption (VO2AT) and VO2AT pulse at the anaerobic threshold were measured during exercise in AAIR mode and in DDDR mode with an AV delay of 120 ms. The indices of diastolic function showed no significant differences between the two pacing modes, except for patients with a stimulus-R interval > 220 ms, for whom the time velocity integral of LV filling and LV inflow time were significantly lower under AAI than under DDD pacing. At 60 beats/min, CO was higher under AAI than under DDD mode only when the stimulus-R interval was below 220 ms. For stimulus-R intervals longer than 220 ms, and also during pacing at 100 beats/min, the CO was higher in DDD mode. The stimulus-R interval decreased in all patients during exercise. The time to anaerobic threshold, VO2AT, and VO2AT pulse showed no significant differences between the two pacing modes. Our results indicate that, at rest, although AAIR pacing does not improve diastolic function in patients with SSS, it maintains a higher CO than does DDDR pacing in cases where the stimulus-R interval is not excessively prolonged. On exertion, the two pacing modes appear to be equally effective, at least in cases where the stimulus-R interval decreases in AAIR mode.

  4. Echocardiographic Follow-Up of Patent Foramen Ovale and the Factors Affecting Spontaneous Closure.

    Science.gov (United States)

    Yildirim, Ali; Aydin, Alperen; Demir, Tevfik; Aydin, Fatma; Ucar, Birsen; Kilic, Zubeyir

    2016-11-01

    The aim of the present study was to evaluate the echocardiographic follow-up of patent foramen ovale, which is considered a potential etiological factor in various diseases, and to determine the factors affecting spontaneous closure. Between January 2000 and June 2012, records of 918 patients with patent foramen ovale were retrospectively reviewed. Patency of less than 3 mm around the fossa ovalis is called patent foramen ovale. Patients with cyanotic congenital heart diseases, severe heart valve disorders and severe hemodynamic left to right shunts were excluded from the study. The patients were divided into three groups based on age; 1 day-1 month in group 1, 1 month-12 months in group 2, and more than 12 months in group 3. Of the 918 patients, 564 (61.4%) had spontaneous closure, 328 (35.8%) had patent foramen ovale continued, 15 (1.6%) patients had patent foramen ovale enlarged to 3-5 mm, 6 patients were enlarged to 5-8 mm, and in one patient patent foramen ovale reached to more than 8 mm size. Defect was spontaneously closed in 65.9% of the patients in group 1, 66.7% of the patients in group 2, and 52.3% of the patients in group 3. There was a negative correlation between the age of diagnosis and spontaneous closure (p Gender, prematurity and coexisting malformations such as patent ductus arteriosus and atrial septal aneurysm did not have any effect on spontaneous closure of patent foramen ovale (p > 0.05). However, ventricular septal defect and spontaneous closure of patent foramen ovale had a positive correlation (p patent foramen ovale is high. Furthermore, a positive correlation was found between spontaneous closure of patent foramen ovale with early diagnosis and small defect size.

  5. Evaluation of Cardiovascular System in Fibromyalgia Syndrome: Tissue Doppler Echocardiographic Investigation

    Directory of Open Access Journals (Sweden)

    Selma YAZICI

    2010-05-01

    Full Text Available Aim: We aim to investigate besides the cardiac structures and functions by both conventionalmethods and Tissue Doppler Echocardiography (TDE which is a new and useful method inpatients with Fibromyalgia (FM. Additionally, we evaluated QT parameters (QT maximum,QT minimum and QT dispertion with the use of electrocardiography in order to measure theautonomic dysfunction which is a possible mechanism in the pathogenesis of the disease. Methods: The study was performed on 42 patients (mean age 41 years, 38 female and 38completely healthy subjects (35 female, mean age of 42 years who were admitted to the sameclinic were collected as the control group. All the individuals were undergone a completephysical examination, electrocardiography (recordings were displayed at 50 mm/s speed andechocardiography evaluation (both conventional methods and TDE.Results: Analysis of electrocardiographic recordings revealed mildly increased mean QTdispertion in the patient group, but this difference was statistically insignificant. Analysis ofconventional echocardiographic parameters revealed similar results between the patient groupand the control cases. However, an important finding of this study is that significant diastolicdysfunction was found in the patient group which was recorded with the TDE technique. Emwave velocity and Em/Am ratios were significantly lower in patients with FM compared withcontrols (p<0.005, p<0.01, respectively. Sm and Am waves velocities were similar in bothgroups. Conclusion: In this study, significant left ventricular diastolic dysfunction which was detectedby TDE technique can partly explain several symptoms such as fatigue and dyspnea in FM. Inaddition, fully cardiac evaluation of patients with FM might be obtained supporting findingsthe autonomic dysfunction theory in fibromyalgia pathogenesis.

