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Sample records for ventricular functional recovery

  1. Recovery of right and left ventricular function after acute pulmonary embolism

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    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.

  2. Plasma YKL-40 and recovery of left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Hedegaard, A.; Ripa, Maria Sejersten; Johansen, J.S.

    2010-01-01

    Background: Plasma YKL-40 is increased early in patients with ST-elevation myocardial infarction (STEMI). It is not known whether plasma YKL-40 is related to infarct size and recovery of ventricular function after primary percutaneous coronary intervention (PCI) of STEMI and whether granulocyte...... colony-stimulating factor (G-CSF) therapy influence plasma YKL-40 concentration. Materials and methods: A total of 72 patients (age: 56 +/- 9 years (mean +/- SD), 56 men and 16 women) with STEMI treated with PCI were included in a double-blind, randomized, placebo-controlled trial with subcutaneous G...... to LVEF recovery (p = 0.04) but not infarct size. G-CSF injections increased YKL-40 compared to placebo (p recovery. Conclusion: Plasma YKL-40 was significantly increased in STEMI patients at admission and G-CSF treatment caused a further increase...

  3. Normalization of cardiac substrate utilization and left ventricular hypertrophy precede functional recovery in heart failure regression.

    Science.gov (United States)

    Byrne, Nikole J; Levasseur, Jody; Sung, Miranda M; Masson, Grant; Boisvenue, Jamie; Young, Martin E; Dyck, Jason R B

    2016-05-15

    Impaired cardiac substrate metabolism plays an important role in heart failure (HF) pathogenesis. Since many of these metabolic changes occur at the transcriptional level of metabolic enzymes, it is possible that this loss of metabolic flexibility is permanent and thus contributes to worsening cardiac function and/or prevents the full regression of HF upon treatment. However, despite the importance of cardiac energetics in HF, it remains unclear whether these metabolic changes can be normalized. In the current study, we investigated whether a reversal of an elevated aortic afterload in mice with severe HF would result in the recovery of cardiac function, substrate metabolism, and transcriptional reprogramming as well as determined the temporal relationship of these changes. Male C57Bl/6 mice were subjected to either Sham or transverse aortic constriction (TAC) surgery to induce HF. After HF development, mice with severe HF (% ejection fraction hypertrophy/HF were returned to values observed in healthy controls. Interestingly, pressure-overload-induced left ventricular hypertrophy (LVH) and cardiac substrate metabolism were restored at 1-week post-DB, which preceded functional recovery. The regression of severe HF is associated with early and dramatic improvements in cardiac energy metabolism and LVH normalization that precede restored cardiac function, suggesting that metabolic and structural improvements may be critical determinants for functional recovery. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  4. Recovery of major organ function in patients awaiting heart transplantation with Thoratec ventricular assist devices. Thoratec Ventricular Assist Device Principal Investigators.

    Science.gov (United States)

    Farrar, D J; Hill, J D

    1994-01-01

    The time course of recovery of hepatic and renal function was determined in 193 patients receiving Thoratec ventricular assist devices while awaiting transplantation at 41 hospitals in eight countries. The duration of circulatory support averaged 26 days (maximum 248 days) and the average ventricular assist device blood flow index was 2.7 +/- 0.5 L/min/m2 compared with a preoperative cardiac index of 1.4 +/- 0.7 L/min/m2. Renal and hepatic function improved in most patients in 1 to 3 weeks of support. When comparing patients with the longest durations on the ventricular assist device (60 to 248 days) to patients with the shortest durations (< 7 days), laboratory values were significantly improved: creatinine (-29%, from 1.7 +/- 1.2 to 1.2 +/- 0.5 mg/dl), blood urea nitrogen (-32%, from 37 +/- 27 to 25 +/- 14 mg/dl), serum glutamic-oxaloacetic transaminase (-81%, from 397 +/- 702 to 76 +/- 45 IU) and total bilirubin (-79%, from 7.0 +/- 8.6 to 1.5 +/- 0.7 mg/dl). However, the posttransplantation survival through hospital discharge was not significantly different: 88% (14 of 16) for patients supported for at least 60 days and 86% (43 of 50) for patients who underwent transplantation after only 1 week of support. Therefore renal and hepatic function improve during ventricular assist device support, but the survival rate after transplantation is not related to duration and is comparable to that of conventional heart transplantation for short or long periods of ventricular assist support. Although it is clearly important not to proceed to transplantation in patients with irreversible organ failure who have ventricular assist devices, these data suggest that as long as the patient is on the path to recovery, the outcome is basically the same as for patients who have full recovery of renal and hepatic function.

  5. Plasma YKL-40 and recovery of left ventricular function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Hedegaard, A.; Ripa, Maria Sejersten; Johansen, J.S.

    2010-01-01

    -CSF or placebo injections from day 1 to 7 after the STEMI. Plasma YKL-40, high-sensitivity C-reactive protein (hs-CRP) and CK-MB concentrations were measured at baseline and during the first month. Infarct size and left ventricular ejection fraction (LVEF) were measured by magnetic resonance imaging at baseline...... and after 6 months. Results: Baseline plasma YKL-40 was increased (median 92 mu g/L) compared to healthy subjects (median 34 mu g/L, p CRP and YKL-40 correlated at baseline (p = 0.04) and day 3 (p = 0.01), but not at day 7 and 30. Moreover, YKL-40 correlated negatively...... in YKL-40. Plasma YKL-40 may be an indirect marker of LVEF recovery, independent of hs-CRP, and higher plasma YKL-40 indicates a lower recovery...

  6. Angiotensin II and ischemic preconditioning synergize to improve mitochondrial function while showing additive effects on ventricular post-ischemic recovery

    Science.gov (United States)

    Nuñez, Rebeca E.; Castro, Miriam; Javadov, Sabzali; Escobales, Nelson

    2014-01-01

    Recent studies indicate that the cardioprotective effects of ischemic preconditioning (IPC) against sustained ischemia/reperfusion (IR) can be replicated by angiotensin II (Ang II). However, it is not clear whether IPC and Ang II-induced preconditioning (APC) act through similar mechanisms or synergize to enhance cardioprotection. In this study, Langendorff-perfused rat hearts were subjected to IPC, APC or their combination (IPC/APC) followed by IR. IPC and less potently APC, significantly increased the percent recovery of the left ventricular developed-pressure, the first derivative of developed pressure and the rate pressure product compared to control. Furthermore, the post-ischemic recovery of the heart was significantly higher for IPC/APC compared to IPC or APC. The improvements in cardiac function by IPC, APC and IPC/APC were associated with similar reductions in LDH release and infarct size. However, a significant improvement in mitochondrial respiration was observed with IPC/APC. The post-ischemic recovery observed with APC and IPC/APC was inhibited by treatment with losartan, an Ang II type-1 receptor blocker, during the preconditioning phase but not by chelerythrine, a pan-PKC inhibitor. Both drugs, however, abolished the enhanced mitochondrial respiration by IPC/APC. Altogether, these results indicate that APC and IPC interact through mechanisms that enhance cardioprotection by affecting cardiac function and mitochondrial respiration. PMID:24705171

  7. Left Atrial Volume as a Predictor of Left Ventricular Functional Recovery in Patients With Dilated Cardiomyopathy and Absence of Delayed Enhancement in Cardiac Magnetic Resonance.

    Science.gov (United States)

    Moon, Jeonggeun; Shim, Chi Young; Kim, Young-Jin; Park, Sungha; Kang, Seok-Min; Chung, Namsik; Ha, Jong-Won

    2016-04-01

    Improvement of left ventricular (LV) systolic dysfunction can occur in patients with dilated cardiomyopathy (DCM), and it is more frequently observed if patients have no delayed enhancement (DE) in cardiac magnetic resonance imaging (CMR). However, even in the absence of DE, not all patients have functional recovery. We retrospectively investigated the predictors of LV functional recovery in patients with DCM who had no DE in CMR. A total of 136 patients with DCM underwent CMR. Among them, 44 (29 male, age 55 ± 14 years) showed no DE and these patients composed the study population. The study patients were divided into 2 groups according to the occurrence of functional recovery defined as an increase in LV ejection fraction to a level of ≥50% and net increase in ejection fraction of 20% or more: group 1 (n = 14) with functional recovery and group 2 (n = 30) without functional recovery. In patients who showed functional recovery, left atrial volume index (LAVI [26 ± 8 mL/m(2) vs 45 ± 18 mL/m(2)]) and LV end-diastolic dimension (62 ± 6 mm vs 67 ± 7 mm) were significantly smaller when compared with those without functional recovery (P functional recovery (hazard ratio 0.932, 95% confidence interval 0.877-0.991, P = .024). LAVI functional recovery with high specificity. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial.

    Science.gov (United States)

    Elias, Joëlle; van Dongen, Ivo M; Hoebers, Loes P; Ouweneel, Dagmar M; Claessen, Bimmer E P M; Råmunddal, Truls; Laanmets, Peep; Eriksen, Erlend; van der Schaaf, René J; Ioanes, Dan; Nijveldt, Robin; Tijssen, Jan G; Hirsch, Alexander; Henriques, José P S

    2017-07-19

    The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment. In the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2-3 collaterals compared to grade 0-1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04). CTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007.

  9. Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement Cardiovascular Magnetic Resonance

    Directory of Open Access Journals (Sweden)

    Karamitsos Theodoros D

    2010-10-01

    Full Text Available Background The new gold standard for myocardial viability assessment is late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR; this technique has demonstrated that the transmural extent of scar predicts segmental functional recovery. We now asked how the number of viable and number of viable+normal, segments predicted recovery of global left ventricular (LV function in patients undergoing CABG. Finally, we examined which segmental transmural threshold of scarring best predicted global LV recovery. Methods and Results Fifty patients with reduced LV ejection fraction (EF referred for CABG were recruited, and 33 included in this analysis. Patients underwent CMR to assess LV function and viability pre-operatively at 6 days and 6 months. Mean LVEF 38% ± 11, which improved to 43% ± 12 after surgery. 21/33 patients improved EF by ≥3% (EF before 38% ± 13, after 47% ± 13, 12/33 did not (EF before 39% ± 6, after 37% ± 8. The only independent predictor for global functional recovery after revascularisation was the number of viable+normal segments: Based on a segmental transmural viability cutoff of Conclusions Based on a 50% transmural viability cutoff, patients with ≥10 viable+normal segments improve global LV function post revascularisation, while patients with fewer such segments do not. LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from CABG. Trial registration Research Ethics Committee Unique Identifier: NRES:05/Q1603/42. The study is listed on the Current Controlled Trials Registry: ISRCTN41388968. URL: http://www.controlled-trials.com

  10. Right ventricular plasticity and functional imaging

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    Brittain, Evan L.; Hemnes, Anna R.; Keebler, Mary; Lawson, Mark; Byrd, Benjamin F.; DiSalvo, Tom

    2012-01-01

    Right ventricular (RV) function is a strong independent predictor of outcome in a number of distinct cardiopulmonary diseases. The RV has a remarkable ability to sustain damage and recover function which may be related to unique anatomic, physiologic, and genetic factors that differentiate it from the left ventricle. This capacity has been described in patients with RV myocardial infarction, pulmonary arterial hypertension, and chronic thromboembolic disease as well as post-lung transplant and post-left ventricular assist device implantation. Various echocardiographic and magnetic resonance imaging parameters of RV function contribute to the clinical assessment and predict outcomes in these patients; however, limitations remain with these techniques. Early diagnosis of RV function and better insight into the mechanisms of RV recovery could improve patient outcomes. Further refinement of established and emerging imaging techniques is necessary to aid subclinical diagnosis and inform treatment decisions. PMID:23130100

  11. Evolution of myocardial perfusion during primary angioplasty in spontaneously reperfused infarct-related artery: impact on long-term clinical outcomes and left ventricular function recovery.

    Science.gov (United States)

    Zalewski, Jaroslaw; Nycz, Krzysztof; Przewlocki, Tadeusz; Durak, Monika; Cul, Michal; Zajdel, Wojciech; Zmudka, Krzysztof

    2011-02-17

    TIMI myocardial perfusion grade (TMPG) reflects the integrity of microvasculature in ST-elevation myocardial infarction (STEMI). We sought to investigate whether TMPG evolution during primary angioplasty (pPCI) in spontaneously reperfused STEMI patients might predict long-term outcomes. 392 patients with TIMI-3 flow before pPCI were analyzed. According to pre- and post-pPCI TMPG four reperfusion patterns were created: A. TMPG deterioration from grade 2/3 to 0/1 after pPCI (n = 55, 14.0%), B. TMPG-0/1 before and after pPCI (n = 111, 28.3%), C. TMPG improvement from grade 0/1 to 2/3 (n = 52, 13.3%), D. TMPG-2/3 before and after pPCI (n = 174, 44.4%). 30-day and 1-year mortality and heart failure requiring hospitalization (HF-hosp) were recorded. Left ventricular ejection fraction (LVEF) was measured at first day (1D) and after 6 months (6M). 1D-LVEF was similar in A-D groups. After 6M, LVEF improved in pattern D (7.5 ± 5.4%, p<0.01) and C (3.7 ± 3.4%, p < 0.05), deteriorated in pattern A (5.2 ± 3.9%, p<0.01) and did not change in pattern B. 6M-LVEF increased (p < 0.001) and frequency of 1-year HF-hosp decreased (p < 0.001) in stepwise fashion among A-D patterns. A 30-day mortality rate for A-D patterns was 9.1%, 2.7%, 1.9% and 0%, respectively (p < 0.001). 1-year mortality was 16.3%, 7.2%, 5.8% and 0.6%, respectively (p < 0.001). By multivariate analysis (c-index = 0.79), TMPG evolution was independent predictor of 1-year mortality (HR = 2.5, 95%CI 1.3-4.0, p = 0.006). Maintaining TMPG-2/3 or improving TMPG-0/1 through pPCI in STEMI implies LV function recovery and good long-term survival. In contrast, substantial deterioration of TMPG is associated with lack of LV function recovery, and the highest mortality rate. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  12. 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...

  13. Right ventricular function during acute exacerbation of severe equine asthma.

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    Decloedt, A; Borowicz, H; Slowikowska, M; Chiers, K; van Loon, G; Niedzwiedz, A

    2017-09-01

    Pulmonary hypertension has been described in horses with severe equine asthma, but its effect on the right ventricle has not been fully elucidated. To evaluate right ventricular structure and function after a 1-week period of pulmonary hypertension secondary to acute exacerbation of severe equine asthma. Prospective study. A clinical episode of severe equine asthma was induced experimentally in six susceptible horses. Examinations in remission and on day 7 of the clinical episode included a physical examination with clinical scoring, echocardiography, arterial blood gas measurements, venous blood sampling for cardiac biomarkers, intracardiac pressure measurements, right ventricular and right atrial myocardial biopsies, airway endoscopy and bronchoalveolar lavage. After 1 month of recovery, physical examination, echocardiography and cardiac biomarker analysis were repeated. Echocardiographic and pressure measurements were compared with those in 10 healthy control horses. All horses developed clinical signs of acute pulmonary obstruction. Right heart pressures increased significantly. Altered right ventricular function could be detected by tissue Doppler and speckle tracking echocardiography. Cardiac troponin concentrations did not increase significantly, but were highly elevated in one horse which exercised in the paddock prior to sampling. Focal neutrophil infiltration was present in two myocardial samples. Even in remission, asthmatic horses showed a thicker right ventricular wall, an increased left ventricular end-systolic eccentricity index at chordal level and decreased right ventricular longitudinal strain compared with controls. The induced clinical episode was rather mild and the number of horses was limited because of the invasive nature of the study. Pulmonary obstruction in asthmatic horses induces pulmonary hypertension with right ventricular structural and functional changes. © 2017 EVJ Ltd.

  14. TIME Trial: Effect of Timing of Stem Cell Delivery Following ST-Elevation Myocardial Infarction on the Recovery of Global and Regional Left Ventricular Function: Final 2-Year Analysis.

    Science.gov (United States)

    Traverse, Jay H; Henry, Timothy D; Pepine, Carl J; Willerson, James T; Chugh, Atul; Yang, Phillip C; Zhao, David X M; Ellis, Stephen G; Forder, John R; Perin, Emerson C; Penn, Marc S; Hatzopoulos, Antonis K; Chambers, Jeffrey C; Baran, Kenneth W; Raveendran, Ganesh; Gee, Adrian P; Taylor, Doris A; Moyé, Lem; Ebert, Ray F; Simari, Robert D

    2018-02-02

    The TIME trial (Timing in Myocardial Infarction Evaluation) was the first cell therapy trial sufficiently powered to determine if timing of cell delivery after ST-segment-elevation myocardial infarction affects recovery of left ventricular (LV) function. To report the 2-year clinical and cardiac magnetic resonance imaging results and their modification by microvascular obstruction. TIME was a randomized, double-blind, placebo-controlled trial comparing 150 million bone marrow mononuclear cells versus placebo in 120 patients with anterior ST-segment-elevation myocardial infarctions resulting in LV dysfunction. Primary end points included changes in global (LV ejection fraction) and regional (infarct and border zone) function. Secondary end points included changes in LV volumes, infarct size, and major adverse cardiac events. Here, we analyzed the continued trajectory of these measures out to 2 years and the influence of microvascular obstruction present at baseline on these long-term outcomes. At 2 years (n=85), LV ejection fraction was similar in the bone marrow mononuclear cells (48.7%) and placebo groups (51.6%) with no difference in regional LV function. Infarct size and LV mass decreased ≥30% in each group at 6 months and declined gradually to 2 years. LV volumes increased ≈10% at 6 months and remained stable to 2 years. Microvascular obstruction was present in 48 patients at baseline and was associated with significantly larger infarct size (56.5 versus 36.2 g), greater adverse LV remodeling, and marked reduction in LV ejection fraction recovery (0.2% versus 6.2%). In one of the longest serial cardiac magnetic resonance imaging analyses of patients with large anterior ST-segment-elevation myocardial infarctions, bone marrow mononuclear cells administration did not improve recovery of LV function over 2 years. Microvascular obstruction was associated with reduced recovery of LV function, greater adverse LV remodeling, and more device implantations. The use

  15. Timing of granulocyte-colony stimulating factor treatment after acute myocardial infarction and recovery of left ventricular function: results from the STEMMI trial

    DEFF Research Database (Denmark)

    Overgaard, Mikkel; Ripa, Rasmus Sejersten; Wang, Yongzhong

    2010-01-01

    Granulocyte-colony stimulating factor (G-CSF) therapy after ST-elevation myocardial infarction (STEMI) have not demonstrated impact on systolic recovery compared to placebo. However, recent studies suggest that timing of G-CSF therapy is crucial.......Granulocyte-colony stimulating factor (G-CSF) therapy after ST-elevation myocardial infarction (STEMI) have not demonstrated impact on systolic recovery compared to placebo. However, recent studies suggest that timing of G-CSF therapy is crucial....

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

    NARCIS (Netherlands)

    I.E. van Geldorp (Irene); T. Delhaas (Tammo); R.A. Gebauer (Roman); P. Frias (Patrick); M. Tomaske (Maren); M.K. Friedberg (Mark); S. Tisma-Dupanovic (Svjetlana); J. Elders (Jan); A. Früh (Andreas); F. Gabbarini (Fulvio); P. Kubuš (Petr); V. Illikova (Viera); E.C. Tsao (Elisa); A.C. Blank (Andreas Christian); A. Hiippala (Anita); T. Sluysmans (Thierry); P. Karpawich (Peter); S.A. Clur (Sally-Ann); X. Ganame (Xavier); K.K. Collins (Kathryn); G.C. Dann (Greg); J.-B. Thambo (Jean-Benoît); C. Trigo (Conceição); B. Nagel (Bert); J. Papagiannis (John); A. Rackowitz (Annette); J. Marek (Josef); J.-H. Nürnberg (Jan-Hendrik); W.Y. Vanagt (Ward); F.W. Prinzen (Frits); J. Janousek (Jan)

    2011-01-01

    textabstractBackground: Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function. Objective In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular

  17. Left ventricular function studied with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Juergens, Kai Uwe; Fischbach, Roman [University of Muenster, Department of Clinical Radiology, Muenster (Germany)

    2006-02-01

    Accurate determination of left ventricular (LV) myocardial function is fundamental for clinical diagnosis, risk stratification, and estimation of prognosis in patients with ischemic and nonischemic cardiomyopathy. Primarily, multi-detector-row spiral CT (MDCT) of the heart aimed at detecting coronary artery obstruction and cardiac morphology. Multiple studies have demonstrated that retrospectively, ECG-gated MDCT determination of LV volumes and consequently global LV function parameters is feasible in good agreement with established imaging modalities such as cineventriculography, echocardiography, and cine magnetic resonance imaging (CMR). Post-processing tools allow fast and semi-automatic determination of LV function parameters from MDCT data in analogy to known CMR evaluation approaches. Although MDCT is not considered to be first-line modality for LV function assessment, this technique provides accessory dynamic information in patients undergoing MDCT coronary angiography, contributing to combined assessment of cardiac morphology and function without need of additional radiation exposure. MDCT regional LV wall motion analysis at rest is feasible, but further improvement in temporal resolution seems mandatory to match results obtained from competing modalities. This paper will discuss the diagnostic potential of MDCT for assessment of LV function with regards to accuracy and clinical applications, as well as limitations, particularly in comparison with CMR as modality of reference. (orig.)

  18. Left Ventricular Myocardial Function in Children With Pulmonary Hypertension: Relation to Right Ventricular Performance and Hemodynamics.

    Science.gov (United States)

    Burkett, Dale A; Slorach, Cameron; Patel, Sonali S; Redington, Andrew N; Ivy, D Dunbar; Mertens, Luc; Younoszai, Adel K; Friedberg, Mark K

    2015-08-01

    Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular strain, and functional measures of PH. At 2 institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. Patients with PH had reduced LV global longitudinal strain (LS; -18.8 [-17.3 to -20.4]% versus -20.2 [-19.0 to -20.9]%; P=0.0046) predominantly because of reduced basal (-12.9 [-10.8 to -16.3]% versus -17.9 [-14.5 to -20.7]%; Pright ventricular free-wall LS (r=0.64; Pright ventricular strain, and functional PH measures. © 2015 American Heart Association, Inc.

  19. Left ventricular systolic function in sickle cell anaemia: an ...

    African Journals Online (AJOL)

    by the report of Balfour and colleagues6 who also ob- served that left ventricular function became increasingly abnormal with age, suggesting that left ventricular func- tion deteriorated with time. It is worth noting that most of the studies reporting abnormal systolic function in sickle cell patients were conducted in children ...

  20. Left Ventricular Function in Nigerians With Type 2 Diabetes Mellitus ...

    African Journals Online (AJOL)

    Background. Diabetes mellitus is an established risk factor for cardiovascular events and has been found to be independently associated with abnormal left ventricular function. We therefore decided to embark on this study to assess the left ventricular function in our diabetic patients. Method. The study design was ...

  1. Quantitation of global and regional left ventricular function by MRI

    NARCIS (Netherlands)

    van der Geest, RJ; Reiber, JHC; Reiber, JHC; VanDerWall, EE

    1998-01-01

    Magnetic resonance imaging (MRI) provides several imaging strategies for assessing left ventricular function. As a three-dimensional imaging technique, all measurements can be performed without relying on geometrical assumptions. Global and regional function parameters can be derived from

  2. Left ventricular systolic function in sickle cell anaemia: An ...

    African Journals Online (AJOL)

    Background: Reliable diagnostic measures for the evaluation of left ventricular systolic performance in the setting of altered myocardial loading characteristics in sickle cell anaemia remains unresolved. Objective: The study was designed to assess left ventricular systolic function in adult sickle cell patients using ...

  3. Normal left ventricular function does not protect against propafenone ...

    African Journals Online (AJOL)

    Propafenone is a class Ic anti-arrhythmic agent with mild B-blocking properties which has recently become available in South Africa. We have used the drug in 3 patients with sustained m.onomorphic ventricular tachycardia not due to ischaemic heart disease. All had norm.al left ventricular function; 1 had Wegener's ...

  4. 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.

  5. 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.

  6. [Ventricular pump function under ectopic excitation of the frog heart].

    Science.gov (United States)

    Kibler, N A; Belogolova, A S; Vaĭkshnoraĭte, M A; Azarov, Ia E; Shmakov, D N

    2008-02-01

    The ventricular pump function under ectopic excitation of the heart was studied in decapitated and pithed adult frogs Rana temporaria (n = 21) at 18-19 degrees C. The intraventricular pressure was recorded with a catheter via ventricular wall. During pacing of the ventricular base and apex, the systolic pressure decreased (6.1 +/- 4.5 mm Hg and 8.9 +/- 5.0 mm Hg, respectively) as compared to the supraventricular rhythm (8.9 +/- 5.0 mm Hg, p < 0.05). The end-diastolic pressure decreased insignificantly both under basal and apical pacing. The systolic rate of pressure rise during dP/dtmax decreased under ventricular pacing, especially during pacing of the ventricular apex, as compared to the supraventricular rhythm (14.4 +/- 6/9 mm Hg/s and 22.1 +/- 11.2 mm Hg/s, respectively, p < 0.003). The isovolumetric relaxation (dP/dtmin) slowed during apical pacing as compared to the supraventricular rhythm (-25.1 +/- 13.6 and -35.6 +/- 18.3 mm Hg/s, respectively, p < 0.03). Ectopic excitation of the ventricular base and apex resulted in increase of the QRS duration (93 +/- 33 ms and 81 +/- 30 ms, respectively) as compared to the supraventricular rhythm (63 +/- 13 ms, p < 0.05). Thus, pacing of different ventricular areas ventricular myocardium with the ventricular pump function being reduced more obviously during the apical pacing compared to the pacing of ventricular base.

  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...... function. Reduced ventricular filling persisted for 7–21 hours despite normalization of biochemical indicators of hydration status, indicating that the observed changes were not entirely related to altered preload conditions. The clinical relevance of cardiac fatigue in horses remains uncertain....

  8. 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.

  9. Androgenic anabolic steroids also impair right ventricular function.

    Science.gov (United States)

    Kasikcioglu, Erdem; Oflaz, Huseyin; Umman, Berrin; Bugra, Zehra

    2009-05-01

    Chronic anabolic steroid use suppresses left ventricular functions. However, there is no information regarding the chronic effects of anabolic steroids on right ventricular function which also plays a key role in global cardiac function. The main objective of the present study was to investigate the effects of androgenic anabolic steroids usage among athletes on remodeling the right part of the heart. Androgenic-anabolic steroids-using bodybuilders had smaller diastolic velocities of both ventricles than drug-free bodybuilders and sedentary counterparts. This study shows that androgenic anabolic steroids-using bodybuilders exhibited depressed diastolic functions of both ventricles.

  10. Diagnostic Approach to Functional Recovery

    DEFF Research Database (Denmark)

    Havsteen, Inger; Madsen, Kristoffer H; Christensen, Hanne Krarup

    2013-01-01

    available and does not pose any adverse effects, repeated fMRI measurements provide unprecedented possibilities to prospectively assess the time course of reorganization in functional neural networks after stroke and relate the temporospatial dynamics of reorganization at the systems level to functional......, only up to 20-25% of patients are eligible to causal treatment. Further, care in a specialized stroke unit improves prognosis in all patients independent of age and stroke severity. Even when it is not possible to prevent tissue loss, the surviving brain areas of functional brain networks have...... a substantial capacity to reorganize after a focal ischemic (or hemorrhagic) brain lesion. This functional reorganization contributes to functional recovery after stroke. Functional magnetic resonance imaging (fMRI) provides a valuable tool to capture the spatial and temporal activity changes in response...

  11. Study of Left Ventricular Diastolic Function in Patients with Diabetes ...

    African Journals Online (AJOL)

    Left Ventricular Function: all controls had normal LV function. Studied patients had normal LV systolic function. A total of 29 patients (58%) were found to have LV diastolic dysfunction. Grade I LVDD was most common (40%). LVDD was significantly correlated with duration of DM and age of the patient (P<0.05). There was a ...

  12. Racing Skiers and Swimmers’ Heart Electric Field during Ventricular Depolarization at Recovery Period after Moderate and Submaximal Physical Load

    Directory of Open Access Journals (Sweden)

    Svetlana V. Strelnikova

    2013-01-01

    Full Text Available The article presents the results of cardioelectrotopographic investigation of racing skiers and swimmers’ heart electric activity during ventricular depolarization at recovery period after moderate and submaximal physical load. Changes in ventricular depolarization time and ventricular depolarization phases ratio due to longer duration of the first and second cardioelectric potential inversions on the chest surface in racing skiers and less duration of the depolarization initial phase in swimmers were detected after moderate and submaximal load

  13. Right ventricular presystolic peak velocity represents right ventricular function in stable patients.

    Science.gov (United States)

    Giovanardi, Paolo; Tincani, Enrico; Stefanelli, Guglielmo; Turrini, Fabrizio; Magnavacchi, Paolo; Sansoni, Stefania; Zennaro, Mauro; Pinelli, Giovanni; Tondi, Stefano

    2017-04-01

    Right ventricular (RV) function is difficult to be measured but plays a role in morbility and mortality of patients with cardiopulmonary diseases, so many echocardiographic parameters have been developed from M-mode, B-mode and Doppler tissue imaging (DTI) evaluation. Right ventricular presystolic peak velocity (RVPrP) measured with DTI of the tricuspidal annulus and its changes in RV dysfunction have never been assessed in a patient's cohort of stable patients with cardiovascular risk factors. RVPrP velocity could have a role in RV function evaluation; this study addresses such issue. Four hundred thirty-six consecutive patients were submitted to a complete echocardiographic examination with the contemporary evaluation of the following RV function indexes: Tricuspid Annulus Plane Systolic Excurtion (TAPSE), RV Systolic Peak (RVSyP) and RVPrP. Pulmonary artery systolic pressure (PASP), left ventricular and RV diastolic function were also evaluated. According to TAPSE and RVSyP taken alone or in combination, 113 patients had RV dysfunction, while 323 patients had normal RV function. RVPrP was reduced in patient's group with RV dysfunction with respect to patient's group with preserved RV function (16.48±7.3 cm/s vs. 23.98±8.4 cm/s, respectively, Pfunction (P=0.033). The study showed RVPrP able to detect stable patients with RV dysfunction.

  14. Left ventricular function in Nigerian diabetics with or without ...

    African Journals Online (AJOL)

    Objectives: This study evaluated left ventricular function, using echocardiographic methods, in Nigerian diabetics with additional aim of assessing the effect of coexisting hypertension. Design: A descriptive cross sectional study. Setting: Hospital based study. Subjects: Ninety five subjects aged 30-60 years comprising 31 ...

  15. Atrial and ventricular function in thalassemic patients with supraventricular arrhythmias

    Directory of Open Access Journals (Sweden)

    Vitantonio Di Bello

    2009-04-01

    Full Text Available The aims of this study were to evaluate through Color Doppler Myocardial Imaging (CDMI echocardiography if atrial or ventricular myocardial alterations could be detectable in patients with thalassemia major (THAL and if these alterations could be considered as predictive elements for supra-ventricular arrhythmic events. Twenty-three patients with THAL underwent clinical and electrocardiographic evaluation; patients were grouped in THAL1 (9 with supra-ventricular arrhythmias and THAL2 (14 without arrhythmias; 12 healthy subjects were considered as control group (C. We examined through conventional 2D Color Doppler echocardiography some morphological and functional parameters regarding left ventricular (LV systolic and diastolic function, and through CDMI the velocities at mitral annulus level, the regional LV and left atrial (LA strain and strain rate. All THAL patients had LV dimension (pless than 0.05, LA area (p less than 0.01 and E/Em ratio (pless than 0.001 to be significantly higher than controls. The mitral annulus longitudinal velocities were significantly lower in THAL1 than in THAL2 (pless than 0.001; the E/Em ratio was higher in THAL1 than THAL2 (pless than 0.001. The THAL1 showed a lower systolic strain rate of atrial wall than THAL2 and C (pless than 0.05. The multiple regression highlighted a significantly inverse correlation among E/Em and atrial strain (pless than 0.02. CDMI showed both THAL subgroups had subtle systolic and diastolic left ventricular myocardial alterations, which could represent the onset of developing “iron cardiomyopathy” and are related to supra-ventricular arrhythmia. Monitoring these parameters in the THAL patients could contribute to decisions about follow-up and therapy.

  16. Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension

    Science.gov (United States)

    Hsu, Steven; Houston, Brian A.; Tampakakis, Emmanouil; Bacher, Anita C.; Rhodes, Parker S.; Mathai, Stephen C.; Damico, Rachel L.; Kolb, Todd M.; Hummers, Laura K.; Shah, Ami A.; McMahan, Zsuzsanna; Corona-Villalobos, Celia P.; Zimmerman, Stefan L.; Wigley, Fredrick M.; Hassoun, Paul M.; Kass, David A.; Tedford, Ryan J.

    2016-01-01

    Background Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis as compared to idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. Methods and Results RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; p=0.039). At matched exercise (25 Watts), SSc-PAH patients failed to augment contractility (end-systolic elastance) whereas IPAH did (p<0.001). RV afterload assessed by effective arterial elastance rose similarly in both groups; thus, ventricular-vascular coupling declined in SSc-PAH. Both end-systolic and end-diastolic RV volumes increased in SSc-PAH patients to offset contractile deficits, whereas chamber dilation was absent in IPAH (+37±10% versus +1±8%, p=0.004, and +19±4% versus −1±6%, p<0.001, respectively). Exercise-associated RV dilation also strongly correlated with resting ventricular-vascular coupling in a larger cohort. Conclusions RV contractile reserve is depressed in SSc-PAH versus IPAH subjects, associated with reduced calcium recycling. During exercise, this results in ventricular-pulmonary vascular uncoupling and acute RV dilation. RV dilation during exercise can predict adverse ventricular-vascular coupling in PAH patients. PMID:27169739

  17. Prediction of functional recovery after revascularization in patients with chronic ischaemic left ventricular dysfunction : head-to-head comparison between Tc-99m-sestamibi/F-18-FDG DISA SPECT and N-13-ammonia/F-18-FDG PET

    NARCIS (Netherlands)

    Slart, Riemer H. J. A.; Bax, Jeroen J.; van Veldhuisen, Dirk J.; van der Wall, Ernst E.; Irwan, Roy; Sluiter, Wim J.; Dierckx, Rudi A.; de Boer, Jaep; Jager, Pieter L.

    Purpose: F-18-FDG PET is an important modality for myocardial viability assessment in patients with left ventricular (LV) dysfunction. Dual-isotope simultaneous acquisition (DISA) SPECT may be an alternative to PET. The aim of this study was to compare the diagnostic performance of PET and DISA

  18. Prediction of functional recovery after revascularization in patients with chronic ischaemic left ventricular dysfunction: head-to-head comparison between 99mTc-sestamibi/18F-FDG DISA SPECT and 13N-ammonia/ 18F-FDG PET.

    Science.gov (United States)

    Slart, Riemer H J A; Bax, Jeroen J; van Veldhuisen, Dirk J; van der Wall, Ernst E; Irwan, Roy; Sluiter, Wim J; Dierckx, Rudi A; de Boer, Jaep; Jager, Pieter L

    2006-06-01

    (18)F-FDG PET is an important modality for myocardial viability assessment in patients with left ventricular (LV) dysfunction. Dual-isotope simultaneous acquisition (DISA) SPECT may be an alternative to PET. The aim of this study was to compare the diagnostic performance of PET and DISA SPECT for the prediction of improvement in regional and global LV function as well as LV reverse remodelling after revascularization. Patients (n=47) with chronic coronary artery disease and LV dysfunction underwent DISA SPECT (with (99m)Tc-sestamibi and (18)F-FDG) and PET (with (13)N-ammonia and (18)F-FDG) on the same day to assess viability. All patients underwent revascularization and recovery of function was derived from serial magnetic resonance imaging studies. Of 264 revascularized, dysfunctional segments, 143 (54%) improved in function. For prediction of improvement in regional LV function, PET and DISA SPECT had similar sensitivity (90% versus 89%, NS) and specificity (86% versus 86%, NS). For prediction of improvement in global LV function, sensitivity was 83% for DISA SPECT and 86% for PET (p=NS), whereas both modalities had a specificity of 100%. Finally, sensitivity and specificity for the prediction of LV reverse remodelling were also similar for DISA SPECT and PET. In patients undergoing revascularization, DISA SPECT and PET predict the improvement in regional and global LV function and LV remodelling equally well post revascularization.

  19. Left ventricular function in endurance runners during exercise.

    Science.gov (United States)

    Jensen-Urstad, M; Bouvier, F; Nejat, M; Saltin, B; Brodin, L A

    1998-10-01

    Left ventricular function in elite runners and controls was compared by means of nuclear angiocardiography. Fifteen middle- or long-distance runners and a control group of 10 sedentary to moderately physically active subjects were studied at rest and during semi-sitting incremental exercise. Ejection fraction was higher in the runners than the controls both at rest and during exercise. At the transition from rest to exercise left ventricular end-diastolic volume initially increased similarly in runners and controls by an average of 14 and 12%, respectively, with an increase in stroke volume by approximately 25 and 23%. The parallel increase in stroke volume and left ventricular end-diastolic volume could at least partly be because of the Frank-Starling mechanism. With increasing workloads, left ventricular end-diastolic volume and ejection fraction remained fairly constant, resulting in an unchanged stroke volume from the lowest to the highest exercise intensity. This was in the runners accomplished by a 41% increase in peak filling rate and a 38% increase in peak emptying rate with similar changes observed in the controls. This has to be due to increased myocardial contractility paralleling the systolic shortening with increasing heart rate. We conclude that endurance-trained athletes have a better systolic function expressed as higher ejection fraction both at rest and during exercise than untrained subjects reflecting an enhanced myocardial contractility contributing to the maintenance of a large stroke volume during exercise. The regulatory mechanisms however, appear to be similar for athletes and healthy controls.

  20. [Adverse effects of type B ventricular pre-excitation on ventricular wall motion and left ventricular function: clinical analysis of 9 cases].

    Science.gov (United States)

    Guo, Baojing; Dai, Chencheng; Li, Wenxiu; Xiao, Yanyan; Han, Ling

    2014-04-01

    To analyze the adverse effects of type B ventricular pre-excitation on ventricular wall motion and left ventricular function and its clinical characteristic. The clinical, electrophysiological and echocardiographic characteristics of the 9 cases with type B ventricular pre-excitation before and after ablation seen between March 2011 and March 2013 were analyzed. The patients aged from 3 to 16 years. Five of them were female. Dyschronous left ventricular contraction was demonstrated by M-Mode echocardiography in all of the cases. The basal segments of the interventricular septum turned thin and moved in a manner similar to that of an aneurysm, with typical bulging during end-systole, which was observed in six cases. All patients received successful RFCAs. The locations of the accessory pathways (APs) were the right-sided anteroseptum (n = 2) and the free wall (n = 7). Their physical activities and growth improved greatly in the four cases with coexisting dilated cardiomyopathy (DCM). The echocardiographic data demonstrated that their LV contraction recovered to synchrony shortly after the ablation, LVEF recovered to normal and LVED decreased to almost normal gradually during the follow-up. Overt right-sided APs may have adverse effects on ventricular wall motion and left ventricular function. They can even result in DCM. Dyssynchronous ventricular contraction induced by right-sided overt accessory pathway may be the vital mechanism. Such kinds of cases are indication for ablation with good prognosis.

  1. Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness

    Directory of Open Access Journals (Sweden)

    Christina Chen

    2017-11-01

    Discussion: Like left ventricular function, right ventricular function is an important determinant of AKI and AKI-associated mortality. Volume overload, independently of ventricular function, is a risk factor for AKI. Whether establishment of euvolemia might mitigate AKI risk will require further study.

  2. 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, p right 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.

