WorldWideScience

Sample records for left ventricular lv

  1. The Natural History of Left Ventricular Geometry in the Community: Clinical Correlates and Prognostic Significance of Change in LV Geometric Pattern

    Science.gov (United States)

    Lieb, Wolfgang; Gona, Philimon; Larson, Martin G.; Aragam, Jayashri; Zile, Michael R.; Cheng, Susan; Benjamin, Emelia J.; Vasan, Ramachandran S.

    2014-01-01

    Objectives We evaluated pattern and clinical correlates of change in left ventricular (LV) geometry over a 4-year period in the community; we also assessed whether the pattern of change in LV geometry over 4 years predicts incident cardiovascular disease (CVD), including myocardial infarction, heart failure and cardiovascular death during an additional subsequent follow-up period. Background It is unclear how LV geometric patterns change over time and whether changes in LV geometry have prognostic significance. Methods We evaluated 4492 observations (2604 unique Framingham Study participants attending consecutive examinations) to categorize LV geometry at baseline and after 4 years. Four groups were defined based on the sex-specific distributions of LV mass (LVM) and relative wall thickness (RWT) (normal: LVM and RWTgeometric pattern over 4 years was associated with increased CVD risk (140 events) during a subsequent median follow-up of 12.0 years (adjusted-hazards ratio, 1.59; 95%CI, 1.04–2.43). Conclusions Our longitudinal observations in the community suggest that dynamic changes in LV geometric pattern over time are common. Higher blood pressure and greater BMI are modifiable factors associated with the development of abnormal LV geometry, and such progression portends an adverse prognosis. PMID:25129518

  2. Left ventricular apical diseases.

    Science.gov (United States)

    Cisneros, Silvia; Duarte, Ricardo; Fernandez-Perez, Gabriel C; Castellon, Daniel; Calatayud, Julia; Lecumberri, Iñigo; Larrazabal, Eneritz; Ruiz, Berta Irene

    2011-08-01

    There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users.

  3. Diastolic Left Ventricular Dysfunction : A Clinical Appraisal

    NARCIS (Netherlands)

    Bronzwaer, J.G.F.

    2003-01-01

    Diastolic left ventricular (LV) distensibility is determined by the material properties of the LV wall and by LV geometry (i.e., LV shape, LV volume and LV wall thickness). These material properties are influenced both by the physical structure of the LV myocardium and by the dynamic process of myoc

  4. Diastolic Left Ventricular Dysfunction : A Clinical Appraisal

    NARCIS (Netherlands)

    Bronzwaer, J.G.F.

    2003-01-01

    Diastolic left ventricular (LV) distensibility is determined by the material properties of the LV wall and by LV geometry (i.e., LV shape, LV volume and LV wall thickness). These material properties are influenced both by the physical structure of the LV myocardium and by the dynamic process of

  5. Diastolic Left Ventricular Dysfunction : A Clinical Appraisal

    OpenAIRE

    Bronzwaer, J.G.F.

    2003-01-01

    Diastolic left ventricular (LV) distensibility is determined by the material properties of the LV wall and by LV geometry (i.e., LV shape, LV volume and LV wall thickness). These material properties are influenced both by the physical structure of the LV myocardium and by the dynamic process of myocardial relaxation. The material properties of the myocardium dictate the strain that follows a given stress, and determine position and shape of the myocardial stress-strain relationship. The mater...

  6. Automated left ventricular capture management.

    Science.gov (United States)

    Crossley, George H; Mead, Hardwin; Kleckner, Karen; Sheldon, Todd; Davenport, Lynn; Harsch, Manya R; Parikh, Purvee; Ramza, Brian; Fishel, Robert; Bailey, J Russell

    2007-10-01

    The stimulation thresholds of left ventricular (LV) leads tend to be less reliable than conventional leads. Cardiac resynchronization therapy (CRT) requires continuous capture of both ventricles. The purpose of this study is to evaluate a novel algorithm for the automatic measurement of the stimulation threshold of LV leads in cardiac resynchronization systems. We enrolled 134 patients from 18 centers who had existing CRT-D systems. Software capable of automatically executing LV threshold measurements was downloaded into the random access memory (RAM) of the device. The threshold was measured by pacing in the left ventricle and analyzing the interventricular conduction sensed in the right ventricle. Automatic LV threshold measurements were collected and compared with manual LV threshold tests at each follow-up visit and using a Holter monitor system that recorded both the surface electrocardiograph (ECG) and continuous telemetry from the device. The proportion of Left Ventricular Capture Management (LVCM) in-office threshold tests within one programming step of the manual threshold test was 99.7% (306/307) with a two-sided 95% confidence interval of (98.2%, 100.0%). The algorithm measured the threshold successfully in 96% and 97% of patients after 1 and 3 months respectively. Holter monitor analysis in a subset of patients revealed accurate performance of the algorithm. This study demonstrated that the LVCM algorithm is safe, accurate, and highly reliable. LVCM worked with different types of leads and different lead locations. LVCM was demonstrated to be clinically equivalent to the manual LV threshold test. LVCM offers automatic measurement, output adaptation, and trends of the LV threshold and should result in improved ability to maintain LV capture without sacrificing device longevity.

  7. Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes

    DEFF Research Database (Denmark)

    Flethøj, M.; Schwarzwald, C. C.; Haugaard, M. M.;

    2016-01-01

    Background: Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown. Objectives :To investigate the effects of prolonged exercise on LV systolic...

  8. Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study). Losartan Intervention For Endpoint

    DEFF Research Database (Denmark)

    Wachtell, K; Smith, G; Gerdts, E;

    2000-01-01

    Abnormal left ventricular (LV) filling may exist in early stages of hypertension. Whether this finding is related to LV hypertrophy is currently controversial. This study was undertaken to assess relations between abnormal diastolic LV filling and LV geometry in a large series of hypertensive pat...

  9. Congenital left ventricular aneurysm coexisting with left ventricular non-compaction in a newborn.

    Science.gov (United States)

    Ootani, Katsuki; Shimada, Jun; Kitagawa, Yosuke; Konno, Yuki; Miura, Fumitake; Takahashi, Toru; Ito, Etsuro; Ichinose, Kouta; Yonesaka, Susumu

    2014-10-01

    Described herein is the case of a rare combination of congenital left ventricular (LV) aneurysm and left ventricular non-compaction (LVNC) in a newborn. The patient developed refractory heart failure soon after birth and died at 5 months of age. The etiology of both congenital LV aneurysm and LVNC seems to be maldevelopment of the ventricular myocardium during early fetal life. Treatment should be individually tailored depending on clinical severity, and treatment options are limited. Given that this combination of congenital LV aneurysm and LVNC is significantly associated with poor prognosis, it appears that patients with congenital LV aneurysm and LVNC are candidates for early, aggressive intervention, including surgical aneurysmectomy and evaluation for transplantation. It is important to be aware of this combination of congenital LV aneurysm and LVNC, and to make earlier decisions on therapeutic strategy.

  10. Left Ventricular Hypertrophy

    Science.gov (United States)

    ... the chamber itself also increases. The enlarged heart muscle loses elasticity and eventually may fail to pump with as much force as needed. Left ventricular hypertrophy is more common in people who have uncontrolled ...

  11. Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS

    Energy Technology Data Exchange (ETDEWEB)

    AlJaroudi, Wael [Imaging Institute, Heart and Vascular, Cleveland, OH (United States); Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH (United States); Alraies, M.C. [Cleveland Clinic, Department of Hospital Medicine, Cleveland, OH (United States); Hachamovitch, Rory; Jaber, Wael A.; Brunken, Richard; Cerqueira, Manuel D.; Marwick, Thomas [Imaging Institute, Heart and Vascular, Cleveland, OH (United States)

    2012-10-15

    LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization. Stress and rest {sup 82}Rb gated PET were performed in 486 consecutive patients (66 {+-} 11 years of age, 82 % men, LV ejection fraction 26 {+-} 6 %) with ischemic cardiomyopathy and QRS <120 ms. LVMD was determined as the standard deviation (SD) of the regional time to minimum volume on phase analysis of the gated PET scan. A propensity score was determined to adjust for nonrandomized referral after imaging to coronary artery bypass grafting (CABG). In a Cox proportional hazards model used to determine the association between measures of LVMD and survival time, CABG was included as a time-dependent covariate and the use of an implantable cardiac defibrillator (ICD) after imaging was modeled as a stratification factor. Over 1.9 {+-} 1.4 years, 96 patients (20 %) underwent CABG and 108 (22 %) died. LVMD was a predictor of mortality (HR 1.16. 95 % CI 1.03;1.30, per 10 increase in phase SD, p = 0.02) after adjusting for baseline covariates, prior ICD use, the use of postimaging CABG, and other imaging data. There was a significant interaction between phase SD and CABG. Nested Cox models showed that LVMD carried prognostic information incremental to clinical variables, ejection fraction and CABG. LVMD is an independent predictor of all-cause mortality in ischemic cardiomyopathy, and may identify patients with a differential survival benefit from CABG versus medical therapy. (orig.)

  12. Left ventricular wall stress compendium.

    Science.gov (United States)

    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  13. Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Assessed by Echocardiography Predicts Adverse Clinical Outcome

    NARCIS (Netherlands)

    Mast, Thomas P.; Teske, Arco J.; van der Heijden, Jeroen F.; Groeneweg, Judith A.; Te Riele, Anneline S J M; Velthuis, Birgitta K.; Hauer, RNW; Doevendans, Pieter A.; Cramer, Maarten J.

    2015-01-01

    Background Among studies describing the phenotype of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), significant discrepancy exists regarding the extent and impact of left ventricular (LV) involvement. The capability of conventional and new quantitative echocardiographic techniqu

  14. Echocardiographic evaluation of left ventricular function in ischemic heart disease

    NARCIS (Netherlands)

    Mollema, Sjoerd Adriaan

    2010-01-01

    The presence of a decreased left ventricular (LV) function after myocardial infarction has demonstrated to be of considerable clinical importance. In this thesis, the role of 2D echocardiography to evaluate LV function in ischemic heart disease was investigated. In the first part of the thesis, rece

  15. Echocardiographic evaluation of left ventricular function in ischemic heart disease

    NARCIS (Netherlands)

    Mollema, Sjoerd Adriaan

    2010-01-01

    The presence of a decreased left ventricular (LV) function after myocardial infarction has demonstrated to be of considerable clinical importance. In this thesis, the role of 2D echocardiography to evaluate LV function in ischemic heart disease was investigated. In the first part of the thesis,

  16. Prevalence and factors associated with left ventricular dysfunction in the EULAR Scleroderma Trial and Research group (EUSTAR) database of patients with systemic sclerosis

    DEFF Research Database (Denmark)

    Allanore, Y; Meune, C; Vonk, M C

    2010-01-01

    To measure the prevalence of, and factors associated with, left ventricular (LV) dysfunction in systemic sclerosis (SSc).......To measure the prevalence of, and factors associated with, left ventricular (LV) dysfunction in systemic sclerosis (SSc)....

  17. [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.

  18. Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non-compaction.

    Science.gov (United States)

    Jacquier, Alexis; Thuny, Franck; Jop, Bertrand; Giorgi, Roch; Cohen, Frederic; Gaubert, Jean-Yves; Vidal, Vincent; Bartoli, Jean Michel; Habib, Gilbert; Moulin, Guy

    2010-05-01

    To describe a method for measuring trabeculated left ventricular (LV) mass using cardiac magnetic resonance imaging and to assess its value in the diagnosis of left ventricular non-compaction (LVNC). Between January 2003 and 2008, we prospectively included 16 patients with LVNC. During the mean period, we included 16 patients with dilated cardiomyopathy (DCM), 16 patients with hypertrophic cardiomyopathy (HCM), and 16 control subjects. Left ventricular volumes, LV ejection fraction, and trabeculated LV mass were measured in the four different populations. The percentage of trabeculated LV mass was almost three times higher in the patients with LVNC (32 +/- 10%), compared with those with DCM (11 +/- 4%, P < 0.0001), HCM (12 +/- 4%, P < 0.0001), and controls (12 +/- 5%, P < 0.0001). A value of trabeculated LV mass above 20% of the global mass of the LV predicted the diagnosis of LVNC with a sensitivity of 93.7% [95% confidence interval (CI), 71.6-98.8%] and a specificity of 93.7% (95% CI, 83.1-97.8%; kappa = 0.84). The method described is reproducible and provides an assessment of the global amount of LV trabeculation. A trabeculated LV mass above 20% of the global LV mass is highly sensitive and specific for the diagnosis of LVNC.

  19. Left ventricular cardiac fibroma in a child presenting with ventricular tachycardia.

    Science.gov (United States)

    Stratemann, Stacy; Dzurik, Yvette; Fish, Frank; Parra, David

    2008-01-01

    Cardiac tumors in children are rare. Although most are histologically benign, they can be associated with life-threatening arrhythmias and sudden death. We report a 7-year-old boy, with a first episode of symptomatic tachycardia, who was found to have a left ventricular (LV) fibroma. He had a normal echocardiogram prior to an electrophysiology study, which revealed a sustained monomorphic ventricular tachycardia and a radio-opacity near the LV apex. These findings prompted a cardiac MRI, which demonstrated a discrete mass on his LV apex and free wall. Our case emphasizes that structural heart disease should be aggressively pursued in children presenting with ventricular tachycardia.

  20. Cardiac MR Elastography: Comparison with left ventricular pressure measurement

    Directory of Open Access Journals (Sweden)

    Samani Abbas

    2009-11-01

    Full Text Available Abstract Purpose of study To compare magnetic resonance elastography (MRE with ventricular pressure changes in an animal model. Methods Three pigs of different cardiac physiology (weight, 25 to 53 kg; heart rate, 61 to 93 bpm; left ventricular [LV] end-diastolic volume, 35 to 70 ml were subjected to invasive LV pressure measurement by catheter and noninvasive cardiac MRE. Cardiac MRE was performed in a short-axis view of the heart and applying a 48.3-Hz shear-wave stimulus. Relative changes in LV-shear wave amplitudes during the cardiac cycle were analyzed. Correlation coefficients between wave amplitudes and LV pressure as well as between wave amplitudes and LV diameter were determined. Results A relationship between MRE and LV pressure was observed in all three animals (R2 ≥ 0.76. No correlation was observed between MRE and LV diameter (R2 ≤ 0.15. Instead, shear wave amplitudes decreased 102 ± 58 ms earlier than LV diameters at systole and amplitudes increased 175 ± 40 ms before LV dilatation at diastole. Amplitude ratios between diastole and systole ranged from 2.0 to 2.8, corresponding to LV pressure differences of 60 to 73 mmHg. Conclusion Externally induced shear waves provide information reflecting intraventricular pressure changes which, if substantiated in further experiments, has potential to make cardiac MRE a unique noninvasive imaging modality for measuring pressure-volume function of the heart.

  1. Determination of left ventricular mass through SPECT imaging

    Science.gov (United States)

    Zárate-Morales, A.; Rodríguez-Villafuerte, M.; Martínez-Rodríguez, F.; Arévila-Ceballos, N.

    1998-08-01

    An edge detection algorithm has been applied to estimate left ventricular (LV) mass from single photon emission computed tomography (SPECT) thallium-201 images. The algorithm was validated using SPECT images of a phantom. The algorithm was applied to 20 patient studies from the Hospital de Cardiologia, Centro Médico Nacional Siglo XXI. Left ventricular masses derived from the stress and redistribution studies were highly correlated (r=0.96). The average LV masses obtained were 162±37 g and 169±34 g in the redistribution and stress studies, respectively.

  2. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension

    NARCIS (Netherlands)

    deVries, SO; Heesen, WF; Beltman, FW; Kroese, AH; May, JF; Smit, AJ; Lie, KI

    1996-01-01

    Although echocardiography provides a reliable method to determine left ventricular (LV) mass, it may not be available in all settings. Numerous electrocardiographic (EGG) criteria for the detection of LV hypertrophy have been developed, but few attempts have been made to predict the LV mass itself f

  3. Magnetic resonance imaging derived left ventricular global and region function parameters in healthy adults

    Institute of Scientific and Technical Information of China (English)

    穆莉莎

    2014-01-01

    Objective To establish cardiac magnetic resonance imaging(MRI)derived left ventricular(LV)global and region function parameters in normal adults.Methods Twenty normal adults were examined with fast imaging employing steady-state(Fiesta)acquisition sequence of cardiac MRI,LV global function and LV region function were measured at basal,middle,apical level and at 16

  4. Relationship between left ventricular longitudinal deformation and clinical heart failure during admission for acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2012-01-01

    Heart failure (HF) complicating acute myocardial infarction (MI) is an ominous prognostic sign frequently caused by left ventricular (LV) systolic dysfunction. However, many patients develop HF despite preserved LV ejection fractions. The aim of this study was to test the hypothesis that LV...

  5. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension

    NARCIS (Netherlands)

    deVries, SO; Heesen, WF; Beltman, FW; Kroese, AH; May, JF; Smit, AJ; Lie, KI

    1996-01-01

    Although echocardiography provides a reliable method to determine left ventricular (LV) mass, it may not be available in all settings. Numerous electrocardiographic (EGG) criteria for the detection of LV hypertrophy have been developed, but few attempts have been made to predict the LV mass itself

  6. Mitochondria and left ventricular hypertrophy

    Institute of Scientific and Technical Information of China (English)

    Haiyan Zhu; Shiwen Wang

    2008-01-01

    @@ Introduction Left ventricular hypertrophy (LVH) is one of the vicious organ damages of essential hypertension.It contributes a lot to high mortality of essential hypertension due to sudden cardiac death,ventricular arrhythmia and heart failure.Many factors involve in the pathogenesis of hypertension-induced LVH including inherited variants as well as environmental factors.

  7. Three-dimensional echocardiography with tissue harmonic imaging shows excellent reproducibility in assessment of left ventricular volumes

    DEFF Research Database (Denmark)

    Kim, Won Yong; Søgaard, Peter; Egeblad, Henrik;

    2001-01-01

    We studied the reproducibility of repeated measurements of left ventricular (LV) volumes by 2-dimensional (biplane method of disks) and 3-dimensional echocardiography (coaxial scanning) with tissue harmonic imaging. Ten healthy subjects underwent estimation of LV volumes by transthoracic echocard......We studied the reproducibility of repeated measurements of left ventricular (LV) volumes by 2-dimensional (biplane method of disks) and 3-dimensional echocardiography (coaxial scanning) with tissue harmonic imaging. Ten healthy subjects underwent estimation of LV volumes by transthoracic...

  8. Usefulness of contrast computed tomography to detect left ventricular apical thrombus associated with takotsubo cardiomyopathy.

    Science.gov (United States)

    Ouchi, Kotaro; Nakamura, Fumitaka; Ikutomi, Masayasu; Oshima, Tsukasa; Ishiwata, Jumpei; Shinohara, Hiroki; Kouzaki, Tsunashi; Amaki, Toshihiro

    2016-05-01

    Left ventricular (LV) apical thrombus can rarely occur during the early phase of takotsubo cardiomyopathy. We report such a case that was depicted clearly in contrast computed tomography (CT) but not in initial echocardiography. Because LV thrombus may lead to thromboembolic events, we should evaluate all patients with takotsubo cardiomyopathy for the presence of a LV thrombus. LV thrombus is generally recognized with echocardiography in the course of follow-up, but limited depiction of the LV apex with echocardiography can make evaluation of LV thrombus difficult. Contrast CT is useful to detect LV apical thrombus associated with takotsubo cardiomyopathy.

  9. The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Wachtell, K.; Devereux, R.B.; Lyle, P.A.;

    2008-01-01

    The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment...

  10. Renal denervation in heart failure with normal left ventricular ejection fraction. Rationale and design of the DIASTOLE (DenervatIon of the renAl Sympathetic nerves in hearT failure with nOrmal Lv Ejection fraction) trial.

    Science.gov (United States)

    Verloop, Willemien L; Beeftink, Martine M A; Nap, Alex; Bots, Michiel L; Velthuis, Birgitta K; Appelman, Yolande E; Cramer, Maarten-Jan; Agema, Willem R P; Scholtens, Asbjorn M; Doevendans, Pieter A; Allaart, Cor P; Voskuil, Michiel

    2013-12-01

    Aim Increasing evidence suggests an important role for hyperactivation of the sympathetic nervous system (SNS) in the clinical phenomena of heart failure with normal LVEF (HFNEF) and hypertension. Moreover, the level of renal sympathetic activation is directly related to the severity of heart failure. Since percutaneous renal denervation (pRDN) has been shown to be effective in modulating elevated SNS activity in patients with hypertension, it can be hypothesized that pRDN has a positive effect on HFNEF. The DIASTOLE trial will investigate whether renal sympathetic denervation influences parameters of HFNEF. Methods DIASTOLE is a multicentre, randomized controlled trial. Sixty patients, diagnosed with HFNEF and treated for hypertension, will be randomly allocated in a 1:1 ratio to undergo renal denervation on top of medical treatment (n = 30) or to maintain medical treatment alone (n = 30). The primary objective is to investigate the efficacy of pRDN by means of pulsed wave Doppler echocardiographic parameters. Secondary objectives include safety of pRDN and a comparison of changes in the following parameters after pRDN: LV mass, LV volume, LVEF, and left atrial volume as determined by magnetic resonance imaging. Also, MIBG (metaiodobenzylguanidine) uptake and washout, BNP levels, blood pressure, heart rate variability, exercise capacity, and quality of life will be assessed. Perspective DIASTOLE is a randomized controlled trial evaluating renal denervation as a treatment option for HFNEF. The results of the current trial will provide important information regarding the treatment of HFNEF, and therefore may have major impact on future therapeutic strategies. Trail registration NCT01583881.

  11. Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

    Science.gov (United States)

    Friedman, Kevin G.; Schidlow, David; Freud, Lindsay; Escobar-Diaz, Maria; Tworetzky, Wayne

    2014-01-01

    Fetal aortic valvuloplasty (FAV) has shown promise in averting progression of mid-gestation aortic stenosis (AS) to hypoplastic left heart syndrome in a subset of patients. Patients who achieve biventricular circulation after FAV frequently have left ventricular (LV) diastolic dysfunction (DD). This study evaluates DD in fetuses with AS by comparing echocardiographic indices of LV diastolic function in fetuses undergoing FAV (n=20) to controls (n=40) and evaluates for LV factors associated with DD in FAV patients. We also compared pre- and post-FAV DD variables (n=16). Median gestational age (24 weeks, range 18–29 weeks) and fetal heart rate were similar between FAV and controls. Compared to controls, FAV patients had universally abnormal LV diastolic parameters including fused mitral inflow E and A waves (p=0.008), higher E velocity(p<0.001), shorter mitral inflow time (p=0.001), lower LV lateral annulus E′ (p<0.001), septal E′ (p=0.003) and higher E/E′ (p<0.001) than controls. FAV patients had abnormal right ventricular mechanics with higher tricuspid inflow E velocity (p<0.001), and shorter tricuspid inflow time (p=0.03). Worse LV diastolic function (lower LV E′) was associated with higher endocardial fibroelastosis (EFE) grade (r=0.74, p<0.001), large LV volume (r=0.55, p=0.013) and sphericity (r=0.58, P=0.009) and with lower LV pressure by mitral regurgitation jet (r=−0.68, p<0.001). Post-FAV, fewer patients had fused mitral inflow E and A than pre-FAV (p=0.05) and septal E′ was higher (=0.04). In conclusion, fetuses with mid-gestation AS have evidence of marked DD. Worse DD is associated with larger, more spherical LV, with more extensive EFE and lower LV pressure. PMID:24819899

  12. Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Bernd Hewing

    2016-10-01

    Full Text Available Background/Aims: Cardiac changes observed in chronic kidney disease patients are of multifactorial origin including chronic uremia, hemodynamics or inflammation. Restoration of renal function by kidney transplantation (KTX may reverse cardiac changes. Novel echocardiographic methods such as speckle tracking echocardiography (STE allow early and sensitive detection of subtle changes of cardiac parameters. We evaluated changes of cardiac structure and function after KTX by advanced echocardiographic modalities. Methods: Thirty-one KTX recipients (female n=11 were evaluated by medical examination, laboratory testing and echocardiography before and after KTX (median follow-up 19 months. Left ventricular (LV and right ventricular (RV diameters and function were assessed by echocardiographic standard parameters. Longitudinal 2D strain of the LV (GLPS and left atrium (LA was determined by 2D STE. Results: After KTX, median serum creatinine level was 1.3 mg/dl (IQR, 1.2-1.5. Systolic blood pressure decreased significantly after KTX. Echocardiography showed a significant reduction in LV end-diastolic septal and posterior wall thickness and LV mass index after KTX, which was accompanied by an improvement of GLPS. There were no relevant changes in parameters of LA (reservoir, conduit or contractile function, LV diastolic or RV function after KTX. Conclusion: LV hypertrophy reversed after successful KTX and was accompanied by an improvement in longitudinal LV function as assessed by STE. Diastolic function and STE-derived LA function parameters did not change significantly after KTX.

  13. Right ventricular remodeling and updated left ventricular geometry classification: is there any relationship?

    Science.gov (United States)

    Tadic, Marijana; Cuspidi, Cesare; Vukomanovic, Vladan; Kocijancic, Vesna; Celic, Vera

    2016-10-01

    We sought to evaluate right ventricular (RV) structure and function in hypertensive patients with various left ventricular (LV) geometric patterns using an updated classification for LV geometry. This cross-sectional study included 232 hypertensive subjects. All the subjects underwent complete two-dimensional (2D) and three-dimensional (3D) echocardiographic examination. Using LV mass index, LV end-diastolic diameter and relative wall thickness, according to the updated classification, all subjects were divided into six different groups: normal LV geometry, concentric remodeling, eccentric LV hypertrophy (LVH), concentric, dilated, and concentric-dilated LVH. RV wall thickness was increased in concentric and concentric-dilated LVH compared with normal LV geometry and LV concentric remodeling. RV longitudinal function was reduced in concentric and concentric-dilated patients compared with other hypertensive groups. 3D RV volumes were significantly higher in eccentric, dilated, and concentric-dilated LVH hypertensive subjects. Conversely, 3D RV ejection fraction was lower in these groups. RV longitudinal myocardial function and 3D RV function are significantly influenced by LV geometry in hypertensive patients. RV remodeling is the most pronounced in the patients with concentric, dilated, and concentric-dilated LVH geometric patterns.

  14. Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

    DEFF Research Database (Denmark)

    Bang, Casper; Gerdts, Eva; Aurigemma, Gerard P;

    2013-01-01

    Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatatio...

  15. Left ventricular biomechanics in professional football players.

    Science.gov (United States)

    von Lueder, T G; Hodt, A; Gjerdalen, G F; Steine, K

    2017-04-04

    Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Color M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, Pplayers (-124.5±4.2 vs -106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both Pplayers. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. A case of chronic left ventricular thrombus with ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Vikram Bhausaheb Vikhe

    2013-01-01

    Full Text Available Left ventricular (LV thrombus is a serious complication of anterior wall myocardial infarction (MI, especially in patients with severe LV dysfunction. LV thrombus carries a high risk of causing stroke and other thromboembolic complications despite adequate anticoagulation therapy. There is a benefit of anticoagulation in patients with ischemic cardiomyopathy to reduce thromboembolic events or in resolution of LV thrombus. Two-dimensional (2D echocardiography is the most commonly used technique for the diagnosis and follow-up of such cases. Our patient developed a chronic LV thrombus with ischemic cardiomyopathy post anterior wall MI and was managed well on anticoagulants to prevent the thromboembolic events under strict vigilance and follow-up.

  17. [Reflected high-intensity motion signals as markers of left ventricular diastolic dysfunction].

    Science.gov (United States)

    Makarenko, E S

    2013-01-01

    Reflected high-intensity signals of left ventricular motion can be used for assessment of diastolic function of left ventricle. There are many correlations between reflected high-intensity signals, transmitral flow, and tissue Doppler imaging parameters. Diagnostic criteria of LV diastolic dysfunction based on measurement of LV motion are suggested.

  18. Predictors of left ventricular remodelling and failure in right ventricular pacing in the young

    Science.gov (United States)

    Gebauer, Roman A.; Tomek, Viktor; Salameh, Aida; Marek, Jan; Chaloupecký, Václav; Gebauer, Roman; Matějka, Tomáš; Vojtovič, Pavel; Janoušek, Jan

    2009-01-01

    Aims To identify risk factors for left ventricular (LV) dysfunction in right ventricular (RV) pacing in the young. Methods and results Left ventricular function was evaluated in 82 paediatric patients with either non-surgical (n = 41) or surgical (n= 41) complete atrioventricular block who have been 100% RV paced for a mean period of 7.4 years. Left ventricular shortening fraction (SF) decreased from a median (range) of 39 (24–62)% prior to implantation to 32 (8–49)% at last follow-up (P +2z-values) and dysfunction (SF < 0.26) was found to increase from 1.3% prior to pacemaker implantation to 13.4% (11/82 patients) at last follow-up (P = 0.01). Ten of these 11 patients had progressive LV remodelling and 8 of 11 were symptomatic. The only significant risk factor for the development of LV dilatation and dysfunction was the presence of epicardial RV free wall pacing (OR = 14.3, P < 0.001). Other pre-implantation demographic, diagnostic, and haemodynamic factors including block aetiology, pacing variables, and pacing duration did not show independent significance. Conclusion Right ventricular pacing leads to pathologic LV remodelling in a significant proportion of paediatric patients. The major independent risk factor is the presence of epicardial RV free wall pacing, which should be avoided whenever possible. PMID:19286675

  19. MR image analysis: Longitudinal cardiac motion influences left ventricular measurements

    Energy Technology Data Exchange (ETDEWEB)

    Berkovic, Patrick [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: pberko17@hotmail.com; Hemmink, Maarten [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: maartenhemmink@gmail.com; Parizel, Paul M. [University Hospital Antwerp, Department of Radiology (Belgium)], E-mail: paul.parizel@uza.be; Vrints, Christiaan J. [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: chris.vrints@uza.be; Paelinck, Bernard P. [University Hospital Antwerp, Department of Cardiology (Belgium)], E-mail: Bernard.paelinck@uza.be

    2010-02-15

    Background: Software for the analysis of left ventricular (LV) volumes and mass using border detection in short-axis images only, is hampered by through-plane cardiac motion. Therefore we aimed to evaluate software that involves longitudinal cardiac motion. Methods: Twenty-three consecutive patients underwent 1.5-Tesla cine magnetic resonance (MR) imaging of the entire heart in the long-axis and short-axis orientation with breath-hold steady-state free precession imaging. Offline analysis was performed using software that uses short-axis images (Medis MASS) and software that includes two-chamber and four-chamber images to involve longitudinal LV expansion and shortening (CAAS-MRV). Intraobserver and interobserver reproducibility was assessed by using Bland-Altman analysis. Results: Compared with MASS software, CAAS-MRV resulted in significantly smaller end-diastolic (156 {+-} 48 ml versus 167 {+-} 52 ml, p = 0.001) and end-systolic LV volumes (79 {+-} 48 ml versus 94 {+-} 52 ml, p < 0.001). In addition, CAAS-MRV resulted in higher LV ejection fraction (52 {+-} 14% versus 46 {+-} 13%, p < 0.001) and calculated LV mass (154 {+-} 52 g versus 142 {+-} 52 g, p = 0.004). Intraobserver and interobserver limits of agreement were similar for both methods. Conclusion: MR analysis of LV volumes and mass involving long-axis LV motion is a highly reproducible method, resulting in smaller LV volumes, higher ejection fraction and calculated LV mass.

  20. Effects of preemptive enoximone on left ventricular diastolic function after valve replacement for aortic stenosis

    NARCIS (Netherlands)

    van der Maaten, Joost M. A. A.; de Vries, Adrianus J.; Rietman, Gerrit W.; Gallandat Huet, Rolf C. G.; De Hert, Stefan G.

    2007-01-01

    Objective: Left ventricular (LV) hypertrophy is associated with increased diastolic chamber stiffness early after aortic valve replacement for valve stenosis. Enoximone, a phosphodiesterase III inhibitor, has been shown to improve myocardial contractility and relaxation when administered as a single

  1. Effects of trimetazidine therapy on left ventricular function after percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    许晓晗

    2013-01-01

    Objective To explore the effects of trimetazidine therapy on left ventricular(LV)function after percutaneous coronary intervention(PCI).Methods A total of 106 patients with unstable angina pectoris undergoing successful

  2. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard;

    2016-01-01

    PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...... conduction, tLVp, and BiV pacing and compared as paired data. Echocardiographic analysis was done blinded with respect to pacing mode. RESULTS: LVEF was significantly higher during BiV pacing (47 ± 11 %) compared with intrinsic conduction (43 ± 13 %, P = 0.001) and tLVp (44 ± 13 %, P = 0.001), while......V pacing. CONCLUSIONS: The acute effect of tLVp on LV systolic function and contraction pattern is significantly lower than the effect of BiV pacing and not different from intrinsic conduction in patients with LBBB and CRT....

  3. Establishment of a chronic left ventricular aneurysm model in rabbit

    Institute of Scientific and Technical Information of China (English)

    Cang-Song XIAO; Chang-Qing GAO; Li-Bing LI; Yao WANG; Tao ZHAO; Wei-Hua YE; Chong-Lei REN; Zhi-Yong LIU; Yang WU

    2014-01-01

    Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm (LVA) in rabbits. Methods Acute myocardial infarction (AMI) was induced in 35 rabbits via concomitant ligation of the left anterior descending (LAD) coronary artery and the circumflex (Cx) branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure (LVESP) and diastolic pressure (LVEDP) were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV), and ejection fraction (EF) were recorded by echo-cardiography. Results Thirty one (88.6%) rabbits survived myocardial infarction and 26 of them developed aneurysm (83.9%). The mean area of aneurysm was 33.4% ± 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle (LV) that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%±2.4%which involves the apex, anterior wall and lateral wall of the LV.

  4. Increased Left Ventricular Stiffness Impairs Exercise Capacity in Patients with Heart Failure Symptoms Despite Normal Left Ventricular Ejection Fraction

    Directory of Open Access Journals (Sweden)

    David Sinning

    2011-01-01

    Full Text Available Aims. Several mechanisms can be involved in the development of exercise intolerance in patients with heart failure despite normal left ventricular ejection fraction (HFNEF and may include impairment of left ventricular (LV stiffness. We therefore investigated the influence of LV stiffness, determined by pressure-volume loop analysis obtained by conductance catheterization, on exercise capacity in HFNEF. Methods and Results. 27 HFNEF patients who showed LV diastolic dysfunction in pressure-volume (PV loop analysis performed symptom-limited cardiopulmonary exercise testing (CPET and were compared with 12 patients who did not show diastolic dysfunction in PV loop analysis. HFNEF patients revealed a lower peak performance (=.046, breathing reserve (=.006, and ventilation equivalent for carbon dioxide production at rest (=.002. LV stiffness correlated with peak oxygen uptake (=−0.636, <.001, peak oxygen uptake at ventilatory threshold (=−0.500, =.009, and ventilation equivalent for carbon dioxide production at ventilatory threshold (=0.529, =.005. Conclusions. CPET parameters such as peak oxygen uptake, peak oxygen uptake at ventilatory threshold, and ventilation equivalent for carbon dioxide production at ventilatory threshold correlate with LV stiffness. Increased LV stiffness impairs exercise capacity in HFNEF.

  5. New strict left bundle branch block criteria reflect left ventricular activation differences

    DEFF Research Database (Denmark)

    Emerek, Kasper Janus Grønn; Risum, Niels; Hjortshøj, Søren Pihlkjær;

    2015-01-01

    applying new strict ECG criteria subsequent rates of response in DCM were 18/19 (95%) and in IHD of 18/23 (78%) respectively, p... ventricular electrical delay (RV-LV-IED) was measured. Response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume. RESULTS: Eighteen of 20 (90%) patients with non-ischemic dilated cardiomyopathy (DCM) and 18 of 29 (62%) with ischemic heart disease (IHD) responded to CRT, p.... CONCLUSION: Interventricular electrical delay predicts left ventricular remodeling after CRT and new, strict ECG criteria of LBBB are superior in predicting remodeling....

  6. Left ventricular muscle and fluid mechanics in acute myocardial infarction.

    Science.gov (United States)

    Nucifora, Gaetano; Delgado, Victoria; Bertini, Matteo; Marsan, Nina Ajmone; Van de Veire, Nico R; Ng, Arnold C T; Siebelink, Hans-Marc J; Schalij, Martin J; Holman, Eduard R; Sengupta, Partho P; Bax, Jeroen J

    2010-11-15

    Left ventricular (LV) diastolic filling is characterized by the formation of intraventricular rotational bodies of fluid (termed "vortex rings") that optimize the efficiency of LV ejection. The aim of the present study was to evaluate the morphology and dynamics of LV diastolic vortex ring formation early after acute myocardial infarction (AMI), in relation to LV diastolic function and infarct size. A total of 94 patients with a first ST-segment elevation AMI (59 ± 11 years; 78% men) were included. All patients underwent primary percutaneous coronary intervention. After 48 hours, the following examinations were performed: 2-dimensional echocardiography with speckle-tracking analysis to assess the LV systolic and diastolic function, the vortex formation time (VFT, a dimensionless index for characterizing vortex formation), and the LV untwisting rate; contrast echocardiography to assess LV vortex morphology; and myocardial contrast echocardiography to identify the infarct size. Patients with a large infarct size (≥ 3 LV segments) had a significantly lower VFT (p mechanical sequence of diastolic restoration play key roles in modulating the morphology and dynamics of early diastolic vortex ring formation.

  7. Prognostic significance of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy and systemic hypertension (the LIFE Study)

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Palmieri, Vittorio; Gerdts, Eva;

    2010-01-01

    Patients with hypertension and left ventricular (LV) hypertrophy commonly have impaired diastolic filling. However, it remains unknown whether changes in LV diastolic filling variables are associated with cardiovascular morbidity and mortality. In this study, 778 patients with hypertension...... valve flow pattern, this was not associated with reduced cardiovascular morbidity and mortality when adjusting for blood pressure, left atrial diameter, LV mass index, and treatment in time-varying Cox analyses. In contrast, lower in-treatment E/A ratios and shorter mitral valve deceleration times were...... associated with less risk for heart failure. Similarly, normal in-treatment transmitral flow pattern was strongly associated with less risk for heart failure (hazard ratio 0.22, 95% confidence interval 0.05 to 0.98, p = 0.048), even when taking in-treatment left atrial diameter and blood pressure...

  8. [Left ventricular function in hypertension without left ventricular hypertrophy: echographic study with modelisation of left ventricular-aortic coupling].

    Science.gov (United States)

    Bonnet, B; Jourdan, F; du Cailar, G; Mimran, A; Fesler, P

    2014-06-01

    Because the functional interaction between the LV and arterial systems, termed ventricular-arterial coupling, is recognized as a key determinant of LV performance, the objective of the present study was to assess the impact of uncomplicated HT without LVH on LV performance using simultaneously echocardiography and carotid tonometry. LV maximal power (PmaxVG), cardiac power output (CPO), LV efficiency (CPO/PmaxVG), input aortic and output LV elastance (Ea and Ees) were assessed in 20 normotensive control subjects (NT) and 10 patients with untreated HT. PmaxVG was calculated according to the integral of the product of LV wall stress with strain rate (as an index of gradient velocity). Cyclic variation of wall thickness and SR were measured by speckel-tracking. Ea and Ees were derived and modelized from the pressure-volume curve. No difference in age, BMI and sex ratio was observed between NT and HT. Systolic BP (160±18 vs. 119±10mmHg), LV mass (99±15 vs. 76±12g/m(2)), PWV (9.7±2 vs. 6.9±1m/s) were significantly higher (P<0.01) in HT when compared to NT. In HT increased of CPO and Ea was compensated by an increase of LV (15±4 vs. 12±3%, P<0.02) and Ees (5.5±2 vs. 4.5±1.5mmHg/mL), which are significantly elevated in HT (P<0.05). No difference was observed in Ea/Ees between NT and HT. In conclusion at the early phase of HT, in patients without LVH, LV performance and ventricular-arterial coupling were adapted to post-load elevation. This adaptation may be the result of an increased of LV contractility.

  9. Worsening diastolic function is associated with elevated fasting plasma glucose and increased left ventricular mass in a supra-additive fashion in an elderly, healthy, Swedish population

    DEFF Research Database (Denmark)

    Pareek, Manan; Nielsen, Mette Lundgren; Gerke, Oke;

    2015-01-01

    AIMS: To examine whether increasing fasting plasma glucose (FPG) levels were associated with worsening left ventricular (LV) diastolic function, independently of LV mass index (LVMI) in elderly, otherwise healthy subjects. METHODS AND RESULTS: We tested cross-sectional associations between...

  10. Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation

    NARCIS (Netherlands)

    M.E. Menting (Myrthe); R.W.J. van Grootel (Roderick W. J.); A.E. van den Bosch (Annemien); J.A. Eindhoven (Jannet); J.S. McGhie (Jackie); J.A.A.E. Cuypers (Judith); M. Witsenburg (Maarten); W.A. Helbing (Willem); J.W. Roos-Hesselink (Jolien)

    2016-01-01

    textabstractDespite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with pati

  11. Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Schou, Morten; Kjaergaard, Jesper; Torp-Pedersen, Christian

    2013-01-01

    Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to...

  12. Effects of the NADPH oxidase inhibitor apocynin on the left ventricular dysfunction induced by cocaine administration

    Institute of Scientific and Technical Information of China (English)

    MarcISABELLE; ChristelleMONTEIL; ChristianTHUILLEZ

    2004-01-01

    AIM: In a previous study, we have shown the role of alphaladrenoceptor in the left ventricular (LV) dysfunction after chronic cocaine administration via the induction of NADPH oxidase. In this study we used the NADPH oxidase inhibitor apocynin, to further investigate the real involvement of this prooxidant system in this LV dysfunction. METHODS: Wistar rats were treated

  13. The influence of right ventricular apical pacing on left atrial volume in patients with normal left ventricular function

    Directory of Open Access Journals (Sweden)

    AR Moaref1

    2008-03-01

    Full Text Available Background: Right ventricular apical (RVA pacing has been reported to induce several deleterious effects particularly in the presence of structural heart disease but can also involve patients with normal left ventricular (LV function. Left atrial (LA enlargement is one of these effects, but the majority of studies have measured LA dimension rather than volume.Objective: The present prospective study was designed to assess the effect of RVA pacing on LA volume in patients with normal LV function.Patients and Methods: The study comprised 41 consecutive patients with LV ejection fraction ≥ 45% and LV end diastolic dimension ≤ 56 mm who underwent single-or dual- chamber pacemaker implantation in RVA and followed for LA volume measurement and pacemaker analysis at least during the ensuing 4.2 months. Results: In all, 21 patients were excluded from the study due to five spontaneous wide QRS complex (≥120msec, one recent acute coronary syndrome,one significant valvular heart disease, three pacing frequency <90%, eight death or losing follow up in three cases. In remaining 20 patients, LA volume ragned from 21 to 54 mm3 with mean of 37.3±9.7 mm3 prior to pacemaker implantation that increased to 31 to 103 mm3 (54.3±17.0 during follow-up (P<0.001.Conclusion: RVA pacing might lead to an increase in LA volume even in patients with normal LV function.

  14. Current cardiac imaging techniques for detection of left ventricular mass

    Directory of Open Access Journals (Sweden)

    Celebi Aksuyek S

    2010-06-01

    Full Text Available Abstract Estimation of left ventricular (LV mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR and cardiovascular computed tomography (CCT are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test.

  15. Assessment of left ventricular function by GPs using pocket-sized ultrasound

    OpenAIRE

    Mjølstad, Ole Christian; Snare, Sten Roar; Folkvord, Lasse; Helland, Frode; Grimsmo, Anders; Torp, Hans; Haraldseth, Olav; Haugen, Bjørn Olav

    2012-01-01

    Background Assessment of left ventricular (LV) function with echocardiography is mandatory in patients with suspected heart failure (HF). Objectives To investigate if GPs were able to evaluate the LV function in patients at risk of developing or with established HF by using pocket-sized ultrasound (pUS). Methods Feasibility study in general practice, seven GPs in three different Norwegian primary care centres participated. Ninety-two patients with reduced or at risk of developing reduced LV f...

  16. Right ventricular dysfunction affects survival after surgical left ventricular restoration.

    Science.gov (United States)

    Couperus, Lotte E; Delgado, Victoria; Palmen, Meindert; van Vessem, Marieke E; Braun, Jerry; Fiocco, Marta; Tops, Laurens F; Verwey, Harriëtte F; Klautz, Robert J M; Schalij, Martin J; Beeres, Saskia L M A

    2017-04-01

    Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function. A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed. Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was -24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left

  17. Delayed efficacy of radiofrequency catheter ablation on ventricular arrhythmias originating from the left ventricular anterobasal wall.

    Science.gov (United States)

    Ding, Ligang; Hou, Bingbo; Wu, Lingmin; Qiao, Yu; Sun, Wei; Guo, Jinrui; Zheng, Lihui; Chen, Gang; Zhang, Linfeng; Zhang, Shu; Yao, Yan

    2017-03-01

    Ventricular arrhythmias (VAs) originating from the left ventricular anterobasal wall (LV-ABW) may represent a therapeutic challenge. The purpose of this study was to investigate the delayed efficacy of radiofrequency catheter (RFCA) ablation without an epicardial approach on VAs originating from the LV-ABW. Eighty patients (mean age 46.9 ± 14.9 years; 47 male) with VAs originating from the LV-ABW were enrolled. After systematic mapping of the right ventricular outflow tract, aortic root, adjacent LV endocardium, and coronary venous system, 3-4 ablation attempts were made at the earliest activation sites and/or best pace-mapping sites. Delayed efficacy was evaluated in patients with acute failure. During mean follow-up of 23.8 ± 21.9 months (range 3-72 months), complete elimination of all VAs was achieved in 47 patients (59%) and partial success in 19 (24%), for an overall success rate of 83%. In 25 of 37 patients (68%) with acute failure, VAs were eliminated or significantly reduced (>80% VA burden) by the delayed effect of RFCA during follow-up. Logistic regression analysis revealed that response time to ablation was a predictor of occurrence of delayed efficacy. No complications occurred during follow-up. Instead of extensive ablation, waiting for delayed efficacy of RFCA may be a reasonable choice for patients with VAs arising from the LV-ABW. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Absence of left ventricular hypertrophy in elite college basketball players.

    Science.gov (United States)

    Wolfe, L A; Martin, R P; Seip, R L

    1985-09-01

    Left ventricular dimensions of 11 successful male college basketball players engaged in pre-season conditioning (mean age, 20.3 years) and 13 tall healthy male controls (mean age, 21.6 years) were studied by echocardiography. Left ventricular internal dimension (LVIDd, mm), posterior wall thickness (PWT, mm), septal thickness (ST, mm), and calculated left ventricular mass (LV mass, g) in the athletes were within or only slightly in excess of echocardiographic normal limits and mean values were not significantly different from the control group. LVIDd (mm/m2 body surface area) was significantly lower in the athletes. However, five guard-type players displayed significantly greater mean values for PWT and LV mass compared to six taller forwards/centers with linear body builds. It was concluded that left ventricular hypertrophy is not a common characteristic of college basketball players. It was hypothesized that cardiac dimensions of young men may vary independently of gross body size in relation to somatotype or other anthropometric variables.

  19. Left Ventricular Non-compaction Cardiomyopathy - A Case Report

    Directory of Open Access Journals (Sweden)

    Timea Szakacs Xantus

    2015-06-01

    Full Text Available Background: Left non-compaction cardiomyopathy (LVNC or “spongy myocardium” is a relatively rare primary genetic cardiomyopathy, characterized by prominent wall trabeculations and intertrabecular recesses which communicate with the ventricular cavity. It appears in isolated form or coexists with other congenital heart diseases and/or systemic abnormalities. Material and method: A 28-year-old woman was admitted with exertional dyspnoea, palpitations, non-specific chest pain and progressive fatigue on exertion. In her family history sudden cardiac-related deaths at young age are present. Cardiovascular system examination revealed tachycardia, intermittent extrabeats. The rest EKG showed sinusal tachycardia (105 bpm, negative T-waves in DII, DIII, aVF, V4-V6. Consecutive 24 hours Holter EKG monitoring revealed nonsustained ventricular tachycardia, paroxysmal atrial fibrillation, isolated ventricular extrasystoles. Echocardiography showed left ventricular systolic dysfunction (LVEF:30-35%, slight LV enlargement, normal right ventricle and small left ventricle (LV trabeculae in the apical area. Cardiac MRI demonstrated dilated LV and the presence of the trabeculations of LV walls suggestive for non-compaction cardiomyopathy. A combined treatment for heart failure and cardiac arrhythmias was initiated with good clinical results. Patient was scheduled for an implantable cardioverter defibrillator “life-saving”. Conclusions: The symptoms of heart failure and cardiac arrhythmias should be considered important in apparently healthy young patients. Besides intensive medical treatment is indicated the implantation of an ICD “life-saving” and in advanced cases heart transplantation. Even if the electrocardiographic findings are non specific for noncompaction, a complete diagnostic evaluation is important, including sophisticated imaging techniques, a screening of first-degree relatives, and an extensive clinical, and genetic appreciation by a

  20. Mitral Annular Kinetics, Left Atrial and Left Ventricular Diastolic Function Post Mitral Valve Repair in Degenerative Mitral Regurgitation

    Directory of Open Access Journals (Sweden)

    Chun eSchiros

    2015-08-01

    Full Text Available Objective: The relationship of mitral annular (MA kinetics to left ventricular (LV and left atrial (LA function before and after mitral valve repair has not been well studied. Here we sought to provide comprehensive analysis that relates to MA motions, LA and LV diastolic function post mitral valve repair. Methods: Three-dimensional analyses of mitral annular motion, LA function and LV volumetric and diastolic strain rates were performed on 35 degenerative mitral regurgitation (MR patients at baseline and 1-year post mitral valve repair, and 51 normal controls, utilizing cardiac magnetic resonance imaging with tissue tagging. Results: All had normal LV ejection fraction (EF at baseline. LV and LA EFs decreased 1-year post-surgery vs. controls. LV early-diastolic myocardial strain rates decreased post-surgery along with decreases in normalized early-diastolic filling rate, E/A ratio and early-diastolic MA relaxation rates. Post-surgical LA late active kick remained higher in MR patients vs. control. LV and LA EFs were significantly associated with peak MA centroid to apex shortening. Furthermore, during LV systolic phase, peak LV ejection and LA filling rates were significantly correlated with peak MA centroid to apex shortening rate, respectively. While during LV diastolic phase, both peak early diastolic MA centroid to apex relaxation rate and LA ejection rate were positively significantly associated with LV peak early diastolic filling rate. Conclusions— MA motion is significantly associated with LA and LV function. Mitral annular motion, left atrial function and left ventricular diastolic strain rates are still impaired one year post mitral valve repair. Long term effects of these impairments should be prospectively evaluated.

  1. Isolated Left Ventricular Apical Hypoplasia with Right Ventricular Outflow Tract Obstruction: A Rare Combination.

    Science.gov (United States)

    Zhao, Yonghui; Zhang, Jiaying; Zhang, Jing

    2015-09-01

    Isolated left ventricular (LV) apical hypoplasia is a unusual and recently recognized congenital cardiac anomaly. A 19-year-old man was found to have an abnormal ECG and cardiac murmur identified during a routine health check since joining work. His ECG revealed normal sinus rhythm, right-axis deviation, poor R wave progression, and T wave abnormalities. On physical examination, a 2/6~3/6 systolic murmur was heard at the second intercostal space along the left sternal border. Subsequent echocardiography and cardiac magnetic resonance imaging confirmed the LV apical hypoplasia. Of note, we first found that LV apical hypoplasia was accompanied by RV outflow tract obstruction due to exaggerated rightward bulging of the basal-anterior septum during systole. A close follow-up was performed for the development of heart failure, pulmonary hypertension, and potentially tachyarrhythmia.

  2. Association of arterial stiffness and electrocardiography-determined left ventricular hypertrophy with left ventricular diastolic dysfunction.

    Directory of Open Access Journals (Sweden)

    Po-Chao Hsu

    Full Text Available OBJECTIVES: Increased arterial stiffness is associated with left ventricular diastolic dysfunction (LVDD, but this association may be influenced by left ventricular (LV performance. Left ventricular hypertrophy (LVH is not only a significant determinant of LV performance, but is also correlated with LVDD. This study is designed to compare LV diastolic function among patients divided by brachial-ankle pulse wave velocity (baPWV and electrocardiography (ECG-determined LVH and to assess whether increased baPWV and ECG-determined LVH are independently associated with LVDD. METHODS: This cross-sectional study enrolled 270 patients and classified them into four groups according to the median value of baPWV and with/without ECG-determined LVH. The baPWV was measured using an ABI-form device. ECG-determined LVH was defined by Sokolow-Lyon criterion. LVDD was defined as impaired relaxation, pseudonormal, and restrictive mitral inflow patterns. Groups 1, 2, 3, and 4 were patients with lower baPWV and without ECG-determined LVH, lower baPWV but with ECG-determined LVH, higher baPWV but without ECG-determined LVH, and higher baPWV and with ECG-determined LVH respectively. RESULTS: Early diastolic mitral velocity (Ea was gradually decreased from group 1 to group 4 (p≦0.027. Patients in group 4 had the highest prevalence of LVDD (all p<0.001. After multivariate analysis, both baPWV and ECG-determined LVH were independent determinants of Ea (β = -0.02, P<0.001; β = -1.77, P<0.001 respectively and LVDD (odds ratio = 1.02, P = 0.011 and odds ratio = 3.53, P = 0.013 respectively. CONCLUSION: Our study showed the group with higher baPWV and ECG-determined LVH had the lowest Ea and highest prevalence of LVDD. In addition, both baPWV and ECG-determined LVH were independently associated with Ea and LVDD. Hence, assessment of arterial stiffness by baPWV and LVH by ECG may be useful in identifying the high risk group of LVDD.

  3. Hydraulic forces contribute to left ventricular diastolic filling

    Science.gov (United States)

    Maksuti, Elira; Carlsson, Marcus; Arheden, Håkan; Kovács, Sándor J.; Broomé, Michael; Ugander, Martin

    2017-03-01

    Myocardial active relaxation and restoring forces are known determinants of left ventricular (LV) diastolic function. We hypothesize the existence of an additional mechanism involved in LV filling, namely, a hydraulic force contributing to the longitudinal motion of the atrioventricular (AV) plane. A prerequisite for the presence of a net hydraulic force during diastole is that the atrial short-axis area (ASA) is smaller than the ventricular short-axis area (VSA). We aimed (a) to illustrate this mechanism in an analogous physical model, (b) to measure the ASA and VSA throughout the cardiac cycle in healthy volunteers using cardiovascular magnetic resonance imaging, and (c) to calculate the magnitude of the hydraulic force. The physical model illustrated that the anatomical difference between ASA and VSA provides the basis for generating a hydraulic force during diastole. In volunteers, VSA was greater than ASA during 75-100% of diastole. The hydraulic force was estimated to be 10-60% of the peak driving force of LV filling (1-3 N vs 5-10 N). Hydraulic forces are a consequence of left heart anatomy and aid LV diastolic filling. These findings suggest that the relationship between ASA and VSA, and the associated hydraulic force, should be considered when characterizing diastolic function and dysfunction.

  4. Rats with high left ventricular end-diastolic pressure can be identified by Doppler echocardiography one week after myocardial infarction

    OpenAIRE

    R.M. Saraiva; Kanashiro-Takeuchi,R.M.; E.L. Antonio; Campos, O; P.J.F. Tucci; Moisés,V.A.

    2007-01-01

    The severity of left ventricular (LV) dysfunction in rats with myocardial infarction (MI) varies widely. Because homogeneity in baseline parameters is essential for experimental investigations, a study was conducted to establish whether Doppler echocardiography (DE) could accurately identify animals with high LV end-diastolic pressure as a marker of LV dysfunction soon after MI. Direct measurements of LV end-diastolic pressure were made and DE was performed simultaneously 1 week after surgica...

  5. Passive and active ventricular elastances of the left ventricle

    Directory of Open Access Journals (Sweden)

    Ng Eddie YK

    2005-02-01

    Full Text Available Abstract Background Description of the heart as a pump has been dominated by models based on elastance and compliance. Here, we are presenting a somewhat new concept of time-varying passive and active elastance. The mathematical basis of time-varying elastance of the ventricle is presented. We have defined elastance in terms of the relationship between ventricular pressure and volume, as: dP = EdV + VdE, where E includes passive (Ep and active (Ea elastance. By incorporating this concept in left ventricular (LV models to simulate filling and systolic phases, we have obtained the time-varying expression for Ea and the LV-volume dependent expression for Ep. Methods and Results Using the patient's catheterization-ventriculogram data, the values of passive and active elastance are computed. Ea is expressed as: ; Epis represented as: . Ea is deemed to represent a measure of LV contractility. Hence, Peak dP/dt and ejection fraction (EF are computed from the monitored data and used as the traditional measures of LV contractility. When our computed peak active elastance (Ea,max is compared against these traditional indices by linear regression, a high degree of correlation is obtained. As regards Ep, it constitutes a volume-dependent stiffness property of the LV, and is deemed to represent resistance-to-filling. Conclusions Passive and active ventricular elastance formulae can be evaluated from a single-beat P-V data by means of a simple-to-apply LV model. The active elastance (Ea can be used to characterize the ventricle's contractile state, while passive elastance (Ep can represent a measure of resistance-to-filling.

  6. A Rare Cardiac Malformation in a Patient Presenting with Transient Ischemic Attack: Isolated Left Ventricular Diverticulum

    Directory of Open Access Journals (Sweden)

    Haldun Müderrisoğlu1

    2012-12-01

    Full Text Available Left ventricular diverticulum is a rare congenital malformation consisting of a localized protrusion of the endocardium and myocardium from the free wall of the left ventricle (LV. The prevalence of the disease is 0.26% in nonselected patients who underwent cardiac catheterization. It is believed that the etiology is an intrinsic abnormality developing during embryogenesis. It often does not cause any symptoms. We report a case of isolated left ventricular diverticulum with complaints of transient ischemic attack.

  7. Giant and thrombosed left ventricular aneurysm

    Institute of Scientific and Technical Information of China (English)

    Jose; Alberto; de; Agustin; Jose; Juan; Gomez; de; Diego; Pedro; Marcos-Alberca; Jose; Luis; Rodrigo; Carlos; Almeria; Patricia; Mahia; Maria; Luaces; Miguel; Angel; Garcia-Fernandez; Carlos; Macaya; Leopoldo; Perez; de; Isla

    2015-01-01

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur,including heart failure,thromboembolism,or tachyarrhythmias. We report the case of a 78-yearold male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded,and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm,causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  8. Giant and thrombosed left ventricular aneurysm.

    Science.gov (United States)

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  9. Feasibility of the left ventricular volume measurement by acoustic quantification method. Comparison with ultrafast computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tomimoto, Shigehiro; Nakatani, Satoshi; Tanaka, Norio; Uematsu, Masaaki; Beppu, Shintaro; Nagata, Seiki; Hamada, Seiki; Takamiya, Makoto; Miyatake, Kunio [National Cardiovascular Center, Suita, Osaka (Japan)

    1995-01-01

    Acoustic quantification (AQ: the real-time automated boundary detection system) allows instantaneous measurement of cardiac chamber volumes. The feasibility of this method was evaluated by comparing the left ventricular (LV) volumes obtained with AQ to those derived from ultrafast computed tomography (UFCT), which enables accurate measurements of LV volumes even in the presence of LV asynergy, in 23 patients (8 with ischemic heart disease, 5 with cardiomyopathy, 3 with valvular heart disease). Both LV end-diastolic and end-systolic volumes obtained with the AQ method were in good agreement with those obtained with UFCT (y=1.04{chi}-16.9, r=0.95; y=0.87{chi}+15.7, r=0.91; respectively). AQ was reliable even in the presence of LV asynergy. Interobserver variability for the AQ measurement was 10.2%. AQ provides a new, clinically useful method for real-time accurate estimation of the left ventricular volume. (author).

  10. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    We sought to investigate the relation between left ventricular (LV) and right ventricular (RV) function assessed with the Doppler-derived myocardial performance index (MPI), to assess serial changes, and to investigate the prognostic value of biventricular assessment of cardiac function after...... a first myocardial infarction (MI). To do so, serial Doppler echocardiography was performed in 77 consecutive patients with a first MI. Right ventricular MPI correlated significantly with LV MPI (r = 0.51, P ....59 +/- 0.18 versus 0.44 +/- 0.19, P =.001), whereas no difference in LV MPI was seen (0.55 +/- 0.19 versus 0.56 +/- 0.13, P = not significant). Right ventricular MPI showed a rapid normalization during follow-up, whereas LV MPI did not decrease. During follow-up, 23 patients died of cardiac causes or were...

  11. Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Abderrahmane Bakkali

    2016-12-01

    Full Text Available Objective: The aim of this study was to evaluate the effect of aortic valve replacement on left ventricular function and remodeling among patients with severe aortic stenosis and severe left ventricular dysfunction. Methods: In this retrospective bicentric study extended over a 15-year period, 61 consecutive patients underwent isolated AVR for severe AS associated to reduced LV function. The mean age was 58.21 ± 12.50 years and 83.60 % were men. 70.50% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF was 32.9 ± 5.6.The mean LVEDD and LVESD were respectively 63.6 ± 9.2 and 50.2 ± 8.8 mm. The mean calculated logistic EuroScore was 12.2 ±4.5. Results: The hospital mortality was 11.5%. Morbidity was marked mainly by low output syndrome in 40.8% of cases. After a median follow-up of 38 months we have recorded 3 deaths. Almost all survivors were in class I and II of NYHA. The mean LV end-diastolic and end-systolic diameters decreased significantly at late postoperative stage. The mean LV ejection fraction increased significantly from 32.9 ± 5.6 to 38.2 ± 9.3 and to 50.3 ± 9.6 in early and late postoperative stages, respectively. Multivariate linear regression analysis found that increased early postoperative LVEF (β= 0.44, 95% CI [0.14; 0.75], p=0.006 and low mean transprosthesis gradient (β=-0.72, 95% CI [-1.42; -0.02], p= 0.04 were the independent predictors of left ventricular systolic function recovery. Conclusion: Patients with aortic valve stenosis and impaired LV systolic function benefited from AVR as regard improvement of LV function parameters and regression of the LV diameters .This improvement depends mainly on early postoperative LVEF and mean transprosthesis gradient.

  12. Improvement of exercise capacity and left ventricular diastolic function with metoprolol XL after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Egstrup, K

    2000-01-01

    BACKGROUND: Left ventricular (LV) diastolic function predicts and correlates with exercise capacity. Beta-blockers improve exercise capacity and LV diastolic function in patients with severe LV systolic dysfunction in dilated cardiomyopathy. However, information on the effect of metoprolol XL...... on exercise capacity in relation to LV diastolic function in patients with mild to moderate LV systolic dysfunction after acute myocardial infarction is limited. METHODS: In a randomized, double-blind, placebo-controlled study of 77 patients, a subgroup of 59 patients with mild to moderate LV systolic...... dysfunction after acute myocardial infarction were given metoprolol XL (n = 29) or placebo (n = 30). The effects of metoprolol XL on exercise capacity in relation to effects on LV diastolic filling were studied. Two-dimensional Doppler echocardiography and maximal symptom limited bicycle test were performed...

  13. Beneficial effects of the Ca2+ sensitizer EMD 57033 in exercising pigs with infarction-induced chronic left ventricular dysfunction.

    NARCIS (Netherlands)

    D.J.G.M. Duncker (Dirk); D.B. Haitsma; D. Liem (Djien); N. Heins; R. Stubenitsky (René); P.D. Verdouw (Pieter)

    2001-01-01

    textabstract1. It is unknown how cardiac stimulation by Ca(2+) sensitization modulates the cardiovascular response to exercise when left ventricular (LV) function is chronically depressed following a myocardial infarction. We therefore investigated the effects of EMD 57033 at rest

  14. Development of left ventricular hypertrophy in a novel porcine model of mitral regurgitation

    DEFF Research Database (Denmark)

    Ravn, Nathja; Zois, Nora Elisabeth; Moesgaard, Sophia Gry

    2014-01-01

    OBJECTIVES: We aimed to develop a porcine model for chronic nonischemic mitral regurgitation (MR) to investigate left ventricular (LV) enlargement and eccentric hypertrophy. DESIGN: Nonischemic MR was induced in 30 pigs by open-chest immobilization of the posterior mitral leaflet by transannular...... traction sutures that where applied in transmyocardial fashion. A sham operated control group (n = 13) was included. Echocardiographic LV size and heart weight assessed at euthanasia were used to evaluate the development of LV enlargement and eccentric hypertrophy after 8 weeks follow-up. RESULTS: Eight...... for chronic moderate to severe nonischemic MR with development of LV enlargement and eccentric hypertrophy within 8 weeks has been established in pigs....