  6. Right Ventricular Dysfunction as an Echocardiographic Measure of Acute Rejection Following Heart Transplantation in Children.

    Science.gov (United States)

    Aggarwal, Sanjeev; Blake, Jennifer; Sehgal, Swati

    2017-03-01

    Noninvasive biomarkers of acute allograft rejection (AAR) following orthotopic heart transplantation (OHT) are needed. The aim of this study was to investigate the accuracy of echocardiographic (ECHO) right ventricular (RV) global functional and resistance indices in the detection of AAR. This retrospective chart review included children with biopsy-proven AAR (grade ≥ 2R cellular or CD4 + antibody-mediated rejection) following OHT and an ECHO within 12 h of the biopsy. ECHO measures: (a) ratio of systolic to diastolic duration (S/D), (b) RV myocardial performance index (MPI) and (c) tricuspid regurgitant gradient to RV outflow tract velocity time integral ratio (TRG/VTI), were derived at baseline, during AAR and at two follow-ups. Sixteen patients [56% male, mean (SD) age at OHT 3.5 (4.3) years] had 16 AAR episodes. S/D (1.15 vs. 1.60, p < 0.01), RV MPI (0.19 vs. 0.39, p < 0.01) and TRG/VTI (1.05 vs. 1.7, p = 0.01) deteriorated during AAR and, except for diastolic duration, improved significantly at first follow-up. The negative predictive values for S/D, RV MPI and TRG/VTI at cutoffs of 1.3, 0.31 and 1.3 were 97, 97 and 87%, respectively. RV S/D, MPI and TRG/VTI deteriorated during AAR. Their excellent negative predictive values suggest that their incorporation in surveillance may obviate the need for routine biopsies.

  7. Trans fats: What physicians should know

    OpenAIRE

    Marchand, V

    2010-01-01

    Hydrogenation of fat products is used in the food industry to extend their shelf life. Trans fats are the result of partial hydrogenation of unsaturated fat. Trans fats increase low-density lipoprotein cholesterol and decrease high-density lipoprotein cholesterol, thus increasing the risk of cardiovascular disease. Canadians have one of the highest dietary intake of trans fat in the world. Health Canada has made recommendations to decrease the trans fat intake of Canadians. Physicians should ...

  8. Coronary microembolization with normal epicardial coronary arteries and no visible infarcts on nitrobluetetrazolium chloride-stained specimens: Evaluation with cardiac magnetic resonance imaging in a swine model

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Hang; Yun, Hong; Zeng, Meng Su [Dept. of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai (China); Ma, Jian Ying; Chen, Zhang Wei; Chang, Shu Fu [Dept. of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai (China)

    2016-02-15

    To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. Eleven pigs underwent intracoronary injection of small-sized microspheres (42 µm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 ± 2.0% at baseline to 20.3 ± 2.3% at 6 hours and 31.5 ± 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.

  9. Epicardial delivery of VEGF and cardiac stem cells guided by 3-dimensional PLLA mat enhancing cardiac regeneration and angiogenesis in acute myocardial infarction.

    Science.gov (United States)

    Chung, Hye-Jin; Kim, Jong-Tae; Kim, Hee-Jung; Kyung, Hei-Won; Katila, Pramila; Lee, Jeong-Han; Yang, Tae-Hyun; Yang, Young-Il; Lee, Seung-Jin