  3. Left ventricular volume and function after endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm in sheep.

    Science.gov (United States)

    Zhang, Peng; Guccione, Julius M; Nicholas, Susan I; Walker, Joseph C; Crawford, Philip C; Shamal, Amin; Saloner, David A; Wallace, Arthur W; Ratcliffe, Mark B

    2005-10-01

    Endoventricular patch plasty (the Dor procedure) has gained favor as a surgical treatment for heart failure associated with large anteroapical myocardial infarction. We tested the hypothesis that the Dor procedure reduces left ventricular volume, increases end-systolic elastance, decreases diastolic compliance, and maintains left ventricular function. In 6 male Dorsett sheep, the left anterior descending coronary artery and its second diagonal branch were ligated 40% of the distance from apex to base. Sixteen weeks after myocardial infarction, a Dor procedure was performed with a Dacron patch that was 50% of the infarct neck dimension. Absolute left ventricular volume was measured with magnetic resonance imaging, and left ventricular pressure and relative left ventricular volume changes during pharmacologic preload reduction were measured with a volume conductance catheter 2 weeks before and 2 and 6 weeks after the Dor procedure. End-systolic elastance, diastolic compliance, and Starling relationships were calculated from the resultant left ventricular pressure/volume loops. Two weeks after the Dor procedure, the left ventricular volume at end systole and end diastole was significantly reduced, and there was no redilation at 6 weeks. Six weeks after the Dor procedure, the ejection fraction was significantly increased. Although stroke volume increased slightly at 6 weeks, the change was not significant. The slopes of end-systolic elastance, diastolic compliance, and Starling relationships were unchanged at 2 and 6 weeks. The Dor procedure significantly reduces left ventricular volume. Unlike linear repair, left ventricular volume changes seem stable. The ejection fraction is improved, and left ventricular function (stroke volume and the Starling relationship) is maintained.

  4. Towards a definition of recovery of function.

    Science.gov (United States)

    Murray, Marion; Fischer, Itzhak; Smeraski, Cynthia; Tessler, Alan; Giszter, Simon

    2004-04-01

    In this review we consider recovery of function after spinal cord injury, and, in particular, recovery improved following intraspinal cellular transplants. Some recovery occurs spontaneously and this can be especially dramatic in neonates, supporting the notion that developing and adult spinal cord respond differently to injury. Recovery can be improved in both neonates and adults by appropriate cellular transplants into the injury site. We describe several functional tests used in animals with spinal lesions and transplants. We compare the effects of transplants of fetal tissue and genetically modified fibroblasts into neonatal and adult injury sites on recovery of motor and sensorimotor function. Fetal tissue transplants support greater recovery and elicit more regeneration in neonates than in adults. Transplants of fibroblasts modified to produce neurotrophic factors however support both recovery and axonal growth even in adults. The contribution of the transplant to recovery is shown by the loss of function that follows a second lesion just rostral to the original lesion/transplant site. The effect of the re-lesion indicates that the recovery is mediated by the presence of the transplant but the way in which transplants act to promote recovery may include a number of mechanisms, including regeneration and sprouting, neuroprotection, and modifications of organization of spared CNS structures.

  5. 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.

  6. Effects of lidoflazine on left ventricular function in patients.

    Science.gov (United States)

    De Hert, S G; Rodrigus, I E; Haenen, L R; Ten Broecke, P W; Boeckxstaens, C J; Gillebert, T C

    1997-02-01

    The present study evaluated the effects of the nucleoside transport inhibitor, lidoflazine, at a dose of 1 mg/kg, on left ventricular function. Patients were randomly assigned to receive either lidoflazine or saline in a double-blind manner. A university hospital. The study was performed in 32 patients scheduled for elective coronary artery bypass surgery. Left ventricular pressures were measured with fluid-filled catheters. Data were digitally recorded during pressure elevation induced by tilt-up of the legs. Transgastric short-axis echocardiographic views of the left ventricle were simultaneously recorded on videotape. Systolic function was evaluated with the slope (Ees, mmHg/mL) of the systolic pressure-volume relationship. Diastolic function was evaluated with the chamber stiffness constant (Kc, mmHg/mL) of the diastolic pressure-volume relationship. Cardiac function was assessed at baseline and after administration of either lidoflazine (group A [n = 16]) or placebo (group B [n = 16]). Data were compared using two-factor analysis of variance. At baseline, diastolic and systolic function were comparable in both groups. Lidoflazine increased Kc from 0.079 +/- 0.015 to 0.125 +/- 0.017 mmHg/mL and decreased Ees from 2.481 +/- 0.213 to 1.217 +/- 0.211 mmHg/mL (p = 0.009 and p = 0.004, respectively). None of these changes occurred when placebo was administered. Administration of lidoflazine before the start of cardiopulmonary bypass impaired left ventricular systolic function but also increased diastolic stiffness.

  7. 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

    BACKGROUND: Persistence or development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria is associated with an increased risk of developing heart failure compared with regression or continued absence of LVH. We postulated that this association might be in part mediated via worse...... in ECG LVH are associated with the changing risk of developing heart failure. CLINICAL TRIALS REGISTRATION: http://clinicaltrials.gov/ct/show/NCT00338260?order=1....... 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...

  8. Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size and pump function.

    Science.gov (United States)

    Erath, H G; Graham, T P; Smith, C W; Boucek, R J

    1978-01-01

    Restrictive cardiomyopathy in an infant with massive biatrial enlargement and normal ventricular size has been reported only once previously [3]. We now present a 13-month-old patient with severe and progressive congestive heart failure who demonstrated normal ventricular cavity size with biatrial enlargement. Ejection fraction and echocardiographic ventricular function studies were normal.

  9. Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

    Science.gov (United States)

    Chen, Kang; Mao, Ye; Liu, Shao-hua; Wu, Qiong; Luo, Qing-zhi; Pan, Wen-qi; Jin, Qi; Zhang, Ning; Ling, Tian-you; Chen, Ying; Gu, Gang; Shen, Wei-feng; Wu, Li-qun

    2014-06-01

    We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% (for all comparisons, Pblock and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.

  10. Biventricular pacing improves left ventricular function by 2-D strain in right ventricular failure.

    Science.gov (United States)

    Wong, Casey; Cabreriza, Santos E; Nugent, Maria; Wang, Daniel Y; Gerrah, Rabin; Rusanov, Alexander; Yalamanchi, Vinay; Wang, Alice; Cheng, Bin; Spotnitz, Henry M

    2012-12-01

    We used speckle-tracking echocardiography to test the hypothesis that regional left ventricular (LV) strain would improve during optimized biventricular pacing (BiVP) in acute right ventricular (RV) pressure overload (PO). Complete heart block and RVPO were induced in five open-chest fully anesthetized pigs. BiVP was optimized by adjusting atrioventricular and interventricular delays to maximize cardiac output derived from an aortic flow probe. LV short axis views were obtained during atrio-RV pacing (RVP), atrio-LV pacing (LVP), and BiVP. Intraventricular synchrony was assessed by comparing speckle-tracking echocardiography-derived time to peak (TTP) strain in the anterior septal (AS) and posterior wall segments. Segmental function was assessed using radial strain. Cardiac output was higher with optimized (RV first) BiVP than with LVP (0.96 ± 0.26 L/min versus 0.89 ± 0.27 L/min; P = 0.05). AS TTP strain (502 ± 19 ms) during LVP was prolonged versus BiVP (392 ± 58 ms) and versus RVP (390 ± 53 ms) (P = 0.0018). AS TTP strain during LVP was prolonged versus posterior (502 ± 19 ms versus 396 ± 72 ms, P = 0.0011). No significant difference in TTP strain in these segments was seen with BiVP or RVP. Posterior strain (20% ± 5%) increased 66% versus AS strain (12% ± 6%) during BiVP (P = 0.0029). A similar increase occurred during RVP (posterior 20% ± 3% versus AS 12% ± 7%, P = 0.0002). Posterior strain did not increase during LVP. BiVP and RVP restore intraventricular LV synchrony and increase regional function versus LVP during RVPO. RV pre-excitation unloads the RV and reduces the duration of AS contraction, facilitating synchrony of all LV segments and increasing free wall LV contraction. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Functional Recovery After Severe Traumatic Brain Injury

    DEFF Research Database (Denmark)

    Hart, Tessa; Kozlowski, Allan; Whyte, John

    2014-01-01

    functional levels received more treatment and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Thus, effects of treatment on outcome could not be disentangled from effects of case mix factors. CONCLUSIONS: FIM gain during inpatient recovery......OBJECTIVE: To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation. DESIGN: Observational prospective longitudinal study. SETTING: Two specialized inpatient TBI rehabilitation...... recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower...

  12. Improved regional ventricular function after successful surgical revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Brundage, B.H.; Massie, B.M.; Botvinick, E.H.

    1984-04-01

    Left ventricular segments with reversible asynergy at rest demonstrate reversible myocardial perfusion defects on exercise thallium-201 scintigrams. To determine if improved perfusion eliminates asynergy at rest, 23 patients with angina (stable in 21, unstable in 2) were studied before and after coronary artery bypass surgery. All patients underwent exercise myocardial perfusion scintigraphy, contrast ventriculography and coronary arteriography before and after surgery. Selective graft angiography was performed during the postoperative catheterization to determine graft patency. Segmental ventricular function was quantitated by a regional fraction method. The scintigrams were divided into five regions and compared with the corresponding regions of the ventriculogram. Seventy-one of a possible 142 ventricular segments exhibited exercise-induced perfusion deficits. Preoperative regional ejection fraction was normal in 42 of these segments and abnormal in 29. Postoperatively, in 19 of the abnormal segments, function improved or normalized. All these segments had improved perfusion during exercise after surgery and were supplied by a patent bypass graft. Nine of the 10 segments in which abnormal wall motion persisted postoperatively continued to have exercise-induced perfusion deficits, and 9 of the 10 segments were supplied by an occluded or stenotic graft or one with poor run off. Of the 42 segments with normal wall motion preoperatively, 30 had improved perfusion after surgery and 35 maintained normal function. This study indicates that asynergy at rest is permanently reversed after coronary bypass surgery if improved myocardial perfusion can be documented. These findings are consistent with but do not prove the concept that reversible rest asynergy may reflect chronic ischemia or a prolonged effect from previous ischemic episodes.

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

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Deibjerg, Lone K; Nielsen, Agnete Desirèe

    2014-01-01

    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......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...

  14. Myocardial Scar Identified by Magnetic Resonance Imaging Can Predict Left Ventricular Functional Improvement after Coronary Artery Bypass Grafting

    Science.gov (United States)

    Sun, Han-Song; Tang, Yue; Pan, Shi-Wei; Zhao, Shi-Hua

    2013-01-01

    Background Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG). Methods From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed. Results The baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, pscar tissue was superior to viable myocardium in predicting cardiac functional recovery (pscar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization. PMID:24358136

  15. Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Tao Yang

    Full Text Available BACKGROUND: Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR on functional recovery in patients undergoing coronary artery bypass grafting (CABG. METHODS: From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA 6 months post-CABG. Predictors for global functional recovery were analyzed. RESULTS: The baseline LVEF was 32.7 ± 9.2%, which improved to 41.6 ± 11.0% 6 months later and 32/52 patients improved LVEF by ≥ 5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172-6.996, p = 0.021. Receiver-Operator-Characteristic (ROC analysis demonstrated that ≤ 4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001. Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001. CONCLUSIONS: Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.

  16. Preoperative left ventricular function in degenerative mitral valve disease.

    Science.gov (United States)

    Malev, Eduard; Kim, Gleb; Mitrofanova, Lubov; Zemtsovsky, Eduard

    2014-03-01

    The aim of the study is to determine the impact of the underlying etiology (Barlow's disease or fibroelastic deficiency) on left ventricular function in patients with degenerative mitral valve disease and severe mitral regurgitation. We studied 233 patients (mean age: 53.8 ± 12.9) undergoing surgery for severe mitral regurgitation due to degenerative mitral valve disease at Almazov Federal Heart Centre between 2009 and 2011. Pathologic diagnoses for valvular tissue specimens were provided by an experienced pathologist. Preoperative strain and strain rate were determined using speckle tracking (Vivid 7 Dimension, EchoPAC'08). Barlow's disease was identified by the pathologist in 60 patients (25.8%), and fibroelastic deficiency in 173 patients (74.2%). There were no significant differences between groups in preoperative mitral regurgitation volume (70.5 ± 9.6 vs. 71.6 ± 8.5 ml, P = 0.40), and in global systolic (ejection fraction: 52.7 ± 6.6 vs. 52.0 ± 7.4%, P = 0.53) and diastolic (E/e': 12.2 ± 3.9 vs. 12.8 ± 4.2, P = 0.35) left ventricular function. Despite the lack of difference in ejection fraction and diastolic tissue Doppler parameters, in patients with Barlow's disease in comparison with fibroelastic deficiency a significant decrease of the left ventricular longitudinal systolic strain (-13.5 ± 2.2 vs. -15.6 ± 2.3%, P = 0.00001) and early diastolic strain rate (1.04 ± 0.20 vs. 1.14 ± 0.18 s, P = 0.0004) were detected. Patients with severe mitral regurgitation due to Barlow's disease have a lower preoperative left ventricular systolic function than those with fibroelastic deficiency, which may affect their postoperative prognosis.

  17. [Functional significance of left ventricular distortion in patients with right ventricular volume or pressure overloading].

    Science.gov (United States)

    Maeda, T; Matsuzaki, M; Anno, Y; Toma, Y; Maeda, R; Konishi, M; Okada, K; Tanaka, N; Suetsugu, M; Ono, S

    1986-06-01

    To evaluate the effects of left ventricular (LV) distortion on its pump function, the LV cavity shape was analyzed by two-dimensional echocardiography in normal subjects and in patients with right ventricular (RV) volume or pressure overload. The functional significance of LV distortion in the short-axis sections was evaluated by an index of the efficiency of ejection (E) of endocardial circumferential fiber length (ECL) shortening in reducing LV cavity area during systole; E = measured systolic area reduction/ideal systolic area reduction X 100 (%), where an ideal area at end-diastole or end-systole was computed for the measured ECL, assuming its shape to be perfectly circular (ideal area = ECL2/4 pi), and then an ideal systolic area reduction was determined. E at the chordal level was termed Ech. In patients with atrial septal defect (ASD), the LV cavity was distorted at end-diastole and became more circular at end-systole. Since this characteristic change during systole diminished the E, and the values of E at the chordal level (Ech) were significantly lower in ASD than those in normal subjects (89.4 +/- 4.4% vs 98.3 +/- 0.8%, p less than 0.001), strongly suggesting impairment of the efficiency of LV pump function in ASD. In patients with pulmonary hypertension, the LV cavity was more distorted at systole, and a decrease in cavity area at end-systole with the distorted LV contributed to increased systolic area reduction. Thus, the values of Ech in this group exceeded 100% in five of nine patients (103.8 +/- 12.3%). In other words, when marked RV systolic overload exists, an increase in LV systolic area reduction due to progressive LV compression will occur against LV systolic pressure. This phenomenon suggests the existence of "cardiac massage on the LV by the RV with elevated pressure". In conclusion, it was strongly suggested that the efficiency of LV pump function is modulated by RV overload through dynamic changes in the LV shape.

  18. Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention.

    Science.gov (United States)

    Sharif, Dawod; Abu-Salem, Mira; Sharif-Rasslan, Amal; Rosenschein, Uri

    2017-10-01

    Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes. The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function. A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of 400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed. Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, Pprimary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery

  19. [Functional recovery in hemifacial transplants in rats].

    Science.gov (United States)

    González-García, E; Landín-Jarillo, L; Piqueras-Del Rey, A

    There are a number of different options open to the surgeon for the reconstruction of the face and scalp, but when tissue loss is very extensive, good aesthetic and functional recovery is not possible. Not only must the damaged tissues be replaced, but motor and sensorial functioning also has to be restored. To evaluate the functional recovery of hemifacial allografts in rats. Twenty-one hemifacial flaps were transplanted from Long-Evans rats to Wistar-Lewis rats, under immunosuppression monotherapy with tacrolimus. Prior to the operation, anatomical and allograft viability studies were conducted. Two groups of transplanted rats were formed: with or without nerve repair. In the nerve repair group, end-to-end suture was employed to repair the infraorbital branch of the trigeminal nerve and the buccolabial, upper mandibular marginal and zygomatico-orbital branches of the facial nerve. Sensory recovery was evaluated by filming traction of the whiskers, whereas motor recovery was assessed by blind tests using electromyography studies of the mystacial muscles and electroneurography of the facial nerve. At eight weeks, the animals were sacrificed and biopsy samples were taken from the mystacial region. The facial flap was successfully lifted in 10 cases. In the nerve repair group both clinical and electrophysiological recovery were observed at six weeks, whereas biopsy samples taken in the eighth week showed recovery of the nerve fascicles. The hemifacial flap can be transplanted. By repairing the nerves of the allograft, it is possible to achieve its functional recovery, as can be confirmed clinically, electrophysiologically and histopathologically. To date, this is the first evidence of functional recovery following a hemifacial transplant in rats.

  20. Recovery of Serum Cholesterol Predicts Survival After Left Ventricular Assist Device Implantation

    Science.gov (United States)

    Vest, Amanda R.; Kennel, Peter J.; Maldonado, Dawn; Young, James B.; Mountis, Maria M.; Naka, Yoshifumi; Colombo, Paolo C.; Mancini, Donna M.; Starling, Randall C.; Schulze, P. Christian

    2017-01-01

    Background Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. Methods and Results A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125–150 mg/dL, 67–85 mg/dL, 32–42 mg/dL, and 97–126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212–0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092–0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. Conclusions Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support. PMID:27623768

  1. Right ventricular systolic function is not depressed in morbid obesity.

    Science.gov (United States)

    Her, Charles; Cerabona, Thomas; Bairamian, Mosses; McGoldrick, Kathryn E

    2006-10-01

    The increased pulmonary blood volume associated with the increased total blood volume in morbidly obese patients increases pulmonary artery pressure and pulmonary vascular resistance, resulting in increased right ventricular (RV) afterload. Thus, the morbidly obese may develop RV dysfunction owing to the increased RV afterload. We examined this possibility by assessing RV contractile function in morbidly obese patients, using RV end-systolic pressure-volume relationship and RV systolic time intervals. Included were 25 morbidly obese patients undergoing gastric bypass surgery under general anesthesia. Pulmonary artery pressure and RV end-systolic volume were measured with a thermodilution pulmonary artery catheter. Pulmonary arterial dicrotic notch pressure was used as an estimate of RV end-systolic pressure. Two data points were used to define RV end-systolic pressure-volume relationship. RV systolic time intervals were determined by simultaneous graphic display of the electrocardiograph, phonocardiograph, and pulmonary artery pressure curve, and were expressed as a pre-ejection period/RV ejection time ratio. The mean slope of right ventricular end-systolic pressure-volume relationship line was 0.54 +/- 0.13 and mean pulmonary vascular resistance 274 +/- 80 dyne.sec.cm(-5).m(-2). The mean pre-ejection period/RV ejection time ratio was 0.4 +/- 0.11. There was an inverse correlation between the pre-ejection/RV ejection time ratio and the slope of RV end-systolic pressure-volume relationship line (R(2)=0.658, P<0.0001). Our data indicate that RV function is not depressed in morbid obesity despite increased RV afterload.

  2. Echocardiographic evaluation of right ventricular function in preterm infants with bronchopulmonary dysplasia.

    Science.gov (United States)

    Bokiniec, Renata; Własienko, Paweł; Borszewska-Kornacka, Maria; Szymkiewicz-Dangel, Joanna

    2017-04-01

    To evaluate right ventricular function in preterm infants with and without bronchopulmonary dysplasia. Eighty-nine preterm infants (bronchopulmonary dysplasia (n=32); (2) mild-bronchopulmonary dysplasia (n=35); (3) severe-bronchopulmonary dysplasia (n=15). Right ventricular echocardiographic parameters included the following: (1) pulsed-wave Doppler through the tricuspid valve (E/A ratio), pulmonary artery acceleration time, right ventricular ejection time, right ventricular velocity-time integral; (2) tissue Doppler measurements of myocardial velocities and atrioventricular conduction times; (3) pulsed-wave Doppler and tissue Doppler evaluation of myocardial performance index and E/E' ratio; and (4) M-mode detection of right ventricular end-diastolic wall diameter. The severe-bronchopulmonary dysplasia group had higher mean right ventricular myocardial performance index (on the 28th day of life by pulsed-wave Doppler) than the no-bronchopulmonary dysplasia (P=.014) or mild-bronchopulmonary dysplasia (P=.031) groups; no differences were found between no-bronchopulmonary dysplasia and mild-bronchopulmonary dysplasia groups (P=.919). A reduction in right ventricular myocardial performance index at later time points was observed in all three groups (Pbronchopulmonary dysplasia severity in other right ventricular echocardiographic parameters. Right ventricular myocardial performance index measured by pulsed-wave Doppler indicates impaired right ventricular function in preterm infants with severe bronchopulmonary dysplasia. © 2017, Wiley Periodicals, Inc.

  3. Left Ventricular Function in Children and Adolescents With Arrhythmogenic Right Ventricular Cardiomyopathy.

    Science.gov (United States)

    Chungsomprasong, Paweena; Hamilton, Robert; Luining, Wietske; Fatah, Meena; Yoo, Shi-Joon; Grosse-Wortmann, Lars

    2017-03-01

    The aim of this study was to determine if left ventricular (LV) contractility is reduced in children with arrhythmogenic right ventricular cardiomyopathy (ARVC). For this retrospective study, children and adolescents undergoing a workup for ARVC were characterized according to the revised Task Force Criteria (rTFC). LV strain, rotation, and torsion were measured by feature-tracking cardiovascular magnetic resonance imaging (CMR). Of 142 pediatric patients, 41% had no, 23% possible, 20% borderline, and 16% definite ARVC. LV ejection fraction (EF) did not differ between rTFC categories. Patients in higher rTFC categories had lower right ventricular (RV) EF z-scores (Z-), higher Z-RV end-diastolic volumes (EDVs) and larger Z-LVEDVs (p rights reserved.

  4. Does surgically induced right bundle branch block really effect ventricular function in children after ventricular septal defect closure?

    Science.gov (United States)

    Karadeniz, Cem; Atalay, Semra; Demir, Fikri; Tutar, Ercan; Ciftci, Omer; Ucar, Tayfun; Uysalel, Adnan; Eyileten, Zeynep

    2015-03-01

    In this prospective study, we aimed to assess left and right ventricular function in terms of the presence of right bundle branch block (RBBB) in the cases with repaired ventricular septal defect (VSD). Fifty-three patients who had VSD surgery at least 1-year preceding admission and 52 healthy controls were enrolled into the study. All the participants underwent electrocardiographic and echocardiographic examination. The cases with RBBB were determined. The conventional and tissue Doppler echocardiographic measurements of the patients with and without RBBB were compared with each other and healthy controls. Twenty-eight of VSD repair groups were male and 25 were female. Control group consisted of 30 males and 22 females. The mean age of the study and control groups was 7.5 ± 5.0 and 6.9 ± 4.3 years, respectively. RBBB was detected in 20 of 53 (37.7 %) operated patients. The only significant difference between the cases with and without RBBB was decreased right ventricular fractional area change (%) in the former group (33 ± 7 vs. 39 ± 5 p < 0.05). When compared to controls, operated group had statistically lower [corrected] tricuspid annular plane systolic excursion (p < 0.05), lower systolic, early diastolic, and late diastolic myocardial velocities, higher left and right ventricular myocardial performance indices, irrespective of the presence of RBBB. The ratios of mitral or tricuspid inflow to left or right ventricular myocardial in early diastolic velocities measured from lateral annular levels were increased in operated group (all p values <0.05). In conclusion, RBBB in the cases with surgical VSD repair might be associated with right ventricular dysfunction. Biventricular systolic and diastolic dysfunction may develop following VSD repair irrespective of the presence of RBBB. Tissue Doppler-derived myocardial performance indices are useful in detection of those subclinical dysfunctions.

  5. Functional ecology of tropical forest recovery

    NARCIS (Netherlands)

    Lohbeck, M.W.M.

    2014-01-01

    Electronic abstract of the thesis for the library for the acquisitions department of Wageningen UR library (published as a html file so hyperlinks may be included) In English, one or 2 pages. Functional ecology of tropical forest recovery Currently in the tropics, the area of

  6. Right ventricular function in late-onset Pompe disease.

    Science.gov (United States)

    Fayssoil, Abdallah; Nardi, Olivier; Annane, Djillali; Orlikowski, David

    2014-08-01

    Pompe's disease is a glycogen storage disease (type II) characterized by inherited autosomal recessive transmission. The right ventricular (RV) function is a determinant parameter of clinical outcome in patients with heart failure. We sought to characterize the RV function using Doppler-echocardiography completed by Doppler tissular imaging and tricuspid annular plane systolic excursion (TAPSE) measurement. We analyzed retrospectively clinical and Doppler-echocardiographic data of patients with adult late onset Pompe disease and compared to a control group. Ten patients with late onset Pompe disease were included in our study and were compared to a control group (seven patients). Mean age was 56.7 ± 10.2 years in late onset Pompe disease versus 55 ± 21 years in control group (p  = 0.65). Left ventricular ejection fraction (LVEF) was similar in the two groups (LVEF 63.7 ± 9 vs 63.7 ± 6.6 % in control group p  = 0.99). LV end diastolic diameter was 40.8 ± 6 mm in Pompe disease versus 45.8 ± 6 mm in control group (p  = 0.11). Mean TAPSE was similar in the two groups (25.6 ± 6.2 vs 21.5 ± 2.7 mm p = 0.23). Mean peak systolic RV velocity Sm was not significantly different in the two groups (17.11 ± 3.4 cm/s in Pompe disease vs 16.14 ± 3.8 cm/s in control group p = 0.61). Mean peak early diastolic Ea velocity in the RV were not significantly different in the two groups (15.6 ± 5.6 vs 18.2 ± 4.9 cm/s p = 0.34). According to our data, RV systolic function seems preserved in late-onset Pompe disease.

  7. Assessment of right ventricular function in acute pulmonary embolism.

    Science.gov (United States)

    Barrios, Deisy; Morillo, Raquel; Lobo, José Luis; Nieto, Rosa; Jaureguizar, Ana; Portillo, Ana K; Barbero, Esther; Fernandez-Golfin, Covadonga; Yusen, Roger D; Jiménez, David

    2017-03-01

    The optimal approach to assess right ventricular (RV) function in patients with acute symptomatic pulmonary embolism (PE) lacks clarity. This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. Eight hundred forty-eight patients were enrolled. Multidetector computed tomography (MDCT) and transthoracic echocardiography agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index (sPESI) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had an sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred twenty-nine patients (15%) had an sPESI of >0 points, MDCT, and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30days, and 10 (7.7%) of them died. Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, whereas it improved identification of those at intermediate-high risk for short-term complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Effects of pacing site on global and regional left ventricular function in the setting of dyssynchronous heart failure

    OpenAIRE

    Howard, Elliot Jacob

    2011-01-01

    Regional estimates of left ventricular function are important for understanding normal cardiac function. In the presence of electrical dyssynchrony and heart failure, substantial remodeling of left ventricular geometry and cellular function occurs, resulting in discoordinate mechanical contraction. However, the determinants of regional left ventricular function during altered electrical activation in the failing heart are unclear. Thus, we sought to investigate the effects of ventricular acti...

  9. 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.

  10. Left Ventricular Diastolic Function in a Predialysis Patient Population ...

    African Journals Online (AJOL)

    CKD) accounting for 40%–66% of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare ...

  11. Right ventricular function in patients with mitral valve disease; Evaluation by radionuclide blood pool scan

    Energy Technology Data Exchange (ETDEWEB)

    Hiraki, Yoshio; Shimizu, Mitsuharu; Noriyasu, Toshiaki; Nakagawa, Tomio; Aono, Kaname; Yanagi, Hidekiyo; Seno, Yoshimasa; Teramoto, Shigeru; Nagaya, Isao (Okayama Univ. (Japan). School of Medicine)

    1989-10-01

    Right ventricular function was studied in 13 patients with mitral valve stenosis (MS), 10 patients with mitral valve regurgitation (MR) and 10 patients after mitral valve replacement (MVR) with radionuclide blood pool scan. In MS, right ventricular end-diastolic and end-systolic volumes were larger than MVR. In MR, right ventricular ejection fraction (RVEF) was smaller and right ventricular end-systolic volume was larger than MVR. In both MS and MR, there was no significant linear correlation between RVEF and mean pulmonary arterial pressure (mPAP) at rest, but during exercise RVEF of patients with elevated mPAP decreased more than that of patients with normal mPAP. RVEF in patients with MS and MR was significantly decreased during exercise, while that in patients after MVR showed no significant change. Radionuclide blood pool scan seems to be useful for the evaluation of right ventricular function in mitral valve disease. (author).

  12. Predicting functional recovery after acute ankle sprain.

    Directory of Open Access Journals (Sweden)

    Sean R O'Connor

    Full Text Available INTRODUCTION: Ankle sprains are among the most common acute musculoskeletal conditions presenting to primary care. Their clinical course is variable but there are limited recommendations on prognostic factors. Our primary aim was to identify clinical predictors of short and medium term functional recovery after ankle sprain. METHODS: A secondary analysis of data from adult participants (N = 85 with an acute ankle sprain, enrolled in a randomized controlled trial was undertaken. The predictive value of variables (age, BMI, gender, injury mechanism, previous injury, weight-bearing status, medial joint line pain, pain during weight-bearing dorsiflexion and lateral hop test recorded at baseline and at 4 weeks post injury were investigated for their prognostic ability. Recovery was determined from measures of subjective ankle function at short (4 weeks and medium term (4 months follow ups. Multivariate stepwise linear regression analyses were undertaken to evaluate the association between the aforementioned variables and functional recovery. RESULTS: Greater age, greater injury grade and weight-bearing status at baseline were associated with lower function at 4 weeks post injury (p<0.01; adjusted R square=0.34. Greater age, weight-bearing status at baseline and non-inversion injury mechanisms were associated with lower function at 4 months (p<0.01; adjusted R square=0.20. Pain on medial palpation and pain on dorsiflexion at 4 weeks were the most valuable prognostic indicators of function at 4 months (p< 0.01; adjusted R square=0.49. CONCLUSION: The results of the present study provide further evidence that ankle sprains have a variable clinical course. Age, injury grade, mechanism and weight-bearing status at baseline provide some prognostic information for short and medium term recovery. Clinical assessment variables at 4 weeks were the strongest predictors of recovery, explaining 50% of the variance in ankle function at 4 months. Further

  13. Relation of left ventricular function, mass, and volume to NT-proBNP in type 1 diabetic patients

    DEFF Research Database (Denmark)

    Astrup, Anne Sofie; Kim, Won Yong; Tarnow, Lise

    2008-01-01

    OBJECTIVES-To measure left ventricular mass (LVM), left ventricular volumes, and left ventricular function (LVF) in a cohort of type 1 diabetic patients and to correlate measures of imaging to NH2-terminal pro-brain natriuretic peptide (NT-proBNP). RESEARCH DESIGN AND METHODS-In a cross-sectional......OBJECTIVES-To measure left ventricular mass (LVM), left ventricular volumes, and left ventricular function (LVF) in a cohort of type 1 diabetic patients and to correlate measures of imaging to NH2-terminal pro-brain natriuretic peptide (NT-proBNP). RESEARCH DESIGN AND METHODS-In a cross...

  14. [Effect of ectopic excitation on the ventricular pump function in chicken].

    Science.gov (United States)

    Kharin, S N; Kibler, N A; Shmakov, D N

    2008-06-01

    The pump function of the heart ventricles was studied in chest-open anaesthetized adult female chickens under sinus rhythm and ectopic excitation of different localization. The intraventricular pressure in the right and left heart ventricles was measured by insertion of catheters through the ventricular free walls. Maximum systolic pressure, end-diastolic pressure, contractility (dP/dtmax) and relaxation (dP/dtmin) of both heart ventricles, and duration of the asynchronous contraction time of the left ventricle were analyzed. It was revealed that reduction of the pump function of the left ventricle tends to be greater under right ventricular ectopic excitation compared with left ventricular one. In comparison with the sinus rhythm, the pump function of the right ventricle was preserved to a greater extent under stimulation of the left ventricular apex and was significantly impaired under right ventricular ectopic excitation. Relaxation of both heart ventricles was more susceptible to ventricular ectopic excitation than contractility, and was more vulnerable in the right ventricle than in the left one. The direction of changes of the pump function of the heart ventricles in chickens under ventricular ectopic excitation was similar to changes of the pump function of mammalian hearts.

  15. Importance of ventricular function in the election of electro heart mode.

    Science.gov (United States)

    Nicolás-Franco, S; Rodríguez-González, F J; Nicolás-Boluda, A; Sánchez-Martos, A

    2015-04-01

    The integration of the ventricular function is essential when making decisions over a patient subjected to cardiac electrostimulation in order to understand the structure followed in the new cardiac stimulation and resynchronising therapy guides. To support the importance of ventricular function in cardiac electrostimulation it is important to know: (i)the deleterious effect of stimulation on the right ventricle apex; (ii)the effect over the left ventricular function produced by complete blockage of the left branch, and (iii)left ventricular disfunction as arrythmogenic substrate. When it comes to decide what type of cardiac electrostimualtion to apply we will know: the percentage of ventricular stimulation needed and its ventricular function. A normal ventricular function will enable electrostimulation from the right ventricle apex or alternative site. On the contrary, if this value is lower than 50% the most recommended electrostimulation is cardiac resynchronisation (CRT-P), which will be accompanied by defibrillation (CRT-D) if FEVI is lower than 35%. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  16. Effect of arotinolol on left ventricular function in patients with idiopathic dilated cardiomyopathy.

    Science.gov (United States)

    Fan, Chao-mei; Yang, Hong; Li, Yi-shi; Xu, Li; Dou, Ke-fei; Zhao, Jing-lin; Yuan, Xian-qi; Zhao, Yan-fen; Shi, Rong-fang; Du, Xiu-qing; Lu, Na-qiang

    2007-12-01

    To evaluate the efficacy and safety of long-term treatment with arotinolol in patients with idiopathic dilated cardiomyopathy (IDCM). Sixty-three patients with IDCM were evaluated at baseline and after 12-month therapy with arotinolol. The conventional therapy for congestive heart failure was continued throughout the study with arotinolol as the only beta-blocker. Left ventricular function was assessed with the New York Heart Association functional class and two-dimensional echocardiography. After 12-month arotinolol treatment, there was a significant improvement in left ventricular systolic function. Left ventricular end-systolic dimension significantly decreased from 59.52 +/- 8.83 mm to 50.89 +/- 8.17 mm (P arotinolol treatment has a favorable effect on left ventricular function in patients with IDCM, and it is safe and well tolerated.

  17. Ventricular volume, chamber stiffness, and function after anteroapical aneurysm plication in the sheep.

    Science.gov (United States)

    Ratcliffe, M B; Wallace, A W; Salahieh, A; Hong, J; Ruch, S; Hall, T S

    2000-01-01

    The success of left ventricular aneurysm plication depends on how the procedure affects both end-systolic elastance and diastolic compliance and how those changes affect ventricular function (stroke work/end-diastolic volume [PRSW] and stroke volume/end-diastolic pressure [Starling] relationships). Five male Dorsett sheep were surgically instrumented with coronary artery snares, an inferior vena caval occluder, and an ascending aortic ultrasonic flow probe. One week later an anteroapical myocardial infarction was produced by tightening the coronary snares. Ten weeks after myocardial infarction, the left ventricular aneurysm was plicated. Absolute left ventricular volume was measured by long-axis transdiaphragmatic echocardiography, and relative changes in left ventricular volume were measured with a conductance catheter. End-systolic elastance, diastolic compliance, PRSW, and Starling relationships were measured immediately before myocardial infarction, 10 weeks after myocardial infarction (immediately before plication), and immediately after and 6 weeks after aneurysm plication. After plication, end-diastolic and end-systolic left ventricular volumes return to preinfarction values. The slopes of end-systolic elastance, diastolic compliance, and PRSW decrease 10 weeks after myocardial infarction, increase with aneurysm plication, and then decrease 6 weeks after aneurysm plication. The Starling relationship undergoes a downward parallel shift with aneurysm plication. Aneurysm plication abruptly decreases left ventricular volume and diastolic compliance, increases end-systolic elastance and PRSW, but decreases the Starling relationship. The net effect on left ventricular function is mixed. Furthermore, left ventricular remodeling 6 weeks after aneurysm plication causes left ventricular volume, end-systolic elastance, diastolic compliance, PRSW, and the Starling relationship to return to preplication values.

  18. How prostacyclin therapy improves right ventricular function in pulmonary arterial hypertension

    OpenAIRE

    Vanderpool, Rebecca R.; Desai, Ankit A.; Knapp, Shannon M.; Simon, Marc A.; Abidov, Aiden; Yuan, Jason X.-J.; Garcia, Joe G. N.; Hansen, Lillian M.; Knoper, Steven R.; Naeije, Robert; Rischard, Franz P.

    2017-01-01

    Within recent years, right ventricular (RV) function has been recognised as a major determinant of outcome in pulmonary arterial hypertension (PAH) [1, 2]. Clinical [3] and in vitro experimental [4, 5] data suggest that prostacyclins, the treatment of choice for most severely ill PAH patients [6], might have a positive inotropic effect on RV function, and reduce pulmonary vascular resistance (PVR). Nevertheless, inotropic effects are difficult to demonstrate in vivo, as ventricular contractil...

  19. Assessment of left ventricular diastolic function in bronchial asthma ...

    African Journals Online (AJOL)

    Ehab

    a relevance of oral β2-AG to acute cardiac death8,9,10 and heart failure11,12. Children with acute severe asthma may ... also by age, heart rate, valvular disease, loading conditions, and contractility of both ventricular and ... up at the Chest clinic, the Children's Hospital, Ain. Shams University hospitals, and presenting in an.

  20. Right ventricular function assessment in single LAD lesion patients ...

    African Journals Online (AJOL)

    Rania Gaber

    2015-10-09

    Oct 9, 2015 ... Abstract Background: Strain and strain rate imaging is currently the most popular echocardio- graphic technique that reveals subclinical myocardial damage, and data are not available on this imaging method with regard to assessing right ventricular involvement in single LAD lesion. Aim: To evaluate right ...

  1. Brain plasticity and recovery of cognitive functions

    Directory of Open Access Journals (Sweden)

    Anja Čuš

    2011-10-01

    Full Text Available Through its capacity of plastic changes, the adult brain enables successful dealing with new demands of everyday life and recovery after an acquired brain damage either spontaneously or by the help of rehabilitation interventions. Studies which explored the effects of cognitive training in the normal population report on different types of changes in the performance of cognitive tasks as well as different types of changes in brain activation patterns.Following practice, brain activation can change in its extent, intensity or location, while cognitive processes can become more efficient or can be replaced by different processes.After acquired brain damage plastic changes are somewhat different. After the injury, the damaged brain area can either gradually regain its previous function, or different brain regions are recruited to perform that function.Studies of spontaneous and guided recovery of cognitive functions have revealed both types of plastic changes that follow each other, as well as significant correlations between these changes and improvement on the behavioural level.

  2. A case of Lamin C gene-mutation with preserved systolic function and ventricular dysrrhythmia

    Directory of Open Access Journals (Sweden)

    Kevin Kit Ng

    2013-02-01

    Full Text Available Lamin A/C gene-related cardiomyopathy is associated with progressive heart failure and malignant arrhythmias. Current guidelines advise the use of implantable defibrillators to prevent arrhythmogenic sudden cardiac death only in situations where there is evidence of severe left ventricular dysfunction. We describe a case of a woman with genetically confirmed Lamin C deficiency with preserved left ventricular function in whom an implantable defibrillator was inserted and within a month of implantation was used to terminate symptomatic ventricular tachycardia.

  3. Relation of left ventricular function, mass, and volume to NT-proBNP in type 1 diabetic patients

    DEFF Research Database (Denmark)

    Astrup, A.S.; Kim, W.Y.; Tarnow, L.

    2008-01-01

    OBJECTIVES: To measure left ventricular mass (LVM), left ventricular volumes, and left ventricular function (LVF) in a cohort of type 1 diabetic patients and to correlate measures of imaging to NH(2)-terminal pro-brain natriuretic peptide (NT-proBNP). RESEARCH DESIGN AND METHODS: In a cross...