  15. Aortic Wave Dynamics and Its Influence on Left Ventricular Workload

    Science.gov (United States)

    Pahlevan, Niema; Gharib, Morteza

    2010-11-01

    Clinical and epidemiologic studies have shown that hypertension plays a key role in development of left ventricular (LV) hypertrophy and ultimately heart failure mostly due to increased LV workload. Therefore, it is crucial to diagnose and treat abnormal high LV workload at early stages. The pumping mechanism of the heart is pulsatile, thus it sends pressure and flow wave into the compliant aorta. The wave dynamics in the aorta is dominated by interplay of heart rate (HR), aortic rigidity, and location of reflection sites. We hypothesized that for a fixed cardiac output (CO) and peripheral resistance (PR), interplay of HR and aortic compliance can create conditions that minimize LV power requirement. We used a computational approach to test our hypothesis. Finite element method with direct coupling method of fluid-structure interaction (FSI) was used. Blood was assumed to be incompressible Newtonian fluid and aortic wall was considered elastic isotropic. Simulations were performed for various heart rates and aortic rigidities while inflow wave, CO, and PR were kept constant. For any aortic compliance, LV power requirement becomes minimal at a specific heart rate. The minimum shifts to higher heart rates as aortic rigidity increases.

  16. Left ventricular and aortic dysfunction in cystic fibrosis mice.

    Science.gov (United States)

    Sellers, Zachary M; Kovacs, Attila; Weinheimer, Carla J; Best, Philip M

    2013-09-01

    Left ventricular (LV) abnormalities have been reported in cystic fibrosis (CF); however, it remains unclear if loss of cystic fibrosis transmembrane conductance regulator (CFTR) function causes heart defects independent of lung disease. Using gut-corrected F508del CFTR mutant mice (ΔF508), which do not develop human lung disease, we examined in vivo heart and aortic function via 2D transthoracic echocardiography and LV catheterization. ΔF508 mouse hearts showed LV concentric remodeling along with enhanced inotropy (increased +dP/dt, fractional shortening, decreased isovolumetric contraction time) and greater lusitropy (-dP/dt, Tau). Aortas displayed increased stiffness and altered diastolic flow. β-adrenergic stimulation revealed diminished cardiac reserve (attenuated +dP/dt,-dP/dt, LV pressure). In a mouse model of CF, CFTR mutation leads to LV remodeling with alteration of cardiac and aortic functions in the absence of lung disease. As CF patients live longer, more active lives, their risk for cardiovascular disease should be considered. Copyright © 2012 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  17. Impact of right-ventricular apical pacing on the optimal left-ventricular lead positions measured by phase analysis of SPECT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Changhua (China); China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China); Huang, Jin-Long [Taichung Veterans General Hospital, Cardiovascular Center, Taichung (China); School of Medicine, National Yang-Ming University, Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, Taipei (China); Chung-Shan Medical University, Department of Medicine, School of Medicine, Taichung (China); Lin, Wan-Yu; Tsai, Shih-Chung [Taichung Veterans General Hospital, Department of Nuclear Medicine, Taichung (China); Wang, Kuo-Yang [Taichung Veterans General Hospital, Cardiovascular Center, Taichung (China); Chung-Shan Medical University, Department of Medicine, School of Medicine, Taichung (China); Chen, Shih-Ann [School of Medicine, National Yang-Ming University, Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, Taipei (China); Taipei Veterans General Hospital, Division of Cardiology, Department of Medicine, Taipei (China); Lloyd, Michael S.; Chen, Ji [Emory University, Department of Radiology and Imaging Sciences, Atlanta, GA (United States)

    2014-06-15

    The use of SPECT phase analysis to optimize left-ventricular (LV) lead positions for cardiac resynchronization therapy (CRT) was performed at baseline, but CRT works as simultaneous right ventricular (RV) and LV pacing. The aim of this study was to assess the impact of RV apical (RVA) pacing on optimal LV lead positions measured by SPECT phase analysis. This study prospectively enrolled 46 patients. Two SPECT myocardial perfusion scans were acquired under sinus rhythm with complete left bundle branch block and RVA pacing, respectively, following a single injection of {sup 99m}Tc-sestamibi. LV dyssynchrony parameters and optimal LV lead positions were measured by the phase analysis technique and then compared between the two scans. The LV dyssynchrony parameters were significantly larger with RVA pacing than with sinus rhythm (p ∝0.01). In 39 of the 46 patients, the optimal LV lead positions were the same between RVA pacing and sinus rhythm (kappa = 0.861). In 6 of the remaining 7 patients, the optimal LV lead positions were along the same radial direction, but RVA pacing shifted the optimal LV lead positions toward the base. The optimal LV lead positions measured by SPECT phase analysis were consistent, no matter whether the SPECT images were acquired under sinus rhythm or RVA pacing. In some patients, RVA pacing shifted the optimal LV lead positions toward the base. This study supports the use of baseline SPECT myocardial perfusion imaging to optimize LV lead positions to increase CRT efficacy. (orig.)

  18. Left atrial strain: a new parameter for assessment of left ventricular filling pressure.

    Science.gov (United States)

    Cameli, Matteo; Mandoli, Giulia Elena; Loiacono, Ferdinando; Dini, Frank Lloyd; Henein, Michael; Mondillo, Sergio

    2016-01-01

    In order to obtain accurate diagnosis, treatment and prognostication in many cardiac conditions, there is a need for assessment of left ventricular (LV) filling pressure. While systole depends on ejection function of LV, diastole and its disturbances influence filling function and pressures. The commonest condition that represents the latter is heart failure with preserved ejection fraction in which LV ejection is maintained, but diastole is disturbed and hence filling pressures are raised. Significant diastolic dysfunction results in raised LV end-diastolic pressure, mean left atrial (LA) pressure and pulmonary capillary wedge pressure, all referred to as LV filling pressures. Left and right heart catheterization has traditionally been used as the gold standard investigation for assessing these pressures. More recently, Doppler echocardiography has taken over such application because of its noninvasive nature and for being patient friendly. A number of indices are used to achieve accurate assessment of filling pressures including: LV pulsed-wave filling velocities (E/A ratio, E wave deceleration time), pulmonary venous flow (S wave and D wave), tissue Doppler imaging (E' wave and E/E' ratio) and LA volume index. LA longitudinal strain derived from speckle tracking echocardiography (STE) is also sensitive in estimating intracavitary pressures. It is angle-independent, thus overcomes Doppler limitations and provides highly reproducible measures of LA deformation. This review examines the application of various Doppler echocardiographic techniques in assessing LV filling pressures, in particular the emerging role of STE in assessing LA pressures in various conditions, e.g., HF, arterial hypertension and atrial fibrillation.

  19. Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases; Evaluation with gated blood pool scintigraphy using [sup 99m]Tc

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tomiro (Okayama Univ. (Japan). School of Medicine)

    1993-06-01

    Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author).

  20. Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

    Science.gov (United States)

    Kudaiberdiev, Taalaibek; Akhmedova, Irina; Imanalieva, Gulzada; Abdildaev, Ildar; Jooshev, Kilichbek; Ashimov, Jamalbek; Mirzabekov, Azamat; Gaybildaev, Janibek

    2017-01-01

    Objective: We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium. Methods: The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago. Results: Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function. Conclusion: Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture. PMID:28228965

  1. Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Taalaibek Kudaiberdiev

    2017-01-01

    Full Text Available Objective: We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium. Methods: The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago. Results: Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function. Conclusion: Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

  2. Neurohumoral prediction of left-ventricular morphologic response to beta-blockade with metoprolol in chronic left-ventricular systolic heart failure

    DEFF Research Database (Denmark)

    Groenning, Bjoern A; Nilsson, Jens C; Hildebrandt, Per R

    2002-01-01

    BACKGROUND: In order to tailor therapy in heart failure, a solution might be to develop sensitive and reliable markers that can predict response in individual patients or monitor effectiveness of therapy. AIMS: To evaluate neurohumoral factors as markers for left-ventricular (LV) antiremodelling...... from metoprolol treatment in patients with chronic LV systolic heart failure. METHODS: Forty-one subjects randomised to placebo or metoprolol were studied with magnetic resonance imaging and blood samples to measure LV dimensions and ejection fraction, epinephrine, norepinephrine, plasma renin activity......-treatment plasma level of ANP may be a predictor of LV antiremodelling from treatment with metoprolol in patients with chronic heart failure. However, the potential for individual neurohumoral monitoring of the effects on LV dimensions during beta-blockade appears limited....

  3. Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial

    DEFF Research Database (Denmark)

    Daubert, Claude; Gold, Michael R; Abraham, William T;

    2009-01-01

    that CRT slows disease progression and improves the outcomes of asymptomatic or mildly symptomatic patients with left ventricular (LV) dysfunction and a wide QRS complex. METHODS: We randomly assigned 262 recipients of CRT pacemakers or defibrillators, with QRS > or =120 ms and LV ejection fraction...

  4. Comparison of regional versus global assessment of left ventricular function in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction: the valsartan in acute myocardial infarction echocardiographic study

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Køber, Lars; Pfeffer, Marc A

    2006-01-01

    BACKGROUND: Left ventricular (LV) ejection fraction (EF) and wall-motion index (WMI) have both been shown to be independent predictors of outcome after myocardial infarction (MI). OBJECTIVES: We sought to determine whether these two measurements of LV systolic function provide similar or compleme...

  5. Survival after blunt left ventricular rupture with cardiac tamponade

    Institute of Scientific and Technical Information of China (English)

    Yu-Jang Su; Chang-Chih Chen

    2013-01-01

    A34-year-old man was drunk and drove to hit a traffic island.Cold sweating and unconscious status were found on arrival.Vital signs revealedBP42/25, and heart rate121/min.There was massive pericardial effusion with cardiac tamponade found byCT.Immediate surgical intervention and rupture of left ventricular(LV) free wall was found.He was discharged after2 d intensive care unit(ICU) observation and5-day regular ward care.There is high mortality rate in traumatic heart rupture although timely repair, over all mortality is around20%-36% in recent3 years.

  6. Survival after blunt left ventricular rupture with cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2013-01-01

    Full Text Available A 34-year-old man was drunk and drove to hit a traffic island. Cold sweating and unconscious status were found on arrival. Vital signs revealed BP 42/25, and heart rate 121/min. There was massive pericardial effusion with cardiac tamponade found by CT. Immediate surgical intervention and rupture of left ventricular (LV free wall was found. He was discharged after 2 d intensive care unit (ICU observation and 5-day regular ward care. There is high mortality rate in traumatic heart rupture although timely repair, over all mortality is around 20%-36% in recent 3 years.

  7. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study

    DEFF Research Database (Denmark)

    Verma, Anil; Meris, Alessandra; Skali, Hicham

    2008-01-01

    OBJECTIVES: This study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction. BACKGROUND: The LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse ca...

  8. Impact of the papillary muscles on cardiac magnetic resonance image analysis of important left ventricular parameters in hypertrophic cardiomyopathy

    NARCIS (Netherlands)

    Gommans, D.H.F.; Bakker, J.; Cramer, G.E.; Verheugt, F.W.A.; Brouwer, M.A.; Kofflard, M.J.M.

    2016-01-01

    PURPOSE: The use of cardiac magnetic resonance (CMR) analysis has increased in patients with hypertrophic cardiomyopathy (HCM). Quantification of left ventricular (LV) measures will be affected by the inclusion or exclusion of the papillary muscles as part of the LV mass, but the magnitude of effect

  9. Isolated left ventricular apical hypoplasia with infundibular pulmonary and aortic stenosis: A rare combination

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Jin Il; Jeong, Yeon Joo; Lee, Gee Won; Choi, Jung Hyun; Lee, Ji Won [Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)

    2013-12-15

    Isolated left ventricular (LV) apical hypoplasia is a rare congenital cardiac anomaly which is not accompanied by other cardiac abnormalities, with the exception of two cases. We report a case of a 33-year-old male patient with isolated LV apical hypoplasia combined with infundibular pulmonary stenosis and aortic stenosis. We review a literature focusing on the characteristic magnetic resonance features and combined cardiac abnormalities.

  10. Asymmetric left ventricular hypertrophy associated with morbid obesity mimicking familial hypertrophic cardiomyopathy.

    Science.gov (United States)

    Wong, Raymond Ching-Chiew; Tan, Kong Bing

    2014-12-01

    Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve is frequently a phenotypic, but not pathognomonic, expression of genetic hypertrophic cardiomyopathy (HCM) with or without obstruction. It can, however, be associated nonspecifically with other forms of increased left ventricular (LV) afterload. We herein report the case of a young man with obesity cardiomyopathy and heart failure who presented with asymmetric septal hypertrophy and marked LV hypertrophy, and endomyocardial biopsy ruled out genetic HCM.

  11. Echocardiographic mapping of left ventricular resynchronization during cardiac resynchronization therapy procedures

    Institute of Scientific and Technical Information of China (English)

    CHAN Ngai-yin; CHOY Chi-chung; CHEUNG Kar-chun; LAU Chun-leung; LO Ying-keung; CHU Pui-shan; YUEN Ho-chuen; LAU Suet-ting; CHOI Yuen-choi

    2010-01-01

    Background Cardiac resynchronization therapy (CRT) is an effective electrical therapy for patients with moderate to severe heart failure and cardiac dyssynchrony. This study aimed to investigate the degree of acute left ventricular (LV)resynchronization with biventricular pacing (BVP) at different LV sites and to examine the feasibility of performing transthoracic echocardiography (TTE) to quantify acute LV resynchronization during CRT procedure.Methods Fourteen patients with NYHA Class ⅢⅣ heart failure, LV ejection fraction ≤35%, QRS duration ≥120 ms and septal-lateral delay (SLD) ≥60 ms on tissue Doppler imaging (TDI), underwent CRT implant. TDI was obtained from three apical views during BVP at each accessible LV site and SLD during BVP was derived. Synchronicity gain index (Sg) by SLD was defined as (1+(SLD at baseline - SLD at BVP)/SLD at baseline).Results Seventy-two sites were studied. Positive resynchronization (R+, Sg>1) was found in 42 (58%) sites. R+ was more likely in posterior or lateral than anterior LV sites (66% vs. 36%, P <0.001). Concordance of empirical LV lead implantation sites and sites with R+ was 50% (7/14).Conclusions The degree of acute LV resynchronization by BVP depends on LV lead location and empirical implantation of LV lead results in only 50% concordance with R+. Performing TTE during CRT implantation is feasible to identify LV sites with positive resynchronization.

  12. Cardiac Magnetic Resonance Imaging in the Diagnosis of Anterolateral Left Ventricular Ballooning, a Variant of Classic Takotsubo Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    R. Zbinden

    2012-01-01

    Full Text Available Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks.

  13. Females have greater left ventricular twist mechanics than males during acute reductions to preload.

    Science.gov (United States)

    Williams, Alexandra M; Shave, Rob E; Stembridge, Mike; Eves, Neil D

    2016-07-01

    Compared to males, females have smaller left ventricular (LV) dimensions and volumes, higher ejection fractions (EF), and higher LV longitudinal and circumferential strain. LV twist mechanics determine ventricular function and are preload-dependent. Therefore, the sex differences in LV structure and myocardial function may result in different mechanics when preload is altered. This study investigated sex differences in LV mechanics during acute challenges to preload. With the use of conventional and speckle-tracking echocardiography, LV structure and function were assessed in 20 males (24 ± 6.2 yr) and 20 females (23 ± 3.1 yr) at baseline and during progressive levels of lower body negative pressure (LBNP). Fourteen participants (8 males, 6 females) were also assessed following a rapid infusion of saline. LV end-diastolic volume, end-systolic volume, stroke volume (SV), and EF were reduced in both groups during LBNP (P mechanics following saline infusion. Females have larger LV twist and a faster untwisting velocity than males during large reductions to preload, supporting that females have a greater reliance on LV twist mechanics to maintain SV during severe reductions to preload.

  14. Case series: Congenital left ventricular diverticulum

    Directory of Open Access Journals (Sweden)

    Shah Dharita

    2010-01-01

    Full Text Available Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac chamber. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture can be the initial presentation. Diagnosis can be established by USG, echocardiography, CT angiography, and MRI. We report here two neonates with congenital left ventricular apical diverticulum associated with epigastric hernia.

  15. Hemodynamic improvement in cardiac resynchronization does not require improvement in left ventricular rotation mechanics: three-dimensional tagged MRI analysis.

    Science.gov (United States)

    Ashikaga, Hiroshi; Leclercq, Christophe; Wang, Jiangxia; Kass, David A; McVeigh, Elliot R

    2010-07-01

    Earlier studies have yielded conflicting evidence on whether or not cardiac resynchronization therapy (CRT) improves left ventricular (LV) rotation mechanics. In dogs with left bundle branch block and pacing-induced heart failure (n=7), we studied the effects of CRT on LV rotation mechanics in vivo by 3-dimensional tagged magnetic resonance imaging with a temporal resolution of 14 ms. CRT significantly improved hemodynamic parameters but did not significantly change the LV rotation or rotation rate. LV torsion, defined as LV rotation of each slice with respect to that of the most basal slice, was not significantly changed by CRT. CRT did not significantly change the LV torsion rate. There was no significant circumferential regional heterogeneity (anterior, lateral, inferior, and septal) in LV rotation mechanics in either left bundle branch block with pacing-induced heart failure or CRT, but there was significant apex-to-base regional heterogeneity. CRT acutely improves hemodynamic parameters without improving LV rotation mechanics. There is no significant circumferential regional heterogeneity of LV rotation mechanics in the mechanically dyssynchronous heart. These results suggest that LV rotation mechanics is an index of global LV function, which requires coordination of all regions of the left ventricle, and improvement in LV rotation mechanics appears to be a specific but insensitive index of acute hemodynamic response to CRT.

  16. Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey.

    Science.gov (United States)

    van Geldorp, Irene E; Delhaas, Tammo; Gebauer, Roman A; Frias, Patrick; Tomaske, Maren; Friedberg, Mark K; Tisma-Dupanovic, Svjetlana; Elders, Jan; Früh, Andreas; Gabbarini, Fulvio; Kubus, Petr; Illikova, Viera; Tsao, Sabrina; Blank, Andreas Christian; Hiippala, Anita; Sluysmans, Thierry; Karpawich, Peter; Clur, Sally-Ann; Ganame, Xavier; Collins, Kathryn K; Dann, Gisela; Thambo, Jean-Benoît; Trigo, Conceição; Nagel, Bert; Papagiannis, John; Rackowitz, Annette; Marek, Jan; Nürnberg, Jan-Hendrik; Vanagt, Ward Y; Prinzen, Frits W; Janousek, Jan

    2011-12-01

    Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function. In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated. Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age 1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics. From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n = 147), RV endocardium (RVendo, n = 113) or LV epicardium (LVepi, n = 37). LVFS was significantly affected by pacing site (p = 0.001), and not by maternal autoantibody status (p = 0.266). LVFS in LVepi (39 ± 5%) was significantly higher than in RVendo (33 ± 7%, p < 0.001) and RVepi (35 ± 8%, p = 0.001; no significant difference between RV-paced groups, p = 0.275). Subnormal LVFS (LVFS < 28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS ≥ 28%) in all LVepi-paced children (p = 0.049). These results are supported by the findings for LVEF (n = 122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥ 50% in 17/18 (94%) LVepi-paced patients. In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.

  17. Interaction of Left Ventricular Remodeling and Regional Dyssynchrony on Long-Term Prognosis after Cardiac Resynchronization Therapy

    DEFF Research Database (Denmark)

    Tayal, Bhupendar; Sogaard, Peter; Delgado-Montero, Antonia

    2017-01-01

    BACKGROUND: Left ventricular (LV) remodeling in heart failure (HF) manifested by chamber dilatation is associated with worse clinical outcomes. However, the impact of LV dilatation on the association of measures of dyssynchrony with long-term prognosis and resynchronization potential after cardiac...... was associated with the resynchronization ability of CRT. CONCLUSIONS: Patients with severe LV remodeling (EDVI ≥ 90 mL/m(2)) have a poor prognosis following CRT device implantation. This is most likely due to impaired resynchronization efficacy....

  18. Outcome of Prolonged Ventricular Fibrillation and CPR in a Rat Model of Chronic Ischemic Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Xiangshao Fang

    2013-01-01

    Full Text Available Patients with chronic left ventricular (LV dysfunction are assumed to have a lower chance of successful CPR and lower likelihood of ultimate survival. However, these assumptions have rarely been documented. Therefore, we investigated the outcome of prolonged ventricular fibrillation (VF and CPR in a rat model of chronic LV dysfunction. Sprague-Dawley rats were randomized to (1 chronic LV dysfunction: animals underwent left coronary artery ligation; and (2 sham control. Echocardiography was used to measure cardiac performance before surgery and 4 weeks after surgery. Four weeks after surgical intervention, 8 min of VF was induced and defibrillation was delivered after 8 min of CPR. LV dilation and low ejection fraction were observed 4 weeks after coronary ligation. With optimal chest compressions, coronary perfusion pressure values during CPR were well maintained and indistinguishable between groups. There were no differences in resuscitability and numbers of shock required for successful resuscitation between groups. Despite the significantly decreased cardiac index in LV dysfunction animals before induction of VF, no differences in cardiac index were observed between groups following resuscitation, which was associated with the insignificant difference in postresuscitation survival. In conclusion, the outcomes of CPR were not compromised by the preexisting chronic LV dysfunction.

  19. Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Boogers, Mark J. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); The Interuniversity Cardiology Institute of the Netherlands, Utrecht (Netherlands); Chen, Ji; Garcia, Ernest V. [Emory University School of Medicine, Department of Radiology, Atlanta, GA (United States); Bommel, Rutger J. van; Borleffs, C.J.W.; Schalij, Martin J.; Wall, Ernst E. van der; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Dibbets-Schneider, Petra; Hiel, Bernies van der; Younis, Imad Al [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

    2011-02-15

    The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT). The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of {>=}15% in LVESV. Enrolled in the study were 90 patients (72% men, 67{+-}10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables. Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements. (orig.)

  20. Temporal pattern of left ventricular structural and functional remodeling following reversal of volume overload heart failure

    Science.gov (United States)

    Hutchinson, Kirk R.; Guggilam, Anuradha; Cismowski, Mary J.; Galantowicz, Maarten L.; West, Thomas A.; Stewart, James A.; Zhang, Xiaojin; Lord, Kevin C.

    2011-01-01

    Current surgical management of volume overload-induced heart failure (HF) leads to variable recovery of left ventricular (LV) function despite a return of LV geometry. The mechanisms that prevent restoration of function are unknown but may be related to the timing of intervention and the degree of LV contractile impairment. This study determined whether reduction of aortocaval fistula (ACF)-induced LV volume overload during the compensatory stage of HF results in beneficial LV structural remodeling and restoration of pump function. Rats were subjected to ACF for 4 wk; a subset then received a load-reversal procedure by closing the shunt using a custom-made stent graft approach. Echocardiography or in vivo pressure-volume analysis was used to assess LV morphology and function in sham rats; rats subjected to 4-, 8-, or 15-wk ACF; and rats subjected to 4-wk ACF followed by 4- or 11-wk reversal. Structural and functional changes were correlated to LV collagen content, extracellular matrix (ECM) proteins, and hypertrophic markers. ACF-induced volume overload led to progressive LV chamber dilation and contractile dysfunction. Rats subjected to short-term reversal (4-wk ACF + 4-wk reversal) exhibited improved chamber dimensions (LV diastolic dimension) and LV compliance that were associated with ECM remodeling and normalization of atrial and brain natriuretic peptides. Load-independent parameters indicated LV systolic (preload recruitable stroke work, Ees) and diastolic dysfunction (tau, arterial elastance). These changes were associated with an altered α/β-myosin heavy chain ratio. However, these changes were normalized to sham levels in long-term reversal rats (4-wk ACF + 11-wk reversal). Acute hemodynamic changes following ACF reversal improve LV geometry, but LV dysfunction persists. Gradual restoration of function was related to normalization of eccentric hypertrophy, LV wall stress, and ECM remodeling. These results suggest that mild to moderate LV systolic

  1. Surgical Treatment of Left Ventricular Pseudoaneurysm

    Science.gov (United States)

    Mujanovic, Emir; Bergsland, Jacob; Avdic, Sevleta; Stanimirovic-Mujanovic, Sanja; Kovacevic-Preradovic, Tamara; Kabil, Emir

    2014-01-01

    Introduction: Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a cata­strophic complication of myocardial infarction, occurring in approximately 4% of pa­tients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. Case report: In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients. PMID:25568538

  2. Prevalence and determinants of left ventricular geometric abnormalities in hypertensive patients: A study based on the updated classification system of left ventricular geometry.

    Science.gov (United States)

    Sha, Tao; Huang, Yu-Qing; Cai, An-Ping; Huang, Cheng; Zhang, Ying; Chen, Ji-Yan; Zhou, Ying-Ling; Yu, Xue-Ju; Zhou, Dan; Tang, Song-Tao; Feng, Ying-Qing; Tan, Ning

    This study was to determine whether different risk factors were associated with different type of left ventricular (LV) geometric abnormalities. This retrospective analysis included 2290 hypertensive participants without other cardiovascular disease, valve disease and with ejection fraction ≥50%. The type of LV geometric abnormality was defined on the basis of the new classification system. LV geometric abnormalities were detected in 1479 subjects (64.6%), wherein concentric LV remodeling is the most common LV geometric abnormality (40.3%). Large waist circumference (WC) and neck circumference (NC) were positively associated with concentric LV remodeling, whereas body mass index (BMI) [odds ratio (OR) 0.89, 95% CI 0.85∼0.92, P < 0.001] and systolic blood pressure (SBP) (OR 0.99, 95% CI 0.98∼0.99, P = 0.018) were inversely associated with concentric abnormalities. SBP and age were positively associated with eccentric dilated LVH, while male was inversely associated with eccentric dilated left ventricular hypertrophy (LVH). Age was the strongest risk factor for eccentric dilated LVH (OR 1.05, 95% CI 1.03∼1.07, P < 0.001). Age, NC, SBP, hyperuricemia, and alcohol use were positively associated with concentric LVH, whereas BMI (OR 0.95, 95% CI 0.90∼0.99, P = 0.033) and male (OR 0.12, 95% CI 0.07∼0.18, P < 0.001) were negatively associated with concentric LVH. The prevalence of hypertensive LV geometric abnormality in rural area of Southern China was obvious higher. Compared with eccentric LV geometric abnormalities, there were more risk factors, including large WC and NC, age, NC, SBP, hyperuricemia, alcohol use, BMI and gender, which were associated with concentric LV geometric abnormalities. Copyright © 2017 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  3. Two different cardiomyopathies in a single patient : hypertrophic cardiomyopathy and left ventricular noncompaction.

    Science.gov (United States)

    Sunbul, M; Ozben, B; Mutlu, B

    2013-05-01

    Hypertrophic cardiomyopathy is a complex and relatively common genetic disorder characterized by left ventricular (LV) hypertrophy, usually associated with a nondilated and hyperdynamic chamber with heterogeneous phenotypic expression and clinical course. On the other hand, LV noncompaction is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with a pattern of prominent trabecular meshwork and deep intertrabecular recesses, systolic dysfunction, and LV dilatation. We report a 29-year-old man with these two different inherent conditions. Our case raises the possibility of a genetic mutation common to these two clinical entities or different gene mutations existing in the same individual.

  4. Peripartum Cardiomyopathy Presenting with Predominant Left Ventricular Diastolic Dysfunction: Efficacy of Bromocriptine

    Directory of Open Access Journals (Sweden)

    Piercarlo Ballo

    2012-01-01

    Full Text Available Management of patients with peripartum cardiomyopathy (PPCM is still a major clinical problem, as only half of them or slightly more show complete recovery of left ventricular (LV function despite conventional evidence-based treatment for heart failure. Recent observations suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. However, no evidence exists regarding its effect on LV diastolic dysfunction, which is commonly observed in these patients. Tissue Doppler (TD is an echocardiographic technique that provides unique information on LV diastolic performance. We report the case of a 37-year-old white woman with heart failure (NYHA class II, moderate LV systolic dysfunction (ejection fraction 35%, and severe LV diastolic dysfunction secondary to PPCM, who showed no improvement after 2 weeks of treatment with ramipril, bisoprolol, and furosemide. At 6-week followup after addition of bromocriptine, despite persistence of LV systolic dysfunction, normalization of LV diastolic function was shown by TD, together with improvement in functional status (NYHA I. At 18-month followup, the improvement in LV diastolic function was maintained, and normalization of systolic function was observed. This paper might support the clinical utility of bromocriptine in patients with PPCM by suggesting a potential benefit on LV diastolic dysfunction.

  5. Peripartum cardiomyopathy presenting with predominant left ventricular diastolic dysfunction: efficacy of bromocriptine.

    Science.gov (United States)

    Ballo, Piercarlo; Betti, Irene; Mangialavori, Giuseppe; Chiodi, Leandro; Rapisardi, Gherardo; Zuppiroli, Alfredo

    2012-01-01

    Management of patients with peripartum cardiomyopathy (PPCM) is still a major clinical problem, as only half of them or slightly more show complete recovery of left ventricular (LV) function despite conventional evidence-based treatment for heart failure. Recent observations suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. However, no evidence exists regarding its effect on LV diastolic dysfunction, which is commonly observed in these patients. Tissue Doppler (TD) is an echocardiographic technique that provides unique information on LV diastolic performance. We report the case of a 37-year-old white woman with heart failure (NYHA class II), moderate LV systolic dysfunction (ejection fraction 35%), and severe LV diastolic dysfunction secondary to PPCM, who showed no improvement after 2 weeks of treatment with ramipril, bisoprolol, and furosemide. At 6-week followup after addition of bromocriptine, despite persistence of LV systolic dysfunction, normalization of LV diastolic function was shown by TD, together with improvement in functional status (NYHA I). At 18-month followup, the improvement in LV diastolic function was maintained, and normalization of systolic function was observed. This paper might support the clinical utility of bromocriptine in patients with PPCM by suggesting a potential benefit on LV diastolic dysfunction.

  6. Left Ventricular Diastolic Function Assessment of a Heterogeneous Cohort of Pulmonary Arterial Hypertension Patients

    Science.gov (United States)

    Hernandez-Suarez, Dagmar F.; Lopez Menendez, Francisco R.; Palm, Denada; Lopez-Candales, Angel

    2017-01-01

    Background Pulmonary arterial hypertension (PAH) is known to trigger right ventricular (RV) remodeling that might compromise left ventricular (LV) filling due to inter-ventricular interdependence. In this study, we aimed to examine standard echocardiographic measurements of LV diastolic function in PAH patients. Methods In this retrospective study, we identified clinical as well as complete echocardiographic data from 128 chronic PAH patients to fully assess LV diastolic dysfunction (LVDD) using standard recommended Doppler guidelines. Accordingly, patients were divided into three groups: LVDD 0, LVDD 1 and LVDD 2. Results The mean age of the studied population was 57 ± 14 years with a mean pulmonary artery systolic pressure (PASP) of 55 ± 21 mm Hg. A total of 36% of the study patients had normal LV diastolic function. However, 64% had LVDD with LVDD stage 1 being the most common (48%). In terms of echocardiographic data, significant differences were found among the three LVDD groups in regards to PASP, LV end systolic and diastolic volumes, tricuspid annular plane systolic excursion, right ventricular fractional area change as well as many other tissue Doppler imaging parameters. Finally, just age and PASP were predictors of abnormal LV diastolic function (P < 0.05). Conclusions Impaired relaxation is a common abnormality in PAH patients. Additional studies are warranted to determine whether LVDD alters prognosis or is related to changes in the symptomatic profile of this group of patients. PMID:28270896

  7. Gated blood-pool SPECT automated versus manual left ventricular function calculations

    NARCIS (Netherlands)

    Slart, RHJA; Poot, L; Piers, DA; van Veldhuisen, DJ; Nichols, K; Jager, PL

    2004-01-01

    Planar gated blood-pool imaging (GBPI) is a standard method for non-invasive assessment of left ventricular (LV) function. Gated blood-pool single photon emission computed tomographic (GBPS) data acquisition can be accomplished in the same time as GBPI, with the benefit of enabling visualization of

  8. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction

    NARCIS (Netherlands)

    Santos, Angela B. S.; Kraigher-Krainer, Elisabeth; Bello, Natalie; Claggett, Brian; Zile, Michael R.; Pieske, Burkert; Voors, Adriaan A.; McMurray, John J. V.; Packer, Milton; Bransford, Toni; Lefkowitz, Marty; Shah, Amil M.; Solomon, Scott D.

    2014-01-01

    Aims Mechanical dyssynchrony has been postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF). Methods and results We quantified left ventricular (LV) systolic dyssynchrony in 130 HFpEF patients with NYHA class II-IV symptoms, ejection fraction (EF) 45, a

  9. Left ventricular diastolic function is associated with symptom status in severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Christensen, Nicolaj L; Videbæk, Lars

    2014-01-01

    BACKGROUND: In aortic valve stenosis (AS), the occurrence of heart failure symptoms does not always correlate with severity of valve stenosis and left ventricular (LV) function. Therefore, we tested the hypothesis that symptomatic patients with AS have impaired diastolic, longitudinal systolic fu...... for indices of AS severity. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00294775....

  10. Left ventricular twist and circumferential strain in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Olsen, N. T.; Moesgaard, S. G.

    2013-01-01

    During the cardiac cycle, the ventricle undergoes a twisting motion because of the oblique orientation of the left ventricular (LV) myofibers. This can be quantified by speckle-tracking echocardiography (STE). In mitral regurgitation (MR) in humans, the short axis deformation has been suggested...

  11. Independent prognostic value of left ventricular mass, diastolic function, and fasting plasma glucose

    DEFF Research Database (Denmark)

    Pareek, Manan; Nielsen, Mette Lundgren; Leósdóttir, Margrét

    2016-01-01

    OBJECTIVE: To explore the independent prognostic value of left ventricular (LV) mass, diastolic function, and fasting plasma glucose (FPG) for the prediction of incident cardiac events in a random population sample. DESIGN AND METHOD: 415 women and 999 men aged 56-79 years, included between 2002...

  12. Model-driven segmentation of X-ray left ventricular angiograms

    NARCIS (Netherlands)

    Oost, Cornelis Roel

    2008-01-01

    X-ray left ventricular (LV) angiography is an important imaging modality to assess cardiac function. Using a contrast fluid a 2D projection of the heart is obtained. In current clinical practice cardiac function is analyzed by drawing two contours manually: one in the end diastolic (ED) phase and on

  13. New method for cardiac resynchronization therapy: Transapical endocardial lead implantation for left ventricular free wall pacing

    NARCIS (Netherlands)

    I. Kassai (Imre); C. Foldesi (Csaba); A. Szekely (Andrea); T. Szili-Torok (Tamas)

    2008-01-01

    textabstractCoronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a significant dislocation rate during follow-up. For these patients, epicardial pacing lead implantation is the most frequen

  14. New method for cardiac resynchronization therapy: Transapical endocardial lead implantation for left ventricular free wall pacing

    NARCIS (Netherlands)

    I. Kassai (Imre); C. Foldesi (Csaba); A. Szekely (Andrea); T. Szili-Torok (Tamas)

    2008-01-01

    textabstractCoronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a significant dislocation rate during follow-up. For these patients, epicardial pacing lead implantation is the most

  15. Simple area-based measurement for multidetector computed tomography to predict left ventricular size

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, Christopher L.; Kwait, Dylan C.; Mahabadi, Amir A.; Hoffmann, Udo [Massachusetts General Hospital, and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Bamberg, Fabian [Massachusetts General Hospital, and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); University Hospitals Munich, and Ludwig Maximilians University, Department of Clinical Radiology, Munich (Germany); O' Donnell, Christopher J. [Lung and Blood Institute' s Framingham Heart Study, National Heart, Framingham (United States); Fox, Caroline S. [Lung and Blood Institute' s Framingham Heart Study, National Heart, Framingham (United States); Brigham and Women' s Hospital, and Harvard Medical School, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Boston, MA (United States)

    2010-07-15

    Measures of left ventricular (LV) mass and dimensions are independent predictors of morbidity and mortality. We determined whether an axial area-based method by computed tomography (CT) provides an accurate estimate of LV mass and volume. A total of 45 subjects (49% female, 56.0 {+-} 12 years) with a wide range of LV geometry underwent contrast-enhanced 64-slice CT. LV mass and volume were derived from 3D data. 2D images were analysed to determine LV area, the direct transverse cardiac diameter (dTCD) and the cardiothoracic ratio (CTR). Furthermore, feasibility was confirmed in 100 Framingham Offspring Cohort subjects. 2D measures of LV area, dTCD and CTR were 47.3 {+-} 8 cm{sup 2}, 14.7 {+-} 1.5 cm and 0.54 {+-} 0.05, respectively. 3D-derived LV volume (end-diastolic) and mass were 148.9 {+-} 45 cm{sup 3} and 124.2 {+-} 34 g, respectively. Excellent inter- and intra-observer agreement were shown for 2D LV area measurements (both intraclass correlation coefficients (ICC) = 0.99, p < 0.0001) and could be confirmed on non-contrast CT. The measured 2D LV area was highly correlated to LV volume, mass and size (r = 0.68; r = 0.73; r = 0.82; all p < 0.0001, respectively). On the other hand, CTR was not correlated to LV volume, mass, size or 2D LV area (all p > 0.27). Compared with traditionally used CTR, LV size can be accurately predicted based on a simple and highly reproducible axial LV area-based measurement. (orig.)

  16. RELATIONSHIP OF LEFT VENTRICULAR SIZE TO LEFT ATRIAL AND LEFT ATRIAL APPENDAGE SIZE IN SINUS RHYTHM PATIENTS WITH DILATED CARDIOMYOPATHY

    Science.gov (United States)

    Bakalli, Aurora; Georgievska-Ismail, Ljubica; Musliu, Nebi; Koçinaj, Dardan; Gashi, Zaim; Zeqiri, Nexhmi

    2012-01-01

    Introduction: Thromboembolic events are a frequent cause of mortality in patients with congestive heart failure. The aim of or study was to evaluate the relationship of left ventricular end diastolic diameter (LVEDD) to left atrial (LA) size and left atrial appendage (LAA) size in patients with dilated cardiomyopathy in sinus rhythm, as well as to determine the prevalence of thrombi in LV and LA /LAA. Methods: This was a prospective cross-sectional study, conducted from December 2009 until December 2011. The study included 95 patients with dilated cardiomyopathy in sinus rhythm. Patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flatter, severe systolic dysfunction, and/or patients who were taking oral anticoagulation therapy were excluded. Results: Mean patient age was 58.6 ± 12.2 years and 68.4% were men. Mean LVEDD of our population was 66.5 ± 6.5 mm, while mean LA atrium, LA volume and LAA maximal area were 46 ± 5.1 mm, 87.2 ± 38.7 cm3 and 4.7 ± 1.2 cm2, respectively. LA diameter (p<0.001) and LAA maximal area (p=0.01) showed to be independent predictors of LV size. LV thrombus was detected in 13 (13.7%) patients, while LAA thrombus in 46 (48.4%) patients of our study population. Conclusions: In conclusion, dilated LV size is associated with enlarged LA and LAA size. On the other hand, dilation of LV, LA and LAA is related to high prevalence of left chamber cardiac thrombi. PMID:23322961

  17. Postoperative normalization of left ventricular noncompaction and new echocardiographic signs in aorta to left ventricular tunnel.

    Science.gov (United States)

    Malakan Rad, Elaheh; Zeinaloo, Ali Akbar

    2013-04-01

    We report postoperative normalization of left ventricular noncompaction in a neonate undergoing successful neonatal surgery for type II aorta to left ventricular tunnel (ALVT) associated with a large patent ductus arteriosus, floppy and extremely redundant anterior mitral leaflet, right coronary artery arising directly from the tunnel, and severe left ventricular noncompaction. We also described 2 novel echocardiographic findings in ALVT including "triple wavy line sign" on M-mode echocardiography which disappeared 1 month after operation and "abnormally increased left ventricular posterior wall motion" on M-mode of standard parasternal long-axis view on color tissue Doppler imaging (TDI) that also normalized postoperatively. We showed that proper definition of endocardial border is extremely important in strain and strain rate imaging in the context of left ventricular noncompaction. Preoperative longitudinal strain and strain rate were significantly decreased in comparison to radial strain and strain rate. Circumferential strain and strain rate were normal. © 2013, Wiley Periodicals, Inc.

  18. Left ventricular remodeling in the first year after acute myocardial infarction and the predictive value of N-terminal pro brain natriuretic peptide

    DEFF Research Database (Denmark)

    Nilsson, Jens C; Groenning, Bjoern A; Nielsen, Gitte;

    2002-01-01

    BACKGROUND: Left ventricular (LV) remodeling after myocardial infarction (MI) has received much attention because of its severe impact on morbidity and mortality rates. However, the incidence and extent of LV remodeling in a modern infarct population who were offered antiremodeling treatment in c......, approximately 30% had significant increments develop in LVEDVI and LVESVI, and LV ejection fraction remained unchanged. Patients in whom LV dilatation developed could be identified early after the MI with elevated plasma levels of NT-proBNP...

  19. Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming

    Institute of Scientific and Technical Information of China (English)

    Sokratis; Pastromas; Antonis; S; Manolis

    2014-01-01

    Cardiac resynchronization therapy(CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class Ⅱ, Ⅲ and ambulatory Ⅳ, reduced left ventricular(LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes.

  20. Effect of pericardiocentesis on right and left ventricular function and volumes in pericardial effusion.

    Science.gov (United States)

    Manyari, D E; Kostuk, W J; Purves, P

    1983-07-01

    To assess the effects of pericardial effusion on ventricular performance and volumes, electrocardiographically gated blood pool cardiac scintigraphy was performed immediately before and after 14 pericardiocenteses in 10 patients, 7 men and 3 women, aged 28 to 73 years (mean 50). Cardiac tamponade was present in 5 patients. After removal of 140 to 1,100 ml of pericardial fluid (527 +/- 305 ml [mean +/- standard deviation]), left ventricular (LV) ejection fraction increased from 63 +/- 5 to 64 +/- 4% (p greater than 0.05) and right ventricular (RV) ejection fraction decreased from 47 +/- 4 to 46 +/- 2% (p greater than 0.05). LV end-diastolic and end-systolic volumes increased (p less than 0.01) by 28 and 33%, and RV volumes by 40 and 43%, respectively. There were 8 patients with normal LV function (ejection fraction greater than 60%) and 6 patients with subnormal LV function. Changes in ejection fraction were nonsignificant in the 4 subgroups. LV end-diastolic volume changes were more marked (p less than 0.01) in patients with cardiac tamponade (+ 56%) than in those without tamponade (+ 17%), and in those with normal LV function (+ 36%) than in those with subnormal LV function (+ 21%). RV end-diastolic volume increased more markedly (p less than 0.05) in patients with tamponade (+ 72%) than in those without tamponade (+ 23%), but were similar in patients with normal (+ 38%) and abnormal (+ 43%) LV function. After pericardiocentesis, RV volume increased more markedly than did LV volume. Thus, hemodynamic and clinical improvement after pericardiocentesis may be related only to an increase in stroke volume. RV and LV ejection fraction, a measure of myocardial contractility, was not affected significantly by the presence of pericardial effusion, even in those patients who had cardiac tamponade.

  1. Left ventricular non-compaction: clinical features and cardiovascular magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Sandman Harald

    2009-08-01

    Full Text Available Abstract Background It is apparent that despite lack of family history, patients with the morphological characteristics of left ventricular non-compaction develop arrhythmias, thrombo-embolism and left ventricular dysfunction. Methods Forty two patients, aged 48.7 ± 2.3 yrs (mean ± SEM underwent cardiovascular magnetic resonance (CMR for the quantification of left ventricular volumes and extent of non-compacted (NC myocardium. The latter was quantified using planimetry on the two-chamber long axis LV view (NC area. The patients included those referred specifically for CMR to investigate suspected cardiomyopathy, and as such is represents a selected group of patients. Results At presentation, 50% had dyspnoea, 19% chest pain, 14% palpitations and 5% stroke. Pulmonary embolism had occurred in 7% and brachial artery embolism in 2%. The ECG was abnormal in 81% and atrial fibrillation occurred in 29%. Transthoracic echocardiograms showed features of NC in only 10%. On CMR, patients who presented with dyspnoea had greater left ventricular volumes (both p Conclusion Left ventricular non-compaction is associated with dysrrhythmias, thromboembolic events, chest pain and LV dysfunction. The inverse correlation between NC area and EF suggests that NC contributes to left ventricular dysfunction.

  2. The effect of right ventricular pacing on myocardial oxidative metabolism and efficiency: relation with left ventricular dyssynchrony

    Energy Technology Data Exchange (ETDEWEB)

    Ukkonen, Heikki; Saraste, Antti; Koistinen, Juhani [Turku University Hospital, Department of Medicine, P.O. Box 52, Turku (Finland); Tops, Laurens; Bax, Jeroen [Leiden University Medical Center, Leiden (Netherlands); Naum, Alexander [University of Turku, Turku PET Centre, Turku (Finland); Knuuti, Juhani [University of Turku, Turku PET Centre, Turku (Finland); Turku University Hospital, Turku PET Centre, P.O. Box 52, Turku (Finland)

    2009-12-15

    Right ventricular (RV) apical pacing induces dyssynchrony by a left bundle branch block type electrical activation sequence in the heart and may impair left ventricular (LV) function. Whether these functional changes are accompanied by changes in myocardial perfusion, oxidative metabolism and efficiency, and the relation with the induction of LV dyssynchrony are unknown. Our study was designed to investigate the acute effects of RV pacing on these parameters. Ten patients with normal LV ejection fraction and VVI/DDD pacemaker were studied during AAI pacing/sinus rhythm without RV pacing (pacing-OFF) and with RV pacing (pacing-ON) at the same heart rate. Dynamic [{sup 15}O]water and [{sup 11}C]acetate positron emission tomography was used to measure perfusion and oxidative metabolism (k{sub mono}) of the LV. An echocardiographic examination was used to assess LV stroke volume (SV) and LV dyssynchrony. Myocardial efficiency of forward work was calculated as systolic blood pressure x cardiac output/LV mass/k{sub mono}. RV pacing decreased SV in all subjects (mean decrease 13%, from 76 {+-} 7 to 66 {+-} 7 ml, p = 0.004), but global perfusion and k{sub mono} were unchanged. The efficiency tended to be lower with pacing-ON (70 {+-} 20 vs 81 {+-} 21 mmHg l/g, p = 0.066). In patients with dyssynchrony during pacing (n = 6) efficiency decreased by 23% (from 78 {+-} 25 to 60 {+-} 14 mmHg l/g, p = 0.02), but in patients without dyssynchrony no change in efficiency was detected. Accordingly, heterogeneity in myocardial perfusion and oxidative metabolism was detected during pacing in patients with dyssynchrony but not in those without dyssynchrony. RV pacing resulted in a significant decrease in SV. However, deleterious effects on LV oxidative metabolism and efficiency were observed only in patients with dyssynchrony during RV pacing. (orig.)

  3. Atorvastatin prevents connexin43 remodeling in hypertrophied left ventricular myocardium of spontaneously hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    CHEN Hong-juan; YAO Lei; CHEN Tu-gang; YU Min; WANG Li-hong; CHEN Jun-zhu

    2007-01-01

    Background Connexin43 (Cx43) is the predominant gap junction protein in heart and is involved in the control of cell-to-cell communication to modulate the contractility and the electrical coupling of cardiac myocytes. Left ventricular(LV) hypertrophy is accompanied by changes of Cx43 expression. Recent studies have demonstrated that statins reduced cardiac hypertrophy. However, it is unknown whether statins can affect Cx43 expression in hypertrophied left ventricular myocardium. This study was designed to assess the effects of atorvastatin on LV hypertrophy and Cx43 expression in spontaneously hypertensive rats (SHR).Methods Nine-week old SHRs were randomly divided into two groups. Some received atorvastatin at 30 mg/kg by oral gavage once daily for 8 weeks (SHR-A); others received vehicle. Age-matched Wistar-Kyoto rats (WKY) received atorvastatin or vehicle for 8 weeks were used as controls. At the end of the experiment, we investigated LV hypertrophy and the expression of Cx43 in LV myocardium in four groups. Cx43 expression was investigated by the methods of Western blotting, immunohistochemistry, and transmission electron microscope. LV hypertrophy was accessed by pathological analysis and plasma brain natriuretic peptide (BNP) level.Results LV hypertrophy was prominent in untreated SHR. In SHR, LV myocardium Cx43 level was upregulated, and the distribution of Cx43 was displaced from their usual locations to other sites at various distances away from the intercalated disks. After atorvastatin treatment, myocardium Cx43 level was reduced in SHR-A, and the distribution of Cx43 gap junction became much regular and confined to intercalated disk. Statins also prevented LV hypertrophy in SHR.Conclusions These results provide novel in vivo evidence for the key role of Cx43 gap junctions in LV hypertrophy and the possible mechanism in anti-hypertrophic effect of statins. Atorvastatin treatment may have beneficial effects on LV hypertrophy in spontaneously hypertensive

  4. Evaluation of global and regional left ventricular function obtained by quantitative gated SPECT using {sup 99m}Tc-tetrofosmin for left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Ban, Kazunobu; Nakajima, Tohru; Iseki, Harukazu; Abe, Sumihisa; Handa, Shunnosuke; Suzuki, Yutaka [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine

    2000-08-01

    The quantitative gated SPECT (QGS) software is able to calculate LV volumes and visualize LV wall motion and perfusion throughout the cardiac cycle using an automatic edge detection algorithm of the left ventricle. We evaluated the reliability of global and regional LV function assessment derived from QGS by comparing it with the results from left ventriculo-cineangiography (LVG). In 20 patients with left ventricular dysfunction who underwent ECG gated {sup 99m}Tc-tetrofosmin SPECT, the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) were calculated. The QGS-assessed regional wall motion was determined using the cinematic display. QGS-derived EDV, ESV and LVEF correlated well with those by LVG (p<0.001 for each). There was a good correlation between wall motion score (WMS) derived from the QGS and the LVG (r=0.40, p<0.05). In some patients with extensive myocardial infarction, there was a discrepancy in the regional wall motion results between QGS and LVG. The ECG-gated SPECT using QGS is useful to evaluate global and regional LV functions in left ventricular dysfunction. (author)

  5. Left ventricular remodeling during and after 60 days of sedentary head-down bed rest.

    Science.gov (United States)

    Westby, Christian M; Martin, David S; Lee, Stuart M C; Stenger, Michael B; Platts, Steven H

    2016-04-15

    Short periods of weightlessness are associated with reduced stroke volume and left ventricular (LV) mass that appear rapidly and are thought to be largely dependent on plasma volume. The magnitude of these cardiac adaptations are even greater after prolonged periods of simulated weightlessness, but the time course during and the recovery from bed rest has not been previously described. We collected serial measures of plasma volume (PV, carbon monoxide rebreathing) and LV structure and function [tissue Doppler imaging, three-dimensional (3-D) and 2-D echocardiography] before, during, and up to 2 wk after 60 days of 6° head down tilt bed rest (HDTBR) in seven healthy subjects (four men, three women). By 60 days of HDTBR, PV was markedly reduced (2.7 ± 0.3 vs. 2.3 ± 0.3 liters,PResting measures of LV volume and mass were ∼15% (Prest values (P< 0.001). As previously reported, decreased PV and LV volume precede and likely contribute to cardiac atrophy during prolonged LV unloading. Although PV and LV volume recover rapidly after HDTBR, there is no concomitant normalization of LV mass. These results demonstrate that reduced LV mass in response to prolonged simulated weightlessness is not a simple effect of tissue dehydration, but rather true LV muscle atrophy that persists well into recovery.

  6. Radionuclide left ventricular dV/dt for the assessment of cardiac function in patients with coronary disease.

    Science.gov (United States)

    Bianco, J A; Makey, D G; Laskey, W K; Shafer, R B

    1979-01-01

    To investigate potential uses of left-ventricular (LV) systolic ejection rate (LV dV/dt) in the evaluation of LV function, we examined the effect of exercise, angiotensin, and leg raising on LV ejection fraction and LV dV/dt in patients with coronary-artery disease. The following observations were made: a) LV ejection fraction and dV/dt changed proportionately, but in opposite directions, during supine exercise; b) LV ejection fraction and dV/dt decreased to a similar extent during angiotensin infusions; and c) LV ejection fraction and dV/dt were unchanged by leg raising. The changes in peak and mean LV dV/dt were similar. Regardless of the physiologic state, peak LV dV/dt occurred during the first third of systole. These data imply that in this population there were no specific advantages of LV dV/dt over LV ejection fraction in the evaluation of LV performance.

  7. Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction.

    Science.gov (United States)

    Aro, Aapo L; Reinier, Kyndaron; Phan, Derek; Teodorescu, Carmen; Uy-Evanado, Audrey; Nichols, Gregory A; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S

    2017-07-01

    The majority of sudden cardiac arrests (SCAs) occur in patients with left-ventricular (LV) ejection fraction (LVEF) >35%, yet there are no methods for effective risk stratification in this sub-group. Since abnormalities of LV geometry can be identified even with preserved LVEF, we investigated the potential impact of LV geometry as a novel risk marker for this patient population. In the ongoing Oregon Sudden Unexpected Death Study, SCA cases with archived echocardiographic data available were prospectively identified during 2002-15, and compared with geographical controls. Analysis was restricted to subjects with LVEF >35%. Based on established measures of LV mass and relative wall thickness (ratio of wall thickness to cavity diameter), four different LV geometric patterns were identified: normal geometry, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Sudden cardiac arrest cases (n = 307) and controls (n = 280) did not differ in age, sex, or LVEF, but increased LV mass was more common in cases. Twenty-nine percent of SCA cases presented with normal LV geometry, 35% had concentric remodelling, 25% concentric hypertrophy, and 11% eccentric hypertrophy. In multivariate model, concentric remodelling (OR 1.76; 95%CI 1.18-2.63; P = 0.005), concentric hypertrophy (OR 3.20; 95%CI 1.90-5.39; P geometry as a potential risk stratification tool in patients with preserved or moderately reduced LVEF.

  8. Effect of catheter-based renal denervation on left ventricular function, mass and (un)twist with two-dimensional speckle tracking echocardiography

    NARCIS (Netherlands)

    L. Feyz (Lida); B.M. van Dalen (Bas); M.L. Geleijnse (Marcel); N.M. van Mieghem (Nicolas); R.T. van Domburg (Ron); J. Daemen (Joost)

    2017-01-01

    markdownabstractBackground: Speckle tracking echocardiography (STE) is an echocardiography modality that is able to measure left ventricular (LV) characteristics, including rotation, strain and strain rate. Strain measures myocardial fibre contraction and relaxation. This study aims to assess the

  9. 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

    overall agreement for identifying patients with severe impairment of LV function. This not only underscores the value of LV-WMI as a useful tool for selecting high-risk patients to be included in multicenter studies but also serves to warn against the use of rigid cutoff values for WMI in the treatment......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 patients...

  10. Left ventricular hypertrophy : virtuous intentions, malign consequences

    NARCIS (Netherlands)

    Pokharel, S; Sharma, UC; Pinto, YM

    2003-01-01

    Left ventricular hypertrophy (LVH) is currently the focus of intense cardiovascular research, with the resultant rapid evolution of novel concepts relating to its exceedingly complex pathophysiology. In addition to the alterations in signal transduction and disturbances in Ca2+ homeostasis, there ar

  11. Congestive cardiomyopathy and left ventricular thrombus.

    Science.gov (United States)

    Gould, L; Gopalaswamy, C; Chandy, F; Kim, B S

    1983-07-01

    A left ventricular thrombus was detected by echocardiography in a 54-year-old man with congestive cardiomyopathy. With the use of anticoagulants, the thrombus completely disappeared. Patients with congestive cardiomyopathy who are at high risk for thrombus formation should be screened with two-dimensional echocardiography. If a thrombus is recognized, anticoagulation therapy can then be instituted.

  12. Assessment of Subclinical Left Ventricular Dysfunction in Patients with Chronic Mitral Regurgitation Using Torsional Parameters Described by Tissue Doppler Imaging

    Directory of Open Access Journals (Sweden)

    Zahra Ojaghi-Haghighi

    2015-10-01

    Full Text Available Background: Left ventricular (LV twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR on the torsional mechanics of the left human ventricle using tissue Doppler imaging.Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI. LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle.Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38˚ ± 4.04˚ vs.13.95˚ ± 4.27˚; p value = 0.020; and 1.29 ± 0.54 ˚/cm vs. 1.76 ± 0.56 ˚/cm; p value = 0.021, respectively, both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 ˚/s vs.-110.96 ± 34.65 ˚/s; p value = 0.020, but there was statistically no significant difference in the LV twist rate.Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients

  13. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jons, Christian; Joergensen, Rikke Moerch; Hassager, Christian;

    2010-01-01

    The aim of this study was to investigate the association between diastolic dysfunction and long-term occurrence of new-onset atrial fibrillation (AF) and cardiac events in patients with acute myocardial infarction (AMI) and left ventricular (LV) systolic dysfunction.......The aim of this study was to investigate the association between diastolic dysfunction and long-term occurrence of new-onset atrial fibrillation (AF) and cardiac events in patients with acute myocardial infarction (AMI) and left ventricular (LV) systolic dysfunction....

  14. Metabolic syndrome is associated with left ventricular dilatation in primary hypertension.

    Science.gov (United States)

    Ratto, E; Viazzi, F; Verzola, D; Bonino, B; Gonnella, A; Parodi, E L; Bezante, G P; Leoncini, G; Pontremoli, R

    2016-03-01

    Metabolic syndrome (MS) has been shown to predict cardiovascular events in hypertension. Recently, a new four-group left ventricular (LV) hypertrophy classification based on both LV dilatation and concentricity was proposed. This classification has been shown to provide a more accurate prediction of cardiovascular events, suggesting that the presence of LV dilatation may add prognostic information. We investigated the relationship between MS and the new classification of LV geometry in patients with primary hypertension. A total of 372 untreated hypertensive patients were studied. Four different patterns of LV hypertrophy (eccentric nondilated, eccentric dilated, concentric nondilated and concentric dilated hypertrophy) were identified by echocardiography. A modified National Cholesterol Education Program definition for MS was used, with body mass index replacing waist circumference. The overall prevalence of MS and LV hypertrophy (LVH) was 29% and 61%, respectively. Patients with MS showed a higher prevalence of LVH (P=0.0281) and dilated LV geometries, namely eccentric dilated and concentric dilated hypertrophy (P=0.0075). Moreover, patients with MS showed higher LV end-diastolic volume (P=0.0005) and prevalence of increased LV end-diastolic volume (P=0.0068). The prevalence of LV chamber dilatation increased progressively with the number of components of MS (P=0.0191). Logistic regression analysis showed that the presence of MS entails a three times higher risk of having LV chamber dilatation even after adjusting for several potential confounding factors. MS is associated with LV dilatation in hypertension. These findings may, in part, explain the unfavourable prognosis observed in patients with MS.

  15. Computational modelling of left-ventricular diastolic mechanics: effect of fibre orientation and right-ventricle topology.

    Science.gov (United States)

    Palit, Arnab; Bhudia, Sunil K; Arvanitis, Theodoros N; Turley, Glen A; Williams, Mark A

    2015-02-26

    Majority of heart failure patients who suffer from diastolic dysfunction retain normal systolic pump action. The dysfunction remodels the myocardial fibre structure of left-ventricle (LV), changing its regular diastolic behaviour. Existing LV diastolic models ignored the effects of right-ventricular (RV) deformation, resulting in inaccurate strain analysis of LV wall during diastole. This paper, for the first time, proposes a numerical approach to investigate the effect of fibre-angle distribution and RV deformation on LV diastolic mechanics. A finite element modelling of LV passive inflation was carried out, using structure-based orthotropic constitutive law. Rule-based fibre architecture was assigned on a bi-ventricular (BV) geometry constructed from non-invasive imaging of human heart. The effect of RV deformation on LV diastolic mechanics was investigated by comparing the results predicted by BV and single LV model constructed from the same image data. Results indicated an important influence of RV deformation which led to additional LV passive inflation and increase of average fibre and sheet stress-strain in LV wall during diastole. Sensitivity of LV passive mechanics to the changes in the fibre distribution was also examined. The study revealed that LV diastolic volume increased when fibres were aligned more towards LV longitudinal axis. Changes in fibre angle distribution significantly altered fibre stress-strain distribution of LV wall. The simulation results strongly suggest that patient-specific fibre structure and RV deformation play very important roles in LV diastolic mechanics and should be accounted for in computational modelling for improved understanding of the LV mechanics under normal and pathological conditions.

  16. Effect of burden and origin sites of premature ventricular contractions on left ventricular function by 7-day Holter monitor.

    Science.gov (United States)

    Xu, Wenhua; Li, Mingfang; Chen, Minglong; Yang, Bing; Wang, Daowu; Kong, Xiangqing; Chen, Hongwu; Ju, Weizhu; Gu, Kai; Cao, Kejiang; Liu, Hailei; Jiang, Qi; Shi, Jiaojiao; Cui, Yan; Wang, Hong

    2015-11-01

    Recent studies have shown that premature ventricular contractions (PVCs) could enlarge the heart, but its risk factors are incompletely understood as a single 24-hour recording cannot reflect the true PVC burden due to day-to-day variability. Our purpose was to investigate the effect of burden and origin sites on left ventricular (LV) function in patients with PVCs by 7-day Holter electrocardiography (ECG). From May 2012 to August 2013, 112 consecutive patients with PVCs were recruited from the authors' affiliated hospital. All patients received 2-dimensional transthoracic echocardiography, 12-lead routing ECG and 7-days Holter ECG. Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured. A total of 102 participants with PVCs were included in the final analysis. Origin of PVCs from the tricuspid annulus had the highest burden and NT-proBNP level. LV papillary muscle had a higher LV ejection fraction (EF) level and a lower LV end-systolic dimension (ESD) than other PVC foci (PHolter monitor showed the true PVC burden on patients with PVCs. PVCs with a lower burden or origin from the LV papillary muscle and the fascicle were relatively benign, while PVCs with a higher burden or origin from the tricuspid annulus may lead to cardiac dysfunction.

  17. Left ventricular volume determined from scintigraphy and digital angiography by a semi-automated geometric method

    Energy Technology Data Exchange (ETDEWEB)

    Seldin, D.W.; Esser, P.D.; Nichols, A.B.; Ratner, S.J.; Alderson, P.O.

    1983-12-01

    The utility of a semi-automatic method of measuring left ventricular (LV) volume geometrically from gated blood-pool studies and digital subtraction angiography (DSA) was investigated using computerized edge detection and spatial calibration algorithms. LAO LV volumes determined from gated blood-pool studies were compared to volumes obtained from contrast left ventriculograms in 21 patients and the applicability of this method to DSA was evaluated in 25 additional patients who also had conventional left ventriculography. There was excellent correlation between the two, both for radionuclide studies and for DSA. Computer-based geometric determinations of LV volume appear to be rapid, accurate, and less dependent on subjective operator decisions than previously reported geometric approaches.

  18. Effects of Mitral Balloon Valvuloplasty on Left Ventricular Systolic Functions: Assessment with Color Tissue Doppler

    Directory of Open Access Journals (Sweden)

    Cevat Kırma

    2010-04-01

    Full Text Available Objective: Left ventricular (LV systolic functions are generally depressed in Mitral Stenosis (MS. Recovery of LV systolic functions demonstrated with 2D echocardiography in some patients by mitral balloon valvuloplasty (MBV. Systolic mitral annular velocity (S' by Tissue Doppler Imaging (TDI predicts LV systolic function. We aimed to evaluate early effects of MBV on LV systolic function by TDI.Methods: Forty-eight consecutive patients included to the study (39 female, 36±10 years. A full transthoracic echocardiographic study (TTE including left ventricular ejection fraction assessment by teicholz method and mitral annular color TDI assessment was performed 24 hours before and after MBV in all patients. MBV performed by Inoue technique under guidance of TTE. Analysis of mitral lateral annular S' wave velocity was performed immediately after echocardiographic examination. Results: MBV performed successfully in 43 patients (Group A, and severe mitral regurgitation developed in 5 patients(Group B. Mitral valve area, and S’ wave velocity increased, mean and maximum mitral gradient, and left atrial diameter, and systolic pulmonary artery pressure (PAP were reduced significantly by MBV in group A patients (p<0.01, =0.046, <0.01, <0.01, <0.01, <0.01, respectively. But, only mitral valve area increased significantly ingroup B patients (p<0.01. LVEF by teicholz did not change significantly in both groups. Conclusion: Improvements of LV systolic functions after successfull MBV can easily showed by color TDI where2D echocardiography could not indicate.

  19. Isolated congenital cardiac diverticulum originating from the left ventricular apex: Report of a pediatric case

    Directory of Open Access Journals (Sweden)

    Fahrettin Uysal

    2016-01-01

    Full Text Available Congenital ventricular diverticulum is a rare cardiac anomaly defined as a localized protrusion of the ventricular free wall. Although, it is usually asymptomatic, complications such as embolism, infective endocarditis, and arrhythmias can occur. The diagnosis can be made by echocardiography, cardiac magnetic resonance imaging, or catheter angiography. Surgical resection is the treatment of choice in symptomatic patients, whereas the management of asymptomatic patients often represents a therapeutic dilemma. We report here, a 9-month-old patient with asymptomatic congenital left ventricular (LV diverticulum associated with epigastric hernia.