    2015-05-10

    Congestive heart failure is mostly resulted in a consequence of the limited myocardial regeneration capacity after acute myocardial infarction. Targeted delivery of proangiogenic factors and/or stem cells to the ischemic myocardium is a promising strategy for enhancing their local and sustained therapeutic effects. Herein, we designed an epicardial delivery system of vascular endothelial growth factor (VEGF) and cardiac stem cells (CSCs) using poly(l-lactic acid) (PLLA) mat applied to the acutely infarcted myocardium. The fibrous VEGF-loaded PLLA mat was fabricated by an electrospinning method using PLLA solution emulsified VEGF. This mat not only allowed for sustained release of VEGF for 4weeks but boosted migration and proliferation of both endothelial cells and CSCs in vitro. Furthermore, sustained release of VEGF showed a positive effect on in vitro capillary-like network formation of endothelial cells compared with bolus treatment of VEGF. PLLA mat provided a permissive 3-dimensional (3D) substratum that led to spontaneous cardiomyogenic differentiation of CSCs in vitro. Notably, sustained stimulation by VEGF-loaded PLLA mat resulted in a substantial increase in the expression of proangiogenic mRNAs of CSCs in vitro. The epicardially implanted VEGF-loaded PLLA mat showed modest effects on angiogenesis and cardiomyogenesis in the acutely infarcted hearts. However, co-implantation of VEGF and CSCs using the PLLA mat showed meaningful therapeutic effects on angiogenesis and cardiomyogenesis compared with controls, leading to reduced cardiac remodeling and enhanced global cardiac function. Collectively, the PLLA mat allowed a smart cargo that enabled the sustained release of VEGF and the delivery of CSCs, thereby synergistically inducing angiogenesis and cardiomyogenesis in acute myocardial infarction. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia.

    Science.gov (United States)

    Dyrda, Katia; Piers, Sebastiaan R D; van Huls van Taxis, Carine F; Schalij, Martin J; Zeppenfeld, Katja

    2014-08-01

    This study evaluates the influence of 3 therapeutic approaches on the incidence of pericarditis and atrial fibrillation (AF) after percutaneous epicardial mapping and ablation for ventricular tachycardia. Eighty-five consecutive procedures (2006-2011) were retrospectively reviewed. After the first 17 procedures (20.0%), no steroids were administered. For the subsequent 30 procedures (35.3%), systemic steroids were administered intravenously or orally, whereas the last 38 procedures (44.7%) were followed by intrapericardial steroid injection. Compared with no steroids, the incidence of pericarditic chest pain was significantly reduced by intrapericardial steroids (58.8% versus 21.1%; P=0.006) but not by intravenous or oral steroids (58.8% versus 43.4%; P=0.31). There was no significant difference in the incidence of pericarditic ECG with steroids (36.8%, 30.0%, and 41.2% for intrapericardial, intravenous or oral, and none, respectively). There was a nonsignificant reduced incidence of chest pain with ECG changes with steroids (13.2%, 10.0%, and 29.4% for intrapericardial, intravenous or oral, and none, respectively). Radiofrequency applications (65.9% of procedures) did not affect the incidence of pericarditic ECG changes, pericarditic chest pain, or pericarditis (all P>0.05). In 7 (8.3%) patients with no prior history of AF, AF was documented a median 36 hours after procedure. Patients with pericarditic ECG tended to be at greater risk of AF (16.7 versus 3.6%; P=0.091). There is a high incidence of pericarditic chest pain and ECG changes after epicardial ventricular tachycardia mapping and ablation. Pericarditic chest pain is significantly decreased by intrapericardial steroids. Procedure-related AF is relatively frequent and tends to occur more commonly with pericarditic ECG changes. © 2014 American Heart Association, Inc.

  11. Magnetic resonance imaging of autologous fat grafting

    Energy Technology Data Exchange (ETDEWEB)

    Goehde, Susanne C.; Kuehl, Hilmar; Ladd, Mark E. [University Hospital Essen, Department of Diagnostic and Interventional Radiology, Essen (Germany)

    2005-12-01

    A 30-year-old female patient with isolated facial lipodystrophy underwent two sessions of fat injection. MR signals of injected fat at different injection ages were compared to native fat. Native T1 signal was smaller for transplant fat, probably due to a slightly lower fat content and/or fibrosis or due to higher perfusion. T2 signal of transplants was significantly higher than that of native fat. T1 post-contrast was also higher, and contrast uptake of transplanted fat increased slightly with transplant age, which could be explained by an increasing perfusion. This study demonstrates the differences and MR signal time changes of native and transplanted fat. (orig.)