  4. Synergic effects of renin and aldosterone on right ventricular function in hypertension: a tissue Doppler study.

    Science.gov (United States)

    Gregori, Mario; Giammarioli, Benedetta; Tocci, Giuliano; Befani, Alberto; Ciavarella, Giuseppino Massimo; Ferrucci, Andrea; Paneni, Francesco

    2015-12-01

    Right ventricular dysfunction (RVD) is associated with poor cardiovascular outcome. The renin-angiotensin-aldosterone system is involved in alterations of the left ventricular geometry and function. Detrimental effects of the renin-angiotensin-aldosterone system on the right ventricular function are being postulated, but data supporting this assumption are still lacking. The aim of the study was to assess the impact of hyperreninemia, hyperaldosteronism or their combination on right ventricular function in hypertensive individuals. Plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) were measured in 116 hypertensive patients, divided as follows: normal PRA and PAC (n = 38); high PRA and normal PAC (hypereninemia) (n = 26); normal PRA and high PAC (hyperaldosternism) (n = 27); high PRA and PAC (HRA) (n = 25). Echocardiographic evaluation of the left and right ventricles (RV), including tissue Doppler imaging, was performed. RVD was identified by tissue Doppler Imaging-derived Myocardial Performance Index, calculated with a multisegmental approach. Indices of the right ventricular structure and function, as well as the prevalence of RVD, were higher in hyperreninemia and hyperaldosternism groups as compared with the normal group, and a further increase was observed in the HRA patients. Regression models showed a similar risk of RVD in the hyperreninemia and hyperaldosternism patients, regardless of systemic and pulmonary pressure, as well as left ventricular dysfunction. Notably, patients with both hyperreninemia and hyperaldosternism exhibited the strongest association with RVD as compared with patients with only hyperreninemia or hyperaldosternism. Isolated hyperreninemia or hyperaldosternism determines a similar impairment of the right ventricular function, whereas their combination is further detrimental. Renin and aldosterone may represent early biomarkers of right ventricular dysfunction in hypertension.

  5. Whole left ventricular functional assessment from two minutes free breathing multi-slice CINE acquisition

    Science.gov (United States)

    Usman, M.; Atkinson, D.; Heathfield, E.; Greil, G.; Schaeffter, T.; Prieto, C.

    2015-04-01

    Two major challenges in cardiovascular MRI are long scan times due to slow MR acquisition and motion artefacts due to respiratory motion. Recently, a Motion Corrected-Compressed Sensing (MC-CS) technique has been proposed for free breathing 2D dynamic cardiac MRI that addresses these challenges by simultaneously accelerating MR acquisition and correcting for any arbitrary motion in a compressed sensing reconstruction. In this work, the MC-CS framework is combined with parallel imaging for further acceleration, and is termed Motion Corrected Sparse SENSE (MC-SS). Validation of the MC-SS framework is demonstrated in eight volunteers and three patients for left ventricular functional assessment and results are compared with the breath-hold acquisitions as reference. A non-significant difference (P > 0.05) was observed in the volumetric functional measurements (end diastolic volume, end systolic volume, ejection fraction) and myocardial border sharpness values obtained with the proposed and gold standard methods. The proposed method achieves whole heart multi-slice coverage in 2 min under free breathing acquisition eliminating the time needed between breath-holds for instructions and recovery. This results in two-fold speed up of the total acquisition time in comparison to the breath-hold acquisition.

  6. [A case of tricuspid pouch associated with ventricular septal defect and functional left ventricular-right atrial communication].

    Science.gov (United States)

    Watanabe, H; Maeda, K; Minowa, T; Shimasaki, T; Shimanuki, T; Kasuya, S; Sakashita, I; Takano, S; Kato, K

    1992-03-01

    We reported a 60-year-old woman with tricuspid pouch associated with ventricular septal defect and subsequent left ventricular-right atrial communication. Preoperative angiographic findings suggested the presence of membranous septal aneurysm, ventricular and atrial septal defects, and tricuspid insufficiency. However, at operation, besides perimembranous inlet type ventricular septal defect, a pouch, 1.5 cm in diameter was found in the adjacent part to the septal leaflet within the anterior one of the tricuspid valve. The ventricular septal defect was closed with a patch. From these findings, it is speculated that the tricuspid pouch was formed by the effect of jet stream through the ventricular septal defect.

  7. GDF-15 (Growth Differentiation Factor 15) Is Associated With Lack of Ventricular Recovery and Mortality After Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Kim, Juyong Brian; Kobayashi, Yukari; Moneghetti, Kegan J; Brenner, Daniel A; O'Malley, Ryan; Schnittger, Ingela; Wu, Joseph C; Murtagh, Gillian; Beshiri, Agim; Fischbein, Michael; Miller, D Craig; Liang, David; Yeung, Alan C; Haddad, Francois; Fearon, William F

    2017-12-01

    Recent data suggest that circulating biomarkers may predict outcome in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association between inflammatory, myocardial, and renal biomarkers and their role in ventricular recovery and outcome after TAVR. A total of 112 subjects undergoing TAVR were included in the prospective registry. Plasma levels of B-type natriuretic peptide, hs-TnI (high-sensitivity troponin I), CRP (C-reactive protein), GDF-15 (growth differentiation factor 15), GAL-3 (galectin-3), and Cys-C (cystatin-C) were assessed before TAVR and in 100 sex-matched healthy controls. Among echocardiographic parameters, we measured global longitudinal strain, indexed left ventricular mass, and indexed left atrial volume. The TAVR group included 59% male, with an average age of 84 years, and 1-year mortality of 18%. Among biomarkers, we found GDF-15 and CRP to be strongly associated with all-cause mortality ( P recovery in global longitudinal strain (>15% improvement) and indexed left ventricular mass (>20% decrease) at 1 year occurred in 48% and 22%, respectively. On multivariate logistic regression, lower baseline GDF-15 was associated with improved global longitudinal strain at 1 year (hazard ratio=0.29; P <0.001). Furthermore, improvement in global longitudinal strain at 1 month correlated with lower overall mortality (hazard ratio=0.45; P =0.03). Elevated GDF-15 correlates with lack of reverse remodeling and increased mortality after TAVR and improves risk prediction of mortality when added to the Society of Thoracic Surgeons score. © 2017 American Heart Association, Inc.

  8. 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.

  9. Three-dimensional Echocardiography of Right Ventricular Function Correlates with Severity of Pediatric Pulmonary Hypertension.

    Science.gov (United States)

    Jone, Pei-Ni; Patel, Sonali S; Cassidy, Courtney; Ivy, David Dunbar

    2016-12-01

    Right ventricular function and biomarkers of B-type natriuretic peptide (BNP) and N-Terminal pro-BNP (NT pro-BNP) are used to determine the severity of right ventricular failure and outcomes from pulmonary hypertension. Real-time three-dimensional echocardiography (3DE) is a novel quantitative measure of the right ventricle and decreases the geometric assumptions from conventional two-dimensional echocardiography (2DE). We correlated right ventricular functional measures using 2DE and single-beat 3DE with biomarkers and hemodynamics to determine the severity of pediatric pulmonary hypertension. We retrospectively evaluated 35 patients (mean age 12.67 ± 5.78 years) with established pulmonary hypertension who had echocardiograms and biomarkers on the same day. Ten out of 35 patients had hemodynamic evaluation within 3 days. 2DE evaluation included tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index from tissue Doppler imaging (RV TDI MPI), and right ventricular fractional area change (FAC). Three-dimensional echocardiography evaluation included right ventricular ejection fraction (EF), end-systolic volume, and end-diastolic volume. The quality of the 3DE was graded as good, fair, or poor. Pearson correlation coefficients were utilized to evaluate between biomarkers and echocardiographic parameters and between hemodynamics and echocardiography. Three-dimensional echocardiography and FAC correlated significantly with BNP and NT pro-BNP. TAPSE and RV TDI MPI did not correlate significantly with biomarkers. 3D right ventricular EF correlated significantly with hemodynamics. Two-dimensional echocardiography did not correlate with hemodynamics. Single-beat 3DE is a noninvasive, feasible tool in the quantification of right ventricular function and maybe more accurate than conventional 2DE in evaluating severity of pulmonary hypertension. © 2016 Wiley Periodicals, Inc.

  10. Normal age-related changes in left ventricular function: Role of afterload and subendocardial dysfunction.

    Science.gov (United States)

    Parikh, Jehill D; Hollingsworth, Kieren G; Wallace, Dorothy; Blamire, Andrew M; MacGowan, Guy A

    2016-11-15

    In normal ageing, both vascular and ventricular properties change, and how these affect left ventricular function is not clear. 96 subjects (ages 20-79) without cardiovascular disease underwent cardiac magnetic resonance (MR) imaging for measurement of global function, diastolic function (E/A ratio), MR tagging for measurement of torsion to shortening ratio (TSR, ratio of epicardial torsion to endocardial circumferential shortening, with increase in TSR suggesting subendocardial dysfunction relative to the subepicardium), and phase contrast MR imaging measurement of central aortic pulse wave velocity (PWV). The Vicorder device was used to measure carotid to femoral PWV. Univariate correlations established that the 4 principal age-related changes in the left ventricular function were: 1) diastolic function: E/A ratio (r: -0.61, psubendocardial dysfunction, has a significant role in reductions of cardiac output and end-diastolic volume index. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  11. Added clinical value of applying myocardial deformation imaging to assess right ventricular function.

    Science.gov (United States)

    Sokalskis, Vladislavs; Peluso, Diletta; Jagodzinski, Annika; Sinning, Christoph

    2017-06-01

    Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use. © 2017, Wiley Periodicals, Inc.

  12. The impact of acute myocardial infarction on left ventricular systolic function.

    Science.gov (United States)

    Koçinaj, Dardan; Bakalli, Aurora; Gashi, Masar; Begolli, Luljeta; Berisha, Merita; Koçinaj, Allma; Berisha, Blerim; Krasniqi, Xhevdet

    2011-01-01

    During acute myocardial infarction left ventricular systolic function is an important prognostic factor whose worsening is still frequent despite the therapeutic approach. We aimed to estimate the incidence of left ventricular systolic dysfunction among patients experiencing acute myocardial infarction. The study involved 154 consecutive patients admitted at Coronary Care Unit. The study design was based upon the collection of patient histories, clinical examination and other complementary tests. In overall study population, predominantly with male gender, the incidence of left ventricle systolic dysfunction was 42.3%, which correlated with myocardial damage, electrocardiography changes, myocardial enzymes, and myocardial wall motion. Transthoracic Echocardiography represents a valuable tool and left ventricular ejection fraction should be evaluated in all patients experiencing acute myocardial infarction since the incidence of left ventricular dysfunction in patients with Acute Myocardial Infarction remains relatively high.

  13. Coronary flow and left ventricular function during environmental stress.

    Science.gov (United States)

    Erickson, H. H.; Adams, J. D.; Stone, H. L.; Sandler, H.

    1972-01-01

    A canine model was used to study the effects of different environmental stresses on the heart and coronary circulation. The heart was surgically instrumented to measure coronary blood flow, left ventricular pressure, and other cardiovascular variables. Coronary flow was recorded by telemetry. Physiologic data were processed and analyzed by analog and digital computers. By these methods the physiologic response to altitude hypoxia, carbon monoxide, hypercapnia, acceleration, exercise, and the interaction of altitude hypoxia and carbon monoxide were described. The effects of some of these stresses on the heart and coronary circulation are discussed.

  14. Evaluation of right ventricular function before and after cardiac surgery in patients with acquired valvular disease by radionuclide cardioangiography

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Yoshihiro; Saito, Keiji; Tanaka, Kuniyoshi; Okabe, Manabu; Kaneda, Masanori (Mie Univ., Tsu (Japan). School of Medicine)

    1984-06-01

    In order to evaluate right ventricular function following cardiac surgery and predict postoperative course, we studied 12 patients with acquired valvular disease by means of equilibrium radionuclide cardioangiography before and after operation. They all included mitral valve stenotic lesion. All patients were studied after intravenous injection of technetium-99m-labeled red blood cell. They undertook supine rest studies and supine exercise studies on a bicycle ergometer. The correlation of the value of ejection fraction between radionuclide cardioangiography and contrast cineangiography was good. The 12 patients could be divided into two groups according to the right ventricular ejection fraction (RVEF) response to exercise; patients who showed increase in RVEF with exercise (Group A) and patients who showed no change in RVEF with exercise (Group B). In group A the RVEF at rest improved soon after operation, in group B the RVEF at rest showed no change after operation. Change of hemodynamic data before and after operation was examined. Cardiac index increased after operation in group A, but decreased in group B. Pulmonary vascular resistance decreased after operation in group A, but remained unchanged in group B. Patients whose RVEF increased with exercise before operation showed improvement of RVEF after operation. On the other hand, patients whose RVEF did not increase with exercise before operation showed no change of RVEF and poor recovery of hemodynamic status after operation, so they required postoperative intensive care. Low cardiac output syndrome following operation developed in 2 cases of group B but none of group A. We can predict right ventricular contractility by measurement of preoperative right ventricular ejection fraction response to exercise.

  15. Effects of Obesity on Cardiovascular Hemodynamics, Cardiac Morphology, and Ventricular Function.

    Science.gov (United States)

    Alpert, Martin A; Omran, Jad; Bostick, Brian P

    2016-12-01

    Obesity produces a variety of hemodynamic alterations that may cause changes in cardiac morphology which predispose to left and right ventricular dysfunction. Various neurohormonal and metabolic alterations commonly associated with obesity may contribute to these abnormalities of cardiac structure and function. These changes in cardiovascular hemodynamics, cardiac morphology, and ventricular function may, in severely obese patients, predispose to heart failure, even in the absence of other forms of heart disease (obesity cardiomyopathy). In normotensive obese patients, cardiac involvement is commonly characterized by elevated cardiac output, low peripheral vascular resistance, and increased left ventricular (LV) end-diastolic pressure. Sleep-disordered breathing may lead to pulmonary arterial hypertension and, in association with left heart failure, may contribute to elevation of right heart pressures. These alterations, in association with various neurohormonal and metabolic abnormalities, may produce LV hypertrophy; impaired LV diastolic function; and less commonly, LV systolic dysfunction. Many of these alterations are reversible with substantial voluntary weight loss.

  16. Renal denervation in male rats with heart failure improves ventricular sympathetic nerve innervation and function.

    Science.gov (United States)

    Pinkham, Maximilian I; Loftus, Michael T; Amirapu, Satya; Guild, Sarah-Jane; Quill, Gina; Woodward, William R; Habecker, Beth A; Barrett, Carolyn J

    2017-03-01

    Heart failure is characterized by the loss of sympathetic innervation to the ventricles, contributing to impaired cardiac function and arrhythmogenesis. We hypothesized that renal denervation (RDx) would reverse this loss. Male Wistar rats underwent myocardial infarction (MI) or sham surgery and progressed into heart failure for 4 wk before receiving bilateral RDx or sham RDx. After additional 3 wk, left ventricular (LV) function was assessed, and ventricular sympathetic nerve fiber density was determined via histology. Post-MI heart failure rats displayed significant reductions in ventricular sympathetic innervation and tissue norepinephrine content (nerve fiber density in the LV of MI+sham RDx hearts was 0.31 ± 0.05% vs. 1.00 ± 0.10% in sham MI+sham RDx group, P heart failure. Our findings show denervating the renal nerves improves cardiac sympathetic innervation and function in the post-MI failing heart. Copyright © 2017 the American Physiological Society.

  17. A prospective study found impaired left ventricular function predicted job retirement after acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, Finn E; Sørensen, Henrik T; Skagen, Knud

    2004-01-01

    adjusting for confounding factors, reduced LVEF was an independent predictor of retirement. Based on a stratified analysis, being female (RR=3.90, 95% CI=1.18-12.62) or having heavy physical job demands (RR=3.83, 95% CI=1.02-14.30) had a more pronounced impact on retirement for patients with LVEF 35......%, compared with patients with better left ventricular function. CONCLUSION: We conclude that impaired left ventricular systolic function is a prognostic determinant of retirement from the job market after acute MI....

  18. Impact of successful percutaneous balloon mitral valvuloplasty on pulmonary vascular resistance and right ventricular functions

    Directory of Open Access Journals (Sweden)

    Mohammad Gouda Mohammad

    2014-03-01

    Conclusions: PMC has a very favorable impact on progressive and sustained improvement of RV functions, regression of pulmonary artery pressure and recovery of PVR (measured non-invasively on short term and after 6 months of follow up. Regression of TRV was strong predictor for recovery of PVR and RVSP while improvement of RVOTFS was a strong predictor of recovery of RVEF.

  19. Plasticity and functional recovery in neurology.

    Science.gov (United States)

    Ramachandran, V S

    2005-01-01

    Experiments on patients with phantom limbs suggest that neural connections in the adult human brain are much more malleable than previously assumed. Three weeks after amputation of an arm, sensations from the ipsilateral face are referred to the phantom; this effect is caused by the sensory input from the face skin 'invading' and activating deafferented hand zones in the cortex and thalamus. Many phantom arms are 'paralysed' in a painful position. If a mirror is propped vertically in the sagittal plane and the patient looks at the reflection of his/her normal hand, this reflection appears superimposed on the 'felt' position of the phantom. Remarkably, if the real arm is moved, the phantom is felt to move as well and this sometimes relieves the painful cramps in the phantom. Mirror visual feedback (MVF) has shown promising results with chronic regional pain syndrome and hemiparesis following stroke. These results suggest two reasons for a paradigm shift in neurorehabilitation. First, there appears to be tremendous latent plasticity even in the adult brain. Second, the brain should be thought of, not as a hierarchy of organised autonomous modules, each of which delivers its output to the next level, but as a set of complex interacting networks that are in a state of dynamic equilibrium with the brain's environment. Both principles can be potentially exploited in a clinical context to facilitate recovery of function.

  20. Heme oxygenase-1 (HO-1) inhibits postmyocardial infarct remodeling and restores ventricular function.

    Science.gov (United States)

    Liu, Xiaoli; Pachori, Alok S; Ward, Christopher A; Davis, J Paul; Gnecchi, Massimiliano; Kong, Deling; Zhang, Lunan; Murduck, Jared; Yet, Shaw-Fang; Perrella, Mark A; Pratt, Richard E; Dzau, Victor J; Melo, Luis G

    2006-02-01

    We reported previously that predelivery of the anti-oxidant gene heme oxygenase-1 (HO-1) to the heart by adeno associated virus (AAV) markedly reduces injury after acute myocardial infarction (MI). However, the effect of HO-1 gene delivery on postinfarction recovery has not been investigated. In the current study, we assessed the effect of HO-1 gene delivery on post-MI left ventricle (LV) remodeling and function using echocardiographic imaging and histomorphometric approaches. Two groups of Sprague-Dawley rats were injected with 4 x 10(11) particles of AAV-LacZ (control) or AAV-hHO-1 in the LV wall. Eight wk after gene transfer, the animals were subjected to 30 min of ischemia by ligation of left anterior descending artery (LAD) followed by reperfusion. Echocardiographic measurements were obtained in a blinded fashion prior and at 1.5 and 3 months after I/R. Ejection fraction (EF) was reduced by 13% and 40% in the HO-1 and LacZ groups, respectively at 1.5 months after MI. Three months after MI, EF recovered fully in the HO-1, but only partially in the LacZ-treated animals. Post-MI LV dimensions were markedly increased and the anterior wall was markedly thinned in the LacZ-treated animals compared with the HO-1-treated animals. Significant myocardial scarring and fibrosis were observed in the LacZ-group in association with elevated levels of interstitial collagen I and III and MMP-2 activity. Post-MI myofibroblast accumulation was reduced in the HO-1-treated animals, and retroviral overexpression of HO-1 reduced proliferation of isolated cardiac fibroblasts. Our data indicate that rAAV-HO-1 gene transfer markedly reduces fibrosis and ventricular remodeling and restores LV function and chamber dimensions after myocardial infarction.

  1. Drugs or implantable cardioverter-defibrillators in patients with poor left ventricular function?

    Science.gov (United States)

    Block, M; Hammel, D; Böcker, D; Borggrefe, M; Breithardt, G

    1996-09-12

    Poor left ventricular function is a predictor of sudden death. Both antiarrhythmic drugs and implantable cardioverter-defibrillators (ICDs) promise to reduce the sudden death rate in these patients and consequently improve survival. In patients without spontaneous ventricular tachyarrhythmias, only beta-blocking agents and amiodarone have been shown to reduce sudden death and improve survival in some studies, whereas class I antiarrhythmic drugs increased mortality. For patients with documented ventricular tachyarrhythmias, protection against sudden death by serially tested class I antiarrhythmic drugs is at best moderate. There is some evidence suggesting that therapy with class III antiarrhythmic drugs, either amiodarone or dl-sotalol, may reduce sudden death rates and improve overall mortality in comparison to therapy with class I antiarrhythmic drugs. ICDs have been shown to prevent sudden death reliably. In published patient cohorts in which only patients who were not inducible off antiarrhythmic drugs or still inducible on antiarrhythmic drugs received an ICD, the ICD seemed to improve overall survival in comparison to class I antiarrhythmic drugs. A small prospective randomized study that compared a conventional therapy strategy to primary ICD implantations showed an improved outcome with ICDs as therapy of first choice. However, these studies included many patients treated with class I antiarrhythmic drugs considered to be less effective. In matched control studies comparing the ICD to amiodarone or dl-sotalol, less sudden deaths and an improved overall survival could be shown for the ICD in general without stratification for left ventricular function. Thus, in patients with hemodynamically nontolerated ventricular tachyarrhythmias, the ICD seems to improve survival in comparison to class I antiarrhythmic drugs, dl-sotalol, or amiodarone. However, in patients with poor left ventricular function, therapy with ICDs seems to be less cost-effective than in

  2. Metformin is associated with improved left ventricular diastolic function measured by tissue Doppler imaging in patients with diabetes

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Søgaard, Peter; Hoffmann, Søren

    2010-01-01

    To examine the association between selected glucose-lowering medications and left ventricular (LV) diastolic function in patients with diabetes.......To examine the association between selected glucose-lowering medications and left ventricular (LV) diastolic function in patients with diabetes....

  3. Healing of acute myocarditis with left ventricular assist device: morphological recovery and evolution to the aspecific features of dilated cardiomyopathy.

    Science.gov (United States)

    Arbustini, E; Grasso, M; Porcu, E; Bellini, O; Magrini, G; Campana, C; Rinaldi, M; Pagani, F; Viganò, M; Tavazzi, L

    2001-01-01

    Dilated cardiomyopathy may result from an acute myocarditis. Little is reported in vivo documenting the progression from the acute inflammatory disease to the healing phase. We describe the consecutive light and electron microscopy studies performed on five myocardial sample series in a 47-year-old female patient who was referred to our hospital with acute myocarditis. She was sustained with left ventricular assist device (LVAD) for 63 days, and then she died of cerebral hemorrhage. The first three consecutive endomyocardial biopsies (days 2, 4, 36 from onset) documented the acute and early healing phase of the inflammatory disease. In the last two biopsies (days 50 and 64 from onset) active inflammation and myocyte necrosis were absent. The histopathological features were those commonly observed in most patients diagnosed with dilated cardiomyopathy, namely myocyte hypertrophy, nuclear size and shape irregularities, and interstitial fibrosis. Overall, the myocyte morphology significantly improved and LVAD support likely contributed to the structural recovery. The major conclusions to be drawn from this case are: 1) the aspecific pathologic findings of dilated cardiomyopathy patients may result from an acute myocardial inflammation; 2) immediate endomyocardial biopsy in patients with clinically diagnosed myocarditis minimizes the risk of missing the diagnosis of inflammatory disease; to this aim a precise definition of "early onset" is especially needed; 3) LVAD support may contribute to the morphological recovery of severely damaged myocytes.

  4. Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy

    Science.gov (United States)

    de Jong, Jonas S.S.G.; Rietveld, Kirsten; van Lochem, Laura T.; Bouma, Berto J.

    2009-01-01

    The aetiology of peripartum cardiomyopathy (PPCM) is still largely unknown. Recent evidence suggests that the breakdown products from prolactin can induce cardiomyopathy. Prolactin secretion can be reduced with bromocriptine which had beneficial effects in a small study. We present a case of a patient with PPCM who received cabergoline, a strong and long lasting antagonist of prolactin secretion. Following treatment, her prolactin levels dropped swiftly. N-terminal pro-BNP levels, which had remained high up to that point, dropped within 1 day (7006 to 4408 pg/mL). Echocardiographic left ventricular ejection fraction recovered from 26% on Day 4 postpartum to 32% and later 47% on Days 2 and 5 after cabergoline treatment. To our knowledge, this is the first description of a case of PPCM in which cabergoline was administered. PMID:19168522

  5. Lung function and left ventricular hypertrophy in morbidly obese candidates for bariatric surgery

    Directory of Open Access Journals (Sweden)

    Paulo de Tarso Müller

    2015-10-01

    Full Text Available Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. Results: Of the 192 patients evaluated, 39 (10 males and 29 females met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area. Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight, gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.

  6. Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease

    NARCIS (Netherlands)

    Schuuring, Mark J.; Bolmers, Pauline P. M.; Mulder, Barbara J. M.; de Bruin-Bon, Rianne H. A. C. M.; Koolbergen, Dave R.; Hazekamp, Mark G.; Lagrand, Wim K.; de Hert, Stefan G.; de Beaumont, E. M. F. H.; Bouma, Berto J.

    2012-01-01

    Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac

  7. Restraining infarct expansion preserves left ventricular geometry and function after acute anteroapical infarction.

    Science.gov (United States)

    Kelley, S T; Malekan, R; Gorman, J H; Jackson, B M; Gorman, R C; Suzuki, Y; Plappert, T; Bogen, D K; Sutton, M G; Edmunds, L H

    Expansion of an acute myocardial infarction predicts progressive left ventricular (LV) dilatation, functional deterioration, and early death. This study tests the hypothesis that restraining expansion of an acute infarction preserves LV geometry and resting function. In 23 sheep, snares were placed around the distal left anterior descending and second diagonal coronary arteries. In 12 sheep, infarct deformation was prevented by Marlex mesh placed over the anticipated myocardial infarct. Snared arteries were occluded 10 to 14 days later. Serial hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained up to 8 weeks after anteroapical infarction of 0.23 of LV mass. In sheep with mesh, circulatory hemodynamics, stroke work, and end-systolic elastance return to preinfarction values 1 week after infarction and do not change subsequently. Ventricular volumes and ejection fraction do not change after the first week postinfarction. Control animals develop large anteroapical ventricular aneurysms, increasing LV dilatation, and progressive deterioration in circulatory hemodynamics and ventricular function. At week 8, differences in LV end-diastolic pressure, cardiac output, end-diastolic and end-systolic volumes, ejection fraction, stroke work, and end-systolic elastance are significant (P<0.01) between groups. Preventing expansion of acute myocardial infarctions preserves LV geometry and function.

  8. 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

    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

  9. Left ventricular function during transluminal angioplasty: a haemodynamic and angiographic study

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); W. Wijns (William); M.J.B.M. van den Brand (Marcel); S. Mey (Simon); J.C.H. Schuurbiers (Johan); P.G. Hugenholtz (Paul); R.W. Brower (Ronald); C.J. Slager (Cornelis)

    1984-01-01

    textabstractThe response of left ventricular function, was studied in a series of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). From 4 to 6 balloon inflations procedures per patient were performed with an average duration per occlusion of 51 +/- 12 sec (mean +/- SD),

  10. Effects of calcium on left ventricular function early after cardiopulmonary bypass

    NARCIS (Netherlands)

    DeHert, S. G.; ten Broecke, P. W.; de Mulder, P. A.; Rodrigus, I. E.; Haenen, L. R.; Boeckxstaens, C. J.; Vermeyen, K. M.; Gillebert, T. C.; Moulijn, A. C.

    1997-01-01

    Evaluation of the effects of intravenous CaCl2 on systolic and diastolic function early after separation from cardiopulmonary bypass (CPB) DESIGN: Prospective study University hospital Twenty patients scheduled for elective coronary artery surgery Left ventricular (LV) pressures were measured with

  11. Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

    Directory of Open Access Journals (Sweden)

    Rosa Eduardo Cantoni

    2002-01-01

    Full Text Available PURPOSE - To evaluate diastolic dysfunction (DD in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT underwent Doppler echocardiography to obtain E/A wave ratio (E/A, atrial deceleration time (ADT, and isovolumetric relaxation time (IRT. All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy and to age (60 years. One hundred six normotensives (NT persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01, was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR. Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01. CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.

  12. Nutritional Therapy Leads To Complete Recovery of Left Ventricular Dysfunction in Anorexia Nervosa: A Case Report

    Directory of Open Access Journals (Sweden)

    Karan Wats

    2016-01-01

    Full Text Available This case highlights the cardiac complications associated with anorexia nervosa and how early recognition and treatment significantly affects overall prognosis. A few cases have been reported in literature where cardiomyopathy associated with anorexia nervosa was reported but this is the first case where adequate medical management and metabolic support lead to complete recovery.

  13. ECG-gated pulmonary artery CTA for evaluation of right ventricular function in patients with acute pulmonary embolism.

    Science.gov (United States)

    Liang, Hong-Wei; Zhao, De-Li; Liu, Xin-Ding; Chen, Peng; Zhou, Hai-Ting; Zhao, Cheng-Lei; Wang, Guo-Kun; Xu, Mei-Ling; Zhang, Jin-Ling

    2017-02-01

    To evaluate right ventricular function in patients with acute pulmonary embolism (APE) using electrocardiogram-gated CTA and to discuss the clinical value of pulmonary artery CTA PATIENTS AND METHODS: Based on death risk evaluation, 86 APE patients were divided into high-risk group (n=46) and non-high-risk group (n=40). The CT pulmonary embolism (PE) index and parameters of right ventricular function were analyzed from the CTPA images and compared between the two groups. Potential correlation between the two was also discussed. CT PE index (median 24.69%) of the high-risk group was obviously higher than that of the non-high-risk group (median 8.58%) (Pright ventricular function were significantly different between the two groups (Pright ventricular function. ECG-gated pulmonary artery CTA is suitable for assessing the severity of APE and right ventricular function. © 2016, Wiley Periodicals, Inc.

  14. Effects of levodopa therapy on global left ventricular systolic function in patients with Parkinson disease.

    Science.gov (United States)

    Günaydın, Zeki Yüksel; Bektaş, Osman; Karagöz, Ahmet; Özer, Fahriye Feriha

    2016-07-01

    Since levodopa was identified as an efficient therapeutic option in Parkinson disease (PD), great success has been achieved in the course and treatment of the disease. However, L‑dopa-related side effects limit the therapeutic use in some patients. The aim of this study was to evaluate the effects of L‑dopa therapy on left ventricular global systolic function via speckle tracking method. In this study, 55 patients with PD under L‑dopa/dopa decarboxylase inhibitor therapy were compared with 30 age- and sex-matched control subjects. Conventional transthoracic echocardiography was performed in the left lateral position by two experienced operators in accordance with generally accepted guidelines. Left ventricular systolic function was analyzed by speckle tracking method using global longitudinal strain (GLS) and global circumferential strain (GCS) imaging. Adequate echocardiographic imaging for the evaluation of global longitudinal strain and global circumferential strain could be achieved in 55 of the patients. LVEF (left ventricular ejection fraction), GLS and GCS values were found to be similar between the patients with PD under L‑dopa therapy and the control group (62 ± 3.5 % vs 61 ± 4 %, p therapy has no unfavorable effect on left ventricular systolic function in patients with PD.

  15. Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?

    Science.gov (United States)

    Bristow, Michael R; Kao, David P; Breathett, Khadijah K; Altman, Natasha L; Gorcsan, John; Gill, Edward A; Lowes, Brian D; Gilbert, Edward M; Quaife, Robert A; Mann, Douglas L

    2017-11-01

    Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Speckle tracking evaluation of right ventricular functions in children with sickle cell disease.

    Science.gov (United States)

    Tolba, Osama Abd Rab Elrasol; El-Shanshory, Mohamed Ramadan; El-Gamasy, Mohamed Abd Elaziz; El-Shehaby, Walid Ahmed

    2017-01-01

    Cardiac dysfunction is a risk factor for death in patients with sickle cell disease (SCD). Aim of the work is to evaluate the right ventricular systolic and diastolic functions by tissue Doppler and speckling tracking imaging in children with SCD. Thirty children with SCD and thirty controls were subjected to clinical, laboratory evaluations, and echocardiographic study using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) including; Two-dimensional and tissue Doppler echocardiographic study (lateral tricuspid valve annulus peak E' velocity, lateral tricuspid valve annulus peak A' velocity, E'/A' ratio, isovolumetric relaxation time, lateral tricuspid valve annulus S' and septal S' waves and peak longitudinal systolic strain [PLSS] and time to PLSS) were done in six right ventricular segments. There was a significant decrease in right ventricular systolic and diastolic function in patients group when compared to controls. Children with SCD have impaired right ventricular systolic and diastolic functions when compared to healthy children with early evaluation of the systolic dysfunction by speckle tracking imaging technique.

  17. [Left ventricular functions in patients with cardiac syndrome X: a tissue Doppler study].

    Science.gov (United States)

    Yazici, Hüseyin Uğur; Sen, Nihat; Tavil, Yusuf; Hizal, Fatma; Turfan, Murat; Poyraz, Fatih; Boyaci, Bülent; Cengel, Atiye

    2009-12-01

    The aim of the study was to compare diagnostic accuracy of tissue Doppler imaging (TDI) and conventional Doppler echocardiography in diagnosis of left ventricular diastolic dysfunction in patients with cardiac syndrome X. Our study was designed as cross-sectional study. In our study, we compared 35 patients with cardiac syndrome X (19 female, mean age 47.2+/- 7.3 years) with 33 healthy persons as control group (18 female, mean age 49.5+/- 7.1 years) with no coronary artery disease and having no ischemic complaints or findings at exercise test. Left ventricular systolic function was found by considering mean values of modified Simpson method for left ventricular ejection fraction and TDI assessment of systolic wave peak velocity. The diastolic function of left ventricle was assessed with conventional echocardiography and TDI. Unpaired t test for independent samples or Mann-Whitney U test were used for comparison of continuous variables, Chi square test - for comparison of categorical variables. To define the capability of predicting diastolic dysfunction for conventional Doppler echocardiography and tissue Doppler imaging ROC curve analysis was applied. Left ventricular ejection fraction and systolic wave peak velocity were similar for both groups. Conventional Doppler echocardiographic measurements for left ventricular diastolic functions delineated the more frequent presence of diastolic dysfunction in cardiac syndrome X group As compared with controls (48% vs 18%; p<0.01). When both methods used for assessing diastolic dysfunction, it was found more apparent (66% vs 24%; p<0.01). When ROC curve was drawn for conventional Doppler echocardiography the AUC was 0.623, the sensitivity and the specificity were 49% and 76%, respectively. When the same was done for TDI the values were AUC=0.669, the sensitivity - 66% and the specificity - 68%. Our study revealed the deterioration of left ventricular diastolic function in patients with cardiac syndrome X. We found TDI

  18. Gene Polymorphism and Left Ventricular Geometry and Function in Hypertensive Subjects

    Directory of Open Access Journals (Sweden)

    Rosario Scaglione

    2010-01-01

    Full Text Available The distribution of the T29C TGFβ1 gene polymorphism was analyzed in 198 hypertensives with left ventricular hypertrophy (LVH and in 235 hypertensives without LVH. Circulating TGFβ1 levels, procollagen type III levels, microalbuminuria, and left ventricular geometry and function were evaluated in all the hypertensives with LVH subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 was evaluated by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, and left ventricular geometry and function by echocardiography. All groups were comparable for gender, age, and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of TC or CC genotypes was significantly (P<.05 higher in hypertensives with LVH than hypertensives without LVH TC and CC LVH hypertensives were characterized by a higher prevalence of subjects with microalbuminuria (P<.05 TC and CC versus TT, by increased levels of TGFβ1, procollagen type III, urinary albumin excretion, LVM, LVM/h2.7, and lower values of left ventricular ejection fraction (P<.05 TC and CC versus TT. Our data suggest that T29C TGFβ1 gene polymorphism was associated with clinical characteristics adequate to recognize a subset of LVH hypertensives with a higher severity of hypertension.

  19. Evaluation of Right Ventricular Systolic Function in Chagas Disease Using Cardiac Magnetic Resonance Imaging.

    Science.gov (United States)

    Moreira, Henrique T; Volpe, Gustavo J; Marin-Neto, José A; Ambale-Venkatesh, Bharath; Nwabuo, Chike C; Trad, Henrique S; Romano, Minna M D; Pazin-Filho, Antonio; Maciel, Benedito C; Lima, João A C; Schmidt, André

    2017-03-01

    Right ventricular (RV) impairment is postulated to be responsible for prominent systemic congestion in Chagas disease. However, occurrence of primary RV dysfunction in Chagas disease remains controversial. We aimed to study RV systolic function in patients with Chagas disease using cardiac magnetic resonance. This cross-sectional study included 158 individuals with chronic Chagas disease who underwent cardiac magnetic resonance. RV systolic dysfunction was defined as reduced RV ejection fraction based on predefined cutoffs accounting for age and sex. Multivariable logistic regression was used to verify the relationship of RV systolic dysfunction with age, sex, functional class, use of medications for heart failure, atrial fibrillation, and left ventricular systolic dysfunction. Mean age was 54±13 years, 51.2% men. RV systolic dysfunction was identified in 58 (37%) individuals. Although usually associated with reduced left ventricular ejection fraction, isolated RV systolic dysfunction was found in 7 (4.4%) patients, 2 of them in early stages of Chagas disease. Presence of RV dysfunction was not significantly different in patients with indeterminate/digestive form of Chagas disease (35.7%) compared with those with Chagas cardiomyopathy (36.8%) ( P =1.000). In chronic Chagas disease, RV systolic dysfunction is more commonly associated with left ventricular systolic dysfunction, although isolated and early RV dysfunction can also be identified. © 2017 American Heart Association, Inc.

  20. Efeitos da estimulação ventricular convencional em pacientes com função ventricular normal Efectos de la estimulación ventricular convencional en pacientes con función ventricular normal Conventional ventricular stimulation effects on patients with normal ventricular function

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Batista de Sá

    2009-08-01

    (CF, test de marcha, dosificación de BNP, ecocardiograma (convencional y parámetros de desincronía intraventricular y prueba de calidad de vida (SF36. Esas mediciones se hicieron con 10 días(d (t1, 120d(t2 y 240 d(t3. Los datos se compararon a lo largo del tiempo según el método ANOVA. Comparaciones múltiples de promedios se efectuaron utilizándose el método de Tukey. RESULTADOS: Desde los datos evaluados, los siguientes no presentaron variación estadística significante (p>0,05: clase funcional, dosificación de BNP, parámetros ecocardiográficos convencionales, desincronía intraventricular (Doppler tisular. Presentaron empeoramiento (pBACKGROUND: The stimulation of the right ventricle (RV may be deleterious in patients with ventricular dysfunction; however there is little evidence about the impact of this stimulation in patients with normal ventricular function. OBJECTIVES: To assess the clinical and laboratory evolution of patients with normal ventricular function submitted to implant of artificial cardiac pacemaker (PM. METHODS: 16 patients enrolled according to the following inclusion criteria: normal ventricular function defined by echocardiogram and presence of upper ventricular stimulation > 90% (generator telemetry assessment submitted to a PM implant were prospectively studied. The following parameters were assessed: Functional Class (FC, walk test, BNP levels, echocardiography evaluation (conventional and intraventricular dyssynchrony and quality of life test (SF36. The patients were assessed after 10 (t1, 120 (t2 and 240 days (t3. Data was compared throughout time according to ANOVA. Multiple comparisons of means were performed through Tukey's test. RESULTS: Among the assessed data, the following did not present significant statistic variation (p> 0.05: functional class, BNP levels, conventional echocardiographic parameters, intraventricular dyssynchrony (tissue Doppler. The walk test (between t2 and t3 and the time between septal contraction

  1. Gender differences in left ventricular structure and function during antihypertensive treatment: the Losartan Intervention for Endpoint Reduction in Hypertension Study

    DEFF Research Database (Denmark)

    Gerdts, E.; Okin, P.M.; Simone, G. de

    2008-01-01

    In hypertensive patients with left ventricular hypertrophy, antihypertensive treatment induces changes in left ventricular structure and function. However, less is known about gender differences in this response. Baseline and annual echocardiograms until the end of study or a primary end point...... hypertrophy regression during long-term antihypertensive treatment Udgivelsesdato: 2008/4...

  2. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

    DEFF Research Database (Denmark)

    Saberniak, Jørg; Hasselberg, Nina E; Borgquist, Rasmus

    2014-01-01

    AIMS: Exercise increases risk of ventricular arrhythmia in subjects with arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed to investigate the impact of exercise on myocardial function in ARVC subjects. METHODS AND RESULTS: We included 110 subjects (age 42 ± 17 years), 65 ARVC...