  20. Cardiac MRI assessed left ventricular hypertrophy in differentiating hypertensive heart disease from hypertrophic cardiomyopathy attributable to a sarcomeric gene mutation

    Energy Technology Data Exchange (ETDEWEB)

    Sipola, Petri [Kuopio University Hospital, Department of Clinical Radiology, Kuopio (Finland); University of Eastern Finland, Institute of Clinical Medicine, Faculty of Health Sciences, Kuopio (Finland); Magga, Jarkko; Peuhkurinen, Keijo [Kuopio University Hospital, Department of Medicine, Kuopio (Finland); Husso, Minna [Kuopio University Hospital, Department of Clinical Radiology, Kuopio (Finland); Jaeaeskelaeinen, Pertti; Kuusisto, Johanna [Kuopio University Hospital, Department of Medicine, Kuopio (Finland); Kuopio University Hospital, Heart Center, P.O. Box 1777, Kuopio (Finland)

    2011-07-15

    To evaluate the value of cardiac magnetic resonance imaging (CMRI)-assessed left ventricular hypertrophy (LVH) in differentiating between hypertensive heart disease and hypertrophic cardiomyopathy (HCM). 95 unselected subjects with mild-to-moderate hypertension, 24 patients with HCM attributable to the D175N mutation of the {alpha}-tropomyosin gene and 17 control subjects were studied by cine CMRI. Left ventricular (LV) quantitative and qualitative characteristics were evaluated. LV maximal end-diastolic wall thickness, wall thickness-to-LV volume ratio, end-diastolic septum thickness and septum-to-lateral wall thickness ratio were useful measures for differentiating between LVH due to hypertension and HCM. The most accurate measure for identifying patients with HCM was the LV maximal wall thickness {>=}17 mm, with a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 90%, 93%, 86%, 95% and 91%, respectively. LV maximal wall thickness in the anterior wall, or regional bulging in left ventricular wall was found only in patients with HCM. LV mass index was not discriminant between patients with HCM and those with LVH due to hypertension. LV maximal thickness measured by CMRI is the best anatomical parameter in differentiating between LVH due to mild-to-moderate hypertension and HCM attributable to a sarcomeric mutation. CMRI assessment of location and quality of LVH is also of value in differential diagnosis. (orig.)

  1. Left Ventricular Myocardial Fibrosis, Atrophy, and Impaired Contractility in Patients With Pulmonary Arterial Hypertension and a Preserved Left Ventricular Function: A Cardiac Magnetic Resonance Study.

    Science.gov (United States)

    Homsi, Rami; Luetkens, Julian A; Skowasch, Dirk; Pizarro, Carmen; Sprinkart, Alois M; Gieseke, Juergen; Meyer Zur Heide Gen Meyer-Arend, Julia; Schild, Hans H; Naehle, Claas P

    2017-01-01

    Using a cardiac magnetic resonance (CMR) approach we investigated left ventricular (LV) myocardial changes associated with pulmonary arterial hypertension (PAH) by strain analysis and mapping techniques. Seventeen patients with PAH (9 men; mean age, 64.2±13.6 y) and 20 controls (10 men, 63.2±10.5 y) were examined using CMR at 1.5 T. Native LV T1-relaxation times (T1) and extracellular volume fraction (ECV) were assessed using a MOLLI sequence, T2-relaxation times (T2) by means of a gradient spin-echo sequence, and LV longitudinal strain (LVS) and right ventricular (RV) longitudinal strain (RVS) by means of CMR feature tracking. The hematocrit and serum levels of pro-Brain Natriuretic Peptide were determined on the day of the CMR examination. Pulmonary arterial pressure and 6-minute walking distance were assessed as part of the clinical evaluation. T1 and ECV were higher (1048.5±46.6 vs. 968.3±22.9 ms and 32.4%±5.7% vs. 28.4%±3.8%; Patrophy with a consecutively impaired contractility despite a preserved LV function, possibly due to longstanding PAH-associated LV underfilling.

  2. The association of metabolic syndrome with left ventricular mass and geometry in community-based hypertensive patients among Han Chinese

    Directory of Open Access Journals (Sweden)

    Shuxia Wang

    2015-01-01

    Full Text Available Background: The association of metabolic syndrome (MS with left ventricular (LV hypertrophy is controversial. The objective of our study was to investigate the influence of MS on LV mass and geometry in community-based hypertensive patients among Han Chinese. Materials and Methods: This study included 1733 metabolic syndrome patients according to the International Diabetes Federation (IDF definition and 2373 non-MS hypertension patients. LV hypertrophy was diagnosed by the criteria of LV mass ≥49.2 g/m 2.7 for men and 46.7 g/m 2.7 for women. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy were calculated according to LV hypertrophy and relative wall thickness. Logistic regression analysis was used to determine odds ratio (OR and 95% confidence interval (CI of MS for LV hypertrophy and LV geometry abnormality. Results: The LV mass and LV mass index were higher in the MS group than in the non-MS group. In multiple adjusted models. LV mass index, LV mass, interventricular septum, and post wall were raised with the increased number of MS disorders. MS was associated with increased LV hypertrophy risk (unadjusted OR 1.38; 95% CI 1.21-1.57; age, sex, and blood pressure (BP; adjusted OR 1.39; 95% CI 1.22-1.59. MS was also associated with increased risk of eccentric hypertrophy in male and female patients. MS was only associated with increased risk of concentric hypertrophy in female patients; and MS was not associated with concentric remodeling. Conclusion: LV mass and LV mass index were associated with the increased number of MS disorders in the Chinese community-based hypertensive population. MS was not only associated with increased LV hypertrophy risk, but also associated with concentric and eccentric LV geometry abnormality, especially in females.

  3. Surgery for left ventricular aneurysm after myocardial infarction:techniques selection and results assessment

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin; QIU Zhi-bing; XU Ming; LIU Le-le; JIANG Ying-shuo; WANG Li-ming

    2012-01-01

    Background The most appropriate surgical approach for patients with post-infarction left ventricular (LV) aneurysm remains undetermined.We compared the efficacy of the linear versus patch repair techniques,and investigated the mid-term changes of LV geometry and cardiac function,for repair of LV aneurysms.Methods We reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010.Short-term and mid-term outcomes,including complications,cardiac function and mortality,were assessed.LV end-diastolic and systolic dimensions (LVEDD and LVESD),LV end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) and LV ejection fraction (LVEF) were measured on pre-operative and follow-up echocardiography.Results Overall in-hospital mortality was 4.12%,and major morbidity showed no significant differences between the two groups.Multivariate analysis identified preoperative left ventricular end diastolic pressure >20 mmHg,low cardiac output and aortic clamping time >2 hours as risk factors for early mortality.Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group (P=0.008),and from 44% pre-operation to 40% 12 months postoperation in the linear group (P=0.032).In contrast,the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation,and increased again at follow-up.However,in the patch group,the LVEDVI and LVESVI were significantly reduced at follow-up.And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups.Conclusions Persistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem.The choice of the technique should be tailored on an individual basis and surgeon's preference.The patch remodeling technique results in a better LVEF improvement,further significant reductions in LV dimensions

  4. High Left Ventricular Lead Sensing Delay Predicts QRS Narrowing and Good Response to Cardiac Resynchronization Therapy.

    Science.gov (United States)

    Kaypakli, Onur; Koç, Mevlüt; Gözübüyük, Gökhan; Şahin, Durmuş Yildiray

    2016-12-01

    Cardiac resynchronization therapy (CRT) was shown to improve heart failure (HF) prognosis. But many patients do not benefit from CRT. Optimization of left ventricular (LV) lead position to the latest activated LV area is important to increase CRT response. We aimed to detect the relationship between LV lead sensing delay and echocardiographic and electrocardiographic response to CRT treatment. We prospectively included 156 consecutive patients with HF diagnosis, QRS ≥ 120 ms, left bundle branch block, New York Heart Association II-IV, LV ejection fraction (LVEF) sensing delay was calculated as the time interval from the onset of surface QRS wave to the onset of depolarization wave recorded from the LV lead by using the LV pacing lead as a bipolar electrode. LVESV reduction was associated with baseline QRS width (r = 0.292, P = 001), QRS narrowing (r = 0.332, P sensing delay (r = 0.454, P sensing delay was found to be the only independent parameter for predicting significant LVESV reduction (β = 0.423, P sensing delay was also found to be significantly associated with LVEF increase (r = 0.320, P sensing delay is the only independent predictor for significant reduction in LVESV and was found to be significantly associated with LVEF increase and QRS narrowing after CRT treatment. We suggest that LV lead sensing delay may be used as a marker to predict the favorable response to CRT. © 2016 Wiley Periodicals, Inc.

  5. Endoventriculoplasty using autologous endocardium for anterior left ventricular aneurysms

    NARCIS (Netherlands)

    Grandjean, JG; Mariani, MA; D'Alfonso, A; Musazzi, A; Boonstra, PW

    Background: There is currently consensus that endoventriculoplasty is the treatment of choice for an anterior left ventricular aneurysm. We describe here a new technique of endoventriculoplasty using autologous endocardium for left ventricular anterior aneurysm. Method: From 1990 until 2003, 49

  6. Acute pulmonary edema in patients with reduced left ventricular ejection fraction is associated with concentric left ventricular geometry.

    Science.gov (United States)

    Imanishi, Junichi; Kaihotsu, Kenji; Yoshikawa, Sachiko; Nishimori, Makoto; Sone, Naohiko; Honjo, Tomoyuki; Iwahashi, Masanori

    2017-08-02

    Although acute pulmonary edema (APE) is common in patients with heart failure (HF) with preserved ejection fraction (EF), its pathogenesis in patients with HF with reduced EF (HFrEF) is not completely understood. The purpose of our study was to explore the contributions of left ventricular (LV) geometry to understand the difference between HFrEF patients with or without APE. We studied 122 consecutive acute decompensated HF patients with HFrEF (≤40%). APE was defined as acute-onset dyspnea and radiographic alveolar edema requiring immediate airway intervention. LV geometry was determined from a combination of the LV mass index and relative wall thickness (RWT). Long-term unfavorable outcome events were tracked during a follow-up of a median of 21 months (interquartile range, 10-28 months), during which APE was observed in 29 patients (24%). Compared to those without APE, hospitalized patients with APE had a higher systolic blood pressure, RWT, and LVEF and lower end-diastolic dimension. Among echocardiographic variables, a multivariate logistic regression analysis identified RWT as the only independent determinant of APE (hazard ratio: 2.46, p geometry (n = 25; RWT > 0.42) had a higher incidence of APE relative to those with non-concentric geometry. Furthermore, among patients with APE, mortality was significantly higher among those with concentric geometry (log-rank, p = 0.008). Compared with non-concentric geometry, concentric geometry (increased RWT, not LV mass) was strongly associated with APE onset and a poorer outcome among APE patients. An easily obtained echocardiographic RWT index may facilitate the risk stratification of patients.

  7. Left ventricular function in treatment-naive early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Deibjerg, Lone K; Hedemann-Andersen, Agnete;

    2014-01-01

    BACKGROUND: The role of inflammation and anti-cyclic citrullinated peptide antibodies (anti-CCP) in the pathogenesis of cardiovascular disease in early rheumatoid arthritis (RA) remains unclear. Previous studies have suggested that both disease activity and disease duration are associated...... with atherosclerosis and a higher mortality rate caused primarily by coronary artery disease. OBJECTIVE: We investigated how disease activity, anti-CCP status and coronary calcium score in treatment-naive early RA impacts left ventricular (LV) systolic function. METHODS: Fifty-tree patients (30 women) with mean age 58...... by computed tomography by calculating the Agaston score. One experienced senior rheumatologist and one experienced cardiologist performed all the clinical assessments as well as all the transthoracic echocardiography (TTE) and coronary CT analysis. RESULTS: Disease activity scores before treatment at baseline...

  8. Comparison of mortality rates and progression of left ventricular dysfunction in patients with idiopathic dilated cardiomyopathy and dilated versus nondilated right ventricular cavities.

    Science.gov (United States)

    Sun, J P; James, K B; Yang, X S; Solankhi, N; Shah, M S; Arheart, K L; Thomas, J D; Stewart, W J

    1997-12-15

    This study assesses the influence of right ventricular (RV) dilation on the progression of left ventricular (LV) dysfunction and survival in patients with idiopathic dilated cardiomyopathy (IDC). Using transthoracic echocardiography, we studied 100 patients with IDC aged 20 to 80 years (mean 55 +/- 14); 67% were men. In the apical 4-chamber view, diastolic LV and RV chamber area measurements classified patients into 2 groups: group RV enlargement+ (RV area/LV area > 0.5) included 54 patients; group RV enlargement- (no RV enlargement) had RV area/LV area < or = 0.5. Echocardiographic studies were repeated in all patients after a mean of 33 +/- 16 months. At the time of the initial study, the 2 groups did not differ in age, gender, incidence of atrial fibrillation and diabetes, left ventricular mass, and LV ejection fraction, but the RV enlargement+ group had more severe tricuspid regurgitation and less LV enlargement. After 47 +/- 22 months (range 12 to 96), patients in group RV enlargement+ had lower LV ejection fraction (29% vs 34%, p = 0.006) than patients with initial RV enlargement-. At clinical follow-up, mortality was higher (43%) in patients with initial RV enlargement+ than the RV enlargement- patients (15%), p = 0.002. For survivors, the mitral deceleration time averaged 157 +/- 36 ms; for nonsurvivors or patients who required transplant, the mitral deceleration time averaged 97 +/- 12 ms (p < 0.0001). With use of a multivariate Cox model adjusting for LV ejection fraction, LV size, and age, the relative risk ratio of mortality from initial RV enlargement+ was 4.4 (95% confidence limits 1.7 to 11.1) (p = 0.002). Thus, patients with significant RV dilation had nearly triple the mortality over 4 years and more rapidly deteriorating LV function than patients with less initial RV dilation. In IDC, RV enlargement is a strong marker for adverse prognosis that may represent a different morphologic subset.

  9. New techniques for the assessment of regional left ventricular wall motion.

    Science.gov (United States)

    Garcia-Fernandez, Miguel Angel; Bermejo, Javier; Perez-David, Esther; Lopez-Fernandez, Teresa; Ledesma, Maria Jesus; Caso, Pio; Malpica, Norberto; Santos, Andres; Moreno, Mar; Desco, Manuel

    2003-10-01

    The assessment of regional left ventricular (LV) function has been an important yet unresolved problem since the introduction of echocardiography as a diagnostic tool. Abnormal regional LV wall motion is an early finding in multiple cardiac pathologies and its diagnosis is of critical importance. In the last few years diagnostic procedures based on combined use of existing echocardiographic technologies were geared toward improving the accuracy of detection of baseline and/or induced regional wall motion abnormalities. One of the assumptions is that the combination of reduced LV wall thickening and reduced myocardial velocities can be used to accurately diagnose regional myocardial dysfunction. In this article we will discuss several new techniques for the quantification of regional LV function using Doppler echocardiography.

  10. Left ventricular motion reconstruction with a prolate spheroidal B-spline model

    Energy Technology Data Exchange (ETDEWEB)

    Li Jin; Denney, Thomas S Jr [Electrical and Computer Engineering Department, 200 Broun Hall, Auburn University, AL 36849-5201 (United States)

    2006-02-07

    Tagged cardiac magnetic resonance (MR) imaging can non-invasively image deformation of the left ventricular (LV) wall. Three-dimensional (3D) analysis of tag data requires fitting a deformation model to tag lines in the image data. In this paper, we present a 3D myocardial displacement and strain reconstruction method based on a B-spline deformation model defined in prolate spheroidal coordinates, which more closely matches the shape of the LV wall than existing Cartesian or cylindrical coordinate models. The prolate spheroidal B-spline (PSB) deformation model also enforces smoothness across and can compute strain at the apex. The PSB reconstruction algorithm was evaluated on a previously published data set to allow head-to-head comparison of the PSB model with existing LV deformation reconstruction methods. We conclude that the PSB method can accurately reconstruct deformation and strain in the LV wall from tagged MR images and has several advantages relative to existing techniques.

  11. Left ventricular motion reconstruction with a prolate spheroidal B-spline model

    Science.gov (United States)

    Li, Jin; Denney, Thomas S., Jr.

    2006-02-01

    Tagged cardiac magnetic resonance (MR) imaging can non-invasively image deformation of the left ventricular (LV) wall. Three-dimensional (3D) analysis of tag data requires fitting a deformation model to tag lines in the image data. In this paper, we present a 3D myocardial displacement and strain reconstruction method based on a B-spline deformation model defined in prolate spheroidal coordinates, which more closely matches the shape of the LV wall than existing Cartesian or cylindrical coordinate models. The prolate spheroidal B-spline (PSB) deformation model also enforces smoothness across and can compute strain at the apex. The PSB reconstruction algorithm was evaluated on a previously published data set to allow head-to-head comparison of the PSB model with existing LV deformation reconstruction methods. We conclude that the PSB method can accurately reconstruct deformation and strain in the LV wall from tagged MR images and has several advantages relative to existing techniques.

  12. Takotsubo cardiomyopathy with left ventricular thrombus presenting as critical limb ischaemia

    Science.gov (United States)

    Gulsin, Gaurav; Serna, Solange; Morris, Clare; Taher, Abutariq; Loke, Ian

    2016-01-01

    Takotsubo cardiomyopathy (TC) is a rare condition, characterized by acute left ventricular (LV) dysfunction in the absence of flow-limiting coronary artery disease, usually provoked by a physical or emotional stressor. The condition is far more common in women. The commonest presenting symptoms in patients with TC are chest pain and shortness of breath, often mimicking an acute coronary syndrome. A number of complications of TC are recognized, and very rarely patients experience cardioembolic phenomena secondary to LV thrombus formation in TC. We present the case of a 48-year-old lady presenting with peripheral limb ischaemia, subsequently found to have an LV thrombus secondary to TC. Diagnosis of TC was made challenging by the absence of chest pain. She required urgent arterial embolectomy and was treated with 6-month oral anticoagulation therapy. She was also commenced on beta-blocker and angiotensin-converting enzyme inhibitor treatment for the management of LV dysfunction. PMID:27679725

  13. Value of 4D-strain imaging echocardiography in detecting left ventricular systolic dysfunction in patients with aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    ZHENG Zhi-chao; LI He-zhi; LI Chang-mao; CHEN Ou-di; FEI Hong-wen; LIN Qiong-wen

    2016-01-01

    Background The myocyte dysfunction may be present in aortic stenosis (AS) patients with preserved left ventricular ejection fraction (LVEF).Early aortic valve replacement (AVR) can reverse the LV hypertrophy and improve LV systolic performance and clinical outcome.Strain imaging has demonstrated to be the most appropriate method to evaluate LV myocardial contractility.However,4D-strain imaging echocardiography for the detection of subclinical left ventricular dysfunction in AS patients with preserved LVEF is seldom studied.Methods We prospectively enrolled 30 consecutive moderate to severe AS patients with preserved LVEF,and 30 healthy controls.Conventional echocardiography and 4D-strain imaging echocardiography were undergone in two groups.The 4D strain echocardiographic analyses were undertaken by using 4D Auto LVQ software.Results Compared with the healthy controls,the moderate to severe AS patients with preserved LVEF had significantly decreased global radial strain (GRS),global longitudinal strain (GLS),global area strain (GAS) and 4D strain (P < 0.05),had significantly increased left ventricular end-diastolic volume index (LVEDVI) and left ventricular mass index (LVMI) (P < 0.05),and had lower global circumferential strain (GCS) (P > 0.05).Conclusions Impaired LV myocardial contractility exists in moderate to severe AS patients,although LVEF is preserved.4D-strain imaging echocardiography can detect early left ventricular dysfunction in AS patients with preserved LVEF.

  14. The effect of geographical indices on left ventricular structure in healthy Han Chinese population

    Science.gov (United States)

    Cen, Minyi; Ge, Miao; Liu, Yonglin; Wang, Congxia; Yang, Shaofang

    2016-07-01

    The left ventricular posterior wall thickness (LVPWT) and interventricular septum thickness (IVST) are generally regarded as the functional parts of the left ventricular (LV) structure. This paper aims to examine the effects of geographical indices on healthy Han adults' LV structural indices and to offer a scientific basis for developing a unified standard for the reference values of adults' LV structural indices in China. Fifteen terrain, climate, and soil indices were examined as geographical explanatory variables. Statistical analysis was performed using correlation analysis. Moreover, a back propagation neural network (BPNN) and a support vector regression (SVR) were applied to developing models to predict the values of two indices. After the prediction models were built, distribution maps were produced. The results show that LV structural indices are characteristically associated with latitude, longitude, altitude, average temperature, average wind velocity, topsoil sand fraction, topsoil silt fraction, topsoil organic carbon, and topsoil sodicity. The model test analyses show the BPNN model possesses better simulative and predictive ability in comparison with the SVR model. The distribution maps of the LV structural indices show that, in China, the values are higher in the west and lower in the east. These results demonstrate that the reference values of the adults' LV structural indices will be different affected by different geographical environment. The reference values of LV structural indices in one region can be calculated by setting up a BPNN, which showed better applicability in this study. The distribution of the reference values of the LV structural indices can be seen clearly on the geographical distribution map.

  15. The effect of geographical indices on left ventricular structure in healthy Han Chinese population

    Science.gov (United States)

    Cen, Minyi; Ge, Miao; Liu, Yonglin; Wang, Congxia; Yang, Shaofang

    2017-02-01

    The left ventricular posterior wall thickness (LVPWT) and interventricular septum thickness (IVST) are generally regarded as the functional parts of the left ventricular (LV) structure. This paper aims to examine the effects of geographical indices on healthy Han adults' LV structural indices and to offer a scientific basis for developing a unified standard for the reference values of adults' LV structural indices in China. Fifteen terrain, climate, and soil indices were examined as geographical explanatory variables. Statistical analysis was performed using correlation analysis. Moreover, a back propagation neural network (BPNN) and a support vector regression (SVR) were applied to developing models to predict the values of two indices. After the prediction models were built, distribution maps were produced. The results show that LV structural indices are characteristically associated with latitude, longitude, altitude, average temperature, average wind velocity, topsoil sand fraction, topsoil silt fraction, topsoil organic carbon, and topsoil sodicity. The model test analyses show the BPNN model possesses better simulative and predictive ability in comparison with the SVR model. The distribution maps of the LV structural indices show that, in China, the values are higher in the west and lower in the east. These results demonstrate that the reference values of the adults' LV structural indices will be different affected by different geographical environment. The reference values of LV structural indices in one region can be calculated by setting up a BPNN, which showed better applicability in this study. The distribution of the reference values of the LV structural indices can be seen clearly on the geographical distribution map.

  16. Association between left ventricular global longitudinal strain and natriuretic peptides in outpatients with chronic systolic heart failure

    DEFF Research Database (Denmark)

    Gaborit, F; Bosselmann, H; Tønder, N;

    2015-01-01

    BACKGROUND: Both impaired left ventricular (LV) global longitudinal strain (GLS) and increased plasma concentrations of natriuretic peptides(NP) are associated with a poor outcome in heart failure (HF). Increased levels of NP reflect increased wall stress of the LV. However, little is known about...... ventricular ejection fraction (LVEF) was 33 % and median LV GLS was -11 %. LV GLS was associated with increased plasma concentrations of NT-proBNP and proANP in multivariate logistic regression (NT-proBNP: Odds RatioGLS: 7.25, 95 %-CI: 2.48-21.1, P ....28-8.30, P = 0.013) and linear regression (NT-proBNP: βGLS: 1.19, 95 %-CI: 0.62-1.76, P fibrillation, renal function) and left atrial volume index...

  17. Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Fischbach, Roman; Juergens, Kai U.; Ozgun, Murat; Maintz, David; Seifarth, Harald; Heindel, Walter [University of Muenster, Department of Clinical Radiology, Muenster (Germany); Grude, Matthias; Wichter, Thomas [University of Muenster, Department of Cardiology and Angiology, Muenster (Germany)

    2007-04-15

    This study compares quantitative and qualitative information on global and regional left ventricular (LV) function obtained with multidetector-row computed tomography (MDCT) with that obtained with magnetic resonance imaging (MRI) in patients with a high prevalence of LV wall motion abnormalities. Thirty patients (19 male, 63.7{+-}15.1 years) with myocardial infarction (n=12), coronary artery disease (n=9), arrhythmogenic right ventricular cardiomyopathy (n=6), and dilation cardiomyopathy (n=3) were included. Segmental LV wall motion (LV-WM) was assessed using a 4-point scale. Wall thickness measurements were calculated in diastolic and systolic short axis images. Two hundred and fifty-two out of 266 (94.7%) normal and 189 out of 214 (88.3%) segments with decreased wall motion were correctly identified by MDCT, yielding a sensitivity of 88% and specificity of 95% for identification of wall motion abnormalities. LV-WM scores were identical in 86.7% of 480 segments ({kappa}=0.809). MDCT had a tendency to underestimate the degree of wall motion impairment. Interobserver agreement was lower in MDCT (66.5%) than in MRI (89.1%; p<0.01). Normokinetic segments are reliably identified with MDCT. Sensitivity for detection and accurate classification of LV wall motion abnormalities need to be improved. Better temporal resolution of the CT system seems to be the most important factor for enhancing MDCT performance. (orig.)

  18. Effect of healthy aging on left ventricular relaxation and diastolic suction.

    Science.gov (United States)

    Carrick-Ranson, Graeme; Hastings, Jeffrey L; Bhella, Paul S; Shibata, Shigeki; Fujimoto, Naoki; Palmer, M Dean; Boyd, Kara; Levine, Benjamin D

    2012-08-01

    Doppler ultrasound measures of left ventricular (LV) active relaxation and diastolic suction are slowed with healthy aging. It is unclear to what extent these changes are related to alterations in intrinsic LV properties and/or cardiovascular loading conditions. Seventy carefully screened individuals (38 female, 32 male) aged 21-77 were recruited into four age groups (young: relaxation, including isovolumic relaxation time and the time constant of isovolumic pressure decay increased progressively, whereas peak early mitral annular longitudinal velocity decreased with advancing age (P relaxation and diastolic suction were not attenuated significantly when PCWP was increased in older subjects or reduced in the younger subjects. There is an early slowing of LV relaxation and diastolic suction beginning in early middle age, with the greatest reduction observed in seniors. Because age-related differences in LV dynamic diastolic filling parameters were not diminished significantly with significant changes in LV loading conditions, a decline in ventricular relaxation is likely responsible for the alterations in LV diastolic filling with senescence.

  19. Left Ventricular Synchrony and Function in Pediatric Patients with Definitive Pacemakers

    Science.gov (United States)

    Ortega, Michel Cabrera; Morejón, Adel Eladio Gonzales; Ricardo, Giselle Serrano

    2013-01-01

    Background Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern, producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. Objective The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those receiving LV pacing (LVP). Methods LV systolic and diastolic function and synchrony were evaluated in 80 pediatric patients with either nonsurgical or postsurgical complete atrioventricular block, with pacing from either the RV endocardium (n = 40) or the LV epicardium (n = 40). Echocardiographic data obtained before pacemaker implantation, immediately after it, and at the end of a mean follow-up of 6.8 years were analyzed. Results LV diastolic function did not change in any patient during follow-up. LV systolic function was preserved in patients with LVP. However, in children with RVP the shortening fraction and ejection fraction decreased from medians of 41% ± 2.6% and 70% ± 6.9% before implantation to 32% ± 4.2% and 64% ± 2.5% (p < 0.0001 and p < 0.0001), respectively, at final follow-up. Interventricular mechanical delay was significantly larger with RVP (66 ± 13 ms) than with LVP (20 ± 8 ms). Similarly, the following parameters were significantly different in the two groups: LV mechanical delay (RVP: 69 ± 6 ms, LVP: 30 ± 11 ms, p < 0.0001); septal to lateral wall motion delay (RVP: 75 ± 19 ms, LVP: 42 ± 10 ms, p < 0.0001); and, septal to posterior wall motion delay (RVP: 127 ± 33 ms, LVP: 58 ± 17 ms, p < 0.0001). Conclusion Compared with RV endocardium, LV epicardium is an optimal site for pacing to preserve cardiac synchrony and function. PMID:24061683

  20. Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Dweck Marc R

    2012-07-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR is the gold standard non-invasive method for determining left ventricular (LV mass and volume but has not been used previously to characterise the LV remodeling response in aortic stenosis. We sought to investigate the degree and patterns of hypertrophy in aortic stenosis using CMR. Methods Patients with moderate or severe aortic stenosis, normal coronary arteries and no other significant valve lesions or cardiomyopathy were scanned by CMR with valve severity assessed by planimetry and velocity mapping. The extent and patterns of hypertrophy were investigated using measurements of the LV mass index, indexed LV volumes and the LV mass/volume ratio. Asymmetric forms of remodeling and hypertrophy were defined by a regional wall thickening ≥13 mm and >1.5-fold the thickness of the opposing myocardial segment. Results Ninety-one patients (61±21 years; 57 male with aortic stenosis (aortic valve area 0.93±0.32cm2 were recruited. The severity of aortic stenosis was unrelated to the degree (r2=0.012, P=0.43 and pattern (P=0.22 of hypertrophy. By univariate analysis, only male sex demonstrated an association with LV mass index (P=0.02. Six patterns of LV adaption were observed: normal ventricular geometry (n=11, concentric remodeling (n=11, asymmetric remodeling (n=11, concentric hypertrophy (n=34, asymmetric hypertrophy (n=14 and LV decompensation (n=10. Asymmetric patterns displayed considerable overlap in appearances (wall thickness 17±2mm with hypertrophic cardiomyopathy. Conclusions We have demonstrated that in patients with moderate and severe aortic stenosis, the pattern of LV adaption and degree of hypertrophy do not closely correlate with the severity of valve narrowing and that asymmetric patterns of wall thickening are common. Trial registration ClinicalTrials.gov Reference Number: NCT00930735

  1. Management of three cardiogenic pulmonary edemas occurring in a patient scheduled for left ventricular assist device implantation: indicators for determining left ventricular assist device pump speed.

    Science.gov (United States)

    Toyama, Hiroaki; Takei, Yusuke; Saito, Kazutomo; Ota, Takahisa; Kurotaki, Kenji; Ejima, Yutaka; Matsuura, Takeshi; Akiyama, Masatoshi; Saiki, Yoshikatsu; Yamauchi, Masanori

    2016-08-01

    A male patient with Marfan syndrome underwent aortic root replacement and developed left ventricular (LV) failure. Four years later, he underwent aortic arch and aortic valve replacement. Thereafter, his LV failure progressed, and cardiogenic pulmonary edema (CPE) appeared, which we treated with extracorporeal LV assist device (LVAD) placement. Three months later, the patient developed aspiration pneumonia, which caused hyperdynamic right ventricle (RV) and CPE. We treated by changing his pneumatic LVAD to a high-flow centrifugal pump. A month later, he underwent thoracoabdominal aortic replacement. After four weeks, he developed septic thrombosis and LVAD failure, which caused CPE. We treated with LVAD circuit replacement and an additional membrane oxygenator. Four months later, he underwent DuraHeart(®) implantation. During this course, pulmonary artery wedge pressure (PAWP) varied markedly. Additionally, systolic pulmonary artery pressure (sPAP), left atrial diameter (LAD), RV end-diastolic diameter (RVEDD) and estimated RV systolic pressure (esRVP) changed with PAWP changes. In this patient, LV failure and hyperdynamic RV caused the CPEs, which we treated by adjusting the LVAD output to the RV output. Determining LVAD output, RV function and LV end-diastolic diameter are typically referred, and PAWP, LAD, RVEDD, and sPAP could be also referred.

  2. Left ventricular geometry and white matter lesions in ischemic stroke patients.

    Science.gov (United States)

    Butenaerts, Demian; Chrzanowska-Wasko, Joanna; Slowik, Agnieszka; Dziedzic, Tomasz

    2016-06-01

    Abnormal left ventricular (LV) geometry is associated with extracardiac organ damage in patients with hypertension. The aim of this study was to determine the relationship between LV geometry and white matter lesions (WMLs) in ischemic stroke patients. We retrospectively analyzed data from 155 patients (median age 62; 49.8% male) with mild ischemic stroke (median National Institutes of Health Stroke Scale score 4) who underwent brain magnetic resonance imaging and echocardiography. Patients were categorized into four groups: normal LV geometry, concentric remodeling, eccentric left ventricular hypertrophy (LVH) and concentric LVH. WMLs were graded using the Fazekas scale on fluid-attenuated inversion recovery images. Extensive WMLs were defined as a Fazekas score > 2. Extensive WMLs were more prevalent in patients with concentric LVH, eccentric LVH and concentric remodeling than in those with normal LV geometry. After adjusting for hypertension, age, diabetes mellitus, hypercholesterolemia, glomerular filtration rate and ischemic heart disease, patients with concentric remodeling [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.26-12.31, p = 0.02] and those with concentric LVH (OR 3.69, 95% CI 1.24-10.95, p = 0.02), but not patients with eccentric LVH (OR 2.44, 95% CI 0.72-8.29, p = 0.15), had higher risk of extensive WMLs than patients with normal LV geometry.

  3. Transthoracic echocardiography in rats. Evalution of commonly used indices of left ventricular dimensions, contractile performance, and hypertrophy in a genetic model of hypertrophic heart failure (SHHF-Mcc-facp-Rats) in comparison with Wistar rats during aging.

    Science.gov (United States)

    Reffelmann, Thorsten; Kloner, Robert A

    2003-09-01

    Two-weekly echocardiographic examinations were conducted in nine SHHF-Mc-fa(cp) rats in comparison with eight age-matched Wistar rats. In the SHHF-rats, characterized by progressive LV-dilation and decreasing contractile function between 77-87 weeks of age, left ventricular (LV) hypertrophy was most sensitively demonstrated by increased LV-mass-index (p rats.

  4. Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Pedersen, O D;

    1996-01-01

    Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously...

  5. Aortic stiffness is related to left ventricular diastolic function in patients with diabetes mellitus type 1: assessment with MRI and speckle tracking strain analysis

    NARCIS (Netherlands)

    Schinkel, L.D. van; Auger, D.; Elderen, S.G. van; Ajmone Marsan, N.; Delgado, V.; Lamb, H.J.; Ng, A.C.; Smit, J.W.A.; Bax, J.J.; Westenberg, J.J.; Roos, A. de

    2013-01-01

    Diabetes mellitus type 1 (DM1) is associated with aortic stiffening and left ventricular (LV) diastolic dysfunction, however the relationship between aortic stiffness and LV diastolic dysfunction in DM1 patients is still largely unknown. The purpose of this study was to evaluate whether an increased

  6. Aortic stiffness is related to left ventricular diastolic function in patients with diabetes mellitus type 1: assessment with MRI and speckle tracking strain analysis

    NARCIS (Netherlands)

    Schinkel, L.D. van; Auger, D.; Elderen, S.G. van; Ajmone Marsan, N.; Delgado, V.; Lamb, H.J.; Ng, A.C.; Smit, J.W.A.; Bax, J.J.; Westenberg, J.J.; Roos, A. de

    2013-01-01

    Diabetes mellitus type 1 (DM1) is associated with aortic stiffening and left ventricular (LV) diastolic dysfunction, however the relationship between aortic stiffness and LV diastolic dysfunction in DM1 patients is still largely unknown. The purpose of this study was to evaluate whether an increased

  7. Relationship between serum amino-terminal propeptide of type III procollagen and changes of left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Høst, N B; Jensen, S E

    2000-01-01

    : The relationship between PIIINP and changes of left ventricular (LV) function was studied in 47 consecutive patients with first acute MI and 16 control subjects. Serum PIIINP analysis was measured daily during hospitalization and on days 90, 180, and 360. LV function was assessed by echocardiography on days 1, 5...

  8. Are left ventricular mass, geometry and function related to vascular changes and/or insulin resistance in long-standing hypertension? ICARUS: a LIFE substudy

    DEFF Research Database (Denmark)

    Olsen, M H; Hjerkinn, E; Wachtell, K;

    2003-01-01

    Vascular hypertrophy and insulin resistance have been associated with abnormal left ventricular (LV) geometry in population studies. We wanted to investigate the influence of vascular hypertrophy and insulin resistance on LV hypertrophy and its function in patients with hypertension. In 89 patients...

  9. Are left ventricular mass, geometry and function related to vascular changes and/or insulin resistance in long-standing hypertension? ICARUS: a LIFE substudy

    DEFF Research Database (Denmark)

    Olsen, M H; Hjerkinn, E; Wachtell, K;

    2003-01-01

    Vascular hypertrophy and insulin resistance have been associated with abnormal left ventricular (LV) geometry in population studies. We wanted to investigate the influence of vascular hypertrophy and insulin resistance on LV hypertrophy and its function in patients with hypertension. In 89 patien...

  10. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function

    DEFF Research Database (Denmark)

    Amigoni, Maria; Meris, Alessandra; Thune, Jens Jakob

    2007-01-01

    AIMS: Mitral regurgitation (MR) confers independent risk in patients with acute myocardial infarction. We utilized data from the VALsartan In Acute myocardial iNfarcTion echo study to relate baseline MR to left ventricular (LV) size, shape, and function, and to assess the relationship between bas...

  11. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Simone Nascimento dos, E-mail: simonens@cardiol.br [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil); Faculdade de Medicina (UnB), Brasília, DF (Brazil); Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; Santos, Marcus Vinícius Nascimento dos; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil)

    2014-12-15

    Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. To evaluate the impact of AF ablation on estimated LV filling pressure. A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m{sup 2} ± 10.6 mL/m{sup 2} to 22.6 mL/m{sup 2} ± 1.1 mL/m{sup 2}, p < 0.001) compared to the non-successful group (37.7 mL/m{sup 2} ± 14.3 mL/m{sup 2} to 37.5 mL/m{sup 2} ± 14.5 mL/m{sup 2}, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

  12. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

    Directory of Open Access Journals (Sweden)

    Simone Nascimento dos Santos

    2014-12-01

    Full Text Available Background: Left ventricular (LV diastolic dysfunction is associated with new-onset atrial fibrillation (AF, and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective: To evaluate the impact of AF ablation on estimated LV filling pressure. Methods: A total of 141 patients underwent radiofrequency (RF ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind, and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e' were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results: One hundred seventeen patients (82.9% were free of AF during the follow-up (average, 18 ± 5 months. LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001 compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns. Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001 but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns. The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001. Conclusion: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

  13. Normal values of regional left ventricular endocardial motion: multicenter color kinesis study.

    Science.gov (United States)

    Mor-Avi, V; Spencer, K; Gorcsan, J; Demaria, A; Kimball, T; Monaghan, M; Perez, J; Sun, J P; Weinert, L; Bednarz, J; Collins, K; Edelman, K; Kwan, O L; Glascock, B; Hancock, J; Baumann, C; Thomas, J; Lang, R

    2000-11-01

    Our goal was to establish normal values for quantitative color kinesis indexes of left ventricular (LV) wall motion over a wide range of ages, which are required for objective diagnosis of regional systolic and diastolic dysfunction. Color-encoded images were obtained in 194 normal subjects (95 males, 99 females, age 2 mo to 79 yr) in four standard views. Quantitative indexes of magnitude and timing of systolic and diastolic function were studied for age- and gender-related differences. Normal limits of all ejection and filling indexes were in a narrow range (kinesis indexes should allow objective detection of regional LV systolic and diastolic dysfunction.

  14. Medical Image of the week: left ventricular non-compaction

    Directory of Open Access Journals (Sweden)

    Khoubyari R

    2016-06-01

    Full Text Available No abstract available. Article truncated at 150 words. A 38-year-old woman with history of type 2 diabetes mellitus and hypertension presented to emergency department with worsening exertional dyspnea and orthopnea for the past 2-3 months. She also reported a 14 pound weight gain within the 2 weeks prior to presentation. She denied any prior history of cardiac or pulmonary disease. Also, there was no family history of heart disease. She denies any recent sick contacts, smoking, alcohol drinking, or substance abuse. Physical exam revealed jugular venous pressure of 10 cm H2O and significant bilateral lower extremity pitting edema. Chest x-ray showed an enlarged cardiac silhouette. Brain naturetic peptide (BNP was 2,917 pg/mL. A subsequent echocardiogram revealed a left ventricular (LV ejection fraction of 23% with severe global LV hypokinesia with moderate mitral regurgitation. Thyroid panel as well as iron panel were within normal range. Other laboratories were unremarkable. For the new onset systolic heart failure, a coronary angiography was ...

  15. Relation Between Pressure and Volume Unloading During Ramp Testing in Patients Supported with a Continuous-Flow Left Ventricular Assist Device

    DEFF Research Database (Denmark)

    Jung, Mette H; Hassager, Christian; Balling, Louise;

    2015-01-01

    Pulmonary capillary wedge pressure (PCWP) is the key to describing left ventricular (LV) unloading, however, the relation between pressure and the echocardiography-derived surrogate of LV volume (left ventricular end-diastolic diameter (LVEDD)) as a function of pump speed (RPM) in continuous......-flow left ventricular assist device (CF-LVAD) patients is unknown. In this study the pressure-volume relationship as a function of RPM during ramp testing was investigated by simultaneously measuring PCWP by Swan-Ganz catheter and LVEDD by echocardiography. The ramp protocol started at usual pump setting...

  16. Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbaek, Lars; Poulsen, Mikael K

    2010-01-01

    In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition...... to conventional treatment is able to augment LV and left atrial (LA) reverse remodeling in patients with AS undergoing AVR, we studied 114 patients scheduled for AVR. Patients were randomized to treatment with candesartan 32 mg 1 time/day or conventional therapy immediately after AVR. Patients were followed...... E/e' ratio or B-type natriuretic peptide. In conclusion, angiotensin receptor blockade with candesartan after AVR in patients with AS is associated with augmented reverse LV and LA remodeling compared to conventional management....

  17. Left ventricular heart failure and pulmonary hypertension†

    Science.gov (United States)

    Rosenkranz, Stephan; Gibbs, J. Simon R.; Wachter, Rolf; De Marco, Teresa; Vonk-Noordegraaf, Anton; Vachiéry, Jean-Luc

    2016-01-01

    In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context. PMID:26508169

  18. Changes of Left Ventricular Geometry Shape and Left Ventricular Regional Function in Patients With Dilated Cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    Liang-yu WANG; Ming-xing XIE; Qing-bo LI; Ping CHEN; Zhi-xiong CAI; Zhi-dan ZHU

    2009-01-01

    Objectives To assess the left ventricle regional systolic and diastolic function, left ventricle geometry and left venti-tie sphericity indexes in patients with dilated cardiomyopathy (DCM) by quantitative tissue velocity imaging (QTVI). Methods Thirty normal subjects and 52 DCM patients underwent QTVI and colour Doppler flow imaging study in or-der to measure the left ventricular regional function along left ventricle apical long-axis view and the left ventricle geom-etry. Peak tissue velocities of left venticle regional muscular tissue during systole (Vs), systolic acceleration (a), ear-ly diastole(Ve) and left atrium contraction(Va) along left venticle apical long axis view were measured. The indexes of left ventdcular regional systolic and diastolic function were mearsured at the same time. The left ventricle geometry shape was reflected from the systolic and diastolic sphericity index (Sis and Sid), the left ventricular ejection fraction (LVEF) and D wave/A wave (PVd/Pva) of pulmonary veins flowing spectrum reflected the global left ventricular systolic and diastolic function. The Vs, Ve, Va, a, PVd/Pva ratio, LVEF, Sis, Sid and their correlations between normal subjects and patients with DCM were compared and analyzed. Results Vs, Ve, Va, a, PVd/Pva, Sis and Sid in patients with DCM were lower than those in normal persons. There were significant relations between Sis and a (r=0.6142, P<0.05), Ve/Va and Sid (r=0.6271, P<0.05). Conclusions QTVI offer a newer method which has a higher sensitivity and accuracy in evaluating the left venticle regional systolic and diastolic function in DCM patients. There was significant relation between regional cardiac function and left venticle sphericity.

  19. Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes

    Science.gov (United States)

    Rodrigues, Jonathan C L; Amadu, Antonio Matteo; Dastidar, Amardeep Ghosh; Szantho, Gergley V; Lyen, Stephen M; Godsave, Cattleya; Ratcliffe, Laura E K; Burchell, Amy E; Hart, Emma C; Hamilton, Mark C K; Nightingale, Angus K; Paton, Julian F R; Manghat, Nathan E; Bucciarelli-Ducci, Chiara

    2016-01-01

    Objective Myocardial intracellular/extracellular structure and aortic function were assessed among hypertensive left ventricular (LV) phenotypes using cardiovascular magnetic resonance (CMR). Methods An observational study from consecutive tertiary hypertension clinic patients referred for CMR (1.5 T) was performed. Four LV phenotypes were defined: (1) normal with normal indexed LV mass (LVM) and LVM to volume ratio (M/V), (2) concentric remodelling with normal LVM but elevated M/V, (3) concentric LV hypertrophy (LVH) with elevated LVM but normal indexed end-diastolic volume (EDV) or (4) eccentric LVH with elevated LVM and EDV. Extracellular volume fraction was measured using T1-mapping. Circumferential strain was calculated by voxel-tracking. Aortic distensibility was derived from high-resolution aortic cines and contemporaneous blood pressure measurements. Results 88 hypertensive patients (49±14 years, 57% men, systolic blood pressure (SBP): 167±30 mm Hg, diastolic blood pressure (DBP): 96±14 mm Hg) were compared with 29 age-matched/sex-matched controls (47±14 years, 59% men, SBP: 128±12 mm Hg, DBP: 79±10 mm Hg). LVH resulted from increased myocardial cell volume (eccentric LVH: 78±19 mL/m2 vs concentric LVH: 73±15 mL/m2 vs concentric remodelling: 55±9 mL/m2, p<0.05, respectively) and interstitial fibrosis (eccentric LVH: 33±10 mL/m2 vs concentric LVH: 30±10 mL/m2 vs concentricremodelling: 19±2 mL/m2, p<0.05, respectively). LVH had worst circumferential impairment (eccentric LVH: −12.8±4.6% vs concentric LVH: −15.5±3.1% vs concentric remodelling: –17.1±3.2%, p<0.05, respectively). Concentric remodelling was associated with reduced aortic distensibility, but not with large intracellular/interstitial expansion or myocardial dysfunction versus controls. Conclusions Myocardial interstitial fibrosis varies across hypertensive LV phenotypes with functional consequences. Eccentric LVH has the most fibrosis and

  20. Left ventricular remodeling after experimental myocardial cryoinjury in rats.

    Science.gov (United States)

    Ciulla, Michele M; Paliotti, Roberta; Ferrero, Stefano; Braidotti, Paola; Esposito, Arturo; Gianelli, Umberto; Busca, Giuseppe; Cioffi, Ugo; Bulfamante, Gaetano; Magrini, Fabio

    2004-01-01

    The standard coronary ligation, the most studied model of experimental myocardial infarction in rats, is limited by high mortality and produces unpredictable areas of necrosis. To standardize the location and size of the infarct and to elucidate the mechanisms of myocardial remodeling and its progression to heart failure, we studied the functional, structural, and ultrastructural changes of myocardial infarction produced by experimental myocardial cryoinjury. The cryoinjury was successful in 24 (80%) of 30 male adult CD rats. A subepicardial infarct was documented on echocardiograms, with an average size of about 21%. Macroscopic examination reflected closely the stamp of the instrument used, without transition zones to viable myocardium. Histological examination, during the acute setting, revealed an extensive area of coagulation necrosis and hemorrhage in the subepicardium. An inflammatory infiltrate was evident since the 7th hour, whereas the reparative phase started within the first week, with proliferation of fibroblasts, endothelial cells, and myocytes. From the 7th day, deposition of collagen fibers was reported with a reparative scar completed at the 30th day. Ultrastructural study revealed vascular capillary damage and irreversible alterations of the myocytes in the acute setting and confirmed the histological findings of the later phases. The damage was associated with a progressive left ventricular (LV) remodeling, including thinning of the infarcted area, hypertrophy of the noninfarcted myocardium, and significant LV dilation. This process started from the 60th day and progressed over the subsequent 120 days period; at 180 days, a significant increase in LV filling pressure, indicative of heart failure, was found. In conclusion, myocardial cryodamage, although different in respect to ischemic damage, causes a standardized injury reproducing the cellular patterns of coagulation necrosis, early microvascular reperfusion, hemorrhage, inflammation

  1. Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia.

    Directory of Open Access Journals (Sweden)

    Christian Eickholt

    Full Text Available OBJECTIVES: The beneficial effects of cardiac resynchronization therapy (CRT are thought to result from favorable left ventricular (LV reverse remodeling, however CRT is only successful in about 70% of patients. Whether response to CRT is associated with a decrease in ventricular arrhythmias (VA is still discussed controversially. Therefore, we investigated the incidence of VA in CRT responders in comparison with non-responders. METHODS: In this nonrandomized, two-center, observational study patients with moderate-to-severe heart failure, LV ejection fraction (LVEF ≤35%, and QRS duration >120 ms undergoing CRT were included. After 6 months patients were classified as CRT responders or non-responders. Incidence of VA was compared between both groups by Kaplan-Meier analysis and Cox regression analysis. ROC analysis was performed to determine the aptitude of LVEF cut-off values to predict VA. RESULTS: In total 126 consecutive patients (64±11 years; 67%male were included, 74 were classified as responders and 52 as non-responders. While the mean LVEF at baseline was comparable in both groups (25±7% vs. 24±8%; P = 0.4583 only the responder group showed an improvement of LVEF (36±6% vs. 24±7; p7% was found to be a predictor of a significantly lower incidence of VA (AUC = 0.606. CONCLUSIONS: Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia.

  2. Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Ozaki, Nobuchika; Sugimoto, Takaki; Okada, Masayoshi [Kobe Univ. (Japan). School of Medicine

    1999-02-01

    To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n=21): %FS has improved late after operation; Group B (n=16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84{+-}54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS ({delta}%FS) was used for assessment. Seven patients in Group A had showed {delta}%FS of more than 9%, while all patients in Group B had showed {delta}%FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. (author)

  3. Echocardiographic assessment of left ventricular geometric patterns in hypertensive patients in Nigeria.

    Science.gov (United States)

    Adebayo, Rasaaq A; Bamikole, Olaniyi J; Balogun, Michael O; Akintomide, Anthony O; Adeyeye, Victor O; Bisiriyu, Luqman A; Mene-Afejuku, Tuoyo O; Ajayi, Ebenezer A; Abiodun, Olugbenga O

    2013-01-01

    Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

  4. Quantitative Assessment of Left Ventricular Diastolic Stiffness Using Cardiac Shear Wave Elastography: A Pilot Study.

    Science.gov (United States)

    Song, Pengfei; Bi, Xiaojun; Mellema, Daniel C; Manduca, Armando; Urban, Matthew W; Greenleaf, James F; Chen, Shigao

    2016-07-01

    The purpose of this study was to systematically investigate the feasible echocardiographic views for human transthoracic cardiac shear wave elastography (SWE) and the impact of myocardial anisotropy on myocardial stiffness measurements. A novel cardiac SWE technique using pulse inversion harmonic imaging and time-aligned sequential tracking was developed for this study. The technique can measure the quantitative local myocardial stiffness noninvasively. Ten healthy volunteers were recruited and scanned by the proposed technique 3 times on 3 different days. Seven combinations of echocardiographic views and left ventricular (LV) segments were found to be feasible for LV diastolic stiffness measurements: basal interventricular septum under parasternal short- and long-axis views; mid interventricular septum under parasternal short- and long-axis views; anterior LV free wall under parasternal short- and long-axis views; and posterior LV free wall under a parasternal short-axis view. Statistical analyses showed good repeatability of LV diastolic stiffness measurements among 3 different days from 70% of the participants for the basal interventricular septum and posterior LV free wall short-axis views. On the same LV segment, the mean diastolic shear wave speed measurements from the short-axis view were statistically different from the long-axis measurements: 1.82 versus 1.29 m/s for the basal interventricular septum; 1.81 versus 1.45 m/s for mid interventricular septum; and 1.96 versus 1.77 m/s for the anterior LV free wall, indicating that myocardial anisotropy plays a substantial role in LV diastolic stiffness measurements. These results establish the preliminary normal range of LV diastolic stiffness under different scan views and provide important guidance for future clinical studies using cardiac SWE.

  5. Left Ventricular Tonic Contraction as a Novel Biomarker of Cardiomyopathy in Duchenne Muscular Dystrophy.

    Science.gov (United States)

    Su, Jennifer A; Ramos-Platt, Leigh; Menteer, JonDavid

    2016-04-01

    Dilated cardiomyopathy (DCM) inevitably afflicts patients with Duchenne muscular dystrophy (DMD) as a consequence of cell death induced by unguarded calcium influx into cardiomyocytes. This mechanism may also inhibit muscle relaxation in early stages of cardiomyopathy. ACE inhibition (ACEi) is known to delay the onset and slow the progression of DCM in DMD. The objective of this study is to use echocardiography to assess for preclinical cardiac changes consistent with intracellular calcium dysregulation before the onset of overt ventricular dysfunction, and to evaluate how prophylactic ACEi may alter these pre-cardiomyopathic changes in the pediatric DMD population. We examined 263 echocardiograms from 70 pediatric patients with DMD. We defined abnormal tonic contraction (TC) as left ventricular internal dimension in diastole (LVIDd) Z-score < -1.5. In our cohort, we found that TC is detectable as early as 8 years of age, and most commonly affects patients between 11 and 15 years. This effect was independent of LV mass and systolic function. Prophylactic ACEi decreased the incidence of TC (p = 0.007) and preserved cardiac function (p < 0.0001). Left ventricular TC often precedes DCM in DMD, most commonly affecting the 11- to 15-year-old age range. TC is not related to ventricular hypertrophy, but rather may be a clinical correlate of the "calcium hypothesis" of DMD pathophysiology. LV TC is thus a promising biomarker for early detection of cardiomyopathy in DMD. ACEi prophylaxis suppresses LV TC and delays the development of DCM in DMD.

  6. Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation

    Directory of Open Access Journals (Sweden)

    Comeau Cindy

    2010-05-01

    Full Text Available Abstract Background The treatment of patients with aortic regurgitation (AR or mitral regurgitation (MR relies on the accurate assessment of the severity of the regurgitation as well as its effect on left ventricular (LV size and function. Cardiovascular Magnetic Resonance (CMR is an excellent tool for quantifying regurgitant volumes as well as LV size and function. The 2008 AHA/ACC management guidelines for the therapy of patients with AR or MR only describe LV size in terms of linear dimensions (i.e. end-diastolic and end-systolic dimension. LV volumes that correspond to these linear dimensions have not been published in the peer-reviewed literature. The purpose of this study is to determine the effect of regurgitant volume on LV volumes and chamber dimensions in patients with isolated AR or MR and preserved LV function. Methods Regurgitant volume, LV volume, mass, linear dimensions, and ejection fraction, were determined in 34 consecutive patients with isolated AR and 23 consecutive patients with MR and no other known cardiac disease. Results There is a strong, linear relationship between regurgitant volume and LV end-diastolic volume index (aortic regurgitation r2 = 0.8, mitral regurgitation r2 = 0.8. Bland-Altman analysis of regurgitant volume shows little interobserver variation (AR: 0.6 ± 4 ml; MR 4 ± 6 ml. The correlation is much poorer between regurgitant volume and commonly used clinical linear measures such as end-systolic dimension (mitral regurgitation r2 = 0.3, aortic regurgitation r2 = 0.5. For a given regurgitant volume, AR causes greater LV enlargement and hypertrophy than MR. Conclusion CMR is an accurate and robust technique for quantifying regurgitant volume in patients with AR or MR. Ventricular volumes show a stronger correlation with regurgitant volume than linear dimensions, suggesting LV volumes better reflect ventricular remodeling in patients with isolated mitral or aortic regurgitation. Ventricular volumes that

  7. The accuracy and optimal slice thickness of multislice helical computed tomography for right and left ventricular volume measurement

    Institute of Scientific and Technical Information of China (English)

    崔炜; 近藤武; 安野泰史; 郭玉印; 佐藤贵久; 皿井正義; 篠崎仁史; 柿澤聡士; 杉浦厚司; 大岛慶太; 片田和廣; 菱田仁

    2004-01-01

    Background Multislice helical computed tomography (MSCT) has been used to depict coronary anatomy noninvasively, and proved useful for evaluating ventricular function. The aim of our study was to assess the accuracy of ventricular volume as measured by MSCT. Methods Fourteen human left ventricular (LV) and 15 right ventricular (RV) casts were scanned by MSCT. A series of LV and RV short-axis images were reconstructed later with slice thickness of 2.0 mm, 3.5 mm, 5.0 mm, 7.0 mm, and 10.0 mm. Ventricular volume was calculated by the multislice tomographic Simpson's method. True LV and RV cast volumes were determined by water displacement. Results Both calculated LV and RV volumes correlated highly with the corresponding true volumes (all r>0.95, P<0.01). But with slice thickness from 2.0 mm to 10.0 mm, MSCT scanning overestimated the corresponding true volume by (3.21±5.95) ml to (12.58±8.56) ml for LV and (10.22±8.45) ml to (23.91±12.24) ml for RV (all P<0.01). There was a very high correlation between the overestimation and the selected slice thickness for both LV and RV volume measurements (r=0.998 and 0.996, P<0.01, respectively). However, when slice thickness was reduced to 5.0 mm, the overestimation for both LV and RV volume measurements became nonsignificant for slice thickness from 2.0 mm to 5.0 mm. Conclusions Both LV and RV volumes can be accurately estimated by MSCT. Thinner slice has more accurate calculated volume. However, 5.0 mm slice thickness is thin enough for an accurate measurement of LV or RV volume.

  8. Aortic Regurgitation Generates a Kinematic Obstruction Which Hinders Left Ventricular Filling.

    Science.gov (United States)

    Okafor, Ikechukwu; Raghav, Vrishank; Condado, Jose F; Midha, Prem A; Kumar, Gautam; Yoganathan, Ajit P

    2017-01-13

    An incompetent aortic valve (AV) results in aortic regurgitation (AR), where retrograde flow of blood into the left ventricle (LV) is observed. In this work, we parametrically characterized the detailed changes in intra-ventricular flow during diastole as a result of AR in a physiological in vitro left-heart simulator (LHS). The loss of energy within the LV as the level of AR increased was also assessed. The validated LHS consisted of an optically-clear, flexible wall LV and a modular AV holder. Two-component, planar, digital particle image velocimetry was used to visualize and quantify intra-ventricular flow. A large coherent vortical structure which engulfed the whole LV was observed under control conditions. In the cases with AR, the regurgitant jet was observed to generate a "kinematic obstruction" between the mitral valve and the LV apex, preventing the trans-mitral jet from generating a coherent vortical structure. The regurgitant jet was also observed to impinge on the inferolateral wall of the LV. Energy dissipation rate (EDR) for no, trace, mild, and moderate AR were found to be 1.15, 2.26, 3.56, and 5.99 W/m(3), respectively. This study has, for the first time, performed an in vitro characterization of intra-ventricular flow in the presence of AR. Mechanistically, the formation of a "kinematic obstruction" appears to be the cause of the increased EDR (a metric quantifiable in vivo) during AR. EDR increases non-linearly with AR fraction and could potentially be used as a metric to grade severity of AR and develop clinical interventional timing strategies for patients.

  9. Anemia treatment and left ventricular hypertrophy in non-dialysis chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    Robert N. Foley; Peter A. McCullough

    2005-01-01

    @@ To this day, the target hemoglobin level that minimizes cardiovascular risk in chronic kidney disease (CKD) patients remains unclear. When one examines the many randomized trials of epoetin therapy in aggregate, enhanced quality of life provides the most cogent argument for hemoglobin levels above 110 g/L. It remains unclear whether treatment of anemia improves longevity, or even a surrogate marker (such as left ventricular [LV] mass index), especially when applied at earlier phases of CKD.

  10. Tamponade by an expanding left ventricular pseudoaneurysm: A unique presentation.

    Science.gov (United States)

    Mahesh, Balakrishnan; Ong, Ping; Kutty, Ramesh; Abu-Omar, Yasir

    2015-10-01

    Left ventricular free wall rupture secondary to myocardial infarction is an uncommon but catastrophic event requiring emergency surgery. We describe a unique presentation of left ventricular free wall rupture as delayed tamponade caused by a gradually expanding pseudoaneurysm compressing the left atrium, leading to pulmonary congestion that required increasing respiratory support to maintain oxygenation, and necessitated emergency surgery. We discuss the options available to treat pseudoaneurysms due to left ventricular free wall rupture.

  11. Atrioventricular Left Ventricular Apical Pacing Improves Haemodynamic, Rotational, and Deformation Variables in Comparison to Pacing at the Lateral Wall in Intact Myocardium: Experimental Study

    Directory of Open Access Journals (Sweden)

    Savvas Toumanidis

    2014-01-01

    Full Text Available Aim. To assess the effect on left ventricular (LV function of atrioventricular (AV and ventricular pacing at the LV apical or lateral wall and to compare the normal torsional and deformation pattern of the intact LV myocardium with those created by the aforementioned LV pacing modes and sites. Methods. Experiments were conducted in pigs (n=21 with normal LV function to investigate the acute hemodynamic effects of epicardial AV and ventricular LV pacing at the LV apical or lateral wall. Torsional and deformation indices of LV function were assessed using speckle tracking echocardiography. Results. AV pacing at the apex revealed a significant reduction in the radial strain of the base (P<0.03, without affecting significantly the ejection fraction and the LV torsion or twist. In contrast, AV pacing at the lateral wall produced, in addition to the reduction of the radial strain of the base (P<0.01, significant reduction of the circumferential and the radial strain of the apex (both P<0.01 as well as of the ejection fraction (P<0.002 and twist (P<0.05. Conclusions. In pig hearts with intact myocardium, LV function is maintained at sinus rhythm level when AV pacing is performed at the LV apex.

  12. Assessment of age-related changes in left ventricular twist by 3-dimensional speckle-tracking echocardiography.

    Science.gov (United States)

    Tavakoli, Vahid; Sahba, Nima

    2013-08-01

    The purpose of this study was to determine the normal value of left ventricular (LV) twist in 3-dimensional (3D) geometry and to study the effects of aging on 3D LV twist by sophisticated newly developed 3D speckle-tracking echocardiographic techniques. Recent developments in miniaturized ultrasound arrays have provided us with high-quality 3D echocardiographic data. Speckle tracking based on 3D images is robust to out-of-plane motion error, whereas 2-dimensional speckle tracking is inherently unable to analyze 3D cardiac motion and may lead to measurement inaccuracies. Three-dimensional LV volumetric images were acquired from 124 healthy volunteers (aged 21-82 years) and were analyzed by a recent speckle-tracking method. Left ventricular twist was analyzed as apical rotation relative to the base in the 3D coordinates. The measured parameters in this study were peak apical rotation, peak basal rotation, peak LV twist, normalized peak LV twist, and peak untwist velocity. As seen from the apex, the normal LV maintains a wringing systolic displacement with an initial counterclockwise rotation followed by a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal twist increases during the aging process, leading to an increased LV twist value. The mean peak twist ± SD in young participants (21-35 years) was 11.73° ± 2.67°, whereas the value for older participants (>65 years) was 18.57° ± 3.08° (P speckle-tracking echocardiography can be an effective noninvasive method for assessing 3D LV twist. Age-related differences in the 3D LV twist may be the result of the age-related changes in the endocardial myofibers.

  13. N-terminal pro brain natriuretic peptide in arterial hypertension--a marker for left ventricular dimensions and prognosis

    DEFF Research Database (Denmark)

    Hildebrandt, Per; Boesen, Mikael; Olsen, Michael

    2004-01-01

    and preserved LV function demonstrated that NT-proBNP was a very strong prognostic marker, especially combined with a history of cardiovascular disease. Patients with high NT-proBNP and known cardiovascular disease had a seven-fold increase in CV events compared to patients with low NT-proBNP and no CV disease...... is present in arterial hypertension, risk factor evaluation would be easier. In 36 patients with arterial hypertension, electrocardiographic LV hypertrophy and preserved left ventricular function, NT-proBNP was eight-fold higher than in healthy subjects. The log NT-proBNP correlated with LV mass index (R=0...

  14. Abnormal glucose metabolism is associated with reduced left ventricular contractile reserve and exercise intolerance in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Egstrup, M; Kistorp, C N; Schou, M;

    2013-01-01

    years, 69% male, 59% had ischaemic heart disease, mean LV ejection fraction (LVEF) 37 ± 9%). Thirty-four (21%) patients had known diabetes mellitus (DM). Oral glucose tolerance testing (OGTT) classified patients without a prior DM diagnosis as normal glucose tolerance (NGT), impaired glucose tolerance......AIMS: To investigate the associations between glucose metabolism, left ventricular (LV) contractile reserve, and exercise capacity in patients with chronic systolic heart failure (HF). METHODS AND RESULTS: From an outpatient HF clinic, 161 patients with systolic HF were included (mean age 70 ± 10...... detected by OGTT, is independently associated with reduced LV contractile reserve and exercise...