  12. Mesotherapy for local fat reduction.

    Science.gov (United States)

    Jayasinghe, S; Guillot, T; Bissoon, L; Greenway, F

    2013-10-01

    Mesotherapy, which is the injection of substances locally into mesodermally derived subcutaneous tissue, developed from empirical observations of a French physician in the 1950s. Although popular in Europe for many medical purposes, it is used for local cosmetic fat reduction in the United States. This paper reviews manuscripts indexed in PubMed/MEDLINE under 'mesotherapy', which pertains to local fat reduction. The history of lipolytic mesotherapy, the physiology of body fat distribution, the mechanism of action of different lipolytic stimulators and their increased efficacy in combination are reviewed. Mesotherapy falls into two categories. Lipolytic mesotherapy using lipolytic stimulators requires more frequent treatments as the fat cells are not destroyed and can refill over time. Ablative mesotherapy destroys fat cells with a detergent, causes inflammation and scarring from the fat necrosis, but requires fewer treatments. The historic and empiric mixing of sodium channel blocking local anaesthetics in mesotherapy solutions inhibits the intended lipolysis. Major mesotherapy safety concerns include injection site infections from poor sterile technique. Cosmetic mesotherapy directs the area from which fat is lost to improve self-image. Studies were of relatively small number, many with limited sample sizes. Future research should be directed towards achieving a Food and Drug Administration indication rather than continuing expansion of off-label use. © 2013 The Authors. obesity reviews © 2013 International Association for the Study of Obesity.

  13. Association of body mass index and visceral fat with aortic valve calcification and mortality after transcatheter aortic valve replacement: the obesity paradox in severe aortic stenosis

    Directory of Open Access Journals (Sweden)

    Jennifer Mancio

    2017-10-01

    Full Text Available Abstract Background Previous studies showed that metabolic syndrome is associated with aortic valve calcification (AVC and poor outcomes in aortic stenosis (AS. However, if these associations change and how body fat impacts the prognosis of patients in late stage of the disease have been not yet explored. Aims To determine the association of body mass index (BMI and visceral fat with AVC and mortality after transcatheter aortic valve replacement (TAVR. Methods This was a prospective cohort of 170 severe AS patients referred to TAVR. We quantified AVC mass score and fat depots including epicardial adipose tissue, intrathoracic fat, and abdominal visceral (VAF and subcutaneous fats by computed tomography. Fat depots were indexed to body surface area. All-cause and cardiovascular-related deaths after TAVR were recorded over a median follow-up of 1.2 years. Results Higher AVC mass was independently associated with low BMI and low VAF. All-cause mortality risk increased with the decrease of BMI and increment of VAF. A stratified analysis by obesity showed that in non-obese, VAF was inversely associated with mortality, whereas in obese, high VAF was associated with higher mortality (p value for interaction < 0.05. At long-term, hazard ratio [HR] with non-obese/low VAF was 2.3 (95% confidence interval [CI] 1.1–4.9; p = 0.021 and HR with obese/high VAF was 2.5 (95% CI 1.1–5.8; p = 0.031 compared with obese/low VAF patients. Conclusions In AS patients submitted to TAVR, BMI and VAF were inversely associated with AVC. Pre-intervention assessment of VAF by computed tomography may provide a better discrimination of mortality than BMI alone.

  14. Determination of Fat Content

    Science.gov (United States)

    Carpenter, Charles

    The term "lipid" refers to a group of compounds that are sparingly soluble in water, but show variable solubility in a number of organic solvents (e.g., ethyl ether, petroleum ether, acetone, ethanol, methanol, benzene). The lipid content of a food determined by extraction with one solvent may be quite different from the lipid content as determined with another solvent of different polarity. Fat content is determined often by solvent extraction methods (e.g., Soxhlet, Goldfish, Mojonnier), but it also can be determined by nonsolvent wet extraction methods (e.g., Babcock, Gerber), and by instrumental methods that rely on the physical and chemical properties of lipids (e.g., infrared, density, X-ray absorption). The method of choice depends on a variety of factors, including the nature of the sample (e.g., dry versus moist), the purpose of the analysis (e.g., official nutrition labeling or rapid quality control), and instrumentation available (e.g., Babcock uses simple glassware and equipment; infrared requires an expensive instrument).

  15. Interobserver agreement on the echocardiographic parameters that estimate right ventricular systolic function in the early postoperative period of cardiac surgery.