  3. Enhancing Propriospinal Relays to Improve Functional Recovery After SCI

    Science.gov (United States)

    2017-10-01

    hindlimb locomotor and   3   increase functional recovery. General Methods: Originally  45   adult  rats  received  T8/T9...recovery or sprouting the examination of synaptic connectivity with this treatment group would not add any information to the overall story. We

  4. Predictors of right ventricular function as measured by tricuspid annular plane systolic excursion in heart failure

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Iversen, Kasper K; Akkan, Dilek

    2009-01-01

    INTRODUCTION: Tricuspid Annular Plane Systolic Excursion (TAPSE) has independent prognostic value in heart failure patients but may be influenced by left ventricular (LV) ejection fraction. The present study assessed the association of TAPSE and clinical factors, global and regional LV function...... in 634 patients admitted for symptomatic heart failure. METHODS & RESULTS: TAPSE were correlated with global and regional measures of longitudinal LV function, segmental wall motion scores and measures of diastolic LV function as measured from transthoracic echocardiography.LV ejection fraction, wall...... failure (beta = 1.3, p = 0.002) were independent predictors of TAPSE, R(2) = 0.28, p failure etiology or any of the other clinical factors analyzed, P(interaction) = NS. CONCLUSION: TAPSE is reduced with left ventricular dysfunction...

  5. Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension.

    Science.gov (United States)

    Gabrielli, Luigi; Ocaranza, María Paz; Sitges, Marta; Kanacri, Andrés; Saavedra, Rodrigo; Sepulveda, Pablo; Sepulveda, Luis; Rossel, Victor; Zagolin, Monica; Verdejo, Hugo E; Baraona, Fernando; Zalaquett, Ricardo; Chiong, Mario; Lavandero, Sergio; Castro, Pablo F

    2017-01-01

    Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated. Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, Pright atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002). Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients. © 2016, Wiley Periodicals, Inc.

  6. Left ventricular function in patients with and without myocardial infarction and one, two or three vessel coronary artery disease.

    Science.gov (United States)

    Moraski, R E; Russell, R O; Smith, M K; Rackley, C E

    1975-01-01

    Ninety-six patients with chest pain were studied to determine the relation between left ventricular function and severity of coronary artery disease in patients with and without a history of myocardial infarction. Coronary arteriography was performed obtaining cineangiograms (60 frames/sec) and large roll film angiograms (2 to 6 frames/sec) for precise definition of the coronary anatomy. The criteria for diagnosis of myocardial infarction were a typical history, a rise and fall in serum glutamic oxaloacetic transaminase levels and evolutionary S-T segment changes associated with Q waves of at least 0.03 second. Left ventricular function was assessed by measurement of left ventricular end-diastolic pressure and volume, and left ventricular ejection fraction, mass and compliance. Fifteen patients had normal findings; 81 were classified according to number of diseased vessels and presence or absence of myocardial infarction. There were no group differences in age or heart rate. Left ventricular end-diastolic pressure was abnormally increased in patients with three vessel disease and myocardial infarction. Left ventricular end-diastolic volume was increased and the ejection fraction was reduced in patients in each vessel disease group with myocardial infarction. Although ejection fraction was reduced in patients with three vessel disease without myocardial infarction, it was further reduced when infarction occurred. Left ventricular mass increased in patients with three vessel disease with or without myocardial infarction. Values for ventricular compliance were reduced in all patients with myocardial infarction and were lower in those with two and three vessel disease and infarction than in those with two and three vessel disease without infarction. These findings suggest that a previous history of myocardial infarction needs to be considered together with anatomic abnormalities of the coronary arteries in assessing cardiac performance in patients with ischemic heart

  7. Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: A practical approach

    Directory of Open Access Journals (Sweden)

    Vido Diane

    2008-07-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR has excellent capabilities to assess ventricular systolic function. Current clinical scenarios warrant routine evaluation of ventricular diastolic function for complete evaluation, especially in congestive heart failure patients. To our knowledge, no systematic assessment of diastolic function over a range of lusitropy has been performed using CMR. Methods and Results Left ventricular diastolic function was assessed in 31 subjects (10 controls who underwent CMR and compared with Transthoracic echocardiogram (TTE evaluation of mitral valve (MV and pulmonary vein (PV blood flow. Blood flow in the MV and PV were successfully imaged by CMR for all cases (31/31,100% while TTE evaluated flow in all MV (31/31,100% but only 21/31 PV (68% cases. Velocities of MV flow (E and A measured by CMR correlated well with TTE (r = 0.81, p Conclusion We have shown that there is homology between CMR and TTE for the assessment of diastolic inflow over a wide range of conditions, including normal, impaired relaxation and restrictive. There is excellent agreement of quantitative velocity measurements between CMR and TTE. Diastolic blood flow assessment by CMR can be performed in a single scan, with times ranging from 20 sec to 3 min, and we show that there is good indication for applying CMR to assess diastolic conditions, either as an adjunctive test when evaluating systolic function, or even as a primary test when TTE data cannot be obtained.

  8. Subclinical changes in MRI-determined right ventricular volumes and function in subjects with prediabetes and diabetes.

    Science.gov (United States)

    Patscheider, Hannah; Lorbeer, Roberto; Auweter, Sigrid; Schafnitzel, Anina; Bayerl, Christian; Curta, Adrian; Rathmann, Wolfgang; Heier, Margit; Meisinger, Christa; Peters, Annette; Bamberg, Fabian; Hetterich, Holger

    2018-02-08

    The aim of this study was to assess subclinical changes in right ventricular volumes and function in subjects with prediabetes and diabetes and controls without a history of cardiovascular disease. Data from 400 participants in the KORA FF4 study without self-reported cardiovascular disease who underwent 3-T whole-body MRI were obtained. The right ventricle was evaluated using the short axis and a four-chamber view. Diabetes was defined according to WHO criteria. Associations between glucose tolerance and right ventricular parameters were assessed using multivariable adjusted linear regression models. Data from 337 participants were available for analysis. Of these, 43 (13%) had diabetes, 87 (26%) had prediabetes, and 207 (61%) were normoglycaemic controls. There was a stepwise decrease in right ventricular volumes in men with prediabetes and diabetes in comparison with controls, including right ventricular end-diastolic volume (β = -20.4 and β = -25.6, respectively; p ≤ 0.005), right ventricular end-systolic volume (β = -12.3 and β = -12.7, respectively; p ≤ 0.037) and right ventricular stroke volume (β = -8.1 and β = -13.1, respectively, p ≤ 0.016). We did not observe any association between prediabetes or diabetes and right ventricular volumes in women or between prediabetes or diabetes and right ventricular ejection fraction in men and women. This study points towards early subclinical changes in right ventricular volumes in men with diabetes and prediabetes. • MRI was used to detect subclinical changes in right ventricular parameters. • Diabetes mellitus is associated with right ventricular dysfunction. • Impairment of right ventricular volumes seems to occur predominantly in men.

  9. Left ventricular structure and function in black normotensive type 2 ...

    African Journals Online (AJOL)

    Patients' age, body weight, duration of DM, LV mass index and left atrial dimension were positive correlates of LVDD while patients' age, weight and left atrial dimension were independent predictors of LVDD. Conclusion: There is high prevalence of alterations in LV structure and function in normotensive type 2 DM; and ...

  10. Effects of droperidol on depolarization-induced automaticity, maximum upstroke velocity (Vmax) and the kinetics of recovery of Vmax in guinea-pig ventricular myocardium.

    Science.gov (United States)

    Grant, A O; Hondeghem, L M; Katzung, B G

    1978-04-01

    The neuroleptic drug droperidol has been shown to have clinically useful antiarrhythmic activity. Prior reports have resulted in conflicting conclusions regarding actions on ventricular myocardial fibers. The present study was carried out to determine whether droperidol did in fact affect the electrophysiological properties of guinea-pig papillary muscle fibers. By means of microelectrode recordings from preparations mounted in a single sucrose gap, the effects of concentrations from 10(-6) to 4 X 10(-5) M were studied on depolarization-induced automaticity, and on Vmax and its recovery time under several conditions of membrane potential, stimulation rate and external ion concentration. The results showed that at clinically relevant concentrations, droperidol significantly slows ventricular pacemaker activity, a depression reversible by epinephrine. Furthermore, Vmax was decreased and the time constant for Vmax recovery was significantly prolonged under several conditions which pertain to clinical arrhythmias, i.e., reduced membrane potential, elevated extracellular potassium concentrations and increased stimulation rate.

  11. Functional Motor Recovery in Stroke Survivors-Determinants in a ...

    African Journals Online (AJOL)

    patient care and evaluation in clinic and frequency of visits to the physical therapist predicted group membership between functional recovery and others. Conclusion: In spite of the lean neurorehabilitation facilities in the setting of this study, ...

  12. Assessment of right ventricular systolic function by tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper

    2012-01-01

    in individual patients [I]. Normal values of tissue Doppler based measurements of RV regional velocities, SR and strain exist, and apply to both sexes and in all age groups with the exception of slightly decreasing values in strain with increasing age. Increasing preload and afterload changes regional...... gained from other quantitative echocardiographic measures of LV and RV function and pressure [VI]. Changes in tissue Doppler based measures of RV systolic function can be used to monitor the effect of selective vasodilation by phosphodiestares-5 inhibition in hypoxic pulmonary hypertension and exercise...... in normal individuals. Phosphodiestares-5 inhibition by sildenafil may predominantly be effective during hypoxia in resting conditions, and may improve the blunted response in RV contractility seen with exercise in hypoxia [VII]. Reduced RV free wall deformation can be quantified by tissue Doppler...

  13. Right and left ventricular function in hospitalized children with respiratory syncytial virus infection.

    Science.gov (United States)

    Horter, Thorsten; Nakstad, Britt; Ashtari, Omid; Solevåg, Anne Lee

    2017-01-01

    Extrapulmonary manifestations including cardiac dysfunction have been demonstrated in children with respiratory syncytial virus (RSV) infection requiring intensive care. The aim of this study was to examine cardiac function in hospitalized children with moderate RSV infection admitted to a regular pediatric ward. We used echocardiography to determine cardiac output, and right and left ventricular function in 26 patients (aged 2 weeks to 24 months) with RSV infection. The echocardiographic results were compared with s-troponin, the need for supplementary oxygen or noninvasive respiratory support, and capillary refill time. The number of measured s-troponins (ten [38%] of the included children) was too low to assess differences between children with elevated levels and those with normal levels. There were no differences in cardiac function between patients receiving oxygen treatment or respiratory support and those who did not. Capillary refill time did not correlate with any of the echocardiographic parameters. Both left and right ventricular output (mL/kg/min) was higher than published reference values. All other echocardiographic parameters were within the reference range. Children with moderate RSV infection had an increased left and right ventricular output, and cardiac function was well maintained. We conclude that routine cardiac ultrasound is not warranted in children with moderate RSV infection. The role of an elevated s-troponin in these patients remains to be determined.

  14. Early MR abnormality indicating functional recovery from spontaneous intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Fumeya, Hiroshi; Hideshima, Hiroshi (Hideshima Hospital, Musashino, Tokyo (Japan))

    1991-10-01

    Magnetic resonance (MR) imaging as an indicator of recovery from hemiparesis was evaluated in 60 patients with spontaneous intracerebral hemorrhage. T{sub 2}-weighted MR images revealed early MR abnormality (EMA) of the corticospinal tract within 1 week of ictus. Most patients without EMA recovered beyond Brunnstrom's Recovery Stage 3 while only a few patients with EMA did so. Patients with EMA cannot regain motor function because EMA is almost always followed by complete tract degeneration. EMA in the brainstem and poor motor function recovery are closely correlated. (author).

  15. Left ventricular function during lethal and sublethal endotoxemia in swine

    Energy Technology Data Exchange (ETDEWEB)

    Goldfarb, R.D.; Nightingale, L.M.; Kish, P.; Weber, P.B.; Loegering, D.J.

    1986-08-01

    Previous studies suggested that after a median lethal dose (LD50) of endotoxin, cardiac contractility was depressed in nonsurviving dogs. The canine cardiovascular system is unlike humans in that dogs have a hepatic vein sphincter that is susceptible to adrenergic stimulation capable of raising hepatic and splanchnic venous pressures. The authors retested the hypothesis that lethality after endotoxin administration is associated with cardiac contractile depression in pigs, because of the hepatic circulation in this species is similar to that of humans. They compared cardiac mechanical function of pigs administered a high dose (250 g/kg) or a low dose (100 g/kg) endotoxin by use of the slope of the end-systolic pressure-diameter relationship (ESPDR) as well as other measurements of cardiac performance. In all the pigs administered a high dose, ESPDR demonstrated a marked, time-dependent depression whereas we observed no significant ESPDR changes after low endotoxin doses. The other cardiodynamic variables were uninterpretable, due to the significant changes in heart rate, end-diastolic diameter (preload), and aortic diastolic pressure (afterload). Plasma myocardia depressant factor activity accumulated in all endotoxin-administered animals, tending to be greater in the high-dose group. In this group, both subendocardial blood flow and global function were depressed, whereas pigs administered the low dose endotoxin demonstrated slight, but nonsignificant, increases in flow and function. These observations indicate that myocardial contractile depression is associated with a lethal outcome to high doses of endotoxin. Myocardial perfusion was measured using radiolabeled microspheres infused into the left atria.

  16. Right ventricular functional analysis utilizing first pass radionuclide angiography for pre-operative ventricular assist device planning: a multi-modality comparison.

    Science.gov (United States)

    Avery, Ryan; Day, Kevin; Jokerst, Clinton; Kazui, Toshinobu; Krupinski, Elizabeth; Khalpey, Zain

    2017-10-10

    Advanced heart failure treated with a left ventricular assist device is associated with a higher risk of right heart failure. Many advanced heart failures patients are treated with an ICD, a relative contraindication to MRI, prior to assist device placement. Given this limitation, left and right ventricular function for patients with an ICD is calculated using radionuclide angiography utilizing planar multigated acquisition (MUGA) and first pass radionuclide angiography (FPRNA), respectively. Given the availability of MRI protocols that can accommodate patients with ICDs, we have correlated the findings of ventricular functional analysis using radionuclide angiography to cardiac MRI, the reference standard for ventricle function calculation, to directly correlate calculated ejection fractions between these modalities, and to also assess agreement between available echocardiographic and hemodynamic parameters of right ventricular function. A retrospective review from January 2012 through May 2014 was performed to identify advanced heart failure patients who underwent both cardiac MRI and radionuclide angiography for ventricular functional analysis. Nine heart failure patients (8 men, 1 woman; mean age of 57.0 years) were identified. The average time between the cardiac MRI and radionuclide angiography exams was 38.9 days (range: 1 - 119 days). All patients undergoing cardiac MRI were scanned using an institutionally approved protocol for ICD with no device-related complications identified. A retrospective chart review of each patient for cardiomyopathy diagnosis, clinical follow-up, and echocardiogram and right heart catheterization performed during evaluation was also performed. The 9 patients demonstrated a mean left ventricular ejection fraction (LVEF) using cardiac MRI of 20.7% (12 - 40%). Mean LVEF using MUGA was 22.6% (12 - 49%). The mean right ventricular ejection fraction (RVEF) utilizing cardiac MRI was 28.3% (16 - 43%), and the mean RVEF calculated by

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    for incident heart failure (HF), as well as their associations with circulating biomarkers of HF risk. METHODS: Among 5801 elderly participants in the ARIC study (Atherosclerosis Risk in Communities; age range, 67-90 years; mean age, 76±5 years; 42% male; 21% black), we determined the continuous association...... of diastolic measures (tissue Doppler imaging [TDI] e', E/e', and left atrial size) with concomitant N-terminal pro-brain natriuretic peptide and subsequent HF hospitalization or death. We also determined sex-specific 10th and 90th percentile limits for these measures using quantile regression in 401...... participants free of prevalent cardiovascular disease and risk factors. RESULTS: Each measure of diastolic function was robustly associated with N-terminal pro-brain natriuretic peptide and incident HF or death. ARIC-based reference limits for TDI e' (4.6 and 5.2 cm/s for septal and lateral TDI e...

  18. Radionuclide methods in the assessment of left ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Bianco, J.A.; Shafer, R.B.

    1979-05-01

    The recent introduction of newer scintillation cameras, convenient radiopharmaceuticals and innovative data-processing systems has hastened the use of radionuclide methods in the evaluation of cardiac function. This review familiarizes the primary internist with physics and instrumentation required in understanding cardiovascular nuclear images. Basic principles underlying the gated cardiac blood-pool scan and the first-pass study are described. Authoritative references are given to readers seeking more complete information. The major emphasis of the review, however, is on the clinical applications of these techniques. The role of these noninvasive methods in myocardial infarction, diagnosis and prognosis of ischemic heart disease, assessment of cardiomyopathies, study of idiopathic hypertrophic subaortic stenosis and left atrial myxoma is discussed. Finally, mention is made of newer applications: evaluation of nitroglycerin action on viable but ischemic myocardium and determination of the hemodynamic effects of propranolol in patients with coronary-artery disease.

  19. Determination of the Effects of Digoxin on the Right Ventricular Function in Patients Undergoing Pneumonectomy

    Directory of Open Access Journals (Sweden)

    Alireza Sharifian Attar

    2014-02-01

    Full Text Available Introduction: Pneumonectomy is the standard treatment of lung cancer, even though patients should undergo several evaluations before surgery; deterioration of cardiopulmonary function after pulmonary resection is inevitable. We have evaluated the effects of digoxin on the improvement of right ventricular function and prevention of probable complications after lung resection surgery. Materials and Methods: All patients who were candidate for pneumonectomy or extensive lobectomy in Ghaem hospital from 2010 to 2012 were enrolled into this study and were divided into two groups randomly. The first group (group D received digoxin during surgery and in the second group (group C normal saline was administered as placebo. Echocardiographic evaluation of the patients was accomplished the day before and the day after surgery. Results: Among 20 patients in each group, male to female ratio was almost 2:1 and mean age was 63.8 (ranged 46-83 years. The most common cause of pneumonectomy was lung cancer. Comparison of the preoperative demographic variables, blood biochemistry, pulmonary function tests, echocardiographic and blood gas indexes showed no statistically significant differences between two groups. ,But postoperative evaluations showed a significant improvement in left ventricular ejection fraction in group D. Right ventricular systolic and diastolic diameters and pulmonary artery pressure were decreased significantly  as well. Conclusion: According to our results, we suggest a single dose of digoxin during lung resection surgery to improve cardiac performance after pneumonectomy.

  20. The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

    Directory of Open Access Journals (Sweden)

    Farahnaz Nikdoust

    2014-12-01

    Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

  1. In-treatment midwall and endocardial fractional shortening predict cardiovascular outcome in hypertensive patients with preserved baseline systolic ventricular function: the Losartan Intervention For Endpoint reduction study

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Gerdts, Eva; Palmieri, Vittorio

    2010-01-01

    Endocardial fractional shortening (EFS) and midwall shortening (MWS) are impaired in patients with left ventricular hypertrophy. However, it remains unknown whether improvement of left ventricular systolic function during treatment reduces cardiovascular morbidity and mortality in hypertensive pa...

  2. Persistence of the prognostic importance of left ventricular systolic function and heart failure after myocardial infarction: 17-year follow-up of the TRACE register

    DEFF Research Database (Denmark)

    Kümler, Thomas; Gislason, Gunnar Hilmar; Køber, Lars

    2010-01-01

    Left ventricular systolic function and presence of heart failure (HF) are important prognostic factors and dictate future therapeutic strategies after myocardial infarction (MI). We evaluated persistence of the prognostic importance of left ventricular dysfunction and HF in consecutive MI patients...

  3. Promoting Kidney Function Recovery in Patients with AKI Requiring RRT.

    Science.gov (United States)

    Cerdá, Jorge; Liu, Kathleen D; Cruz, Dinna N; Jaber, Bertrand L; Koyner, Jay L; Heung, Michael; Okusa, Mark D; Faubel, Sarah

    2015-10-07

    AKI requiring RRT is associated with high mortality, morbidity, and long-term consequences, including CKD and ESRD. Many patients never recover kidney function; in others, kidney function improves over a period of many weeks or months. Methodologic constraints of the available literature limit our understanding of the recovery process and hamper adequate intervention. Current management strategies have focused on acute care and short-term mortality, but new data indicate that long-term consequences of AKI requiring RRT are substantial. Promotion of kidney function recovery is a neglected focus of research and intervention. This lack of emphasis on recovery is illustrated by the relative paucity of research in this area and by the lack of demonstrated effective management strategies. In this article the epidemiologic implications of kidney recovery after AKI requiring RRT are discussed, the available literature and its methodologic constraints are reviewed, and strategies to improve the understanding of factors that affect kidney function recovery are proposed. Measures to promote kidney function recovery are a serious unmet need, with a great potential to improve short- and long-term patient outcomes. Copyright © 2015 by the American Society of Nephrology.

  4. Functional connectivity metrics during stroke recovery

    DEFF Research Database (Denmark)

    Yourganov, Grigori; Schmah, Tanya; Small, Steven L.

    2010-01-01

    measures of recovery In Schmah et al (2010), we applied Linear and Quadratic Discriminants (LD and QD) computed on a principal components (PC) subspace to classify the fMRI volumes into "early" and "late" sessions We demonstrated excellent classification accuracy with QD but not LD, indicating...... field strength Finally, we produced sensitivity maps (Kjems et al, 2002) corresponding to both linear and quadratic discriminants for the "early" vs "late" classification These maps measure the influence of each voxel on the class assignments for a given classifier Differences between the scaled...... is the number of PCs that minimizes the classification accuracy of QD Although these approaches measure different kinds of complexity, all showed strong correlations with one or more behavioral tests nine-hole peg test, hand grip test and pinch test We could not demonstrate that either sphericity...

  5. The Short-Term Effects of Ketogenic Diet on Cardiac Ventricular Functions in Epileptic Children.

    Science.gov (United States)

    Doksöz, Önder; Çeleğen, Kübra; Güzel, Orkide; Yılmaz, Ünsal; Uysal, Utku; İşgüder, Rana; Çeleğen, Mehmet; Meşe, Timur

    2015-09-01

    Our primary aim was to determine the short-term effects of a ketogenic diet on cardiac ventricular function in patients with refractory epilepsy. Thirty-eight drug-resistant epileptic patients who were treated with a ketogenic diet were enrolled in this prospective study. Echocardiography was performed on all patients before beginning the ketogenic diet and after the sixth month of therapy. Two-dimensional, M-mode, color flow, spectral Doppler, and pulsed-wave tissue Doppler imaging measurements were performed on all patients. The median age of the 32 patients was 45.5 months, and 22 (57.8%) of them were male. Body weight, height, and body mass index increased significantly at the sixth month of therapy when compared with baseline values (P 0.05). Doppler flow indices of mitral annulus and tricuspid annulus velocity of patients at baseline and month 6 showed no significant differences (P > 0.05). Tricuspid annular E/A ratio was lower at month 6 (P 0.05), there was a decrease in Ea velocity and Ea/Aa ratio gathered from tricuspid annulus at month 6 compared with baseline (P ketogenic diet does not impair left ventricular functions in children with refractory epilepsy; however, it may be associated with a right ventricular diastolic dysfunction. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Evaluation of left ventricular function, rotation, twist and untwist in patients with hypertrophic cardiomyopathy.

    Science.gov (United States)

    He, Xue-Wei; Song, Ze-Zhou

    2013-01-01

    Hypertrophic cardiomyopathy (HCM) is a disease with an autosomal-dominant pattern of inheritance associated with a variety of disease courses, age of onset, symptom severity, left ventricular outflow obstruction and risk for sudden cardiac death. Left ventricular systolic function is typically normal in most HCM patients using conventional echocardiographic indexes; however, myocardial systolic and diastolic function are reduced, and the mechanism of myocardial dysfunction remains unclear. Echocardiography is an invaluable tool for the diagnosis and assessment of hemodynamic condition, evaluation of therapy and outcome, and follow-up of patients with HCM. The recent advent of speckle tracking imaging provides a novel index for the noninvasive assessment of left ventricular myocardial dysfunction, and has been confirmed by many studies. A search for original articles focusing on HCM and its associated twist and untwist mechanisms was performed in the MEDLINE and PubMed databases with no date restrictions. All articles identified were English-language, full-text publications. The reference lists of identified articles were also searched for additional articles and reviews.

  7. A miniature cadmium telluride detector module for continuous monitoring of left-ventricular function.

    Science.gov (United States)

    Hoffer, P B; Berger, H J; Steidley, J; Brendel, A F; Gottschalk, A; Zaret, B L

    1981-02-01

    The authors describe a miniature cadmium telluride (CdTe) detector module for continuous monitoring of ventricular function using an equilibrium radionuclide blood-pool label. The detector and collimator are small, light, and suitable for direct attachment to the chest wall. Clinical studies in 18 patients using a prototype system demonstrated reasonably good correlation with left-ventricular ejection fractions (LVEF) determined by first-pass studies performed with a multicrystal scintillation camera (r = 0.74) and gated equilibrium studies performed with a computerized sodium iodide (Nal) probe (r = 0.76). The CdTe device may prove to be useful in patients in intensive and coronary care units as well as in ambulatory patients.

  8. Effects of ischemia and omeprazole preconditioning on functional recovery of isolated rat heart.

    Science.gov (United States)

    Jeremic, Nevena; Petkovic, Anica; Srejovic, Ivan; Zivkovic, Vladimir; Djuric, Dragan; Jakovljevic, Vladimir

    2015-01-01

    The aim of this study was to compare protective effects of ischemic and potential protective effects of pharmacological preconditioning with omeprazole on isolated rat heart subjected to ischemia/reperfusion. The hearts of male Wistar albino rats were excised and perfused on a Langendorff apparatus. In control group (CG) after stabilization period, hearts were subjected to global ischemia (perfusion was totally stopped) for 20 minutes and 30 minutes of reperfusion. Hearts of group II (IPC) were submitted to ischemic preconditioning lasting 5 minutes before 20 minutes of ischemia and 30 minutes of reperfusion. In third group (OPC) hearts first underwent preconditioning lasting 5 minutes with 100 μM omeprazole, and then submitted 20 minutes of ischemia and 30 minutes of reperfusion. Administration of omeprazole before ischemia induction had protective effect on myocardium function recovery especially regarding to values of systolic left ventricular pressure and dp/dt max. Also our findings are that values of coronary flow did not change between OPC and IPC groups in last point of reperfusion. Based on our results it seems that ischemic preconditioning could be used as first window of protection after ischemic injury especially because all investigated parameters showed continuous trend of recovery of myocardial function. On the other hand, preconditioning with omeprazole induced sudden trend of recovery with positive myocardium protection, although less effective than results obtained with ischemic preconditioning not withstand, we must consider that omeprazole may be used in many clinical circumstances where direct coronary clamping for ischemic preconditioning is not possible.

  9. Impact of left ventricular function on health-related quality of life in coronary artery disease patients

    Directory of Open Access Journals (Sweden)

    Margarita Staniūtė

    2015-01-01

    Conclusions: In stable CAD patients with NYHA I-II functional class HRQoL was not strongly associated with left ventricular function; in NYHA III functional class patients’ greater systolic function mainly was associated with better physical health and better diastolic function, with better mental health.

  10. Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function-value of the wearable cardioverter/defibrillator.

    Science.gov (United States)

    Duncker, David; Haghikia, Arash; König, Thorben; Hohmann, Stephan; Gutleben, Klaus-Jürgen; Westenfeld, Ralf; Oswald, Hanno; Klein, Helmut; Bauersachs, Johann; Hilfiker-Kleiner, Denise; Veltmann, Christian

    2014-12-01

    The true incidence of life-threatening ventricular tachyarrhythmic events and the risk of sudden cardiac death in the early stage of peripartum cardiomyopathy (PPCM) are still unknown. We aimed to assess the usefulness of the wearable cardioverter/defibrillator (WCD) to bridge a potential risk for life-threatening arrhythmic events in patients with early PPCM, severely reduced left ventricular ejection fraction (LVEF) and symptoms of heart failure. Twelve consecutively admitted women with PPCM were included in this single-centre, prospective observational study between September 2012 and September 2013. Patients with LVEF ≤35% were considered to use the WCD for 3 months or even 6 months when considered necessary for LVEF recovery. Nine of the 12 women had a severely reduced LVEF (mean 18.3%) at the time of study enrollment; seven women received a WCD, while two patients refused to wear a WCD. During a median WCD follow-up of 81 days (range 25-345 days), we observed a total of four events of ventricular fibrillation with appropriate and successful WCD shocks in three of the seven women receiving a WCD. No syncope or sudden arrhythmic deaths occurred in women not using the WCD during a median follow-up of 12 months (range 5-15 months). All women showed impressive improvement of LVEF during follow-up. PPCM patients with severely reduced LVEF have an elevated risk for ventricular tachyarrhythmias early after diagnosis. Therefore, use of the WCD should be considered in all women with early-stage PPCM and severely reduced LVEF during the first 6 months after initiation of heart failure therapy. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology.

  11. [Changes in the left ventricular function in hemodialyzed patients. Role of Doppler echocardiography].

    Science.gov (United States)

    Cavarra, M; Lo Giudice, P; Statella, P; Liuzzo, G; Circo, A

    1993-09-01

    The aim of this study was to provide a further contribution to the study on the alterations of left ventricular diastolic function induced by dialysis, using simple indexes of diastolic function obtained with Doppler. The study is conduced in 15 patients with renal failure aged between 22 and 51 years old by means of echocardiography M-2D a pulsed Doppler analysis of the left ventricular refilling flow, evaluated before and after dialysis. By the results is risen up that the dLA has had a significant reduction (p = 0.032), the dSLV have undergone a reduction that is not being significant, while the dDLV has had a significant reduction (p = 0.029), shortening fraction is improved even if in a not significant manner. Also the Doppler indexes has had a behaviour homogeneous in the group of studied patients. Early ventricular refilling is reduced, as showed by the reduction of E, consequence of the reduction preload, while the diastolic late refilling has showed a little increment, expressed by the increase af the peak A. The variations of these indexes, even if not statistically significant, express an alteration of pattern diastolic Doppler caused by both the reduction of preload and the alteration of ventricular relaxation. Besides this alteration, to our notice, is not to consider expression of myocardial compromise in this group studied patients. It would be however useful enlargement of the study to greater number of patients with follow-up for better comprehension of this cardiopathy and makes a more individual treatment of these patients.

  12. Right ventricular function after repair of tetralogy of Fallot: a comparison between bovine pericardium and porcine small intestinal extracellular matrix.

    Science.gov (United States)

    Naik, Ronak; Johnson, Jason; Kumar, T K S; Philip, Ranjit; Boston, Umar; Knott-Craig, Christopher J

    2017-05-29

    The porcine small intestinal extracellular matrix reportedly has the potential to differentiate into viable myocardial cells. When used in tetralogy of Fallot repair, it may improve right ventricular function. We evaluated right ventricular function after repair of tetralogy of Fallot with extracellular matrix versus bovine pericardium. Subjects with non-transannular repair of tetralogy of Fallot with at least 1 year of follow-up were selected. The extracellular matrix and bovine pericardium groups were compared. We used three-dimensional right ventricular ejection fraction, right ventricle global longitudinal strain, and tricuspid annular plane systolic excursion to assess right ventricular function. The extracellular matrix group had 11 patients, whereas the bovine pericardium group had 10 patients. No differences between the groups were found regarding sex ratio, age at surgery, and cardiopulmonary bypass time. The follow-up period was 28±12.6 months in the extracellular matrix group and 50.05±17.6 months in the bovine pericardium group (p=0.001). The mean three-dimensional right ventricular ejection fraction (55.7±5.0% versus 55.3±5.2%, p=0.73), right ventricular global longitudinal strain (-18.5±3.0% versus -18.0±2.2%, p=0.44), and tricuspid annular plane systolic excursions (1.59±0.16 versus 1.59±0.2, p=0.93) were similar in the extracellular matrix group and in the bovine pericardium group, respectively. Right ventricular global longitudinal strain in healthy children is reported at -29±3% in literature. In a small cohort of the patients undergoing non-transannular repair of tetralogy of Fallot, there was no significant difference in right ventricular function between groups having extracellular matrix versus bovine pericardium patches followed-up for more than 1 year. Lower right ventricular longitudinal strain noted in both the groups compared to healthy children.

  13. Comparison of left ventricular function assessment between echocardiography and MRI in Duchenne muscular dystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Buddhe, Sujatha; Lewin, Mark; Olson, Aaron; Soriano, Brian D. [University of Washington School of Medicine and Seattle Children' s Hospital, Division of Cardiology, Department of Pediatrics, Seattle, WA (United States); Ferguson, Mark [University of Washington School of Medicine and Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States)

    2016-09-15

    Cardiomyopathy in Duchenne muscular dystrophy (DMD) is associated with death in approximately 40% of patients. Echocardiography is routinely used to assess left ventricular (LV) function; however, it has limitations in these patients. We compared echocardiographic measures of cardiac function assessment to cardiac MRI. We included children and young adults with DMD who had MRI performed between January 2010 and July 2015. We measured echocardiographic and MRI parameters of function assessment, including strain. Presence of late gadolinium enhancement (LGE) was assessed by MRI. Subjects were divided into two groups based on MRI left ventricular ejection fraction (LVEF): group I, LVEF ≥55% and group II, LVEF <55%. We included 41 studies in 33 subjects, with 25 in group I and 16 in group II. Mean age of subjects was 13.6 ± 2.8 years and mean duration between echocardiogram and MRI was 7.6 ± 4.1 months. Only 8 of 16 (50%) patients in group II had diminished function on echocardiogram. Echocardiographic images were suboptimal in 16 subjects (39%). Overall, echocardiographic parameters had weak correlation with MRI-derived ejection fraction percentage. MRI-derived myocardial strain assessment has better correlation with MRI ejection fraction as compared to echocardiography-derived strain parameters. Echocardiography-based ventricular functional assessment has weak correlation with MRI parameters in children and young adults with Duchenne muscular dystrophy. While this correlation improves in the subset of subjects with adequate echocardiographic image quality, it remains modest and potentially suboptimal for clinical management. Accordingly, we conclude that MRI should be performed routinely and early in children with DMD, not only for LGE imaging but also for functional assessment. (orig.)

  14. Arrhythmogenic right ventricular dysplasia

    OpenAIRE

    Bockeria O.L.; Lе T.G.

    2015-01-01

    Arrhythmogenic right ventricular dysplasia is a hereditary cardiomyopathy characterized by structural and functional disorders in the right ventricle, which results in ventricular arrhythmias. Arrhythmogenic right ventricular dysplasia is one of the important causes of sudden cardiac death in young people and athletes. Structural disorders in arrhythmogenic right ventricular dysplasia are associated with fibrosis and fatty infiltration of the right ventricular myocardium. These changes lead t...

  15. Transcranial brain stimulation to promote functional recovery after stroke

    DEFF Research Database (Denmark)

    Raffin, Estelle; Siebner, Hartwig R

    2014-01-01

    PURPOSE OF REVIEW: Noninvasive brain stimulation (NIBS) is increasingly used to enhance the recovery of function after stroke. The purpose of this review is to highlight and discuss some unresolved questions that need to be addressed to better understand and exploit the potential of NIBS...... therapeutic efficacy. SUMMARY: This review addressed six questions: How does NIBS facilitate the recovery of function after stroke? Which brain regions should be targeted by NIBS? Is there a particularly effective NIBS modality that should be used? Does the location of the stroke influence the therapeutic...... response? How often should NIBS be repeated? Is the functional state of the brain during or before NIBS relevant to therapeutic efficacy of NIBS? We argue that these questions need to be tackled to obtain sufficient mechanistic understanding of how NIBS facilitates the recovery of function. This knowledge...

  16. Do nondipping pattern and metabolic syndrome impact left ventricular geometry and global function in hypertensive patients?

    Science.gov (United States)

    Tadic, Marijana; Ivanovic, Branislava; Celic, Vera; Neskovic, Aleksandar

    2013-01-01

    The aim of this study was to investigate the impact of nondipping arterial blood pressure pattern and the metabolic syndrome (MS), as well as their interaction, on left ventricular (LV) structural and function remodeling. The study included 352 never-treated hypertensive patients with and without MS. Nondipping pattern and MS, separately, as well as their interaction, significantly impacted LV structure, LV geometry pattern, systolic, diastolic and global function in hypertensive patients. Abdominal obesity was the only MS criterion which was simultaneously associated with LV hypertrophy, LV diastolic dysfunction and, LV global dysfunction.

  17. Assessment of the right ventricular function in patients with chronic obstructive pulmonary disease using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Gao Yan; Du Xiangying; Qin Wen; Li Kuncheng (Dept. of Radiology, Xuanwu Hospital of Capital Medical Univ., Beijing (China)), email: kuncheng.li@gmail.com

    2011-09-15

    Background: Chronic obstructive pulmonary disease (COPD) is often associated with changes of the structure and the function of the right ventricle (RV). Therefore, the assessment of right ventricular function and myocardial mass (MM) is clinically important for the evaluation of the severity of COPD, which may provide an objective basis for therapeutic strategy. Purpose: To assess the right ventricular function and RV MM in patients with mild to severe COPD using magnetic resonance imaging (MRI). Material and Methods: We prospectively studied 49 COPD patients determined by the pulmonary function test (PFT). Using the Global Initiative for COPD classification, the COPD patients were divided into three groups according to the severity of the disease: group I = mild (n = 18); group II = moderate (n = 16); and group III = severe (n = 15). The patient groups were compared to a control group consisting of 30 age-matched, healthy, non-smoking subjects. The RV function and RV MM were obtained by 1.5T cardiac MRI in all of the four groups. The results were compared among the four groups using the ANOVA. Pearson's correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and MM with the PFT results in COPD patients. Results: The RVEF was significantly lower in group III than in the other groups (P < 0.01). The RV MM differed significantly among all groups (P < 0.01) and gradually increased with the severity of COPD (P < 0.01). The correlation was significant between the MRI results and forced expiratory volume in 1 s (r = 0.860 for RVEF, r = -0.838 for RV MM) in COPD patients. Conclusion: The RVEF and RV MM measured by MRI correlate significantly with the severity of disease as determined by PFT in patients with COPD

  18. [Effect of spironolactone in patients with heart failure and preserved left ventricular function - TOPCAT study].

    Science.gov (United States)

    Widimský, Jiří

    2015-05-01

    The TOPCAT study followed the effect of spironolactone on a chronic heart failure with a preserved left ventricular ejection fraction. The study did not find any impact on the primary goal of the study, i.e. a combination of cardiovascular mortality, managed cardiac arrest or hospitalization rate for heart failure treatment. The only finding of the study was the decrease in hospitalization rates for a heart failure. A post hoc analysis, however, identified a significant difference between patients from the Americas (USA, Canada, Argentina, Brazil) on the one hand and those from Russia/Georgia on the other. The differences were rather striking. Whereas the former manifested a significant reduction in the incidence of the primary goal, i.e. cardiovascular mortality and hospitalization with heart failure through treatment with spironolactone, the incidence of all clinical events was considerably lower in Russia/Georgia and no impact of spironolactone at all on any of the goals was identified regarding the patients from Russia/Georgia. This post hoc analysis therefore suggested a possible therapeutic effect of spironolactone in the Americas, as well as in the populations of similar characteristics. Most studies accept a definition only based on the heart failure with a preserved left ventricular ejection fraction. The study points to the need to further elaborate this definition which also has to consider changes of the left ventricular diastolic function when defining a diastolic heart failure.

  19. Exercise capacity in the Bidirectional Glenn physiology: Coupling cardiac index, ventricular function and oxygen extraction ratio.

    Science.gov (United States)

    Vallecilla, Carolina; Khiabani, Reza H; Trusty, Phillip; Sandoval, Néstor; Fogel, Mark; Briceño, Juan Carlos; Yoganathan, Ajit P

    2015-07-16

    In Bi-directional Glenn (BDG) physiology, the superior systemic circulation and pulmonary circulation are in series. Consequently, only blood from the superior vena cava is oxygenated in the lungs. Oxygenated blood then travels to the ventricle where it is mixed with blood returning from the lower body. Therefore, incremental changes in oxygen extraction ratio (OER) could compromise exercise tolerance. In this study, the effect of exercise on the hemodynamic and ventricular performance of BDG physiology was investigated using clinical patient data as inputs for a lumped parameter model coupled with oxygenation equations. Changes in cardiac index, Qp/Qs, systemic pressure, oxygen extraction ratio and ventricular/vascular coupling ratio were calculated for three different exercise levels. The patient cohort (n=29) was sub-grouped by age and pulmonary vascular resistance (PVR) at rest. It was observed that the changes in exercise tolerance are significant in both comparisons, but most significant when sub-grouped by PVR at rest. Results showed that patients over 2 years old with high PVR are above or close to the upper tolerable limit of OER (0.32) at baseline. Patients with high PVR at rest had very poor exercise tolerance while patients with low PVR at rest could tolerate low exercise conditions. In general, ventricular function of SV patients is too poor to increase CI and fulfill exercise requirements. The presented mathematical model provides a framework to estimate the hemodynamic performance of BDG patients at different exercise levels according to patient specific data. Published by Elsevier Ltd.