  15. Left ventricular mechanoenergetics under altered coronary perfusion in guinea pig hearts.

    Science.gov (United States)

    Matsushita, T; Takaki, M; Fujii, W; Matsubara, H; Suga, H

    1995-01-01

    Coronary perfusion pressure (CPP) is well known to affect left ventricular (LV) mechanoenergetics (Gregg's phenomenon). The garden hose effect via the Frank-Starling mechanism caused by coronary distension has long been considered to be the underlying mechanism of this phenomenon. However, recent studies have revealed a close correlation between CPP and the excitation-contraction coupling in myocytes. The aim of this study was to investigate the mechanoenergetic aspects of Gregg's phenomenon by the ventricular contractility (Emax) dependency of the myocardial oxygen consumption (VO2)-total mechanical energy (PVA, systolic pressure-volume area) relationship. Experiments were performed in the excised, cross-circulated guinea pig heart preparation. The protocol consisted of LV volume loading (VOL run), changing coronary perfusion pressure at a fixed LV volume (CPP run) and intracoronary calcium (Ca) infusion also at the same LV volume (Ca run). In all seven hearts, we obtained a linear VO2-PVA relation in VOL run. The VO2-PVA relations in CPP and Ca runs, which equally enhanced Emax, were highly linear and had no significant difference in their slopes, both significantly steeper than in VOL run. These findings suggest no significant difference in the oxygen cost of Emax between CPP and Ca runs. The enhanced LV mechanoenergetics under increasing CPP is characterized by increases in the VO2 component primarily for the excitation-contraction coupling to a greater degree than expected from the mechanical (garden hose) effect.

  16. The Effects of Exercise Intensity vs. Metabolic State on the Variability and Magnitude of Left Ventricular Twist Mechanics during Exercise.

    Science.gov (United States)

    Armstrong, Craig; Samuel, Jake; Yarlett, Andrew; Cooper, Stephen-Mark; Stembridge, Mike; Stöhr, Eric J

    2016-01-01

    Increased left ventricular (LV) twist and untwisting rate (LV twist mechanics) are essential responses of the heart to exercise. However, previously a large variability in LV twist mechanics during exercise has been observed, which complicates the interpretation of results. This study aimed to determine some of the physiological sources of variability in LV twist mechanics during exercise. Sixteen healthy males (age: 22 ± 4 years, [Formula: see text]O2peak: 45.5 ± 6.9 ml∙kg-1∙min-1, range of individual anaerobic threshold (IAT): 32-69% of [Formula: see text]O2peak) were assessed at rest and during exercise at: i) the same relative exercise intensity, 40%peak, ii) at 2% above IAT, and, iii) at 40%peak with hypoxia (40%peak+HYP). LV volumes were not significantly different between exercise conditions (P > 0.05). However, the mean margin of error of LV twist was significantly lower (F2,47 = 2.08, P rate (P 0.05). Overall, LV twist mechanics were linearly related to rate pressure product. During exercise, the intra-individual variability of LV twist mechanics is smaller at the same relative exercise intensity compared with IAT. However, the absolute magnitude (degrees) of LV twist mechanics appears to be associated with the prevailing rate pressure product. Exercise tests that evaluate LV twist mechanics should be standardised by relative exercise intensity and rate pressure product be taken into account when interpreting results.

  17. Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Chinali, M.; Simone, G. de; Wachtell, K.;

    2008-01-01

    systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n......In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... with larger left ventricular diameter and higher left ventricular mass index (both P ventricular hypertrophy was greater (84 vs. 64%; P

  18. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation.

    Science.gov (United States)

    Cole, Graham D; Dhutia, Niti M; Shun-Shin, Matthew J; Willson, Keith; Harrison, James; Raphael, Claire E; Zolgharni, Massoud; Mayet, Jamil; Francis, Darrel P

    2015-10-01

    Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1-20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an "eyeball" EF estimate and (3) an image quality rating on a 0-100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator's chance of agreement with another operator was 50% and with themself on blinded re-presentation was 68%. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators' assessments, correlated with EF estimate variability (r = -0.616, p visual grading agreement (r = 0.58, p visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.

  19. Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction

    DEFF Research Database (Denmark)

    Stone, Gregg W; Chung, Eugene S; Stancak, Branislav;

    2016-01-01

    AIMS: We sought to determine whether peri-infarct pacing prevents left ventricular (LV) remodelling and improves functional and clinical outcomes in patients with large first myocardial infarction (MI). METHODS AND RESULTS: A total of 126 patients at 27 international sites within 10 days of onset...

  20. Effects of Intensive Statin Therapy on Left Ventricular Function in Patients with Myocardial Infarction and Abnormal Glucose Tolerance

    DEFF Research Database (Denmark)

    Auscher, Søren; Løgstrup, Brian Bridal; Møller, Jacob Eifer

    2017-01-01

    statin therapy. Patients were assessed with an oral glucose tolerance test and their left ventricular (LV) function was assessed with speckle-tracking echocardiography measuring regional longitudinal systolic strain (RLSS) in the infarct area. RESULTS: Overall RLSS in the infarct area improved by a mean...

  1. A novel approach for endocardial resynchronization therapy: Initial experience with transapical implantation of the left ventricular lead

    NARCIS (Netherlands)

    I. Kassai (Imre); A. Mihalcz (Attila); C. Foldesi (Csaba); A. Kardos (Attila); T. Szili-Torok (Tamas)

    2009-01-01

    textabstractBackground: Coronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a considerable dislocation rate during follow-up. For these patients epicardial pacing lead implantation is the

  2. Acute anti-ischemic effects ef perindoprilat in men with coronary artery disease and their relation with left ventricular function

    NARCIS (Netherlands)

    Bartels, GL; van den Heuvel, AFM; van Veldhuisen, DJ; van der Ent, M; Remme, WJ

    1999-01-01

    Long-term angiotensin-converting enzyme (ACE) inhibition may reduce ischemic events in patients with coronary artery disease, but whether it protects against acute ischemia or the effects of preexisting left ventricular (LV) dysfunction on potential anti-ischemic properties is unknown. We performed

  3. A novel approach for endocardial resynchronization therapy: Initial experience with transapical implantation of the left ventricular lead

    NARCIS (Netherlands)

    I. Kassai (Imre); A. Mihalcz (Attila); C. Foldesi (Csaba); A. Kardos (Attila); T. Szili-Torok (Tamas)

    2009-01-01

    textabstractBackground: Coronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a considerable dislocation rate during follow-up. For these patients epicardial pacing lead implantation is the

  4. Change of genetic determinants of left ventricular structure in adolescence : Longitudinal evidence from the Georgia Cardiovascular Twin Study

    NARCIS (Netherlands)

    Kapuku, Gaston K.; Ge, Dongliang; Vemulapalli, Sarita; Harshfield, Gregory A.; Treiber, Frank A.; Snieder, Harold

    2008-01-01

    BACKGROUND Genetic contribution to left ventricular (LV) structure is generally recognized, but whether and how this influence varies by ethnicity or with age is unknown. METHODS Participants were 517 European-American (EA) and African-American (AA) twin pairs (mean age: 14.6 +/- 3.0) at visit 1 and

  5. Effect of Metformin on Metabolites and Relation With Myocardial Infarct Size and Left Ventricular Ejection Fraction After Myocardial Infarction

    NARCIS (Netherlands)

    Eppinga, Ruben N; Kofink, Daniel; Dullaart, Robin P F; Dalmeijer, Geertje W; Lipsic, Erik; van Veldhuisen, Dirk J; van der Horst, Iwan C C; Asselbergs, Folkert W; van der Harst, Pim

    2017-01-01

    BACKGROUND: Left ventricular ejection fraction (LVEF) and infarct size (ISZ) are key predictors of long-term survival after myocardial infarction (MI). However, little is known about the biochemical pathways driving LV dysfunction after MI. To identify novel biomarkers predicting post-MI LVEF and IS

  6. Management and outcomes in patients with moderate or severe functional mitral regurgitation and severe left ventricular dysfunction

    DEFF Research Database (Denmark)

    Samad, Zainab; Shaw, Linda K; Phelan, Matthew

    2015-01-01

    AIMS: The management and outcomes of patients with functional moderate/severe mitral regurgitation and severe left ventricular (LV) systolic dysfunction are not well defined. We sought to determine the characteristics, management strategies, and outcomes of patients with moderate or severe mitral...

  7. Acute impact of pacing at different cardiac sites on left ventricular rotation and twist in dogs.

    Directory of Open Access Journals (Sweden)

    Zhi-Wen Zhou

    Full Text Available We evaluated the acute impact of different cardiac pacing sites on two-dimensional speckle-tracking echocardiography (STE derived left ventricular (LV rotation and twist in healthy dogs.Twelve dogs were used in this study. The steerable pacing electrodes were positioned into right heart through the superior or inferior vena cava, into LV through aorta across the aortic valve. The steerable pacing electrodes were positioned individually in the right atrium (RA, right ventricular apex (RVA, RV outflow tract (RVOT, His bundle (HB, LV apex (LVA and LV high septum (LVS, individual pacing mode was applied at 10 minutes interval for at least 5 minutes from each position under fluoroscopy and ultrasound guidance and at stabilized hemodynamic conditions. LV short-axis images at the apical and basal levels were obtained during sinus rhythm and pacing. Offline STE analysis was performed. Rotation, twist, time to peak rotation (TPR, time to peak twist (TPT, and apical-basal rotation delay (rotational synchronization index, RSI values were compared at various conditions. LV pressure was monitored simultaneously.Anesthetic death occurred in 1 dog, and another dog was excluded because of bad imaging quality. Data from 10 dogs were analyzed. RVA, RVOT, HB, LVA, LVS, RARV (RA+RVA pacing resulted in significantly reduced apical and basal rotation and twist, significantly prolonged apical TPR, TPT and RSI compared to pre-pacing and RA pacing (all P<0.05. The apical and basal rotation and twist values were significantly higher during HB pacing than during pacing at ventricular sites (all P<0.05, except basal rotation at RVA pacing. The apical TPR during HB pacing was significantly shorter than during RVOT and RVA pacing (both P<0.05. The LV end systolic pressure (LVESP was significantly lower during ventricular pacing than during pre-pacing and RA pacing.Our results show that RA and HB pacing results in less acute reduction on LV twist, rotation and LVESP compared

  8. Myocardial connective tissue growth factor (CCN2/CTGF attenuates left ventricular remodeling after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Jørgen Gravning

    Full Text Available AIMS: Myocardial CCN2/CTGF is induced in heart failure of various etiologies. However, its role in the pathophysiology of left ventricular (LV remodeling after myocardial infarction (MI remains unresolved. The current study explores the role of CTGF in infarct healing and LV remodeling in an animal model and in patients admitted for acute ST-elevation MI. METHODS AND RESULTS: Transgenic mice with cardiac-restricted overexpression of CTGF (Tg-CTGF and non-transgenic littermate controls (NLC were subjected to permanent ligation of the left anterior descending coronary artery. Despite similar infarct size (area of infarction relative to area at risk 24 hours after ligation of the coronary artery in Tg-CTGF and NLC mice, Tg-CTGF mice disclosed smaller area of scar tissue, smaller increase of cardiac hypertrophy, and less LV dilatation and deterioration of LV function 4 weeks after MI. Tg-CTGF mice also revealed substantially reduced mortality after MI. Remote/peri-infarct tissue of Tg-CTGF mice contained reduced numbers of leucocytes, macrophages, and cells undergoing apoptosis as compared with NLC mice. In a cohort of patients with acute ST-elevation MI (n = 42 admitted to hospital for percutaneous coronary intervention (PCI serum-CTGF levels (s-CTGF were monitored and related to infarct size and LV function assessed by cardiac MRI. Increase in s-CTGF levels after MI was associated with reduced infarct size and improved LV ejection fraction one year after MI, as well as attenuated levels of CRP and GDF-15. CONCLUSION: Increased myocardial CTGF activities after MI are associated with attenuation of LV remodeling and improved LV function mediated by attenuation of inflammatory responses and inhibition of apoptosis.

  9. Association between routine and standardized blood pressure measurements and left ventricular hypertrophy among patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Walsh Michael

    2010-06-01

    Full Text Available Abstract Background Left ventricular (LV hypertrophy is common among patients on hemodialysis. While a relationship between blood pressure (BP and LV hypertrophy has been established, it is unclear which BP measurement method is the strongest correlate of LV hypertrophy. We sought to determine agreement between various blood pressure measurement methods, as well as identify which method was the strongest correlate of LV hypertrophy among patients on hemodialysis. Methods This was a post-hoc analysis of data from a randomized controlled trial. We evaluated the agreement between seven BP measurement methods: standardized measurement at baseline; single pre- and post-dialysis, as well as mean intra-dialytic measurement at baseline; and cumulative pre-, intra- and post-dialysis readings (an average of 12 monthly readings based on a single day per month. Agreement was assessed using Lin's concordance correlation coefficient (CCC and the Bland Altman method. Association between BP measurement method and LV hypertrophy on baseline cardiac MRI was determined using receiver operating characteristic curves and area under the curve (AUC. Results Agreement between BP measurement methods in the 39 patients on hemodialysis varied considerably, from a CCC of 0.35 to 0.94, with overlapping 95% confidence intervals. Pre-dialysis measurements were the weakest predictors of LV hypertrophy while standardized, post- and inter-dialytic measurements had similar and strong (AUC 0.79 to 0.80 predictive power for LV hypertrophy. Conclusions A single standardized BP has strong predictive power for LV hypertrophy and performs just as well as more resource intensive cumulative measurements, whereas pre-dialysis blood pressure measurements have the weakest predictive power for LV hypertrophy. Current guidelines, which recommend using pre-dialysis measurements, should be revisited to confirm these results.

  10. Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Delewi, Ronak [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Interuniversity Cardiology Institute of the Netherlands (Netherlands); Nijveldt, Robin [Department of Cardiology, VU University Medical Center, Amsterdam (Netherlands); Hirsch, Alexander [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Marcu, Constantin B.; Robbers, Lourens [Department of Cardiology, VU University Medical Center, Amsterdam (Netherlands); Hassell, Marriela E.C.J.; Bruin, Rianne H.A. de; Vleugels, Jim; Laan, Anja M. van der; Bouma, Berto J. [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Tio, René A. [Thorax Center, University Medical Center Groningen, Groningen (Netherlands); Tijssen, Jan G.P. [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Rossum, Albert C. van [Department of Cardiology, VU University Medical Center, Amsterdam (Netherlands); Zijlstra, Felix [Thorax Center, Department of Cardiology, Erasmus University Medical Center, Rotterdam (Netherlands); Piek, Jan J., E-mail: j.j.piek@amc.uva.nl [Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2012-12-15

    Introduction: Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI. Methods: 200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events. Results: On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B = 0.02, SE = 0.02, p < 0.001). Routine TTE had a sensitivity of 21–24% and a specificity of 95–98% compared to CMR for the detection of LV thrombi. Intra- and interobserver variation for detection of LV thrombus were lower for CMR (κ = 0.91 and κ = 0.96) compared to TTE (κ = 0.74 and κ = 0.53). Conclusion: LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large.

  11. Heart Disease and Left Ventricular Rotation – A Systematic Review and Quantitative Summary

    Directory of Open Access Journals (Sweden)

    Phillips Aaron A

    2012-06-01

    Full Text Available Abstract Background Left ventricular (LV rotation is increasingly examined in those with heart disease. The available evidence measuring LV rotation in those with heart diseases has not been systematically reviewed. Methods To review systematically the evidence measuring LV rotational changes in various heart diseases compared to healthy controls, literature searches were conducted for appropriate articles using several electronic databases (e.g., MEDLINE, EMBASE. All randomized-controlled trials, prospective cohort and case–controlled studies that assessed LV rotation in relation to various heart conditions were included. Three independent reviewers evaluated each investigation’s quality using validated scales. Results were tabulated and levels of evidence assigned. Results A total of 1,782 studies were found through the systematic literature search. Upon review of the articles, 47 were included. The articles were separated into those investigating changes in LV rotation in participants with: aortic stenosis, myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, non-compaction, restrictive cardiomyopathy/ constrictive pericarditis, heart failure, diastolic dysfunction, heart transplant, implanted pacemaker, coronary artery disease and cardiovascular disease risk factors. Evidence showing changes in LV rotation due to various types of heart disease was supported by evidence with limited to moderate methodological quality. Conclusions Despite a relatively low quality and volume of evidence, the literature consistently shows that heart disease leads to marked changes in LV rotation, while rotational systolic-diastolic coupling is preserved. No prognostic information exists on the potential value of rotational measures of LV function. The literature suggests that measures of LV rotation may aid in diagnosing subclinical aortic stenosis and diastolic dysfunction.

  12. Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters

    Science.gov (United States)

    Korre, Maria; Porto, Luiz Guilherme G.; Farioli, Andrea; Yang, Justin; Christiani, David C.; Christophi, Costas A.; Lombardi, David A.; Kovacs, Richard J.; Mastouri, Ronald; Abbasi, Siddique; Steigner, Michael; Moffatt, Steven; Smith, Denise; Kales, Stefanos N.

    2017-01-01

    Left ventricular (LV) mass is a strong predictor of cardiovascular disease (CVD) events; increased LV mass is common among US firefighters and plays a major role in firefighter sudden cardiac death. We aim to identify significant predictors of LV mass among firefighters. Cross-sectional study of 400 career male firefighters selected by an enriched randomization strategy. Weighted analyses were performed based on the total number of risk factors per subject with inverse probability weighting. LV mass was assessed by echocardiography (ECHO) and cardiac magnetic resonance, and normalized (indexed) for height. CVD risk parameters included vital signs at rest, body mass index (BMI)–defined obesity, obstructive sleep apnea risk, low cardiorespiratory fitness, and physical activity. Linear regression models were performed. In multivariate analyses, BMI was the only consistent significant independent predictor of LV mass indexes (all, p <0.001). A 1-unit decrease in BMI was associated with 1-unit (g/m1.7) reduction of LV mass/height1.7 after adjustment for age, obstructive sleep apnea risk, and cardiorespiratory fitness. In conclusion, after height-indexing ECHO-measured and cardiac magnetic resonance–measured LV mass, BMI was found to be a major driver of LV mass among firefighters. Our findings taken together with previous research suggest that reducing obesity will improve CVD risk profiles and decrease on-duty CVD and sudden cardiac death events in the fire service. Our results may also support targeted noninvasive screening for LV hypertrophy with ECHO among obese firefighters. PMID:27687051

  13. Intraoperative transesophageal echocardiographic assessment of left ventricular Tei index in congenital heart disease

    Directory of Open Access Journals (Sweden)

    Shanthi Sivanandam

    2015-01-01

    Full Text Available Background: Use of the Tei index has not been described to assess myocardial function before or after surgery in pediatric patients. This study was designed to evaluate the left ventricular (LV function using the Tei index pre- and post-cardiopulmonary bypass in patients with lesion that result in a volume loaded right ventricle (RV. Methods: Retrospective data on 55 patients who underwent repair of a cardiac defect were analyzed. Patients with volume overload RV (n = 15 were compared to patients without volume overload but with other cardiac defects (n = 40. We reviewed pre- and post-operative LV myocardial performance index (Tei index. Tei index was obtained from transesophageal Doppler echocardiogram. Results: Patients with right heart volume overload, the mean preoperative Tei index was 0.6, with a postoperative mean decrease of 0.207 (P = 0.014. Patients without right heart volume overload, the mean preoperative Tei was 0.48 with no significant postoperative change (P = 0.82. Conclusion: Pre- and post-operative transesophageal echocardiogram assessment provides an easy and quick way of evaluating LV function intra-operatively using LV Tei index. Preoperative LV Tei index was greater in the RV volume overload defects indicating diminished LV global function. This normalized in the immediate postoperative period, implying an immediate improvement in LV function. In patients without right heart volume load, consist of other cardiac defects, demonstrated no changes in the pre- and post-operative LV Tei. This implies that LV function was similar after the surgery.

  14. Evaluation of global left ventricular function assessment by dual-source computed tomography compared with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Vleuten, Pieter A. van der; Tio, Rene A.; Zijlstra, Felix [University Medical Centre Groningen, Thoraxcenter, Department of Cardiology, P.O. Box 30001, Groningen (Netherlands); Jonge, Gonda J. de; Lubbers, Daniel D.; Willems, Tineke P.; Oudkerk, Matthijs [University Medical Centre Groningen, Department of Radiology, Groningen (Netherlands)

    2009-02-15

    Left ventricular (LV) function assessment by dual-source computed tomography (DSCT) was compared with the reference standard method using magnetic resonance imaging (MRI). Accurate assessment of LV function is essential for the prediction of prognosis in cardiac disease. Thirty-four patients undergoing DSCT examination of the heart for various clinical indications underwent MRI after DSCT. Short-axis cine images were reconstructed from the DSCT datasets and were analyzed using a dedicated post-processing software-tool to generate global left ventricular function parameters. Five DSCT datasets were considered to be of insufficient image quality. DSCT showed a small overestimation of end-diastolic and end-systolic volumes of 11.0 ml and 3.5 ml, nrespectively. Myocardial mass assessed by DSCT showed an average underestimation of 0.2 g. DSCT showed a small overestimation of LV ejection fraction (LVEF) of 0.4%-point with a Bland-Altman interval of [-8.67 (0.40) 9.48]. Global LV functional parameters calculated from DSCT datasets acquired in daily clinical practice correlated well with MRI and may be considered interchangeable. However, visual assessment of the image quality of the short-axis cine slices should be performed to detect any artifacts in the DSCT data which could influence accuracy. (orig.)

  15. Computer-based assessment of left ventricular wall stiffness in patients with ischemic dilated cardiomyopathy

    Science.gov (United States)

    Su, Y.; Teo, S. K.; Tan, R. S.; Lim, C. W.; Zhong, L.

    2013-02-01

    Ischemic dilated cardiomyopathy (IDCM) is a degenerative disease of the myocardial tissue accompanied by left ventricular (LV) structural changes such as interstitial fibrosis. This can induce increased passive stiffness of the LV wall. However, quantification of LV passive wall stiffness in vivo is extremely difficult, particularly in ventricles with complex geometry. Therefore, we sought to (i) develop a computer-based assessment of LV passive wall stiffness from cardiac magnetic resonance (CMR) imaging in terms of a nominal stiffness index (E*); and (ii) investigate whether E* can offer an insight into cardiac mechanics in IDCM. CMR scans were performed in 5 normal subjects and 5 patients with IDCM. For each data sample, an in-house software was used to generate a 1-to-1 corresponding mesh pair of the LV from the ED and ES phases. The E* values are then computed as a function of local ventricular wall strain. We found that E* in the IDCM group (40.66 - 215.12) was at least one order of magnitude larger than the normal control group (1.00 - 6.14). In addition, the IDCM group revealed much higher inhomogeneity of E* values manifested by a greater spread of E* values throughout the LV. In conclusion, there is a substantial elevated ventricular stiffness index in IDCM. This would suggest that E* could be used as discriminator for early detection of disease state. The computational performance per data sample took approximately 25 seconds, which demonstrates its clinical potential as a real-time cardiac assessment tool.

  16. Vanishing left ventricular thrombus in a woman with peripartum cardiomyopathy: a case report

    Directory of Open Access Journals (Sweden)

    Altuwaijri Wafa A

    2012-10-01

    Full Text Available Background Peripartum cardiomyopathy (PPCM is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other identifiable causes of cardiac failure. The combination of left ventricular (LV systolic dysfunction and hypercoaguability can cause thromboembolic complications including intra-cardiac thrombi. Case presentation A 25-year-old Caucasian female with PPCM demonstrated multiple thrombi in the LV on transthoracic echocardiography. Following anticoagulation with parenteral heparin, a cardiac MRI four days later demonstrated near resolution of the thrombi. Conclusion We review the presentation, diagnosis and management of LV thrombi in the clinical setting of PPCM.

  17. Association between left ventricular perfusion defects and myocardial deformation indexes in heart transplantation recipients.

    Science.gov (United States)

    D'Andrea, Antonello; De Rimini, Maria Luisa; America, Raffaella; Cirillo, Chiara; Riegler, Lucia; Limongelli, Giuseppe; D'Alto, Michele; Salerno, Gemma; Maiello, Ciro; Muto, Pietro; Russo, Maria Giovanna; Calabrò, Raffaele; Bossone, Eduardo; Pacileo, Giuseppe

    2017-10-01

    The aim of the study was to analyze possible correlations between strain echocardiography (STE) and PET myocardial perfusion in a population of heart transplantation (HTx) recipients showing preserved left ventricular (LV) ejection fraction. By STE, LV global longitudinal strain (LV GLS) was lower in HTx. PET showed no transient or chronic ischemia in 83 of 115 HTx (73%). Fixed perfusion defects were observed in 17% of HTx and reversible ischemia in 10%. Significant coronary stenosis was observed only in 10 cases. GLS was independently associated with age at HTx and fixed perfusion defects (HR 0.41; P<.001). Such relationships underline STE ability to early identify HTx pts with subclinical myocardial dysfunction during long-term follow-up. © 2017, Wiley Periodicals, Inc.

  18. Left ventricular pacing improves haemodynamic variables in patients with heart failure with a normal QRS duration

    Science.gov (United States)

    Turner, M S; Bleasdale, R A; Mumford, C E; Frenneaux, M P; Morris-Thurgood, J A

    2004-01-01

    Objectives: To assess whether patients with congestive heart failure (CHF) and a normal QRS duration can benefit from left ventricular (VDD-LV) pacing. Design: Cardiac resynchronisation is reserved for patients with a broad QRS duration on the premise that systolic resynchronisation is the mechanism of benefit, yet improvement from pacing correlates poorly with QRS duration. In CHF patients with a broad QRS duration, those with a high resting pulmonary capillary wedge pressure (PCWP) > 15 mm Hg benefit. In this acute haemodynamic VDD-LV pacing study, patients with CHF with a normal QRS duration were divided into two groups—patients with a resting PCWP > 15 mm Hg and patients with a resting PCWP 15 mm Hg (n  =  10), cardiac output increased from 3.9 (1.5) to 4.5 (1.65) l/min (p 15 mm Hg derive acute haemodynamic benefit from VDD-LV pacing. PMID:15084543

  19. Evaluation of docosahexaenoic acid in a dog model of hypertension induced left ventricular hypertrophy.

    Science.gov (United States)

    Stanley, William C; Cox, James W; Asemu, Girma; O'Connell, Kelly A; Dabkowski, Erinne R; Xu, Wenhong; Ribeiro, Rogerio F; Shekar, Kadambari C; Hoag, Stephen W; Rastogi, Sharad; Sabbah, Hani N; Daneault, Caroline; des Rosiers, Christine

    2013-12-01

    Marine n-3 polyunsaturated fatty acids alter cardiac phospholipids and prevent cardiac pathology in rodents subjected to pressure overload. This approach has not been evaluated in humans or large animals with hypertension-induced pathological hypertrophy. We evaluated docosahexaenoic acid (DHA) in old female dogs with hypertension caused by 16 weeks of aldosterone infusion. Aldosterone-induced hypertension resulted in concentric left ventricular (LV) hypertrophy and impaired diastolic function in placebo-treated dogs. DHA supplementation increased DHA and depleted arachidonic acid in cardiac phospholipids, but did not improve LV parameters compared to placebo. Surprisingly, DHA significantly increased serum aldosterone concentration and blood pressure compared to placebo. Cardiac mitochondrial yield was decreased in placebo-treated hypertensive dogs compared to normal animals, which was prevented by DHA. Extensive analysis of mitochondrial function found no differences between DHA and placebo groups. In conclusion, DHA did not favorably impact mitochondrial or LV function in aldosterone hypertensive dogs.

  20. Quercetin prevents left ventricular hypertrophy in the Apo E knockout mouse

    Directory of Open Access Journals (Sweden)

    Elena Ulasova

    2013-01-01

    Full Text Available Hypercholesterolemia is a risk factor for the development of hypertrophic cardiomyopathy. Nevertheless, there are few studies aimed at determining the effects of dietary compounds on early or mild cardiac hypertrophy associated with dyslipidemia. Here we describe left ventricular (LV hypertrophy in 12 week-old Apo E−/− hypercholesterolemic mice. The LV end diastolic posterior wall thickness and overall LV mass were significantly increased in Apo E−/− mice compared with wild type (WT controls. Fractional shortening, LV end diastolic diameter, and hemodynamic parameters were unchanged from WT mice. Oral low dose quercetin (QCN; 0.1 µmol QCN/kg body weight for 6 weeks significantly reduced total cholesterol and very low density lipoprotein in the plasma of Apo E−/− mice. QCN treatment also significantly decreased LV posterior wall thickness and LV mass in Apo E−/− mice. Myocardial geometry and function were unaffected in WT mice by QCN treatment. These data suggest that dietary polyphenolic compounds such as QCN may be effective modulators of plasma cholesterol and could prevent maladaptive myocardial remodeling.

  1. Cardiac morphology in left ventricular hypertrophy using thallium-201 myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Torii, Yukio; Adachi, Haruhiko; Katsume, Hiroshi; Ochiai, Masakazu; Ijichi, Hamao

    1985-06-01

    To evaluate cardiac morphology in the patients with various cases of hypertrophy, we measured left ventricular (LV) size using thallium-201 myocardial scintigraphy in 29 normal subjects and in 90 patients. Cardiac shape and dimension were assessed by measuring the wall thickness and external length in the short and long axis of LV image in LAO projection. In aortic stenosis and hypertensive heart disease the shape was spherical and the wall was thickened. In both mitral (MR) and aortic (AR) regurgitations, LV dilatation were shown; spherical shape in chronic MR but ellipsoid shape in acute MR and AR. Decreased LV size but normal shape was observed in mitral stenosis and cor pulmonale. In hypertrophic cardiomyopathy the LV wall was asymmetrically hypertrophied, while in congestive cardiomyopathy the wall is thin with marked LV dilatation and the shape was spherical. We concluded that the heart had characteristic configuration which might reflect cardiac performance or compensate for the load to the heart, and that thallium-201 myocardial scintigraphy is useful in the evaluation of cardiac morphology as well as in diagnosis of myocardial ischemia. (author).

  2. Increased left ventricular torsion in hypertrophic cardiomyopathy mutation carriers with normal wall thickness

    Directory of Open Access Journals (Sweden)

    Marcus Tim J

    2011-01-01

    Full Text Available Abstract Background Increased left ventricular (LV torsion has been observed in patients with manifest familial hypertrophic cardiomyopathy (HCM, and is thought to be caused by subendocardial dysfunction. We hypothesize that increased LV torsion is already present in healthy mutation carriers with normal wall thickness. Methods Seventeen carriers with an LV wall thickness Results LV volumes, mass and circumferential strain were comparable between groups, whereas LV ejection fraction, torsion and TECS-ratio were increased in carriers compared to controls (63 ± 3% vs. 60 ± 3%, p = 0.04, 10.1 ± 2.5° vs. 7.7 ± 1.2°, p = 0.001, and 0.52 ± 0.14°/% vs. 0.42 ± 0.10°/%, p = 0.02, respectively. Conclusions Carriers with normal wall thickness display increased LV torsion and TECS-ratio with respect to controls, which might be due to subendocardial myocardial dysfunction. As similar abnormalities are observed in patients with manifest HCM, the changes in healthy carriers may be target for clinical intervention to delay or prevent the onset of hypertrophy.

  3. Non-uniform recovery of left ventricular transmural mechanics in ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Wilansky Susan

    2010-08-01

    Full Text Available Abstract Background After a transient ischemic episode, the subendocardial region is more severely injured than outer subepicardial layers and may regain a proportionately greater degree of mechanical function in the longitudinal direction. We sought to explore left ventricular (LV transmural mechanics in patients with ST-segment elevation myocardial infarction (STEMI for determining the mechanism underlying recovery of global LV function after primary percutaneous coronary intervention (PCI. Methods A total of 42 patients (62 ± 11 years old, 71% male with a first STEMI underwent serial assessments of LV longitudinal, circumferential and radial strains (LS, CS and RS by selective tracking of subendocardial and subepicardial regions within 48 hours and a median of 5 months after PCI. LV mechanical parameters were compared with sixteen age and gender matched normal controls. Results In comparison with controls, endocardial and epicardial LS were markedly attenuated at 48 hours following PCI (P 5% following PCI was seen in 24 (57% patients and was associated with improvement in endocardial and epicardial LS (P Conclusions In patients with STEMI treated by PCI, the recovery of LV subendocardial shortening strain seen in the longitudinal direction underlies the improvement in LV global function despite persistent abnormalities in radial mechanics and wall motion score index.

  4. Matrix metalloproteinases and left ventricular function and structure in spinal cord injured subjects.

    Science.gov (United States)

    Schreiber, Roberto; Paim, Layde R; de Rossi, Guilherme; Matos-Souza, José R; Costa E Silva, Anselmo de A; Souza, Cristiane M; Borges, Mariane; Azevedo, Eliza R; Alonso, Karina C; Gorla, José I; Cliquet, Alberto; Nadruz, Wilson

    2014-11-01

    Subjects with spinal cord injury (SCI) exhibit impaired left ventricular (LV) diastolic function, which has been reported to be attenuated by regular physical activity. This study investigated the relationship between circulating matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) and echocardiographic parameters in SCI subjects and the role of physical activity in this regard. Forty-two men with SCI [19 sedentary (S-SCI) and 23 physically-active (PA-SCI)] were evaluated by clinical, anthropometric, laboratory, and echocardiographic analysis. Plasmatic pro-MMP-2, MMP-2, MMP-8, pro-MMP-9, MMP-9, TIMP-1 and TIMP-2 levels were determined by enzyme-linked immunosorbent assay and zymography. PA-SCI subjects presented lower pro-MMP-2 and pro-MMP-2/TIMP-2 levels and improved markers of LV diastolic function (lower E/Em and higher Em and E/A values) than S-SCI ones. Bivariate analysis showed that pro-MMP-2 correlated inversely with Em and directly with E/Em, while MMP-9 correlated directly with LV mass index and LV end-diastolic diameter in the whole sample. Following multiple regression analysis, pro-MMP-2, but not physical activity, remained associated with Em, while MMP-9 was associated with LV mass index in the whole sample. These findings suggest differing roles for MMPs in LV structure and function regulation and an interaction among pro-MMP-2, diastolic function and physical activity in SCI subjects.

  5. N-terminal pro brain natriuretic peptide in arterial hypertension--a marker for left ventricular dimensions and prognosis

    DEFF Research Database (Denmark)

    Hildebrandt, Per; Boesen, Mikael; Olsen, Michael

    2004-01-01

    In arterial hypertension risk factor evaluation, including LV mass measurements, and risk stratification using risk charts or programs, is generally recommended. In heart failure NT-proBNP has been shown to be a marker of LV dimensions and of prognosis. If the same diagnostic and prognostic value...... is present in arterial hypertension, risk factor evaluation would be easier. In 36 patients with arterial hypertension, electrocardiographic LV hypertrophy and preserved left ventricular function, NT-proBNP was eight-fold higher than in healthy subjects. The log NT-proBNP correlated with LV mass index (R=0...... and preserved LV function demonstrated that NT-proBNP was a very strong prognostic marker, especially combined with a history of cardiovascular disease. Patients with high NT-proBNP and known cardiovascular disease had a seven-fold increase in CV events compared to patients with low NT-proBNP and no CV disease...

  6. Comparison of gated radionuclide scans and chest radiographs. Assessment of left ventricular impairment in patients with coronary disease.

    Science.gov (United States)

    Bianco, J A; Reinke, D B; Makey, D G; Shafer, R B

    1980-03-01

    Diagnostic efficacy of gated cardiac blood pool imaging was studied in 41 consecutive patients with LV ejection fractions (LVEF) less than or equal to 0.50. Eighty percent of patients were receiving therapy for LV failure at the time of the study. All patients had documented coronary-artery disease (CAD). Chest x-ray films were interpreted blindly by a senior radiologist. Cardiothoracic ratio of less than or equal to 0.50 was recorded as normal. Radionuclide assessment of LV function contributes importantly to the diagnostic and screening value of chest x-ray films. Patients with coronary disease and clinical evidence of heart failure should have radioisotopic studies even if chest x-ray film findings are normal. In patients with coronary artery disease and enlarged LV on chest films, radionuclide study of left ventricular performance aids in defining LV impairment, and in the prognostication of subsequent clinical course.

  7. Global and regional left ventricular strain indices in post-myocardial infarction patients with ventricular arrhythmias and moderately abnormal ejection fraction.

    Science.gov (United States)

    Nguyen, Bich Lien; Capotosto, Lidia; Persi, Alessandro; Placanica, Attilio; Rafique, Asim; Piccirillo, Gianfranco; Gaudio, Carlo; Gang, Eli S; Siegel, Robert J; Vitarelli, Antonio

    2015-02-01

    The aim of the study described here was to compare myocardial strains in ischemic heart patients with and without sustained ventricular tachycardia (VT) and moderately abnormal left ventricular ejection fraction (LVEF) to investigate which index could better predict VT on the basis of the analysis of global and regional left ventricular (LV) dysfunction. We studied 467 patients with previous myocardial infarction and LVEF >35%. Fifty-one patients had documented VT, and 416 patients presented with no VT. LV volumes and score index were obtained by 2-D echocardiography. Longitudinal, radial and circumferential strains were determined. Strains of the infarct, border and remote zones were also obtained. There were no differences in standard LV 2-D parameters between patients with and those without VT. Receiver operating characteristic values were -12.7% for global longitudinal strain (area under the curve [AUC] = 0.72), -4.8% for posterior-inferior wall circumferential strain (AUC = 0.80), 61 ms for LV mechanical dispersion (AUC = 0.84), -10.1% for longitudinal strain of the border zone (AUC = 0.86) and -9.2% for circumferential strain of the border zone (AUC = 0.89). In patients with previous myocardial infarction and moderately abnormal LVEF, peri-infarct circumferential strain was the strongest predictor of documented ventricular arrhythmias among all strain quantitative indices. Additionally, strain values from posterior-inferior wall infarctions had a higher association with arrhythmic events compared with global strain.

  8. Predictors of ventricular remodelling in patients with reperfused acute myocardial infarction and left ventricular dysfunction candidates for bone marrow cell therapy: insights from the BONAMI trial

    Energy Technology Data Exchange (ETDEWEB)

    Manrique, Alain [Nuclear Medicine, CHU de Caen, Caen (France); Universite de Caen Normandie, EA 4650, Caen (France); CHU de Caen et GIP Cyceron, Caen cedex 6 (France); Lemarchand, Patricia; Delasalle, Beatrice; Lamirault, Guillaume; Trochu, Jean-Noel; Le Tourneau, Thierry [L' Institut du thorax, INSERM, UMR1087, Nantes (France); CNRS, UMR 6291, Nantes (France); Universite de Nantes, Nantes (France); CHU de Nantes, Nantes (France); Lairez, Olivier; Roncalli, Jerome [Institut CARDIOMET-Toulouse, Cardiac Imaging Center, CIC Biotherapies, CHU de Toulouse, Toulouse (France); Sportouch-Duckan, Catherine; Piot, Christophe [Universite Montpellier, Institut de Genomique Fonctionnelle, INSERM U661, CNRS UMR 5203, Montpellier (France); Clinique du Millenaire, Montpellier (France); Le Corvoisier, Philippe [Hopital Henri Mondor, INSERM, Centre d' Investigation Clinique 1430 et U955 equipe 3, Creteil (France); Neuder, Yannick [CHU de Grenoble, Pole Thorax et Vaisseaux, Grenoble (France); Richardson, Marjorie [CHRU Lille, Service d' Explorations Fonctionnelles Cardiovasculaires, Hopital Cardiologique, Lille (France); Lebon, Alain [CHU de Caen, Service de Cardiologie, Caen (France); Teiger, Emmanuel [Hopital Henri Mondor, AP-HP, Unite de Cardiologie Interventionnelle et Federation de Cardiologie, Creteil (France); Hossein-Foucher, Claude [Hopital Salengro CHRU de Lille, Service de Medecine Nucleaire, Lille (France); Universite de Lille 2, UFR de Medecine, Lille (France)

    2016-04-15

    Few data are available regarding the relation of left ventricular (LV) mechanical dyssynchrony to remodelling after acute myocardial infarction (MI) and stem cell therapy. We evaluated the 1-year time course of both LV mechanical dyssynchrony and remodelling in patients enrolled in the BONAMI trial, a randomized, multicenter controlled trial assessing cell therapy in patients with reperfused MI. Patients with acute MI and ejection fraction (EF) ≤ 45 % were randomized to cell therapy or to control and underwent thallium single-photon emission computed tomography (SPECT), radionuclide angiography, and echocardiography at baseline, 3 months, and 1 year. Eighty-three patients with a comprehensive 1-year follow-up were included. LV dyssynchrony was assessed by the standard deviation (SD) of the LV phase histogram using radionuclide angiography. Remodelling was defined as a 20 % increase in LV end-systolic volume index (LVESVI) at 1 year. At baseline, LVEF, wall motion score index, and perfusion defect size were significantly impaired in the 43 patients (52 %) with LV remodelling (all p < 0.001), without significant increase in LV mechanical dyssynchrony. During follow-up, there was a progressive increase in LV SD (p = 0.01). Baseline independent predictors of LV remodelling were perfusion SPECT defect size (p = 0.001), LVEF (p = 0.01) and a history of hypertension (p = 0.043). Bone marrow cell therapy did not affect the time-course of LV remodelling and dyssynchrony. LV remodelling 1 year after reperfused MI is associated with progressive LV dyssynchrony and is related to baseline infarct size and ejection fraction, without impact of cell therapy on this process. (orig.)

  9. Comparative effects of valsartan versus amlodipine on left ventricular mass and reactive oxygen species formation by monocytes in hypertensive patients with left ventricular hypertrophy.

    Science.gov (United States)

    Yasunari, Kenichi; Maeda, Kensaku; Watanabe, Takanori; Nakamura, Munehiro; Yoshikawa, Junichi; Asada, Akira

    2004-06-02

    To compare the effects of the angiotensin receptor blocker (ARB) valsartan versus the calcium channel blocker amlodipine, reactive oxygen species (ROS) formation by monocytes, C-reactive protein (CRP), and left ventricular (LV) mass were studied in 104 hypertensive patients with left ventricular hypertrophy (LVH). There is evidence that ARBs have blood pressure (BP)-independent effects on LV mass. Whether regression of LV mass by ARBs is correlated to ROS formation by monocytes and CRP is not fully understood yet. A cross-sectional and prospective study was performed. Participants were randomly assigned to either the 80-mg valsartan (n = 52) or 5-mg amlodipine (n = 52) group and were treated for eight months. The left ventricular mass index (LVMI) was calculated from two-dimensional M-mode echocardiography. Formation of ROS by monocytes was measured by gated flow cytometry. In addition, CRP, plasma renin activity, plasma aldosterone, and traditional risk factors were assessed. Multiple regression analysis showed a significant correlation between LVMI and ROS formation by monocytes and between LVMI and CRP. Treatment reduced BP to a similar extent in both groups. Valsartan significantly reduced LVMI after eight months, but amlodipine had less effect (16% vs. 1.2%, n = 50, p < 0.01). Formation of ROS by monocytes was reduced to a greater extent with valsartan than with amlodipine (28% vs. 2%, n = 50, p < 0.01). Valsartan but not amlodipine reduced CRP levels. A significant correlation between changes in ROS formation by monocytes and LVMI or between CRP and LVMI was observed. The ARB valsartan has BP-independent effects on LVH, ROS formation by monocytes, and CRP in hypertensive patients with LVH.

  10. In Heart Failure Patients with Left Bundle Branch Block Single Lead MultiSpot Left Ventricular Pacing Does Not Improve Acute Hemodynamic Response To Conventional Biventricular Pacing. A Multicenter Prospective, Interventional, Non-Randomized Study

    OpenAIRE

    Maciej Sterliński; Adam Sokal; Radosław Lenarczyk; Frederic Van Heuverswyn; Aldo Rinaldi, C.; Marc Vanderheyden; Vladimir Khalameizer; Darrel Francis; Joeri Heynens; Berthold Stegemann; Richard Cornelussen

    2016-01-01

    Introduction Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive. Aim The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV). Methods Patients with left bundle branch block (LBBB) underwent an acute hemodynamic study to determine the %change in...

  11. Three dimensional endo-cardiovascular volume-rendered cine computed tomography of isolated left ventricular apical hypoplasia; A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Sun Hwa; Kim, Yang Min; Lee, Hyun Jong [Sejong General Hospital, Bucheon (Korea, Republic of)

    2016-02-15

    We report multidetector computed tomography (MDCT) and cardiac magnetic resonance (CMR) findings of a 34-year-old female with isolated left ventricular apical hypoplasia. The MDCT and CMR scans displayed a spherical left ventricle (LV) with extensive fatty infiltration within the myocardium at the apex, interventricular septum and inferior wall, anteroapical origin of the papillary muscle, right ventricle wrapping around the deficient LV apex, and impaired systolic function. MDCT visualized morphologic and also functional findings of this unique cardiomyopathy.

  12. Impact of diabetes on treatment-induced changes in left ventricular structure and function in hypertensive patients with left ventricular hypertrophy. The LIFE study

    DEFF Research Database (Denmark)

    Gerdts, E; Okin, P M; Omvik, P

    2009-01-01

    BACKGROUND AND AIM: Diabetes is associated with left ventricular hypertrophy (LVH) and impaired systolic function in hypertensive patients, but less is known about its impact on LVH regression and functional improvement during antihypertensive treatment. METHODS AND RESULTS: We performed annual...... shortening (both pantihypertensive treatment....... echocardiography in 730 non-diabetic and 93 diabetic patients (aged 55-80 years) with hypertension and electrocardiographic LVH during 4.8-year losartan- or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Baseline mean blood pressure (BP) and LV mass did...

  13. THE EFFECT OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ON THE PATHOGENESIS OF ANGINA DECUBITUS

    Institute of Scientific and Technical Information of China (English)

    陈纪林; 高润霖; 姚康宝; 杨跃进; 秦学文; 乔树宾; 姚民

    2000-01-01

    Objective. To investigate the effect of left ventricular diastohc dysfunction on the pathogenesis of angina decubitus (AD). Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ . Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF) > 50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease. Results. Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction(1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ (both P < 0.001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ (P <0.05, P < 0.01). Left ventricular end-diastolic pressure(LVEDP)was markedly increased before and after LVG in group Ⅱ and Ⅲ as compared with group Ⅰ (bothP<0.05, both P< 0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD)before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P <0.01, P < 0.001). Howevere,there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P < 0.01). Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogen esis of angina decubitus.

  14. Myocardial Integrated Backscatter in Obese Adolescents: Associations with Measures of Adiposity and Left Ventricular Deformation.

    Directory of Open Access Journals (Sweden)

    Lijian Xie

    Full Text Available Myocardial fibrosis has been proposed to play an important pathogenetic role in left ventricular (LV dysfunction in obesity. This study tested the hypothesis that calibrated integrated backscatter (cIB as a marker of myocardial fibrosis is altered in obese adolescents and explored its associations with adiposity, LV myocardial deformation, and metabolic parameters.Fifty-two obese adolescents and 38 non-obese controls were studied with conventional and speckle tracking echocardiography. The average cIB of ventricular septum and LV posterior wall was measured. In obese subjects, insulin resistance as estimated by homeostasis model assessment (HOMA-IR and glucose tolerance were determined. Compared with controls, obese subjects had significantly greater cIB of ventricular septum (-16.8±7.8 dB vs -23.2±7.8 dB, p<0.001, LV posterior wall (-20.5±5.6 dBvs -25.0±5.1 dB, p<0.001 and their average (-18.7±5.7 dB vs -24.1±5.0 dB, p<0.001. For myocardial deformation, obese subjects had significantly reduced LV longitudinal systolic strain rate (SR (p = 0.045 and early diastolic SR (p = 0.015, and LV circumferential systolic strain (p = 0.008, but greater LV longitudinal late diastolic SR (p<0.001, and radial early (p = 0.037 and late (p = 0.002 diastolic SR than controls. For the entire cohort, myocardial cIB correlated positively with body mass index (r = 0.45, p<0.001 and waist circumference (r = 0.45, p<0.001, but negatively with LV circumferential systolic strain (r = -0.23, p = 0.03 and systolic SR (r = -0.25, p = 0.016. Among obese subjects, cIB tended to correlate with HOMA-IR (r = 0.26, p = 0.07.Obese adolescents already exhibit evidence of increased myocardial fibrosis, which is associated with measures of adiposity and impaired LV circumferential myocardial deformation.

  15. ECG manifestations of left ventricular electrical remodeling.

    Science.gov (United States)

    Estes, E Harvey

    2012-01-01

    Research and thinking about the electrocardiographic manifestations of left ventricular hypertrophy has been constrained by a limited conceptual model of the process: heart disease produces chamber enlargement (increased mass), which in turn produces an altered electrocardiogram. The process is much more complex than can be represented in this simple model. A more robust and intricate model is proposed, in which heart (and vascular) disease causes structural changes, electrical changes, biochemical changes, and others, all of which interact to produce electrical remodeling of ventricular myocardium. This electrical remodeling results in a variety of ECG changes. All of these changes interact, leading to an altered clinical course, and to premature death. It is suggested that research, based on this model, can provide new clues to the processes involved, and improve the prediction of clinical outcomes. New directions in research, in recording equipment, and in organizational activities are suggested to test this new model, and to improve the usefulness of the electrocardiogram as a research and diagnostic tool.

  16. 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.

  17. Beta blockers & left ventricular hypertrophy regression.

    Science.gov (United States)

    George, Thomas; Ajit, Mullasari S; Abraham, Georgi

    2010-01-01

    Left ventricular hypertrophy (LVH) particularly in hypertensive patients is a strong predictor of adverse cardiovascular events. Identifying LVH not only helps in the prognostication but also in the choice of therapeutic drugs. The prevalence of LVH is age linked and has a direct correlation to the severity of hypertension. Adequate control of blood pressure, most importantly central aortic pressure and blocking the effects of cardiomyocyte stimulatory growth factors like Angiotensin II helps in regression of LVH. Among the various antihypertensives ACE-inhibitors and angiotensin receptor blockers are more potent than other drugs in regressing LVH. Beta blockers especially the newer cardio selective ones do still have a role in regressing LVH albeit a minor one. A meta-analysis of various studies on LVH regression shows many lacunae. There have been no consistent criteria for defining LVH and documenting LVH regression. This article reviews current evidence on the role of Beta Blockers in LVH regression.

  18. 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.

  19. Myocardial oxygen consumption change predicts left ventricular relaxation improvement in obese humans after weight loss.

    Science.gov (United States)

    Lin, C Huie; Kurup, Suraj; Herrero, Pilar; Schechtman, Kenneth B; Eagon, J Christopher; Klein, Samuel; Dávila-Román, Víctor G; Stein, Richard I; Dorn, Gerald W; Gropler, Robert J; Waggoner, Alan D; Peterson, Linda R

    2011-09-01

    Obesity adversely affects myocardial metabolism, efficiency, and diastolic function. Our objective was to determine whether weight loss can ameliorate obesity-related myocardial metabolism and efficiency derangements and that these improvements directly relate to improved diastolic function in humans. We studied 30 obese (BMI >30 kg/m2) subjects with positron emission tomography (PET) (myocardial metabolism, blood flow) and echocardiography (structure, function) before and after marked weight loss from gastric bypass surgery (N = 10) or moderate weight loss from diet (N = 20). Baseline BMI, insulin resistance, hemodynamics, left ventricular (LV) mass, systolic function, myocardial oxygen consumption (MVO2), and fatty acid (FA) metabolism were similar between the groups. MVO2/g decreased after diet-induced weight loss (P = 0.009). Total MVO2 decreased after dietary (P = 0.02) and surgical weight loss (P = 0.0006) and was related to decreased BMI (P = 0.006). Total myocardial FA utilization decreased (P = 0.03), and FA oxidation trended lower (P = 0.06) only after surgery. FA esterification and LV efficiency were unchanged. After surgical weight loss, LV mass decreased by 23% (Doppler-derived) E/E' by 33%, and relaxation increased (improved) by 28%. Improved LV relaxation related significantly to decreased BMI, insulin resistance, total MVO2, and LV mass but not FA utilization. Decreased total MVO(2) predicted LV relaxation improvement independent of BMI change (P = 0.02). Weight loss can ameliorate the obesity-related derangements in myocardial metabolism and LV structure and diastolic function. Decreased total MVO2 independently predicted improved LV relaxation, suggesting that myocardial oxygen metabolism may be mechanistically important in determining cardiac relaxation.

  20. Relation of left ventricular thickness to age and gender in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Maron, Barry J; Casey, Susan A; Hurrell, David G; Aeppli, Dorothee M

    2003-05-15

    Left ventricular (LV) wall thickening is the most consistent clinical marker of hypertrophic cardiomyopathy (HC), and characteristically increases substantially during adolescence. In this study, we used 2-dimensional echocardiography to develop a cross-sectional profile of LV wall thicknesses in adult patients with HC. We studied a regional community-based cohort of 239 consecutively enrolled patients (aged 18 to 91 years). On average, maximum LV wall thickness decreased relative to increasing age (p = 0.007) within 4 age groups: 22.8 +/- 5.1 mm (18 to 39 years) to 22.1 +/- 5.1 mm (40 to 59 years) to 21.1 +/- 3.7 mm (60 to 74 years) to 20.8 +/- 3.6 mm (>or=75 years). The LV thickness index (summation of wall thicknesses in all 4 segments) also decreased with age (p = 0.017): 63.0 +/- 12.2 mm to 59.8 +/- 11.9 mm to 58.3 +/- 10.4 mm to 57.9 +/- 9.8 mm. Decreasing magnitude of LV hypertrophy was independently associated with increasing age, but not with other relevant disease variables, such as symptoms and outflow obstruction. However, when separated by gender, this inverse relation between age and LV wall thickness was statistically significant only for women (p = 0.007). In conclusion, in an unselected HC cohort, cross-sectional analysis showed a modest but statistically significant inverse relation between age and LV hypertrophy that was largely gender-specific for women. This association constitutes another facet of the natural history of this complex and heterogenous disease and may reflect disproportionate occurrence of premature death in young patients with HC with marked hypertrophy or possibly gradual LV remodeling.

  1. Effect of paricalcitol on left ventricular mass and function in CKD--the OPERA trial.

    Science.gov (United States)

    Wang, Angela Yee-Moon; Fang, Fang; Chan, John; Wen, Yue-Yi; Qing, Shang; Chan, Iris Hiu-Shuen; Lo, Gladys; Lai, Kar-Neng; Lo, Wai-Kei; Lam, Christopher Wai-Kei; Yu, Cheuk-Man

    2014-01-01

    Vitamin D seems to protect against cardiovascular disease, but the reported effects of vitamin D on patient outcomes in CKD are controversial. We conducted a prospective, double blind, randomized, placebo-controlled trial to determine whether oral activated vitamin D reduces left ventricular (LV) mass in patients with stages 3-5 CKD with LV hypertrophy. Subjects with echocardiographic criteria of LV hypertrophy were randomly assigned to receive either oral paricalcitol (1 μg) one time daily (n=30) or matching placebo (n=30) for 52 weeks. The primary end point was change in LV mass index over 52 weeks, which was measured by cardiac magnetic resonance imaging. Secondary end points included changes in LV volume, echocardiographic measures of systolic and diastolic function, biochemical parameters of mineral bone disease, and measures of renal function. Change in LV mass index did not differ significantly between groups (median [interquartile range], -2.59 [-6.13 to 0.32] g/m(2) with paricalcitol versus -4.85 [-9.89 to 1.10] g/m(2) with placebo). Changes in LV volume, ejection fraction, tissue Doppler-derived measures of early diastolic and systolic mitral annular velocities, and ratio of early mitral inflow velocity to early diastolic mitral annular velocity did not differ between the groups. However, paricalcitol treatment significantly reduced intact parathyroid hormone (P<0.001) and alkaline phosphatase (P=0.001) levels as well as the number of cardiovascular-related hospitalizations compared with placebo. In conclusion, 52 weeks of treatment with oral paricalcitol (1 μg one time daily) significantly improved secondary hyperparathyroidism but did not alter measures of LV structure and function in patients with severe CKD.

  2. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance.

    Science.gov (United States)

    Ohte, Nobuyuki; Narita, Hitomi; Sugawara, Motoaki; Niki, Kiyomi; Okada, Takashi; Harada, Akimitsu; Hayano, Junichiro; Kimura, Genjiro

    2003-07-01

    Wave intensity (WI) is a novel hemodynamic index, which is defined as (d P/d t) x (d U/d t) at any site of the circulation, where d P/d t and d U/d t are the derivatives of blood pressure and velocity with respect to time, respectively. However, the pathophysiological meanings of this index have not been fully elucidated in the clinical setting. Accordingly, we investigated this issue in 64 patients who underwent invasive evaluation of left ventricular (LV) function. WI was obtained at the right carotid artery using a color Doppler system for blood velocity measurement combined with an echo-tracking method for detecting vessel diameter changes. The vessel diameter changes were automatically converted to pressure waveforms by calibrating its peak and minimum values by systolic and diastolic brachial blood pressures. The WI of the patients showed two sharp positive peaks. The first peak was found at the very early phase of LV ejection, while the second peak was observed near end-ejection. The magnitude of the first peak of WI significantly correlated with the maximum rate of LV pressure rise (LV max. d P/d t) (r = 0.74, P WI significantly correlated with the time constant of LV relaxation (r = -0.77, P WI reflects LV contractile performance, and the amplitude of the second peak of WI is determined by LV behavior during the period from late systole to isovolumic relaxation. WI is a noninvasively obtained, clinically useful parameter for the evaluation of LV systolic and early diastolic performance at the same time.

  3. Cytokines profile in hypertensive patients with left ventricular remodeling and dysfunction.

    Science.gov (United States)

    Kuznetsova, Tatiana; Haddad, Francois; Knez, Judita; Rosenberg-Hasson, Yael; Sung, Janine; Cauwenberghs, Nicholas; Thijs, Lutgarde; Karakikes, Ioannis; Maecker, Holden; Mahaffey, Kenneth W; Wu, Joseph C; Staessen, Jan A

    2015-12-01

    There is strong evidence that inflammatory mediators play a key role in the progression to heart failure in patients with systemic hypertension (HTN). The present study aimed to identify a set of cytokines that are associated with early left ventricular (LV) remodeling and dysfunction as captured by echocardiography in patients with HTN in a cross-sectional case-control study nested within the FLEMish study on ENvironment, Genes and Health Outcome. We identified three groups of participants from the cohort: normotensive subjects (normotension; n = 30), HTN with normal LV structure and function (HTN [LV-]; n = 30), and HTN with evidence of adverse LV remodeling (HTN [LV+]; n = 50). We measured cytokines using a 63-plex Luminex platform. Using partial least squares-discriminant analysis, we constructed three latent variables from the measured cytokines that explained 35%-45% of the variance between groups. We identified five common cytokines (interleukin 18, monokine induced by gamma interferon, hepatocyte growth factor, epithelial neutrophil-activating peptide 78, and vascular endothelial growth factor D) with a stable signal which had a major impact on the construction of the latent variables. Among these cytokines, after adjustment for confounders, interleukin 18 remained significantly different between HTN participants with and without LV involvement (P = .02). Moreover, granulocyte-macrophage colony-stimulating factor and leptin showed a consistent upward trend in all HTN patients compared with normotensive subjects. In conclusion, in HTN patients with LV remodeling or/and dysfunction, we identified a set of cytokines strongly associated with LV maladaptation. We also found a distinct profile of inflammatory biomarkers that characterize HTN.

  4. Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction?

    Directory of Open Access Journals (Sweden)

    Marcio Silva Miguel Lima

    Full Text Available Abstract Background: Estimative of left ventricular ejection fraction (LVEF is a major indication for echocardiography. Speckle tracking echocardiography (STE allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before. Objective: This study aims to check which one has the highest correlation with LVEF. Methods: Patients with normal LVEF (> 0,55 and systolic dysfunction (LVEF <0,55 were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested. Results: A total of 131 patients were included (mean age, 46 ± 14y; 43%, men. LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001, more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001. Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001; torsion (r = 0.75; r2 = 0.56; p < 0.001. Conclusion: GLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.

  5. Factors influencing recovery of left ventricular structure in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    DUAN Hong-yan; WU Xue-si; HAN Zhi-hong; GUO Yong-fang; FANG Shan-juan; ZHANG Xiao-xia; WANG Chun-mei

    2011-01-01

    Background Angiotensin converting enzyme (ACE) inhibitors and β-blockers (βB) have beneficial effects on left ventricular (LV) remodeling, alleviate symptoms and reduce morbidity and mortality in patients with chronic heart failure (CHF). However the correlation between the d osages of ACE inhibitors, βB, and recovery of LV structure remains controversial. Clinical factors associated with recovery of normal ventricular structure in CHF patients receiving medical therapy are poorly defined. Here we aimed to identify variables associated with recovery of normal or near-normal structure in patients with CHF.Methods We recruited 231 consecutive CHF outpatients, left ventricular ejection fraction (LVEF) ≤40% and left ventricular end diastolic diameter (LVEDD) >55/50 mm (male/female), who were receiving optimal pharmacotherapy between January 2001 and June 2009, and followed them until December 31, 2009. They were divided into three groups according to LVEDD and whether they were still alive at final follow-up: group A, LVEDD <60/55 mm (male/female); group B, LVEDD >60/55 mm (male/female); and group C, those who died before final follow-up. Apart from group C, univariate analysis was performed followed by Logistic multivariate analysis to determine the predictors of recovery of LV structure.Results A total of 217 patients completed follow-up, and median follow-up time was 35 months (range 6-108).Twenty-five patients died during that period; the all-cause mortality rate was 11.5%. Group A showed clinical characteristics as follows: the shortest duration of disease and shortest QRS width, the lowest N-terminal brain natriuretic peptide (NT-proBNP) at baseline, the highest dose of βB usage, the highest systolic blood pressure (SBP), diastolic blood pressure (DBP) and the lowest New York Heart Association (NYHA) classification, serum creatinine, uric acid, total bilirubin and NT-proBNP after treatment. Logistic multivariate analysis was performed according to

  6. Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients: Effect of Left Ventricular Mass Index Criteria

    Directory of Open Access Journals (Sweden)

    Eduardo Cantoni Rosa

    2002-04-01

    Full Text Available PURPOSE: To evaluate left ventricular mass (LVM index in hypertensive and normotensive obese individuals. METHODS: Using M mode echocardiography, 544 essential hypertensive and 106 normotensive patients were evaluated, and LVM was indexed for body surface area (LVM/BSA and for height² (LVM/h². The 2 indexes were then compared in both populations, in subgroups stratified according to body mass index (BMI: or = 30kg/m². RESULTS: The BSA index does not allow identification of significant differences between BMI subgroups. Indexing by height² provides significantly increased values for high BMI subgroups in normotensive and hypertensive populations. CONCLUSION: Left ventricular hypertrophy (LVH has been underestimated in the obese with the use of LVM/BSA because this index considers obesity as a physiological variable. Indexing by height² allows differences between BMI subgroups to become apparent and seems to be more appropriate for detecting LVH in obese populations.

  7. Factors influencing left ventricular structure and stress-corrected systolic function in men and women with asymptomatic aortic valve stenosis (a SEAS Substudy)

    DEFF Research Database (Denmark)

    Cramariuc, D.; Rieck, A.E.; Staal, E.M.

    2008-01-01

    also was a predictor of LV hypertrophy (p heart rate, aortic valve area, LV......To identify determinants of left ventricular (LV) structure and stress-corrected systolic function in men and women with asymptomatic aortic stenosis (AS), Doppler echocardiography was performed at baseline in 1,046 men and 674 women 28 to 86 years of age (mean 67 +/- 10) recruited.......05). In logistic regression analyses, LV hypertrophy was independently associated with male gender, severity of AS, hypertension, higher systolic blood pressure, and lower stress-corrected midwall shortening (scMWS) or stress-corrected fractional shortening (scFS; all p values

  8. Acute Effects of Hemodialysis on Left and Right Ventricular Function: A Doppler Tissue Imaging Study

    Directory of Open Access Journals (Sweden)

    Tansel Erol

    2012-08-01

    Full Text Available Purpose: Doppler tissue imaging (DTI allows noninvasive assessment of both left ventricular (LV and right ventricular (RV function. The aim of this study was to evaluate the effect of hemodialysis (HD on LV and RV function using DTI. Method: Our study group included 30 patients on chronic HD program (mean age 45 15 years. Myocardial (Sm, Em, Am and annular velocities (Ea, Aa were measured in several cardiac territories before and after HD. Results: After HD, Ea significantly reduced from 10.8 3.4 cm/s to 9.6 2.4 cm/s (p = 0.029. Patients exhibited a lower Em following HD in all measured territories. Em/Am ratio was also reduced for each LV wall investigated after HD in all measured territories. At the RV segments, Sm, Em, and Am decreased significantly in all measured territories. Em of the anterior wall was positively related to ultrafiltration volume (r = 0.25, p = 0.006, whereas the decrease of Sm of RV basal segment correlated with a decrease of diastolic blood pressure (r = 0.23, p < 0.01. Conclusion: Our data indicate that a single HD session is associated with acute changes of systolic and diastolic parameters of LV and RV. [Cukurova Med J 2012; 37(4.000: 215-222

  9. Left ventricular regional and global diastolic function assessed using Quantitative Tissue velocity Imaging in patients with hypertrophic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    王良玉; 王新房; 谢明星; 蔡志雄; 陈纪平

    2003-01-01

    Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、 left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue Velocity Imaging (QTVI).Methods 42 patients with hypertrophic cardiomyopathy and 36 age-matched normal subjects underwent QTVI study. Off-line LV regional muscular tissue velocity Imaging along LV aplcal long-axis view were obtained. Regional diastolic function was assessed in using peak tissue velocities of LV regional muscular tissue during early diastole (Ve)and LA contraction (Va) , Ve/Va ratio, derived from Tissue Velocity Imaging. Global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity ( E/A ) calculated with pulsed wave doppler.The end-diastolic interventricular septal thickness (IVSt) was measured by conventional 2 - dimension the segments of hypertrophic interventricular septum (IVS) reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in duced in the segments of hypertrophic interventricular septum compared with other LV segments in HCM paE/A in HCM patients with abnormal E/A ratio (r = 0.Va and IVSt in non- obstruction HCM patients (B group , r = - 0.61 ) Conclusions QTVI offers a newer method in clinical practice which has a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients.