    Science.gov (United States)

    Olmos-Temois, S G; Santos-Martínez, L E; Álvarez-Álvarez, R; Gutiérrez-Delgado, L G; Baranda-Tovar, F M

    2016-11-01

    To know the variability of transthoracic echocardiographic parameters that assess right ventricular systolic function by analyzing interobserver agreement in the early postoperative period of cardiovascular surgery. To assess the feasibility of these echocardiographic measurements. A cross-sectional study, double-blind pilot study was carried out from May 2011 to February 2013. Cardiovascular postoperative critical care at the National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico. Consecutive, non-probabilistic sampling. Fifty-six patients were studied in the postoperative period of cardiac surgery. The first echocardiographic parameters were obtained between 6-8hours after cardiac surgery, followed by blinded second measurements. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity on tissue Doppler imaging (VSPAT), diameters and right ventricular outflow area, tract fractional shortening. The agreement was analyzed by the Bland-Altman method, and its magnitude was assessed by the intraclass correlation coefficient (95% confidence interval). Both observers evaluated TAPSE and VSPAT in 48 patients (92%). The average TAPSE was 11.68±4.53mm (range 4-27mm). Right ventricular systolic dysfunction was observed in 41 cases (85%) and normal TAPSE in 7 patients (15%). The average difference and its limits according to TAPSE were -0.917±2.95 (-6.821, 4.988), with a magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic velocity on tissue Doppler imaging was -0.001±0.015 (-0.031, 0.030), and its magnitude 0.825 (0.708, 0.898), respectively. VSPAT and TAPSE were estimated by both observers in 92% of the patients, these parameters exhibiting the lowest interobserver variability. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  16. Echocardiographic assessment of long-term hemodynamic characteristics of mechanical mitral valve prostheses with different mitral valvular diseases.

    Science.gov (United States)

    Zhu, Xiliang; Li, Qian; Tang, Hong; Xiao, Xijun

    2017-03-01

    Mitral stenosis (MS) and mitral insufficiency (MI) have different pre-operative hemodynamic characteristics. However, it is unclear if there are differences in long-term echocardiographic characteristics of MS and MI patients after mechanical mitral valve replacement. This study is to compare long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients. From January 2003 to January 2009, a total of 199 consecutive patients were recruited in this study. Patients were classified as group MS (n = 123) and MI (n = 76) according to the manifestation of mitral valvular disease. The mean age for patients was 50.1 ± 10.5 years and follow-up time was 7.2 ± 2.0 years. The MS after operation were more likely to experience atrial fibrillation (p = 0.002). The New York Heart Association (NYHA) class in MI showed a greater improvement (p = 0.006) than in MS. The left ventricular end-diastolic dimension (LVEDD) (p = 0.010) and stroke volume (SV) (p = 0.000) in MI were still larger than that in MS patients. These differences did not disappear with time after operation. The long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients are significantly different. Over a long-term follow up, MI patients still have a larger LVEDD and SV than MS, and associated with a greater improvement of NYHA class.

  17. Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin.

    Science.gov (United States)

    Vinereanu, Dragos; Lopes, Renato D; Mulder, Hillary; Gersh, Bernard J; Hanna, Michael; de Barros E Silva, Pedro G M; Atar, Dan; Wallentin, Lars; Granger, Christopher B; Alexander, John H

    2017-12-01

    Few data exist on the long-term outcomes of patients with spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA) thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation receiving oral anticoagulation. We explored the relationship between these 3 echocardiographic findings and clinical outcomes, and the comparative efficacy and safety of apixaban and warfarin for each finding. Patients from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either transthoracic or transesophageal echocardiography were compared with patients with none of these findings on transesophageal echocardiography. A total of 1251 patients were included: 217 had SEC, 127 had LA/LAA thrombus, 241 had CAP, and 746 had none. The rates of stroke/systemic embolism were not significantly different among patients with and without these echocardiographic findings (hazard ratio, 0.96; 95% confidence interval, 0.25-3.60 for SEC; hazard ratio, 1.27; 95% confidence interval, 0.23-6.86 for LA/LAA thrombus; hazard ratio, 2.21; 95% confidence interval, 0.71-6.85 for CAP). Rates of ischemic stroke, myocardial infarction, cardiovascular death, and all-cause death were also not different between patients with and without these findings. For patients with either SEC or CAP, there was no evidence of a differential effect of apixaban over warfarin. For patients with LA/LAA thrombus, there was also no significant interaction, with the exception of all-cause death and any bleeding where there was a greater benefit of apixaban compared with warfarin among patients with no LA/LAA thrombus. In anticoagulated patients with atrial fibrillation and risk factors for stroke, echocardiographic findings do not seem to add to the risk of thromboembolic events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984. © 2017 American Heart Association, Inc.