  20. Acute aortocaval fistula: role of low perfusion pressure and subendocardial remodeling on left ventricular function.

    Science.gov (United States)

    Mazzo, Flávia R R; de Carvalho Frimm, Clovis; Moretti, Ana Iochabel S; Guido, Maria C; Koike, Marcia K

    2013-06-01

    The experimental model of aortocaval fistula is a useful model of cardiac hypertrophy in response to volume overload. In the present study it has been used to investigate the pathologic subendocardial remodeling associated with the development of heart failure during the early phases (day 1, 3, and 7) following volume overload. Compared with sham treated rats, aortocaval fistula rats showed lower systemic blood pressure and higher left ventricular end-diastolic pressure This resulted in lower coronary driving pressure and left ventricular systolic and diastolic dysfunction. Signs of myocyte necrosis, leukocyte cell infiltration, fibroplasia and collagen deposition appeared sequentially in the subendocardium where remodeling was more prominent than in the non-subendocardium. Accordingly, increased levels of TNF-alpha, IL-1 beta, and IL-6, and enhanced MMP-2 activity were all found in the subendocardium of rats with coronary driving pressure ≤ 60 mmHg. The coronary driving pressure was inversely correlated with MMP-2 activity in subendocardium in all time-points studied, and blood flow in this region showed positive correlation with systolic and diastolic function at day 7. Thus the predominant subendocardial remodeling that occurs in response to low myocardial perfusion pressure during the acute phases of aortocaval fistula contributes to early left ventricular dysfunction. © 2013 The Authors. International Journal of Experimental Pathology © 2013 International Journal of Experimental Pathology.

  1. Maximal exercise tolerance in chronic congestive heart failure. Relationship to resting left ventricular function.

    Science.gov (United States)

    Carell, E S; Murali, S; Schulman, D S; Estrada-Quintero, T; Uretsky, B F

    1994-12-01

    The relationship between maximal exercise tolerance and resting radionuclide indexes of left ventricular systolic and diastolic function were evaluated in 20 ischemic and 44 idiopathic cardiomyopathy patients with New York Heart Association class 2-4 chronic congestive heart failure. Left ventricular ejection fraction, peak systolic ejection rate, peak diastolic filling rate, time to peak filling from end-systolic volume, and fractional filling in early diastole were measured from the radionuclide ventriculogram. All patients underwent symptom-limited exercise testing with on-line measurement of oxygen consumption. In the ischemic group, all of the radionuclide indexes correlated poorly with maximal exercise oxygen consumption (VO2max) except the peak systolic ejection rate which correlated modestly (r = 0.58, p 14 mL/kg/min). In the idiopathic group, none of the radionuclide indexes correlated well with VO2max; and all indexes were similar in patients with and without marked exercise intolerance. These data suggest that (1) resting left ventricular ejection fraction poorly predicts maximal exercise capacity in both ischemic and idiopathic cardiomyopathy and (2) resting peak systolic ejection rate, peak diastolic filling rate, and fractional filling in early diastole may predict exercise tolerance in ischemic but not idiopathic cardiomyopathy.

  2. Challenges in postdischarge function and recovery

    DEFF Research Database (Denmark)

    Aasvang, E K; Luna, I E; Kehlet, H

    2015-01-01

    This narrative review updates the recent advances in our understanding of the multifactorial pathogenesis for reduced postdischarge physical and cognitive function after fast-track surgery, using total hip and knee arthroplasty as surgical models. Relevant factors discussed include the surgical...

  3. 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.)

  4. Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome

    Science.gov (United States)

    Fournier, Sara B.; Reger, Brian L.; Donley, David A.; Bonner, Daniel E.; Warden, Bradford E.; Gharib, Wissam; Failinger, Conard F.; Olfert, Melissa D.; Frisbee, Jefferson C.; Olfert, I. Mark; Chantler, Paul D.

    2013-01-01

    MetS is the manifestation of a cluster of cardiovascular (CV) risk factors and is associated with a three-fold increase risk of CV morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to comprehensively examine LV and arterial responses to exercise in MetS individuals without diabetes and/or overt CVD compared to a healthy control population. CV function was characterized using Doppler echocardiography and gas exchange in MetS (n=27) vs. healthy controls (n=20) at rest and during peak exercise. At rest, MetS individuals displayed normal LV systolic function but reduced LV diastolic function vs. healthy controls. During peak exercise, individuals with MetS had impaired contractility; pump performance, and vasodilator reserve capacity vs. controls. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in MetS vs. controls. These findings possess clinical importance as they provide insight to the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of CV morbidity and mortality. PMID:24036595

  5. Hospitalized congestive heart failure patients with preserved versus abnormal left ventricular systolic function: clinical characteristics and drug therapy.

    Science.gov (United States)

    McDermott, M M; Feinglass, J; Sy, J; Gheorghiade, M

    1995-12-01

    To compare clinical characteristics of and pharmacologic therapy for hospitalized patients with congestive heart failure (CHF) and left ventricular systolic dysfunction or normal left ventricular systolic function. Medical records were reviewed for all patients discharged with a principal diagnosis of CHF from a university hospital and a community hospital between September 1, 1991 and August 31, 1992. Pertinent medical history items and prescribed drug therapies at discharge were recorded for each patient's first calendar year admission. Patients were categorized as having either normal left ventricular systolic function or systolic dysfunction based on the results of echocardiography and radionuclide angiography or contrast ventriculogram. Of 298 patients with CHF, 92 (31%) had normal left ventricular systolic function. Patients with normal systolic function were older, were more often women, were less likely to have a history of coronary artery disease, and were more likely to have a history of hypothyroidism than patients with systolic dysfunction. However, the prevalence of clinical characteristics overlapped considerably between the two groups. Among patients with systolic dysfunction, 79% were discharged on a therapeutic regimen of digoxin, 65% on an angiotensin-converting enzyme inhibitor, and 26% on either a beta-blocker or a calcium channel blocker. Among patients with normal systolic function, 50% were discharged on a regimen of a beta-blocker or a calcium channel blocker and 38% were discharged on digoxin. Twenty-six percent of patients with normal systolic function and without a history of atrial fibrillation were discharged on a digoxin regimen. Hospitalized CHF patients with normal left ventricular systolic function and those with diminished left ventricular systolic function share many clinical features. Since recommended drug therapy and prognosis differ, our data underscore the importance of diagnostic testing to assess left ventricular systolic

  6. Diminished physical capacity in obese individuals with normal left ventricular function

    Directory of Open Access Journals (Sweden)

    Iliana Cabrera Rojo

    2015-03-01

    Full Text Available Introduction: Obesity is a pandemic today. The physical capacity of subjects with ex-cess body weight decreases due to high energy consumption, even though their heart function is normal.Objective: The objective was to determine the physical capacity in subjects with over-nutrition and in those with normal weight, with normal systolic left ventricular func-tion.Method: A descriptive, observational, cross-sectional analytical study was conducted in 170 subjects who came to the General Calixto García University Hospital in Havana, Cuba from April 2009 to November 2012. The sample was divided, according to body mass index, into normal weight (50, overweight (60 and obese (60. An exercise test and an echocardiogram were performed.Results: Females and white skin color predominated (53.2%, respectively. A seden-tary lifestyle and adding salt to food were found in a greater proportion among the overweight and obese subjects (p<0.001 vs. normal weight. The systolic blood press-ure at maximal effort differed between the groups: 200 ± 15 mmHg in obese subjects, 185 ± 27 mmHg in overweight subjects and 173 ± 24 mmHg in normal weight (p<0.05. The physical capacity, measured in METs, was low in obese subjects (5.8 ± 1.3 compared with overweight subjects (7.8 ± 2.1 and normal weight subjects (8.3 ± 1.7, p<0.001. The diameters, wall thickness and left ventricular mass increased in obese subjects with normal systolic function.Conclusions: Physical capacity deteriorates as body mass index increases even with normal systolic left ventricular function.Key words: Obesity, Physical capacity, Systolic function, Echocardiography, Exercise testing

  7. Assessment of left ventricular function by tissue Doppler imaging in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Osman Kuloglu

    2012-05-01

    Full Text Available Ankylosing spondylitis (ASpis a chronic, inflammatory and systemic disease affecting pericardium, myocardium and the conduction system of the heart. In this study, we aimed to analyse left ventricular systolic and diastolic functions using tissue Doppler imaging (TDI. 30 patients with ASp and 30 healthy volunteers having the similar demographic characteristics were included. Left ventricular systolic and diastolic functions were assessed by using two dimensional (2D echocardiography, M-mode, pulsed-wave (PW and tissue Doppler echocardiography. The peak systolic velocity (Sm, early diastolic myocardial peak velocity (m, late diastolic myocardial peak velocity (Am, isovolumic acceleration (IVA, myocardial precontraction time (PCTm, myocardial contraction time (CTm, myocardial relaxation time (RTm, and myocardial performance index (MPI were measured at septal and lateral mitral annulus. In conventional echocardiography, end-diastolic interventricular septum and posterior wall diameters were higher in patients with ASp than the control group. The ratio of E/A was significantly lower and deceleration time was significantly prolonged in patients with ASp, but mitral E and A velocities, isovolumic relaxation time and MPI were similar in patient and control group (P>0.05. Left ventricular lateral and septal wall tissue Doppler echocardiography showed that Em, Em/Am ratio and CTm were significantly lower, IVRTm was longer and MPI was higher in patients with ASp. No significant differences were detected between the groups for IVA, Sm, Am, PCTm, PCTm/CTm ratio (P>0.05. We have demonstrated that in patients with ASp, diastolic functions were impaired but systolic functions were preserved by using TDI.

  8. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters.

    Science.gov (United States)

    Marterer, Robert; Hongchun, Zeng; Tschauner, Sebastian; Koestenberger, Martin; Sorantin, Erich

    2015-12-01

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, branch bundle block leads to an asynchronous ventricular contraction • In CMR, a delayed right ventricular contraction due to RBBB can be detected • Ignoring RV physiology in RBBB patients leads to underscoring of RV performance.

  9. Analysis of Regional Left Ventricular Strain in Patients with Chagas Disease and Normal Left Ventricular Systolic Function.

    Science.gov (United States)

    Gomes, Victor Augusto M; Alves, Gabriel F; Hadlich, Marcelo; Azevedo, Clerio F; Pereira, Iane M; Santos, Carla Renata F; Brasil, Pedro Emmanuel A A; Sangenis, Luiz Henrique C; Cunha, Ademir B; Xavier, Sergio S; Saraiva, Roberto M

    2016-07-01

    Chagas heart disease has a high socioeconomic burden, and any strategy to detect early myocardial damage is welcome. Speckle-tracking echocardiography assesses global and segmental left ventricular (LV) systolic function, yielding values of two-dimensional strain (ε). The aim of this study was to determine if patients with chronic Chagas disease and normal LV ejection fractions present abnormalities in global and segmental LV ε. In this prospective study, patients with Chagas disease with no evidence of cardiac involvement (group I; n = 83) or at stage A of the cardiac form (i.e., with changes limited to the electrocardiogram) (group A; n = 42) and 43 control subjects (group C) underwent evaluation of global and segmental LV ε by speckle-tracking echocardiography. A subset of randomly selected patients in group A underwent cardiac magnetic resonance imaging and repeated echocardiography 3.5 ± 0.8 years after the first evaluation. Mean age, chamber dimensions, and LV ejection fraction were similar among the groups. Global longitudinal (group C, -19 ± 2%; group I, -19 ± 2%; group A, -19 ± 2%), circumferential (group C, -19 ± 3%; group I, -20 ± 3%; group A, -19 ± 3%), and radial (group C, 46 ± 10%; group I, 45 ± 13%; group A, 42 ± 14%) LV ε were similar among the groups. Segmental longitudinal, circumferential, and radial LV ε were similar across the studied groups. Seven of 14 patients had areas of fibrosis on cardiac magnetic resonance imaging. Patients with fibrosis had lower global longitudinal (-15 ± 2% vs -18 ± 2%, P = .004), circumferential (-14 ± 2% vs -19 ± 2%, P = .002), and radial LV ε (36 ± 13% vs 54 ± 12%, P = .02) than those without cardiac fibrosis despite similar LV ejection fractions. Patients with fibrosis had lower radial LV ε in the basal inferoseptal wall than patients without cardiac fibrosis (27 ± 17% vs 60 ± 15%, P = .04). Patients with chronic Chagas disease and normal

  10. Impaired coronary microvascular and left ventricular diastolic function in patients with inflammatory bowel disease.

    Science.gov (United States)

    Caliskan, Zuhal; Gokturk, Huseyin Savas; Caliskan, Mustafa; Gullu, Hakan; Ciftci, Ozgur; Ozgur, Gülsüm Teke; Guven, Aytekin; Selcuk, Haldun

    2015-01-01

    Increased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. Seventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove-Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. Compared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1±3.9 vs. 22. 4±2.9, pcoronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP. Copyright © 2014. Published by Elsevier Inc.

  11. Effects of calcium on left ventricular function early after cardiopulmonary bypass.

    Science.gov (United States)

    DeHert, S G; Ten Broecke, P W; De Mulder, P A; Rodrigus, I E; Haenen, L R; Boeckxstaens, C J; Vermeyen, K M; Gillebert, T C; Moulijn, A C

    1997-12-01

    Evaluation of the effects of intravenous CaCl2 on systolic and diastolic function early after separation from cardiopulmonary bypass (CPB) DESIGN: Prospective study University hospital Twenty patients scheduled for elective coronary artery surgery Left ventricular (LV) pressures were measured with fluid-filled catheters. Data were digitally recorded during pressure elevation induced by tilt-up of the legs. Transgastric short-axis echocardiographic views of the LV were simultaneously recorded on videotape. Measurements were obtained before the start of CPB, 10 minutes after termination of CPB, after intravenous administration of CaCl2, 5 mg/kg, and 10 minutes later. Systolic function was evaluated with the slope (Ees, mmHg/mL) of the systolic pressure-volume relation. Diastolic function was evaluated with the chamber stiffness constant (Kc, mmHg/mL) of the diastolic pressure-volume relation. CaCl2 increased Ees from 2.62 +/- 0.46 to 5.58 +/- 0.61 (mean +/- SD), but induced diastolic dysfunction with an increase in Kc from 0.011 +/- 0.006 to 0.019 +/- 0.007. These changes were transient and had disappeared within 10 minutes after administration of CaCl2. CaCl2 early after CPB transiently improved systolic function at the expense of an increase in ventricular stiffness, suggesting temporary diastolic dysfunction.

  12. Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study.

    Science.gov (United States)

    Kaye, Gerald C; Linker, Nicholas J; Marwick, Thomas H; Pollock, Lucy; Graham, Laura; Pouliot, Erika; Poloniecki, Jan; Gammage, Michael

    2015-04-07

    Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period. We randomized 240 patients (age 74 ± 11 years, 67% male) with a high-grade AV block requiring >90% ventricular pacing and preserved baseline LVEF >50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 ± 9 to 55 ± 9%, P = 0.047) and the RVHS groups (56 ± 10 to 54 ± 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 ± 25 vs. 56 ± 24 min, P < 0.0001) with longer fluoroscopy times (11 ± 7 vs. 5 ± 4 min, P < 0.0001). In patients with a high-grade AV block and preserved LV function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years. ClinicalTrials.gov number NCT00461734. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  13. Effects of an Isolated Complete Right Bundle Branch Block on Mechanical Ventricular Function.

    Science.gov (United States)

    Zhang, Qin; Xue, Minghua; Li, Zhan; Wang, Haiyan; Zhu, Lei; Liu, Xinling; Meng, Haiyan; Hou, Yinglong

    2015-12-01

    The purpose of this study was to investigate the effects of an isolated complete right bundle branch block on mechanical ventricular function. Two groups of participants were enrolled in this study: a block group, consisting of 98 patients with isolated complete right bundle branch blocks without structural heart disease, and a control group, consisting of 92 healthy adults. The diameter, end-diastolic area, end-systolic area, and right ventricular (RV) fractional area change were obtained to evaluate morphologic and systolic function by 2-dimensional sonographic technology. Systolic and diastolic velocities and time interval parameters were measured to assess mechanical ventricular performance using pulsed wave tissue Doppler imaging. Although there was no significant difference in the RV fractional area change between the patients with blocks and controls, the diameter, end-diastolic area, and end-systolic area of the RV were significantly larger in the patients with blocks (P blocks, the peak velocities during systole and early diastole and the ratio of the peak velocities during early and late diastole decreased. The block group had a prolonged pre-ejection period, electromechanical delay time, and isovolumic relaxation time, a decreased ejection time, and an increased pre-ejection period/ejection time ratio, and the myocardial performance index (Tei index) at the basal RV lateral wall was significantly increased. There were no significant differences in any echocardiographic parameters at different sites of the left ventricle. In patients with isolated complete right bundle branch blocks, systolic and diastolic functions are impaired in the RV, and follow-up is needed. © 2015 by the American Institute of Ultrasound in Medicine.

  14. Right ventricular function in children with bronchial asthma: a tissue Doppler echocardiographic study.

    Science.gov (United States)

    Shedeed, Soad A

    2010-10-01

    Asthma is the most common cause of respiratory disability among children. Patients with severe bronchial asthma can experience cor pulmonale later in life, but little is known about the function of the right ventricle early in the disease. This study aimed to investigate the right ventricular function in children with bronchial asthma as detected by tissue Doppler echocardiography. This case-control study compared 60 asthmatic children ages 5 to 15 years between attacks (study group) with 60 apparently healthy children (control group). All the children were subjected to full history-taking, complete physical examination, measurement of peak expiratory flow rate (PEFR), chest x-ray, electrocardiography (ECG), echocardiographic examination, and both conventional and tissue Doppler study. The results of the tissue Doppler study examining the right ventricular diastolic function showed that peak E' velocity (10.08 ± 2.8 cm/s), peak A' velocity (5.7 ± 2.5 cm/s), E'/A' ratio (1.77 ± 0.58 m/s), and isovolumetric relaxation time (IVRT) of the lateral tricuspid annulus (138.9 ± 30.7 m/s) among the asthmatic patients differed significantly from those among the control subjects (12.4 ± 2.3, 7.8 ± 2.1 cm/s; 1.58 ± 0.32, and 91.1 ± 32.6 m/s, respectively). In addition, the E' velocity and IVRT of the lateral tricuspid annulus were significantly different among the mild, moderate, and severe cases (P children were apparently normal, the tissue Doppler echocardiographic study showed right ventricular dysfunction that is positively correlated with the severity of asthma. These findings signify the diagnostic value of tissue Doppler echocardiography for the early detection and monitoring of such deleterious effects among asthmatic patients.

  15. Recovery of cardiomyopathy induced by ventricular premature beats of paraHisian origin after successful radiofrequency catheter ablation.

    Science.gov (United States)

    Aksan, Gökhan; Elitok, Ali; Tezcan, Mehmet; Bilge, Ahmet Kaya; Adalet, Kamil

    2017-12-01

    A 51-year-old male patient presented with frequent and symptomatic premature ventricular complexes (PVCs) that had induced cardiomyopathy. Radiofrequency (RF) catheter ablation of the origin of the PVCs was planned and the patient underwent electrophysiological study. During activation mapping, the earliest ventricular activation was identified at the His bundle region. Small His bundle electrogram recording by the distal ablation electrode during sinus rhythm revealed that the earliest ventricular activation during PVC preceded the QRS onset by 58 milliseconds. The PVCs were successfully eliminated without occurrence of atrioventricular block using incremental application of RF energy to the para-Hisian region. At the conclusion of a 5-month follow-up period, the patient remained asymptomatic and transthoracic echocardiography demonstrated an improvement in left ventricular ejection fraction.

  16. Effect of clenbuterol on cardiac and skeletal muscle function during left ventricular assist device support.

    Science.gov (United States)

    George, Isaac; Xydas, Steve; Mancini, Donna M; Lamanca, John; DiTullio, Marco; Marboe, Charles C; Shane, Elizabeth; Schulman, Allison R; Colley, Patrick M; Petrilli, Christopher M; Naka, Yoshifumi; Oz, Mehmet C; Maybaum, Simon

    2006-09-01

    High-dose clenbuterol (a selective beta2-adrenergic agonist) has been proposed to promote myocardial recovery during left ventricular assist device (LVAD) support, but its effects on cardiac and skeletal muscle are largely unknown. Seven subjects with heart failure (5 ischemic, 2 non-ischemic) were started on oral clenbuterol 5 to 46 weeks post-LVAD implantation and up-titrated to daily doses of 720 microg. The following procedures were performed at baseline and after 3 months of therapy: echocardiography at reduced support (4 liters/min); cardiopulmonary exercise testing; body composition analysis; and quadriceps maximal voluntary contraction (MVC). Myocardial histologic analysis was measured at device implantation and explantation. There were no serious adverse events or arrhythmias. Creatine phosphokinase (CPK) was elevated in 4 subjects, with no clinical sequelae. No change in ejection fraction was seen. End-diastolic dimension increased significantly (4.73 +/- 0.67 vs 5.24 +/- 0.66; p clenbuterol. However, clenbuterol therapy increased skeletal muscle mass and strength and prevented the expected decrease in myocyte size during LVAD support. Further study will clarify its potential for cardiac and skeletal muscle recovery.

  17. Pulse pressure, left ventricular function and cardiovascular events during antihypertensive treatment (the LIFE study)

    DEFF Research Database (Denmark)

    Gerdts, Eva; Franklin, Stanley; Rieck, Ashild

    2009-01-01

    Background. Pulse pressure (PP) has been related to risk of cardiovascular events in hypertension. However, less is known about modification of this risk marker during antihypertensive treatment in patients with left ventricular (LV) hypertrophy. Methods. Associations of in-treatment PP with LV......, Framingham risk score and study treatment allocation. Conclusion. During systematic antihypertensive treatment in hypertensive patients with electrocardiographic LV hypertrophy, lower in-treatment PP was associated with lower in-treatment LV function and cardiac output as well as higher rate...

  18. Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Møller, J E; Nørager, B

    2001-01-01

    The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis...... of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73......%) and D (38%) compared to A (2%) (p regression analysis identified LV diastolic dysfunction (p = 0.001), Killip class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved...

  19. Alterations in left ventricular diastolic function in conscious dogs with pacing-induced heart failure

    Science.gov (United States)

    Komamura, K.; Shannon, R. P.; Pasipoularides, A.; Ihara, T.; Lader, A. S.; Patrick, T. A.; Bishop, S. P.; Vatner, S. F.

    1992-01-01

    We investigated in conscious dogs (a) the effects of heart failure induced by chronic rapid ventricular pacing on the sequence of development of left ventricular (LV) diastolic versus systolic dysfunction and (b) whether the changes were load dependent or secondary to alterations in structure. LV systolic and diastolic dysfunction were evident within 24 h after initiation of pacing and occurred in parallel over 3 wk. LV systolic function was reduced at 3 wk, i.e., peak LV dP/dt fell by -1,327 +/- 105 mmHg/s and ejection fraction by -22 +/- 2%. LV diastolic dysfunction also progressed over 3 wk of pacing, i.e., tau increased by +14.0 +/- 2.8 ms and the myocardial stiffness constant by +6.5 +/- 1.4, whereas LV chamber stiffness did not change. These alterations were associated with increases in LV end-systolic (+28.6 +/- 5.7 g/cm2) and LV end-diastolic stresses (+40.4 +/- 5.3 g/cm2). When stresses and heart rate were matched at the same levels in the control and failure states, the increases in tau and myocardial stiffness were no longer observed, whereas LV systolic function remained depressed. There were no increases in connective tissue content in heart failure. Thus, pacing-induced heart failure in conscious dogs is characterized by major alterations in diastolic function which are reversible with normalization of increased loading condition.

  20. Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach.

    Science.gov (United States)

    Smolarek, Dorota; Gruchała, Marcin; Sobiczewski, Wojciech

    2017-01-01

    Estimation of right ventricular (RV) performance still remains technically challenging due to its anatomical and functional distinctiveness. The current guidelines for the echocardiographic quantification of RV function recommend using multiple indices to describe the RV in a thorough and comprehensive manner, such as RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'-wave), three-dimensional RV ejection fraction (3D RVEF), RV longitudinal strain (RVLS)/strain rate by speckle- tracking echocardiography (STE). Among these, the last one mentioned here is an innovative and a particularly promising tool that yields more precise information about complex regional and global RV mechanics. STE was initially designed to evaluate left ventricular function, but recently it has been introduced to assess RV performance, which is difficult due to its unique structure and physiology. Many studies have shown that both free wall and 6-segment RVLS present a stronger correlation with the RVEF assessed by cardiac magnetic resonance than conventional parameters and seem to be more sensitive in detecting myocardial dysfunction at an earlier, subclinical stage.

  1. Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery.

    Science.gov (United States)

    Prior, David L; Stevens, Susanna R; Holly, Thomas A; Krejca, Michal; Paraforos, Alexandros; Pohost, Gerald M; Byrd, Krysti; Kukulski, Tomasz; Jones, Robert H; Desvigne-Nickens, Patrice; Varadarajan, Padmini; Amanullah, Aman; Lin, Grace; Al-Khalidi, Hussein R; Aldea, Gabriel; Santambrogio, Carlo; Bochenek, Andrzej; Berman, Daniel S

    2017-09-01

    To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or without (n=499) surgical ventricular reconstruction (SVR). Novel multivariable methods to analyse global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age and NYHA (New York Heart Association) class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG. NCT00023595. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. [The role of Doppler echocardiography in assessing left ventricular diastolic function. Case histories].

    Science.gov (United States)

    Lo Giudice, P; Scaccianoce, G; Cavarra, M; Francaviglia, B; Gulizia, M; Circo, A

    1992-12-01

    The aim of this study was to provide a further contribution to evaluate the alterations induced by age on a number of simple Doppler indexes of left ventricular diastolic function. A population of 48 healthy subjects aged between 15 and 78 years old was examined using pulsed Doppler analysis of the left ventricular refilling flow. Linear regression analysis revealed a significant inverse correlation between age and peak speed during rapid refilling (r = -0.80); between age and the ratio between peak speed during rapid refilling and peak during atrial systole (r = -0.92); between age and deceleration time of peak E wave speed, although on the contrary the peak speed of diastolic refilling flow during the atrial systole (r = 0.81) increased significantly with age. Variance analysis showed that indexes of left ventricular diastolic function and age continued on the contrary to be significant n the population as a whole and in both sexes. From these findings it is clear that in the different age groups (15-29, 30-49, 50-65, and over 65) the peak speed of rapid refilling flow was significantly lower in over-65-year-olds than in elderly, middle-aged and young subjects (55 +/- 0.8, 60 +/- 0.5, 65 +/- 0.7 and 75 +/- 0.6 respectively; p < 0.001). The ratio between the peak speed of rapid refilling and that during the atrial systole was lower in over-65-year-olds compared to elderly subjects, middle-aged subjects or the youngest age group (0.94 +/- 0.09, 1.05 +/- 0.13, 1.96 +/- 0.21 and 2.68 +/- 0.50 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Does left ventricular function improve with L-carnitine after acute myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Iyer R

    1999-04-01

    Full Text Available A double blind randomized placebo controlled clinical trial was carried out to assess the efficacy and safety of L-carnitine in patients suffering from acute anterior wall myocardial infarction with respect to left ventricular function. Sixty patients (34 men, 26 women, mean age 56+11 yr. with acute anterior wall myocardial infarction were randomized to placebo and L-carnitine. All the patients were given intravenous L-carnitine / placebo in the dose of 6gm/day for the first seven days followed by oral L-carnitine / placebo 3 gm/day in three divided doses for a period of three months. Echocardiography was performed for regional wall motion abnormality, left ventricular end systolic volume (ESV, end diastolic volume (EDV and ejection fraction (EF on admission, after seven days and after three months of the infarction. Forty-four patients completed the study. There were three deaths, two in the placebo and one in the L-carnitine group (p>0.05. Thirteen patients were lost to follow up. Echo parameters in both groups were comparable (p>0.05. The duration of chest pain prior to initiation of the I.V. L-carnitine was 7.5 + 5.2 hrs in the L-carnitine group and 7 + 4 hrs in the placebo group (p>0.05. There was no statistical difference in the EF, ESV and EDV on admission, at discharge and after three months in the L-carnitine and the placebo groups (p>0.05. No significant adverse effects were noted. L-carnitine, though a safe drug, does not affect the left ventricular function in patients with myocardial infarction.

  4. Aging profoundly delays functional recovery from gustatory nerve injury.

    Science.gov (United States)

    He, L; Yadgarov, A; Sharif, S; McCluskey, L P

    2012-05-03

    The peripheral taste system remains plastic during adulthood. Sectioning the chorda tympani (CT) nerve, which sends sensory information from the anterior tongue to the central nervous system, causes degeneration of distal fibers and target taste buds. However, taste function is restored after about 40 days in young adult rodents. We tested whether aging impacts the reappearance of neural responses after unilateral CT nerve injury. Taste bud regeneration was minimal at day 50-65 after denervation, and most aged animals died before functional recovery could be assessed. A subset (n=3/5) of old rats exhibited normal CT responses at day 85 postsectioning, suggesting the potential for efficient recovery. The aged taste system is fairly resilient to sensory receptor loss and major functional changes in normal aging. However, injury to the taste system reveals a surprising vulnerability in old rodents. The gustatory system provides an excellent model to study mechanisms underlying delayed recovery from peripheral nerve injury. Strategies to accelerate recovery and restore normal function will be of interest, as the elderly population continues to grow. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

  5. Impact of central haemodynamics on left ventricular function in individuals with an exaggerated blood pressure response to exercise.

    Science.gov (United States)

    Shim, Chi Young; Hong, Geu-Ru; Park, Sungha; Yang, Woo-In; Choi, Donghoon; Chung, Namsik; Ha, Jong-Won

    2015-03-01

    The impact of exaggerated blood pressure response (EBPR) to exercise on left ventricular function and the mechanism of its association are poorly understood. This study investigated the impact of arterial stiffening on left ventricular function in individuals with an EBPR to exercise. We hypothesized that individuals with low pulse pressure (PP) amplification during exercise would have worse left ventricular function than those with high PP amplification in individuals with an EBPR to exercise. Fifty-nine individuals with an EBPR to exercise (18 men, age 57 ± 12 years) and 59 age and sex-matched controls were studied. Radial artery tonometry was performed at rest and immediately after exercise during supine bicycle exercise echocardiography. There were no differences in left ventricular structure or function between individuals with an EBPR to exercise and controls. When individuals with an EBPR to exercise were divided into two groups on the basis of PP amplification after exercise [Group 1 (n = 30), high PP amplification after exercise; Group 2 (n = 29), low PP amplification after exercise], group 2 showed larger left atrial volume and lower early diastolic (e') and systolic (S') mitral annular velocities. Left ventricular apical rotation was also exaggerated in group 2. In multiple regression, PP amplification after exercise was an independent determinant of e' (β = 0.16, P = 0.019) and S' (β = 0.25, P = 0.009) in individuals with an EBPR to exercise. In individuals with an EBPR to exercise, the degree of left ventricular dysfunction is variable. EBPR to exercise in the presence of arterial stiffening contributes to the deterioration of left ventricular function.

  6. Advanced Echocardiography in Adult Zebrafish Reveals Delayed Recovery of Heart Function after Myocardial Cryoinjury

    Science.gov (United States)

    Kossack, Mandy; Juergensen, Lonny; Fuchs, Dieter; Katus, Hugo A.; Hassel, David

    2015-01-01

    Translucent zebrafish larvae represent an established model to analyze genetics of cardiac development and human cardiac disease. More recently adult zebrafish are utilized to evaluate mechanisms of cardiac regeneration and by benefiting from recent genome editing technologies, including TALEN and CRISPR, adult zebrafish are emerging as a valuable in vivo model to evaluate novel disease genes and specifically validate disease causing mutations and their underlying pathomechanisms. However, methods to sensitively and non-invasively assess cardiac morphology and performance in adult zebrafish are still limited. We here present a standardized examination protocol to broadly assess cardiac performance in adult zebrafish by advancing conventional echocardiography with modern speckle-tracking analyses. This allows accurate detection of changes in cardiac performance and further enables highly sensitive assessment of regional myocardial motion and deformation in high spatio-temporal resolution. Combining conventional echocardiography measurements with radial and longitudinal velocity, displacement, strain, strain rate and myocardial wall delay rates after myocardial cryoinjury permitted to non-invasively determine injury dimensions and to longitudinally follow functional recovery during cardiac regeneration. We show that functional recovery of cryoinjured hearts occurs in three distinct phases. Importantly, the regeneration process after cryoinjury extends far beyond the proposed 45 days described for ventricular resection with reconstitution of myocardial performance up to 180 days post-injury (dpi). The imaging modalities evaluated here allow sensitive cardiac phenotyping and contribute to further establish adult zebrafish as valuable cardiac disease model beyond the larval developmental stage. PMID:25853735

  7. Advanced echocardiography in adult zebrafish reveals delayed recovery of heart function after myocardial cryoinjury.

    Directory of Open Access Journals (Sweden)

    Selina J Hein

    Full Text Available Translucent zebrafish larvae represent an established model to analyze genetics of cardiac development and human cardiac disease. More recently adult zebrafish are utilized to evaluate mechanisms of cardiac regeneration and by benefiting from recent genome editing technologies, including TALEN and CRISPR, adult zebrafish are emerging as a valuable in vivo model to evaluate novel disease genes and specifically validate disease causing mutations and their underlying pathomechanisms. However, methods to sensitively and non-invasively assess cardiac morphology and performance in adult zebrafish are still limited. We here present a standardized examination protocol to broadly assess cardiac performance in adult zebrafish by advancing conventional echocardiography with modern speckle-tracking analyses. This allows accurate detection of changes in cardiac performance and further enables highly sensitive assessment of regional myocardial motion and deformation in high spatio-temporal resolution. Combining conventional echocardiography measurements with radial and longitudinal velocity, displacement, strain, strain rate and myocardial wall delay rates after myocardial cryoinjury permitted to non-invasively determine injury dimensions and to longitudinally follow functional recovery during cardiac regeneration. We show that functional recovery of cryoinjured hearts occurs in three distinct phases. Importantly, the regeneration process after cryoinjury extends far beyond the proposed 45 days described for ventricular resection with reconstitution of myocardial performance up to 180 days post-injury (dpi. The imaging modalities evaluated here allow sensitive cardiac phenotyping and contribute to further establish adult zebrafish as valuable cardiac disease model beyond the larval developmental stage.

  8. 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.

  9. 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

  10. Acute intraoperative effect of intravenous amiodarone on right ventricular function in patients undergoing valvular surgery.

    Science.gov (United States)

    Denault, André Y; Beaulieu, Yanick; Couture, Pierre; Haddad, Francois; Shi, Yanfen; Pagé, Pierre; Levesque, Sylvie; Tardif, Jean-Claude; Lambert, Jean

    2015-08-01

    Amiodarone is commonly used in the acute care setting. However the acute hemodynamic and echocardiographic effect of intravenous amiodarone administered intraoperatively on right ventricular (RV) systolic and diastolic function using transesophageal echocardiography (TEE) has not been described. The study design was a randomized controlled trial in elective cardiac surgical patients undergoing valvular surgery. Patients received an intravenous loading dose of 300 mg of either amiodarone or placebo in the operating room, followed by an infusion of 15 mg/kg for two days. Hemodynamic profiles, echocardiographic measurement of RV and left ventricular (LV) dimensions, Doppler interrogation of tricuspid and mitral valve, hepatic and pulmonary venous flow combined with tissue Doppler imaging of the tricuspid and mitral valve annulus were obtained before and after bolus. Although more patients in the placebo group had chronic obstructive lung disease (14 vs 6, p=0.05) and diabetes (14 vs 5; p=0.0244), there was no difference in terms of baseline hemodynamic, 2D and Doppler variables. After bolus, a significant increase in pulmonary artery pressure, central venous pressure and pulmonary vascular resistance index (pAcute administration of amiodarone is associated with alteration in RV diastolic properties and has minimal negative inotropic effect on RV systolic function in cardiac surgical patients with valvular disease. © The European Society of Cardiology 2014.

  11. The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism.

    Science.gov (United States)

    Selcuk, Murat; Sayar, Nurten; Demir, Serafettin; Rodi Tosua, Aydın; Aslan, Vedat

    2014-10-01

    The aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE). Fifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis. In the control group IVA was 2.8±0.2 m/s(2), while in the acute PE group, it was 2.0±0.1 m/s(2) at the time of diagnosis and 2.9±0.1 m/s(2) at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p<0.0001; control and PE at one-month follow-up p=0.983). In our study, IVA was shown to be a reliable marker of right ventricular systolic function in patients with acute PE. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Cordeiro Pedro

    2008-05-01

    Full Text Available Abstract Background- Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM. The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts in their daily activities, neither during effort nor during orthostatic recovery. Aim- To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts. Methods- We studied 17 HCM pts (9 males, mean age 53 ± 16 years, 11 with obstructive HCM. Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD and orthostatic position. The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position. Results- 3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 ± 24 mmHg; in orthostatic position was 62 ± 29 mmHg (p Conclusion- In HCM pts the intraventricular gradient increases in orthostatic position, increases significantly during treadmill exercise and continues increasing in the recovery period in orthostatic position. This type of evaluation can help us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.

  13. Residual Stress Impairs Pump Function After Surgical Ventricular Remodeling: A Finite Element Analysis.

    Science.gov (United States)

    Pantoja, Joe Luis; Zhang, Zhihong; Tartibi, Mehrzad; Sun, Kay; Macmillan, Warrick; Guccione, Julius M; Ge, Liang; Ratcliffe, Mark B

    2015-12-01

    Surgical ventricular restoration (Dor procedure) is generally thought to reduce left ventricular (LV) myofiber stress (FS) but to adversely affect pump function. However, the underlying mechanism is unclear. The goal of this study was to determine the effect of residual stress (RS) on LV FS and pump function after the Dor procedure. Previously described finite element models of the LV based on magnetic resonance imaging data obtained in 5 sheep 16 weeks after anteroapical myocardial infarction were used. Simulated polyethylene terephthalate fiber (Dacron) patches that were elliptical and 25% of the infarct opening area were implanted using a virtual suture technique (VIRTUAL-DOR). In each case, diastole and systole were simulated, and RS, FS, LV volumes, systolic and diastolic function, and pump (Starling) function were calculated. VIRTUAL-DOR was associated with significant RS that was tensile (2.89 ± 1.31 kPa) in the remote myocardium and compressive (234.15 ± 65.53 kPa) in the border zone. VIRTUAL-DOR+RS (compared with VIRTUAL-DOR-NO-RS) was associated with further reduction in regional diastolic and systolic FS, with the greatest change in the border zone (43.5-fold and 7.1-fold, respectively; p < 0.0001). VIRTUAL-DOR+RS was also associated with further reduction in systolic and diastolic volumes (7.9%; p = 0.0606, and 10.6%; p = 0.0630, respectively). The resultant effect was a further reduction in pump function after VIRTUAL-DOR+RS. Residual stress that occurs after the Dor procedure is positive (tensile) in the remote myocardium and negative (compressive) in the border zone and associated with reductions in FS and LV volumes. The resultant effect is a further reduction in LV pump (Starling) function. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Multidetector computed tomography predictors of late ventricular remodeling and function after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Lessick, Jonathan, E-mail: j_lessick@rambam.health.gov.il [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Abadi, Sobhi [Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Agmon, Yoram [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Keidar, Zohar [Nuclear Medicine Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Carasso, Shemi; Aronson, Doron [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Ghersin, Eduard [Department of Diagnostic Radiology, University of Miami, Miller School of Medicine, Miami, FL (United States); Rispler, Shmuel [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Sebbag, Anat [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Israel, Ora [Nuclear Medicine Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel); Hammerman, Haim; Roguin, Ariel [Cardiology Department, Rambam Health Care Campus, Haaliya Street, Haifa (Israel); Technion-IIT, Haaliya Street, Haifa (Israel)

    2012-10-15

    Background: Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI. Methods: In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling. Results: Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r = 0.74), and LD area (r = 0.72), and to a lesser extent LE area (r = 0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p < 0.05) and ejection fraction by LD enhancement ratio. Conclusions: LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.