  10. Evaluation of left ventricular volumes measured by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Møgelvang, J; Thomsen, C; Mehlsen, J

    1986-01-01

    Left ventricular end-diastolic and end-systolic volumes were determined in 17 patients with different levels of left ventricular function by magnetic resonance imaging (MRI). A 1.5 Tesla Magnet was used obtaining ECG triggered single and multiple slices. Calculated cardiac outputs were compared...

  11. Quantitative analysis of left ventricular strain using cardiac computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Buss, Sebastian J., E-mail: sebastian.buss@med.uni-heidelberg.de [Department of Cardiology, University of Heidelberg, 69120 Heidelberg (Germany); Schulz, Felix; Mereles, Derliz [Department of Cardiology, University of Heidelberg, 69120 Heidelberg (Germany); Hosch, Waldemar [Department of Diagnostic and Interventional Radiology, University of Heidelberg, 69120 Heidelberg (Germany); Galuschky, Christian; Schummers, Georg; Stapf, Daniel [TomTec Imaging Systems GmbH, Munich (Germany); Hofmann, Nina; Giannitsis, Evangelos; Hardt, Stefan E. [Department of Cardiology, University of Heidelberg, 69120 Heidelberg (Germany); Kauczor, Hans-Ulrich [Department of Diagnostic and Interventional Radiology, University of Heidelberg, 69120 Heidelberg (Germany); Katus, Hugo A.; Korosoglou, Grigorios [Department of Cardiology, University of Heidelberg, 69120 Heidelberg (Germany)

    2014-03-15

    Objectives: To investigate whether cardiac computed tomography (CCT) can determine left ventricular (LV) radial, circumferential and longitudinal myocardial deformation in comparison to two-dimensional echocardiography in patients with congestive heart failure. Background: Echocardiography allows for accurate assessment of strain with high temporal resolution. A reduced strain is associated with a poor prognosis in cardiomyopathies. However, strain imaging is limited in patients with poor echogenic windows, so that, in selected cases, tomographic imaging techniques may be preferable for the evaluation of myocardial deformation. Methods: Consecutive patients (n = 27) with congestive heart failure who underwent a clinically indicated ECG-gated contrast-enhanced 64-slice dual-source CCT for the evaluation of the cardiac veins prior to cardiac resynchronization therapy (CRT) were included. All patients underwent additional echocardiography. LV radial, circumferential and longitudinal strain and strain rates were analyzed in identical midventricular short axis, 4-, 2- and 3-chamber views for both modalities using the same prototype software algorithm (feature tracking). Time for analysis was assessed for both modalities. Results: Close correlations were observed for both techniques regarding global strain (r = 0.93, r = 0.87 and r = 0.84 for radial, circumferential and longitudinal strain, respectively, p < 0.001 for all). Similar trends were observed for regional radial, longitudinal and circumferential strain (r = 0.88, r = 0.84 and r = 0.94, respectively, p < 0.001 for all). The number of non-diagnostic myocardial segments was significantly higher with echocardiography than with CCT (9.6% versus 1.9%, p < 0.001). In addition, the required time for complete quantitative strain analysis was significantly shorter for CCT compared to echocardiography (877 ± 119 s per patient versus 1105 ± 258 s per patient, p < 0.001). Conclusion: Quantitative assessment of LV strain

  12. Relation of osteoprotegerin in severe aortic valve stenosis to postoperative outcome and left ventricular function

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K

    2013-01-01

    ventricular (LV) function and remodeling and to evaluate the significance of preoperative OPG on long-term outcome in terms of survival and symptomatic improvement in 124 patients with severe AS scheduled for aortic valve replacement (AVR). Patients were divided according to tertiles of preoperative OPG......, 41 patients died of a presumed cardiovascular cause or remained in New York Heart Association functional class III or IV. The risk of a poor postoperative outcome after AVR increased with increasing OPG tertiles (15% vs 33% vs 51%, p = 0.002). In a multivariate model containing age, ejection fraction......, N-terminal pro-brain natriuretic peptide and left atrial volume index, OPG was still significantly associated with postoperative outcome. In addition, OPG levels associated with cardiovascular mortality during follow-up. In conclusion, OPG is associated with LV and left atrial remodeling in patients...

  13. Association between circulating fibroblast growth factor 23, α-Klotho, and the left ventricular ejection fraction and left ventricular mass in cardiology inpatients.

    Directory of Open Access Journals (Sweden)

    Kensaku Shibata

    Full Text Available BACKGROUND: Fibroblast growth factor 23 (FGF23, with its co-receptor Klotho, plays a crucial role in phosphate metabolism. Several recent studies suggested that circulating FGF23 and α-Klotho concentrations might be related to cardiovascular abnormalities in patients with advanced renal failure. PURPOSE: Using data from 100 cardiology inpatients who were not undergoing chronic hemodialysis, the association of circulating levels of FGF23, α-Klotho, and other calcium-phosphate metabolism-related parameters with the left ventricular ejection fraction (LVEF and left ventricular mass (LVM was analyzed. METHODS AND RESULTS: LVEF was measured using the modified Simpson method for apical 4-chamber LV images and the LVM index (LVMI was calculated by dividing the LVM by body surface area. Univariate analysis showed that log transformed FGF23, but not that of α-Klotho, was significantly associated with LVEF and LVMI with a standardized beta of -0.35 (P<0.001 and 0.26 (P<0.05, respectively. After adjusting for age, sex, estimated glomerular filtration rate, and serum concentrations of intact parathyroid hormone, and 25-hydroxyvitamin D as covariates into the statistical model, log-transformed FGF23 was found to be a statistically positive predictor for decreased left ventricular function and left ventricular hypertrophy. CONCLUSIONS: In cardiology department inpatients, circulating FGF23 concentrations were found to be associated with the left ventricular mass and LVEF independent of renal function and other calcium-phosphate metabolism-related parameters. Whether modulation of circulating FGF23 levels would improve cardiac outcome in such a high risk population awaits further investigation.

  14. Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty.

    Science.gov (United States)

    Arakawa, Mamoru; Yamaguchi, Atsushi; Nishimura, Takashi; Itoh, Satoshi; Yuri, Koichi; Kyo, Shunei; Adachi, Hideo

    2015-12-01

    Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case.

  15. Usefulness of real-time 3-dimensional echocardiography to identify and quantify left ventricular dyssynchrony in patients with Kawasaki disease.

    Science.gov (United States)

    Yu, Yi; Sun, Kun; Xue, Haihong; Chen, Sun; Yang, Jianping

    2013-06-01

    The role of left ventricular (LV) dyssynchrony in Kawasaki disease is unknown. This study sought to establish values for real-time 3-dimensional (3D) echocardiographically derived LV dyssynchrony parameters and identify and quantify LV dyssynchrony in patients with Kawasaki disease. Forty patients hospitalized for Kawasaki disease were analyzed retrospectively, and 40 sex- and age-matched healthy control volunteers were also enrolled. The systolic dyssynchrony index (percentage of the cardiac cycle) from 16 and 12 LV segments on real-time 3D echocardiography was analyzed to calculate LV dyssynchrony (defined as the standard deviation of the time to reach the minimum systolic volume for 16 LV segments) according to a 17-segment model. We analyzed the 3D LV ejection fraction (LVEF), end-diastolic volume, and end-systolic volume in the patients with Kawasaki disease compared to the controls. The 16-segment systolic dyssynchrony index ± SD was significantly higher in the patients with Kawasaki disease: 2.73% ± 0.96% compared to 2.01% ± 0.85% in the controls (P Kawasaki disease was 2.65% ± 0.93% compared to 1.98% ± 0.81% in the controls (PKawasaki disease and an LVEF of less than 50% had a significantly higher systolic dyssynchrony index compared to patients with an LVEF of 50% or greater (2.89% ± 0.79% versus 2.26% ± 0.73%; P Kawasaki disease, and global systolic function was impaired. The LVEF measured by a biplane method was sufficiently related to the LVEF measured by echocardiography. Real-time 3D echocardiography is a noninvasive and feasible method for identifying and evaluating LV dyssynchrony in children with Kawasaki disease. Left ventricular dyssynchrony is significantly impaired and related to LV systolic function in patients with Kawasaki disease.

  16. Acculturation is associated with left ventricular mass in a multiethnic sample: the Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Effoe, Valery S; Chen, Haiying; Moran, Andrew; Bertoni, Alain G; Bluemke, David A; Seeman, Teresa; Darwin, Christine; Watson, Karol E; Rodriguez, Carlos J

    2015-12-03

    Acculturation involves stress-related processes and health behavioral changes, which may have an effect on left ventricular (LV) mass, a risk factor for cardiovascular disease (CVD). We examined the relationship between acculturation and LV mass in a multiethnic cohort of White, African-American, Hispanic and Chinese subjects. Cardiac magnetic resonance assessment was available for 5004 men and women, free of clinical CVD at baseline. Left ventricular mass index was evaluated as LV mass indexed by body surface area. Acculturation was characterized based on language spoken at home, place of birth and length of stay in the United States (U.S.), and a summary acculturation score ranging from 0 = least acculturated to 5 = most acculturated. Mean LV mass index adjusted for traditional CVD risk factors was compared across acculturation levels. Unadjusted mean LV mass index was 78.0 ± 16.3 g/m(2). In adjusted analyses, speaking exclusively English at home compared to non-English language was associated with higher LV mass index (81.3 ± 0.4 g/m(2) vs 79.9 ± 0.5 g/m(2), p = 0.02). Among foreign-born participants, having lived in the U.S. for ≥ 20 years compared to acculturation score, those with the highest score had greater LV mass index (78.9 ± 1.1 g/m(2) vs 81.1 ± 0.4 g/m(2), p = 0.002). There was heterogeneity in which measure of acculturation was associated with LV mass index across ethnic groups. Greater acculturation is associated with increased LV mass index in this multiethnic cohort. Acculturation may involve stress-related processes as well as behavioral changes with a negative effect on cardiovascular health.

  17. Speckle-tracking echocardiography elucidates the effect of pacing site on left ventricular synchronization in the normal and infarcted rat myocardium.

    Directory of Open Access Journals (Sweden)

    Michal Mor

    Full Text Available BACKGROUND: Right ventricular (RV pacing generates regional disparities in electrical activation and mechanical function (ventricular dyssynchrony. In contrast, left ventricular (LV or biventricular (BIV pacing can improve cardiac efficiency in the setting of ventricular dyssynchrony, constituting the rationale for cardiac resynchronization therapy (CRT. Animal models of ventricular dyssynchrony and CRT currently relay on large mammals which are expensive and not readily available to most researchers. We developed a methodology for double-site epicardial pacing in conscious rats. Here, following post-operative recovery, we compared the effects of various pacing modes on LV dyssynchrony in normal rats and in rats with ischemic cardiomyopathy. METHODS: Two bipolar electrodes were implanted in rats as follows: Group A (n = 6 right atrial (RA and RV sites; Group B (n = 7 RV and LV sites; Group C (n = 8 as in group B in combination with left coronary artery ligation. Electrodes were exteriorized through the back. Following post-operative recovery, two-dimensional transthoracic echocardiography was performed during pacing through the different electrodes. Segmental systolic circumferential strain (Ecc was used to evaluate LV dyssynchrony. RESULTS: In normal rats, RV pacing induced marked LV dyssynchrony compared to RA pacing or sinus rhythm, as measured by the standard deviation (SD of segmental time to peak Ecc, SD of peak Ecc, and the average delay between opposing ventricular segments. LV pacing and, to a greater extend BIV pacing diminished the LV dyssynchrony compared to RV pacing. In rats with extensive MI, the effects of LV and BIV pacing were markedly attenuated, and the response of individual animals was variable. CONCLUSIONS: Rodent cardiac pacing mimics important features seen in humans. This model may be developed as a simple new tool to study the pathophysiology of ventricular dyssynchrony and CRT.

  18. Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure.

    Science.gov (United States)

    Pugliese, Nicola Riccardo; Fabiani, Iacopo; La Carrubba, Salvatore; Conte, Lorenzo; Antonini-Canterin, Francesco; Colonna, Paolo; Caso, Pio; Benedetto, Frank; Santini, Veronica; Carerj, Scipione; Romano, Maria Francesca; Citro, Rodolfo; Di Bello, Vitantonio

    2017-01-01

    Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13 years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29 mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (p = 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.

  19. Left ventricular torsion and untwisting during exercise in heart transplant recipients.

    Science.gov (United States)

    Esch, Ben T; Scott, Jessica M; Warburton, Darren E R; Thompson, Richard; Taylor, Dylan; Cheng Baron, June; Paterson, Ian; Haykowsky, Mark J

    2009-05-15

    Left ventricular (LV) rotation is the dominant deformation during relaxation and links systole with early diastolic recoil. LV torsion and untwisting rates during submaximal exercise were compared between heart transplant recipients (HTRs), young adults and healthy older individuals to better understand impaired diastolic function in HTRs. Two dimensional and colour M-mode echocardiography with speckle-tracking analysis were completed in eight HTRs (age: 61 +/- 9 years), six recipient age-matched (RM, age: 60 +/- 11 years), and five donor age-matched (DM, age: 35 +/- 8 years) individuals (all males) at rest and during submaximal cycle exercise. LV peak torsion, peak rate of untwisting and peak intraventricular pressure gradients (IVPGs) were examined. LV torsion increased with exercise in DMs (6.5 +/- 5.6 deg, P change from rest to exercise in the peak rate of untwisting was significantly greater for DMs (-2.1 +/- 0.5 rads s(-1), P exercise in RMs and HTRs only. The change in IVPGs was 1.3-fold greater in DMs versus HTRs or RMs (P > 0.05). Peak LV torsion and untwisting are blunted during exercise in HTRs and RMs compared to DMs. These factors may contribute to the impaired diastolic filling found in HTRs during exercise. Similarities between HTRs and RMs during exercise suggest functional accelerated ageing of the cardiac allograft.

  20. Effects of inotropic stimulation on segmental left ventricular relaxation quantified by color kinesis.

    Science.gov (United States)

    Carey, C F; Mor-Avi, V; Koch, R; Lang, R; Pérez, J E

    2000-06-15

    Although myocardial ischemia impairs left ventricular (LV) relaxation before contractile function, regional LV diastolic dysfunction is difficult to evaluate by conventional echocardiography. Because beta-adrenergic stimulation enhances myocardial relaxation, we sought to characterize segmental LV diastolic function (by color kinesis) during dobutamine stress echocardiography and compare it with independently assessed segmental systolic function. We studied 22 patients with suspected coronary artery disease with color kinesis by acquiring digital images with endocardial motion display throughout diastole. Quantification of LV segmental diastolic peak filling rate (SPFR, normalized to segmental end-diastolic area/s) was obtained at rest, low-dose, and peak dobutamine infusion in myocardial segments visualized from the short-axis and/or apical 4-chamber views. In patients with resting normal LV systolic function and a dobutamine-induced hypercontractile response (group I, n = 13 patients; 102 segments), progressive increases in SPFR (p kinesis at rest and after inotropic stimulation, allowing comparison with segmental systolic function during pharmacologic stress testing.

  1. Association between arterial stiffness and left ventricular diastolic function in relation to gender and age

    Science.gov (United States)

    Kim, Hack-Lyoung; Lim, Woo-Hyun; Seo, Jae-Bin; Chung, Woo-Young; Kim, Sang-Hyun; Kim, Myung-A.; Zo, Joo-Hee

    2017-01-01

    Abstract Left ventricular (LV) diastolic dysfunction and subsequent overt heart failure are more prevalent in elderly women. Close interaction between arterial stiffness and LV morphology/function has been reported. The aim of this study was to investigate whether there is an age- and gender-dependent relationship between arterial stiffness and LV diastolic function. A total of 819 subjects (58.6 ± 13.3 years, 50.2% men) without structural heart disease (LV ejection fraction ≥50%) were retrospectively analyzed. All participants underwent transthoracic echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement on the same day. The association of baPWV with septal e′ velocity and average E/e′ was assessed. In the total study subjects, baPWV was negatively correlated with septal e′ velocity (r = 0.383, P  0.05 for each). In conclusion, baPWV was independently associated with septal e′ velocity and E/e′ in elderly women but not in younger women or men. The results of this study provide additional evidence that increased arterial stiffness plays an important role in the development of heart failure with preserved ejection fraction as well as LV diastolic dysfunction in elderly women. PMID:28072727

  2. Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics.

    Science.gov (United States)

    Nash, M S; Bilsker, S; Marcillo, A E; Isaac, S M; Botelho, L A; Klose, K J; Green, B A; Rountree, M T; Shea, J D

    1991-11-01

    Left ventricular (LV) myocardial atrophy and diminished cardiac function have been shown to accompany chronic human tetraplegia. These changes are attributable both to physical immobilisation and abnormal autonomic circulatory regulation imposed by a spinal cord injury (SCI). To test whether exercise training increases LV mass following chronic SCI, 8 neurologically complete quadriplegic males at 2 SCI rehabilitation and research centres underwent one month of electrically-stimulated quadriceps strengthening followed by 6 months of electrically-stimulated cycling exercise. Resting M-mode and 2-D echocardiograms were measured before and after exercise training to quantify the interventricular septal and posterior wall thicknesses at end-diastole (IVSTED and PWTED, respectively), and the LV internal dimension at end-diastole (LVIDED). LV mass was computed from these measurements using standard cube function geometry. Results showed a 6.5% increase in LVIDED following exercise training (p less than 0.02), with increases in IVSTED and PWTED of 17.8 (p less than 0.002) and 20.3% (p less than 0.01), respectively. Computed LV mass increased by 35% following exercise training (p = 0.002). These data indicate that myocardial atrophy is reversed in tetraplegics following electrically-stimulated exercise training, and that the changes in cardiac architecture are likely to be the result of both pressure and volume challenge to the heart imposed by exercise.

  3. Left and right ventricular diastolic function in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rudhani Ibrahim

    2010-01-01

    Full Text Available The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD and the correlation of this func-tion with the duration of HD. The study included 42 patients (22 females and 20 males with chro-nic renal failure (CRF, treated with HD, and 40 healthy subjects (24 females and 16 males with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under-went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E, acceleration time of E wave (AT-E, tricuspid E and A waves (E tr and A tr and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  4. Effect of angiotensin-converting enzyme inhibitor on left ventricular parameters and circulating brain natriuretic peptide in elderly hypertensives with left venticular hypertrophy.

    Science.gov (United States)

    Kohno, M; Minami, M; Kano, H; Yasunari, K; Maeda, K; Hanehira, T; Yoshikawa, J

    2000-10-01

    In the elderly, left ventricular hypertrophy (LVH) is a powerful risk factor for cardiovascular events and cardiovascular death. The purpose of the present study is to investigate the effect of long-term effective blood pressure control with the angiotensin-converting enzyme (ACE) inhibitor temocapril on left ventricular (LV) mass and function indices and the circulating concentration of the cardiac hormone brain natriuretic peptide (BNP) in elderly hypertensives with LVH. Temocapril treatment was administered for 1 year to 11 elderly hypertensives (mean age, 72 years) with LVH. Cardiac dimensions and circulating concentrations of BNP were monitored before initiation of treatment and after 1 year of treatment. At entry, BNP levels were positively correlated with the LV mass index, but were not correlated with the mean blood pressure, LV ejection fraction, or E/A ratio (the ratio of peak transmitral flow velocity in early diastole, peak E, to that in late diastole, peak A). After 1 year, temocapril treatment resulted in effective control of blood pressure. The treatment did not affect the LV ejection fraction, but modestly increased the E/A ratio. Temocapril significantly reduced septal and posterior wall thickness and the LV mass index. BNP significantly declined after 1 year. Changes in BNP were significantly related to changes in the LV mass index, but were not related to changes in the mean blood pressure, LV ejection fraction, or E/A ratio. The results suggest that long-term ACE inhibitor treatment with temocapril can induce the regression of LV mass and reduce elevated plasma BNP in elderly hypertensive patients with LVH. In this study, changes in BNP reflected the magnitude of regression of LVH.

  5. Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction.

    Science.gov (United States)

    Fernández-Golfín, Covadonga; De Agustin, Alberto; Manzano, M Carmen; Bustos, Ana; Sánchez, Tibisay; Pérez de Isla, Leopoldo; Fuentes, Manuel; Macaya, Carlos; Zamorano, José

    2011-04-01

    Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction below 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.

  6. Left Ventricular Regional Systolic Function in Patient with Hypertrophic Cardiomyopathy by Quantitative Tissue Velocity Imaging

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy (HCM) were assessed by using quantitative tissue velocity imaging (QTVI). Left ventricular (LV) regional myocardial velocity along long- and short-axis in 31 HCM patients and 20 healthy subjects were analyzed by QTVI, and the regional myocardial systolic peak velocities (MVS) were measured. Mean MVS at each level including mitral annular, basal, middle and apical segments were calculated. The ratio of MVS along long-axis to that along short-axis (Ri) at basal and middle segments of the LV posterior wall and ventricular septum were calculated. The results showed that mean MVS was slower at each level including mitral annular, basal, middle and apical segments in the HCM patients than that in the healthy subjects (P<0.01). There were no significant differences in mean MVS between obstructive and non-obstructive groups in HCM patients. MVS of all regional myocardial segments along long-axis in the HCM patients were significantly slower than that in the healthy subjects (P<0. 05), but there was no significant difference in MVS of all regional myocardial segments along long-axis between hypertrophied and non-hypertrophied group in the HCM patients. Ri was significantly lower in the HCM patients than that in the healthy subjects. The LV regional myocardial contractility along long-axis was impaired not only in the hypertrophied wall but also in the non-hypertrophied one in patients with HCM, suggesting that QTVI can assess accurately LV regional systolic function in patient with HCM and provides a novel means for an early diagnosis before and independent of hypertrophy.

  7. Quantification of Global Left Ventricular Function: Comparison of Multidetector Computed Tomography and Magnetic Resonance Imaging. A Meta-analysis and Review of the Current Literature

    Energy Technology Data Exchange (ETDEWEB)

    Vleuten, P.A. van der; Willems, T.P.; Goette, M.J.; Tio, R.A.; Greuter, M.J.; Zijlstra, F.; Oudkerk, M. [Univ. Medical Centre Groningen (Netherlands). Depts. of Cardiology and Radiology

    2006-12-15

    Cardiac morbidity and mortality are closely related to cardiac volumes and global left ventricular (LV) function, expressed as left ventricular ejection fraction. Accurate assessment of these parameters is required for the prediction of prognosis in individual patients as well as in entire cohorts. The current standard of reference for left ventricular function is analysis by short-axis magnetic resonance imaging. In recent years, major extensive technological improvements have been achieved in computed tomography. The most marked development has been the introduction of the multidetector CT (MDCT), which has significantly improved temporal and spatial resolutions. In order to assess the current status of MDCT for analysis of LV function, the current available literature on this subject was reviewed. The data presented in this review indicate that the global left ventricular functional parameters measured by contemporary multi-detector row systems combined with adequate reconstruction algorithms and post-processing tools show a narrow diagnostic window and are interchangeable with those obtained by MRI.

  8. Comparison of contrast enhanced three dimensional echocardiography with MIBI gated SPECT for the evaluation of left ventricular function

    Directory of Open Access Journals (Sweden)

    Cosyns Bernard

    2009-06-01

    Full Text Available Abstract Background In clinical practice and in clinical trials, echocardiography and scintigraphy are used the most for the evaluation of global left ejection fraction (LVEF and left ventricular (LV volumes. Actually, poor quality imaging and geometrical assumptions are the main limitations of LVEF measured by echocardiography. Contrast agents and 3D echocardiography are new methods that may alleviate these potential limitations. Methods Therefore we sought to examine the accuracy of contrast 3D echocardiography for the evaluation of LV volumes and LVEF relative to MIBI gated SPECT as an independent reference. In 43 patients addressed for chest pain, contrast 3D echocardiography (RT3DE and MIBI gated SPECT were prospectively performed on the same day. The accuracy and the variability of LV volumes and LVEF measurements were evaluated. Results Due to good endocardial delineation, LV volumes and LVEF measurements by contrast RT3DE were feasible in 99% of the patients. The mean LV end-diastolic volume (LVEDV of the group by scintigraphy was 143 ± 65 mL and was underestimated by triplane contrast RT3DE (128 ± 60 mL; p Conclusion Contrast RT3DE allows an accurate assessment of LVEF compared to the LVEF measured by SPECT, and shows low variability between observers. Although RT3DE triplane provides accurate evaluation of left ventricular function, RT3DE full-volume is superior to triplane modality in patients with suspected coronary artery disease.

  9. Direct left ventricular endocardial pacing: an alternative when traditional resynchronization via coronary sinus is not feasible or effective.

    Science.gov (United States)

    Moriña-Vázquez, Pablo; Roa-Garrido, Jessica; Fernández-Gómez, Juan M; Venegas-Gamero, José; Pichardo, Rafael B; Carranza, Manuel H

    2013-06-01

    Biventricular pacing through the coronary sinus (CS) is effective for the treatment of patients with heart failure and left bundle-branch block. However, this approach is not always feasible. Although surgical epicardial lead implantation is an alternative, the technique may be deleterious in some patients. Thus, direct left ventricular (LV) endocardial pacing under local anesthesia may be an option. We describe our technique and analyze the results of direct LV endocardial pacing. Fourteen patients with failed resynchronization via CS (April 2006-September 2011) were selected. Using a femoral approach, we performed transseptal puncture and LV mapping, then fixed the active lead where the longest electrical delay was observed; the generator was placed in the anterior thigh. For resynchronization, eight patients with a device previously implanted through the upper veins received a single-chamber generator that was set to the VVT mode to sense the subclavian pacing spike. Six patients received a complete femoral resynchronization system with either a defibrillator or pacemaker. Patients were followed for 6-54 months. The LV lead was successfully implanted in all cases. Two patients experienced excessive bleeding and two died during follow-up. All except one improved at least one New York Heart Association class and experienced improved left ventricle ejection fraction. One patient with recurrent episodes of ventricular fibrillation was asymptomatic. Direct LV endocardial pacing is safe and may be a less risky, more efficient alternative than surgical epicardial lead implantation for resynchronization via CS. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  10. Effect of hepatocyte growth factor on left ventricular remodeling after acute myocardial infarction in canine

    Institute of Scientific and Technical Information of China (English)

    Ping LI; Tingshu YANG; Liling LIANG

    2006-01-01

    Background and objectives To investigate the effect of hepatocyte growth factor (HGF) on left ventricular (LV) remodeling after acute myocardial infarction (AMI). Methods AMI was produced by ligation of proximal left anterior descending coronary artery(LAD) in 12 mongrel canines. These animals were randomized into 2 groups. In HGF group (n=6), canines were injected with pcDNA3-HGF lml (about 300ug) at the margin of infarcted myocardium; in control group (n=6) canines were injected with equal volume of normal saline. Cardiac function and left ventricular remodeling were evaluated with echocardiography at 1, 4, 8 weeks after MI. LV myocardium specimens were obtained at 8 weeks and stained with hematoxylin and eosin for histological examination or with sirius red to assess the collagen content. Results Compared with control group, LVEF in HGF group was significantly higher at 4 weeks (49.61+6.66 vs 39.84+6.39; P<0.05) and at 8 weeks (51.57+8.53 vs 40.61+7.67; P<0.05) after AMI, while LVESV was significantly lower in HGF group than that in control group at 8 weeks after AMI (18.98+3.47 vs 25.66+5.86; P<0.05). Posterior left ventricular wall thickness decreased significantly from 1 wk to 8 wks after AMI in control group, while remained unchanged in HGF group. Compared with control group, histological examination showed more neovascularization and less scar, and sirius red staining indicated higher volume of type Ⅲ collagen (7.10±4.06% vs 3.77±1.09%; P<0.05) and lower collagen Ⅰ/Ⅲ ratio value (1.11±0.52 vs 2.94±2.48; P<0.05)in HGF group. Conclusion HGF gene transfer might improve cardiac function and LV remodeling after acute myocardial infarction by stimulating angiogenesis, reducing fibrosis, and reducing myocardial scarring.

  11. Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography

    Directory of Open Access Journals (Sweden)

    Murathan Kucuk

    2017-01-01

    Full Text Available By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r=0.27, p=0.083. Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.

  12. Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load

    Directory of Open Access Journals (Sweden)

    A’roch Roman

    2012-06-01

    Full Text Available Abstract Background Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of left ventricular (LV contractility. Methods Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon (IVCB catheter produced controlled load reduction. First and last beats in the sequence of eight were analysed with speckle tracking (STE during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status. Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal. Paired comparisons were made for different load states using the Wilcoxon’s Signed Rank test. Results The inferior vena cava balloon occlusion (IVCBO load change compared for first to last beat resulted in LV twist increase (11.67° ±2.65° vs. 16.17° ±3.56° respectively, p  Conclusions Peak systolic LV twist and peak early diastolic untwisting rate are load dependent. Differences in LV load should be included in the interpretation when serial measures of twist are compared.

  13. Effect of Left Ventricular Outflow Tract Obstruction on Left Atrial Mechanics in Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Lynne K. Williams

    2015-01-01

    Full Text Available Left atrial (LA volumes are known to be increased in hypertrophic cardiomyopathy (HCM and are a predictor of adverse outcome. In addition, LA function is impaired and is presumed to be due to left ventricular (LV diastolic dysfunction as a result of hypertrophy and myocardial fibrosis. In the current study, we assess the incremental effect of outflow tract obstruction (and concomitant mitral regurgitation on LA function as assessed by LA strain. Patients with HCM (50 obstructive, 50 nonobstructive were compared to 50 normal controls. A subset of obstructive patients who had undergone septal myectomy was also studied. Utilising feature-tracking software applied to cardiovascular magnetic resonance images, LA volumes and functional parameters were calculated. LA volumes were significantly elevated and LA ejection fraction and strain were significantly reduced in patients with HCM compared with controls and were significantly more affected in patients with obstruction. LA volumes and function were significantly improved after septal myectomy. LVOT obstruction and mitral regurgitation appear to further impair LA mechanics. Septal myectomy results in a significant reduction in LA volumes, paralleled by an improvement in function.

  14. Preventive effect of yuzu and hesperidin on left ventricular remodeling and dysfunction in rat permanent left anterior descending coronary artery occlusion model.

    Directory of Open Access Journals (Sweden)

    Hye Yon Yu

    Full Text Available Left ventricular (LV remodeling, which includes ventricular dilatation and increased interstitial fibrosis after myocardial infarction (MI, is the critical process underlying the progression to heart failure. Therefore, a novel approach for preventing LV remodeling after MI is highly desirable. Yuzu is a citrus plant originating in East Asia, and has a number of cardioprotective properties such as hesperidin. However, no study has proved whether yuzu can prevent LV remodeling. The aim of this study was to determine the effects of yuzu on heart failure (HF and its potential impact on the LV remodeling process after MI. Our in vivo study using the permanent left anterior descending coronary artery (LAD occlusion model demonstrate that one week pre-treatment with yuzu or its major metabolite hesperidin before LAD occlusion significantly attenuated cardiac dysfunction, myocyte apoptosis and inflammation. Not only yuzu but also hesperidin inhibited caspase-3 activity, myeloperoxidase expression, α-smooth muscle actin expression, and matrix metalloproteinase-2 activity in a permanent LAD occlusion rat model. To our knowledge, our findings provide the first evidence that yuzu and hesperidin prevent MI-induced ventricular dysfunction and structural remodeling of myocardium.

  15. Preventive effect of yuzu and hesperidin on left ventricular remodeling and dysfunction in rat permanent left anterior descending coronary artery occlusion model.

    Science.gov (United States)

    Yu, Hye Yon; Ahn, Ji Hun; Park, Se Won; Jung, Yi-Sook

    2015-01-01

    Left ventricular (LV) remodeling, which includes ventricular dilatation and increased interstitial fibrosis after myocardial infarction (MI), is the critical process underlying the progression to heart failure. Therefore, a novel approach for preventing LV remodeling after MI is highly desirable. Yuzu is a citrus plant originating in East Asia, and has a number of cardioprotective properties such as hesperidin. However, no study has proved whether yuzu can prevent LV remodeling. The aim of this study was to determine the effects of yuzu on heart failure (HF) and its potential impact on the LV remodeling process after MI. Our in vivo study using the permanent left anterior descending coronary artery (LAD) occlusion model demonstrate that one week pre-treatment with yuzu or its major metabolite hesperidin before LAD occlusion significantly attenuated cardiac dysfunction, myocyte apoptosis and inflammation. Not only yuzu but also hesperidin inhibited caspase-3 activity, myeloperoxidase expression, α-smooth muscle actin expression, and matrix metalloproteinase-2 activity in a permanent LAD occlusion rat model. To our knowledge, our findings provide the first evidence that yuzu and hesperidin prevent MI-induced ventricular dysfunction and structural remodeling of myocardium.

  16. A Model of Left Ventricular Dysfunction Complicated by CAWS Arteritis in DBA/2 Mice

    Directory of Open Access Journals (Sweden)

    Naoto Hirata

    2012-01-01

    Full Text Available It was reported previously that a Candida albicans water-soluble fraction (CAWS, including a mannoprotein and β-glucan complex, has strong potency in inducing fatal necrotizing arteritis in DBA/2 mice. In this study, histopathological changes and cardiac function were investigated in this system. One mg/day of CAWS was given to DBA/2 mice via peritoneal injection for five days. The CAWS-treated DBA/2 mice were induced aortitis and died at an incidence of 100% within several weeks. Histological findings included stenosis in the left ventricular outflow tract (LVOT and severe inflammatory changes of the aortic valve with fibrinoid necrosis. Cardiomegaly was observed and heart weight increased 1.62 fold (<0.01. Echocardiography revealed a severe reduction in contractility and dilatation of the cavity in the left ventricle (LV: LV fractional shortening (LVFS decreased from 71% to 38% (<0.01, and the LV end-diastolic diameter (LVDd increased from 2.21 mm to 3.26 mm (<0.01. The titer of BNP mRNA increased in the CAWS-treated group. Severe inflammatory changes resulting from CAWS brought about lethal LV dysfunction by aortic valve deformation with LVOT stenosis. This system is proposed as an easy and useful experimental model of heart failure because CAWS arteritis can be induced by CAWS injection alone.

  17. Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency

    Science.gov (United States)

    Nishiyama, Motohiro; Shirakawa, Motoaki

    2017-01-01

    Protein C deficiency is a risk of venous thrombosis because of poor fibrinolytic activity. It remains controversial whether protein C deficiency causes arterial thrombosis. A 21-year-old woman was referred with a chief complaint of right leg pain and numbness. Contrast-enhanced computed tomography revealed a low-density mass in the left ventricle (LV), splenic infarction, and peripheral arterial obstructions in her right leg. Thrombosis extending from the renal vein to the inferior vena cava was also detected. Electrocardiography revealed ST depression in leads II, III, and aVF. Transthoracic echocardiography revealed hypokinesis of the apex and interventricular septum and a hypoechoic mass in the LV (26 × 20 mm). She was diagnosed with acute arterial obstruction caused by the LV thrombus, which might have resulted from previous myocardial infarction. Protein C activation turned out to be low (41%) 5 days after admission. The anticoagulant therapy was switched from heparin to rivaroxaban 16 days after admission. The LV thrombus disappeared 24 days after initial treatment, and she has had no thrombotic episodes for 2.8 years under rivaroxaban therapy. Thrombophilia should be investigated for cases of simultaneous left ventricular and deep venous thrombi. Rivaroxaban can be effective in prevention of further thrombotic events. PMID:28194181

  18. Timing effect of intramyocardial hydrogel injection for positively impacting left ventricular remodeling after myocardial infarction.

    Science.gov (United States)

    Yoshizumi, Tomo; Zhu, Yang; Jiang, Hongbin; D'Amore, Antonio; Sakaguchi, Hirokazu; Tchao, Jason; Tobita, Kimimasa; Wagner, William R

    2016-03-01

    Intramyocardial injection of various injectable hydrogel materials has shown benefit in positively impacting the course of left ventricular (LV) remodeling after myocardial infarction (MI). However, since LV remodeling is a complex, time dependent process, the most efficacious time of hydrogel injection is not clear. In this study, we injected a relatively stiff, thermoresponsive and bioabsorbable hydrogel in rat hearts at 3 different time points - immediately after MI (IM), 3 d post-MI (3D), and 2 w post-MI (2W), corresponding to the beginnings of the necrotic, fibrotic and chronic remodeling phases. The employed left anterior descending coronary artery ligation model showed expected infarction responses including functional loss, inflammation and fibrosis with distinct time dependent patterns. Changes in LV geometry and contractile function were followed by longitudinal echocardiography for 10 w post-MI. While all injection times positively affected LV function and wall thickness, the 3D group gave better functional outcomes than the other injection times and also exhibited more local vascularization and less inflammatory markers than the earlier injection time. The results indicate an important role for injection timing in the increasingly explored concept of post-MI biomaterial injection therapy and suggest that for hydrogels with mechanical support as primary function, injection at the beginning of the fibrotic phase may provide improved outcomes.

  19. Left ventricular diastolic function in patients with advanced cystic fibrosis.

    Science.gov (United States)

    Koelling, Todd M; Dec, G William; Ginns, Leo C; Semigran, Marc J

    2003-05-01

    To assess left ventricular systolic and diastolic function in adult patients with cystic fibrosis using radionuclide ventriculography. Although myocardial fibrosis has been described in autopsy specimens of patients with cystic fibrosis, the possibility that myocardial dysfunction may occur during life in adult patients with cystic fibrosis has not been explored. To assess the possibility of cardiac dysfunction occurring in cystic fibrosis, we studied 40 patients with advanced cystic fibrosis with first-pass radionuclide ventriculography and compared them to 9 patients with advanced bronchiectasis and 18 normal control subjects. Indexes of right ventricular systolic function were similarly impaired in patients with cystic fibrosis and patients with bronchiectasis. Left ventricular ejection fraction of patients with cystic fibrosis, patients with bronchiectasis, and normal control subjects did not differ. Fractional left ventricular filling at 50% of diastole, an index of diastolic function, was significantly lower in patients with cystic fibrosis (54 +/- 13%, mean +/- SD) in comparison to patients with bronchiectasis (66 +/- 4%, p = 0.009) or normal control subjects (69 +/- 14, p = 0.0002). The contribution of atrial systole to total diastolic left ventricular filling was greater in patients with cystic fibrosis (38 +/- 18%) than in patients with bronchiectasis (21 +/- 4%, p = 0.01) or normal control subjects (25 +/- 12%, p = 0.01). Patients with advanced cystic fibrosis demonstrate impaired left ventricular distensibility when compared to normal control subjects and patients with bronchiectasis. Patients with cystic fibrosis may be at risk of heart failure due to right ventricular dysfunction or left ventricular diastolic dysfunction.

  20. Hindlimb unloading results in increased predisposition to cardiac arrhythmias and alters left ventricular connexin 43 expression.

    Science.gov (United States)

    Moffitt, Julia A; Henry, Matthew K; Welliver, Kathryn C; Jepson, Amanda J; Garnett, Emily R

    2013-03-01

    Hindlimb unloading (HU) is a well-established animal model of cardiovascular deconditioning. Previous data indicate that HU results in cardiac sympathovagal imbalance. It is well established that cardiac sympathovagal imbalance increases the risk for developing cardiac arrhythmias. The cardiac gap junction protein connexin 43 (Cx43) is predominately expressed in the left ventricle (LV) and ensures efficient cell-to-cell electrical coupling. In the current study we wanted to test the hypothesis that HU would result in increased predisposition to cardiac arrhythmias and alter the expression and/or phosphorylation of LV-Cx43. Electrocardiographic data using implantable telemetry were obtained over a 10- to 14-day HU or casted control (CC) condition and in response to a sympathetic stressor using isoproterenol administration and brief restraint. The arrhythmic burden was calculated using a modified scoring system to quantify spontaneous and provoked arrhythmias. In addition, Western blot analysis was used to measure LV-Cx43 expression in lysates probed with antibodies directed against the total and an unphosphorylated form of Cx43 in CC and HU rats. HU resulted in a significantly greater total arrhythmic burden during the sympathetic stressor with significantly more ventricular arrhythmias occurring. In addition, there was increased expression of total LV-Cx43 observed with no difference in the expression of unphosphorylated LV-Cx43. Specifically, the increased expression of LV-Cx43 was consistent with the phosphorylated form. These data taken together indicate that cardiovascular deconditioning produced through HU results in increased predisposition to cardiac arrhythmias and increased expression of phosphorylated LV-Cx43.

  1. Apolipoprotein E4 allele and the risk of left ventricular dysfunction in thalassemia major

    Directory of Open Access Journals (Sweden)

    M Bazrgar

    2007-07-01

    Full Text Available Background: Left ventricular (LV failure is the main cause of death in thalassemia. Iron overload in thesepatients leads to formation of oxygen free radicals. Apolipoprotein (ApoE E4 allele is the least efficient inoxidative stress condition compared with apoE2 and apoE3 alleles. This study was performed to determinethe association of three different ApoE alleles with LV dysfunction in thalassemia major patients in southernIran.Methods: The present study comprised 202 patients with thalassemia major divided into three groups accordingto echocardiographic findings: Group 1 (n=135 had no cardiac impairment; Group 2 (n=38 exhibitedLV dilatation but normal LV systolic function and Group 3 (n=29 showed LV systolic dysfunction.DNA was obtained from all patients and 198 healthy control subjects for ApoE genotyping.Results: Frequency of both apoE3/E4 genotype and apoE4 allele in Group 3 were higher than the controlgroup with corresponding values of P<0.05, Odds Ratio=2.97, 1.06<8.32 and P<0.01, OR=3.01,1.15<7.69, respectively and confidence Interval of 95%. There were no differences observed betweencontrols and patient groups in relation to other genotype and allele frequencies. Interventricular septumthickness and LV end diastolic diameter in apoE4/- patients were more than those of apoE3/E3 patients.Conclusion: ApoE4 allele increases the risk of LV impairment in thalassemia major.

  2. Left and right ventricular diastolic function in hemodialysis patients.

    Science.gov (United States)

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  3. Endocarditis in left ventricular assist device

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

    2016-01-01

    Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

  4. Arterial baroreflex function and left ventricular hypertrophy

    Institute of Scientific and Technical Information of China (English)

    MIAO Chao-Yu; SU Ding-Feng

    2004-01-01

    It is well known that the arterial baroreflex(ABR)plays a key role in the regulation of heart rate and stabilization of blood pressure.Currently,it appears that ABR dysfunction is involved in the pathophysiology of cardiovascular disease states.Since the mid-1990s,a number of studies have been carried out in our laboratory to explore the pathological significance of ABR function in cardiovascular damage.This minireview summarizes our research work on the topic of ABR and left ventricular hypertrophy(LVH).On the basis of discussion concerning the importance of ABR dysfunction in hypertensive LVH and sinoaortic denervation-induced LVH,we advance a new strategy for reversal of LVH,that is,restoration of impaired ABR function.We tested this hypothesis in animal models with ABR deficiency.It was found that improvement of impaird ABR function with long-term treatment of ketanserin or candesartan was accompanied by reversal of LVH.The preliminary results indicate that it is feasible to target ABR for treatment of LVH.

  5. Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: a comparison with tissue Doppler imaging

    Energy Technology Data Exchange (ETDEWEB)

    Boogers, Mark J.; Veltman, Caroline E. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Interuniversity Cardiology Institute of the Netherlands, Utrecht (Netherlands); Chen, Ji; Garcia, Ernest V. [Emory University School of Medicine, Department of Radiology, Atlanta, GA (United States); Bommel, Rutger J. van; Mooyaart, Eline A.Q.; Wall, Ernst E. van der; Schalij, Martin J.; Bax, Jeroen J.; Delgado, Victoria [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Younis, Imad Al; Hiel, Bernies van der; Dibbets-Schneider, Petra [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

    2011-11-15

    The aim of the current study was to evaluate the feasibility of phase analysis on gated myocardial perfusion SPECT (GMPS) for the assessment of left ventricular (LV) diastolic dyssynchrony in a head-to-head comparison with tissue Doppler imaging (TDI). The population consisted of patients with end-stage heart failure of New York Heart Association functional class III or IV with a reduced LV ejection fraction of {<=}35%. LV diastolic dyssynchrony was calculated using TDI as the maximal time delay between early peak diastolic velocities of two opposing left ventricle walls (diastolic mechanical delay). Significant LV diastolic dyssynchrony was defined as a diastolic mechanical delay of >55 ms on TDI. Furthermore, phase analysis on GMPS was performed to evaluate LV diastolic dyssynchrony; diastolic phase standard deviation (SD) and histogram bandwidth (HBW) were used as markers of LV diastolic dyssynchrony. A total of 150 patients (114 men, mean age 66.0 {+-} 10.4 years) with end-stage heart failure were enrolled. Both diastolic phase SD (r = 0.81, p < 0.01) and diastolic HBW (r = 0.75, p < 0.01) showed good correlations with LV diastolic dyssynchrony on TDI. Additionally, patients with LV diastolic dyssynchrony on TDI (>55 ms) showed significantly larger diastolic phase SD (68.1 {+-} 13.4 vs. 40.7 {+-} 14.0 , p < 0.01) and diastolic HBW (230.6 {+-} 54.3 vs. 129.0 {+-} 55.6 , p < 0.01) as compared to patients without LV diastolic dyssynchrony on TDI ({<=}55 ms). Finally, phase analysis on GMPS showed a good intra- and interobserver reproducibility for the determination of diastolic phase SD (ICC 0.97 and 0.88) and diastolic HBW (ICC 0.98 and 0.93). Phase analysis on GMPS showed good correlations with TDI for the assessment of LV diastolic dyssynchrony. (orig.)

  6. Salt and left ventricular hypertrophy: what are the links?

    Science.gov (United States)

    Langenfeld, M R; Schmieder, R E

    1995-11-01

    Left ventricular hypertrophy is a frequent and prognostically unfavourable finding in patients with essential hypertension and has been found to be a predictor for the development of essential hypertension in normotensive subjects. Among various genetic, haemodynamic and humoral determinants, dietary salt intake has been demonstrated to influence left ventricular mass in hypertensive disease. Several cross-sectional studies have shown a close relation between dietary salt intake and parameters of left ventricular hypertrophy. Moreover, reduction of dietary sodium intake was associated with a decrease of left ventricular mass in a prospective study. The underlying mechanism of how salt intake modulates myocardial structure has not been explained yet. Three possible explanations are discussed: (1) sodium influences left ventricular mass via raised preload, (2) the sympathetic nervous system acts as a mediator, and (3) the renin-angiotensin-aldosterone system is the responsible link. Recent animal experiments and clinical studies suggest that the renin-angiotensin-aldosterone system may mediate both the cardiotrophic and the blood pressure raising effects of salt. However, not all individuals have a similar high susceptibility to blood pressure elevation develop left ventricular hypertrophy when exposed to high salt intake. We suggest that the underlying mechanism is a dysregulation of the renin-angiotensin-aldosterone system. Some individuals may have an impaired downregulation of angiotensin II synthesis when challenged with high salt intake. Accordingly, we found that relatively too high levels of angiotensin II in relation to urinary sodium excretion were associated with left ventricular hypertrophy in these individuals on high salt intake.

  7. In-treatment reduced left atrial diameter during antihypertensive treatment is associated with reduced new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy: The LIFE Study

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Gerdts, Eva; Aurigemma, Gerard P;

    2010-01-01

    It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF.......It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF....

  8. In-treatment reduced left atrial diameter during antihypertensive treatment is associated with reduced new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy: The LIFE Study

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Gerdts, Eva; Aurigemma, Gerard P

    2010-01-01

    It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF.......It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF....

  9. Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain

    Energy Technology Data Exchange (ETDEWEB)

    Shang, Quanliang [University of Nebraska College of Medicine and Children' s Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, NE (United States); Central South University, Department of Radiology, Second Xiangya Hospital, Changsha, Hunan Province (China); Sarikouch, Samir; Beerbaum, Philipp [Hannover Medical School, Hannover (Germany); Patel, Shivani; Danford, David A.; Kutty, Shelby [University of Nebraska College of Medicine and Children' s Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, NE (United States); Schuster, Andreas [Department of Cardiology and Pneumonology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Goettingen (Germany); Steinmetz, Michael [Department of Pediatric Cardiology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Goettingen (Germany); Ou, Phalla [University Paris Diderot, Department of Radiology, Hospital Bichat, APHP, Paris (France)

    2017-01-15

    In patients with repaired coarctation of aorta (CoA), we assessed ventriculo-vascular characteristics using CMR-derived aortic area strain (AAS), left atrial (LA) and left ventricular (LV) longitudinal and circumferential strain (LS, CS). Seventy-five subjects including 50 with repaired CoA divided into hypertensive (n = 25), normotensive (n = 25) and 25 controls were studied. AAS was measured at 3 levels: ascending aorta, proximal descending and descending aorta. LA and LV LS were measured using CMR-feature tracking. LA and LV end-diastolic volumes, ejection fraction (EF) and mass were measured. Mean patient age was 19.7 ± 6.7 and controls 23 ± 15 (years). All strains (LA, LV, ascending and descending aortic) were lower in CoA subgroups compared to controls except the AAS at diaphragm, which was not different. Comparisons between hypertensive and normotensive CoA showed no differences in LV mass, LV volumetric indices, and LA and LV strain indices; however, ascending AAS was lower in hypertensive subgroup (p = 0.02). Ascending AAS was correlated with LV mass (r = -0.4, p = 0.005), LVEF (r = -0.4, p = 0.004), systolic blood pressure (r = -0.5, p = 0.0001) and LVLS (r = 0.5, p = 0.001). Ascending AAS correlated with LV mass, EF and LVLS. In hypertensive CoA, ascending AAS was reduced compared to normotensive CoA and controls, indicating vascular remodelling differences influenced by ongoing hypertension. (orig.)

  10. Relationship between morphologic features of myocardial tissue and left ventricular function in patients with aortic valve disease and left ventricular hypertrophy.

    Science.gov (United States)

    Chang, Hyoung Woo; Kim, Kyung-Hwan; Kim, Jun Sung; Kim, Kyung-Hee; Kim, Yong-Jin

    2013-07-01

    The study aim was to investigate the correlation of myocardial fibrosis with myocardial remodeling and clinical outcome of aortic valve replacement (AVR) in patients with aortic stenosis and left ventricular (LV) hypertrophy. Between 2007 and 2010, a total of 43 patients (23 males, 20 females; mean age 65.5 +/- 10.6 years; range: 33-84 years) underwent AVR at the authors' institution. During surgery, specimens (10 mm3) were obtained from the LV outflow tract and stained with Masson's trichrome. The fibrosis fraction (FF) was quantified. The mean follow up duration was 18.8 +/- 12.2 months (range: 0-46 months). Patients were allocated to either of two groups: the lower fibrosis (LF) group (n = 24) with FF fibrosis (HF) group (n = 19) with FF > or = 5%. There were no significant differences between the two groups in terms of preoperative NYHA functional class and complications. In total, 33 patients (19 LF and 14 HF) were followed up for at least six months. The preoperative LV mass index (LVMI) and LV ejection fraction (LVEF) were not significantly different between the two groups (p = 0.805 and p = 0.377, respectively). At the last follow up examination the LVMI showed a significant inter-group difference (LF group 111.4 +/- 23.2 g/m2; HF group 91.9 +/- 21.5 g/m2; p = 0.005), but the LVEF did not differ significantly between groups (p = 0.457). There was one early (non-cardiac) death in the LF group, and one early death and one late death (both cardiac-related) in the HF group. In patients with aortic stenosis, a higher LVMI was not related to more severe myocardial fibrosis, and LV mass regression after AVR was not influenced by the severity of the myocardial fibrosis. Rather, cardiac-related death might be related to a highly fibrotic heart.

  11. Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy.

    Directory of Open Access Journals (Sweden)

    Christoph Hammerstingl

    Full Text Available BACKGROUND: Obstructive sleep apnea (OSA has deteriorating effect on LV function, whereas its impact on RV function is controversial. We aimed to determine the effect of OSA and continuous positive airway pressure (CPAP treatment on left and right ventricular (LV, RV function using transthoracic echocardiography (TTE and 2 dimensional speckle tracking (2D ST analysis of RV deformation capability. METHODS AND RESULTS: 82 patients with OSA and need for CPAP therapy were prospectively enrolled and underwent TTE at study inclusion and after 6 months of follow up (FU. Multivariate regression analysis revealed an independent association between baseline apical right ventricular longitudinal strain (RV-Sl, BMI and the severity of OSA (apical RV-Sl: P = 0.0002, BMI: P = 0.02. After CPAP therapy, LV functional parameters (LVEF: P30:54.1 ± 12.4%, 68.2 ± 13.6%[P30: -6.3 ± 5.7%, -17.9 ± 11.2% [P<0.0001]. CONCLUSIONS: OSA seems to have deteriorating effect on LV and RV function. We found a beneficial effect of CPAP on LV and RV functional parameters predominately in patients with severe OSA. 2D speckle tracking might be of value to determine early changes in global and regional right ventricular function.

  12. A two phase harmonic model for left ventricular function

    CERN Document Server

    Dubi, S; Dubi, Y

    2006-01-01

    A minimal model for mechanical motion of the left ventricle is proposed. The model assumes the left ventricle to be a harmonic oscillator with two distinct phases, simulating the systolic and diastolic phases, at which both the amplitude and the elastic constant of the oscillator are different. Taking into account the pressure within the left ventricle, the model shows qualitative agreement with functional parameters of the left ventricle. The model allows for a natural explanation of heart failure with preserved systolic left ventricular function, also termed diastolic heart failure. Specifically, the rise in left ventricular filling pressures following increased left-ventricular wall stiffness is attributed to a mechanism aimed at preserving heart rate and cardiac output.

  13. Modeling the Link between Left Ventricular Flow and Thromboembolic Risk Using Lagrangian Coherent Structures

    Directory of Open Access Journals (Sweden)

    Karen May-Newman

    2016-11-01

    Full Text Available A thrombus is a blood clot that forms on a surface, and can grow and detach, presenting a high risk for stroke and pulmonary embolism. This risk increases with blood-contacting medical devices, due to the immunological response to foreign surfaces and altered flow patterns that activate the blood and promote thromboembolism (TE. Abnormal blood transport, including vortex behavior and regional stasis, can be assessed from Lagrangian Coherent Structures (LCS. LCS are flow structures that bound transport within a flow field and divide the flow into regions with maximally attracting/repelling surfaces that maximize local shear. LCS can be identified from finite time Lyapunov exponent (FTLE fields, which are computed from velocity field data. In this study, the goal was to use FTLE analysis to evaluate LCS in the left ventricle (LV using velocity data obtained from flow visualization of a mock circulatory loop. A model of dilated cardiomyopathy (DCM was used to investigate the effect of left ventricular assist device (LVAD support on diastolic filling and transport in the LV. A small thrombus in the left ventricular outflow tract was also considered using data from a corresponding LV model. The DCM LV exhibited a direct flow of 0.8 L/cardiac cycle, which was tripled during LVAD support Delayed ejection flow was doubled, further illustrating the impact of LVAD support on blood transport. An examination of the attracting LCS ridges during diastolic filling showed that the increase is due primarily to augmentation of A wave inflow, which is associated with increased vortex circulation, kinetic energy and Forward FTLE. The introduction of a small thrombus in the left ventricular outflow tract (LVOT of the LV had a minimal effect on diastolic inflow, but obstructed systolic outflow leading to decreased transport compared with the unobstructed LVOT geometry. Localized FTLE in the LVOT increased dramatically with the small thrombus model, which reflects

  14. Ultrasound Speckle Tracking Imaging Contributes to Early Diagnosis of Impaired Left Ventricular Systolic Function in Patients with Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    Hong MA; Mingxing XIE; Jing WANG; Qing LU; Xinfang WANG; Xiaofang LU; Yali YANG; Lijun HU

    2008-01-01

    To investigate the value of ultrasound speckle tracking imaging (STI) in the assessment of the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus (DM), 100 subjects with normal ejection fraction were studied, including 41 patients with DM only (DM group), 22 patients with both DM and left ventricular hypertrophy (DH group),and 37 healthy subjects (control group). Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations,and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group (P0.05). Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group (P<0.01 for each). Basal LV rotation and LV twist were greater in DH group than those in DM group (P<0.01). It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.

  15. Value of cardiovascular MR in diagnosing left ventricular non-compaction cardiomyopathy and in discriminating between other cardiomyopathies

    Energy Technology Data Exchange (ETDEWEB)

    Grothoff, Matthias; Lehmkuhl, Lukas; Gutberlet, Matthias [University of Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Pachowsky, Milena [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Berlin (Germany); Hoffmann, Janine [University of Leipzig, Department of Obstetrics, Leipzig (Germany); Posch, Maximilian [Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin, Berlin (Germany); Klaassen, Sabine [Experimental and Clinical Research Center, Charite Medical Faculty and Max Delbrueck Center for Molecular Medicine, Berlin (Germany)

    2012-12-15

    To analyse the value of cardiovascular magnetic resonance (CMR)-derived myocardial parameters to differentiate left ventricular non-compaction cardiomyopathy (LVNC) from other cardiomyopathies and controls. We retrospectively analysed 12 patients with LVNC, 11 with dilated and 10 with hypertrophic cardiomyopathy and compared them to 24 controls. LVNC patients had to fulfil standard echocardiographic criteria as well as additional clinical and imaging criteria. Cine steady-state free precession and late gadolinium enhancement (LGE) imaging was performed. The total LV myocardial mass index (LV-MMI), compacted (LV-MMI{sub compacted}), non-compacted (LV-MMI{sub non-compacted}), percentage LV-MM{sub non-compacted}, ventricular volumes and function were calculated. Data were compared using analysis of variance and Dunnett's test. Additionally, semi-quantitative segmental analyses of the occurrence of increased trabeculation were performed. Total LV-MMI{sub non-compacted} and percentage LV-MM{sub non-compacted} were discriminators between patients with LVCN, healthy controls and those with other cardiomyopathies with cut-offs of 15 g/m{sup 2} and 25 %, respectively. Furthermore, trabeculation in basal segments and a ratio of non-compacted/compacted myocardium of {>=}3:1 were criteria for LVNC. A combination of these criteria provided sensitivities and specificities of up to 100 %. None of the LVNC patients demonstrated LGE. Absolute CMR quantification of the LV-MMI{sub non-compacted} or the percentage LV-MM{sub non-compacted} and increased trabeculation in basal segments allows one to reliably diagnose LVNC and to differentiate it from other cardiomyopathies. (orig.)

  16. Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing

    Directory of Open Access Journals (Sweden)

    Morales Maria-Aurora

    2011-12-01

    Full Text Available Abstract Background Chronic right ventricular (RV apical pacing may lead to left ventricular (LV dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients. Methods Sixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC in 28 and ischemic cardiomyopathy (IC in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU. Results Decreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p 10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p 10% decrease in LVESD remained highly significant (p Conclusions CRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.

  17. Association Between Myocardial Mechanics and Ischemic LV Remodeling.

    Science.gov (United States)

    D'Elia, Nicholas; D'hooge, Jan; Marwick, Thomas H

    2015-12-01

    The outcomes associated with heart failure after myocardial infarction are still poor. Both global and regional left ventricular (LV) remodeling are associated with the progression of the post-infarct patient to heart failure, but although global remodeling can be accurately measured, regional LV remodeling has been more difficult to investigate. Preliminary evidence suggests that post-MI assessment of LV mechanics using stress and strain may predict global (and possibly regional) LV remodeling. A method of predicting both global and regional LV remodeling might facilitate earlier, targeted, and more extensive clinical intervention in those most likely to benefit from novel interventions such as cell therapy.

  18. Left ventricular mechanics in repaired tetralogy of Fallot with and without pulmonary valve replacement: analysis by three-dimensional speckle tracking echocardiography.

    Directory of Open Access Journals (Sweden)

    Shu-Na Li

    Full Text Available BACKGROUND: Altered septal curvature and left ventricular (LV geometry secondary to right ventricular (RV dilation render two-dimensional assessment of LV mechanics difficult in repaired tetralogy of Fallot (TOF patients. The novel three-dimensional (3D speckle tracking echocardiography enables comprehensive evaluation of true 3D LV mechanics. METHODS AND RESULTS: Seventy-six patients aged 23.6 ± 8.3 years, 55 with isolated repair (group I and 21 with subsequent pulmonary valve replacement (group II, and 34 healthy controls were studied. Three-dimensional volume datasets were acquired for assessment of LV global and regional 3D strain, systolic dyssynchrony index (SDI, twist, twist gradient (twist/LV length, and ejection fraction. A global performance index was calculated as (global 3D strain•twist gradient/SDI. The septal curvature and LV eccentricity were determined from the mid-ventricular short-axis. Compared with controls, group I and II patients had significantly reduced LV global 3D strain, LV twist, twist gradient, septal curvature, and global performance index, and greater LV systolic and diastolic eccentricity and SDI (all p<0.05. All but the four apical LV segments in patients had reduced regional 3D strain compared with controls (all p<0.05. Septal curvature correlated with LV global 3D strain (r=0.41, p<0.001, average septal strain (r=0.38, p<0.001, twist (r=0.32, p<0.001, twist gradient (r=0.33, p<0.001, and global performance index (r=0.43, p<0.001. CONCLUSIONS: Adverse 3D LV mechanics as characterized by impaired global and regional 3D systolic strain, mechanical dyssynchrony, and reduced twist is related to reduced septal curvature in repaired TOF patients with and without pulmonary valve replacement.

  19. Effects of suture position on left ventricular fluid mechanics under mitral valve edge-to-edge repair.

    Science.gov (United States)

    Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming

    2014-01-01

    Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.

  20. The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    To investigate the value of the Doppler-derived myocardial performance index to predict early left-ventricular (LV) dilation and cardiac death after a first acute myocardial infarction (AMI), Doppler echocardiography was performed within 24 h of hospital admission, on day 5, 1 and 3 months after.......63, (p or = 0.63 (relative risk 5.6, p or = II (relative risk 4.0, p = 0.04) to be independent predictors of cardiac death. Therefore......, we conclude that the Doppler echocardiographic myocardial performance index is a predictor of LV dilation and cardiac death after a first AMI....

  1. Left Ventricular function during episodes of silent and symptomatic myocardial ischemia; Linksventrikulaere Funktion waehrend symptomatischer und asymptomatischer Myokardischaemie

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, A. [Abt. fuer Kardiologie, Zentrum der Inneren Medizin, Frankfurt Univ. (Germany); Maul, F.D. [Abt. fuer Nuklearmedizin, Zentrum der Radiologie, Frankfurt Univ. (Germany); Zimny, M. [Abt. fuer Kardiologie, Zentrum der Inneren Medizin, Frankfurt Univ. (Germany); Klepzig, H. [Abt. fuer Kardiologie, Zentrum der Inneren Medizin, Frankfurt Univ. (Germany); Hoer, G. [Abt. fuer Nuklearmedizin, Zentrum der Radiologie, Frankfurt Univ. (Germany)

    1993-12-01

    Transluminal coronary angioplasty (PTCA) causes transient occlusion of the coronary artery and temporary ischemia of the left ventricle. Left ventricular dysfunction during silent and symptomatic episodes of myocardial ischemia during PTCA was evaluated continuously with a newly developed miniature, non-imaging scintillation probe. Parameters of left ventricular function were compared before and during balloon inflations of 60 s duration: Ejection fraction (EF), indices of end-systolic and end-diastolic volumes (ESV, EDV), peak ejection and peak filling rates (PER, PFR). 13 patients (age 54{+-}7.4 years) were symptomatic, 10 patients (age 61{+-}8 years) were asymptomatic. Impairment of left ventricular function during ischemia did not show any significant differences between the symptomatic and asymptomatic patients. It is therefore concluded that symptomatic and asymptomatic episodes of myocardial ischemia during PTCA cause similar impairment of systolic and diastolic left ventricular function. The degree of left ventricular dysfunction during PTCA cannot be estimated on the basis of clinical symptoms. (orig.) [Deutsch] Um zu untersuchen, ob sich Episoden stummer und symptomatischer Myokardischaemie waehrend transluminaler koronarer Angioplastie (PTCA) im Ausmass der linksventrikulaeren (LV) Funktionsbeeintraechtigung unterscheiden, wurden Auswurffraktion (EF), Indices des endsystolischen und enddiastolischen Volumens (ESV, EDV) sowie maximale Auswurf- (PER) und maximale Fuellungsgeschwindigkeiten (PFR) vor aund waehrend PTCA kontinuierlich on-line mit einer nicht-bildgebenden CsI-Szintillationssonde bestimmt. 13 Patienten (Alter 54{+-}7,4 Jahre) waren symptomatisch, 10 Patienten (Alter 61{+-}8 Jahre) waren asymptomatisch. Die linksventrikulaeren Funktionsparameter zeigten keine signifkanten Unterschiede zwischen den beiden Patientengruppen. Es wird daher gefolgert, dass symptomatische und stumme Ischaemieepisoden waehrend PTCA zu einer gleichartigen

  2. Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults

    DEFF Research Database (Denmark)

    Shah, Amil M; Claggett, Brian; Kitzman, Dalane

    2017-01-01

    BACKGROUND: Although age-associated changes in left ventricular diastolic function are well recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values for in...