  18. Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Techniques.

    Science.gov (United States)

    Karamnov, Sergey; Burbano-Vera, Nelson; Huang, Chuan-Chin; Fox, John A; Shernan, Stanton K

    2017-09-01

    A comprehensive evaluation of mitral stenosis (MS) severity commonly utilizes two-dimensional (2D) echocardiography techniques. However, the complex three-dimensional (3D) structure of the mitral valve (MV) poses challenges to accurate measurements of its orifice area by 2D imaging modalities. We aimed to assess MS severity by comparing measurements of the MV orifice area using conventional echocardiography methods to 3D orifice area (3DOA), a novel echocardiographic technique which minimizes geometric assumptions. Routine 2D and 3D intraoperative transesophageal echocardiographic images from 26 adult cardiac surgery patients with at least moderate rheumatic MS were retrospectively reviewed. Measurements of the MV orifice area obtained by pressure half-time (PHT), proximal isovelocity surface area (PISA), continuity equation, and 3D planimetry were compared to those acquired using 3DOA. MV areas derived by PHT, PISA, continuity equation, 3D planimetry, and 3DOA (mean value ± standard deviation) were 1.12 ± 0.27, 1.03 ± 0.27, 1.16 ± 0.35, 0.97 ± 0.25, and 0.76 ± 0.21 cm, respectively. Areas obtained from the 3DOA method were significantly smaller than areas derived from PHT (mean difference 0.35 cm, P PISA (mean difference: 0.28 cm, P = .0002), continuity equation (mean difference: 0.43 cm, P = .0015), and 3D planimetry (mean difference: 0.19 cm, P PISA (42%, P = .01), and continuity equation (39%, P = .017) but not in comparison to 3D planimetry (62%, P = .165). Novel measures of the stenotic MV 3DOA in patients with rheumatic heart disease are significantly smaller than calculated values obtained by conventional methods and may be consistent with a higher incidence of severe MS compared to 2D techniques. Further investigation is warranted to determine the clinical relevance of 3D echocardiographic techniques used to measure MV area.

  19. Reference intervals for the echocardiographic measurements of the right heart in children and adolescents: a systematic review.

    Science.gov (United States)

    Lemmer Hunsinger, Carolina E; Engel, Mark E; Stanfliet, John C; Mayosi, Bongani M

    2014-01-29

    Transthoracic echocardiography is the primary imaging modality for the diagnosis of right ventricular (RV) involvement in congenital and acquired heart diseases. There is increasing recognition of the contribution of RV dysfunction in heart diseases affecting children and adolescents, but there is insufficient information on reference intervals for the echocardiographic measurements of the right heart in children and adolescents that represent all the continental populations of the world. The aim of this systematic review was to collate, from published studies, normative data for echocardiographic evaluation of the right heart in children and adolescents, and to identify gaps in knowledge in this field especially with respect to sub-Saharan Africans. We performed a systematic literature search to identify studies of reference intervals for right heart measurements as determined by transthoracic echocardiography in healthy children and adolescents of school-going age. Articles were retrieved from electronic databases with a combination of search terms from the earliest date available until May 2013. Reference data were available for a broad range of variables. Fifty one studies out of 3096 publications were included. The sample sizes of the reference populations ranged from 13 to 2036 with ages varying from 5 to 21 years. We identified areas lacking sufficient reference data. These included reference data for determining right atrial size, tricuspid valve area, RV dimensions and areas, the RV % fractional area change, pulmonary artery pressure gradients and the right-sided haemodynamics, including the inferior vena cava dimensions and collapsibility. There were no data for sub-Saharan African children and adolescents. Reliable reference data are lacking for important echocardiographic measurements of the RV in children and adolescents, especially for sub-Saharan Africans.

  20. Dietary Fats and Metabolic Syndrome

    OpenAIRE

    Danijela Ristic-Medic

    2013-01-01

    The quantity and quality of fats consumed in the diet can have important effects on prevention and/or improvement clustering metabolic abnormalities of the metabolic syndrome. Fatty acids as food ingredients regulate cholesterol homeostasis and concentrations of blood lipoproteins, and affect the levels of other cardiometabolic risk factors, such as blood pressure, haemostasis, and body weight, through various mechanisms. There is convincing evidence that exchanging dietary saturated fat with...