  15. EVALUACIÓN ECOCARDIOGRÁFICA DE LA FUNCIÓN VENTRICULAR IZQUIERDA EN CENTENARIOS / Echocardiographic assessment of left ventricular function in centenarians

    Directory of Open Access Journals (Sweden)

    Vanessa Peña-Bofill

    2013-10-01

    Full Text Available Resumen Introducción: El envejecimiento poblacional es un fenómeno mundial y constituye un logro de la humanidad. Objetivo: Caracterizar ecocardiográficamente la función ventricular izquierda de pacientes ambulatorios mayores de 100 años del municipio Plaza de la Revolución, en el período de septiembre del 2009 a septiembre del 2010. Método: Se realizó un estudio descriptivo de corte transversal con 20 longevos, en el Departamento de Ecocardiografía del Hospital Universitario "General Calixto García", a los cuáles se les realizó ecocardiograma para evaluar la función ventricular izquierda. Resultados: La edad media fue de 102 años, predominó el sexo femenino con 15 pacientes (75 % y el 50 % tenía color de piel blanco. El factor de riesgo coronario de mayor prevalencia fue la hipertensión arterial (40 %; la diabetes mellitus tipo 2, el tabaquismo y la dislipidemia le sucedieron en orden. Los centenarios tenían conservada la función sistólica del ventrículo izquierdo (90 % con poca tendencia a la supernormalidad, una paciente presentó trastornos segmentarios de la contractilidad en cara inferior, lo que correspondía a antecedentes de infarto de miocardio. Cuatro centenarios tenían patrón de llenado normal, 11 presentaron alteración de la relajación ventricular y cinco patrones pseudonormales. Conclusiones: En los centenarios estudiados se mantiene una función sistólica del ventrículo izquierdo evaluada por ecocardiografía, dentro de parámetros normales, con signos de disfunción diastólica leve. / Abstract Introduction: Population aging is a global phenomenon and an achievement of mankind. Objective: To characterize left ventricular function by echocardiography in ambulatory patients over 100 years old in Plaza de la Revolution Municipality, between September 2009 and September 2010. Method: A descriptive cross-sectional study was carried out with 20 long-lived people, in the Department of Echocardiography of

  16. Left ventricular diastolic function and cardiometabolic factors in obese normotensive children.

    Science.gov (United States)

    Porcar-Almela, M; Codoñer-Franch, P; Tuzón, M; Navarro-Solera, M; Carrasco-Luna, J; Ferrando, J

    2015-01-01

    Left ventricular (LV) hypertrophy and diastolic function have been found to be associated with obesity and hypertension in adults. However, there are scarce data about the association of obesity itself to cardiac alteration in children. The aim of this study was to detect early changes in LV structure and function in obese children and whether they are associated with the biomarkers of metabolic risk and endothelial activation. A total of 130 children aged 7-16 years (88 obese and 42 normal-weight children) were studied. All children had normal resting blood pressure. Two-dimensional ultrasound with M-mode imaging was performed to assess the LV mass index (LVMi), calculated as LV mass/height(2.7), and the peak diastolic of pulmonary venous flow velocity (PVFD). Tissue Doppler imaging was used to analyze ventricular performance through the ratio of the transmitral peak early filling velocity to the early average diastolic peak myocardial velocity (E/E'). The indicators of metabolic control, inflammation, and endothelial cell activation were evaluated. Compared to the controls, the obese subjects had significantly higher LVMi and E/E' and lower PVFD values, the two latest being found especially in severely obese subjects. In the multivariate analysis, the parameters of diastolic function (E/E' and PVFD) were independently associated with obesity, apolipoprotein A1, soluble vascular cell endothelial molecule-1 (sVCAM-1), and retinol-binding protein 4 (RBP4). An echocardiographic evaluation of diastolic function is a useful tool to detect early cardiac changes in obese children. Emergent cardiovascular risk markers such as apolipoprotein A1, RBP4, and sVCAM-1 are associated with the parameters of diastolic function. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Transmyocardial laser revascularization fails to prevent left ventricular functional deterioration and aneurysm formation after acute myocardial infarction in sheep.

    Science.gov (United States)

    Malekan, R; Kelley, S T; Suzuki, Y; Reynolds, C; Plappert, T; Sutton, M S; Edmunds, L H; Bridges, C R

    1998-11-01

    Transmyocardial laser revascularization is an investigational technique for revascularizing ischemic myocardium in patients with inoperable coronary arterial disease. This study tests the hypothesis that laser revascularization prevents left ventricular functional deterioration and aneurysm formation after acute anteroapical myocardial infarction. An ultrasonic ascending aortic flow probe and snares around the distal left anterior descending and second diagonal coronary arteries were placed in 26 Dorsett hybrid sheep. Ten to 14 days later, snared arteries were occluded to produce an anteroapical infarction of 23% of left ventricular mass. Before infarction 14 animals had 34 +/- 4 transmyocardial perforations in the area of the anticipated infarction made with a carbon dioxide laser. Twelve animals served as controls. Hemodynamic measurements and transdiaphragmatic quantitative echocardiograms were obtained before, immediately after, and 2, 5, and 8 weeks after infarction. Eighteen sheep completed the protocol. All animals had large anteroapical left ventricular aneurysms with massive ventricular enlargement. Immediately after infarction the anterior wall became thinner and dyskinetic in all sheep. At 8 weeks aneurysmal size and shape were indistinguishable between groups. Two days after infarction, laser holes were filled with fibrin. At 5 and 8 weeks the infarct consisted of dense collagen, fibroblasts, scattered calcifications, myocyte fragments, neutrophils, macrophages, and no laser holes. There were no significant differences at any time between groups for cardiac pressures or output, ventricular volumes, ejection fraction, stroke work, and the stroke work-left ventricular end-diastolic pressure index. Transmyocardial laser perforations do not revascularize acute myocardial infarction in sheep.

  18. Enhanced recovery after surgery (ERAS) protocol facilitates faster functional patient recovery in elective cardiac surgery

    OpenAIRE

    Kaluinaitė, Greta; Mačiukaitienė, Jomantė; Jakubauskaitė, Ramunė

    2017-01-01

    Introduction: Fast-track cardiac surgery today is an established and safe method because of achieved early tracheal extubation that leads to decreased length of hospital stay (LOS) with no increased risk of complications. However, we hypothesized, that fast-track protocols not only improve such system-oriented outcomes as LOS or complication rate, but facilitate better patient-oriented outcomes such as functional recovery. Our fast-track protocol was based on ERAS society guidelines, which be...

  19. Right and left ventricular cardiac function in a developed world population with human immunodeficiency virus studied with radionuclide ventriculography

    DEFF Research Database (Denmark)

    Lebech, Anne-Mette; Gerstoft, Jan; Hesse, Birger

    2004-01-01

    ), and endothelin-1 (ET-1) were measured. Thirty age- and sex-matched healthy volunteer subjects were included to establish reference values of radionuclide measurements of left and right ventricular ejection fraction and of left ventricular volume. RESULTS: Of 95 patients with HIV, 1 (1%) had a reduced left...... ventricular ejection fraction and 6 (7%) had a reduced right ventricle ejection fraction (0.35-0.42) compared with reference values from the age- and sex-matched reference population. Patients with HIV and reduced cardiac function did not differ in the duration of HIV, CD4 count, CD4 nadir, or HIV RNA load....... No correlations were found between reduced cardiac function and levels of the 3 peptides measured. CONCLUSIONS: No major dysfunction of the left ventricle is present in a developed world HIV population. However, a small but significant part of this population has modestly reduced right-sided systolic function....

  20. Beneficial effects of elevating cardiac preload on left-ventricular diastolic function and volume during heat stress

    DEFF Research Database (Denmark)

    Brothers, R M; Pecini, Redi; Dalsgaard, Morten

    2014-01-01

    conditions prior to and during a simulated hemorrhagic challenge. Heat stress did not change indices of diastolic function. Subsequent volume infusion elevated indices of diastolic function, specifically early diastolic mitral annular tissue velocity (E') and early diastolic propagation velocity (E) relative......Volume loading normalizes tolerance to a simulated hemorrhagic challenge in heat-stressed individuals, relative to when these individuals are thermoneutral. The mechanism(s) by which this occurs is unknown. This project tested two unique hypotheses; that is, the elevation of central blood volume...... via volume loading while heat stressed would 1) increase indices of left ventricular diastolic function, and 2) preserve left ventricular end-diastolic volume (LVEDV) during a subsequent simulated hemorrhagic challenge induced by lower-body negative pressure (LBNP). Indices of left ventricular...

  1. The Assessment of left ventricular Function in MRI using the detection of myocardial borders and optical flow approaches: A Review

    Directory of Open Access Journals (Sweden)

    Narjes Benameur

    2017-08-01

    Full Text Available The evaluation of left ventricular wall motion in Magnetic Resonance Imaging (MRI clinical practice is based on a visual assessment of cine-MRI sequences. In fact, clinical interpreters (radiologists proceed with a global visual evaluation of multiple cine-MRI sequences acquired in the three standard views. In addition, some functional parameters are quantified following a manual or a semi-automatic contouring of the myocardial borders. Although these parameters give information about the functional state of the left ventricle, they are not able to provide the location and the extent of wall motion abnormalities, which are associated with many cardiovascular diseases. In the past years, several approaches were developed to overcome the limitations of the classical evaluation techniques of left ventricular function. The aim of this article is to present an overview of the different methods and to summarize the relevant techniques based on myocardial contour detection and optical flow for regional assessment of left ventricular abnormalities.

  2. Tissue-Doppler assessment of cardiac left ventricular function during short-term adjuvant epirubicin therapy for breast cancer

    DEFF Research Database (Denmark)

    Appel, Jon M; Sogaard, Peter; Mortensen, Christiane E

    2011-01-01

    It has been hypothesized that the extent of acute anthracycline-induced cardiotoxicity reflects the risk for late development of heart failure. The aim of this study was to examine if short-term changes in cardiac function can be detected even after low-dose adjuvant epirubicin therapy for breast...... cancer when using Doppler tissue imaging of longitudinal left ventricular function....

  3. Systolic left ventricular function is preserved during therapeutic hypothermia, also during increases in heart rate with impaired diastolic filling

    OpenAIRE

    Kerans, Viesturs; Espinoza, Andreas; Skulstad, Helge; Halvorsen, Per S.; Edvardsen, Thor; Bugge, Jan F

    2015-01-01

    Background Systolic left ventricular function during therapeutic hypothermia is found both to improve and to decline. We hypothesized that this discrepancy would depend on the heart rate and the variables used to assess systolic function. Methods In 16 pigs, cardiac performance was assessed by measurements of invasive pressures and thermodilution cardiac output and with 2D strain echocardiography. Lef...

  4. 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

    to be particularly attributable to an increased incidence of post-infarction congestive heart failure. A relationship between glucose metabolism and LV function could potentially explain this excess mortality. METHODS: In patients without known diabetes, glucose metabolism was determined using an oral glucose......OBJECTIVES: We studied the influence of abnormal glucose metabolism on left ventricular (LV) function and prognosis in 203 patients with acute myocardial infarction. BACKGROUND: Abnormal glucose metabolism is associated with increased mortality after acute myocardial infarction. This appears...... 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)

  5. Left ventricular structure and diastolic function in subjects with two hypertensive parents

    DEFF Research Database (Denmark)

    Andersen, U B; Steensgaard-Hansen, F; Rokkedal, J

    2001-01-01

    vetricular mass index, diastolic function parameters, insulin sensitivity and plasma concentrations of cardiomyotrophic hormones. The increased RWT was not attributable to any other factor than the systolic blood pressure. CONCLUSION: In a carefully selected group of subjects with two hypertensive parents......PURPOSE: To examine the influence of (i) strong predisposition to essential hypertension and (ii) insulin sensitivity and plasma levels of cardiomyotrophic hormones on echocardiographic parameters of left ventricular structure and function. METHODS: 26 normotensive subjects (age 18-35) with bi-parental...... hypertension and 26 matched controls with normotensive parents. Families with non-insulin-dependent diabetes or morbid obesity were excluded. (i) Echocardiography; (ii) plasma concentrations of renin, angiotensin-II, aldosterone, epinephrine and norepinephrine; (iii) euglycaemic, hyperinsulinemic clamp study...

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Prearrest hypothermia improved defibrillation and cardiac function in a rabbit ventricular fibrillation model.

    Science.gov (United States)

    Jiang, Li; Hu, Chun-lin; Wang, Zhen-Ping; Li, Yin-Ping; Qin, Jian

    2015-10-01

    Hypothermia when cardiopulmonary resuscitation begins may help achieve defibrillation and return of spontaneous circulation (ROSC), but few data are available. The objective of this study was to determine whether prearrest hypothermia improved defibrillation and cardiac function in a rabbit ventricular fibrillation (VF) model. Thirty-six New Zealand rabbits were randomized equally to receive normothermia (Norm) (~39°C), post-ROSC hypothermia (~33°C), or prearrest hypothermia (~33°C). Ventricular fibrillation was induced by alternating current. After 4 minutes of VF, rabbits were defibrillated and given cardiopulmonary resuscitation until ROSC or no response (≥30 minutes). Hemodynamics and electrocardiogram were monitored; N-terminal pro-brain natriuretic peptideand troponin I were determined by enzyme-linked immunosorbent assay. Myocardial histology and echocardiographic data were evaluated. First-shock achievement of perfusion rhythm was more frequent in prearrest than normothermic animals (7/12 vs 1/12; P=.027). After ROSC, dp/dtmax was higher in prearrest than normothermic animals (Pdefibrillation and facilitating resuscitation. Copyright © 2015. Published by Elsevier Inc.

  8. The Role of Levosimendan in Patients with Decreased Left Ventricular Function Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Marija Bozhinovska

    2016-06-01

    Full Text Available The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand. Furthermore, the drug opens potassium ATP (KATP channels in cardiac mitochondria and in the vascular muscle cells, showing cardioprotective and vasodilator properties, respectively. In the past decade, levosimendan demonstrated promising results in treating patients with reduced left ventricular function when administered in peri- or post- operative settings. In addition, pre-operative use of levosimendan in patients with severely reduced left ventricular ejection fraction may reduce the requirements for postoperative inotropic support, mechanical support, duration of intensive care unit stay as well as hospital stay and a decrease in post-operative mortality. However, larger studies are needed to clarify clinical advantages of levosimendan versus conventional inotropes.

  9. Internal medicine point-of-care ultrasound assessment of left ventricular function correlates with formal echocardiography.

    Science.gov (United States)

    Johnson, Benjamin K; Tierney, David M; Rosborough, Terry K; Harris, Kevin M; Newell, Marc C

    2016-02-01

    Although focused cardiac ultrasonographic (FoCUS) examination has been evaluated in emergency departments and intensive care units with good correlation to formal echocardiography, accuracy for the assessment of left ventricular systolic function (LVSF) when performed by internal medicine physicians still needs independent evaluation. This prospective observational study in a 640-bed, academic, quaternary care center, included 178 inpatients examined by 10 internal medicine physicians who had completed our internal medicine bedside ultrasound training program. The ability to estimate LVSF with FoCUS as "normal," "mild to moderately decreased," or "severely decreased" was compared with left ventricular ejection fraction (>50%, 31-49%, and medicine physician-performed FoCUS and formal echocardiography for any LVSF impairment was "good/substantial" with κ = 0.77 (p medicine physicians using FoCUS identify normal versus decreased LVSF with high sensitivity, specificity, and "good/substantial" interrater agreement when compared with formal echocardiography. These results support the role of cardiac FoCUS by properly trained internal medicine physicians for discriminating normal from reduced LVSF. © 2015 Wiley Periodicals, Inc.

  10. Preservation of diastolic function in monocrotaline-induced right ventricular hypertrophy in rats.

    Science.gov (United States)

    Lamberts, Regis R; Caldenhoven, Eric; Lansink, Mirian; Witte, Gerrit; Vaessen, Rob J; St Cyr, John A; Stienen, Ger J M

    2007-09-01

    During ischemic heart diseases and when heart failure progresses depletion of myocardial energy stores occurs. D-Ribose (R) has been shown to improve cardiac function and energy status after ischemia. Folic acid (FA) is an essential cofactor in the formation of adenine nucleotides. Therefore, we assessed whether chronic R-FA administration during the development of hypertrophy resulted in an improved cardiac function and energy status. In Wistar rats (n = 40) compensatory right ventricular (RV) hypertrophy was induced by monocrotaline (30 mg/kg; MCT), whereas saline served as control. Both groups received a daily oral dose of either 150 mg.kg(-1).day(-1) dextrose (placebo) or R-FA (150 and 40 mg.kg(-1).day(-1), respectively). In Langendorff-perfused hearts, RV and left ventricular (LV) pressure development and collagen content as well as total RV adenine nucleotides (TAN), creatine content, and RV and LV collagen content were determined. In the control group R-FA had no effect. In the MCT-placebo group, TAN and creatine content were reduced, RV and LV diastolic pressure-volume relations were steeper, RV systolic pressures were elevated, RV and LV collagen content was increased, and RV-LV diastolic interaction was altered compared with controls. In the MCT-R-FA group, TAN, RV and LV diastolic stiffness, RV and LV collagen content, and RV-LV diastolic interaction were normalized to the values in the control group while creatine content remained depressed and RV systolic function remained elevated. In conclusion, the depression of energy status in compensated hypertrophic myocardium observed was partly prevented by chronic R-FA administration and accompanied by a preservation of diastolic function and collagen deposition.

  11. Utility of prechemotherapy evaluation of left ventricular function for patients with lymphoma.

    Science.gov (United States)

    Steuter, John; Bociek, Robert; Loberiza, Fausto; Mathers, Daniel; Armitage, James; Vose, Julie; Bast, Martin; Saxena, Shikhar; Porter, Thomas; Bierman, Philip

    2015-01-01

    Published guidelines recommend baseline cardiac function testing before initiating anthracycline-based chemotherapy. These recommendations are based largely on consensus, and there is little information regarding how often testing leads to alterations in therapy or whether testing is able to predict subsequent cardiac toxicity. We performed a retrospective analysis of patients with Hodgkin lymphoma and non-Hodgkin lymphoma to determine whether there was a prechemotherapy evaluation of left ventricular function and whether findings from the evaluation led to alterations in therapy. Records also were reviewed to evaluate subsequent test results of cardiac function. We identified 309 patients with lymphoma between 2004 and 2012 with a planned anthracycline- or anthracenedione-based regimen. Of this total, 232 patients (75%) had a pretreatment cardiac evaluation. There were 201 patients (87%) in this group with no history of cardiac disease. Although 22 of these patients (11%) had abnormal echocardiograms, none had a change in therapy and no subsequent cases of cardiomyopathy were identified. Five of the remaining 179 patients with a normal cardiac evaluation developed a cardiomyopathy. Thirty-one patients had a history of cardiac disease, and only 4 patients had a change in therapy. There were 77 patients (25%) who did not have a prechemotherapy cardiac evaluation. No subsequent cases of cardiomyopathy were identified in this group. Pretreatment evaluation rarely leads to a change in management and is not helpful in predicting subsequent cardiomyopathy. Guidelines that recommend evaluation of left ventricular function in all patients before anthracycline-based chemotherapy should be reexamined. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. [The effect of chemical ablation with lugol solution for ventricular tachyarrhythmia on cardiac function].

    Science.gov (United States)

    Yajima, T; Ikeshita, M; Shoji, T

    1990-12-01

    Among various methods to treat ventricular tachyarrhythmia (VT) in the presence of acute myocardial infraction, the surgical approach is a somewhat unsatisfactory method in case of preoperative acute hemodynamic deterioration. The transatrial approach with the "topical" application of Lugol solution on left ventricular (LV) endocardium, without left ventriculotomy, i.e. a transatrial chemical ablation method; has been reported in our department as suggestive to being efficacious. The objective of the present study is to investigate the occurrence of left bundle branch block (LBBB) and the like, as well as to examine the impact on heart function, particularly LV function, by employing the just-above mentioned approach. 15 mongrel dogs were being experimented on. Through a left transatrial approach toward LV endocardium and the application of Lugol solution, with pulmonary artery flow being as constant; we measured pre- and post-operative left atrial (LA) pressure, LV pressure, aortic pressure, LV functional shortening, and stroke volume. In addition, the same protocol was also employed in another group, with the application of physiologic normal saline solution, instead. A comparative study was made between the two groups. In the Lugol solution group, postoperative LA pressure and LVEDP showed a tendency toward exhibiting higher values, when compared to preoperative readings. However, no significant difference was observed in this setting. Furthermore, in comparison with postoperative readings in the saline group, the mean LA pressure in the Lugol solution group exhibited a tendency toward somewhat higher values. Nonetheless, no significant difference was observed in LV functional shortening between the two groups; though it is known a LBB pattern could be noticed on ECG in the Lugol solution group.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Associations of childhood and adult obesity with left ventricular structure and function.

    Science.gov (United States)

    Yang, H; Huynh, Q L; Venn, A J; Dwyer, T; Marwick, T H

    2017-04-01

    Overweight and obesity are associated with left ventricular (LV) dysfunction. We sought whether echocardiographic evidence of abnormal adult cardiac structure and function was related to childhood or adult adiposity. This study included 159 healthy individuals aged 7-15 years and followed until age 36-45 years. Anthropometric measurements were performed both at baseline and follow-up. Cardiac structure (indexed left atrial volume (LAVi), left ventricular mass (LVMi)) and LV function (global longitudinal strain (GLS), mitral e') were assessed using standard echocardiography at follow-up. Conventional cutoffs were used to define abnormal LAVi, LVMi, GLS and mitral annular e'. Childhood body mass index (BMI) was correlated with LVMi (r=0.25, P=0.002), and child waist circumference was correlated with LVMi (r=0.18, P=0.03) and LAVi (r=0.20, P=0.01), but neither were correlated with GLS. One s.d. (by age and sex) increase in childhood BMI was associated with LV hypertrophy (relative risk: 2.04 (95% confidence interval (CI): 1.09, 3.78)) and LA enlargement (relative risk: 1.81 (95% CI: 1.02, 3.21)) independent of adult BMI, but the association was not observed with impaired GLS or mitral e'. Cardiac functional measures were more impaired in those who had normal BMI as child, but had high BMI in adulthood (Pobese as a child and remained so in adulthood (P>0.33). Childhood adiposity is independently associated with structural cardiac disturbances (LVMi and LAVi). However, functional alterations (GLS and mitral e') were more frequently associated with adult overweight or obesity, independent of childhood adiposity.

  14. [The effect of atrial pacing on left ventricular diastolic function and BNP levels in patients with DDD pacemaker].

    Science.gov (United States)

    Apali, Zeynep; Bayata, Serdar; Yeşil, Murat; Arikan, Erdinç; Postaci, Nursen

    2010-08-01

    We aimed to investigate the effect of atrial pacing on left ventricular diastolic function and brain natriuretic peptide (BNP) levels in patients with DDD pacemaker. Thirty patients with complete atrio-ventricular (AV) block and DDD pacemaker were included. All patients had normal left ventricular systolic function. Echocardiographic diastolic function parameters (transmitral and tissue Doppler velocities during early (E and E') and late (A and A') filling) and NT-pro-BNP levels were evaluated prospectively during atrial sensing and pacing periods. Echocardiographic data were compared with paired sample t test and NT-pro-BNP levels were compared with Wilcoxon test. Echocardiographic E/A, E'/A', E/E' ratios were calculated as 0.72+/-0.34, 0.61+/-0.21 and 8.76+/-2.58 during atrial sensing period. Same parameters were found as 0.71+/-0.23, 0.64+/-0.16 and 8.93+/-3.16 respectively during atrial pacing period. Echocardiographic left ventricular diastolic function parameters were not significantly different during atrial pacing and atrial sensing periods. Median plasma NT-pro-BNP levels were measured as 142 pg/ml (min-max 47-563 pg/ml) and 147 pg/ml (min-max 33-1035 pg/ml) during atrial sensing and pacing periods respectively. These levels were not significantly different (p=0.86). The result of this study has shown that, atrial pacing has not any additional detrimental effect on left ventricular diastolic function parameters in paced patients with normal left ventricular systolic function.

  15. Left ventricular systolic function is associated with sympathetic nervous activity and markers of inflammation in cirrhosis.

    Science.gov (United States)

    Yotti, Raquel; Ripoll, Cristina; Benito, Yolanda; Catalina, Maria Vega; Elízaga, Jaime; Rincón, Diego; Fernández-Avilés, Francisco; Bermejo, Javier; Bañares, Rafael

    2017-06-01

    An accurate evaluation of cardiac function in patients with cirrhosis remains a challenge. We used robust echocardiographic indices to characterize left ventricular (LV) systolic function and its relationship to activation of the sympathetic nervous system and inflammation in 59 patients with cirrhosis and 59 age-matched controls. Additionally, in 11 patients we withdrew beta-blockers and diuretics and used phenylephrine and albumin infusion to evaluate the response to acute afterload and preload changes (interventional substudy). Measures of systolic LV function such as the ejection intraventricular pressure difference (EIVPD) and the systolic strain rate were higher in patients with cirrhosis than in controls (median [1st-3rd quartile], 4.0 [3.1-5.1] versus 2.9 [2.4-3.6] mm Hg and -1.3 [-1.6 to -1.1] versus -1.2 [-1.6 to -1.1)] s-1 , respectively; P function (P function is enhanced in cirrhosis due to augmented adrenergic tone and modulated by treatment with beta-blockers; acute afterload stress induces a deeper impairment of systolic function in patients with more advanced degrees of vasodilatation and inflammation; these changes in LV function related to cirrhosis can be assessed using robust echocardiographic methods. (Hepatology 2017;65:2019-2030). © 2017 by the American Association for the Study of Liver Diseases.

  16. Effects of ischemia and omeprazole preconditioning on functional recovery of isolated rat heart

    Directory of Open Access Journals (Sweden)

    Nevena Jeremic

    2015-04-01

    Full Text Available AbstractObjective:The aim of this study was to compare protective effects of ischemic and potential protective effects of pharmacological preconditioning with omeprazole on isolated rat heart subjected to ischemia/reperfusion.Methods:The hearts of male Wistar albino rats were excised and perfused on a Langendorff apparatus. In control group (CG after stabilization period, hearts were subjected to global ischemia (perfusion was totally stopped for 20 minutes and 30 minutes of reperfusion. Hearts of group II (IPC were submitted to ischemic preconditioning lasting 5 minutes before 20 minutes of ischemia and 30 minutes of reperfusion. In third group (OPC hearts first underwent preconditioning lasting 5 minutes with 100μM omeprazole, and then submitted 20 minutes of ischemia and 30 minutes of reperfusion.Results:Administration of omeprazole before ischemia induction had protective effect on myocardium function recovery especially regarding to values of systolic left ventricular pressure and dp/dt max. Also our findings are that values of coronary flow did not change between OPC and IPC groups in last point of reperfusion.Conclusion:Based on our results it seems that ischemic preconditioning could be used as first window of protection after ischemic injury especially because all investigated parameters showed continuous trend of recovery of myocardial function. On the other hand, preconditioning with omeprazole induced sudden trend of recovery with positive myocardium protection, although less effective than results obtained with ischemic preconditioning not withstand, we must consider that omeprazole may be used in many clinical circumstances where direct coronary clamping for ischemic preconditioning is not possible.

  17. Multi-slice computer tomography of left ventricular function with automated analysis software in comparison with conventional ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Gilard, Martine [Departments of Cardiology, EA 3878, Brest University Hospital, Brest (France)]. E-mail: martine.gilard@chu-brest.fr; Pennec, Pierre-Yves [Departments of Cardiology, EA 3878, Brest University Hospital, Brest (France); Cornily, Jean-Christophe [Departments of Cardiology, EA 3878, Brest University Hospital, Brest (France); Vinsonneau, Ulric [Service de cardiologie, hopital d' instruction des armees Clermont-Tonnerre, 29240 Brest Armees (France); Le Gal, Gregoire [Department of Internal Medicine, Brest University Hospital, Brest (France); Nonent, Michel [Departments of Radiology, Brest University Hospital, Brest (France); Mansourati, Jacques [Departments of Cardiology, EA 3878, Brest University Hospital, Brest (France); Boschat, Jacques [Departments of Cardiology, EA 3878, Brest University Hospital, Brest (France)

    2006-08-15

    Purpose: To evaluate the accuracy of left ventricular volumetric and functional parameters from multi-slice computed tomography using automated analysis software, and to correlate results with those of invasive left ventriculography. Materials and methods: In 145 consecutive patients (mean age, 61 years {+-} 12) known or suspected to have coronary artery disease, a 16-channel multi-slice computed tomography (Philips Mx8000 IDT 16) was performed using a standard technique. Using short-axis secondary multi-slice computed tomography reformations, we determined end-diastolic and end-systolic left ventricular volumes and ejection fraction with a commercially available analysis software capable of automated contour detection. Conventional left ventriculography was performed according to standard techniques within the following 24 h. Bland-Altman analysis was performed to calculate the limits of agreement and systematic errors between multi-slice computed tomography and conventional left ventriculography. Results: As determined by computer tomography, mean end-systolic (53 {+-} 29 mL) left ventricular volumes had an acceptable correlation with conventional ventriculography (67 {+-} 50 mL; r = 0.74; p < 0.001) and mean end-diastolic (119 {+-} 33 mL) left ventricular volumes a poor correlation with conventional ventriculography measurements (154 {+-} 69 mL; r = 0.41). Left ventricular ejection fraction (57% {+-} 14 versus 55% {+-} 14 for conventional ventriculography; r = 0.79) showed a very good correlation (p < 0.001). Bland-Altman analysis showed acceptable limits of agreement ({+-}9.2% for ejection fraction) without systematic errors. Conclusion: The use of a multi-slice computed tomography with an automatic calculation software has a good correlation with conventional ventriculography findings and could accurately assess left ventricular function, but should not be used for ventricular volumes, because of biased estimations.

  18. Dynamic changes in left ventricular function after a percutaneous coronary intervention: prevalence, predictors, and prognosis.

    Science.gov (United States)

    Levi, Amos; Bental, Tamir; Assali, Abid R; Lev, Eli I; Vaknin Assa, Hana; Shaul, Aviv A; Sagie, Alexander; Kornowski, Ran

    2016-05-01

    To estimate the prevalence, identify predictors, and assess the prognostic implications of left ventricular ejection fraction (LVEF) changes after an elective percutaneous coronary intervention (PCI). We included all consecutive patients who underwent elective PCI in our institution and were evaluated with echocardiography before and within 1 year of the procedure. Patients were grouped in terms of baseline LVEF. Hazard ratios (HRs) for all-cause mortality and acute myocardial infarction were calculated for baseline LVEF groups and in terms of LVEF normalization or decline. A total of 974 patients were included. Patients with moderately impaired (HR 1.41, P=0.01) and poor LVEF (HR 2.44, P<0.001) had significantly worse survival in comparison with patients with good LVEF. Decline from preserved to impaired LVEF following PCI was associated with an increased 1-year risk (HR 3.48, P<0.001) and 5-year risk (HR 2.79, P<0.001) for the composite outcome of all-cause mortality and acute myocardial infarction. LVEF recovery from impaired to preserved was associated with a decreased 5-year risk for the composite outcome (HR 0.5, P<0.001). Changes in LVEF after elective PCI occur often. Both higher baseline LVEF and post-PCI LVEF normalization are associated with improved outcomes.

  19. Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Miranda, Rita; Cotrim, Carlos; Cardim, Nuno; Almeida, Sofia; Lopes, Luís; Loureiro, Maria José; Simões, Otília; Cordeiro, Pedro; Fazendas, Paula; João, Isabel; Carrageta, Manuel

    2008-05-15

    Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts) in their daily activities, neither during effort nor during orthostatic recovery. To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts. We studied 17 HCM pts (9 males, mean age 53 +/- 16 years, 11 with obstructive HCM). Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD) and orthostatic position). The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position. 3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 +/- 24 mmHg; in orthostatic position was 62 +/- 29 mmHg (p us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.

  20. Effects of chronic inflammatory bowel diseases on left ventricular structure and function: a study protocol

    Directory of Open Access Journals (Sweden)

    Botti Fiorenzo

    2002-09-01

    Full Text Available Abstract Background Experimental evidences suggest an increased collagen deposition in inflammatory bowel diseases (IBD. In particular, large amounts of collagen type I, III and V have been described and correlated to the development of intestinal fibrotic lesions. No information has been available until now about the possible increased collagen deposition far from the main target organ. In the hypothesis that chronic inflammation and increased collagen metabolism are reflected also in the systemic circulation, we aimed this study to evaluate the effects on left ventricular wall structure by assessing splancnic and systemic collagen metabolism (procollagen III assay, deposition (ultrasonic tissue characterization, and cardiac function (echocardiography in patients with different long standing history of IBD, before and after surgery. Methods Thirty patients affected by active IBD, 15 with Crohn and 15 with Ulcerative Colitis, submitted to surgery will be enrolled in the study in a double blind fashion. They will be studied before the surgical operation and 6, 12 months after surgery. A control group of 15 healthy age and gender-matched subjects will also be studied. At each interval blood samples will be collected in order to assess the collagen metabolism; a transthoracic echocardiogram will be recorded for the subsequent determination of cardiac function and collagen deposition. Discussion From this study protocol we expect additional information about the association between IBD and cardiovascular disorders; in particular to address the question if chronic inflammation, through the altered collagen metabolism, could affect left ventricular structure and function in a manner directly related to the estimated duration of the disease.

  1. Alterations in left ventricular function during therapy of unstable angina pectoris: relationship to clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Narahara, K.A.; Hillert, M.C. Jr.; Smitherman, T.C.; Burden, L.L.

    1984-02-01

    We studied 30 consecutive patients with unstable angina during pain-free intervals with gated blood pool scintigraphy. The initial study was performed within 18 hours of admission to the coronary care unit. A second study was performed near the time of hospital discharge, after stabilization with medical therapy. Three months thereafter patients were categorized according to their worst anginal status following hospital discharge. Fifteen patients were New York Heart Association functional class I or II (group A); 15 patients were in functional class III or IV (group B). Left ventricular ejection fraction was similar at the time of initial study (55.9 +/- 2.18% and 56.0 +/- 3.55% for groups A and B respectively). At the time of hospital discharge the ejection fraction had risen to 60.3 +/- 1.85% (p less than 0.01) in group A and in group B it had fallen to 48.1 +/- 3.4% (p less than 0.005). End-systolic volume index in group B rose from 37 ml/m2 +/- 6.1 to 43 +/- 6.2 ml/m2 (p less than 0.005) at the time of the follow-up study. There were no significant intergroup patients during the two scintigraphic examinations. Eleven group B patients subsequently underwent coronary artery bypass surgery. A significant increase in ejection fraction and a significant decrease in end-systolic volume index were noted when these patients were restudied an average of 3.2 months after surgery. This study suggests that changes in left ventricular function during the course of unstable angina pectoris are common and may be detected by serial gated blood pool scintigraphy.

  2. Impact of levosimendan on right ventricular functions by using novel tissue Doppler derived indices in patients with ischaemic left ventricular failure.

    Science.gov (United States)

    Alibaz-Oner, Fatma; Gurbuz, Ozlem Zeynep; Oner, Ender; Yurdakul, Selen; Erguney, Mecdi

    2013-01-01

    Right ventricular (RV) dysfunction complicates advanced left ventricular (LV) heart failure (HF) and contributes to a poor prognosis. Levosimendan is a positive inotropic agent improving cardiac contractility without increasing myocardial oxygen consumption in HF. To evaluate the effect of levosimendan therapy on RV systolic function, by using derived tissue Doppler imaging (TDI) in patients with ischaemic HF. The study consisted of 30 patients with HF who were admitted to our hospital due to new onset of decompensated HF, having LV ejection fraction functional status class III-IV, according to the New York Heart Association (NYHA). TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration [IVA], peak myocardial velocity during isovolumic contraction [IVV], peak systolic velocity during ejection period [Sa]) and diastolic indices (early [Ea] and late diastolic [Aa] velocities, Ea/Aa, E/Ea ratios and myocardial performance index [Tei index]) were measured. 72 hours after treatment, all measurements were re-evaluated. Considering TDI-derived systolic indices of the RV, IVA and IVV increased significantly, whereas Tei index decreased, after the therapy. Also, there was a significant decrease in serum levels of B-type natriuretic peptide. No significant change was observed in TDI derived diastolic indices of the RV. Levosimendan improves RV systolic function as expressed by TDI-derived parameters in patients with acutedecompensated HF.

  3. Renal Function Recovery with Total Artificial Heart Support.

    Science.gov (United States)

    Quader, Mohammed A; Goodreau, Adam M; Shah, Keyur B; Katlaps, Gundars; Cooke, Richard; Smallfield, Melissa C; Tchoukina, Inna F; Wolfe, Luke G; Kasirajan, Vigneshwar

    2016-01-01

    Heart failure patients requiring total artificial heart (TAH) support often have concomitant renal insufficiency (RI). We sought to quantify renal function recovery in patients supported with TAH at our institution. Renal function data at 30, 90, and 180 days after TAH implantation were analyzed for patients with RI, defined as hemodialysis supported or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m. Between January 2008 and December 2013, 20 of the 46 (43.5%) TAH recipients (age 51 ± 9 years, 85% men) had RI, mean preoperative eGFR of 48 ± 7 ml/min/1.73 m. Renal function recovery was noted at each follow-up interval: increment in eGFR (ml/min/1.73 m) at 30, 90, and 180 days was 21 ± 35 (p = 0.1), 16.5 ± 18 (p = 0.05), and 10 ± 9 (p = 0.1), respectively. Six patients (30%) required preoperative dialysis. Of these, four recovered renal function, one remained on dialysis, and one died. Six patients (30%) required new-onset dialysis. Of these, three recovered renal function and three died. Overall, 75% (15 of 20) of patients' renal function improved with TAH support. Total artificial heart support improved renal function in 75% of patients with pre-existing significant RI, including those who required preoperative dialysis.

  4. Xenon protects left ventricular diastolic function during acute ischemia, less than ischemic preconditioning

    Directory of Open Access Journals (Sweden)

    Jan H Baumert

    2016-01-01

    Full Text Available Anesthetics modify regional left ventricular (LV dysfunction following ischemia/reperfusion but their effects on global function in this setting are less clear. Aim of this study was to test the hypothesis that xenon would limit global LV dysfunction as caused by acute anterior wall ischemia, comparable to ischemic preconditioning. In an open-chest model under thiopental anesthesia, 30 pigs underwent 60-minute left anterior descending coronary artery occlusion, followed by 120 minutes of reperfusion. A xenon group (constant inhalation from previous to ischemia through end of reperfusion was compared to control and ischemic preconditioning. Load-independent measures of diastolic function (end-diastolic pressure-volume relation, time constant of relaxation and systolic function (end-systolic pressure-volume relation, preload-recruitable stroke work were determined. Heart rate, arterial pressure, cardiac output, and arterial elastance were recorded. Data were compared in 26 pigs. Ischemia impaired global diastolic but not systolic function in control, which recovered during reperfusion. Xenon limited and preconditioning abolished diastolic dysfunction during ischemia. Arterial pressure decreased during reperfusion while arterial elastance increased. Tachycardia and antero-septal wall edema during reperfusion were observed in all groups. In spite of ischemia of 40% of LV mass, global systolic function was preserved. Deterioration in global diastolic function was limited by xenon and prevented by preconditioning.

  5. Xenon protects left ventricular diastolic function during acute ischemia, less than ischemic preconditioning.

    Science.gov (United States)

    Baumert, Jan-H; Roehl, Anna B; Funcke, Sandra; Hein, Marc

    2016-01-01

    Anesthetics modify regional left ventricular (LV) dysfunction following ischemia/reperfusion but their effects on global function in this setting are less clear. Aim of this study was to test the hypothesis that xenon would limit global LV dysfunction as caused by acute anterior wall ischemia, comparable to ischemic preconditioning. In an open-chest model under thiopental anesthesia, 30 pigs underwent 60-minute left anterior descending coronary artery occlusion, followed by 120 minutes of reperfusion. A xenon group (constant inhalation from previous to ischemia through end of reperfusion) was compared to control and ischemic preconditioning. Load-independent measures of diastolic function (end-diastolic pressure-volume relation, time constant of relaxation) and systolic function (end-systolic pressure-volume relation, preload-recruitable stroke work) were determined. Heart rate, arterial pressure, cardiac output, and arterial elastance were recorded. Data were compared in 26 pigs. Ischemia impaired global diastolic but not systolic function in control, which recovered during reperfusion. Xenon limited and preconditioning abolished diastolic dysfunction during ischemia. Arterial pressure decreased during reperfusion while arterial elastance increased. Tachycardia and antero-septal wall edema during reperfusion were observed in all groups. In spite of ischemia of 40% of LV mass, global systolic function was preserved. Deterioration in global diastolic function was limited by xenon and prevented by preconditioning.