  3. left ventricular hypertrophy in renal failure a review

    African Journals Online (AJOL)

    Key words: Left Ventricular hypertrophy (LVH), Renal failure; cardiovascular. INTRODUCTION. Chronic ... of anaemia; age, disturbed elasticity of the central arteries with elevated ..... Arodiwe E. B. Prevalence of and factors associated with LVH ...

  4. Autosomal dominant inheritance of left ventricular outflow tract obstruction

    NARCIS (Netherlands)

    Wessels, Marjolein; Berger, Rudolphus; Frohn-Mulder, Ingrid M E; Roos-Hesselink, Jolien W; Hoogeboom, Jeanette J M; Mancini, Grazia S; Bartelings, Margot M; Krijger, Ronald de; Wladimiroff, Jury W; Niermeijer, Martinus F; Grossfeld, Paul; Willems, Patrick J

    2005-01-01

    Most nonsyndromic congenital heart malformations (CHMs) in humans are multifactorial in origin, although an increasing number of monogenic cases have been reported recently. We describe here four new families with presumed autosomal dominant inheritance of left ventricular outflow tract obstruction

  5. Metabolites of MDMA induce oxidative stress and contractile dysfunction in adult rat left ventricular myocytes.

    Science.gov (United States)

    Shenouda, Sylvia K; Varner, Kurt J; Carvalho, Felix; Lucchesi, Pamela A

    2009-03-01

    Repeated administration of 3,4-methylenedioxymethamphetamine (MDMA) (ecstasy) produces eccentric left ventricular (LV) dilation and diastolic dysfunction. While the mechanism(s) underlying this toxicity are unknown, oxidative stress plays an important role. MDMA is metabolized into redox cycling metabolites that produce superoxide. In this study, we demonstrated that metabolites of MDMA induce oxidative stress and contractile dysfunction in adult rat left ventricular myocytes. Metabolites of MDMA used in this study included alpha-methyl dopamine, N-methyl alpha-methyl dopamine and 2,5-bis(glutathion-S-yl)-alpha-MeDA. Dihydroethidium was used to detect drug-induced increases in reactive oxygen species (ROS) production in ventricular myocytes. Contractile function and changes in intracellular calcium transients were measured in paced (1 Hz), Fura-2 AM loaded, myocytes using the IonOptix system. Production of ROS in ventricular myocytes treated with MDMA was not different from control. In contrast, all three metabolites of MDMA exhibited time- and concentration-dependent increases in ROS that were prevented by N-acetyl-cysteine (NAC). The metabolites of MDMA, but not MDMA alone, significantly decreased contractility and impaired relaxation in myocytes stimulated at 1 Hz. These effects were prevented by NAC. Together, these data suggest that MDMA-induced oxidative stress in the left ventricle can be due, at least in part, to the metabolism of MDMA to redox active metabolites.

  6. A new "twist" on right heart failure with left ventricular assist systems.

    Science.gov (United States)

    Houston, Brian A; Shah, Keyur B; Mehra, Mandeep R; Tedford, Ryan J

    2017-07-01

    Despite significant efforts to predict and prevent right heart failure, it remains a leading cause of morbidity and mortality after implantation of left ventricular assist systems (LVAS). In this Perspective, we review the underappreciated anatomic and physiologic principles that govern the relationship between left and right heart function and contribute to this phenomenon. This includes the importance of considering the right ventricle (RV) and pulmonary arterial circuit as a coupled system; the contribution of the left ventricle (LV) to RV contractile function and the potential negative impact of acutely unloading the LV; the influence of the pericardium and ventricular twist on septal function; the role of RV deformation in reduced mechanical efficiency after device placement; and the potential of ongoing stressors of an elevated right-sided preload. We believe an appreciation of these complex issues is required to fully understand the expression of the unique phenotypes of right heart failure after LVAS implantation and for developing better prognostic and therapeutic strategies. Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  7. Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation.

    Science.gov (United States)

    Menting, Myrthe E; van Grootel, Roderick W J; van den Bosch, Annemien E; Eindhoven, Jannet A; McGhie, Jackie S; Cuypers, Judith A A E; Witsenburg, Maarten; Helbing, Willem A; Roos-Hesselink, Jolien W

    2016-05-01

    Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with repaired CoA and healthy controls were recruited prospectively. All subjects underwent echocardiography, ECG and blood sampling within 1 day. With speckle-tracking echocardiography, we assessed LV GLS on the apical four-, three- and two-chamber views. We included 150 subjects: 75 patients (57 % male, age 33.4 ± 12.8 years, age at repair 2.5 [IQR: 0.1-11.1] years) and 75 healthy controls of similar sex and age. LV GLS was lower in patients than in controls (-17.1 ± 2.3 vs. -20.2 ± 1.6 %, P < 0.001). Eighty percent of the patients had a normal LV ejection fraction, but GLS was still lower than in controls (P < 0.001). In patients, GLS correlated with systolic and diastolic blood pressure (r = 0.32, P = 0.009; r = 0.31, P = 0.009), QRS duration (r = 0.34, P = 0.005), left atrial dimension (r = 0.27, P = 0.029), LV mass (r = 0.30, P = 0.014) and LV ejection fraction (r = -0.48, P < 0.001). Patients with either associated cardiac lesions, multiple cardiac interventions or aortic valve replacement had lower GLS than patients without. Although the majority of adults with repaired CoA seem to have a normal systolic LV function, LV GLS was decreased. Higher blood pressure, associated cardiac lesions, and larger left atrial dimension are related with lower GLS. Therefore, LV GLS may be used as objective criterion for early detection of ventricular dysfunction.

  8. In vivo Echocardiographic Assessment of Left Ventricular Function in Transgenic and Gene-Targeted Mice.

    Science.gov (United States)

    Hoit, B D; Walsh, R A

    1997-05-01

    Manipulation of the mammalian genome with transgenic and gene-targeting techniques is a powerful method for unambiguously identifying the molecular mechanisms underlying cardiac development and function. Although the small size of the mouse heart and the rapid heart rates encountered have limited echocardiographic assessment of the murine heart in the past, the use of sophisticated transducers operating at a high frequency results in highly reliable and reproducible image quality. M-mode echocardiography has been shown to provide a good correlation with gravimetrically determined left ventricular mass (LV) and to estimate accurately LV dimensions and systolic function. Doppler interrogation of transvalvular flows permits assessment of global LV systolic and diastolic function independent of ventricular geometry. Linear stress-shortening relations can be determined in the adult mouse with the use of pharmacologically induced changes in systemic arterial pressure, and these relations are capable of detecting changes in myocardial contractility in vivo, relatively independent of loading conditions. The present review focuses on the current advantages and limitations of M-mode and Doppler echocardiography to evaluate cardiac function in mice. (Trends Cardiovasc Med 1997;7:129-134). © 1997, Elsevier Science Inc.

  9. Dobutamine stress echocardiography for assessing the role of dynamic intraventricular obstruction in left ventricular ballooning syndrome

    Directory of Open Access Journals (Sweden)

    Repetto Alessandra

    2010-04-01

    Full Text Available Abstract Background Dynamic intraventricular obstruction has been observed in patients with left ventricular ballooning syndrome (LVBS and has been hypothesized as a possible mechanism of the syndrome. The aim of this study was to assess the prevalence and significance of dynamic intraventricular obstruction in patients with LVBS. Methods and Results Dobutamine stress echocardiography was carried out in 22 patients with LVBS (82% apical, all women, aged 68 ± 9 years. At baseline 1 patient had a > 30 mmHg LV gradient; during stress a LV gradient > 30 mm Hg developed in 6/21 patients (28% and was caused by systolic anterior motion of the mitral valve in the 3 patients with severe gradient (mean 116 ± 29 mmHg, who developed mitral regurgitation and impaired apical wall motion and by obstruction at mid-ventricular level in the other 3 with a moderate gradient (mean 46 ± 16 mmHg. Compared with patients without obstruction those with obstruction had a greater mean septal thickness (11.6 ± .6 vs 9.8. ± 3, p Conclusion Spontaneous or dobutamine-induced dynamic LV obstruction is documented in 32% of patients with LVBS, is correlated with the presence of septal hypertrophy and may play a role in the development of LVBS in this subset of patients. In those without septal hypertrophy a dynamic obstruction is rarely induced with dobutamine and is unlikely to be a major pathogenetic factor of the syndrome.

  10. Usefulness of Left Atrial Reservoir Size and Left Ventricular Untwisting Rate for Predicting Outcome in Primary Mitral Regurgitation.

    Science.gov (United States)

    Zito, Concetta; Manganaro, Roberta; Khandheria, Bijoy; Oreto, Giuseppe; Cusmà-Piccione, Maurizio; Todaro, Maria Chiara; Caprino, Alessandra; Pugliatti, Pietro; Di Bella, Gianluca; Carerj, Scipione

    2015-10-15

    The present study proposed to evaluate whether analysis of cardiac mechanics through speckle-tracking imaging is useful for risk stratification in asymptomatic patients with chronic primary mitral regurgitation (MR). We prospectively enrolled 67 patients (mean age 57 ± 18 years) and followed them over time. MR was mild in 20 patients (30%), moderate in 24 (36%), and severe in 23 (34%). After a mean time of 24.8 ± 17 months, 34 patients (51%) remained asymptomatic, whereas 33 (49%) developed events (19 underwent mitral valve surgery, 9 required hospitalization for acute heart failure, and 5 patients died). Compared to asymptomatic patients, those with events at baseline showed more severe MR, larger and spherical ventricles, diastolic dysfunction, and greater systolic pulmonary arterial pressure. Moreover, patients with events had decreased left atrial (LA) reservoir (p <0.001) and left ventricular (LV) untwisting rate (p <0.001). On univariate Cox regression analysis, effective regurgitant orifice area (p <0.001), vena contracta (p <0.001), systolic pulmonary arterial pressure (p = 0.003), LV end-systolic diameter (p <0.001), E/E' ratio (p = 0.004), LA volume (p = 0.001), LA reservoir (p <0.001), and LV untwisting rate (p <0.001) were associated with an increased risk of events. On multivariate analysis, only LA reservoir (p = 0.013) and LV untwisting rate were independent predictors (p = 0.017) of outcome. Moreover, LA reservoir evaluation significantly improved (p = 0.013) risk stratification compared to recommended parameters. In conclusion, impaired cardiac mechanics is more closely associated than severity of MR with the occurrence of events in asymptomatic chronic primary MR.

  11. Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging.

    Science.gov (United States)

    Kim, Jiwon; Kochav, Jonathan D; Gurevich, Sergey; Afroz, Anika; Petashnick, Maya; Volo, Samuel; Diaz, Belen; Okin, Peter M; Horn, Evelyn; Devereux, Richard B; Weinsaft, Jonathan W

    2014-12-01

    Left ventricular (LV) remodeling and myocardial fibrosis have been linked to adverse heart failure outcomes. Mid wall late gadolinium enhancement (MW-LGE) on cardiac magnetic resonance (CMR) imaging is well-associated with non-ischemic cardiomyopathy (NICM), but prevalence in ischemic cardiomyopathy (ICM) and association with remodeling are unknown. The population comprised patients with systolic dysfunction [LV ejection fraction (LVEF ≤ 40 %)]. CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. 285 patients were studied. MW-LGE was present in 12 %, and was tenfold more common with NICM (32 %) versus ICM (3 %, p MW-LGE had ICM. LV wall stress was higher (p = 0.02) among patients with, versus those without, MW-LGE despite similar systolic blood pressure (p = 0.24). In multivariate analysis, MW-LGE was associated with CMR-quantified LV end-diastolic volume (p = 0.03) independent of LVEF and mass. Incorporation of clinical and imaging variables demonstrated MW-LGE to be associated with higher LV end-diastolic volume (OR 1.13, CI 1.004-1.27 per 10 ml/m(2), p = 0.04) after controlling for presence of NICM (OR 16.0, CI 5.8-44.1, p MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.

  12. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Caselli, Stefano; Maron, Martin S; Urbano-Moral, Josè A; Pandian, Natesa G; Maron, Barry J; Pelliccia, Antonio

    2014-11-01

    Identification of hypertrophic cardiomyopathy (HC) in young athletes is challenging when left ventricular (LV) wall thickness is between 13 and 15 mm. The aim of this study was to revise the ability of simple echocardiographic and clinical variables for the differential diagnosis of HC versus athlete's heart. Twenty-eight athletes free of cardiovascular disease were compared with 25 untrained patients with HC, matched for LV wall thickness (13 to 15 mm), age, and gender. Clinical, electrocardiographic, and echocardiographic variables were compared. Athletes had larger LV cavities (60 ± 3 vs 45 ± 5 mm, p 40 mm excluded HC with sensitivity of 92% and specificity of 71% (p <0.001). Athletes showed higher e' velocity by tissue Doppler imaging than patients with HC (12.5 ± 1.9 vs 9.3 ± 2.3 cm/second, p <0.001), with values <11.5 cm/second yielding sensitivity of 81% and specificity of 61% for the diagnosis of HC (p <0.001). Absence of diffuse T-wave inversion on electrocardiography (specificity 92%) and negative family history for HC (specificity 100%) also proved useful for excluding HC. In conclusion, in athletes with LV hypertrophy in the "gray zone" with HC, LV cavity size appears the most reliable criterion to help in diagnosis, with a cut-off value of <54 mm useful for differentiation from athlete's heart. Other criteria, including LV diastolic dysfunction, absence of T-wave inversion on electrocardiography, and negative family history, further aid in the differential diagnosis.

  13. Impact of regional left ventricular function on outcome for patients with AL amyloidosis.

    Directory of Open Access Journals (Sweden)

    Dan Liu

    Full Text Available OBJECTIVES: The aim of this study was to explore the left ventricular (LV deformation changes and the potential impact of deformation on outcome in patients with proven light-chain (AL amyloidosis and LV hypertrophy. BACKGROUND: Cardiac involvement in AL amyloidosis patients is associated with poor outcome. Detecting regional cardiac function by advanced non-invasive techniques might be favorable for predicting outcome. METHODS: LV longitudinal, circumferential and radial peak systolic strains (Ssys were assessed by speckle tracking imaging (STI in 44 biopsy-proven systemic AL amyloidosis patients with LV hypertrophy (CA and in 30 normal controls. Patients were divided into compensated (n = 18 and decompensated (n = 26 group based on clinical assessment and followed-up for a median period of 345 days. RESULTS: Ejection fraction (EF was preserved while longitudinal Ssys (LSsys was significantly reduced in both compensated and decompensated groups. Survival was significantly reduced in decompensated group (35% vs. compensated 78%, P = 0.001. LSsys were similar in apical segments and significantly reduced in basal segments between two patient groups. LSsys at mid-segments were significantly reduced in all LV walls of decompensated group. Patients were further divided into 4 subgroups according to the presence or absence of reduced LSsys in no (normal, only basal (mild, basal and mid (intermediate and all segments of the septum (severe. This staging revealed continuously worse prognosis in proportion to increasing number of segments with reduced LSsys (mortality: normal 14%, mild 27%, intermediate 67%, and severe 64%. Mid-septum LSsys<11% suggested a 4.8-fold mortality risk than mid-septum LSsys≥11%. Multivariate regression analysis showed NYHA class and mid-septum LSsys were independent predictors for survival. CONCLUSIONS: Reduced deformation at mid-septum is associated with worse prognosis in systemic amyloidosis patients with LV

  14. A miniature intraventricular axial flow blood pump that is introduced through the left ventricular apex.

    Science.gov (United States)

    Yamazaki, K; Umezu, M; Koyanagi, H; Kitamura, M; Eishi, K; Kawai, A; Tagusari, O; Niinami, H; Akimoto, T; Nojiri, C

    1992-01-01

    A new intraventricular axial flow blood pump has been designed and developed as an implantable left ventricular assist device (LVAD). The pump consists of a tube housing (10 cm in length and 14 mm in diameter), a three-vane impeller combined with a guide vane, and a DC motor. This pump is introduced into the LV cavity through the LV apex, and the outlet cannula is passed antegrade across the aortic valve. Blood is withdrawn from the LV through the inlet ports at the pump base, and discharged into the ascending aorta. A pump flow of > 8 L/min was obtained against 90 mmHg differential pressure in the mock circulatory system. In an acute dog model, this pump could produce a sufficient output of 200 ml/kg/min. In addition, the pump flow profile demonstrated a pulsatile pattern, although the rotation speed was fixed. This is mainly due to the changes in flow rate during a cardiac cycle--that is, during systole, the flow rate increases to the maximum, while the differential pressure between the LV and the aorta decreases to the minimum. Thus, this simple and compact axial flow blood pump can be a potential LVAD, with prompt accessibility and need for less invasive surgical procedures.

  15. Long-term intake of sesamin improves left ventricular remodelling in spontaneously hypertensive rats.

    Science.gov (United States)

    Li, Wen-xing; Kong, Xiang; Zhang, Jun-xiu; Yang, Jie-ren

    2013-02-26

    This study was designed to evaluate the in vivo cardioprotective effects of food-derived sesamin in spontaneously hypertensive rats (SHR). The study was performed with 17-week-old male normotensive Wistar-Kyoto rats (WKY) and SHR which are untreated or treated with orally administered sesamin for 16 weeks before they were sacrificed. Long-term treatment with sesamin obviously improved left ventricular (LV) hypertrophy and fibrosis in SHR, as indicated by the decrease of LV weight/body weight, myocardial cell size, cardiac fibrosis and collagen type I expression as well as the amelioration of the LV ultrastructure. These effects were associated with reduced systolic blood pressure, enhanced cardiac total antioxidant capability and decreased malondialdehyde content, nitrotyrosine level and transforming growth factor β1 (TGF-β1) expression. All these results suggest that chronic treatment with sesamin improves LV remodeling in SHR through alleviation of oxidative and nitrative stress, reduction of blood pressure and downregulation of TGF-β1 expression.

  16. Stress-induced alteration of left ventricular eccentricity: An additional marker of multivessel CAD.

    Science.gov (United States)

    Gimelli, Alessia; Liga, Riccardo; Giorgetti, Assuero; Casagranda, Mirta; Marzullo, Paolo

    2017-03-28

    Abnormal left ventricular (LV) eccentricity index (EI) is a marker of adverse cardiac remodeling. However, the interaction between stress-induced alterations of EI and major cardiac parameters has not been explored. We sought to evaluate the relationship between LV EI and coronary artery disease (CAD) burden in patients submitted to myocardial perfusion imaging (MPI). Three-hundred and forty-three patients underwent MPI and coronary angiography. LV ejection fraction (EF) and EI were computed from gated stress images as measures of stress-induced functional impairment. One-hundred and thirty-six (40%), 122 (35%), and 85 (25%) patients had normal coronary arteries, single-vessel CAD, and multivessel CAD, respectively. Post-stress EI was lower in patients with multivessel CAD than in those with normal coronary arteries and single-vessel CAD (P = 0.001). This relationship was confirmed only in patients undergoing exercise stress test, where a lower post-stress EI predicted the presence of multivessel CAD (P = 0.039). Post-stress alterations of LV EI on MPI may unmask the presence of multivessel CAD.

  17. Detection of left ventricular motion abnormality via information measures and bayesian filtering.

    Science.gov (United States)

    Punithakumar, Kumaradevan; Ben Ayed, Ismail; Ross, Ian G; Islam, Ali; Chong, Jaron; Li, Shuo

    2010-07-01

    We present an original information theoretic measure of heart motion based on the Shannon's differential entropy (SDE), which allows heart wall motion abnormality detection. Based on functional images, which are subject to noise and segmentation inaccuracies, heart wall motion analysis is acknowledged as a difficult problem, and as such, incorporation of prior knowledge is crucial for improving accuracy. Given incomplete, noisy data and a dynamic model, the Kalman filter, a well-known recursive Bayesian filter, is devised in this study to the estimation of the left ventricular (LV) cavity points. However, due to similarity between the statistical information of normal and abnormal heart motions, detecting and classifying abnormality is a challenging problem, which we investigate with a global measure based on the SDE. We further derive two other possible information theoretic abnormality detection criteria, one is based on Rényi entropy and the other on Fisher information. The proposed methods analyze wall motion quantitatively by constructing distributions of the normalized radial distance estimates of the LV cavity. Using 269 x 20 segmented LV cavities of short-axis MRI obtained from 30 subjects, the experimental analysis demonstrates that the proposed SDE criterion can lead to a significant improvement over other features that are prevalent in the literature related to the LV cavity, namely, mean radial displacement and mean radial velocity.

  18. Higher resolution cine imaging with compressed sensing for accelerated clinical left ventricular evaluation.

    Science.gov (United States)

    Lin, Aaron C W; Strugnell, Wendy; Riley, Robyn; Schmitt, Benjamin; Zenge, Michael; Schmidt, Michaela; Morris, Norman R; Hamilton-Craig, Christian

    2017-06-01

    To assess the clinical feasibility of a compressed sensing cine magnetic resonance imaging (MRI) sequence of both high temporal and spatial resolution (CS_bSSFP) in comparison to a balanced steady-state free precession cine (bSSFP) sequence for reliable quantification of left ventricular (LV) volumes and mass. Segmented MRI cine images were acquired on a 1.5T scanner in 50 patients in the LV short-axis stack orientation using a retrospectively gated conventional bSSFP sequence (generalized autocalibrating partially parallel acquisition [GRAPPA] acceleration factor 2), followed by a prospectively triggered CS_bSSFP sequence with net acceleration factor of 8. Image quality was assessed by published criteria. Comparison of sequences was made in LV volumes and mass, image quality score, quantitative regional myocardial wall motion, and imaging time using Pearson's correlation, Bland-Altman and paired 2-tailed Student's t-test. Differences (bSSFP minus CS_bSSFP, mean ± SD) and Pearson's correlations were 14.8 ± 16.3 (P = 0.31) and r = 0.98 (P cine CS_bSSFP accurately and reliably quantitates LV volumes and mass, shortens acquisition times, and is clinically feasible. 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1693-1699. © 2016 International Society for Magnetic Resonance in Medicine.

  19. Zygotic LvBMP5-8 is required for skeletal patterning and for left-right but not dorsal-ventral specification in the sea urchin embryo.

    Science.gov (United States)

    Piacentino, Michael L; Chung, Oliver; Ramachandran, Janani; Zuch, Daniel T; Yu, Jia; Conaway, Evan A; Reyna, Arlene E; Bradham, Cynthia A

    2016-04-01

    Skeletal patterning in the sea urchin embryo requires coordinated signaling between the pattern-dictating ectoderm and the skeletogenic primary mesenchyme cells (PMCs); recent studies have begun to uncover the molecular basis for this process. Using an unbiased RNA-Seq-based screen, we have previously identified the TGF-ß superfamily ligand, LvBMP5-8, as a skeletal patterning gene in Lytechinus variegatus embryos. This result is surprising, since both BMP5-8 and BMP2/4 ligands have been implicated in sea urchin dorsal-ventral (DV) and left-right (LR) axis specification. Here, we demonstrate that zygotic LvBMP5-8 is required for normal skeletal patterning on the left side, as well as for normal PMC positioning during gastrulation. Zygotic LvBMP5-8 is required for expression of the left-side marker soxE, suggesting that LvBMP5-8 is required for left-side specification. Interestingly, we also find that LvBMP5-8 knockdown suppresses serotonergic neurogenesis on the left side. While LvBMP5-8 overexpression is sufficient to dorsalize embryos, we find that zygotic LvBMP5-8 is not required for normal DV specification or development. In addition, ectopic LvBMP5-8 does not dorsalize LvBMP2/4 morphant embryos, indicating that, in the absence of BMP2/4, BMP5-8 is insufficient to specify dorsal. Taken together, our data demonstrate that zygotic LvBMP5-8 signaling is essential for left-side specification, and for normal left-side skeletal and neural patterning, but not for DV specification. Thus, while both BMP2/4 and BMP5-8 regulate LR axis specification, BMP2/4 but not zygotic BMP5-8 regulates DV axis specification in sea urchin embryos.

  20. Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future Arrhythmic Events in Patients With Systolic Dysfunction.

    Science.gov (United States)

    Mikami, Yoko; Jolly, Umjeet; Heydari, Bobak; Peng, Mingkai; Almehmadi, Fahad; Zahrani, Mohammed; Bokhari, Mahmoud; Stirrat, John; Lydell, Carmen P; Howarth, Andrew G; Yee, Raymond; White, James A

    2017-01-01

    Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance. Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02). RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker

  1. Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD.

    Science.gov (United States)

    Schneider, Markus P; Raff, Ulrike; Kopp, Christoph; Scheppach, Johannes B; Toncar, Sebastian; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Floege, Jürgen; Schmid, Matthias; Birukov, Anna; Dahlmann, Anke; Linz, Peter; Janka, Rolf; Uder, Michael; Schmieder, Roland E; Titze, Jens M; Eckardt, Kai-Uwe

    2017-06-01

    The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using (23)sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, Pskin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients. Copyright © 2017 by the American Society of Nephrology.

  2. Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study

    Science.gov (United States)

    Yousaf, Fahad; Kingston, Andrew; Kenny, Antoinette; Davies, Karen; Jagger, Carol; Robinson, Louise; Kirkwood, Thomas B L; Keavney, Bernard

    2012-01-01

    Objective Heart failure (HF) prevalence rises sharply among those aged 85 years and over. Previous population based echocardiographic studies of left ventricular (LV) dysfunction, the substrate for HF, have included only small numbers in this age group. We used domiciliary echocardiography to estimate the prevalence of LV systolic and diastolic dysfunction in 87–89 year olds and the proportion remaining undiagnosed. Design Cross sectional analysis of data from Newcastle 85+ Study. Setting Primary care, North-East England. Participants 376 men and women aged 87–89 years. Measures Domiciliary echocardiography was performed and LV systolic and diastolic function was graded. The presence of limiting dyspnoea was assessed by questionnaire. Previous diagnoses of HF were abstracted from general practice (GP) records. Results 32% of participants (119/376) had LV systolic dysfunction (ejection fraction (EF) ≤50%) and a further 20% (75/376) had moderate or severe LV diastolic dysfunction with preserved EF. Both echocardiographic assessment of LV function and dyspnoea status were available in 74% (278/376) of participants. Among these participants, limiting dyspnoea was present in approximately two thirds of those with significant (systolic or isolated moderate/severe diastolic) LV dysfunction. 84% (73/87) of participants with significant LV dysfunction and limiting dyspnoea did not have a pre-existing HF diagnosis in their GP records. Overall, 26% (73/278) of participants with both echocardiographic and dyspnoea data had undiagnosed, symptomatic, significant LV dysfunction. Conclusion Significant systolic and diastolic LV dysfunction is much commoner in community dwelling 87–89 year olds than previous studies have suggested. The majority are both symptomatic and undiagnosed. PMID:22859497

  3. Rats with high left ventricular end-diastolic pressure can be identified by Doppler echocardiography one week after myocardial infarction.

    Science.gov (United States)

    Saraiva, R M; Kanashiro-Takeuchi, R M; Antonio, E L; Campos, O; P J F, Tucci; Moisés, V A

    2007-11-01

    The severity of left ventricular (LV) dysfunction in rats with myocardial infarction (MI) varies widely. Because homogeneity in baseline parameters is essential for experimental investigations, a study was conducted to establish whether Doppler echocardiography (DE) could accurately identify animals with high LV end-diastolic pressure as a marker of LV dysfunction soon after MI. Direct measurements of LV end-diastolic pressure were made and DE was performed simultaneously 1 week after surgically induced MI (N = 16) or sham-operation (N = 17) in female Wistar rats (200 to 250 g). The ratio of peak early (E) to late (A) diastolic LV filling velocities and the ratio of E velocity to peak early (Em) diastolic myocardial velocity were the best predictors of high LV end-diastolic pressure (>12 mmHg) soon after MI. Cut-off values of 1.77 for the E/A ratio (P = 0.001) identified rats with elevated LV end-diastolic pressure with 90% sensitivity and 80% specificity. Cut-off values of 20.4 for the E/Em ratio (P = 0.0001) identified rats with elevated LV end-diastolic pressure with 81.8% sensitivity and 80% specificity. Moreover, E/A and E/Em ratios were the only echocardiographic parameters independently associated with LV end-diastolic pressure in multiple linear regression analysis. Therefore, DE identifies rats with high LV end-diastolic pressure soon after MI. These findings have implications for using serial DE in animal selection and in the assessment of their response to experimental therapies.

  4. Association of Late Gadolinium Enhancement and Degree of Left Ventricular Hypertrophy Assessed on Cardiac Magnetic Resonance Imaging With Ventricular Tachycardia in Children With Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Spinner, Joseph A; Noel, Cory V; Denfield, Susan W; Krishnamurthy, Rajesh; Jeewa, Aamir; Dreyer, William J; Maskatia, Shiraz A

    2016-04-15

    There are limited data on the clinical significance of left ventricular (LV) mass and late gadolinium enhancement (LGE) in pediatric hypertrophic cardiomyopathy (HC). We reviewed cardiovascular magnetic resonance (CMR) studies of children with HC to investigate the associations between the extent and distribution of LGE and LV mass with ventricular tachycardia (VT) in children with HC. A blinded observer reviewed CMR studies for the presence and distribution of LV hypertrophy and LGE using a 17-segment model. The primary outcome was VT. LGE was present 17 of 33 subjects (52%). VT was present on outpatient Holter monitor or exercise stress test in 7 patients, of which 5 patients (71%) had LGE. Each additional segment of LGE was associated with an increase in the odds of VT (odds ratio [OR] 1.4, 95% CI 1.1 to 1.9) and fewer than 5 segments with LGE had 93% specificity for the presence or absence of VT (OR 0.06, 95% CI 0.01 to 0.5). VT was more common in patients with LGE in the apical septal (p = 0.03), basal inferoseptal (p <0.01), and basal inferior (p = 0.04) segments, whereas LGE in more commonly involved segments (midanteroseptal and midinferoseptal) was not associated with VT (p = 0.13, 0.26). Patients with VT had greater LV mass index (76.4 ± 40.4 g/m(2.7) vs 50.9 ± 24.3 g/m(2.7); p = 0.03). Each centimeter of increased maximum LV thickness was associated with increased likelihood of VT (OR 2.9, 95% CI 1.2 to 6.8). In conclusion, in pediatric HC, CMR to evaluate the extent and pattern of LGE, LV mass index, and maximum LV thickness may help to identify children with HC at risk of VT.

  5. Relationship between right and left ventricular function in candidates for implantable cardioverter defibrillator with low left ventricular ejection fraction.

    Science.gov (United States)

    Jimenez-Juan, Laura; Karur, Gauri R; Connelly, Kim A; Deva, Djeven; Yan, Raymond T; Wald, Rachel M; Singh, Sheldon; Leung, General; Oikonomou, Anastasia; Dorian, Paul; Angaran, Paul; Yan, Andrew T

    2017-04-01

    Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD. In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured. In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m(2) and 81±27 mL/m(2), respectively. Eighty-six (84%) patients had a LVEF right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF (r=0.40, pright ventricular systolic dysfunction (Kappa=0.041). Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa.

  6. Left ventricular rupture postmitral valve replacement: Surviving a catastrophe

    Directory of Open Access Journals (Sweden)

    Samarjit Bisoyi

    2015-01-01

    Full Text Available One of the dreaded mechanical complications of mitral valve replacement (MVR is rupture of the left ventricle (LV. This report describes the early diagnosis and successful repair of rupture of posterior wall of LV in an elderly patient who underwent MVR. We have discussed the risk factors and perioperative issues implicated in such complication. The anesthesiologist as an intra-operative echocardiographer can aid in identifying the patient at risk. Though important surgical steps are necessary to prevent the complication; nonetheless, the anesthesiologist needs to take key measures in the perioperative period.

  7. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    Science.gov (United States)

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  8. Effects of Injectable Anesthetic Combinations on Left Ventricular Function and Cardiac Morphology in Sprague–Dawley Rats

    OpenAIRE

    Sabatini, Carla F; O'Sullivan, M. Lynne; Valcour, James E.; Sears, William; Johnson, Ron J

    2013-01-01

    Novel anesthetic agents or combinations may provide superior general anesthesia for echocardiography in rodents with the potential for reduced adverse effects. This study sought to characterize the effects of 3 injectable anesthetics on left ventricular (LV) systolic function and cardiac morphology in healthy male and female rats. Rats underwent echocardiographic assessment after general anesthesia via pentobarbital or combinations of ketamine and medetomidine (KME) and ketamine and midazolam...

  9. Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, You-Zhou [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Qiao, Shu-Bin, E-mail: qsbfw@sina.com [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Hu, Feng-Huan; Yuan, Jian-Song; Yang, Wei-Xian; Cui, Jin-Gang [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Zhang, Yan [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Zhang, Chang-Lin [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China)

    2015-08-15

    Highlights: • There are significant differences in LV remodeling and fibrosis as divided by sex. • Women have worse diastolic dysfunction compared to men measured by CMR. • LV remodeling and fibrosis correlate with markers of diastolic dysfunction. - Abstract: Objectives: We investigated sex differences in left ventricular (LV) remodeling and fibrosis and their relationship with LV diastolic dysfunction by cardiovascular magnetic resonance (CMR). Methods: CMR imaging was performed simultaneously in 152 age-matched patients (76 men, 76 women; mean age: 49 ± 9 years) without LV systolic dysfunction. LV remodeling index (LVRI) was calculated as the ratio of LV mass and end-diastolic volume. Diastolic function indexes including peak filling rate (PFR) and time to PFR (tPFR) were evaluated. Extent of late gadolinium enhancement (LGE) was measured. Results: LVRI and extent of LGE were greater in women compared with men (1.48 ± 0.22 vs. 1.36 ± 0.28 g/ml; 13.15 ± 2.48 vs. 11.35 ± 2.34 g, respectively, both P < 0.001). Women had lower PFR and higher tPFR (both P < 0.001) than men. LVRI and the extent of LGE showed significant relationships with parameters of diastolic function in both sex. In a multivariate analysis, LVRI remained a strong independent predictor of PFR and TPFR in women (β = −0.272, P = 0.032; β = 0.348, P = 0.016, respectively), and in men (β = −0.374, P < 0.001; β = 0.660, P < 0.001, respectively). Furthermore, the extent of LGE also remained an independent predictor of PFR in women (β = −0.283, P = 0.033) and men (β = −0.492, P < 0.001). Conclusions: There are prominent sex differences in LV remodeling and myocardial fibrosis. We suggest that the effects of LV remodeling and fibrosis may lead to diastolic dysfunction with greater susceptibility to worse clinical outcome in women.

  10. Assessment of left ventricular torsion in patients with anterior wall myocardial infarction before and after revascularization using speckle tracking imaging

    Institute of Scientific and Technical Information of China (English)

    HAN Wei; XIE Ming-xing; WANG Xin-fang; L(U) Qing; WANG Jing; ZHANG li; ZHANG Jing

    2008-01-01

    Background Rotation of the left ventricular(LV)apex to the base,or LV torsion,is related to myocardial contractility and structure and has recently been recognized as a sensitive indicator of cardiac performance,but it has been difficult to measure.The recent development of 2-dimensional(2D)speckle tracking imaging(STI)may provide a powerful means of assessing LV torsion.This study was conducted to evaluate the global and regional LV twist in patients with anterior wall myocardial infarction(AMI)disease before and after revascularization by STI.Methods 2D STI was performed in 35 AMI patients before and one month after revascularization,as well as in 32 normal controls.Left ventricular global and regional rotations were obtained at basal and apical short-axis levels;LV torsion was defined as apical rotation relative to the base.The time sequences were normalized to the percentage of systolic and diastolic duration.Results Before revascularization,LV peak regional and global torsion in patients with Aml were significantly reduced as the result of reduced apical and basal rotation relative to those of normal control group(all P<0.001):most significantly in the anterior and anterior-septal regions(P<0.001);one month after revascularization,there were significant changes in peak rotation at either the base or apex relative to pre-revascularization values(all P<0.001).Similarly,peak regional and global LV torsion were increased significantly(all P<0.001).Global torsion inversely correlated with EDV(r=0.605,P=0.028)and ESV(r=-0.638,P=-0.019):and positively correlated with LVEF(r=0.630,P=0.021).tlght relations were also found between torsion and.LV longitudinal and short axis function.Conclusions Systolic torsion was decreased in AMI patients.Revascularization therapy can improve the LV function of the AMI patients.STI has a potential to quantify left ventricular global and segment torsion in patients with AMI,and may make the assessment more available in clinical and

  11. Rhythm changes and the function of the left ventricle: analysis of effects on the left ventricular ejection fraction

    Directory of Open Access Journals (Sweden)

    Ferati Fatmir

    2013-03-01

    Full Text Available The purpose of the case report is the analysis of the effects of rhythm changes on ejection fraction (EF of the left ventricle (LV, which can be determined by transthoracal echocardiography. For this purpose, we have analyzed five patients with different rhythm changes. From three of them the conversion was spontaneous, one patient was converted with DC shock of ICD, and the other patient was converted medicamentosly.While analyzing the hemodynamic changes of the heart rhythm, one can see the need and the urgency for converting some of these changes — based on the effects that rhythm changes have in the hemodynamic function of the heart. According to the data, some of hemodynamic changes of the LV are almost minimal, like in the paroxysmal supraventicular tachycardia (PSVT, while the changes are enhanced in the atrial fibrillation (AF with an uncontrolled ventricular rhythm, and especially in the ventricular tachycardia (VT. This indicates the need for a fast conversion of the rhythm in VT and with a DC shock when required. Also in the cases of AF, in cases of inability of conversion of the rhythm in a sinus rhythm, control of the heart rate gives an important hemodynamic effect that can be seen from echocardiographic parameters

  12. Increased left ventricular ejection fraction after a meal: potential source of error in performance of radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.M.; White, C.J.; Sobol, S.M.; Lull, R.J.

    1983-06-01

    The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function.

  13. The effect of exercise training on left ventricular relaxation and diastolic suction at rest and during orthostatic stress after bed rest.

    Science.gov (United States)

    Carrick-Ranson, Graeme; Hastings, Jeffrey L; Bhella, Paul S; Shibata, Shigeki; Levine, Benjamin D

    2013-02-01

    A marked reduction in upright stroke volume (SV) contributes substantially to orthostatic intolerance after exposure to spaceflight or bed rest. It is unclear whether slowed left ventricular (LV) relaxation and diastolic suction contribute to the reduction in SV or whether these changes are influenced by exercise training while in bed. Twenty-seven healthy adults completed 5 weeks of -6 deg head-down bed rest (HDBR). During HDBR, nine subjects were sedentary (NOEX), while 18 performed near-daily rowing ergometry (EX). Left ventricular mass, SV, LV end-diastolic volume (LVEDV), pulmonary capillary wedge pressure and Doppler ultrasound indices of LV function were collected pre- and post-HDBR during supine rest (twice) and during reduced LV loading (lower body negative pressure; LBNP) and increased LV loading (saline infusion). Post-HDBR, LV mass increased in the EX group, but decreased in the NOEX group. The reduction in SV and LVEDV during supine rest and LBNP were greater with NOEX in comparison to EX after HDBR. Peak early mitral annular velocity, isovolumic relaxation time, early propagation velocity, a non-invasive index of early diastolic filling and ventricular diastolic suction, and peak global longitudinal early strain rate were slowed during supine rest after HDBR with NOEX; however, these variables were either unaltered or the reduction was less prominent with EX. Doppler ultrasound measures of early diastolic filling, ventricular relaxation and diastolic suction were not significantly affected during LV unloading by LBNP after HDBR in either group. All Doppler indices were restored to pre-HDBR levels in both groups during saline infusion to normalize LV filling pressure after HDBR. It is concluded that Doppler indices of dynamic LV filling were reduced in both groups after HDBR; however, these effects were more pronounced in the NOEX group. Irrespective of group, post-HDBR Doppler parameters were restored when LV filling pressure was increased to pre

  14. Recovery of right and left ventricular function after acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Klok, F.A., E-mail: f.a.klok@lumc.nl [Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden (Netherlands); Romeih, S. [Department of Cardiology, Leiden University Medical Center, Leiden (Netherlands); Kroft, L.J.M.; Westenberg, J.J.M. [Department of Radiology, Leiden University Medical Center, Leiden (Netherlands); Huisman, M.V. [Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden (Netherlands); Roos, A. de [Department of Radiology, Leiden University Medical Center, Leiden (Netherlands)

    2011-12-15

    Aim: To evaluate recovery of cardiac function after acute pulmonary embolism (PE). Materials and methods: Routine breath-held computed tomography (CT)-pulmonary angiography was performed in patients with suspected PE to confirm or exclude the diagnosis of PE at initial presentation. Electrocardiogram (ECG)-triggered cardiac CT was performed to assess biventricular function. After 6 months, cardiac magnetic resonance imaging (MRI) was performed. In total, 15 consecutive patients with PE and 10 without were studied. A significant change in ventricular volume was defined as a >15% change in end-diastolic or -systolic volumes (EDV, ESV), and significant ventricular function improvement as a >5% increase in ejection fraction (EF) as based on reported cut-off values. Results: Right and left ventricular (RV and LV) EDV and ESV changed non-significantly (<1.3%) in the patients without PE, indicating good comparability of those values measured by CT and MRI. PE patients with baseline normal RV function (RVEF {>=}47%) revealed a >5% improvement in the RVEF (+5.4 {+-} 3.1%) due to a decrease in the RVESV. Patients with baseline abnormal RV function showed a >5% improvement in the RVEF (+14 {+-} 15%) due to decreases in both the RVESV and RVEDV. Furthermore, the LVEDV increased in this latter patient group. Conclusions: The present study demonstrated an improvement in RV function in the majority of patients with PE, independent of baseline RV function. The degree of RV and LV recovery was dependent on the severity of baseline RV dysfunction.

  15. THE EFFECT OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ON THE PATHOGENESIS OF ANGINA DECUBITUS

    Institute of Scientific and Technical Information of China (English)

    陈纪林; 高润霖; 姚康宝; 杨跃进; 秦学文; 乔树宾; 姚民

    2000-01-01

    Objective. To investigate the effect of left veraricular diastolic dysfunction on the pathogenesis of angina decubitus (AD).Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ . Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF) > 50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease.Results. Left ventricnlography (LVG) showed that left ventricnlar (LV) first 1/3 filling fraction (1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ (both P <0.001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ (P < 0.05, P < 0.01). Left ventricular end-diastohc presstrre(LVEDP) was markedly inereased before and after LVGin group Ⅱ and Ⅲ as compared with group Ⅰ (beth P<0.05, beth P<0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD) before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P < 0.01, P < 0.001). Howevere, there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P < 0.01).Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogen-esis of angina decubitus.

  16. Takotsubo Cardiomyopathy With a Rapidly Resolved Left Ventricular Thrombus

    Science.gov (United States)

    Anabtawi, Abdel; Roldan, Paola C.; Roldan, Carlos A.

    2017-01-01

    This article presents the case of a 53-year-old man who presented with acute right superficial femoral and popliteal arterial thrombosis for which he underwent an emergent uncomplicated thrombectomy. He denied preceding cardiovascular or neurologic symptomatology and had no history of coronary or peripheral arterial disease, trauma, hypercoagulability, or malignancy. However, he reported having several days of intense emotional stress prior to presentation. His cardiac exam was normal, his electrocardiogram showed normal sinus rhythm and nonspecific ST-T wave abnormalities, and his troponin levels were normal. Transthoracic echocardiography (TTE) revealed a large (2.4 × 2 cm) apical left ventricle (LV) thrombus, LV apical akinesis, and LV ejection fraction of 40% to 45%. Coronary angiography revealed only luminal irregularities. A repeat TTE performed 3 days after initiating unfractionated heparin revealed complete resolution of the LV thrombus. The patient had an uneventful clinical course and was discharged home in stable condition on oral anticoagulants. The lower incidence of LV thrombus in takotsubo cardiomyopathy (TC) of 1.3% in comparison to 4% to 8% in acute myocardial infarction due to coronary artery disease in the current era of early reperfusion may be explained by the lower extent of ischemic myocardial necrosis associated with TC. This case suggests that the lower extent of myocardial necrosis in TC may also lead to faster resolution of LV thrombus. Therefore, earlier follow-up with TTE (within 2 weeks) and shorter duration of anticoagulation (<3 months) may be considered in patients with TC complicated by LV thrombus formation with or without systemic embolism.

  17. Different predictors of right and left ventricular metabolism in healthy middle-aged men

    Directory of Open Access Journals (Sweden)

    Marja eHeiskanen

    2015-12-01

    Full Text Available Dysfunction of the right ventricle (RV plays a crucial role in the outcome of various cardiovascular diseases. Previous studies on RV metabolism are sparse although evidence implies it may differ from left ventricular (LV metabolism. Therefore, the aims of this study were 1 to determine predictors of RV glucose uptake (GU and free fatty acid uptake (FFAU and 2 to compare them to predictors of LV metabolism in healthy middle-aged men. Altogether 28 healthy, sedentary, middle-aged (40-55 years men were studied. Insulin-stimulated GU and fasting FFAU were measured by positron emission tomography and RV and LV structural and functional parameters by cardiac magnetic resonance. Several parameters related to whole-body health were also measured. Predictors of RV and LV metabolism were determined by pairwise correlation analysis, lasso regression models, and variable clustering using heatmap. RVGU was most strongly predicted by age and moderately by RV ejection fraction (EF. The strongest determinants of RVFFAU were exercise capacity (peak oxygen uptake, resting heart rate, LVEF, and whole-body insulin-stimulated glucose uptake rate. When considering LV metabolism, age and RVEF were associated also with LVGU. In addition, LVGU was strongly, and negatively, influenced by whole-body insulin-stimulated glucose uptake rate. LVFFAU was predicted only by LVEF. This study shows that while RV and LV metabolism have shared characteristics, they also have unique properties. Age of the subject should be taken into account when measuring myocardial glucose utilization. Ejection fraction is related to myocardial metabolism, and even so that RVEF may be more closely related to GU of both ventricles and LVEF to FFAU of both ventricles, a finding supporting the ventricular interdependence. However, only RV fatty acid utilization associates with exercise capacity so that better physical fitness in a relatively sedentary population is related with decreased RV fat

  18. Different Predictors of Right and Left Ventricular Metabolism in Healthy Middle-Aged Men.

    Science.gov (United States)

    Heiskanen, Marja A; Leskinen, Tuija; Eskelinen, Jari-Joonas; Heinonen, Ilkka H A; Löyttyniemi, Eliisa; Virtanen, Kirsi; Pärkkä, Jussi P; Hannukainen, Jarna C; Kalliokoski, Kari K

    2015-01-01

    Dysfunction of the right ventricle (RV) plays a crucial role in the outcome of various cardiovascular diseases. Previous studies on RV metabolism are sparse although evidence implies it may differ from left ventricular (LV) metabolism. Therefore, the aims of this study were (1) to determine predictors of RV glucose uptake (GU) and free fatty acid uptake (FFAU) and (2) to compare them to predictors of LV metabolism in healthy middle-aged men. Altogether 28 healthy, sedentary, middle-aged (40-55 years) men were studied. Insulin-stimulated GU and fasting FFAU were measured by positron emission tomography and RV and LV structural and functional parameters by cardiac magnetic resonance. Several parameters related to whole-body health were also measured. Predictors of RV and LV metabolism were determined by pairwise correlation analysis, lasso regression models, and variable clustering using heatmap. RVGU was most strongly predicted by age and moderately by RV ejection fraction (EF). The strongest determinants of RVFFAU were exercise capacity (peak oxygen uptake), resting heart rate, LVEF, and whole-body insulin-stimulated glucose uptake rate. When considering LV metabolism, age and RVEF were associated also with LVGU. In addition, LVGU was strongly, and negatively, influenced by whole-body insulin-stimulated glucose uptake rate. LVFFAU was predicted only by LVEF. This study shows that while RV and LV metabolism have shared characteristics, they also have unique properties. Age of the subject should be taken into account when measuring myocardial glucose utilization. Ejection fraction is related to myocardial metabolism, and even so that RVEF may be more closely related to GU of both ventricles and LVEF to FFAU of both ventricles, a finding supporting the ventricular interdependence. However, only RV fatty acid utilization associates with exercise capacity so that better physical fitness in a relatively sedentary population is related with decreased RV fat metabolism. To

  19. Left ventricular thrombus in patients with acute myocardial infarction: Case report and Caribbean focused update

    Directory of Open Access Journals (Sweden)

    CR Potu

    2012-03-01

    Full Text Available Despite the well documented benefit of echocardiography in acute coronary syndromes, its wide-scale use in the Caribbean is limited by access, health literacy and affordability. Because of the limited use of echocardiography in the region, routine complications of acute myocardial infarction (AMI are not fully appreciated and may go unrecognized, further contributing to increased cardiovascular morbidity and mortality. It is therefore necessary to bring focus to this common clinical condition and highlight the clinical utility of echocardiography in facilitating timely and accurate diagnosis. We report here a case of large left ventricular (LV thrombus in a patient with AMI. Coronary angiography showed completely occluded left anterior descending artery (LAD with angiographically normal remaining vessels. Immediate anticoagulation was commenced with heparin and overlapped with warfarin. No Primary Angioplasty (PA was done based on the evidence from occluded artery trial. LV thrombus was completely resolved on echocardiography at three months. No evidence of thrombo-embolism was found during the resolution of LV thrombus.

  20. Left ventricular thrombus in patients with acute myocardial infarction:Case report and Caribbean focused update.

    Science.gov (United States)

    Potu, Cr; Tulloch-Reid, Ee; Baugh, Ds; Madu, Ec

    2012-01-01

    Despite the well documented benefit of echocardiography in acute coronary syndromes, its wide-scale use in the Caribbean is limited by access, health literacy and affordability. Because of the limited use of echocardiography in the region, routine complications of acute myocardial infarction (AMI) are not fully appreciated and may go unrecognized, further contributing to increased cardiovascular morbidity and mortality. It is therefore necessary to bring focus to this common clinical condition and highlight the clinical utility of echocardiography in facilitating timely and accurate diagnosis. We report here a case of large left ventricular (LV) thrombus in a patient with AMI. Coronary angiography showed completely occluded left anterior descending artery (LAD) with angiographically normal remaining vessels. Immediate anticoagulation was commenced with heparin and overlapped with warfarin. No Primary Angioplasty (PA) was done based on the evidence from occluded artery trial. LV thrombus was completely resolved on echocardiography at three months. No evidence of thrombo-embolism was found during the resolution of LV thrombus.

  1. Acute transient coronary sinus hypertension impairs left ventricular function and induces myocardial edema.

    Science.gov (United States)

    Pratt, J W; Schertel, E R; Schaefer, S L; Esham, K E; McClure, D E; Heck, C F; Myerowitz, P D

    1996-09-01

    This study was performed to evaluate the direct and indirect effects of acute coronary sinus hypertension (CSH) on systolic and diastolic left ventricular (LV) function. Coronary sinus pressure was elevated to 25 mmHg for 3 h in eight pentobarbital-anesthetized dogs and then relieved. LV contractility was assessed by preload recruitable stroke work (PRSW) and end-systolic elastance (Ees). Diastolic function was assessed by the time constant of isovolumic relaxation (tau) and the end-diastolic pressure volume relationship (EDPVR). PRSW and Ees decreased progressively, and tau and the slope of the EDPVR increased progressively with CSH. These changes persisted after relief of CSH. beta-Adrenergic and cholinergic receptor blockade, performed in six dogs, did not alter the effects of CSH on systolic or diastolic function. The LV wet-to-dry weight ratios of the groups with CSH were significantly greater than those of a control group without CSH. We conclude that CSH results in changes in the left ventricle that depress contractility, prolong active relaxation, and increase diastolic stiffness. The dysfunction was not the direct effect of CSH or autonomic reflex activation, but may have been induced by fluid accumulation within the interstitium.

  2. Effect of intra-abdominal hypertension on left ventricular relaxation: a preliminary animal study.

    Science.gov (United States)

    Mahjoub, Y; Lorne, E; Maizel, J; Plantefève, G; Massy, Z A; Dupont, H; Slama, M

    2012-02-01

    In the intensive care unit, intra-abdominal hypertension (IAH) is a frequently encountered, life-threatening condition. The aim of this animal study was to evaluate the effect of IAH on left ventricular (LV) relaxation (i.e. the active phase of diastole). Seven male rabbits were anaesthetized before mechanical ventilation. A 20 mm Hg increase in intra-abdominal pressure (IAP) was then induced by intraperitoneal infusion of 1.5% glycine solution. Haemodynamic parameters were recorded and the relaxation time constant tau (considered to be the best index of left ventricle relaxation) was calculated. All haemodynamic measurements were recorded at baseline and then after induction of IAH. A 20 mm Hg increase in IAP was not followed by a significant change in arterial pressure, but was associated with increases in central venous pressure (from 2 [-2 to 6] to 7 [-2 to 12] mm Hg, P= 0.03), LV end-diastolic pressure (from 7 [6-8] to 15 [11-19] mm Hg, P= 0.04) and the relaxation time constant tau (from 16 [14-18] to 43 [34-52] ms, P= 0.048). In this animal study, a 20 mm Hg increase in IAP impaired LV relaxation. Further studies are necessary to identify the causes of this impairment.

  3. Genome-wide association study identifies single-nucleotide polymorphism in KCNB1 associated with left ventricular mass in humans: The HyperGEN Study

    Directory of Open Access Journals (Sweden)

    Kraemer Rachel

    2009-05-01

    Full Text Available Abstract Background We conducted a genome-wide association study (GWAS and validation study for left ventricular (LV mass in the Family Blood Pressure Program – HyperGEN population. LV mass is a sensitive predictor of cardiovascular mortality and morbidity in all genders, races, and ages. Polymorphisms of candidate genes in diverse pathways have been associated with LV mass. However, subsequent studies have often failed to replicate these associations. Genome-wide association studies have unprecedented power to identify potential genes with modest effects on left LV mass. We describe here a GWAS for LV mass in Caucasians using the Affymetrix GeneChip Human Mapping 100 k Set. Cases (N = 101 and controls (N = 101 were selected from extreme tails of the LV mass index distribution from 906 individuals in the HyperGEN study. Eleven of 12 promising (Q Results Despite the relatively small sample, we identified 12 promising SNPs in the GWAS. Eleven SNPs were successfully genotyped in the validation study of 704 Caucasians and 1467 African Americans; 5 SNPs on chromosomes 5, 12, and 20 were significantly (P ≤ 0.05 associated with LV mass after correction for multiple testing. One SNP (rs756529 is intragenic within KCNB1, which is dephosphorylated by calcineurin, a previously reported candidate gene for LV hypertrophy within this population. Conclusion These findings suggest KCNB1 may be involved in the development of LV hypertrophy in humans.

  4. [Malnutrition in dilated cardiomyopathy. Correlation with echocardiographic indices of left ventricular function].

    Science.gov (United States)

    Velloso, L G; Csengeri, L F; Alonso, R R; Ciscato, C M; Barreto, A C; Bellotti, G; Pileggi, F

    1992-03-01

    To evaluate the incidence of severe protein-calorie malnutrition in patients with dilated cardiomyopathy (DC), and its correlation with left ventricular contractility. Group A--51 patients with DC in decompensated congestive heart failure class III or IV, 36 men, aged 51.9 +/- 15.6 years. Group B--25 patients admitted for elective myocardial revascularization with normal LV contractility, 20 men, aged 57.2 +/- 10.5 years. Tricipital skinfold thickness (TS) and mid-arm muscle circumference (MAMC) were obtained in all patients. Severe protein-calorie malnutrition was defined when both measurements were below the fifth populational percentile (Frisancho tables). In Group Am the echocardiographic left ventricular (LV) diastolic diameter (DD), ejection fraction (EF) and systolic volume (SV) were obtained. Those LV parameters were compared between DC patients with and without severe malnutrition. Correlation analysis were performed between TS, MAMC and LV DD, EF, and SV, in the patients of Group A. Severe malnutrition occurred in 7/51 (13.7%) of Group A, and none in Group B. TS values were of 8.90 +/- 4.47 cm in Gr. A and 23.48 +/- 8.52 in B (p < 0.001). MAMC measured 22.25 +/- 3.13 cm in Gr. A and 23.58 +/- 8.52 in B (p = 0.03), LVEF was of 36.29 +/- 9.43% in severe malnutrition patients and of 37.84 +/- 9.78 in the other patients of Group A (p = 0.70). Conversely, LVDD was of 70.90 +/- 11.3 mm vs. 70.75 +/- 8.54 mm (p = 0.98), and LVSV was of 113.0 +/- 52.7 ml vs. 137.6 +/- 56.8 (p = 0.45), when compared severe malnutrition with the rest of patients of Group A. No correlation was found between TS and MAMC and LV, EF, DD and SV in Group A. Severe malnutrition was frequent in patients with DC and heart failure. TS measurements, reflecting caloric reserves, were more affected. Echocardiographic parameters of LV function did not correlate with nutritional status.

  5. Pregnancy and treatment outcome in a patient with left ventricular non-compaction.

    Science.gov (United States)

    Sawant, Rahul D; Freeman, Leisa J; Stanley, Katherine P S; McKelvey, Alistair

    2013-05-01

    Left ventricular non-compaction (LVNC) is a rare form of cardiomyopathy. This case reviews a woman with familial LVNC (EF 45%, NYHA class I, evidence of non-sustained ventricular tachycardia pre-pregnancy) who had significant decompensation with heart failure in the third trimester that required early delivery. Deterioration in symptoms and LV function 7 days after delivery required further hospitalization and aggressive treatment. Suppression of lactation with bromocriptine, together with standard heart failure management, has allowed recovery and return to full activities and work. Acknowledged adverse risk factors in LVNC are considered, and pre-pregnancy risk assessment is reviewed. There is no specific treatment for LVNC in pregnancy besides the usual management of dilated cardiomyopathy. This is the ninth case report of LVNC in pregnancy reported in the literature.

  6. Value of left ventricular regional ejection fraction determined by real-time three-dimensional echocardiography in diagnosis of aneurysm: compared with left ventriculography

    Institute of Scientific and Technical Information of China (English)

    LI Xiu-chang; YAN Cheng-jun; YAO Gui-hua; ZHANG Mei; LI Ji-fu; ZHANG Yun

    2009-01-01

    Background Regional ejection fraction (EF_R) measured by real-time three-dimensional echocardiography (RT-3DE)provides a novel method for quantifying left-ventricular (LV) regional systolic function. We aimed to explore the diagnostic value of regional ejection fraction (EFR) derived from RT-3DE in detecting LV aneurysms in patients with myocardial infarction. Methods Thirty-eight patients with myocardial infarction were prospectively enrolled and underwent electrocardiography (ECG), two-dimensional echocardiography (2-DE), RT-3DE and left ventriculography (LVG).Subjects with a negative EFR in at least one segment on RT-3DE were considered as having a ventricular aneurysm. We compared the sensitivity, specificity, Youden's index, and positive and negative predictive values of ECG, 2-DE and RT-3DE in determining LV aneurysm with detection by LVG.Results On LVG an LV aneurysm was diagnosed in 16 (42.1%) patients. The sensitivity and specificity were 62.5% and 86.4% for ECG, 81.2% and 95.4% for 2-DE, and 100.0% and 90.9% for RT-3DE in diagnosing LV aneurysm. Youden's indexes for ECG, 2-DE and RT-3DE were 0.49, 0.77 and 0.91, respectively. Positive and negative predictive values were 76.9% and 76.0% for ECG, 92.9% and 87.5% for 2-DE, and 88.9% and 100.0% for RT-3DE. Conclusions RT-3DE-derived EFR provides a novel, reliable index in the diagnosis of LV aneurysm and has excellent sensitivity and specificity.

  7. Left ventricular filling pressure estimation at rest and during exercise in patients with severe aortic valve stenosis: comparison of echocardiographic and invasive measurements

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Kjaergaard, Jesper; Pecini, Redi;

    2009-01-01

    BACKGROUND: The Doppler index of left ventricular (LV) filling (E/e') is recognized as a noninvasive measure for LV filling pressure at rest but has also been suggested as a reliable measure of exercise-induced changes. The aim of this study was to investigate changes in LV filling pressure......, measured invasively as pulmonary capillary wedge pressure (PCWP), at rest and during exercise to describe the relation with E/e' in patients with severe aortic stenosis. METHODS: Twenty-eight patients with an aortic valve areas

  8. Evaluation of the effects of transvenous pacing site on left ventricular function and synchrony in healthy anesthetized dogs.

    Science.gov (United States)

    Maisenbacher, Herbert W; Estrada, Amara H; Prosek, Robert; Shih, Andre C; Vangilder, James M

    2009-04-01

    OBJECTIVE-To compare the acute effects of cardiac pacing from various transvenous pacing sites on left ventricular (LV) function and synchrony in clinically normal dogs. ANIMALS-10 healthy adult mixed-breed dogs. PROCEDURES-Dogs were anesthetized, and dual-chamber transvenous biventricular pacing systems were implanted. Dogs were paced in single-chamber mode from the right atrial appendage (RAA) alone and in dual-chamber mode from the right ventricular apex (RVA), from the left ventricular free wall (LVFW), and simultaneously from the RVA and LVFW (BiV). Standard ECG and echocardiographic measurements, cardiac output measured with the lithium dilution method (LiDCO), and tissue Doppler-derived measurements of LV synchrony were obtained during each of the pacing configurations. RESULTS-Placement of the biventricular pacing systems was possible in 8 of the 10 dogs. The QRS duration was significantly different among all pacing sites, and the order of increasing duration was RAA, BiV, LVFW, and RVA. Pacing sites did not differ with respect to fractional shortening; however, pacing from the RVA resulted in a significantly lower ejection fraction than pacing from all other sites. During RVA and LVFW pacing, LiDCO was significantly lower than that at other sites; there was no significant difference between RAA and BiV pacing with respect to LiDCO. Although the degree of dyssynchrony was significantly lower during pacing from the RAA versus other ventricular pacing sites, it was not significantly different among sites. CONCLUSIONS AND CLINICAL RELEVANCE-Ventricular activation by RAA pacing provided the best LV function and synchrony. Pacing from the RVA worsened LV function, and although pacing from the LVFW improved it, BiV pacing may provide additional improvement.

  9. Pressure-overload hypertrophy of the developing heart reveals activation of divergent gene and protein pathways in the left and right ventricular myocardium.

    Science.gov (United States)

    Friehs, Ingeborg; Cowan, Douglas B; Choi, Yeong-Hoon; Black, Kendra M; Barnett, Reanne; Bhasin, Manoj K; Daly, Christian; Dillon, Simon J; Libermann, Towia A; McGowan, Francis X; del Nido, Pedro J; Levitsky, Sidney; McCully, James D

    2013-03-01

    Right ventricular (RV) and left ventricular (LV) myocardium differ in their pathophysiological response to pressure-overload hypertrophy. In this report we use microarray and proteomic analyses to identify pathways modulated by LV-aortic banding (AOB) and RV-pulmonary artery banding (PAB) in the immature heart. Newborn New Zealand White rabbits underwent banding of the descending thoracic aorta [LV-AOB; n = 6]. RV-PAB was achieved by banding the pulmonary artery (n = 6). Controls (n = 6 each) were sham-manipulated. After 4 (LV-AOB) and 6 (RV-PAB) wk recovery, the hearts were removed and matched RNA and proteins samples were isolated for microarray and proteomic analysis. Microarray and proteomic data demonstrate that in LV-AOB there is increased transcript expression levels for oxidative phosphorylation, mitochondria energy pathways, actin, ILK, hypoxia, calcium, and protein kinase-A signaling and increased protein expression levels of proteins for cellular macromolecular complex assembly and oxidative phosphorylation. In RV-PAB there is also an increased transcript expression levels for cardiac oxidative phosphorylation but increased protein expression levels for structural constituents of muscle, cardiac muscle tissue development, and calcium handling. These results identify divergent transcript and protein expression profiles in LV-AOB and RV-PAB and provide new insight into the biological basis of ventricular specific hypertrophy. The identification of these pathways should allow for the development of specific therapeutic interventions for targeted treatment and amelioration of LV-AOB and RV-PAB to ameliorate morbidity and mortality.