  6. Monitoring of right ventricular function by single probe system (nuclear stethoscope) and sup(81m)Kr

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Ohmine, Hiromi; Kimura, Motomasa (National Cardiovascular Center, Suita, Osaka (Japan))

    1982-12-01

    A single probe system (nuclear stethoscope) was developed to evaluate the monitoring of right ventricular function by sup(81m)Kr continuous infusion method. Optimal right ventricular and background positions were determined by position/monitor mode on beat-to-beat basis, and right ventricular ejection fraction (RVEF) was calculated by multi-gated method (MUGA). The correlation coefficient of nuclear stethoscope RVEF and camera-computer RVEF (MUGA) was 0.82, while the correlation coefficient of nuclear stethoscope RVEF and camera-computer RVEF (first-pass method) was 0.64. Therefore, the RVEF by nuclear stethoscope is useful for monitoring of right ventricular function. Clinical applications by sup(81m)Kr and nuclear stethoscope were as follows. 1. Exercise/rest RVEF is an extremely sensitive indicator to discriminate coronary artery disease (RCA occlusion) from normal subjects. 2. Beat-to-beat right ventricular volume response is useful for the monitoring of arrythmia such as atrial fibrillation.

  7. Effects of losartan and captopril on left ventricular systolic and diastolic function after acute myocardial infarction

    DEFF Research Database (Denmark)

    Møller, Jacob E; Dahlström, Ulf; Gøtzsche, Ole

    2004-01-01

    of losartan and captopril on regional systolic, diastolic, and overall left ventricular (LV) function after AMI. METHODS: Two hundred twenty-five patients aged > or =50 years with documented AMI and heart failure and/or LV dysfunction were randomly assigned treatment with either losartan (50 mg......: WMSI decreased in both groups (losartan 1.58 +/- 0.23 to 1.52 +/- 0.26, P =.009, captopril 1.60 +/- 0.24 to 1.48 +/- 0.22, P losartan -0.05 +/- 0.19, P =.007). In both groups E-DT increased......, although the increase was significant only in patients treated with captoril (193 +/- 61 ms to 208 +/- 70 ms, P =.05). The change in E-DT was not different between treatment groups (captopril 14 +/- 74 ms vs losartan 7 +/- 80 ms, P =.52). Tei index decreased in both groups (losartan 0.59 +/- 0.13 to 0...

  8. Effects of nisoldipine and lisinopril on left ventricular mass and function in diabetic nephropathy

    DEFF Research Database (Denmark)

    Tarnow, L; Sato, A; Ali, S

    1999-01-01

    . A multiple linear regression analysis revealed that after 1 year of treatment, LVMI increased with higher systolic blood pressure level and declining glomerular filtration rate (R2 = 0.25). Fractional shortening was within normal range at baseline, 42 +/- 1 vs. 41 +/- 1% with nisoldipine and lisinopril......OBJECTIVE: To compare the effects of the calcium channel blocker, nisoldipine, and the ACE inhibitor, lisinopril, on left ventricular mass (LVM) and systolic function in type 1 diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS: M-mode echocardiography was performed in 50...... hypertensive type 1 diabetic patients with diabetic nephropathy enrolled in a 1-year, randomized, double-blind, parallel study of antihypertensive treatment with nisoldipine CC (20-40 mg/day) or lisinopril (10-20 mg/day). Ambulatory 24-h blood pressure was measured with the Takeda TM 2420 device (A & D, Tokyo...

  9. Impaired left-ventricular function in insulin-dependent diabetic patients with increased urinary albumin excretion

    DEFF Research Database (Denmark)

    Kelbaek, H; Jensen, T; Feldt-Rasmussen, B

    1991-01-01

    Cardiac function was studied in 30 patients with insulin-dependent diabetes mellitus. Three groups, matched for age and diabetes duration, were defined as: group I (n = 10), normal urinary albumin excretion less than 30 mg 24 h-1; group II (n = 10), incipient diabetic nephropathy (urinary albumin...... excretion in the range of 30-300 mg 24 h-1); and group III (n = 10), clinical diabetic nephropathy (urinary albumin excretion greater than 300 mg 24 h-1). Ten non-diabetic subjects matched for sex and age served as controls. The left-ventricular end-diastolic volume measured by radionuclide cardiography was...... of coronary heart disease. Our results might suggest that insulin-dependent diabetic patients with slightly but persistently elevated urinary albumin excretion have reduced diastolic compliance of the left-ventricle leading to impaired cardiac performance.(ABSTRACT TRUNCATED AT 250 WORDS)...

  10. Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction

    DEFF Research Database (Denmark)

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

    1999-01-01

    BACKGROUND: Left ventricular (LV) diastolic dysfunction contributes to signs and symptoms of clinical heart failure and may be related to prognosis in heart diseases. LV diastolic dysfunction is reported to be present in acute myocardial infarction (MI); however, little is known about the time....../restrictive. Patients with MI were observed for development of congestive heart failure (Killip class >I) during hospitalization and for death during 1-year follow-up, and these complications were related to LV diastolic function. LV diastolic dysfunction was present in the very early phase of acute MI, with signs......-hospital congestive heart failure and cardiac death during 12 months of follow-up. CONCLUSIONS: LV diastolic dysfunction is present in the very early phase of MI. LV remodeling and development of in-hospital congestive heart failure appear in patients with very early signs of LV diastolic dysfunction. Furthermore...

  11. Assessment of left ventricular regional function by means of radioactive isotopes

    Energy Technology Data Exchange (ETDEWEB)

    Sigel, H.; Adam, W.E.; Bitter, F.; Nechwatal, W.; Kress, P.; Zenkner, D.; Weller, R.; Stauch, M.

    1981-06-01

    Extensive analysis of heart function by scintigraphy yields global parameters of ventricular volumes and their changes during the heart cycle (ejection fraction, enddiastolic and endsystolic volumes, velocity of contraction and relaxation). Additionally, information regarding localized disorders of wall motion may be obtained in a qualitative and quantitative manner by the parameters 'phase' and 'amplitude'. These parameters can be computed from regional time-activity curves by Fourier analysis. The radionuclide ventriculogram at rest is suitable for the detection and follow-up of asynergies caused by acute and chronic infarction. It can also be used as a method of distinguishing between reversible and irreversible asynergy by therapeutical intervention (intervention ventriculography). Abnormalities of regional wall motion which develop during exercise may indicate hemodynamically relevant coronary artery stenoses.

  12. Evaluation of cardiac function in unrestrained dogs and monkeys using left ventricular dP/dt.

    Science.gov (United States)

    Buchanan, Lewis V; Warner, William A; Arthur, Susan R; Gleason, Carol R; Lewen, Geoff; Levesque, Paul C; Gill, Michael W

    2016-01-01

    Preclinical assessment for alterations in cardiac ventricular function for drug candidates has not been a focus of ICH S7b guidelines for cardiovascular safety studies, but there is growing interest given that the cardiovascular risk is associated with positive and negative inotropes. From 2003 through 2013, 163 telemetry studies with left-ventricular function analyses were conducted in dogs and monkeys at Bristol Myers Squibb (BMS) in support for drug development programs. The ability of the telemetry system to detect changes in cardiac contractility was verified with positive control agents pimobendan and atenolol. Control data from a subset of studies were analyzed to determine dP/dt reference range values, and minimum detectable mean differences (control vs. treated) for statistical significance. Median minimum detectable differences for dogs ranged from 14 to 21% for positive dP/dt and 11 to 21% for negative dP/dt. For monkeys, median minimum detectable differences were 25 and 14% for positive and negative dP/dt, respectively. For BMS programs, 15 drug candidates were identified that produced primary effects on contractility. Changes in contractility that were associated with, and potentially secondary to, drug-related effects on heart rate or systemic blood pressure were observed with an additional 29 drug candidates. Changes in contractility have been observed in large animals during drug development studies at BMS over the past 10years. Model sensitivity has been demonstrated and a dP/dt beat-to-beat cloud analysis tool has been developed to help distinguish primary effects from those potentially secondary to systemic hemodynamic changes. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. 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.

  14. 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...... 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...... shortening (both phypertensive patients with LVH, diabetes is associated with more residual LVH and less improvement in systolic LV function by echocardiography over 4.8 years of antihypertensive treatment....

  15. Racial/Ethnic Differences in Left Ventricular Structure and Function in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort.

    Science.gov (United States)

    Ahmad, Faraz S; Cai, Xuan; Kunkel, Katherine; Ricardo, Ana C; Lash, James P; Raj, Dominic S; He, Jiang; Anderson, Amanda H; Budoff, Matthew J; Wright Nunes, Julie A; Roy, Jason; Wright, Jackson T; Go, Alan S; St John Sutton, Martin G; Kusek, John W; Isakova, Tamara; Wolf, Myles; Keane, Martin G

    2017-08-01

    Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease (CVD) and it is especially common among Blacks. Left ventricular hypertrophy (LVH) is an important subclinical marker of CVD, but there are limited data on racial variation in left ventricular structure and function among persons with CKD. In a cross-sectional analysis of the Chronic Renal Insufficiency Cohort Study, we compared the prevalence of different types of left ventricular remodeling (concentric hypertrophy, eccentric hypertrophy, and concentric remodeling) by race/ethnicity. We used multinomial logistic regression to test whether race/ethnicity associated with different types of left ventricular remodeling independently of potential confounding factors. We identified 1,164 non-Hispanic Black and 1,155 non-Hispanic White participants who completed Year 1 visits with echocardiograms that had sufficient data to categorize left ventricular geometry type. Compared to non-Hispanic Whites, non-Hispanic Blacks had higher mean left ventricular mass index (54.7 ± 14.6 vs. 47.4 ± 12.2 g/m2.7; P 3 antihypertensive medications, Black race/ethnicity was independently associated with higher odds of concentric LVH compared to White race/ethnicity (odds ratio: 2.73; 95% confidence interval: 2.02, 3.69). In a large, diverse cohort with CKD, we found significant differences in left ventricular mass and hypertrophic morphology between non-Hispanic Blacks and Whites. Future studies will evaluate whether higher prevalence of LVH contribute to racial/ethnic disparities in cardiovascular outcomes among CKD patients.

  16. Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension.

    Science.gov (United States)

    Tavil, Yusuf; Kanbay, Asiye; Sen, Nihat; Ciftçi, Tansu Ulukavak; Abaci, Adnan; Yalçin, M Ridvan; Köktürk, Oğuz; Cengel, Atiye

    2007-08-01

    To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction. The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography. Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 +/- 3.2, 18.4 +/- 2.5, 20.1 +/- 2.1, and 20.7 +/- 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 +/- 1.5, 10.9 +/- 0.9, 11.2 +/- 1.1, and 13.1 +/- 2.1 cm/s, respectively, P < 0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 +/- 0.06, 0.44 +/- 0.06, 0.45 +/- 0.07, and 0.41 +/- 0.06, respectively, P < 0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = -0

  17. 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)

  18. Macrovascular and microvascular function after implantation of left ventricular assist devices in end-stage heart failure: Role of microparticles.

    Science.gov (United States)

    Sansone, Roberto; Stanske, Beate; Keymel, Stefanie; Schuler, Dominik; Horn, Patrick; Saeed, Diyar; Boeken, Udo; Westenfeld, Ralf; Lichtenberg, Artur; Kelm, Malte; Heiss, Christian

    2015-07-01

    The hemodynamic vascular consequences of implanting left ventricular assist devices (LVADs) have not been studied in detail. We investigated the effect of LVAD implantation compared with heart transplant (HTx) on microvascular and macrovascular function in patients with end-stage heart failure and evaluated whether microparticles may play a role in LVAD-related endothelial dysfunction. Vascular function was assessed in patients with end-stage heart failure awaiting HTx, patients who had undergone implantation of a continuous-flow centrifugal LVAD, and patients who had already received a HTx. Macrovascular function was measured by flow-mediated vasodilation (FMD) using high-resolution ultrasound of the brachial artery. Microvascular function was assessed in the forearm during reactive hyperemia using laser Doppler perfusion imaging and pulsed wave Doppler. Age-matched patients without heart failure and without coronary artery disease (CAD) (healthy control subjects) and patients with stable CAD served as control subjects. Circulating red blood cell (CD253(+)), leukocyte (CD45(+)), platelet (CD31(+)/CD41(+)), and endothelial cell (CD31(+)/CD41(-), CD62e(+), CD144(+)) microparticles were determined by flow cytometry and free hemoglobin by enzyme-linked immunosorbent assay. FMD and microvascular function were significantly impaired in patients with end-stage heart failure compared with healthy control subjects and patients with stable CAD. LVAD implantation led to recovery of microvascular function, but not FMD. In parallel, increased free hemoglobin was observed along with red and white cell microparticles and endothelial and platelet microparticles. This finding indicates destruction of blood cells with release of hemoglobin and activation of endothelial cells. HTx and LVAD implantation led to similar improvements in microvascular function. FMD increased and microparticle levels decreased in patients with HTx, whereas shear stress during reactive hyperemia was

  19. Preserved recovery of cardiac function following ischemia-reperfusion in mice lacking SIRT3.

    Science.gov (United States)

    Koentges, Christoph; Pfeil, Katharina; Meyer-Steenbuck, Maximilian; Lother, Achim; Hoffmann, Michael M; Odening, Katja E; Hein, Lutz; Bode, Christoph; Bugger, Heiko

    2016-01-01

    Lack of the mitochondrial deacetylase sirtuin 3 (SIRT3) impairs mitochondrial function and increases the susceptibility to induction of the mitochondrial permeability transition pore. Because these alterations contribute to myocardial ischemia-reperfusion (IR) injury, we hypothesized that SIRT3 deficiency may increase cardiac injury following myocardial IR. Hearts of 10-week-old mice were perfused in the isolated working mode and subjected to 17.5 min of global no-flow ischemia, followed by 30 min of reperfusion. Measurements before ischemia revealed a decrease in cardiac power (-20%) and rate pressure product (-15%) in SIRT3(-/-) mice. Mitochondrial state 3 respiration (-15%), ATP synthesis (-39%), and ATP/O ratios (-29%) were decreased in hearts of SIRT3(-/-) mice. However, percent recovery of cardiac power (WT 94% ± 9%; SIRT3(-/-) 89% ± 9%) and rate pressure product (WT 89% ± 16%; SIRT3(-/-) 96% ± 3%) following IR was similar in both groups. Myocardial infarct size was not increased in SIRT3(-/-) mice following permanent ligation of the left anterior descending coronary artery (LAD). Left ventricular pressure and dP/dtmax, and mitochondrial respiration and ATP synthesis were not different between groups following LAD ligation. Thus, despite pre-existing defects in cardiac function and mitochondrial respiratory capacity in SIRT3(-/-) mice, SIRT3 deficiency does not additionally impair cardiac function following IR or following myocardial infarction.

  20. Maximising functional recovery following hip fracture in frail seniors.

    Science.gov (United States)

    Beaupre, Lauren A; Binder, Ellen F; Cameron, Ian D; Jones, C Allyson; Orwig, Denise; Sherrington, Cathie; Magaziner, Jay

    2013-12-01

    This review discusses factors affecting recovery following hip fracture in frail older people as well as interventions associated with improved functional recovery. Prefracture function, cognitive status, co-morbidities, depression, nutrition and social support impact recovery and may interact to affect post-fracture outcome. There is mounting evidence that exercise is beneficial following hip fracture with higher-intensity/duration programmes showing more promising outcomes. Pharmacologic management for osteoporosis has benefits in preventing further fractures, and interest is growing in pharmacologic treatments for post-fracture loss of muscle mass and strength. A growing body of evidence suggests that sub-populations - those with cognitive impairment, residing in nursing homes or males - also benefit from rehabilitation after hip fracture. Optimal post-fracture care may entail the use of multiple interventions; however, more work is needed to determine optimal exercise components, duration and intensity as well as exploring the impact of multimodal interventions that combine exercise, pharmacology, nutrition and other interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Maximising functional recovery following hip fracture in frail seniors

    Science.gov (United States)

    Beaupre, Lauren A.; Binder, Ellen F.; Cameron, Ian D.; Jones, C. Allyson; Orwig, Denise; Sherrington, Cathie; Magaziner, Jay

    2015-01-01

    This review discusses factors affecting recovery following hip fracture in frail older people as well as interventions associated with improved functional recovery. Prefracture function, cognitive status, co-morbidities, depression, nutrition and social support impact recovery and may interact to affect post-fracture outcome. There is mounting evidence that exercise is beneficial following hip fracture with higher-intensity/duration programmes showing more promising outcomes. Pharmacologic management for osteoporosis has benefits in preventing further fractures, and interest is growing in pharmacologic treatments for post-fracture loss of muscle mass and strength. A growing body of evidence suggests that sub-populations – those with cognitive impairment, residing in nursing homes or males – also benefit from rehabilitation after hip fracture. Optimal post-fracture care may entail the use of multiple interventions; however, more work is needed to determine optimal exercise components, duration and intensity as well as exploring the impact of multimodal interventions that combine exercise, pharmacology, nutrition and other interventions. PMID:24836335

  2. Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival.

    Science.gov (United States)

    Gerges, Mario; Gerges, Christian; Pistritto, Anna-Maria; Lang, Marie B; Trip, Pia; Jakowitsch, Johannes; Binder, Thomas; Lang, Irene M

    2015-11-15

    Patients with pulmonary hypertension due to left heart disease (PH-LHD) and a diastolic pulmonary vascular pressure gradient ≥ 7 mm Hg, representing PH out of proportion to pulmonary arterial wedge pressure, have pulmonary vascular disease and increased mortality. Little information exists on this condition, recently labeled as "combined pre- and post-capillary PH" (Cpc-PH). To investigate epidemiology, risk factors, right ventricular function, and outcomes in patients with chronic heart failure and Cpc-PH. The study population was identified from a retrospective chart review of a clinical database of 3,107 stable patients who underwent first diagnostic right heart catheterization and from a prospective cohort of 800 consecutive patients at a national university-affiliated tertiary center. The retrospective cohort had 664 patients with systolic heart failure (SHF) and 399 patients with diastolic heart failure (DHF), 12% of whom were classified as Cpc-PH. The prospective cohort had 172 patients with SHF (14% Cpc-PH) and 219 patients with DHF (12% Cpc-PH). Chronic obstructive pulmonary disease (P = 0.034) and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (P = 0.015) predicted Cpc-PH in SHF. Younger age (P = 0.004), valvular heart disease (P = 0.046), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio predicted Cpc-PH in DHF (P = 0.016). Right ventricular-pulmonary vascular coupling was worse in Cpc-PH patients (end-systolic elastance to effective arterial elastance [Ees/Ea]: SHF: 1.05 ± 0.25; P = 0.002; DHF: 1.17 ± 0.27; P = 0.027) than in those with isolated post-capillary PH (Ees/Ea: SHF: 1.52 ± 0.51; DHF: 1.45 ± 0.29). Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes.

  3. Isolated pulmonary regurgitation causes decreased right ventricular longitudinal function and compensatory increased septal pumping in a porcine model

    DEFF Research Database (Denmark)

    Kopic, S; Stephensen, S S; Heiberg, E

    2017-01-01

    AIM: Longitudinal ventricular contraction is a parameter of cardiac performance with predictive power. Right ventricular (RV) longitudinal function is impaired in patients with free pulmonary regurgitation (PR) following corrective surgery for Tetralogy of Fallot (TOF). It remains unclear whether...... received a stent in the pulmonary valve orifice, inducing PR. After 2-3 months, animals were subjected to cardiac magnetic resonance imaging. A subset of animals (n = 6) then underwent percutaneous pulmonary valve replacement (PPVR) with follow-up 1 month later. Longitudinal, lateral and septal...

  4. Characterization of the functional and anatomical differences in the atrial and ventricular myocardium from three species of elasmobranch fishes

    DEFF Research Database (Denmark)

    Larsen, Julie; Bushnell, Peter; Steffensen, John Fleng

    2017-01-01

    We assessed the functional properties in atrial and ventricular myocardium (using isolated cardiac strips) of smooth dogfish (Mustelus canis), clearnose skate (Raja eglanteria), and sandbar shark (Carcharhinus plumbeus) by blocking Ca(2+) release from the sarcoplasmic reticulum (SR) with ryanodine...... positive first derivative (i.e., contractility), and increased time to 50 % relaxation in atrial tissue from smooth dogfish at 30 °C. It also increased times to peak force and half relaxation in clearnose skate atrial and ventricular tissue at both temperatures, but only in atrial tissue from sandbar shark...

  5. Impact of right ventricular endocardial trabeculae on volumes and function assessed by CMR in patients with tetralogy of Fallot

    NARCIS (Netherlands)

    Freling, Hendrik G.; van Wijk, Kees; Jaspers, Karolien; Pieper, Petronella G.; Vermeulen, Karin M.; van Swieten, Jeroen M.; Willems, Tineke P.

    The objective of this study was to assess the impact of right ventricular (RV) trabeculae and papillary muscles on measured volumes and function assessed by cardiovascular magnetic resonance imaging in patients with repaired tetralogy of Fallot. Sixty-five patients with repaired tetralogy of Fallot

  6. Serum levels of advanced glycation end products are associated with left ventricular diastolic function in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Berg, T J; Snorgaard, O; Faber, J

    1999-01-01

    Impairment of left ventricular diastolic function, possibly caused by increased collagen cross-linking of the cardiac muscle, is common in patients with type 1 diabetes even without coronary artery disease. Advanced glycation end products (AGEs) cross-link tissue collagen and are found within...

  7. Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation

    Directory of Open Access Journals (Sweden)

    Cosmo Godino

    2016-06-01

    Conclusions: This study shows that successful MitraClip implantation in patients with FMR and concomitant right ventricular dysfunction yields significant improvement of RV function at mid-term follow-up. Further data on larger population will be required to confirm our observations.

  8. Age-related Ventricular Remodeling is an Independent Risk for Heart Failure Symptoms in Subjects With Preserved Systolic Function

    Directory of Open Access Journals (Sweden)

    Chung-Lieh Hung

    2011-03-01

    Conclusion: Cardiac structure, function, and various ventricular remodeling patterns were age-related. Such remodeling process is not only associated with a higher incidence of cardiovascular morbidities but also more likely to develop HF symptoms, which are independent of clinical variables and LV mass.

  9. Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Yu San; Jaw, Fu Shan [Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei (China); Chen, Jo Yu; Tai, Mei Hwa [Dept. of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei (China); Hsu, Hsao Hsun [Dept. of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei (China)

    2014-12-15

    This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R2 = 0.340, p = 0.023), RV stroke volume (R2 = 0.406, p = 0.011), and RV cardiac output (R2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

  10. End-systolic stress-velocity relation and circumferential fiber velocity shortening for analysing left ventricular function in mice

    Energy Technology Data Exchange (ETDEWEB)

    Fayssoil, A. [Cardiologie, Hopital europeen Georges Pompidou, 20, rue le blanc, Paris (France)], E-mail: fayssoil2000@yahoo.fr; Renault, G. [CNRS UMR 8104, Inserm, U567, Institut Cochin, Universite Paris Descartes, Paris (France); Fougerousse, F. [Genethon, RD, Evry (France)

    2009-08-15

    Traditionally, analysing left ventricular (LV) performance relies on echocardiography by evaluating shortening fraction (SF) in mice. SF is influenced by load conditions. End-systolic stress-velocity (ESSV) relation and circumferential fiber velocity (VcF) shortening are more relevant parameters for evaluating systolic function regardless load conditions particularly in mice's models of heart failure.

  11. Quantitative Computed Tomography of Pulmonary Emphysema and Ventricular Function in Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension

    Science.gov (United States)

    Huang, Yu-Sen; Hsu, Hsao-Hsun; Chen, Jo-Yu; Tai, Mei-Hwa; Jaw, Fu-Shan

    2014-01-01

    Objective This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Materials and Methods Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Results Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R2 = 0.340, p = 0.023), RV stroke volume (R2 = 0.406, p = 0.011), and RV cardiac output (R2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. Conclusion The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients. PMID:25469102

  12. Aortic root dysfunctioning and its effect on left ventricular function in Ross procedure patients assessed with magnetic resonance imaging

    NARCIS (Netherlands)

    Grotenhuis, Heynric B.; Westenberg, Jos J. M.; Doornbos, Joost; Kroft, Lucia J. M.; Schoof, Paul H.; Hazekamp, Mark G.; Vliegen, Hubert W.; Ottenkamp, Jaap; de Roos, Albert

    2006-01-01

    Background This study evaluated the diameters and distensibility of the aortic root as well as the degree of aortic regurgitation (AR) and its effect on left ventricular (LV) function in patients 8.2 +/- 3.1 years after they underwent the Ross procedure, with a comparison of these parameters between

  13. Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension.

    Science.gov (United States)

    Huang, Yu-Sen; Hsu, Hsao-Hsun; Chen, Jo-Yu; Tai, Mei-Hwa; Jaw, Fu-Shan; Chang, Yeun-Chung

    2014-01-01

    This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R(2) = 0.340, p = 0.023), RV stroke volume (R(2) = 0.406, p = 0.011), and RV cardiac output (R(2) = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

  14. Myocardial Steatosis and Left Ventricular Function in Type 2 Diabetes Mellitus : Assessed with Magnetic Resonance Imaging and Spectroscopy

    NARCIS (Netherlands)

    Meer, Rutger Wouter van der

    2008-01-01

    The aim of the thesis was to provide more insight into the influence of myocardial steatosis on left ventricular function in healthy volunteers and in patients with type 2 diabetes mellitus. Therefore we developed a reproducible proton magnetic resonance (MR) spectroscopic technique with respiratory

  15. Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

    NARCIS (Netherlands)

    G. Bol-Raap (Goris); A.H.J. Koning (Anton); T.V. Scohy (Thierry); A.D.J. ten Harkel (Arend); F.J. Meijboom (Folkert); A.P. Kappetein (Arie Pieter); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)

    2007-01-01

    textabstractBackground. This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods. 12

  16. Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography-based and Doppler tissue imaging-based analysis of right atrial and ventricular function.

    Science.gov (United States)

    Brand, Anna; Bathe, Marny; Oertelt-Prigione, Sabine; Seeland, Ute; Rücke, Mirjam; Regitz-Zagrosek, Vera; Stangl, Karl; Knebel, Fabian; Stangl, Verena; Dreger, Henryk

    2018-01-01

    The aim of our study was to describe right atrial (RA) and right ventricular (RV) function, assessed by Doppler tissue imaging and 2D speckle tracking echocardiography (2DSTE), in women with signs of early impaired left ventricular diastolic function (DD). In a cross-sectional trial, standard parameters of diastolic and right heart function were investigated in 438 women of the Berlin Female Risk Evaluation (BEFRI) study. In a subset of women, average peak systolic RA strain (RAS), as well as the average peak systolic RV strain of the free wall (RVS free wall) and of all RV segments (average RV strain; RVS Avg), was analyzed using 2DSTE. Compared to women with normal diastolic function (DD0), RAS, RVS free wall and RVS Avg were significantly reduced in DD (43.1% ± 11.9%, -26.7% ± 5.6%, and -23.3% ± 3.5% in DD0; vs 35.1% ± 10.4%, -23.9% ± 5.5%, and -20.6% ± 3.8% in DD; P right heart function is significantly altered in DD. DTI as well as 2DSTE constitute sensitive echocardiographic tools that enable the diagnosis of impaired right heart mechanics in early-staged DD. © 2017 Wiley Periodicals, Inc.

  17. Sensorimotor integration for functional recovery and the Bobath approach.

    Science.gov (United States)

    Levin, Mindy F; Panturin, Elia

    2011-04-01

    Bobath therapy is used to treat patients with neurological disorders. Bobath practitioners use hands-on approaches to elicit and reestablish typical movement patterns through therapist-controlled sensorimotor experiences within the context of task accomplishment. One aspect of Bobath practice, the recovery of sensorimotor function, is reviewed within the framework of current motor control theories. We focus on the role of sensory information in movement production, the relationship between posture and movement and concepts related to motor recovery and compensation with respect to this therapeutic approach. We suggest that a major barrier to the evaluation of the therapeutic effectiveness of the Bobath concept is the lack of a unified framework for both experimental identification and treatment of neurological motor deficits. More conclusive analysis of therapeutic effectiveness requires the development of specific outcomes that measure movement quality.

  18. Recovery of infraorbital nerve function after zygomaticomaxillary cheek pedicled flap.

    Science.gov (United States)

    Giannì, A B; Biglioli, F; Brevi, B; Brusati, R

    1995-10-01

    The zygomaticomaxillary cheek pedicled flap (ZMCF) involves the intentional section of the infraorbital nerve to reflect the flap laterally in order to give access to the rhinopharynx, clivus and upper cervical spine. The aim of this trial was to examine the recovery of sensation of the infraorbital nerve, both quantitatively (touch sensation, localisation test, two-point discrimination) and qualitatively (sharp/blunt test, temperature sensation, pain sensitivity, dental sensitivity) in 7 patients, at least 12 months after surgery. In each patient, four cutaneous areas (lower eyelid, nose ala, upper lip, cheek) and the upper vestibulum were tested. Results of each test in all the examined areas were evaluated and compared with the data obtained on the nonoperated side (control side). Results of neurosensory tests indicated good recovery of sensation with little difference in comparison with the control side, showing that the functional consequence of ZMCF should actually be considered only as a transitory event.

  19. Association between alcohol consumption and systolic ventricular function: a population-based study.

    Science.gov (United States)

    Yousaf, Haroon; Rodeheffer, Richard J; Paterick, Timothy E; Ashary, Zain; Ahmad, Mirza Nubair; Ammar, Khawaja Afzal

    2014-06-01

    Although moderate alcohol consumption is associated with decreased clinical heart failure, there are no population-based studies evaluating the relationship between alcohol consumption and left ventricular (LV) systolic function. We sought to evaluate the relationship between alcohol consumption and LV systolic function in the community. In a population-based random sample of 2,042 adults, age ≥45 years, we assessed alcohol consumption by a self-administered questionnaire. Responders were categorized by alcohol consumption level: abstainer, former drinker, light drinker (2 drinks a day). Systolic function was assessed by echocardiography. We identified 38 cases of systolic dysfunction in 182 abstainers, 309 former drinkers, 1,028 light drinkers, 251 moderate drinkers, and 146 heavy drinkers. A U-shaped relationship was observed between alcohol consumption and moderate systolic dysfunction (LV ejection fraction [LVEF] ≤40%), with the lowest prevalence in light drinkers (0.9%) compared to the highest prevalence in heavy drinkers (5.5%) (odds ratio 0.14, 95% CI 0.04-0.43). This association persisted across different strata of risk factors of systolic dysfunction as well as in multivariate analysis. No significant association between alcohol consumption and systolic function was seen in subjects with LVEF >50% or ≤50%. There is a U-shaped relationship between alcohol consumption volume and LVEF, with the lowest risk of moderate LV dysfunction (LVEF ≤40%) observed in light drinkers (consumption and cardiovascular disease prevalence. Copyright © 2014 Mosby, Inc. All rights reserved.

  20. DDDR pacing results in left ventricular asynchrony with preservation of ejection fraction and NT-proBNP: a prospective study in sick sinus syndrome and normal ventricular function.

    Science.gov (United States)

    Psychari, Stavroula N; Apostolou, Thomas S; Iliodromitis, Efstathios K; Charalampopoulos, Athanasios; Kremastinos, Dimitrios T

    2010-10-08

    Desynchronization induced by right ventricular pacing may increase the risk for heart failure. We aimed to compare left ventricular (LV) function, synchrony and left atrial size along with NT-proBNP levels, in 2 different modes of pacing: AAIR versus DDDR. This was a prospective study of 60 patients with sick sinus syndrome, preserved LV function and normal atrioventricular conduction. Each pacing mode lasted at least 2 months, in every patient, after which period every patient was switched to the alternate pacing mode. Intraventricular asychrony was assessed by: 1) M-Mode septal-to-posterior wall motion delay (SPWMD), and 2) Tissue Doppler imaging (TDI) septal to lateral delay. NT-proBNP was measured at the end of each pacing mode. LV ejection fraction and left atrial diameter were not different in the 2 pacing modes, although asynchrony was induced in the DDDR arm (pAAIR mode (p=0.003, F=9.64). The NT-proBNP was inversely correlated to LV ejection fraction in the DDDR mode (p=0.0001, R=-0.75), whilst it was significantly correlated to the TDI septal-lateral delay and SPWMD (p=0.007, R=0.4 and p=0.002, R=0.5) in the AAIR mode. In conclusion in sick sinus syndrome with preserved LV function the DDDR mode does not compromise LV systolic function although it causes asynchrony. The NT-proBNP is lower when the right ventricle is paced, is inversely related to LV function and it is related to the degree of LV synchronization in the AAIR mode. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  1. Renal function recovery in end-stage renal disease.

    Science.gov (United States)

    Pichette, V; Quérin, S; Desmeules, M; Ethier, J; Copleston, P

    1993-09-01

    Renal function recovery (RFR) is a rare event in patients with end-stage renal disease (ESRD). Although some predictive factors have been described, there are still unresolved questions. We have analyzed the Canadian Organ Replacement Register data for the 1981 to 1989 period to assess the incidence and factors predictive of RFR in a large ESRD population as well as the outcome after recovery. Renal function recovery was defined as the interruption of renal replacement therapy (RRT) for more than 3 months. Patients on RRT for < or = 45 days were excluded. Of 14,318 registered ESRD patients, 342 (2.4%) experienced RFR after 8.9 +/- 0.5 months of RRT (mean +/- SEM); 52.3% of the recoveries occurred within 6 months of initiating RRT, while 23.7% were only observed after 12 months or more. By Cox regression, patients within the following diagnostic groups had a significantly higher rate of RFR than those with primary glomerulonephritis, who are considered to comprise the reference group: myeloma (relative rate [RR] = 6.00; P < 0.001), drug-induced disease (RR = 4.21; P < 0.001), vascular/hypertensive disease (RR = 2.60; P < 0.001), and systemic disease (RR = 2.58; P < 0.001). Inversely, patients with polycystic kidneys (RR = 0.06; P = 0.004) and diabetic patients (RR = 0.56; P = 0.024) had a lower rate of RFR than those with glomerulonephritis. Men younger than 45 years had a lower rate of RFR than older men and women of all ages (P < or = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. 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.

  3. 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.

  4. Functional neurologic recovery in two dogs diagnosed with severe

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    Mônica Vicky Bahr Arias

    2015-04-01

    Full Text Available Traumatic injuries to the vertebral column, spinal cord, and cauda equina nerve roots occur frequently in human and veterinary medicine and lead to devastating consequences. Complications include partial or complete loss of motor, sensory, and visceral functions, which are among the main causes of euthanasia in dogs. The present case report describes neurological functional recovery in two dogs that were treated surgically for severe spinal fracture and vertebral luxation. In the first case, a stray, mixed breed puppy was diagnosed with thoracolumbar syndrome and Schiff-Scherrington posture, as well as a T13 caudal epiphyseal fracture with 100% luxation between vertebrae T13 and L1; despite these injuries, the animal did show deep pain sensation in the pelvic limbs. Decompression through hemilaminectomy and spinal stabilization with vertebral body pins and bone cement were performed, and the treatment was supplemented with physiotherapy and acupuncture . In the second case, a mixed breed dog was diagnosed with a vertebral fracture and severe luxation between L6 and L7 after a vehicular trauma, but maintained nociception and perineal reflex. Surgical stabilization of the spine was performed using a modified dorsal segmental fixation technique Both patients showed significant recovery of neurological function. Complete luxation of the spinal canal observed radiographically does not mean a poor prognosis, and in some cases, motor, sensory, and visceral functions all have the potential for recovery. In the first case the determining factor for good prognosis was the presence of deep pain perception, and in the second case the prognosis was determined by the presence of sensitivity and anal sphincter tone during the initial neurological examination

  5. Maximal oxygen uptake in severe aortic regurgitation: a different view of left ventricular function.

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    Scriven, A J; Lipkin, D P; Fox, K M; Poole-Wilson, P A

    1990-10-01

    Respiratory gas exchange was used to assess left ventricular (LV) function in 22 patients with severe aortic regurgitation (19 men and three women, aged 18 and 70 years, mean 49 years). Anaerobic threshold and symptom-limited maximal oxygen consumption (VO2 max) were measured during treadmill exercise, and the results were compared with conventional echocardiographic and radionuclide indices of LV systolic function. The results were considered with respect to the patients' New York Heart Association functional class. Both rest and exercise LV ejection fractions were variable, but the mean results were similar in all classes. The echocardiographic indices of LV cavity dimensions, fractional shortening, radius/thickness ratio, and systolic wall stress also showed a wide range but with similar mean results in each class. In contrast, VO2 max and anaerobic threshold showed a relationship to functional class. VO2 max was 32.4 +/- 3.4 ml/kg/min in age-matched control subjects; in the patients it was 27.9 +/- 4.7 in class I, 24.7 +/- 5.7 in class II, and 14.2 +/- 2 in the combined class III/IV. Results in patients in classes I and II were similar, but both groups were significantly different from control subjects (p less than 0.05) and from patients in class III/IV (p less than 0.01). About half of the patients with moderate LV dysfunction (judged by reduced VO2 max) were asymptomatic, and LV function was impaired in 4 of 10 patients in class I. Thus, unlike conventional indices of LV function, VO2 max appeared capable of distinguishing patients with moderate-to-severe LV dysfunction from those with little or no LV dysfunction. Measurement of respiratory gas exchange appears to be a valid and useful supplementary means of assessing LV function in severe aortic regurgitation. Further long-term evaluation is required.

  6. Impaired Cerebral Mitochondrial Oxidative Phosphorylation Function in a Rat Model of Ventricular Fibrillation and Cardiopulmonary Resuscitation

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    Jun Jiang

    2014-01-01

    Full Text Available Postcardiac arrest brain injury significantly contributes to mortality and morbidity in patients suffering from cardiac arrest (CA. Evidence that shows that mitochondrial dysfunction appears to be a key factor in tissue damage after ischemia/reperfusion is accumulating. However, limited data are available regarding the cerebral mitochondrial dysfunction during CA and cardiopulmonary resuscitation (CPR and its relationship to the alterations of high-energy phosphate. Here, we sought to identify alterations of mitochondrial morphology and oxidative phosphorylation function as well as high-energy phosphates during CA and CPR in a rat model of ventricular fibrillation (VF. We found that impairment of mitochondrial respiration and partial depletion of adenosine triphosphate (ATP and phosphocreatine (PCr developed in the cerebral cortex and hippocampus following a prolonged cardiac arrest. Optimal CPR might ameliorate the deranged phosphorus metabolism and preserve mitochondrial function. No obvious ultrastructural abnormalities of mitochondria have been found during CA. We conclude that CA causes cerebral mitochondrial dysfunction along with decay of high-energy phosphates, which would be mitigated with CPR. This study may broaden our understanding of the pathogenic processes underlying global cerebral ischemic injury and provide a potential therapeutic strategy that aimed at preserving cerebral mitochondrial function during CA.

  7. Sex differences in associations of cardio-ankle vascular index with left ventricular function and geometry.

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    Ye, Zi; Pellikka, Patricia A; Kullo, Iftikhar J

    2017-12-01

    The cardio-ankle vascular index (CAVI) is a measure of global arterial stiffness. We hypothesized that CAVI is associated with left ventricular (LV) function and geometry in individuals without structural heart disease. We measured CAVI in 600 participants (mean age 60.3±14.6 years, 54% men) without history of atherosclerotic cardiovascular disease who were referred for transthoracic echocardiography. Linear regression analysis was used to assess the association of CAVI with LV function (peak mitral annular systolic s' and early diastolic velocity e') and structure (LV mass index (LVMI) and relative wall thickness (RWT)). Older age, male sex, lower body mass index, history of hypertension, diabetes and chronic kidney disease were each associated with a higher CAVI (adjusted R 2 = 0.56, all p 0.1 in men). In conclusion, a higher CAVI, a measure of global arterial stiffness, is associated with worse LV systolic function, worse diastolic relaxation, and greater LV RWT in both men and women, and with LVMI in women.