  10. Left ventricular dyssynchrony assessed by two three-dimensional imaging modalities: phase analysis of gated myocardial perfusion SPECT and tri-plane tissue Doppler imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ajmone Marsan, Nina [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, ZA, Leiden (Netherlands); Policlinico S. Matteo, Department of Cardiology, Pavia (Italy); Henneman, Maureen M.; Ypenburg, Claudia; Bleeker, Gabe B.; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, ZA, Leiden (Netherlands); Chen, Ji; Garcia, Ernest V. [Emory University School of Medicine, Department of Radiology, Atlanta, Georgia (United States); Dibbets, Petra; Stokkel, Marcel P. [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands); Ghio, Stefano; Tavazzi, Luigi [Policlinico S. Matteo, Department of Cardiology, Pavia (Italy); Wall, Ernst E. van der [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, ZA, Leiden (Netherlands); The Interuniversity Cardiology Institute of the Netherlands, Utrecht (Netherlands)

    2008-01-15

    To compare left ventricular (LV) dyssynchrony assessment by phase analysis from gated myocardial perfusion SPECT (GMPS) with LV dyssynchrony assessment by tri-plane tissue Doppler imaging (TDI). Baseline LV dyssynchrony assessed with standard deviation (SD) of time-to-peak systolic velocity of 12 LV segments (Ts-SD) with TDI has proven to be a powerful predictor of response to CRT. Information on LV dyssynchrony can also be provided by GMPS with phase analysis of regional LV maximal count changes throughout the cardiac cycle. Forty heart failure patients, referred for evaluation of potential eligibility for CRT, underwent both 3D echocardiography, with tri-plane TDI, and resting GMPS. From tri-plane TDI, Ts-SD was used as a validated parameter of LV dyssynchrony and compared with different indices (histogram bandwidth, phase SD, histogram skewness and kurtosis) derived from phase analysis of GMPS. Histogram bandwidth and phase SD showed good correlation with Ts-SD (r=0.77 and r=0.74, p<0.0001, respectively). Patients with substantial LV dyssynchrony assessed with tri-plane TDI (Ts-SD {>=}33 ms) had also significantly higher values of histogram bandwidth and phase SD. The results of this study support the use of phase analysis by GMPS to evaluate LV dyssynchrony. Histogram bandwidth and phase SD showed the best correlation with Ts-SD assessed with tri-plane TDI and appeared the most optimal variables for assessment of LV dyssynchrony with GMPS. (orig.)

  11. Concentric left ventricular morphology in aerobically trained kayak canoeists.

    Science.gov (United States)

    Gates, Phillip E; Campbell, Ian G; George, Keith P

    2004-09-01

    The aim of the present study was to test the hypothesis that upper body aerobically trained athletes (kayak canoeists) would have greater left ventricular wall thickness, but similar left ventricular diastolic chamber dimensions, compared with recreationally active and sedentary men. Ultrasound echocardiography was used to determine cardiac structure and function in highly trained kayak canoeists (n = 10), moderately active (n = 10) and sedentary men (n = 10). The septal and posterior left ventricular walls were approximately 0.2 cm thicker in kayak canoeists (P kayak canoeists had a concentric pattern of left ventricular adaptation to aerobic upper body training. Scaling the data to body composition indices had no effect on the outcome of the statistical analysis. There were no differences in resting Doppler left ventricular diastolic or systolic function among the groups. Ejection fraction was lower in the kayak canoeists, but the magnitude of the difference was within the normal variability for this measurement. Thus aerobically upper body trained athletes demonstrated a concentric pattern of cardiac enlargement, but resting left ventricle function was not different between athletes, moderately active and sedentary individuals.

  12. Assessment of the right and left ventricular function in patients with cor pulmonale using high-definition CT

    Institute of Scientific and Technical Information of China (English)

    GAO Yan; QIN Jian; DU Xiang-ying; YANG Jing; LI Kun-cheng

    2013-01-01

    Background Cor pulmonale is often associated with changes of structure and function of the right ventricle (RV) and thus further affects functional changes of the left heart.Our study aimed to assess the left ventricular (LV) and RV function in patients with cor pulmonale using high-definition CT (HDCT).Methods We prospectively studied 18 cor pulmonale patients determined by the pulmonary function test,clinical examination,chest radiograph,electrocardiogram,and echocardiogram.The subject group was compared to a control group consisting of 18 subjects.The RV and LV functions and RV myocardial mass (MM) were obtained by HDCT in the two groups.The results were compared between the two groups using the independent sample t test.Echocardiographic examination for cardiac function analysis was performed on the same day.Results The RV end-diastolic volume (EDV),RV end-systolic volume (ESV) and RV myocardial mass were significantly larger in the 18 cor pulmonale patients than in the control group (P<0.05).The right ventricular ejection fraction (RVEF) was significantly lower in the 18 cor pulmonale patients than in controls (P<0.01).The left ventricular EDV (LVEDV) and LVEF were significantly lower in cor pulmonale patients than in controls (P<0.01).There were strong correlations between MDCT and echocardiography,rRVEF=0.839 and rLVEF=0.916,respectively.Conclusions HDCT can accurately quantify RV and LV function.The right ventricular function is impaired in patients with cor pulmonale,while at the same time the left ventricular function is also impaired.

  13. Radionuclide assessment of left ventricular function following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Howe, W.R.; Jones, R.H.; Sabiston, D.C. Jr.

    1976-01-01

    Use of a high count-rate gamma scintillation camera permits the noninvasive assessment of left ventricular function by nuclear angiocardiography. Counts recorded from the region of the left ventricle at 50- or 100-msec intervals during the first transit of an intravenously administered bolus of radioisotope produce a high-fidelity indicator-dilution curve. Count fluctuations reflect left ventricular volume changes during the cardiac cycle and permit measurement of dv/dt, ejection fraction, mean transit time, and wall motion of this chamber. The present study evaluates (1) the accuracy of this technique compared to standard biplane cineangiography and (2) its usefulness in evaluating patients after cardiac surgery.

  14. Long-term changes in collagen formation expressed by serum carboxyterminal propeptide of type-I procollagen and relation to left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Høst, N B; Egstrup, K

    2001-01-01

    The purpose of this study was to investigate the long-term sequential changes in serum levels of the carboxyterminal propeptide of type-I procollagen (s-PICP), which is a marker of type-I collagen synthesis, and to assess its clinical value in relation to left ventricular (LV) function...

  15. Assessment of global left ventricular functional parameters : analysis of every second short-axis magnetic resonance imaging slices is as accurate as analysis of consecutive slices

    NARCIS (Netherlands)

    Lubbers, Daniel D.; Willems, Tineke P.; van der Vleuten, Pieter A.; Overbosch, Jelle; Goette, Marco J. W.; van Veldhuisen, Dirk J.; Oudkerk, Matthijs

    The purpose of this study was to assess whether accurate global left-ventricular (LV) functional parameters can be obtained by analyzing every second short-axis magnetic resonance imaging cine series instead of consecutive slices, in order to reduce post-processing time. Forty patients, were scanned

  16. Semi-automatic measurement of left ventricular function on dual source computed tomography using five different software tools in comparison with magnetic resonance imaging

    NARCIS (Netherlands)

    de Jonge, G. J.; van der Vleuten, P. A.; Overbosch, J.; Lubbers, D. D.; Jansen-van der Weide, M. C.; Zijlstra, F.; van Ooijen, P. M. A.; Oudkerk, M.

    2011-01-01

    Purpose: To compare left ventricular (LV) function assessment using five different software tools on the same dual source computed tomography (DSCT) datasets with the results of MRI. Materials and methods: Twenty-six patients, undergoing cardiac contrast-enhanced DSCT were included (20 men, mean age

  17. Left ventricular deformation at 2-year follow-up in treatment-naive rheumatoid arthritis patients is associated with high inflammation parameters

    DEFF Research Database (Denmark)

    Logstrup, B. B.; Masic, D.; Laurbjerg, T. B.;

    2015-01-01

    Introduction: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD). The role of autoimmunity and especially citrullination in the pathogenesis of the increased risk of CVD and the time-course of left ventricular (LV) dysfunction are unknown. Hypothesis: To...

  18. Comparison of (semi-)automatic and manually adjusted measurements of left ventricular function in dual source computed tomography using three different software tools

    NARCIS (Netherlands)

    de Jonge, G. J.; van Ooijen, P. M. A.; Overbosch, J.; Litcheva Gueorguieva, A.; Janssen-van der Weide, M. C.; Oudkerk, M.

    To assess the accuracy of (semi-)automatic measurements of left ventricular (LV) functional parameters in cardiac dual-source computed tomography (DSCT) compared to manually adjusted measurements in three different workstations. Forty patients, who underwent cardiac DSCT, were included (31 men, mean

  19. Semi-automatic measurement of left ventricular function on dual source computed tomography using five different software tools in comparison with magnetic resonance imaging

    NARCIS (Netherlands)

    de Jonge, G. J.; van der Vleuten, P. A.; Overbosch, J.; Lubbers, D. D.; Jansen-van der Weide, M. C.; Zijlstra, F.; van Ooijen, P. M. A.; Oudkerk, M.

    2011-01-01

    Purpose: To compare left ventricular (LV) function assessment using five different software tools on the same dual source computed tomography (DSCT) datasets with the results of MRI. Materials and methods: Twenty-six patients, undergoing cardiac contrast-enhanced DSCT were included (20 men, mean age

  20. DETRAINING-RELATED CHANGES IN LEFT VENTRICULAR WALL THICKNESS AND LONGITUDINAL STRAIN IN A YOUNG ATHLETE LIKELY TO HAVE HYPERTROPHIC CARDIOMYOPATHY

    Directory of Open Access Journals (Sweden)

    Cesare de Gregorio

    2012-09-01

    Full Text Available One of the diagnostic criteria in order to differentiate between physiological and pathological left ventricular hypertrophy is the wall thickness reduction after at least 3-month detraining period, which is considered a marker of the athlete's heart. This report describes detraining-related regression of LV hypertrophy and improvement in myocardial deformation in a junior athlete likely to have hypertrophic cardiomyopathy

  1. Prevalence and factors associated with left ventricular dysfunction in the EULAR Scleroderma Trial and Research group (EUSTAR) database of patients with systemic sclerosis.

    NARCIS (Netherlands)

    Allanore, Y.; Meune, C.; Vonk, M.C.; Airo, P.; Hachulla, E.; Caramaschi, P.; Riemekasten, G.; Cozzi, F.; Beretta, L.; Derk, C.T.; Komocsi, A.; Farge, D.; Balbir, A.; Riccieri, V.; Distler, O.; Chiala, A.; Papa, N.D.; Simic, K.P.; Ghio, M.; Stamenkovic, B.; Rednic, S.; Host, N.; Pellerito, R.; Zegers, E.; Kahan, A.; Walker, U.A.; Matucci-Cerinic, M.

    2010-01-01

    OBJECTIVES: To measure the prevalence of, and factors associated with, left ventricular (LV) dysfunction in systemic sclerosis (SSc). METHODS: The EUSTAR database was first searched. A case-control study of a patient subset was then performed to further identify independent factors associated with

  2. Assessment of global left ventricular functional parameters : analysis of every second short-axis magnetic resonance imaging slices is as accurate as analysis of consecutive slices

    NARCIS (Netherlands)

    Lubbers, Daniel D.; Willems, Tineke P.; van der Vleuten, Pieter A.; Overbosch, Jelle; Goette, Marco J. W.; van Veldhuisen, Dirk J.; Oudkerk, Matthijs

    2008-01-01

    The purpose of this study was to assess whether accurate global left-ventricular (LV) functional parameters can be obtained by analyzing every second short-axis magnetic resonance imaging cine series instead of consecutive slices, in order to reduce post-processing time. Forty patients, were scanned

  3. Radiofrequency ablation therapy of intractable ventricular tachycardia present with a left ventricular assist device

    DEFF Research Database (Denmark)

    Nielsen, Jan Møller; Kristiansen, Steen Buus; Gerdes, Christian;

    2015-01-01

    Ventricular tachycardia (VT) occurs in up to 59% of patients with left ventricular assist devices (LVAD). In some of these patients, the VT cannot be managed medically or by implantable cardioverter-defibrillator. In this case, a 66-year-old male was successfully treated with radiofrequency...

  4. Right ventricular failure after implantation of a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Cordtz, Johan Joakim; Nilsson, Jens C; Hansen, Peter B;

    2014-01-01

    Right ventricular failure (RVF) is a significant complication after implantation of a left ventricular assist device. We aimed to identify haemodynamic changes in the early postoperative phase that predicted subsequent development of RVF in a cohort of HeartMate II (HMII) implanted patients....

  5. Giant left ventricular fibroma presenting as ventricular tachycardia in a child.

    Science.gov (United States)

    Khan, Muhammad Arif; Saeedi, Abdul Raoof Al; Tayeab, Hyfeah Al; Momenah, Tarek

    2014-06-01

    We present a rare case of giant left ventricular apical fibroma presenting as recurrent ventricular tachycardia in a 14-month-old girl. The diagnosis was made by echocardiography and chest computed tomography, and confirmed by histopathology. The fibroma was resected surgically, and the patient followed up for 4 years.

  6. Evaluation of left ventricular diastolic function according to new criteria and determinants in acromegaly.

    Science.gov (United States)

    Akdeniz, Bahri; Gedik, Arzu; Turan, Onur; Ozpelit, Ebru; Ikiz, Ahmet Omer; Itil, Oya; Badak, Ozer; Baris, Nezihi; Cömlekçi, Abdurrahman

    2012-01-01

    Left ventricular diastolic dysfunction (LVDD) develops in the early stages of acromegaly. The purpose of this study was to identify LVDD analyzing by new echocardiograpic criteria as well as to evaluate determinants of the LVDD in acromegaly. This cross-sectional study examined 42 patients with acromegaly; 16 in active disease (AA) and 26 cured/ well controlled (CA), and compared them with 30 healthy controls (CG). Ventricular systolic and diastolic functions were studied by conventional and tissue Doppler imaging based on the E/Em ratio and myocardial performance index (MPI). Other clinical parameters possibly contributing to LVDD in acromegaly were also investigated. The prevalence of LV hypertrophy (33%) and LVDD (35.7%) were increased in acromegaly, however, there were no differences between the AA and CA groups. Acromegalic patients had higher LV volumes and LV mass, and septal E/Em ratio compared to CG, whereas LV ejection fraction and MPI were not different. The presence of acromegaly (r = 0.29, P = 0.013), diabetes mellitus (DM) (r = 0.41, P < 0.001), hypertension (r = 0.35, P = 0.002), and sleep apnea (r = 0.56, P = 0.003) were found to be correlated with LVDD, whereas duration and activity of acromegaly were not. In regression analysis, advanced age (OR: 8.53, P = 0.006) and DM (OR: 25.9, P = 0.007) were found to be independent risk factors for LVDD. The risk of LVDD according to new criteria increases in acromegaly. However, it seems to be related to the presence of DM and advanced age and is independent of disease duration and activity.

  7. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2013-01-01

    This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%....

  8. Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

    Directory of Open Access Journals (Sweden)

    Gribaa Rim

    2011-10-01

    Full Text Available Abstract Introduction Right ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern. Case presentation We report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction. Conclusion Right ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.

  9. Phenotyping of left and right ventricular function in mouse models of compensated hypertrophy and heart failure with cardiac MRI.

    Directory of Open Access Journals (Sweden)

    Bastiaan J van Nierop

    Full Text Available BACKGROUND: Left ventricular (LV and right ventricular (RV function have an important impact on symptom occurrence, disease progression and exercise tolerance in pressure overload-induced heart failure, but particularly RV functional changes are not well described in the relevant aortic banding mouse model. Therefore, we quantified time-dependent alterations in the ventricular morphology and function in two models of hypertrophy and heart failure and we studied the relationship between RV and LV function during the transition from hypertrophy to heart failure. METHODS: MRI was used to quantify RV and LV function and morphology in healthy (n = 4 and sham operated (n = 3 C57BL/6 mice, and animals with a mild (n = 5 and a severe aortic constriction (n = 10. RESULTS: Mice subjected to a mild constriction showed increased LV mass (P0.05. Animals with a severe constriction progressively developed LV hypertrophy (P<0.001, depressed LVEF (P<0.001, followed by a declining RVEF (P<0.001 and the development of pulmonary remodeling, as compared to controls during a 10-week follow-up. Myocardial strain, as a measure for local cardiac function, decreased in mice with a severe constriction compared to controls (P<0.05. CONCLUSIONS: Relevant changes in mouse RV and LV function following an aortic constriction could be quantified using MRI. The well-controlled models described here open opportunities to assess the added value of new MRI techniques for the diagnosis of heart failure and to study the impact of new therapeutic strategies on disease progression and symptom occurrence.

  10. Atorvastatin therapy during the peri-infarct period attenuates left ventricular dysfunction and remodeling after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Xian-Liang Tang

    Full Text Available Although statins impart a number of cardiovascular benefits, whether statin therapy during the peri-infarct period improves subsequent myocardial structure and function remains unclear. Thus, we evaluated the effects of atorvastatin on cardiac function, remodeling, fibrosis, and apoptosis after myocardial infarction (MI. Two groups of rats were subjected to permanent coronary occlusion. Group II (n = 14 received oral atorvastatin (10 mg/kg/d daily for 3 wk before and 4 wk after MI, while group I (n = 12 received equivalent doses of vehicle. Infarct size (Masson's trichrome-stained sections was similar in both groups. Compared with group I, echocardiographic left ventricular ejection fraction (LVEF and fractional area change (FAC were higher while LV end-diastolic volume (LVEDV and LV end-systolic and end-diastolic diameters (LVESD and LVEDD were lower in treated rats. Hemodynamically, atorvastatin-treated rats exhibited significantly higher dP/dt(max, end-systolic elastance (Ees, and preload recruitable stroke work (PRSW and lower LV end-diastolic pressure (LVEDP. Morphometrically, infarct wall thickness was greater in treated rats. The improvement of LV function by atorvastatin was associated with a decrease in hydroxyproline content and in the number of apoptotic cardiomyocyte nuclei. We conclude that atorvastatin therapy during the peri-infarct period significantly improves LV function and limits adverse LV remodeling following MI independent of a reduction in infarct size. These salubrious effects may be due in part to a decrease in myocardial fibrosis and apoptosis.

  11. Evaluation of left ventricular enlargement as a marker of early disease in familial dilated cardiomyopathy.

    Science.gov (United States)

    Fatkin, Diane; Yeoh, Thomas; Hayward, Christopher S; Benson, Victoria; Sheu, Angela; Richmond, Zara; Feneley, Michael P; Keogh, Anne M; Macdonald, Peter S

    2011-08-01

    Echocardiographic screening of families with dilated cardiomyopathy has identified a subgroup of asymptomatic relatives with left ventricular enlargement (LVE). The prognostic significance of LVE in this setting is incompletely understood. We evaluated 457 asymptomatic relatives in 128 dilated cardiomyopathy families and identified 110 individuals (24%) with LVE. Serial echocardiograms in 72 untreated LVE relatives showed that 9 individuals (13%) had development of dilated cardiomyopathy over 10 to 152 months (median, 52). Thirty LVE relatives and 30 age- and sex-matched healthy control subjects were evaluated using 2-dimensional and M-mode echocardiography, tissue Doppler imaging, noninvasive pressure-volume assessment, exercise stress echocardiography, and brain natriuretic peptide levels. LVE relatives showed mild defects of systolic and diastolic LV function, with normal filling pressures and exercise-induced increments in systolic contraction in most cases. LV dimensions and fractional shortening most effectively differentiated LVE relatives from control subjects, with other functional indices lacking additive discriminative value. In a receiver operating characteristics analysis, the area under the curve for LV end-diastolic diameter (% predicted) was 0.96 (P116% or LV end-diastolic diameter (% predicted) 112% to 116%+fractional shortening ≤29% had high sensitivity (100%) and specificity (93%) for LVE relatives and identified 8 of 9 progressors. LVE is a common finding in asymptomatic relatives in dilated cardiomyopathy families and can be a marker of preclinical cardiomyopathy. Assessment of LV size and contractile function is required for differentiating between pathological and physiological causes of LVE and may help to identify those at risk of disease progression.

  12. Left ventricular diastolic dysfunction limits use of maximum systolic elastance as an index of contractile function.

    Science.gov (United States)

    Zile, M R; Izzi, G; Gaasch, W H

    1991-02-01

    We tested the hypothesis that maximum systolic elastance (Emax) fails to detect a decline in left ventricular (LV) contractile function when diastolic dysfunction is present. Canine hearts were studied in an isolated blood-perfused heart apparatus (isovolumic LV); contractile dysfunction was produced by 60 or 90 minutes of global ischemia, followed by 90 minutes of reperfusion. Nine normal hearts underwent 60 minutes of ischemia, and five underwent 90 minutes of ischemia. After the ischemia-reperfusion sequence, developed pressure, pressure-volume area, and myocardial ATP level were significantly less than those at baseline in all 14 hearts. In the group undergoing 60 minutes of ischemia, LV diastolic pressure did not increase, whereas Emax decreased from 5.2 +/- 2.5 to 2.9 +/- 1.4 mm Hg/ml (p less than 0.05). In the group undergoing 90 minutes of ischemia, diastolic pressure increased (from 10 +/- 2 to 37 +/- 20 mm Hg, p less than 0.05), and Emax did not change significantly (from 5.1 +/- 4.3 to 4.3 +/- 2.5 mm Hg/ml). A second series of experiments was performed in 13 hearts with pressure-overload hypertrophy (aortic-band model with echocardiography and catheterization studies before the ischemia-reperfusion protocol). Five had evidence for pump failure, whereas eight remained compensated. After 60 minutes of ischemia and 90 minutes of reperfusion, developed pressure, pressure-volume area, and myocardial ATP level were significantly less than those at baseline in all 13 hearts. In the group with compensated LV hypertrophy, LV diastolic pressure did not change, whereas Emax decreased from 6.9 +/- 3.0 to 3.1 +/- 2.3 mm Hg/ml (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Importance of length and external diameter in left ventricular geometry. Normal values from the HUNT Study

    Science.gov (United States)

    Støylen, Asbjørn; Mølmen, Harald E; Dalen, Håvard

    2016-01-01

    Background We aimed to study left ventricular (LV) geometry assessed by length (LVWL), external diameter (LVEDD) and relative wall thickness (RWT) in relation to age, body size and gender in healthy individuals. Methods 1266 individuals underwent echocardiography in the Nord-Trøndelag Health Study (HUNT3), Norway. Septum thickness (IVS), posterior wall thickness (LVPWd) and end-diastolic internal diameter (LVIDD) were measured in M-mode, and LVEDD was calculated as the sum. Myocardial wall lengths were measured in a straight line from apex to the mitral ring in apical views at end diastole and averaged to LVWL. RWT ([IVSd+LVPWd]/LVIDD) and the ratio between length and diameter (L/D) were calculated. Results Normal age-related and gender-related values are provided. Conventional measures conform to previous studies. All measures correlated with body surface area (BSA) (r 0.29–0.60), and BSA indexed values were higher in women. Wall thickness (WT) and LVEDD, but not LVIDD, were higher with higher age. LVWL and L/D were lower with increasing age, but L/D was independent of BSA and similar in women and men (1.41 vs 1.40). RWT correlated with BSA and age (r 0.17 and 0.34). Conclusions LV WT increases and LVWL decreases with higher age. Excluding length in LV mass calculations increasingly overestimates mass with ageing. L/D is a BSA independent measure of LV age-related geometry and may be useful as a body size independent measure in LV hypertrophy. RWT depends on body size and age, and a single cut-off value is not warranted. PMID:27752332

  14. Predictors of improved left ventricular systolic function in an urban cardiomyopathy program.

    Science.gov (United States)

    Sam, Flora; Halickman, Isaac; Vita, Joseph A; Levitzky, Yamini; Cupples, L Adrienne; Loscalzo, Joseph; Allensworth-Davies, Donald

    2006-12-15

    After long-term therapy, some patients with systolic heart failure (HF) display improved left ventricular (LV) function over time, a response that is associated with improved long-term outcomes. To investigate predictors of improved LV function in an ethnically diverse HF cohort, we selected 71 patients with HF who had baseline ejection fractions (EF) or =50%, and >20% increases on follow-up echocardiography performed > or =6 months later. Their clinical features were compared with 142 age- and gender-matched control patients with baseline EFs <40% and no change or worse EFs on follow-up echocardiography. The baseline EFs were similar between patients and controls. Compared with controls, patients had a lower prevalence of diabetes mellitus (19.7% vs 36.6%, p = 0.01), a lower prevalence of an ischemic cause of disease (8.4% vs 35.2%, p <0.001), but a higher prevalence of a hypertensive cause of cardiomyopathy (29.6% vs 12%, p <0.001). Fewer patients than controls used aspirin (p = 0.04) or statins (p = 0.001) or had previous cardiac procedures (p = 0.009). In a multivariate conditional logistic regression model adjusting for age, gender, disease cause, statin use, cardiac procedures, change in heart rate, and follow-up time, hypertensive etiology was most strongly associated with improved LV function (adjusted odds ratio 9.73, 95% confidence interval 1.44 to 52.76, p = 0.02). In conclusion, patients with hypertensive causes of HF are more likely to demonstrate improved LV function over time than patients with ischemic causes of HF. Because long-term prognosis and indication for defibrillator implantation may be affected by changes in LV function, the present study provides additional support for the importance of evaluating the cause of HF to guide management.

  15. Krill oil attenuates left ventricular dilatation after myocardial infarction in rats

    Directory of Open Access Journals (Sweden)

    Fosshaug Linn E

    2011-12-01

    Full Text Available Abstract Background In the western world, heart failure (HF is one of the most important causes of cardiovascular mortality. Supplement with n-3 polyunsaturated fatty acids (PUFA has been shown to improve cardiac function in HF and to decrease mortality after myocardial infarction (MI. The molecular structure and composition of n-3 PUFA varies between different marine sources and this may be of importance for their biological effects. Krill oil, unlike fish oil supplements, contains the major part of the n-3 PUFA in the form of phospholipids. This study investigated effects of krill oil on cardiac remodeling after experimental MI. Rats were randomised to pre-treatment with krill oil or control feed 14 days before induction of MI. Seven days post-MI, the rats were examined with echocardiography and rats in the control group were further randomised to continued control feed or krill oil feed for 7 weeks before re-examination with echocardiography and euthanization. Results The echocardiographic evaluation showed significant attenuation of LV dilatation in the group pretreated with krill oil compared to controls. Attenuated heart weight, lung weight, and levels of mRNA encoding classical markers of LV stress, matrix remodeling and inflammation reflected these findings. The total composition of fatty acids were examined in the left ventricular (LV tissue and all rats treated with krill oil showed a significantly higher proportion of n-3 PUFA in the LV tissue, although no difference was seen between the two krill oil groups. Conclusions Supplement with krill oil leads to a proportional increase of n-3 PUFA in myocardial tissue and supplement given before induction of MI attenuates LV remodeling.

  16. Inhalation of hydrogen gas attenuates left ventricular remodeling induced by intermittent hypoxia in mice.

    Science.gov (United States)

    Hayashi, Tetsuya; Yoshioka, Toshitaka; Hasegawa, Kenichi; Miyamura, Masatoshi; Mori, Tatsuhiko; Ukimura, Akira; Matsumura, Yasuo; Ishizaka, Nobukazu

    2011-09-01

    Sleep apnea syndrome increases the risk of cardiovascular morbidity and mortality. We previously reported that intermittent hypoxia increases superoxide production in a manner dependent on nicotinamide adenine dinucleotide phosphate and accelerates adverse left ventricular (LV) remodeling. Recent studies have suggested that hydrogen (H(2)) may have an antioxidant effect by reducing hydroxyl radicals. In this study, we investigated the effects of H(2) gas inhalation on lipid metabolism and LV remodeling induced by intermittent hypoxia in mice. Male C57BL/6J mice (n = 62) were exposed to intermittent hypoxia (repetitive cycle of 1-min periods of 5 and 21% oxygen for 8 h during daytime) for 7 days. H(2) gas (1.3 vol/100 vol) was given either at the time of reoxygenation, during hypoxic conditions, or throughout the experimental period. Mice kept under normoxic conditions served as controls (n = 13). Intermittent hypoxia significantly increased plasma levels of low- and very low-density cholesterol and the amount of 4-hydroxy-2-nonenal-modified protein adducts in the LV myocardium. It also upregulated mRNA expression of tissue necrosis factor-α, interleukin-6, and brain natriuretic peptide, increased production of superoxide, and induced cardiomyocyte hypertrophy, nuclear deformity, mitochondrial degeneration, and interstitial fibrosis. H(2) gas inhalation significantly suppressed these changes induced by intermittent hypoxia. In particular, H(2) gas inhaled at the timing of reoxygenation or throughout the experiment was effective in preventing dyslipidemia and suppressing superoxide production in the LV myocardium. These results suggest that inhalation of H(2) gas was effective for reducing oxidative stress and preventing LV remodeling induced by intermittent hypoxia relevant to sleep apnea.

  17. Detection of postischemic regional left ventricular delayed outward wall motion or diastolic stunning after exercise-induced ischemia in patients with stable effort angina by using color kinesis.

    Science.gov (United States)

    Ishii, Katsuhisa; Miwa, Kunihisa; Sakurai, Takahiro; Kataoka, Kazuaki; Imai, Makoto; Kintaka, Aya; Aoyama, Takeshi; Kawanami, Masaki

    2008-04-01

    To determine whether postischemic diastolic stunning could be detected using color kinesis, we evaluated regional left ventricular (LV) diastolic wall motion in 36 patients with stable effort angina and a coronary stenosis (> or = 70% of luminal diameter), and in 30 control subjects. Regional LV filling fraction in the short-axis view during the first 30% of the LV filling time (color kinesis diastolic index) was determined before, 20 minutes, 1 hour, and 24 hours after the treadmill exercise test. In 33 of the 36 patients (92%), new regional LV delayed outward motion during early diastole (color kinesis diastolic index < or = 40%) was detected at 20 minutes after exercise. The regional LV delayed diastolic wall motion showed significant improvement but persisted 1 hour afterward in 20 of 36 patients (56%), and disappeared 24 hours after exercise. Detection of regional stunned myocardium with impaired diastolic function may be a useful tool for the diagnosis of coronary artery disease.

  18. Reliability and reproducibility of quantitative assessment of left ventricular function and volumes with 3-slice segmentation of cine steady-state free precession short axis images

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Christopher, E-mail: cnguye38@uci.edu [School of Medicine, University of California, Irvine, Orange, CA (United States); Kuoy, Edward, E-mail: ekuoy@uci.edu [School of Medicine, University of California, Irvine, Orange, CA (United States); Ruehm, Stefan, E-mail: sruehm@mednet.ucla.edu [Diagnostic Cardiovascular Imaging, University of California, Los Angeles (United States); Krishnam, Mayil, E-mail: mskrishn@uci.edu [Cardiovascular and Thoracic Imaging, Radiological Sciences, University of California, Irvine, Orange, CA (United States)

    2015-07-15

    Highlights: • Quantitative LV assessment in CMR requires contour tracing of multiple SA images. • Conventional multi-slice method for LV assessment is tedious and time-consuming. • 3-slice segmentation is comparable to multi-slice method in determining LVEF. • 3-slice method is reliable and reproducible in determining LV volumes and mass. • 3-slice method reduces post-processing time compared to multi-slice method. - Abstract: Objectives: Quantitative assessment of left ventricular (LV) functional parameters in cardiac MR requires time-consuming contour tracing across multiple short axis images. This study assesses global LV functional parameters using 3-slice segmentation on steady state free precision (SSFP) cine short axis images and compares the results with conventional multi-slice segmentation of LV. Methods: Data were collected from 61 patients who underwent cardiac MRI for various clinical indications. Semi-automated cardiac MR software was used to trace LV contours both at multiple slices from base to apex as well as just 3 slices (base, mid, and apical) by two readers. Left ventricular ejection fraction (LVEF), LV volumes, and LV mass were calculated using both methods. Results: Bland–Altman plot revealed narrow limits of agreement (−4.4% to 5.1%) between LVEF obtained by the two methods. Bland–Altman analysis showed slightly wider limits of agreement between end-diastolic volumes (−5.0 to 12.0%; −3.9 to 8.5 ml/m{sup 2}), end-systolic volumes (−10.9 to 14.7%; −4.1 to 6.5 ml/m{sup 2}), and LV mass (−5.2 to 12.7%; −4.8 to 10.2 g/m{sup 2}) obtained by the two methods. There was a small mean difference between LV volumes and LV mass obtained using multi-slice and 3-slice segmentation. No statistically significant difference existed between the LV parameters obtained by the two readers using 3-slice segmentation (p > 0.05). Multi-slice assessment required approximately 15 min per study while 3-slice assessment required less than 5

  19. PREDICTORS OF MORTALITY IN PATIENTS WITH SUSTAINED VENTRICULAR TACHYCARDIAS OR VENTRICULAR-FIBRILLATION AND DEPRESSED LEFT-VENTRICULAR FUNCTION - IMPORTANCE OF BETA-BLOCKADE

    NARCIS (Netherlands)

    SZABO, BM; CRIJNS, HJGM; WIESFELD, ACP; VANVELDHUISEN, DJ; HILLEGE, HL; LIE, KI

    1995-01-01

    To study prognostic factors in patients with sustained ventricular tachycardias (VT) or ventricular fibrillation (VF) complicated by left ventricular dysfunction, we evaluated the predictive value of demographic, clinical, and hemodynamic parameters for cardiac mortality and sudden cardiac death in

  20. Evaluation of right and left ventricular function using speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy and their first degree relatives

    Directory of Open Access Journals (Sweden)

    Aneq Meriam

    2012-09-01

    Full Text Available Abstract Introduction and aim The identification of right ventricular abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC in early stages is still difficult. The aim of this study was to investigate if longitudinal strain based on speckle tracking can detect subtle right (RV or left ventricular (LV dysfunction as an early sign of ARVC. Methods and results Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32–70 years old, nineteen male first degree relatives 29 (19–73 y.o. and twenty-two healthy male volunteers 36 (24–66 y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86% but less feasible in patients (59%. Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index  Conclusion Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.

  1. Assessment of left ventricular systolic and diastolic function in juvenile rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Bharti Bishwa Bhushan

    2004-10-01

    Full Text Available Background and Aims: Recognizing the paucity of data regarding echocardiographic studies of Left ventricular (LV systolic and diastolic function in patients with juvenile rheumatoid arthritis (JRA, a study was carried out to study these parameters in these subjects. Settings, Design and Methods: Thirty-five patients with JRA and an equal number of age- and sex-matched controls were studied by two-dimensional and Doppler echocardiography. Results: Patients with JRA had higher systolic and diastolic blood pressures, resting heart rates, LV systolic (26.9±4.3 vs. 22.4 ± 4.1 mm, p=0.001 and diastolic size (42.3±4.6 vs. 35.4±3.8 mm, p<0.001 and volumes. Though ejection fraction (EF and fractional shortening (FS were normal, they were lower in those with JRA as compared to controls (EF: 62.9±4.47 vs. 67.5±3.63 %, p<0.001; FS: 36.4±4.5 vs. 38.5 ± 6.87, p=0.2. On Doppler analysis the JRA group had lower peak E velocity, higher peak A velocity, higher A VTI and more prolonged IVRT. Male patients had higher A VTI and IVRT as compared to females. Those with longer duration of disease had larger LV systolic (r=0.517, p=0.01 and diastolic dimension (r=0.40, p=0.05 and lower FS (r=-0.506, p=0.01. Patients with polyarticular JRA had higher E and A VTI as compared to those with systemic or oligoarticular types. Conclusion: Despite an asymptomatic cardiac status, significant systolic and diastolic functional abnormalities exist in patients with JRA. The duration of the disease, mode of presentation, patient's age and gender have a significant impact on the left ventricular systolic and diastolic functions in patients with JRA.

  2. Pre-operative Tei Index does not predict left ventricular function immediately after mitral valve repair

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Echocardiographic assessment of systolic left ventricular (LV function in patients with severe mitral regurgitation (MR undergoing mitral valve (MV repair can be challenging because the measurement of ejection fraction (EF or fractional area change (FAC in pathological states is of questionable value. The aim of our study was to evaluate the usefulness of the pre-operative Tei Index in predicting left ventricular EF or FAC immediately after MV repair. One hundred and thirty patients undergoing MV repair with sinus rhythm pre- and post-operatively were enrolled in this prospective study. Twenty-six patients were excluded due to absence of sinus rhythm post-operatively. Standard transesophageal examination(IE 33,Philips,Netherlands was performed before and after cardiopulmonary bypass according to the guidelines of the ASE/SCA. FAC was determined in the transgastric midpapillary short-axis view. LV EF was measured in the midesophageal four- and two-chamber view. For calculation of the Tei Index, the deep transgastric and the midesophageal four-chamber view were used. Statistical analysis was performed with SPSS 17.0. values are expressed as mean with standard deviation. LV FAC and EF decreased significantly after MV repair (FAC: 56±12% vs. 50±14%, P<0.001; EF: 58±11 vs. 50±12Έ P<0.001. The Tei Index decreased from 0.66±0.23 before MV repair to 0.41±0.19 afterwards (P<0.001. No relationship between pre-operative Tei Index and post-operative FAC or post-operative EF were found (FAC: r=−0.061, P=0.554; EF: r=−0.29, P=0.771. Conclusion: Pre-operative Tei Index is not a good predictor for post-operative FAC and EF in patients undergoing MV repair.

  3. Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial.

    Science.gov (United States)

    DeVore, Adam D; McNulty, Steven; Alenezi, Fawaz; Ersboll, Mads; Vader, Justin M; Oh, Jae K; Lin, Grace; Redfield, Margaret M; Lewis, Gregory; Semigran, Marc J; Anstrom, Kevin J; Hernandez, Adrian F; Velazquez, Eric J

    2017-07-01

    While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  4. Crossing the bends: Support-catheter based left ventricular lead placement in challenging cardiac resynchronization therapy device implantation

    Directory of Open Access Journals (Sweden)

    Amit Kumar Malik, MBBS, MD

    2012-08-01

    Full Text Available The combined use of an Amplatz guiding catheter and support catheter creates a progressively supportive rail to implant the left ventricular (LV lead in difficult cardiac resynchronization therapy device implantation. We describe the case of a 32-year-old male with non-ischaemic cardiomyopathy, left bundle-branch block, and an LV ejection fraction of 30%, who was referred to our centre for a repeat attempt at an LV lead implant. Previously, the implanter had been unable to advance different guide catheters over the wire to the desired tributary of the coronary sinus (CS. At our centre, the CS was cannulated with a 6-Fr AL2 coronary guiding catheter. A 135-cm support catheter (Spectranetics Quick-Cross was advanced via AL2 guiding over the 0.035 in. guide wire to the distal CS. The proximal luer fitting of the support catheter was cut and an inner sheath (Medtronic ATTAIN SELECT II advanced over the support catheter into the CS. A 4-Fr over-the-wire LV lead was advanced through the inner sheath over a 0.014 in. percutaneous transluminal coronary angioplasty wire after removal of the support catheter. The use of a support catheter serves as rail for the placement of the inner sheath deep in the CS and facilitates implantation of the LV pacing lead. This technique is safe and easily applied.

  5. Role of common sarcomeric gene polymorphisms in genetic susceptibility to left ventricular dysfunction

    Indian Academy of Sciences (India)

    SURENDRA KUMAR; AVSHESH MISHRA; ANSHIKA SRIVASTAVA; MANSI BHATT; N. GARG; S. K. AGARWAL; SHANTANU PANDE; BALRAJ MITTAL

    2016-06-01

    Mutations in sarcomeric genes are common genetic cause of cardiomyopathies. An intronic 25-bp deletion in cardiac myosin binding protein C (MYBPC3) at 3' region is associated with dilated and hypertrophic cardiomyopathies in Southeast Asia. However, the frequency of sarcomeric gene polymorphisms and associated clinical presentation have not been established with left ventricular dysfunction (LVD). Therefore, the aim of the present study was to explore the association of MYBPC3 25-bp deletion, titin (TTN) 18 bp I/D, troponin T type 2 (TNNT2) 5 bp I/D and myospryn K2906N polymorphisms with LVD. This study includes 988 consecutive patients with angiographically confirmed coronary artery disease (CAD) and 300 healthy controls. Among the 988 CAD patients, 253 with reduced left ventricle ejection fraction (LVEF≤45%) were categorized as LVD. MYBPC3 25-bp deletion,TTN 18 bp I/D and TNNT25 bp I/D polymorphisms were determined by direct polymerase chain reaction method, while myospryn K2906N polymorphism by TaqMan assay. Our results showed that MYBPC3 25-bpdeletion polymorphism was significantly associated with elevated risk of LVD (LVEF <45) (healthy controls versus LVD: OR= 3.85,P<0.001; and nonLVD versus LVD: OR=1.65,P=0.035), while TTN 18 bp I/D, TNNT25bpI/Dand myospryn K2906N polymorphisms did not show any significant association with LVD. The results also showed that MYBPC3 25-bp deletion polymorphism was significantly associated with other parameters of LV remodelling, i.e. LV dimensions (LV end diastole dimension, LVEDD: P= 0.037 and LV end systolic dimension, LVESD: P= 0.032).Our data suggests that MYBPC3 25-bp deletion may play significant role in conferring LVD as well as CAD risk in north Indian population

  6. Ventricular fibrillation via torsade des pointes of cardiac sarcoidosis with preserved left ventricular ejection fraction.

    Science.gov (United States)

    Sekihara, Takayuki; Nakane, Eisaku; Nakasone, Kazutaka; Inoko, Moriaki

    2016-10-25

    Generally, low left ventricular ejection fraction (LVEF) is a risk for ventricular arrhythmia in patients with cardiac sarcoidosis. We present a case of cardiac sarcoidosis with preserved LVEF that evoked ventricular fibrillation (VF). A 73-year-old woman with VF presented to our emergency department. She had a history of ocular sarcoidosis, with gradual thinning of the basal intraventricular septum. LVEF was 62% on the most recent echocardiography. The electrocardiogram after defibrillation showed complete atrioventricular block (CAVB) with QT segment prolongation and frequent ventricular premature beats. VF via torsade des pointes (TdP) was suspected, and temporary intravenous ventricular pacing and magnesium sulfate infusion suppressed her VF. Cardiac sarcoidosis was diagnosed, and an implantable cardioverter defibrillator was implanted. Patients with cardiac sarcoidosis with CAVB are at risk of evoking VF via TdP regardless of LVEF. If cardiac sarcoidosis is suspected, early diagnosis and risk stratification of ventricular arrhythmia are important. 2016 BMJ Publishing Group Ltd.

  7. Assessment of left ventricular function and mass in dual-source computed tomography coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Christoph J., E-mail: c.jensen@contilia.d [Department of Cardiology and Angiology, Elisabeth Hospital, Essen (Germany); Jochims, Markus [Department of Cardiology and Angiology, Elisabeth Hospital, Essen (Germany); Hunold, Peter; Forsting, Michael; Barkhausen, Joerg [Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen (Germany); Sabin, Georg V.; Bruder, Oliver [Department of Cardiology and Angiology, Elisabeth Hospital, Essen (Germany); Schlosser, Thomas [Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen (Germany)

    2010-06-15

    Purpose: To quantify left ventricular (LV) function and mass (LVM) derived from dual-source computed tomography (DSCT) and the influence of beta-blocker administration compared to cardiac magnetic resonance imaging (CMR). Methods: Thirty-two patients undergoing cardiac DSCT and CMR were included, where of fifteen received metoprolol intravenously before DSCT. LV parameters were calculated by the disc-summation method (DSM) and by a segmented region-growing algorithm (RGA). All data sets were analyzed by two blinded observers. Interobserver agreement was tested by the intraclass correlation coefficient. Results.: 1. Using DSM LV parameters were not statistically different between DSCT and CMR in all patients (DSCT vs. CMR: EF 63 {+-} 8% vs. 64 {+-} 8%, p = 0.47; EDV 136 {+-} 36 ml vs. 138 {+-} 35 ml, p = 0.66; ESV 52 {+-} 21 ml vs. 52 {+-} 22 ml, p = 0.61; SV 83 {+-} 22 ml vs. 87 {+-} 19 ml, p = 0.22; CO 5.4 {+-} 0.9 l/min vs. 5.7 {+-} 1.2 l/min, p = 0.09, LVM 132 {+-} 33 g vs. 132 {+-} 33 g, p = 0.99). 2. In a subgroup of 15 patients beta-blockade prior to DSCT resulted in a lower ejection fraction (EF), stroke volume (SV), cardiac output (CO) and increase in end systolic volume (ESV) in DSCT (EF 59 {+-} 8% vs. 62 {+-} 9%; SV 73 {+-} 17 ml vs. 81 {+-} 15 ml; CO 5.7 {+-} 1.2 l/min vs. 5.0 {+-} 0.8 l/min; ESV 52 {+-} 27 ml vs. 57 {+-} 24 ml, all p < 0.05). 3. Analyzing the RGA parameters LV volumes were not significantly different compared to DSM, whereas LVM was higher using RGA (177 {+-} 31 g vs. 132 {+-} 33 g, p < 0.05). Interobserver agreement was excellent comparing DSM values with best agreement between RGA calculations. Conclusion: Left ventricular volumes and mass can reliably be assessed by DSCT compared to CMR. However, beta-blocker administration leads to statistically significant reduced EF, SV and CO, whereas ESV significantly increases. DSCT RGA reliably analyzes LV function, whereas LVM is overestimated compared to DSM.

  8. Ebstein's Anomaly, Left Ventricular Noncompaction, and Sudden Cardiac Death

    Science.gov (United States)

    McGee, Michael; Warner, Luke; Collins, Nicholas

    2015-01-01

    Ebstein's anomaly is a congenital disorder characterized by apical displacement of the septal leaflet of the tricuspid valve. Ebstein's anomaly may be seen in association with other cardiac conditions, including patent foramen ovale, atrial septal defect, and left ventricular noncompaction (LVNC). LVNC is characterized by increased trabeculation within the left ventricular apex. Echocardiography is often used to diagnose LVNC; however, magnetic resonance (MR) imaging offers superior characterization of the myocardium. We report a case of sudden cardiac death in a patient with Ebstein's anomaly with unrecognized LVNC noted on post mortem examination with screening documenting the presence of LVNC in one of the patient's twin sons. PMID:26240764

  9. Influence of verapamil therapy on left ventricular performance at rest and during exercise in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Hanrath, P; Schlüter, M; Sonntag, F; Diemert, J; Bleifeld, W

    1983-09-01

    To determine the hemodynamic effect of verapamil at rest and during exercise, 18 patients with hypertrophic cardiomyopathy were studied before and after 7 weeks of treatment with oral verapamil (maximal dose, 720 mg/day). At rest and at peak exercise, verapamil produced a significant increase in left ventricular (LV) systolic performance in terms of stroke volume index (rest, from 43 +/- 11 to 53 +/- 11 ml/m2, p less than 0.001; exercise, from 46 +/- 11 to 51 +/- 10 ml/m2, p less than 0.01), whereas heart rate decreased (rest, from 81 +/- 14 to 70 +/- 11 min-1, p less than 0.001; exercise, from 150 +/- 21 to 141 +/- 18 min-1, p less than 0.01). Cardiac index at rest and during exercise remained unchanged. Systolic vascular resistance did not change at rest, but decreased significantly during exercise (974 +/- 243 to 874 +/- 174 dynes s cm-5; p less than 0.05). After verapamil administration, pulmonary artery pressures did not change at rest, but decreased significantly during exercise. This was probably due to a shift in the LV pressure-volume relation. The improvement in LV hemodynamics was associated with a significant increase in exercise capacity. The findings of this study indicate that in patients with hypertrophic cardiomyopathy, hemodynamic improvement at rest and during exercise can be achieved by chronic administration of verapamil.

  10. Changes in plasma cardiac natriuretic peptides concentrations during 1 year treatment with angiotensin-converting enzyme inhibitor in elderly hypertensive patients with left ventricular hypertrophy.

    Science.gov (United States)

    Kohno, M; Yokokawa, K; Yasunari, K; Kano, H; Minami, M; Hanehira, T; Yoshikawa, J

    1997-01-01

    Plasma concentrations of atrial and brain natriuretic peptides (ANP and BNP) are high in patients with hypertension and congestive heart failure. The present study examined changes in plasma ANP and BNP concentrations during 1 year of monotherapy with enalapril in elderly hypertensive patients with left ventricular (LV) hypertrophy. Eight elderly hypertensive patients with LV hypertrophy were treated with enalapril for 1 year, during which time serial changes were recorded in LV mass index, LV systolic function, and plasma concentrations of ANP and BNP. Enalapril maintained systolic and diastolic blood pressure in the normal range for over 1 year. Treatment significantly reduced posterior wall thickness at 6 months, and more so at 1 year, and tended to reduce septal wall thickness and LV mass index at 1 year. LV ejection fraction was slightly but significantly increased at 1 year. Plasma ANP and BNP, which were markedly elevated at study entry, both decreased after 1 year of enalapril. These results suggest that 1 year of treatment with enalapril caused both a modest regression of LV hypertrophy and a modest improvement in LV systolic function in our selected group of elderly hypertensive patients. The drug reduced elevated plasma ANP and BNP levels but did not alter BUN and serum creatinine levels. Enalapril appears to be useful for the treatment of elderly hypertensive patients with LV hypertrophy.

  11. In vivo quantification of intraventricular flow during left ventricular assist device support

    Science.gov (United States)

    Vu, Vi; Wong, Kin; Del Alamo, Juan; Aguilo, Pablo M. L.; May-Newman, Karen; Department of Bioengineering, San Diego State University Collaboration; Department of Mechanical; Aerospace Engineering, University of California San Diego Collaboration; Mechanical Assist Device Program, Sharp Memorial Hospital Collaboration

    2014-11-01

    Left ventricular assist devices (LVADs) are mechanical pumps that are surgically connected to the left ventricle (LV) and aorta to increase aortic flow and end-organ perfusion. Clinical studies have demonstrated that LVADs improve patient health and quality of life and significantly reduce the mortality of cardiac failure. However, In the presence of left ventricular assisted devices (LVAD), abnormal flow patterns and stagnation regions are often linked to thrombosis. The aim of our study is to evaluate the flow patterns in the left ventricle of the LVAD-assisted heart, with a focus on alterations in vortex development and blood stasis. To this aim, we applied color Doppler echocardiography to measure 2D, time resolved velocity fields in patients before and after implantation of LVADs. In agreement with our previous in vitro studies (Wong et al., Journal of Biomechanics 47, 2014), LVAD implantation resulted in decreased flow velocities and increased blood residence time near the outflow tract. The variation of residence time changes with LVAD operational speed was characterized for each patient.

  12. Left ventricular ejection fraction and left ventricular end-diastolic volume in patients with diastolic dysfunction.

    Science.gov (United States)

    Jovin, Ion S; Ebisu, Keita; Liu, Yi-Hwa; Finta, Laurie A; Oprea, Adriana D; Brandt, Cynthia A; Dziura, James; Wackers, Frans J

    2013-01-01

    Diastolic dysfunction can be diagnosed on equilibrium radionuclide angiocardiography (ERNA) by a low peak filling rate (PFR) in the setting of a normal left ventricular ejection fraction (LVEF). The authors evaluated the relationship between diastolic dysfunction, LVEF, and end-diastolic volume (EDV). A total of 408 predominantly asymptomatic patients with an LVEF ≥50% by ERNA were studied. LVEF of patients with a low PFR was compared with the LVEF of patients with a normal PFR. Correlation analyses to evaluate the association between PFR and EDV were also performed. The LVEF of patients with a low PFR was lower than the LVEF of patients with normal PFR (59±7 vs 63%±7%; PPFR (r=-0.04; P=.32). The results did not change when the EDV indices were used. In patients who had repeat scans, there was no correlation between the change in EDV and the change in PFR (r=0.16; P=.2). In asymptomatic patients undergoing ERNA who have normal systolic function, a low PFR can be associated with a lower LVEF, but it is not associated with changes in EDV. This suggests that diastolic dysfunction is associated with mild systolic dysfunction.

  13. Serum uric acid is associated with left ventricular hypertrophy independent of serum parathyroid hormone in male cardiac patients.

    Directory of Open Access Journals (Sweden)

    Shu-ichi Fujita

    Full Text Available BACKGROUND: Several studies have shown that serum uric acid (UA is associated with left ventricular (LV hypertrophy. Serum levels of parathyroid hormone (PTH, which has bbe shown to be correlated with UA, is also known to be associated with cardiac hypertrophy; however, whether the association between UA and cardiac hypertrophy is independent of PTH remains unknown. PURPOSE: We investigated whether the relationship between serum uric acid (UA and LV hypertrophy is independent of intact PTH and other calcium-phosphate metabolism-related factors in cardiac patients. METHODS AND RESULTS: In a retrospective study, the association between UA and left ventricular mass index was assessed among 116 male cardiac patients (mean age 65 ± 12 years who were not taking UA lowering drugs. The median UA value was 5.9 mg/dL. Neither age nor body mass index differed significantly among the UA quartile groups. Patients with higher UA levels were more likely to be taking loop diuretics. UA showed a significant correlation with intact PTH (R = 0.34, P<0.001 but not with other calcium-phosphate metabolism-related factors. Linear regression analysis showed that log-transformed UA showed a significant association with left ventricular mass index, and this relationship was found to be significant exclusively in patients who were not taking loop and/or thiazide diuretics. Multivariate logistic regression analysis showed that log-transformed UA was independently associated with LV hypertrophy with an odds ratio of 2.79 (95% confidence interval 1.48-5.28, P = 0.002 per one standard deviation increase. CONCLUSIONS: Among cardiac patients, serum UA was associated with LV hypertrophy, and this relationship was, at least in part, independent of intact PTH levels, which showed a significant correlation with UA in the same population.

  14. Radionuclide left ventricular dV/dt for the assessment of cardiac function in patients with coronary disease. [/sup 99m/Ic-labelled red blood cells and contrast radiography

    Energy Technology Data Exchange (ETDEWEB)

    Bianco, J.A.; Makey, D.G.; Laskey, W.K.; Shafer, R.B.

    1979-01-01

    To investigate potential uses of left-ventricular (LV) systolic ejection rate (LV dV/dt) in the evaluation of LV function, we examined the effect of exercise, angiotensin, and leg raising on LV ejection fraction and LV dV/dt in patients with coronary-artery disease. The following observations were made: (a) LV ejection fraction and dV/dt changed proportionately, but in opposite directions, during supine exercise; (b) LV ejection fraction and dV/dt decreased to a similar extent during angiotensin infusions; and (c) LV ejection fraction and dV/dt were unchanged by leg raising. The changes in peak and mean LV dV/dt were similar. Regardless of the physiologic state, peak LV dV/dt occurred during the first third of systole. These data imply that in this population there were no specific advantages of LV dV/dt over LV ejection fraction in the evaluation of LV performance.

  15. Global and regional left ventricular function: a comparison between gated SPECT, 2D echocardiography and multi-slice computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Henneman, Maureen M.; Bax, Jeroen J.; Holman, Eduard R. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Schuijf, Joanne D.; Jukema, J.W.; Wall, Ernst E. van der [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); The Interuniversity Cardiology Institute of the Netherlands, Utrecht (Netherlands); Stokkel, Marcel P.M. [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands); Lamb, Hildo J.; Roos, Albert de [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands)

    2006-12-15

    Global and regional left ventricular (LV) function are important indicators of the cardiac status in patients with coronary artery disease (CAD). Therapy and prognosis are to a large extent dependent on LV function. Multi-slice computed tomography (MSCT) has already earned its place as an imaging modality for non-invasive assessment of the coronary arteries, but since retrospective gating to the patient's ECG is performed, information on LV function can be derived. In 49 patients with known or suspected CAD, coronary angiography with MSCT imaging was performed, in addition to gated SPECT and 2D echocardiography. LV end-diastolic and LV end-systolic volumes and LV ejection fraction were analysed with dedicated software (CMR Analytical Software System, Medis, Leiden, The Netherlands for MSCT; gated SPECT by QGS, Cedars-Sinai Medical Center, Los Angeles, CA, USA), and by the biplane Simpson's rule for 2D echocardiography. Regional wall motion was evaluated according to a 17-segment model and a three-point score system. Correlations were fairly good between gated SPECT and MSCT (LVEDV: r=0.65; LVESV: r=0.63; LVEF: r=0.60), and excellent between 2D echocardiography and MSCT (LVEDV: r=0.92; LVESV: r=0.93; LVEF: r=0.80). Agreement for regional wall motion was 95% ({kappa}=0.66) between gated SPECT and MSCT, and 96% ({kappa}=0.73) between 2D echocardiography and MSCT. Global and regional LV function and LV volumes can be adequately assessed with MSCT. Correlations with 2D echocardiography are stronger than with gated SPECT. (orig.)

  16. Hemodynamic effects of fructose 1,6-diphosphate in patients with normal and impaired left ventricular function.

    Science.gov (United States)

    Markov, A K; Brumley, M A; Figueroa, A; Skelton, T N; Lehan, P H

    1997-05-01

    We compared the short-term hemodynamic effects of intravenous fructose 1,6-diphosphate (FDP) administration in patients with coronary artery disease. Hemodynamic measurements were performed before and after administration of FDP in two groups of patients: those with impaired left ventricular (LV) function, elevated LV end-diastolic pressures (LVEDP > or =12 mm Hg, n = 30), and those with normal LV function (LVEDP <12 mm Hg, n = 17). In those with impaired LV function, FDP induced a decrease in LVEDP from 22 +/- 1.31 to 16.73 +/- 1.46 mm Hg (p< 0.0001). The cardiac index increased (2.50 +/- 0.11 to 2.81 +/- 0.13 L/m2 [p < 0.0001]), as did the LV stroke work index (31.7 +/- 2.04 to 40.3 +/- 2.67 gm x m x m2 [p < 0.0001]). FDP induced no significant change in heart rate and mean aortic pressure. Pulmonary pressure and resistance declined (p<0.002 and p< 0.0001, respectively). Systemic vascular resistance decreased because of increased cardiac output and unchanged arterial pressure (p < 0.001). In those patients with normal baseline LVEDP (5.06 +/- 0.27 mm Hg), FDP decreased heart rate (p< 0.0001) and systemic and pulmonary resistance (p < 0.03 and p < 0.004, respectively), whereas LVEDP and mean aortic and pulmonary pressures remained unchanged. FDP moderately increased cardiac output (p < 0.05), stroke volume index, and LV stroke work index (p< 0.002 and p< 0.003, respectively). The observed improvement in LV function in those patients with elevated LV filling pressures is thought to be a result of an increased energy production by the Embden-Meyerhoff pathway and to act as a positive inotrope.

  17. Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

    Directory of Open Access Journals (Sweden)

    Radu Vatasescu, MD

    2012-05-01

    Full Text Available Hypertrophic cardiomyopathy (HCM is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT, contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD. In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA and more recently radiofrequency (RF septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling.

  18. Left ventricular T2 distribution in Duchenne Muscular Dystrophy

    Directory of Open Access Journals (Sweden)

    Hagenbuch Sean

    2010-03-01

    Full Text Available Abstract Background Although previous studies have helped define the natural history of Duchenne Muscular Dystrophy (DMD-associated cardiomyopathy, the myocardial pathobiology associated with functional impairment in DMD is not yet known. The objective of this study was to assess the distribution of transverse relaxation time (T2 in the left ventricle (LV of DMD patients, and to determine the association of myocardial T2 heterogeneity to the severity of cardiac dysfunction. DMD patients (n = 26 and normal control subjects (n = 13 were studied by Cardiovascular Magnetic Resonance (CMR. DMD subject data was stratified based on subject age and LV Ejection Fraction (EF into the following groups: A (12 years, n = 5. LV mid-slice circumferential myocardial strain (εcc was calculated using tagged CMR imaging. T2 maps of the LV were generated for all subjects using a black blood dual spin echo method at two echo times. The Full Width at Half Maximum (FWHM was calculated from a histogram of LV T2 distribution constructed for each subject. Results In DMD subject groups, FWHM of the T2 histogram rose progressively with age and decreasing EF (Group A FWHM= 25.3 ± 3.8 ms; Group B FWHM= 30.9 ± 5.3 ms; Group C FWHM= 33.0 ± 6.4 ms. Further, FWHM was significantly higher in those with reduced circumferential strain (|εcc| ≤ 12% (Group B, and C than those with |εcc| > 12% (Group A. Group A FWHM was not different from the two normal groups (N1 FWHM = 25.3 ± 3.5 ms; N2 FWHM= 24.0 ± 7.3 ms. Conclusion Reduced EF and εcc correlates well with increased T2 heterogeneity quantified by FWHM, indicating that subclinical functional impairments could be associated with pre-existing abnormalities in tissue structure in young DMD patients.

  19. Relationship of left ventricular systolic function to persistence or development of electrocardiographic left ventricular hypertrophy in hypertensive patients

    DEFF Research Database (Denmark)

    Okin, Peter M; Wachtell, Kristian; Gerdts, Eva;

    2014-01-01

    left ventricular systolic function in patients with new or persistent ECG LVH. METHODS: Baseline and year-3 ECG LVH and left ventricular midwall shortening (MWS) were examined in 725 hypertensive patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic...... or regression of ECG LVH in 427 patients and persistence or development of new LVH in 298 patients. At baseline, although there were no significant differences in the mean values of MWS and scMWS, patients with persistence or development of ECG LVH at year 3 had significantly higher baseline prevalences...

  20. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J;

    2011-01-01

    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements...

  1. Regional left ventricular myocardial contraction abnormalities and asynchrony in patients with hypertrophic cardiomyopathy evaluated by magnetic resonance spatial modulation of magnetization myocardial tagging

    Energy Technology Data Exchange (ETDEWEB)

    Mishiro, Yuichiro; Oki, Takashi [Tokushima Univ. (Japan). School of Medicine; Iuchi, Arata [and others

    1999-06-01

    Global left ventricular (LV) pump function is generally preserved in patients with hypertrophic cardiomyopathy (HCM). However, it is unknown whether regional myocardial contractility is impaired, especially in nonhypertrophied regions. The purpose of this study was to evaluate regional LV myocardial contraction in patients with HCM using magnetic resonance (MR) spatial modulation of magnetization (SPAMM) myocardial tagging. The study group comprised 20 patients with asymmetric septal hypertrophy (HCM group) and 16 age-matched normal patients (control group), and data were collected using transthoracic M-mode and 2-dimensional echocardiography, and MR SPAMM myocardial tagging. The systolic strain ratio, maximum systolic strain velocity, and time from end-diastole to maximum systolic strain ({Delta}T) in the anterior, ventricular septal, inferior and lateral regions for 2 LV short-axis sections at the levels of the chordae tendineae and papillary muscles were measured at 50-ms intervals by MR myocardial tagging. The end-diastolic anterior and ventricular septal wall thicknesses and LV mass index were significantly different between the HCM and control groups. The systolic strain ratio for all 4 walls, particularly the anterior and ventricular septal regions, was significantly lower in the HCM group. In the HCM group, the maximum systolic strain velocity was significantly lower and {Delta}T was significantly shorter for all 4 walls, particularly the anterior and ventricular septal regions. The standard deviation for the {Delta}T, calculated from the {Delta}T for the 8 regions of the 2 LV short-axis sections, was significantly greater in the HCM group. In conclusion, regional LV myocardial contraction is impaired in both hypertrophied and nonhypertrophied regions, and systolic LV wall asynchrony occurs in patients with HCM. (author)

  2. 2-D Speckle tracking in the assessment of left and right ventricular functions in hemodialysis versus recently diagnosed uremic patients with preserved systolic function

    Directory of Open Access Journals (Sweden)

    Hatem Abdel Rahman Helmy Ali

    2016-12-01

    Full Text Available Several studies have demonstrated that uremic patients who have preserved left ventricular (LV systolic function could still have subtle systolic dysfunction. In our study, we assessed the right ventricular (RV and LV myocardial functions measured by conventional echocardiography and two-dimensional (2D longitudinal speckle-tracking in hemodialysis and non-dialysis recently diagnosed uremic patients. The study population consisted of 24 newly diagnosed uremic patients, 25 hemodialysis patients, and 20 healthy controls. The RV and LV longitudinal strains were significantly lower in patients than in controls (−9.6 vs. −15.3, P < 0.001 for RV and −11.3 vs. −14.8, p < 0.001 for LV. In the hemodialysis group, the RV longitudinal strain was significantly lower than in the non-dialysis group (p = 0.018. The RV longitudinal strain was correlated with hypertension and LV strain. The 2-D longitudinal speckle tracking can detect early ventricular (left and right systolic dysfunction in patients with uremia in the presence of normal systolic function by conventional methods.

  3. Revascularization in severe left ventricular dysfunction.

    Science.gov (United States)

    Velazquez, Eric J; Bonow, Robert O

    2015-02-17

    The highest-risk patients with heart failure with reduced ejection fraction are those with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (ejection fraction≤35%). The cornerstone of treatment is guideline-driven medical therapy for all patients and implantable device therapy for appropriately selected patients. Surgical revascularization offers the potential for improved survival and quality of life, particularly in patients with more extensive multivessel disease and the greatest degree of left ventricular systolic dysfunction and remodeling. These are also the patients at greatest short-term risk of mortality with coronary artery bypass graft surgery. The short-term risks of surgery need to be balanced against the potential for long-term benefit. This review discusses the evolving data on the role of surgical revascularization, surgical ventricular reconstruction, and mitral valve surgery in this high-risk patient population.

  4. Laparoscopic repair of diaphragmatic hernia after left ventricular assist device.

    Science.gov (United States)

    Farma, Jeffrey; Leeser, David; Furukawa, Satoshi; Dempsey, Daniel T

    2003-06-01

    This case report describes a patient with a symptomatic diaphragmatic hernia that developed after orthotopic heart transplantation and explantation of a left ventricular assist device. The hernia was repaired laparoscopically, and at 6-month follow-up, she is without evidence of recurrence.

  5. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the endo

  6. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, M.I.|info:eu-repo/dai/nl/412015625; Vink, Aryan; Bergmann, W.|info:eu-repo/dai/nl/36275585X; Szatmári, V.|info:eu-repo/dai/nl/272734497

    2016-01-01

    Background: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation: A previously healthy 12-year-old male West Highland white terrier was found dead

  7. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

    2016-01-01

    BACKGROUND: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. CASE PRESENTATION: A previously healthy 12-year-old male West Highland white terrier was found dead

  8. Roseomonas infection associated with a left ventricular assist device.

    Science.gov (United States)

    Singal, Amit; Malani, Preeti N; Day, Larry J; Pagani, Francis D; Clark, Nina M

    2003-12-01

    Roseomonas species have been increasingly noted as causes of human infection. We present what we believe is the first case of left ventricular assist device (LVAD) infection secondary to Roseomonas. The clinical characteristics of Roseomonas infection and the pertinent features of LVAD infection are reviewed.

  9. Electrocardiographic criteria for left ventricular hypertrophy in children.

    NARCIS (Netherlands)

    Rijnbeek, P.R.; Herpen, G van; Kapusta, L.; Harkel, AD Ten; Witsenburg, M.; Kors, J.A.

    2008-01-01

    Previous studies to determine the sensitivity of the electrocardiogram (ECG) for left ventricular hypertrophy (LVH) in children had their imperfections: they were not done on an unselected hospital population, several criteria used in adults were not applied to children, and obsolete limits of norma

  10. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the endo

  11. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

    2016-01-01

    BACKGROUND: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. CASE PRESENTATION: A previously healthy 12-year-old male West Highland white terrier was found dead

  12. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, M.I.; Vink, Aryan; Bergmann, W.; Szatmári, V.

    2016-01-01

    Background: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation: A previously healthy 12-year-old male West Highland white terrier was found dead

  13. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the

  14. The diagnosis of left ventricular assist device thrombosis

    NARCIS (Netherlands)

    Gerds, H. Z. R.; Brugemann, J.; Rienstra, M.; Erasmus, M. E.

    2015-01-01

    The clinical course of a patient with a left ventricular assist device is described. A total of 6 weeks after device insertion, the lactate dehydrogenase (LDH) level increased to 2801 U/l despite adding low-molecular-weight heparin to acenocoumarol and aspirin. Pump thrombosis was suspected but unco

  15. Patient-reported outcomes in left ventricular assist device therapy

    DEFF Research Database (Denmark)

    Brouwers, Corline; Denollet, Johan; de Jonge, Nicolaas;

    2011-01-01

    Technological advancements of left ventricular assist devices (LVAD) have created today's potential for extending the lives of patients with end-stage heart failure. Few studies have examined the effect of LVAD therapy on patient-reported outcomes (PROs), such as health status, quality of life...

  16. Angiographic left ventricular wall motion score to predict arrhythmia recurrence in patients with sustained ventricular tachycardia or fibrillation

    NARCIS (Netherlands)

    Wiesfeld, ACP; Crijns, HJGM; VandenBroek, SAJ; Landsman, MLJ; Hillege, HL; vanGilst, WH; Lie, KI

    1996-01-01

    Methods Sixty-nine patients with sustained ventricular tachyarrhythmias were followed up to evaluate the predictive value of functional capacity (i.e. New York Heart Association class and peak oxygen consumption) and resting left ventricular function (i.e. radionuclide left ventricular ejection frac

  17. Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

    Science.gov (United States)

    Pierson, Richard N; Howser, Renee; Donaldson, Terri; Merrill, Walter H; Dignan, Rebecca J; Drinkwater, Davis C; Christian, Karla G; Butler, Javed; Chomsky, Don; Wilson, John R; Clark, Rick; Davis, Stacy F

    2002-03-01

    Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.

  18. Left ventricular dysfunction measured by tissue Doppler imaging and strain rate imaging in hypertensive adolescents

    Directory of Open Access Journals (Sweden)

    Hye Mi Ahn

    2010-01-01

    Full Text Available Purpose : Left ventricular (LV hypertrophy and impaired diastolic function may occur early in systemic hypertension. Diastolic dysfunction is associated with increased cardiovascular risk. Tissue Doppler imaging (TDI-derived tissue velocity and strain rate are new parameters for assessing diastolic dysfunction. The aim of this study is to determine whether TDI and strain rate imaging (SRI would improve the ability to recognize early impaired diastolic and systolic functions compared with conventional echocardiography in hypertensive adolescents. Methods : We included 38 hypertensive patients with systolic blood pressure above 140 mmHg or diastolic blood pressure above 90 mmHg. Ejection fraction and myocardial performance index (MPI were estimated by conventional echocardiography. Peak systolic myocardial velocity, early diastolic myocardial velocity (Em, and peak late diastolic myocardial velocity (Am were obtained by using TDI and SRI. Results : In the hypertensive group, interventricular septal thickness was significantly increased on M-mode echocardiography. Em/Am was significantly decreased at the mitral valve annulus. Among hypertensive subjects, the E strain rate at basal, mid, and apex was significantly decreased. Systolic strain was significantly decreased at the septum in the hypertensive group. Conclusion : Strain rate might be a useful new parameter for the quantification of both regional and global LV functions and could be used in long-term follow up in hypertensive patients. Early identification by SRI of subjects at risk for hypertensive and ventricular dysfunction may help to stratify risk and guide therapy. Further studies, including serial assessment of LV structure and function in a larger number of adolescents with hypertension, is necessary.

  19. Reversal of premature ventricular complex-induced cardiomyopathy following successful radiofrequency catheter ablation.

    Science.gov (United States)

    Efremidis, Michalis; Letsas, Konstantinos P; Sideris, Antonios; Kardaras, Fotios

    2008-06-01

    Premature ventricular complex (PVC)-induced cardiomyopathy is an underappreciated cause of left-ventricular (LV) dysfunction. The present report describes the case of an elderly man with a very high burden of monomorphic PVCs and LV dysfunction. Elimination of the left ventricular focus following radiofrequency catheter ablation resulted in reversal of cardiomyopathy.

  20. Study of the association between left ventricular diastolic impairment and cardiac autonomic neuropathy in diabetic patients using [{sup 123}I] metaiodobenzylguanidine scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Rokuro; Tanaka, Shiro; Tojo, Osamu; Ishii, Tomofusa; Sato, Toshihiko; Fujii, Satoru [Osaka City General Hospital (Japan); Tumura, Kei

    1994-12-01

    The association between left ventricular (LV) diastolic dysfunction and myocardial MIBG accumulation was investigated. The subjects were 14 Type II diabetic patients who had no evidence of ischemic heat disease, LV hypertrophy or dilated cardiomyopathy as determined by exercise Tl-201 myocardial scintigraphy and echocardiography. In 14 diabetic patients, isovolumic relaxation time (IRT) was measured by M-mode echocardiography, and the subjects were subdivided into two groups: Group1, 8 patients with impaired left ventricular diastolic function (IRT{>=}80 msec), and Group 2, 6 patients with normal left ventricular diastolic function (IRT<80 msec). {sup 123}I-MIBG myocardial scintigraphy was performed, and the myocardial accumulation of {sup 123}I-MIBG was investigated. The ratio of myocardial to mediastinal MIBG uptake was significantly (p<0.01) lower in Group 1 than in Group 2. And scintigraphic defects were significantly (p<0.05) more numerous in Group 1 than in Group 2. Patients in Group 1 had a greater frequency of cardiac autonomic neuropathy evaluated by QTc interval and coefficient of variation of R-R interval, when compared with Group 2. These data suggest that, in diabetic patients with no evidence of ischemic heart disease, LV hypertrophy or dilated cardiomyopathy, impairment of left ventricular diastolic function is associated with cardiac autonomic neuropathy. (author).

  1. Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility

    Science.gov (United States)

    Greenberg, Neil L.; Firstenberg, Michael S.; Castro, Peter L.; Main, Michael; Travaglini, Agnese; Odabashian, Jill A.; Drinko, Jeanne K.; Rodriguez, L. Leonardo; Thomas, James D.; Garcia, Mario J.

    2002-01-01

    BACKGROUND: Myocardial fiber strain is directly related to left ventricular (LV) contractility. Strain rate can be estimated as the spatial derivative of velocities (dV/ds) obtained by tissue Doppler echocardiography (TDE). The purposes of the study were (1) to determine whether TDE-derived strain rate may be used as a noninvasive, quantitative index of contractility and (2) to compare the relative accuracy of systolic strain rate against TDE velocities alone. METHODS AND RESULTS: TDE color M-mode images of the interventricular septum were recorded from the apical 4-chamber view in 7 closed-chest anesthetized mongrel dogs during 5 different inotropic stages. Simultaneous LV volume and pressure were obtained with a combined conductance-high-fidelity pressure catheter. Peak elastance (Emax) was determined as the slope of end-systolic pressure-volume relationships during caval occlusion and was used as the gold standard of LV contractility. Peak systolic TDE myocardial velocities (Sm) and peak (epsilon'(p)) and mean (epsilon'(m)) strain rates obtained at the basal septum were compared against Emax by linear regression. Emax as well as TDE systolic indices increased during inotropic stimulation with dobutamine and decreased with the infusion of esmolol. A stronger association was found between Emax and epsilon'(p) (r=0.94, P<0.01, y=0.29x+0.46) and epsilon'(m) (r=0.88, P<0.01) than for Sm (r=0.75, P<0.01). CONCLUSIONS: TDE-derived epsilon'(p) and epsilon'(m) are strong noninvasive indices of LV contractility. These indices appear to be more reliable than S(m), perhaps by eliminating translational artifact.

  2. Ischemic Left Ventricular Dysfunction: Severity of Remodeling, Myocardial Viability and Survival After Surgical Revascularization

    Science.gov (United States)

    Bonow, Robert O.; Castelvecchio, Serenella; Panza, Julio A.; Berman, Daniel S.; Velazquez, Eric J.; Michler, Robert E.; She, Lilin; Holly, Thomas A.; Desvigne-Nickens, Patrice; Kosevic, Dragana; Rajda, Miroslaw; Chrzanowski, Lukasz; Deja, Marek; Lee, Kerry L.; White, Harvey; Oh, Jae K.; Doenst, Torsten; Hill, James A; Rouleau, Jean L.; Menicanti, Lorenzo

    2015-01-01

    Objectives The objectives of this study were to test the hypothesis that end-systolic volume (ESV), as a marker of severity of left ventricular (LV) remodeling, influences the relationship between myocardial viability and survival in patients with coronary artery disease and LV systolic dysfunction. Background Retrospective studies of ischemic LV dysfunction suggest that severity of LV remodeling determines whether myocardial viability predicts improved survival with surgical (CABG) compared to medical (MED) therapy, with CABG only benefitting patients with viable myocardium who have smaller ESV. However, this has not been tested prospectively. Methods Interactions of ESV index (ESVI), myocardial viability and treatment with respect to survival were assessed in patients in the prospective randomized STICH trial of CABG vs MED who underwent viability assessment (n=601, age 61±9 years, ejection fraction ≤35%), median follow-up 5.1 years. Median ESVI was 84 ml/m2. Viability was assessed by SPECT or dobutamine echocardiography using prespecified criteria. Results Mortality was highest among patients with larger ESVI and non-viability (P84 ml/m2 (HR 0.87, 95% CI 0.57,1.31). Other ESVI thresholds yielded similar results, including ESVI ≤60 ml/m2 (HR 0.87, 95% CI 0.44,1.74). ESVI and viability assessed as continuous rather than dichotomous variables yielded similar results (P=0.562). Conclusions Among patients with ischemic cardiomyopathy, those with greater LVESVI and no substantial viability have worse prognosis. However, the effect of CABG relative to MED is not differentially influenced by the combination of these two factors. Lower ESVI does not identify patients in whom myocardial viability predicts better outcome with CABG relative to MED. PMID:26363840

  3. Cardiac resynchronization therapy modulation of exercise left ventricular function and pulmonary O₂ uptake in heart failure.

    Science.gov (United States)

    Tomczak, Corey R; Paterson, Ian; Haykowsky, Mark J; Lawrance, Richard; Martellotto, Andres; Pantano, Alfredo; Gulamhusein, Sajad; Haennel, Robert G

    2012-06-15

    To better understand the mechanisms contributing to improved exercise capacity with cardiac resynchronization therapy (CRT), we studied the effects of 6 mo of CRT on pulmonary O(2) uptake (Vo(2)) kinetics, exercise left ventricular (LV) function, and peak Vo(2) in 12 subjects (age: 56 ± 15 yr, peak Vo(2): 12.9 ± 3.2 ml·kg(-1)·min(-1), ejection fraction: 18 ± 3%) with heart failure. We hypothesized that CRT would speed Vo(2) kinetics due to an increase in stroke volume secondary to a reduction in LV end-systolic volume (ESV) and that the increase in peak Vo(2) would be related to an increase in cardiac output reserve. We found that Vo(2) kinetics were faster during the transition to moderate-intensity exercise after CRT (pre-CRT: 69 ± 21 s vs. post-CRT: 54 ± 17 s, P exercise, LV ESV reserve (exercise - resting) increased 9 ± 7 ml (vs. a 3 ± 9-ml decrease pre-CRT, P increased (pre-CRT: 42 ± 8 ml vs. post-CRT: 61 ± 12 ml, P exercise post-CRT (P > 0.05). CRT improved heart rate, measured as a lower resting and steady-state exercise heart rate and as faster heart rate kinetics after CRT (pre-CRT: 89 ± 12 s vs. post-CRT: 69 ± 21 s, P exercise, cardiac output reserve increased significantly post-CRT and was 22% higher at peak exercise post-CRT (both P increase in cardiac output was due to both a significant increase in peak and reserve stroke volume and to a nonsignificant increase in heart rate reserve. Similar patterns in LV volumes as moderate-intensity exercise were observed at peak exercise. Cardiac output reserve was related to peak Vo(2) (r = 0.48, P increase in peak Vo(2) in clinically stable heart failure patients.

  4. Left ventricular twist mechanics during incremental cycling and knee extension exercise in healthy men.

    Science.gov (United States)

    Beaumont, Alexander; Hough, John; Sculthorpe, Nicholas; Richards, Joanna

    2017-01-01

    The objective of the present study was to investigate left ventricular (LV) twist mechanics in response to incremental cycling and isometric knee extension exercises. Twenty-six healthy male participants (age = 30.42 ± 6.17 years) were used to study peak twist mechanics at rest and during incremental semi-supine cycling at 30 and 60% work rate maximum (W max) and during short duration (15 s contractions) isometric knee extension at 40 and 75% maximum voluntary contraction (MVC), using two-dimensional speckle tracking echocardiography. Data presented as mean ± standard deviation or median (interquartile range). LV twist increased from rest to 30% W max (13.21° ± 4.63° to 20.04° ± 4.76°, p  0.05), whilst twisting velocity increased (rest 89.15° ± 21.77° s(-1) to 75% MVC 124.32° ± 34.89° s(-1), p  0.05) then increased from 40 to 75% MVC [-98.44 (43.54)° s(-1) to -138.42 (73.29)° s(-1), p < 0.01]. Apical rotations and rotational velocities were greater than basal during all conditions and intensities (all p < 0.01). Cycling increased LV twist to 30% W max which then remained unchanged thereafter, whereas twisting velocities showed further increases to greater intensities. A novel finding is that LV twist was unaffected by incremental knee extension, yet systolic and diastolic twisting velocities augmented with isometric exercise.

  5. Ambulatory blood pressure and echocardiographic left ventricular dimensions in elderly hypertensive subjects.

    Science.gov (United States)

    Rizzo, V; Piccirillo, G; Cicconetti, P; Bianchi, A; Capponi, L; Salza, M C; Cacciafesta, M; Marigliano, V

    1996-10-01

    In a consecutive series of 62 hypertensive elderly subjects, the authors studied the relation of blood pressure circadian variations with echocardiographic parameters of left ventricular (LV) hypertrophy. All the subjects were submitted to an ambulatory blood pressure monitoring (ABPM) and to B- and M-mode echocardiography. In the elderly hypertensive group, LV mass index (LVMI) was more strongly related to twenty-four-hour, daytime and nighttime systolic ambulatory blood pressure (r = 0.52, r = 0.37, r = 0.51) than diastolic ambulatory blood pressures were (r = 0.32, r = 0.18, r = 0.33). Casual systolic and diastolic blood pressure (CBP) was found more weakly related to LVMI than ambulatory blood pressures were (r = 0.35, r = 0.26). Elderly hypertensive subjects were divided into two subgroups in relation to the presence (group 1) or absence (group 2) of blood pressure nocturnal decline. No differences were found between these two subgroups in regard to: casual blood pressure values, ambulatory blood pressures in the diurnal period, sex, body surface area, height, weight, and age. LVMIs were computed in all three groups and showed the following results: 89.32 +/- 19.76 in elderly normotensives, 91.21 +/- 31.32 in group 1, and 99.80 +/- 18.21 in group 2. Echocardiographic parameters of LV dimensions and LVMIs were different in group 1 and 2. An inverse correlation, statistically significant, was observed between LVMIs and the nocturnal blood pressure reduction (systolic: r = -0.36, P < 0.05; diastolic: r = -0.29, P < 0.05). These results suggest an association between a smaller LV mass and nocturnal blood pressure decline in elderly hypertensive patients.

  6. Role of left ventricular twist mechanics in cardiomyopathies, dance of the helices

    Institute of Scientific and Technical Information of China (English)

    Floris; Kauer; Marcel; Leonard; Geleijnse; Bastiaan; Martijn; van; Dalen

    2015-01-01

    Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in "the cardiology community" as it comes to twist mechanics. Fortunately the development of speckle tracking echocardiography, allowing accurate, reproducible and rapid bedside assessment of left ventricular twist, has boosted the interest in this important mechanical aspect of left ventricular deformation. Although the fundamental physiological role of left ventricular twist is undisputable, the clinical relevance of assessment of left ventricular twist in cardiomyopathies still needs to be established. The fact remains; analysis of left ventricular twist mechanics has already provided substantial pathophysiological understanding on a comprehensive variety of cardiomyopathies. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial(microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the "diagnostic toolbox" for cardiomyopathies.

  7. [Automatic calculation of left ventricular volume and ejection fraction from gated myocardial perfusion SPECT--basic evaluation using phantom].

    Science.gov (United States)

    Kinoshita, Y; Nanbu, I; Tohyama, J; Ooba, S

    1998-02-01

    We evaluated accuracy of Quantitative Gated SPECT Program that enabled calculation of the left ventricular (LV) volume and ejection fraction by automatically tracing the contour of the cardiac surface. Cardiac phantoms filled with 99mTc-solution were used. Data acquisition was made by 180-degree projection in L type and 360-degree projection in opposed type. Automatic calculation could be done in all processes, which required 3-4 minutes. Reproducibility was sufficient. The adequate cut off value of a prefilter was 0.45. At this value LV volume was 93% of the actual volume in L type acquisition and 95.9% in opposed type acquisition. The LV volume obtained in L type was smaller than that obtained in opposed type (p defects was fair, on the cardiac phantoms with all of 90-degree defects and 180-degree defects of the septal and lateral wall. The LV volume was estimated to be larger on the phantom with 180-degree defect of the anterior wall, and to be smaller on the phantom of 180-degree defect of the inferoposterior wall. Because tracing was deviated anteriorly at the defects. In the patients with similar conditions to 180-degree defect of the anterior wall or inferoposterior wall, the LV volume should be carefully evaluated.

  8. Automatic calculation of left ventricular volume and ejection fraction from gated myocardial perfusion SPECT. Basic evaluation using phantom

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, Yoshimi; Nanbu, Ichirou [Nagoya Daini Red Cross Hospital (Japan); Tohyama, Junko; Ooba, Satoru

    1998-02-01

    We evaluated accuracy of Quantitative Gated SPECT Program that enabled calculation of the left ventricular (LV) volume and ejection fraction by automatically tracing the contour of the cardiac surface. Cardiac phantoms filled with {sup 99m}Tc-solution were used. Data acquisition was made by 180-degree projection in L type and 360-degree projection in opposed type. Automatic calculation could be done in all processes, which required 3-4 minutes. Reproducibility was sufficient. The adequate cut off value of a prefilter was 0.45. At this value LV volume was 93% of the actual volume in L type acquisition and 95.9% in opposed type acquisition. The LV volume obtained in L type was smaller than that obtained in opposed type (p<0.05). The tracing of the defects was fair, on the cardiac phantoms with all of 90-degree defects and 180-degree defects of the septal and lateral wall. The LV volume was estimated to be larger on the phantom with 180-degree defect of the anterior wall, and to be smaller on the phantom of 180-degree defect of the inferoposterior wall. Because tracing was deviated anteriorly at the defects. In the patients with similar conditions to 180-degree defect of the anterior wall or inferoposterior wall, the LV volume should be carefully evaluated. (author)

  9. Effects of injectable anesthetic combinations on left ventricular function and cardiac morphology in Sprague-Dawley rats.

    Science.gov (United States)

    Sabatini, Carla F; O'Sullivan, M Lynne; Valcour, James E; Sears, William; Johnson, Ron J

    2013-01-01

    Novel anesthetic agents or combinations may provide superior general anesthesia for echocardiography in rodents with the potential for reduced adverse effects. This study sought to characterize the effects of 3 injectable anesthetics on left ventricular (LV) systolic function and cardiac morphology in healthy male and female rats. Rats underwent echocardiographic assessment after general anesthesia via pentobarbital or combinations of ketamine and medetomidine (KME) and ketamine and midazolam (KMI) according to a crossover Latin-square design. Blood samples for serum estradiol measurements were obtained from all females after echocardiography with each anesthetic. Rats given KMI showed superior LV systolic function with the highest values for fractional shortening (FS), ejection fraction (EF) and stroke volume, whereas heart rate was greatest with pentobarbital, followed by KMI and then KME. KME produced the greatest effects on cardiac morphology, most notably during systole, including reduced septal and posterior wall thickness and increased LV chamber dimensions and volumes. In addition, KME had the greatest cardiac-depressing effects on LV systolic function, including reduced FS, EF, and heart rate values. Compared with male rats, female rats had superior LV function with greater EF and FS values, whereas male rats showed higher heart rate. Significant negative correlations were noted between serum estradiol levels and FS and EF values in female rats receiving KME. We conclude that the combination of KMI may be a superior anesthetic for use in male and female rats undergoing echocardiography.

  10. Effects of nicardipine on coronary blood flow, left ventricular inotropic state and myocardial metabolism in patients with angina pectoris.

    Science.gov (United States)

    Rousseau, M F; Vincent, M F; Cheron, P; van den Berghe, G; Charlier, A A; Pouleur, H

    1985-01-01

    The effects of intravenous nicardipine (2.5 mg) on the left ventricular (LV) inotropic state, LV metabolism, and coronary haemodynamics were analysed in 22 patients with angina pectoris. Measurements were made at fixed heart rate (atrial pacing), under basal state, and during a cold pressor test. After nicardipine, coronary blood flow and oxygen content in the coronary sinus increased significantly. The indices of inotropic state increased slightly, and the rate of isovolumic LV pressure fall improved. Myocardial oxygen consumption was unchanged despite the significant reduction in pressure-rate product, but LV lactate uptake increased, particularly during the cold pressor test. When nicardipine was administered after propranolol, the indices of inotropic state were unaffected. The lack of direct effect of nicardipine on LV inotropic state was further confirmed by intracoronary injection of 0.1 and 0.2 mg in a separate group of 10 patients. It is concluded that the nicardipine-induced coronary dilatation seems to improve perfusion and aerobic metabolism in areas with chronic ischaemia, resulting in reduced lactate production and augmented oxygen consumption.

  11. Progression of Left Ventricular Dysfunction and Remodelling under Optimal Medical Therapy in CHF Patients: Role of Individual Genetic Background

    Directory of Open Access Journals (Sweden)

    Marzia Rigolli

    2011-01-01

    Full Text Available Background. Neurohormonal systems play an important role in chronic heart failure (CHF. Due to interindividual heterogeneity in the benefits of therapy, it may be hypothesized that polymorphisms of neurohormonal systems may affect left ventricular (LV remodelling and systolic function. We aimed to assess whether genetic background of maximally treated CHF patients predicts variations in LV systolic function and volumes. Methods and Results. We prospectively studied 131 CHF outpatients on optimal treatment for at least six months. Echocardiographic evaluations were performed at baseline and after 12 months. Genotype analysis for ACE I/D, β1adrenergic receptor (AR Arg389Gly, β2AR Arg16Gly, and β2AR Gln27Glu polymorphisms was performed. No differences in baseline characteristics were detected among subgroups. ACE II was a significant predictor of improvement of LV end-diastolic and end-systolic volume (=.003 and =.002, respectively but not of LV ejection fraction (LVEF; β1AR389 GlyGly was related to improvement of LVEF (=.02 and LV end-systolic volume (=.01. The predictive value of polymorphisms remained after adjustment for other clinically significant predictors (<.05 for all. Conclusions. ACE I/D and β1AR Arg389Gly polymorphisms are independent predictors of reverse remodeling and systolic function recovery in CHF patients under optimal treatment.

  12. Prevalence, pattern, and functional impact of late gadolinium enhancement in left ventricular hypertrophy due to aortic valve stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Nassenstein, K.; Schlosser, T. [Universitaetsklinikum Essen (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Bruder, O. [Elisabeth-Krankenhaus Essen (Germany). Klinik fuer Kardiologie und Angiologie; Breuckmann, F.; Erbel, R. [Universitaetsklinikum Essen (Germany). Westdeutsches Herzzentrum Essen; Barkhausen, J. [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Radiologie und Nuklearmedizin

    2009-05-15

    Purpose: To assess the prevalence and pattern of myocardial late gadolinium enhancement (LGE) and its functional impact on patients with left ventricular hypertrophy caused by aortic valve stenosis. Materials and Methods: Cardiac magnetic resonance imaging of 40 patients (17 female, 23 male, mean age: 76.6 {+-} 22.5 years) with known aortic valve stenosis (mean aortic valve area: 89.8 {+-} 19.2 mm{sup 2}) and without coronary artery disease was performed at 1.5 T using steady-state free precession sequences for aortic valve planimetry and for the assessment of left ventricular (LV) volumes and mass. Ten to 15 minutes after injection of 0.2 mmol Gd-DTPA per kilogram body weight, inversion-recovery prepared spoiled gradient echo images were acquired in standard long and short axis views to detect areas of LGE. Results: LGE was observed in 32.5 % (13/40) of our patients. LGE was mainly located in the basal septal and inferior LV segments, and showed a non-ischemic pattern with sparing of the subendocardial region. Patients with LGE showed lower LV ejection fractions (55.5 {+-} 13.8 % vs. 69.1 {+-} 10.7 %, p = 0.0014), higher LV end-systolic volumes (59.8 {+-} 33.3 ml vs. 36.6 {+-} 16.0 ml, p = 0.0048), and LV masses (211.0 {+-} 13.8 vs. 157.9 {+-} 37.5 g, p = 0.0002) compared to patients without LGE. (orig.)

  13. Correlation of pulse wave velocity with left ventricular mass in patients with hypertension once blood pressure has been normalized

    Directory of Open Access Journals (Sweden)

    Siu H. Chan

    2012-02-01

    Full Text Available Vascular stiffness has been proposed as a simple method to assess arterial loading conditions of the heart which induce left ventricular hypertrophy (LVH. There is some controversy as to whether the relationship of vascular stiffness to LVH is independent of blood pressure, and which measurement of arterial stiffness, augmentation index (AI or pulse wave velocity (PWV is best. Carotid pulse wave contor and pulse wave velocity of patients (n=20 with hypertension whose blood pressure (BP was under control (<140/90 mmHg with antihypertensive drug treatment medications, and without valvular heart disease, were measured. Left ventricular mass, calculated from 2D echocardiogram, was adjusted for body size using two different methods: body surface area and height. There was a significant (P<0.05 linear correlation between LV mass index and pulse wave velocity. This was not explained by BP level or lower LV mass in women, as there was no significant difference in PWV according to gender (1140.1+67.8 vs 1110.6+57.7 cm/s. In contrast to PWV, there was no significant correlation between LV mass and AI. In summary, these data suggest that aortic vascular stiffness is an indicator of LV mass even when blood pressure is controlled to less than 140/90 mmHg in hypertensive patients. The data further suggest that PWV is a better proxy or surrogate marker for LV mass than AI and the measurement of PWV may be useful as a rapid and less expensive assessment of the presence of LVH in this patient population.

  14. Implantation of left ventricular assist device complicated by undiagnosed thrombophilia.

    Science.gov (United States)

    Szarszoi, Ondrej; Maly, Jiri; Turek, Daniel; Urban, Marian; Skalsky, Ivo; Riha, Hynek; Maluskova, Jana; Pirk, Jan; Netuka, Ivan

    2012-01-01

    A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.

  15. Assessment of the Effect of Cardiomyocyte Transplantation on Left Ventricular Remodeling and Function in Post-Infarction Wister Rats by Using High-frequency Ultrasound

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing; XIE Mingxing; WANG Xinfang; L(U) Qing; LANG Mingjian; DENG Binhua

    2007-01-01

    The effects of cardiomyocyte grafting on left ventricular (LV) remodeling and function in rats with chronic myocardial infarction were evaluated using high-frequency ultrasound. Chronic myocardial infarction was induced in 50 Wister rats by ligating the left anterior descending artery. They were randomized into two groups: a trial group that received neonatal rat cardiomyocyte trans- plantation (n=25) and a control group which were given intramyocardial injection of culture medium (n=25). The left ventricular (LV) geometry and function were evaluated by high-frequency ultrasound before and 4 weeks after the cell transplantation. After the final evaluation, all rats were sacrificed for histological study. The results showed that 4 weeks after the cell transplantation, as compared with the control group, the LV end-systolic dimension, end-diastolic dimension, end-systolic volume and end-diastolic volume were significantly decreased and the LV anterior wall end-diastolic thickness, LV ejection fraction and fractional shortening were significantly increased in the trial group (P<0.01). Histological study showed that transplanted neonatal rat cardiomyocytes were found in all host hearts and identified by Brdu staining. It was suggested that transplantation of neonatal rat cardiomyocytes can reverse cardiac remodeling and improve heart function in chronic myocardial infarction rats. High-frequency ultrasound can be used as a reliable technique for the non-invasive evaluation of the effect of cardiomyocyte transplantation.

  16. Genetic heterogeneity of left-ventricular noncompaction cardiomyopathy.

    Science.gov (United States)

    Moric-Janiszewska, Ewa; Markiewicz-Łoskot, Grazyna

    2008-05-01

    Isolated noncompaction of the ventricular myocardium (INVM) sometimes referred to as spongy myocardium is a rare, congenital and also acquired cardiomyopathy. It appears to divide the presentation into neonatal, childhood and adult forms of which spongy myocardium and systolic dysfunction is the commonality. The disorder is characterized by a left ventricular hypertrophy with deep trabeculations, and with diminished systolic function, with or without associated left ventricular dilation. In half or more of the cases, the right ventricle is also affected. The sporadic type, however, in some patients, may be due to chromosomal abnormalities and the occurrence of familial incidence. Isolated noncompaction of the left ventricular myocardium in the majority of adult patients is an autosomal dominant disorder. The familial and X-linked disorders have been described by various authors. We here describe the genetic background of this disorder: some of the most mutated genes that are responsible for the disease are (G4.5 (tafazzin gene): alpha-dystrobrevin gene (DTNA); FKBP-12 gene; lamin A/C gene; Cypher/ZASP (LIM, LDB3) gene); and some genotype-phenotype correlations (Becker muscular dystrophy, Emery-Dreifuss muscular dystrophy or Barth syndrome) based on the literature review.

  17. New three-dimensional speckle-tracking echocardiography identifies global impairment of left ventricular mechanics with a high sensitivity in childhood cancer survivors.

    Science.gov (United States)

    Yu, Hong-kui; Yu, Wei; Cheuk, Daniel K L; Wong, Sophia J; Chan, Godfrey C F; Cheung, Yiu-fai

    2013-08-01

    The aim of this case-control study was to assess the usefulness of three-dimensional (3D) speckle-tracking echocardiography in the evaluation of global left ventricular (LV) myocardial performance in adolescent and adult survivors of childhood cancers. Fifty-three anthracycline-treated survivors of childhood cancers (mean age, 18.6 ± 5.1 years) and 38 controls were studied. Three-dimensional speckle-tracking echocardiography was performed to assess LV 3D global and segmental strain, time to peak segmental 3D strain, LV torsion, and ejection fraction. LV systolic dyssynchrony index (SDI) was calculated as the percentage of the standard deviation of times to peak strain of the 16 segments divided by the RR interval. A global performance index (GPI) was calculated as (global 3D strain × torsion)/SDI. The area under the receiver operating characteristic curve was calculated to determine the capability of various echocardiographic indices to discriminate between patients and controls. Compared with controls, patients had significantly reduced LV global 3D strain (P speckle-tracking echocardiography enables the derivation of an index of LV global performance that incorporates LV 3D strain, dyssynchrony, and torsion for the sensitive detection of altered LV mechanics in childhood cancer survivors. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  18. Echocardiographic evaluation of changes in left ventricular size and valvular regurgitation associated with physical training during and after maturity in Standardbred trotters.

    Science.gov (United States)

    Buhl, Rikke; Ersbøll, Annette Kjær

    2012-01-15

    To assess whether physical training induces cardiac hypertrophy and valvular regurgitation in maturing Standardbred trotters and to establish a prediction model for the size of the left ventricle. Longitudinal observational study. 53 Standardbred trotters. Each horse underwent 2-D, M-mode, and color flow Doppler echocardiography at 5.5 years of age; previously, each horse had been examined at 2, 2.5, 3, and 3.5 (time of maturity) years of age. Horses were or were not in training or racing for variable periods during the entire assessment period; data for a given horse were assigned to 1 of 2 groups on the basis of the horse's status at the fifth examination (racing [n = 40] or not racing [13]). At each examination, left ventricular (LV) internal diameter in diastole (LVIDd), LV mass, and mean and relative LV wall thicknesses were measured. Prevalence and severity of tricuspid, pulmonary, mitral, and aortic valve regurgitation were determined. During the assessment period, LVIDd, LV mass, and mean LV wall thickness increased; body weight was significantly associated with those variables. Prediction of LV mass was possible when sex and weight were included in the model. Prevalence of valvular regurgitation increased for all valves. An increased risk of development of tricuspid and pulmonary valve regurgitation for horses in racing was observed. The LV mass and prevalence of valvular regurgitation increased (indicative of development of exercise-induced cardiac hypertrophy and valvular regurgitation) in young horses, even during the latter part of the assessment period, when maturity was attained.

  19. Prevalence of left ventricular dyssynchrony in patients with heart failure assessed by a novel programmer-cardioGRAF

    Institute of Scientific and Technical Information of China (English)

    Can-Zhan Zhu; Naoto Takahashi; Akira Yamamoto; Masahira Ishikawa; Naomi Kawaguchi; Takahiro Uchida; Kazuo Munakata

    2009-01-01

    Objectives Left ventricular systolic dyssynchrony is the most important determinant of response to cardiac resynchronization therapy (CRT), playing a vital role to predict improvement of systolic function or LV reverse remodeling. CardioGRAF is a novel programmer based on the ECG gated single photon emission computed tomography (G-SPECT) imaging to detect LV systolic and diastolic dyssynchrony simultaneously. This study was to investigate the prevalence of systolic and diastolic left ventricular (LV) dyssynchrony in patients with heart failure. Methods We retrospectively studied 69 patients with heart disease, including 31 patients who had symptoms of heart failure (NYHA class Ⅱ-Ⅲ), and 38 patients who had no symptoms of heart failure (NYHA class Ⅰ). G-SPECT data were analyzed by cardiaGRAF, and measurements included the time to end systole (TES), the time to peak ejection (TPE), the time to peak filling (TPF), TES+TPF and maximal difference (MD) of each parameters were obtained, using the 95th percentile of the control group as a cutoffof 150 ms for MD-TES, 139 ms for MD-TPE, 345 ms for MD-TPF and 315 ms for MD-TES+TPF. Results The prevalence of LV systolic dyssynchrony was significantly higher in heart failure patients with reduced LV ejection fraction (LVEF)<45% (72% for MD-TES; 64% for MD-TPE) compared with heart failure patients with preserved LVEF=45% (14% for both MD-TES and MD-TPE; P=0.002, P=0.005, respectively); The prevalence of MD-TES<150 ms was higher in NYHA class Ⅲ patients (64%) compared with NYHA class Ⅱ patients (27%, P=0.049). However, the prevalence of the LV diastolic dyssynchrony were high but not difference between NYHA class Ⅲ(47% for both MD-TPF and MD-TES+TPF) and class Ⅲ(63% for MD-TPF; 69% for MD-TES+TPF; P=NS) patients as well as between patients with preserved LVEF (43% for both MD-TPF and MD-TES+TPF) and patients with reduced LVEF(64% for MD-TPF; 72% for MD-TES+TPF; P=NS). Conclusions The prevalence of LV systolic

  20. Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Gerdts, Eva; Okin, Peter M; Boman, Kurt

    2012-01-01

    The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.......The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain....

  1. Insulin resistance syndrome and left ventricular mass in an elderly population (The Rotterdam Study)

    NARCIS (Netherlands)

    Rheeder, P; Stolk, RP; Mosterd, A; Pols, HAP; Hofman, A; Grobbee, DE

    1999-01-01

    In a study of elderly men and women, age, body mass index, and systolic blood pressure (and in men, also glucose) were significant predictors of left ventricular mass. Postload insulin was not independently associated with left ventricular mass.

  2. Differences in global and regional left ventricular myocardial mechanics in various morphologic subtypes of patients with obstructive hypertrophic cardiomyopathy referred for ventricular septal myotomy/myectomy.

    Science.gov (United States)

    Kobayashi, Taisei; Dhillon, Ashwat; Popovic, Zoran; Bhonsale, Aditya; Smedira, Nicholas G; Thamilarasan, Maran; Lytle, Bruce W; Lever, Harry M; Desai, Milind Y

    2014-06-01

    Patients with obstructive hypertrophic cardiomyopathy (HC) have various left ventricular (LV) shapes: reverse septal curvature (RSC, commonly familial), sigmoid septum (SS, common in hypertensives), and concentric hypertrophy (CH). Longitudinal (systolic and early diastolic) strain rate (SR) is sensitive in detecting regional myocardial dysfunction. We sought to determine differences in longitudinal SR of patients with obstructive HC, based on LV shapes. We studied 199 consecutive patients with HC (50% men) referred for surgical myectomy. Clinical and echocardiographic parameters were recorded. LV shapes were classified on echocardiography, using basal septal 1/3 to posterior wall ratio: RSC = ratio >1.3 (extending to mid and distal septum), SS = ratio >1.3 (extending only to basal 1/3), and concentric = ratio ≤1.3. Longitudinal systolic and early diastolic SRs were measured from apical 4- and 2-chamber views (VVI 2.0; Siemens, Erlangen). Distribution of RSC, SS, and CH was 50%, 28%, and 22%, respectively. Patients with RSC were significantly younger (47 ± 12 vs 64 ± 10 and 57 ± 11, respectively) with lower hypertension (40% vs 71% and 67%, respectively) than patients with SS or CH (both p RSC had lower global systolic (-0.99 ± 0.3 vs -1.05 ± 0.3 and -1.17 ± 0.3) and early diastolic SR (0.95 ± 0.4 vs 0.98 ± 0.3 and 1.16 ± 0.4) versus patients with SS and CH (in 1/s, both p RSC was associated with abnormal global LV systolic (beta 0.16) and early diastolic (beta -0.17) SR (both p <0.01). In conclusion, patients with HC with RCS have significantly abnormal LV mechanics, despite being younger and less hypertensive. A combination of LV mechanics and shapes could help differentiate between genetically mediated and other causes of obstructive HC.

  3. Iron overload in polytransfused patients without heart failure is associated with subclinical alterations of systolic left ventricular function using cardiovascular magnetic resonance tagging

    Directory of Open Access Journals (Sweden)

    Vanoverschelde Jean-Louis

    2011-04-01

    Full Text Available Abstract Background It remains incompletely understood whether patients with transfusion related cardiac iron overload without signs of heart failure exhibit already subclinical alterations of systolic left ventricular (LV dysfunction. Therefore we performed a comprehensive evaluation of systolic and diastolic cardiac function in such patients using tagged and phase-contrast CMR. Methods 19 patients requiring regular blood transfusions for chronic anemia and 8 healthy volunteers were investigated using cine, tagged, and phase-contrast and T2* CMR. LV ejection fraction, peak filling rate, end-systolic global midventricular systolic Eulerian radial thickening and shortening strains as well as left ventricular rotation and twist, mitral E and A wave velocity, and tissue e' wave and E/e' wave velocity ratio, as well as isovolumic relaxation time and E wave deceleration time were computed and compared to cardiac T2*. Results Patients without significant iron overload (T2* > 20 ms, n = 9 had similar parameters of systolic and diastolic function as normal controls, whereas patients with severe iron overload (T2* 20 ms or normal controls. Patients with moderate iron overload (T2* 10-20 ms, n = 5, had preserved ejection fraction (59 ± 6%, p = NS vs. pts. with T2* > 20 ms and controls, but showed reduced maximal LV rotational twist (1.8 ± 0.4 degrees. The magnitude of reduction of LV twist (r = 0.64, p Conclusion Multiple transfused patients with normal ejection fraction and without heart failure have subclinical alterations of systolic and diastolic LV function in direct relation to the severity of cardiac iron overload. Among all parameters, left ventricular twist is affected earliest, and has the highest correlation to log (T2*, suggesting that this parameter might be used to follow systolic left ventricular function in patients with iron overload.

  4. Fourier coefficient description of left ventricular shape.

    Science.gov (United States)

    Round, W H; Bates, R H; Ikram, H

    1991-12-01

    A method of quantifying the shape of the left ventricle of the heart as seen in 2D echocardiograms was developed. It is based on describing the shape in terms of the coefficients a fifth-order trigonometric Fourier series. Such a series has eleven Fourier coefficients which is too large a number for clinical application so pairs of coefficients are combined to give six coefficients (alpha 0, alpha 1, ... , alpha 5). A trial was conducted to test the ability of the coefficient description to classify subjects as having normal right ventricles or ventricles with an apical abnormality. The tests showed that one of the coefficients (alpha 2) was higher for the subjects with an apical abnormality and that this difference increased with exercise. This is as was expected. However, it was found to be difficult to get a reliable estimate of alpha 2 from a single scan of a patient and that it is therefore probably necessary to average data from several scans to obtain a reliable alpha 2 value for a single patient.

  5. Dihydroxyflavonol reduces post-infarction left ventricular remodeling by preventing myocyte apoptosis in the non-infarcted zone in goats

    Institute of Scientific and Technical Information of China (English)

    WANG Sheng; FEI Ke; XU Ya-wei; WANG Liang-xu; Chen Yan-qin

    2009-01-01

    Background Myocyte apoptosis is considered to be the major causative factor of left ventricular (LV) remodeling following myocardial infarction (MI). We previously reported that 3', 4'-dihydroxyflavonol (DiOHF), was able to suppress oxidative stress and preserve the expression of endothelial nitric oxide synthase during myocardial reperfusion injury, which may benefit the reduction of myocyte apoptosis. We therefore aimed to evaluate the potential actions of DiOHF against myocyte apoptosis and post-infarction LV remodeling in this study. Methods Following experimental MI, surgical instrumented goats were randomly assigned into vehicle and DiOHF (2 mg/kg; i.v., daily) groups to receive 4 weeks of reperfusion with corresponding treatments. LV pressure recordings and echocardiogram were performed at baseline, 2 and 4 weeks of reperfusion. Myocardial tissues were collected in the end to determine infarct size and apoptosis related assays. Results LV end-diastolic volume and diameter were significantly increased 4 weeks after MI in the vehicle group, accompanied by reduced posterior wall thickness, septal thickness and LV mass, whereas those changes were markedly prevented by DiOHF treatment. Similarly, significantly reduced infarct size was found in DiOHF group as compared to vehicle group, and DiOHF dramatically inhibited the increase in LV end-diastolic pressure and the reductions in ejection fraction, fraction shortening and dP/dtmax. Moreover, DiOHF treatment significantly reduced the extent of myocyte apoptosis detected by TUNEL assay, enhanced the protein expression of caspase-3, Fas, Bax and cytochrome c in the non-infarcted myocardium in comparison to vehicle. Conclusions Daily DiOHF treatment during the reperfusion period after MI in the ovine hearts markedly reduced the magnitude of post-infarction LV remodeling through the inhibition of myocyte apoptosis in the remote non-infarcted myocardium.

  6. Effect of Papillary Muscles and Trabeculae on Left Ventricular Measurement Using Cardiovascular Magnetic Resonance Imaging in Patients with Hypertrophic Cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Eun-Ah; Lee, Whal [Department of Radiology, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744 (Korea, Republic of); Kim, Hyung-Kwan [Department of Internal Medicine, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744 (Korea, Republic of); Chung, Jin Wook [Department of Radiology, Cardiovascular Division, Seoul National University Hospital, Seoul 110-744 (Korea, Republic of)

    2015-11-01

    To evaluate the influence of papillary muscles and trabeculae on left ventricular (LV) cardiovascular magnetic resonance (CMR) analysis using three methods of cavity delineation (classic or modified inclusion methods, and the exclusion method) in patients with hypertrophic cardiomyopathy (HCM). This retrospective study included 20 consecutive HCM patients who underwent 1.5-T CMR imaging with short-axis cine stacks of the entire LV. LV measurements were performed using three different methods of manual cavity delineation of the endocardial and epicardial contours: method A, presumed endocardial boundary as seen on short-axis cine images; method B, including solely the cavity and closely adjacent trabeculae; or method C, excluding papillary muscles and trabeculae. Ascending aorta forward flow was measured as reference for LV-stroke volume (SV). Interobserver reproducibility was assessed using intraclass correlation coefficients. Method A showed larger end-diastole and end-systole volumes (largest percentage differences of 25% and 68%, respectively, p < 0.05), compared with method C. The ejection fraction was 55.7 ± 6.9% for method A, 68.6 ± 8.4% for B, and 71.7 ± 7.0% for C (p < 0.001). Mean mass was also significantly different: 164.6 ± 47.4 g for A, 176.5 ± 50.5 g for B, and 199.6 ± 53.2 g for C (p < 0.001). LV-SV error was largest with method B (p < 0.001). No difference in interobserver agreement was observed (p > 0.05). In HCM patients, LV measurements are strikingly different dependent on whether papillary muscles and trabeculae are included or excluded. Therefore, a consistent method of LV cavity delineation may be crucial during longitudinal follow-up to avoid misinterpretation and erroneous clinical decision-making.

  7. Meta-analysis of randomized controlled trials comparing isolated left ventricular and biventricular pacing in patients with chronic heart failure.

    Science.gov (United States)

    Liang, Yixiu; Pan, Wenzhi; Su, Yangang; Ge, Junbo

    2011-10-15

    Cardiac resynchronization therapy (CRT) has been mostly achieved by biventricular pacing (BVP) in patients with chronic heart failure (CHF), although it can also be provided by left ventricular pacing (LVP). The superiority of BVP over LVP remains uncertain. The present meta-analysis of randomized controlled trials was performed to compare the effects of LVP to BVP in patients with CHF. Outcomes analyzed included clinical status (6-minute walk distance, peak oxygen consumption, quality of life, New York Heart Association class), LV function (LV ejection fraction), and LV remodeling (LV end-systolic volume). Five trials fulfilled criteria for inclusion in analysis, which included 574 patients with CHF indicated for CRT. After a midterm follow-up, pooled analysis demonstrated that LVP resulted in similar improvements in 6-minute walk distance (weighted mean difference [WMD] 11.25, 95% confidence interval [CI] -12.39 to 34.90, p = 0.35), quality of life (WMD 0.34, 95% CI -3.72 to 4.39, p = 0.87), peak oxygen consumption (WMD 1.00, 95% CI -0.84 to 2.85, p = 0.29), and New York Heart Association class (WMD -0.19, 95% CI -0.79 to 0.42, p = 0.54). There was a trend toward a superiority of BVP over LVP for LV ejection fraction (WMD 1.28, 95% CI -0.11 to 2.68, p = 0.07) and LV end-systolic volume (WMD -5.73, 95% CI -11.86 to 0.39, p = 0.07). In conclusion, LVP achieves similar improvement in clinical status as BVP in patients with CHF, whereas there was a trend toward superiority of BVP over LVP for LV reverse modeling and systolic function.

  8. A model-based time-reversal of left ventricular motion improves cardiac motion analysis using tagged MRI data

    Directory of Open Access Journals (Sweden)

    Cook Larry T

    2008-05-01

    Full Text Available Abstract Background Myocardial motion is an important observable for the assessment of heart condition. Accurate estimates of ventricular (LV wall motion are required for quantifying myocardial deformation and assessing local tissue function and viability. Harmonic Phase (HARP analysis was developed for measuring regional LV motion using tagged magnetic resonance imaging (tMRI data. With current computer-aided postprocessing tools including HARP analysis, large motions experienced by myocardial tissue are, however, often intractable to measure. This paper addresses this issue and provides a solution to make such measurements possible. Methods To improve the estimation performance of large cardiac motions while analyzing tMRI data sets, we propose a two-step solution. The first step involves constructing a model to describe average systolic motion of the LV wall within a subject group. The second step involves time-reversal of the model applied as a spatial coordinate transformation to digitally relax the contracted LV wall in the experimental data of a single subject to the beginning of systole. Cardiac tMRI scans were performed on four healthy rats and used for developing the forward LV model. Algorithms were implemented for preprocessing the tMRI data, optimizing the model parameters and performing the HARP analysis. Slices from the midventricular level were then analyzed for all systolic phases. Results The time-reversal operation derived from the LV model accounted for the bulk portion of the myocardial motion, which was the average motion experienced within the overall subject population. In analyzing the individual tMRI data sets, removing this average with the time-reversal operation left small magnitude residual motion unique to the case. This remaining residual portion of the motion was estimated robustly using the HARP analysis. Conclusion Utilizing a combination of the forward LV model and its time reversal improves the performance of

  9. Relationship between site of myocardial infarction, left ventricular function and cytokine levels in patients undergoing coronary artery surgery.

    Science.gov (United States)

    Kiris, Ilker; Kapan, Sahin; Narin, Cuneyt; Ozaydın, Mehmet; Cure, Medine Cumhur; Sutcu, Recep; Okutan, Huseyin

    The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.

  10. Physiological and pathological left ventricular hypertrophy of comparable degree is associated with characteristic differences of in vivo hemodynamics.

    Science.gov (United States)

    Oláh, Attila; Németh, Balázs Tamás; Mátyás, Csaba; Hidi, László; Lux, Árpád; Ruppert, Mihály; Kellermayer, Dalma; Sayour, Alex Ali; Szabó, Lilla; Török, Marianna; Meltzer, Anna; Gellér, László; Merkely, Béla; Radovits, Tamás

    2016-03-01

    Left ventricular (LV) hypertrophy is a physiological or pathological response of LV myocardium to increased cardiac load. We aimed at investigating and comparing hemodynamic alterations in well-established rat models of physiological hypertrophy (PhyH) and pathological hypertrophy (PaH) by using LV pressure-volume (P-V) analysis. PhyH and PaH were induced in rats by swim training and by abdominal aortic banding, respectively. Morphology of the heart was investigated by echocardiography. Characterization of cardiac function was completed by LV P-V analysis. In addition, histological and molecular biological measurements were performed. Echocardiography revealed myocardial hypertrophy of similar degree in both models, which was confirmed by post-mortem heart weight data. In aortic-banded rats we detected subendocardial fibrosis. Reactivation of fetal gene program could be observed only in the PaH model. PhyH was associated with increased stroke volume, whereas unaltered stroke volume was detected in PaH along with markedly elevated end-systolic pressure values. Sensitive indexes of LV contractility were increased in both models, in parallel with the degree of hypertrophy. Active relaxation was ameliorated in athlete's heart, whereas it showed marked impairment in PaH. Mechanical efficiency and ventriculo-arterial coupling were improved in PhyH, whereas they remained unchanged in PaH. Myocardial gene expression of mitochondrial regulators showed marked differences between PaH and PhyH. We provided the first comparative hemodynamic characterization of PhyH and PaH in relevant rodent models. Increased LV contractility could be observed in both types of LV hypertrophy; characteristic distinction was detected in diastolic function (active relaxation) and mechanoenergetics (mechanical efficiency), which might be explained by mitochondrial differences.

  11. Selective left ventricular sensing lead implantation to overcome undersensing of ventricular fibrillation during implantable cardioverter defibrillator implantation.

    Science.gov (United States)

    Steinberg, Christian; Philippon, François; O'Hara, Gilles; Molin, Franck

    2013-06-01

    Accurate sensing of malignant arrhythmia is critical for the appropriate delivery of therapy from implantable cardioverter defibrillators, and undersensing of ventricular tachyarrhythmias can have catastrophic consequences. Here, we present an unusual case of ventricular fibrillation undersensing from the right ventricular lead at multiple different implantation sites because of very low amplitude voltage signals during induced ventricular fibrillation. A left ventricular sensing electrode was implanted to allow correct sensing and therapy delivery.

  12. Improvement of impaired diastolic left ventricular function after diet-induced weight reduction in severe obesity

    Science.gov (United States)

    Karimian, Sevda; Stein, Juergen; Bauer, Boris; Teupe, Claudius

    2017-01-01

    Background/objectives Obesity is independently associated with left ventricular (LV) diastolic dysfunction and altered cardiac morphology. Morbidity and mortality in patients with diastolic dysfunction are similar to values observed in patients with systolic heart failure. We hypothesized that dysfunctional cardiac responses in people with obesity are reversible after weight loss. Thus, we studied the effect of dietary weight reduction on LV diastolic function as well as on cardiac structure using transthoracic echocardiography and tissue Doppler imaging (TDI). Subjects/methods Thirty-two subjects with obesity underwent a 12-week low-calorie fasting phase of a formula diet. Echocardiographic tissue Doppler indices of diastolic function and measurements of cardiac size were obtained prior to and after the fasting phase. Results A 12-week diet significantly reduced body mass index from 40.3 ± 6.6 kg/m2 to 33.2 ± 6.1 kg/m2 (p < 0.01). Weight loss was associated with a significant reduction in blood pressure and heart rate. Echocardiography revealed diastolic dysfunction in subjects with obesity, which was improved by dieting. After weight loss, trans-mitral Doppler echocardiography showed a significant reduction in A-wave velocity, from 65.8 ± 19.2 cm/s to 57.0 ± 16.8 cm/s, and an increase in E/A ratio from 1.2 ± 0.4 to 1.4 ± 0.5 (p < 0.01). TDI displayed a significantly lower a′-wave velocity (10.3 ± 2.3 cm/s and 8.9 ± 1.7 cm/s; p < 0.01). Left atrial and LV dimensions were normal and remained unchanged after weight loss. Conclusion Obesity is associated with diastolic dysfunction. A 12-week low-calorie diet with successful weight loss can reduce blood pressure and heart rate and partially normalize diastolic dysfunction. PMID:28123309

  13. Losartan reduced connexin43 expression in left ventricular myocardium of spontaneously hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    Li-li ZHAO; Hong-juan CHEN; Jun-zhu CHEN; Min YU; Yun-lan NI; Wei-fang ZHANG

    2008-01-01

    Objective: To assess the effect of angiotensin Ⅱ type 1 (AT1) receptor antagonist losartan on myocardium connexin43 (Cx43) gap junction (GJ) expression in spontaneously hypertensive rats (SHRs) and investigate possible mechanisms. Methods: Sixteen 9-week-old male SHRs and 8 age-matched male Wistar-Kyoto (WKY) rats were included in this study. SHRs were randomly divided into two groups to receive losartan at 30mg/(kg·d) by oral gavage once daily for 8 weeks (SHR-L) or vehicle (0.9% saline) to act as controls (SHR-V); WKY rats receiving vehicle for 8 weeks served as normotensive controls. At the end of the experiment, rats were sacrificed and the hearts were removed. Expressions of Cx43 and nuclear factor-kappaB p65 (NF-κB p65) proteins in all three groups were observed and further investigations on the effect of angiotensin Ⅱ type 1 receptor antagonist losartan (30mg/(kg·d), 8 weeks) on Cx43 expression were conducted with Western blot and immunohistochemistry. NF-κB p65 protein in nuclear extracts was determined by Western blot. Results: Left ventricular (LV) hypertrophy was prominent in SHRs, Cx43 and NF-κB p65 protein expressions were obviously upregulated and Cx43 distribution was dispersed over the cell surface. Treatment with losarton reduced the over-expressions of Cx43 and NF-κB p65 in LV myocardium. The distribution of Cx43 gap junction also became much regular and confined to intercalated disk after losartan treatment. Conclusion: Cx43 level was upregulated in LV myocardium of SHR during early stage of hypertrophy. Angiotensin Ⅱ type l receptor antagonist losartan prevented Cx43 gap junction remodeling in hypertrophied left ventricles, possibly through the NF-κB pathway.

  14. Abnormal glucose metabolism in acute myocardial infarction: influence on left ventricular function and prognosis

    DEFF Research Database (Denmark)

    Høfsten, Dan E; Løgstrup, Brian B; Møller, Jacob E

    2009-01-01

    tolerance test before discharge. LV function was assessed using echocardiographic measurements (LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, restrictive diastolic filling pattern, early transmitral flow velocity to early diastolic mitral annular velocity ratio [E/e'], and left...... atrial volume index) and by measuring plasma N-terminal pro-B-type natriuretic peptide levels. RESULTS: After adjustment for age and gender, a linear relationship between the degree of abnormal glucose metabolism was observed for each marker of LV dysfunction (p(trend)

  15. The Effect and Mechanism of Forsinopril on Ventricular Hypertrophy of SHR and Left Ventricular Pressure overloading Rat

    Institute of Scientific and Technical Information of China (English)

    黄恺; 戴闺柱

    2002-01-01

    The effects and mechanism of long-term angiotensin converting enzyme inhibitor (ACEI)Forsinopril on left ventricular hypertrophy of spontaneous hypertension rat (SHR) and left ventricular pressure overloading rat were studied. The left ventricular index (left ventricle weight/body weight) was used to evaluate left ventricular hypertrophy and the in situ hybridization to investigate the TGF-β1 gene expression in left ventricle. The results showed that Forsinopril significantly decreased the left ventricular index of both SHR and left ventricle pressure overloading rat. Forsinopril reduced the integral photic density of TGF-β1 gene statement from 2. 836± 0. 314 to 1.91 ± 0. 217(P<0.01, n=8 ) of SHR rat and from 3. 071±0. 456 to 2. 37640. 379 (P<0.01, n=8) of left ventricular pressure overloading rat respectively. It was concluded that Forsinopril could prevent the occurrence of left ventricular hypertrophy and reduce the TGF-β1 gene expression in left ventricle of both SHR and left ventricular pressure overloading rat significantly.

  16. ECONOMIC BENEFITS OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN PATIENTS WITH ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    E. I. Tarlovskaya

    2011-01-01

    Full Text Available Aim. To evaluate by modelling the economic benefits of left ventricular hypertrophy (LVH regression in patients with arterial hypertension (HT due to therapy with fixed combination of valsartan/amlodipine.  Material and methods. 20 patients (15 females and 5 males, aged 18 to 70 years with essential HT accompanied by metabolic syndrome with a history of previous ineffective antihypertensive therapy were included into the study. All patients were treated with fixed combination of amlodipine/valsartan in doses of 5/160 and 10/160 mg depending on blood pressure (BP level. Treatment duration was 24 weeks. Changes in BP level, LVH regression were assessed. Economic evaluation was performed on the basis of modelling with the specialized software Decision Tree 4.xla. Results. Effect of fixed amlodipine/valsartan combination therapy on LVH was used to estimate treatment effectiveness and to build the model. Patients were distributed according to left ventricular (LV mass (at baseline and after 24 weeks of therapy. Significant decrease in LV mass from 205.8±50.4 to 181.9±45.1 g (p<0.05 was revealed. The model took into account economic and frequency factors for 10 year prognosis: this therapy prevents 36 deaths, 6 strokes, 24 myocardial infarction per 1000 patients. Absence of need in treatment of these prevented events can save 2 516 772.42 RUR for every 1 000 patients. It would reduce the total costs per patient during 10 years. Conclusion. Treatment with amlodipine/valsartan single pill combination has not only clinical advantages, but also pharmacoeconomic benefits. This combination reduces risk of acute myocardial infarction and death more effectively. Treatment with fixed valsartan/amlodipine combination saves maximum years of life with less cost during 10 years. Despite of higher pharmacotherapy costs, fixed valsartan/amlodipine combination reduces total costs due to prevention of fatal and nonfatal cardiovascular events.

  17. Left ventricular hypertrophy: an initial response to myocardial injury.

    Science.gov (United States)

    Francis, G S; McDonald, K M

    1992-06-04

    The prevailing wisdom generally has been that the failing heart hypertrophies in response to increased wall stress. The increase in myocardial mass observed in heart failure is therefore a relatively late compensatory event geared to normalize wall stress. Although this is undoubtedly true, especially for heart failure resulting from a large anterior myocardial infarction accompanied by rapid left ventricular expansion, it is possible that an important form of hypertrophy occurs much earlier as an initial response to myocardial injury. One can hypothesize that the initial response to injury is a nonspecific phenotypic alteration of the cardiac myocyte to one of growth and development. Such changes may be driven by both trophic and mechanical forces and may be important in altering the architecture of the myocardial cell and surrounding cardiac interstitium. Preliminary data from a variety of models support the concept that neuroendocrine activity is an important component in the ventricular remodeling process, and that pharmacologic interventions designed to block systemic and tissue neuroendocrine activity may prevent excessive cardiac enlargement and its ultimate consequences. Because this concept has important implications for preventive cardiology, the results of several prevention trials, including the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS), Studies of Left Ventricular Dysfunction (SOLVD), and Survival and Ventricular Enlargement (SAVE) are awaited eagerly.

  18. Carotid artery longitudinal wall motion is associated with local blood velocity and left ventricular rotational, but not longitudinal, mechanics.

    Science.gov (United States)

    Au, Jason S; Ditor, David S; MacDonald, Maureen J; Stöhr, Eric J

    2016-07-01

    Recent studies have identified a predictable movement pattern of the common carotid artery wall in the longitudinal direction. While there is evidence that the magnitude of this carotid artery longitudinal wall motion (CALM) is sensitive to cardiovascular health status, little is known about the determinants of CALM The purpose of this integrative study was to evaluate the contribution of left ventricular (LV) cardiac motion and local blood velocity to CALM Simultaneous ultrasound measurements of CALM, common carotid artery mean blood velocity (MBV), and left ventricular motion were performed in ten young, healthy individuals (6 males; 22 ± 1 years). Peak anterograde CALM occurred at a similar time as peak MBV (18.57 ± 3.98% vs. 18.53 ± 2.81% cardiac cycle; t-test: P = 0.94; ICC: 0.79, P longitudinal displacement was not associated with peak CALM (r = 0.11, P = 0.77). These results suggest that the rotational mechanical movement of the LV base may be closely associated with longitudinal mechanics in the carotid artery. This finding may have important implications for interpreting the complex relationship between ventricular and vascular function.

  19. Longitudinal structural, functional, and cellular myocardial alterations with chronic centrifugal continuous-flow left ventricular assist device support.

    Science.gov (United States)

    Muthiah, Kavitha; Humphreys, David T; Robson, Desiree; Dhital, Kumud; Spratt, Phillip; Jansz, Paul; Macdonald, Peter S; Hayward, Christopher S

    2017-07-01

    Left ventricular assist device (LVAD) support triggers adaptations within failing hearts. The HeartWare (HeartWare Internat