  8. Effect of beta-blockade on regional left ventricular function in patients with dilated cardiomyopathy.

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    Morozumi, T; Ishida, Y; Kusuoka, H; Sato, H; Hori, M; Kamada, T; Nishimura, T

    1995-01-01

    It has been reported that beta-blockade has beneficial effects on the cardiac function and prognosis of patients with congestive heart failure. However, the mechanism for these effects remained unclear. This study compared the use of an angiotensin-converting enzyme (ACE) inhibitor (enalapril, 2.5 to 5.0 mg/day, or delapril, 15 to 30 mg/day) alone with the effects of beta-blockade therapy (metoprolol, 40 to 60 mg/day) coupled with an ACE inhibitor on global and regional left ventricular (LV) function in patients with dilated cardiomyopathy. In 12 patients with dilated cardiomyopathy, the global LV ejection fraction (EF), regional EF (rEF), and regional ejection time (rET) were determined by sector analysis of the radionuclide ventriculogram before and after therapy (duration 14 +/- 9 months). The coefficients of variation of rEF and rET were calculated as indexes of the heterogeneity of regional LV systolic wall motion. EF increased significantly from 20% +/- 8% to 30% +/- 8% (p < 0.05) in patients who received beta-blockade and an ACE inhibitor (n = 5). Furthermore, the coefficients of variation of rET decreased from 27% +/- 13% to 16% +/- 7% (p < 0.05). In contrast, patients treated with an ACE inhibitor only (n = 7) showed no significant improvements in any of these parameters. These results suggest that, compared with an ACE inhibitor alone, beta-blockade improves global and regional LV function in dilated cardiomyopathy by synchronizing myocardial contraction.

  9. Noninvasive perioperative evaluation of right ventricular function in children with tetralogy of Fallot.

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    Ye, Jing-Jing; Shu, Qiang; Liu, Xi-Wang; Gu, Wei-zhong; Yu, Jin; Jiang, Guo-ping

    2014-01-01

    Early and accurate noninvasive means of identifying right ventricular (RV) dysfunction in children with tetralogy of Fallot (TOF) are needed. RV function was examined using tissue Doppler imaging (TDI), strain rate (SR), and strain analysis (SA) in children before (N = 37) and after (6-12 months; N = 32) TOF repair, and in a control group of children (N = 37). Plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase 9 (MMP-9) were measured. TDI, SR, and SA revealed that RV systolic and diastolic function indices were lower preoperatively in the TOF group compared with the control group, and did not improve after TOF repair. Plasma NT-proBNP concentrations were significantly higher in the TOF group pre- and postoperatively compared with the control group. In the preoperative TOF group, NT-proBNP concentration was significantly correlated with peak systolic SR and systolic strain in the mid segments of RV free wall. Plasma MMP-9 concentrations were significantly increased in the preoperative TOF group compared with the control group, and significantly correlated with plasma NT-proBNP and logNT-proBNP concentrations. RV function correlated with plasma NT-proBNP concentrations in children with TOF. Assessment of this noninvasive measure may help identify RV dysfunction in patients with TOF before they become clinically symptomatic. © 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation.

  10. Effect of myocardial revascularisation on left ventricular systolic function in patients with and without viable myocardium: should non-viable segments be revascularised?

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    Stipac, Alja Vlahovic; Stankovic, Ivan; Vidakovic, Radosav; Putnikovic, Biljana; Ilic, Ivan; Milicic, Biljana; Neskovic, Aleksandar N

    2013-12-01

    To assess the effect of surgical revascularisation on left ventricular (LV) systolic function in patients with viable and non-viable dysfunctional LV segments determined by low dose dobutamine stress echocardiography (DSE). Prospective observational cohort study. Single tertiary care centre. Consecutive patients referred to surgical revascularisation (n=115). DSE and surgical revascularisation. Functional recovery defined as increase in ejection fraction ≥ 5% 1 year after revascularisation in patients with and without viable myocardium (viability defined as improvement of contractility in ≥ 4 LV segments on DSE). The mean age, ejection fraction and wall motion score index (WMSi) of patients were 59 ± 9 years, 44 ± 9% and 1.82 ± 0.31, respectively. There was no difference between DSE positive and DSE negative patients for any of those parameters at baseline study (p>0.05 for all). After 12 months, the ejection fraction increased 11 ± 1% in patients with viable myocardium vs 7 ± 1% in patients without viable myocardium (p=0.002). Moreover, in patients with viable myocardium, the greatest increase of ejection fraction occurred 1 month after surgery (9 ± 1%), whereas in those patients with negative DSE the ejection fraction increased more gradually (2±1% after 1 month, p=0.002 between groups for 1 month vs preoperative value), but still improved after 12 months follow-up (pmyocardial revascularisation. Functional recovery continuously occurs throughout the first year after surgical treatment.

  11. Is autonomic function associated with left ventricular systolic function in Chagas heart disease patients undergoing treatment for heart failure?

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    Lotte Raadschilders

    2014-04-01

    Full Text Available Introduction The association between cardiac autonomic and left ventricular (LV dysfunction in Chagas disease (ChD is controversial. Methods A standardized protocol that includes the Valsalva maneuver, a respiratory sinus arrhythmia (RSA test, and an echocardiographic examination was used. Spearman correlation coefficients (rho were used to investigate associations. Results The study population consisted of 118 ChD patients undergoing current medical treatment, with an average LV ejection fraction of 51.4±2.6%. The LV ejection fraction and diastolic dimension were correlated with the Valsalva index (rho=0.358, p<0.001 and rho=-0.266, p=0.004, respectively and the RSA (rho=0.391, p<0.001 and rho=-0.311, p<0.001, respectively. Conclusions The impairment of LV function is directly associated with a reduction of cardiac autonomic modulation in ChD.

  12. Total Renal Artery Occlusion: Recovery of Function After Revascularization.

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    Manohar, Sandhya; Hamadah, Abdurrahman; Herrmann, Sandra M; Textor, Stephen C

    2018-02-08

    Current trends in managing atherosclerotic renal artery stenosis favor medical therapy, on account of negative results from prospective trials of revascularization, such as CORAL and ASTRAL. One result of this trend has been encountering occasional patients with progressive disease, sometimes leading to total arterial occlusion. We illustrate a case of accelerated hypertension with complete renal artery occlusion in which the patient recovered function after surgical bypass and we review the clinical approach used and the advanced imaging modalities available to us. A high index of suspicion and careful radiologic imaging play important roles in selecting patients who may have residual function and may benefit from revascularization. This case illustrates an example whereby restoring renal artery perfusion for carefully selected patients can be life changing, with recovery of kidney function and improved blood pressure, pill burden, and overall quality of life. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Non-ventricular, Clinical, and Functional Features of the RyR2(R420Q) Mutation Causing Catecholaminergic Polymorphic Ventricular Tachycardia.

    Science.gov (United States)

    Domingo, Diana; Neco, Patricia; Fernández-Pons, Elena; Zissimopoulos, Spyros; Molina, Pilar; Olagüe, José; Suárez-Mier, M Paz; Lai, F Anthony; Gómez, Ana M; Zorio, Esther

    2015-05-01

    Catecholaminergic polymorphic ventricular tachycardia is a malignant disease, due to mutations in proteins controlling Ca(2+) homeostasis. While the phenotype is characterized by polymorphic ventricular arrhythmias under stress, supraventricular arrhythmias may occur and are not fully characterized. Twenty-five relatives from a Spanish family with several sudden deaths were evaluated with electrocardiogram, exercise testing, and optional epinephrine challenge. Selective RyR2 sequencing in an affected individual and cascade screening in the rest of the family was offered. The RyR2(R420Q) mutation was generated in HEK-293 cells using site-directed mutagenesis to conduct in vitro functional studies. The exercise testing unmasked catecholaminergic polymorphic ventricular tachycardia in 8 relatives (sensitivity = 89%; positive predictive value = 100%; negative predictive value = 93%), all of them carrying the heterozygous RyR2(R420Q) mutation, which was also present in the proband and a young girl without exercise testing, a 91% penetrance at the end of the follow-up. Remarkably, sinus bradycardia, atrial and junctional arrhythmias, and/or giant post-effort U-waves were identified in patients. Upon permeabilization and in intact cells, the RyR2(R420Q) expressing cells showed a smaller peak of Ca(2+) release than RyR2 wild-type cells. However, at physiologic intracellular Ca(2+) concentration, equivalent to the diastolic cytosolic concentration, the RyR2(R420Q) released more Ca(2+) and oscillated faster than RyR2 wild-type cells. The missense RyR2(R420Q) mutation was identified in the N-terminus of the RyR2 gene in this highly symptomatic family. Remarkably, this mutation is associated with sinus bradycardia, atrial and junctional arrhythmias, and giant U-waves. Collectively, functional heterologous expression studies suggest that the RyR2(R420Q) behaves as an aberrant channel, as a loss- or gain-of-function mutation depending on cytosolic intracellular Ca(2

  14. Left ventricular function response to exercise in normotensive obese subjects: influence of degree and duration of obesity.

    Science.gov (United States)

    Licata, G; Scaglione, R; Paterna, S; Parrinello, G; Indovina, A; Dichiara, M A; Alaimo, G; Merlino, G

    1992-11-01

    This study has been designed to evaluate whether duration and severity of obesity can influence left ventricular function response to exercise in obese subjects without other known cardiovascular risk factors such as hypertension, diabetes or hyperlipoproteinemia. A total of 29 obese subjects were included and they were divided, according to their body mass index and to Garrow's criteria as follows: Overweight or mildly obese subjects: body mass index from 25 to 30 kg/m2; moderately obese subjects: body mass index > 30 and < 40 kg/m2. Both obese groups were further subdivided according to their duration of obesity evaluated by accurate anamnesis in subgroup A (duration of obesity less than 120 months) and subgroup B (duration of obesity more than 120 months). Left ventricular ejection fraction was detected by blood pool gated radionuclide angiocardiography both at rest and after symptom-limited bicycle ergometer procedure. At peak exercise left ventricular ejection fraction increased significantly (p < 0.05) only in overweight subjects. Exercise produced an increase of left ventricular ejection fraction in 14 overweight and in 5 moderately obese subjects and a decrease in 2 moderately obese subjects. At peak exercise mean heart rate and mean blood pressure increased significantly (p < 0.001) in both groups. When obese subjects were subgrouped according to duration of obesity, left ventricular ejection fraction increased significantly (p < 0.05) only in overweight subjects with duration of obesity less than 120 months. Duration of obesity correlated inversely with percent change in left ventricular ejection fraction (EF) at peak exercise (delta EF) (r = -0.59; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Super-resolution scanning patch clamp reveals clustering of functional ion channels in adult ventricular myocyte.

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    Bhargava, Anamika; Lin, Xianming; Novak, Pavel; Mehta, Kinneri; Korchev, Yuri; Delmar, Mario; Gorelik, Julia

    2013-04-12

    Compartmentation of ion channels on the cardiomyocyte surface is important for electric propagation and electromechanical coupling. The specialized T-tubule and costameric structures facilitate spatial coupling of various ion channels and receptors. Existing methods such as immunofluorescence and patch clamp techniques are limited in their ability to localize functional ion channels. As such, a correlation between channel protein location and channel function remains incomplete. To validate a method that permits routine imaging of the topography of a live cardiomyocyte and study clustering of functional ion channels from a specific microdomain. We used scanning ion conductance microscopy and conventional cell-attached patch clamp with a software modification that allows controlled increase of pipette tip diameter. The sharp nanopipette used for topography scan was modified into a larger patch pipette that could be positioned with nanoscale precision to a specific site of interest (crest, groove, or T-tubules of cardiomyocytes) and sealed to the membrane for cell-attached recording of ion channels. Using this method, we significantly increased the probability of detecting activity of L-type calcium channels in the T-tubules of ventricular cardiomyocytes. We also demonstrated that active sodium channels do not distribute homogenously on the sarcolemma instead, they segregate into clusters of various densities, most crowded in the crest region, that are surrounded by areas virtually free of functional sodium channels. Our new method substantially increases the throughput of recording location-specific functional ion channels on the cardiomyocyte sarcolemma, thereby allowing characterization of ion channels in relation to the microdomain where they reside.

  16. The effects of candesartan on left ventricular hypertrophy and function in nonobstructive hypertrophic cardiomyopathy: a pilot, randomized study.

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    Penicka, Martin; Gregor, Pavel; Kerekes, Roman; Marek, Dan; Curila, Karol; Krupicka, Jiri

    2009-01-01

    Hypertrophic cardiomyopathy is caused by mutations in the genes that encode sarcomeric proteins and is primarily characterized by unexplained left ventricular hypertrophy, impaired cardiac function, reduced exercise tolerance, and a relatively high incidence of sudden cardiac death, especially in the young. The extent of left ventricular hypertrophy is one of the major determinants of disease prognosis. Angiotensin II has trophic effects on the heart and plays an important role in the development of myocardial hypertrophy. Here in a double-blind, placebo-controlled, randomized study, we show that the long-term administration of the angiotensin II type 1 receptor antagonist candesartan in patients with hypertrophic cardiomyopathy was associated with the significant regression of left ventricular hypertrophy, improvement of left ventricular function, and exercise tolerance. The magnitude of the treatment effect was dependent on specific sarcomeric protein gene mutations that had the greatest responses on the carriers of ss-myosin heavy chain and cardiac myosin binding protein C gene mutations. These data indicate that modulating the role of angiotensin II in the development of hypertrophy is specific with respect to both the affected sarcomeric protein gene and the affected codon within that gene. Thus, angiotensin II type 1 receptor blockade has the potential to attenuate myocardial hypertrophy and may, therefore, provide a new treatment option to prevent sudden cardiac death in patients with hypertrophic cardiomyopathy.

  17. The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries.

    Science.gov (United States)

    Topuz, Mustafa; Dogan, Ali

    2017-01-01

    The aim of this study is to evaluate the effect of epicardial adipose tissue (EAT) thickness on left ventricular diastolic functions in patients with normal coronary arteries (NCA) proven by angiography. We selected study patients who were referred to coronary angiography due to typical chest pain or atypical chest pain with a positive pre-test result for coronary artery disease (CAD). After coronary angiography, 85 patients with significant coronary lesion (≥ 50% stenosis) served as the CAD group, 82 patients with non-significant coronary lesion (thickness and left ventricular diastolic properties. Gensini score, total cholesterol, and C-reactive protein were significantly higher in the CAD group compared to the non-significant CAD group and the NCA group. The average of EAT thickness was 7.3 ± 2.4 mm in all groups. It was 5.8 ± 2.3 mm in the NCA group, 6.4 ± 2.4 mm in the non-significant CAD group, and 7.8 ± 2.2 mm in the CAD group (p thickness was significantly correlated with E/e' ratio in the NCA group. In multivariate analysis, average of EAT thickness was significantly associated with left ventricular diastolic dysfunction in subjects with NCA (OR 1.019, 95% CI 1.012-1.027, p thickness may have an effect on left ventricular diastolic functions. This independent relationship showed us the clinical importance of measuring of EAT thickness.

  18. Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

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    Nusarintowati Ramadhina

    2015-07-01

    Results Subjects had a mean gestational age of 31.5 (SD 2.18 weeks and mean birth weight of 1,525 (SD 437.5 g. The mean LV function measured by MPI was 0.281 (SD 0.075; mean EF was 72.5 (SD 5.09%; and mean FS was 38.3 (SD 4.29%. The RV function measured by TAPSE was mean 6.85 (SD 0.94 and that measured by MPI was median 0.255 (range 0.17-0.59. Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81 pg/mL vs. 97.75 (24.2-142.2 pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001, as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005. The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P <0.001.Conclusion Left and right ventricular MPI show positive correlations with hs-cTnT levels. Serum hs-cTnT is significantly higher in non survivors. As such, this marker may have prognostic value for neonatal sepsis patients.

  19. Assessment of left ventricular size and function in horses using anatomical M-mode echocardiography.

    Science.gov (United States)

    Grenacher, Patrizia A; Schwarzwald, Colin C

    2010-08-01

    To study the applicability of anatomical M-mode (AMM) for assessment of left ventricular (LV) size and function in horses, evaluate agreement with conventional M-mode (CMM), determine reliability, and establish reference intervals for AMM measurements. 98 horses; 13.1 +/- 5.6 years; 538 +/- 78 kg. Two-dimensional and M-mode recordings were analyzed retrospectively. Standard LV dimensions and indices of LV function, including time intervals, were measured in CMM and compared with AMM studies in long-axis (lx) and short-axis (sx) views. The percentages of measureable cycles were 99%, 97%, and 90% for routine LV studies in CMM(sx), AMM(sx), and AMM(lx) mode. For time intervals, >or= 93% of cycles could be measured using AMM compared to a maximum of 77% using CMM. AMM(sx) measurements agreed well with CMM(sx) measurements for LV studies; the agreement of AMM(lx) with CMM(sx) was markedly lower. The LV ejection time and the duration of electromechanical systole, but not the LV pre-ejection period and the index of myocardial performance, showed fair agreement between methods. Intraobserver and interobserver measurement variabilities were low for most variables. AMM can replace CMM for assessment of LV dimensions in horses, but is not recommended for measurement of time intervals. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  20. Novel and Functional DNA Sequence Variants within the GATA6 Gene Promoter in Ventricular Septal Defects

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    Chunyu Li

    2014-07-01

    Full Text Available Congenital heart disease (CHD is the most common birth defect in humans. Genetic causes and underlying molecular mechanisms for isolated CHD remain largely unknown. Studies have demonstrated that GATA transcription factor 6 (GATA6 plays an essential role in the heart development. Mutations in GATA6 gene have been associated with diverse types of CHD. As GATA6 functions in a dosage-dependent manner, we speculated that changed GATA6 levels, resulting from DNA sequence variants (DSVs within the gene regulatory regions, may mediate the CHD development. In the present study, GATA6 gene promoter was genetically and functionally analyzed in large groups of patients with ventricular septal defect (VSD (n = 359 and ethnic-matched healthy controls (n = 365. In total, 11 DSVs, including four SNPs, were identified in VSD patients and controls. Two novel and heterozygous DSVs, g.22169190A>T and g.22169311C>G, were identified in two VSD patients, but in none of controls. In cultured cardiomyocytes, the activities of the GATA6 gene promoter were significantly reduced by the DSVs g.22169190A>T and g.22169311C>G. Therefore, our findings suggested that the DSVs within the GATA6 gene promoter identified in VSD patients may change GATA6 levels, contributing to the VSD development as a risk factor.

  1. Assessment of right ventricular function by intravenous infusion of krypton-81m

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    Spielmann, R.P.; Nienaber, C.; Wasmus, G.; Stritzke, P.; Montz, R.; Mathey, D.G.

    1984-01-01

    Kr-81m equilibrium ventriculography was used to assess right ventricular (RV) function at rest (R) and during submaximal bicycle exercise (E) in patients (pts) with different cardiopulmonary disorders. Kr-81 was continuously eluted in 5% dextrose from a portable Rb-81 generator and infused through a peripheral vein. Due to the short half-life (13s) and the free diffusibility of Kr-81 through the alveolar membrane, activity in the left side of the heart is negligible. This allows imaging in a RAO position which provides the best separation between the right atrium and the RV. Determination of RV ejection fraction (RVEF) involved the definition of an endiastolic and an endsystolic region of interest by a semiautomatic computer algorithm. The standard deviation of RVEF determinations by two independent observers was 0.047. Kr-81 RVEF was related to X-ray angiographic (XR) RVEF and hemodynamic measurements. The correlation coefficient between Kr-81 and XR RVEF was 0.82(n=25). When all pts were divided into two groups according to their mean pulmonary artery pressure, significant differences in the RVEF during E between these groups were found with both Kr-81 and XR ventriculography. The correspondence between KR-81 and XR data underlines the potential of Kr-81 as a reliable noninvasive tool in assessing RV function.

  2. Successful weight reduction improves left ventricular diastolic function and physical performance in severe obesity.

    Science.gov (United States)

    Fenk, Sabine; Fischer, Marcus; Strack, Christina; Schmitz, Gerd; Loew, Thomas; Lahmann, Claas; Baessler, Andrea

    2015-01-01

    Obesity and the metabolic syndrome (MetS) are risk factors for left ventricular diastolic dysfunction (LVDD). However, little is known about the impact of successful weight reduction (WR) on diastolic function and physical performance.Obese subjects (øBMI 40.2 ± 8.6 kg/m(2)) underwent a 1-year WR program comprising diet and lifestyle components. Echocardiography and exercise capacity (6-minute walk) were performed at baseline and after 1 year. The distribution of weight reduction was split at the sample median and subjects were dichotomized in "successful WR" (% WR ≥ median, corresponding to a weight loss of 8%) and "failed-WR" (% WR obese subjects, 71 had LVDD at baseline. Obese patients with successful WR improved their MetS alterations, including fasting glucose, insulin, lipids, adipokines, blood pressure levels, and epicardial fat thickness. The same was not true for obesity with failed WR. Subjects with successful WR demonstrated significant improvement in echocardiographic LVDD parameters (median [interquartile range]): Δe' (2,5 [-1.0, 4.7], P severe obesity, successful long-term WR was associated with improved LV diastolic function and exercise capacity.

  3. Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy

    Science.gov (United States)

    Saccheri, María Cristina; Cianciulli, Tomás Francisco; Morita, Luis Alberto; Méndez, Ricardo José; Beck, Martín Alejandro; Guerra, Juan Enrique; Cozzarin, Alberto; Puente, Luciana Jimena; Balletti, Lorena Romina; Lax, Jorge Alberto

    2017-01-01

    AIM To explore regional systolic strain of midwall and endocardial segments using speckle tracking echocardiography in patients with apical hypertrophic cardiomyopathy (HCM). METHODS We prospectively assessed 20 patients (mean age 53 ± 16 years, range: 18-81 years, 10 were male), with apical HCM. We measured global longitudinal peak systolic strain (GLPSS) in the midwall and endocardium of the left ventricle. RESULTS The diastolic thickness of the 4 apical segments was 16.25 ± 2.75 mm. All patients had a normal global systolic function with a fractional shortening of 50% ± 8%. In spite of supernormal left ventricular (LV) systolic function, midwall GLPSS was decreased in all patients, more in the apical (-7.3% ± -8.8%) than in basal segments (-15.5% ± -6.93%), while endocardial GLPPS was significantly greater and reached normal values (apical: -22.8% ± -7.8%, basal: -17.9% ± -7.5%). CONCLUSION This study shows that two-dimensional strain was decreased mainly confined to the mesocardium, while endocardium myocardial deformation was preserved in HCM and allowed to identify subclinical LV dysfunction. This transmural heterogeneity in systolic strain had not been previously described in HCM and could be explained by the distribution of myofibrillar disarray in deep myocardial areas. The clinical application of this novel finding may help further understanding of the pathophysiology of HCM. PMID:28515855

  4. Evaluation of subendocardial and subepicardial left ventricular functions using tissue Doppler imaging after complete revascularization.

    Science.gov (United States)

    Sürücü, Hüseyin; Tatli, Ersan; Okudan, Selnur; Aktoz, Meryem

    2009-02-01

    We aim to evaluate subepicardial and subendocardial left ventricular (LV) functions in patient single coronary artery lesion at early stage after percutaneous coronary intervention (PCI). Additionally, a comparison of LV functions between patients and control cases was aimed. Patients with culprit left anterior descending (LAD) lesion (n = 25) and subjects with normal coronary angiography (n = 25) were evaluated. Patients underwent PCI and at least one coronary stent was placed. After PCI, the pulsed-wave tissue Doppler imaging (pw-TDI) parameters taken from subepicardial and subepicardial layers were compared among the patients. Left atrium (P = 0.050), LV end-diastolic (P = 0.049), and end-systolic (P = 0.006) diameters were larger compared to the control group. LV inflow velocities were not different between the patient and the control group. But, the myocardial performance index was different (P = 0.049). The systolic and diastolic pw-TDI parameters were apparently different between the patient and the control group. While the systolic pw-TDI parameters did not change, the diastolic pw-TDI parameters taken from both subepicardial (circumferential contraction) and subendocardial layers (longitudinal contraction) improved after PCI. After PCI, it was shown that while Ea velocity (P = 0.012) taken from the subendocardial layer increased, IVRa velocity (P subendocardial and subepicardial layers. These dysfunctions can be easily presented with pw-TDI. Although systolic dysfunction persists, diastolic dysfunction improves at early stage after PCI.

  5. Assessment of the left ventricular systolic and diastolic function by the left ventricular density curve derived from intravenous digital subtraction angiography in children

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    Horigome, Hitoshi; Satoh, Hideo; Isobe, Takeshi; Takita, Hitoshi (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine)

    1991-05-01

    To evaluate the left ventricular (LV) systolic and diastolic function, fifty-four children with various heart diseases underwent intravenous digital subtraction angiography (IV-DSA). Global left ventricular density curve was obtained through densitometry of the DSA images. The curve was smoothed by a third-degree Fourier transformation and systolic and diastolic indexes were obtained. In the control group, consisting of Kawasaki disease without coronary lesion and mild pulmonary stenosis, the peak ejection rate (PER) and the peak filling rate in early diastole (PFR-E) correlated positively with the heart rate (HR) in a quadratic curve manner (PER: r= 0.93 p<0.01, PFR-E: r= 0.94 p<0.01). Time from end-diastolic to PER (T-PER) and time from end-systolic to PFR (T-PFR) were correlated negatively with HR (T-PER: r=-0.86 p<0.01, T-PFR: r=-0.91 p<0.01). However, T-PER/RR and T-PFR/RR values were rather constant (20.9+-3.2%, 17.0+-2.6%, respectively). We also found significant correlations of PER and PFR-E with left ventricular ejection fraction (LVEF). Patients with corrected tetralogy of Fallot and with cardiomyopaties showed not only abnormal systolic indexes but some depressed diastolic indexes. LV density curve also disclosed isolated diastolic dysfunction in a group of aortic stenosis and in two patients with coronary lesions. A correlation of LVEF derived from the density curve and conventional area-length method was high (r= 0.91 p<0.001). To evaluate the reproducibility, we were able to obtain the digital data twice with over one month interval on 24 patients. The intraobserver correlation was satisfactory. We applied the remasking method, resulting in improving the quality of digital images under spontaneous breathing. Our results indicated that IV-DSA was a less-invasive and clinically reliable method for assessment of LV function in children. (author).

  6. Association of plasma angiotensin-(1-7 level and left ventricular function in patients with type 2 diabetes mellitus.

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    Pan-Pan Hao

    Full Text Available We recently found that overexpression of angiotensin (Ang-converting enzyme 2, which metabolizes Ang-II to Ang-(1-7 and Ang-I to Ang-(1-9, may prevent diabetes-induced left ventricular remodeling and dysfunction in rats. Our objective was to evaluate the association of plasma Ang-(1-7 level and left ventricular function in patients with type 2 diabetes mellitus.We measured the left ventricular ejection fraction (EF, ratio of early to late left ventricular filling velocity (E/A and ratio of early diastolic mitral inflow to annular velocity (E/Ea by ultrasonography in 110 patients with type 2 diabetes mellitus for more than 5 years. Anthropometric and fasting blood values were obtained from medical records. The plasma Ang-(1-7 level in patients with a poor EF (15 was significantly lower than that in patients with E/Ea ≤15. Ang-(1-7 level was negatively correlated with E/Ea and Log-N-terminal pro-B-type natriuretic peptide and positively with EF and E/A. Stepwise multiple regression analysis revealed that Ang-(1-7, hemoglobin A1c and Ang-II levels as well as duration of diabetes predicted EF; Ang-(1-7 level, fasting blood glucose, low-density lipoprotein cholesterol level and duration of diabetes predicted E/A; and Ang-(1-7 and hemoglobin A1c levels predicted E/Ea.Plasma Ang-(1-7 level is independently associated with left ventricular function in patients with type 2 diabetes mellitus and may be a biomarker for assessing cardiac function in such patients.

  7. Assessment of left ventricular function and mass in dual-source computed tomography coronary angiography

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    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. Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography.

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    Felix Heggemann

    Full Text Available AIMS: This study sought to characterize global and regional right ventricular (RV myocardial function in patients with Takotsubo cardiomyopathy (TC using 2D strain imaging. METHODS: We compared various parameters of RV and left ventricular (LV systolic function between 2 groups of consecutive patients with TC at initial presentation and upon follow-up. Group 1 had RV involvement and group 2 did not have RV involvement. RESULTS: At initial presentation, RV peak systolic longitudinal strain (RVPSS and RV fractional area change (RVFAC were significantly lower in group 1 (-13.2±8.6% vs. -21.8±5.4%, p = 0.001; 30.7±9.3% vs. 43.5±6.3%, p = 0.001 and improved significantly upon follow-up. Tricuspid annular plane systolic excursion (TAPSE did not differ significantly at initial presentation between both groups (14.8±4.1 mm vs. 17.9±3.5 mm, p = 0.050. Differences in regional systolic RV strain were only observed in the mid and apical segments. LV ejection fraction (LVEF and LV global strain were significantly lower in group 1 (36±8% vs. 46±10%, p = 0.006 and -5.5±4.8% vs. -10.2±6.2%, p = 0.040 at initial presentation. None of the parameters were significantly different between the 2 groups upon follow-up. A RVPSS cut-off value of >-19.1% had a sensitivity of 85% and a specificity of 71% to discriminate between the 2 groups. CONCLUSION: In TC, RVFAC, RVPSS, LVEF and LV global strain differed significantly between patients with and without RV dysfunction, whereas TAPSE did not. 2 D strain imaging was feasible for the assessment of RV dysfunction in TC and could discriminate between patients with and without RV involvement in a clinically meaningful way.

  9. Right Ventricular Function in Patients With Left Ventricular Assist Device Support by Pulsatile Polvad MEV and Continuous-Flow Pumps Heartware and Heartmate II.

    Science.gov (United States)

    Nadziakiewicz, P; Borkowski, J; Szygula-Jurkiewicz, B; Niklewski, T; Pacholewicz, J; Zakliczynski, M; Hrapkowicz, T; Zembala, M

    2016-06-01

    Left ventricular assist device (LVAD) support is increasingly used in patients with heart failure. The right ventricle (RV) plays a main role in LVAD support. Little is known about the effects of pulsatile Polvad MEV devices or continuouseconds flow pumps on RV function. We compared hemodynamic parameters of RV in patients after implantation of Polvad MEV (PM) and Heartware (HW) or Heartmate II (HMII) LVADs. Forty-four patients were retrospectively reviewed after implantation of PM (group P; n = 24 [21 M, 3 F]) or HW or HMII (group C; n = 20 [20 M, 0 F]) LVADs from April 2007 to February 2014. Hemodynamic data-mean pulmonary pressure (mPAP), central venous pressure (CVP), cardiac output (CO), and cardiac index (CI)-were collected before surgery, after surgery, and every 2 hours in the intensive care unit, with the time points numbered from 1 to 120. Right ventricular work (RVW) was calculated according to the equation: RCW = CO × (mPAP - CVP) × 0.0144 (g·m). Baseline characteristic of the patients were similar. mPAP values were similar between groups. CVP values were higher in group P, significantly at time points 5 and 7-33. CO values were higher in group C, significantly from point 3 and almost all the time to point 43. CI reached significance at point 9, 12-14, 16-19, and 30-41. RCW was higher in group P before implantation. Post-implantation RCW values were higher in group C, significantly at time points 19, 20, 32-34, 51-53, and 55-57. Continuous-flow pumps more effectively optimize RV function than pulsatile LVADs, which can result in more effective prevention of RV failure or insuffiency in that group. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Best anesthetics for assessing left ventricular systolic function by echocardiography in mice.

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    Pachon, Ronald E; Scharf, Bruce A; Vatner, Dorothy E; Vatner, Stephen F

    2015-06-15

    Our review of the literature of the major cardiovascular journals for the past three years showed that for all studies using anesthesia for mouse echocardiography, the predominant anesthetic was isoflurane, which was used in 76% of the studies. The goal of this investigation was to determine if isoflurane is indeed the best anesthetic. Accordingly, we compared isoflurane with 2,2,2-tribromoethanol (Avertin), ketamine-xylazine, and ketamine on different days in the same 14 mice, also studied in the conscious state without anesthesia. A randomized crossover study design was employed to compare the effects on left ventricular (LV) systolic function and heart rate of the four different anesthetic agents assessed by transthoracic echocardiography. As expected, each anesthetic depressed LV ejection fraction and heart rate when compared with values in conscious mice. Surprisingly, isoflurane was not the best, but actually second to last in maintaining normal LV function and heart rate. The anesthetic with the least effect on LV function and heart rate was ketamine alone at a dose of 150 mg/kg, followed by Avertin at 290 mg/kg, isoflurane at 3% induction and 1 to 2% maintenance, and lastly ketamine-xylazine at 100 and 10 mg/kg, respectively. In summary, these results indicate that ketamine alone exerts the least depressant effects on LV function and heart rate, with Avertin second, suggesting that these anesthetics should be used when it is not feasible to study the animals in the conscious state as opposed to the most commonly used anesthetic, isoflurane. Copyright © 2015 the American Physiological Society.

  11. Relationship between bone turnover and left ventricular function in primary hyperparathyroidism: The EPATH trial.

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    Nicolas Verheyen

    Full Text Available Observational studies suggested a link between bone disease and left ventricular (LV dysfunction that may be pronounced in hyperparathyroid conditions. We therefore aimed to test the hypothesis that circulating markers of bone turnover correlate with LV function in a cohort of patients with primary hyperparathyroidism (pHPT. Cross-sectional data of 155 subjects with pHPT were analyzed who participated in the "Eplerenone in Primary Hyperparathyroidism" (EPATH Trial. Multivariate linear regression analyses with LV ejection fraction (LVEF, systolic function or peak early transmitral filling velocity (e', diastolic function as dependent variables and N-terminal propeptide of procollagen type 1 (P1NP, osteocalcin (OC, bone-specific alkaline phosphatase (BALP, or beta-crosslaps (CTX as the respective independent variable were performed. Analyses were additionally adjusted for plasma parathyroid hormone, plasma calcium, age, sex, HbA1c, body mass index, mean 24-hours systolic blood pressure, smoking status, estimated glomerular filtration rate, antihypertensive treatment, osteoporosis treatment, 25-hydroxy vitamin D and N-terminal pro-brain B-type natriuretic peptide. Independent relationships were observed between P1NP and LVEF (adjusted β-coefficient = 0.201, P = 0.035 and e' (β = 0.188, P = 0.042, respectively. OC (β = 0.192, P = 0.039 and BALP (β = 0.198, P = 0.030 were each independently related with e'. CTX showed no correlations with LVEF or e'. In conclusion, high bone formation markers were independently and paradoxically related with better LV diastolic and, partly, better systolic function, in the setting of pHPT. Potentially cardio-protective properties of stimulated bone formation in the context of hyperparathyroidism should be explored in future studies.

  12. Acute Ascorbic Acid Infusion Increases Left Ventricular Diastolic Function in Postmenopausal Women

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    Ozemek, Cemal; Hildreth, Kerry L.; Groves, Daniel W.; Moreau, Kerrie L.

    2016-01-01

    Objectives We tested the hypothesis that oxidative stress contributes to reductions in left ventricular diastolic function in estrogen-deficient postmenopausal women, related in part to reduced nitric oxide (NO) bioavailability. Study design LV diastolic function – recorded using transthoracic echocardiography and determined as the peak early (E) to late (A) mitral inflow velocity ratio and the E to peak early (e’) mitral annular velocity ratio – and brachial artery flow mediated dilation (FMD), a biomarker of NO bioavailability, were measured during acute systemic infusions of saline (control) and ascorbic acid (experimental model to decrease oxidative stress) in healthy premenopausal women (N=14, 18-40 years) and postmenopausal women (N=23, 45-75 years). Results The E/A ratio was lower (1.16[1.06−1.33] vs 1.65[1.5−2.3]; median[interquartile range]) and the E/e’ ratio was elevated (8.8[7.6−9.9] vs. 6.6[5.5−7.3]) in postmenopausal compared with premenopausal women, indicating reduced LV diastolic function. E/A and E/e’ were correlated with FMD (r=0.54 and r=−0.59, respectively, both PAscorbic acid infusion improved both FMD (5.4±2.0% to 7.8±2.6%) and E/e’ (to 8.1[7.2−9.7], P=0.01) in postmenopausal women but not in premenopausal women. Ascorbic acid did not change E/A in either group. Conclusion The current study provides evidence that oxidative stress contributes to reduced LV diastolic function in estrogen-deficient postmenopausal women, possibly by reducing the availability of NO. PMID:27621254

  13. Effects of preoperative treatment with diltiazem on diastolic ventricular function after coronary artery bypass graft surgery

    NARCIS (Netherlands)

    van der Maaten, JMAA; de Vries, AJ; Henning, RH; Epema, AH; van den Berg, MP; Lip, H

    2001-01-01

    Objective: To examine whether preoperative treatment with diltiazem could ameliorate left ventricular (LV) diastolic dysfunction in patients after coronary artery bypass graft (CABG) surgery. Design: Prospective, nonrandomized clinical study. Setting: University hospital. Participants: Thirty-four

  14. Left ventricular function and exercise performance in idiopathic dilated cardiomyopathy: role of tissue Doppler imaging.

    Science.gov (United States)

    Zambon, Elena; Iorio, Annamaria; Di Nora, Concetta; Carriere, Cosimo; Abate, Elena; Merlo, Marco; Barbati, Giulia; Di Lenarda, Andrea; Pinamonti, Bruno; Agostoni, Piergiuseppe; Sinagra, Gianfranco

    2017-04-01

    To examine the relationship between left ventricular (LV) function evaluated at echocardiography and exercise performance in idiopathic dilated cardiomyopathy (IDCM) patients. We enrolled 76 consecutive IDCM patients in sinus rhythm, undergoing cardiopulmonary exercise testing and echocardiography [49 ± 13 years old; LV ejection fraction 31 ± 7%, LV end-diastolic volume 96 ± 31 ml/m; peak oxygen consumption (peak VO2/kg) 18 ± 5.6 ml/kg/min]. Linear regression analysis revealed that peak systolic velocity (S') (r = 0.46; P < 0.001) and E/E' (r = -0.43; P < 0.001), two tissue Doppler imaging derived parameters, were related to peak VO2/kg, whereas ejection fraction and mitral inflow variables were not. Considering the 69 patients (90%) without diastolic restrictive pattern (a well known index of severe diastolic dysfunction), multivariate regression analysis showed that age, E/E' and S' were the only independent variables related to peak VO2/kg. Similarly, age and E/E' were confirmed as independent parameters for the prediction of ventilation/carbon dioxide production slope in the whole population. In IDCM patients, cardiopulmonary exercise performance variables were strongly related to E/E' and S'.

  15. [Usefulness of left atrial diametres and volumes for the evaluation of left ventricular diastolic function].

    Science.gov (United States)

    Vizzardi, Enrico; Bonadei, Ivano; Teli, Melissa; Caretta, Giorgio; Maiandi, Cristian; Madureri, Alberto; Bordonali, Tania; Chiari, Ermanna; Raddino, Riccardo; Cas, Livio Dei

    2009-06-01

    The diastolic function of the left ventricle is a main point of the physiological adaptations of the cardiovascular system to the various situations. Evaluation of left atrium diameter change during diastole and left atrial volume and their possible correlation with different left ventricular diastolic filling pattern. Ninety patients with echocardiographically determined diastolic dysfunction and eighty healthy volunteers were included in the study. We measured left atrium emptying fraction (LAEF), defined as ratio of end-diastolic left atrial diameter to end-systolic diameter and left atrial volume. Mitral flow pulsed wave velocities were recorded. E, A, E/A, deceleration time of early diastolic filling, isovolumetric relaxation time were measured. Pulmonary vein S, D and atrial reversal velocities and tissue Doppler imaging of E' and A' mitral anular velocities were obtained. LAEF was found 0.6 +/- 0.4 (mean SE) in the control group, 0.81 +/- 0.04 in pseudonormal pattern (P E group (P E pattern group). LAEF and atrial volume are a new and practical methods for the differentiation of the normal-pseudonormal mitral flow pattern, in particular in setting without new ultrasound technologies.

  16. [Optimization of ventricular function during anesthesia induction by administering crystalloids and colloids to heart surgery patients].

    Science.gov (United States)

    Ballesteros, M; Boldt, J; Zickmann, B; Knothe, C; Hempelmann, G

    1995-01-01

    To describe the changes in cardiac function after administration of three different solutions infused after anesthetic induction. Thirty-six patients scheduled for elective aortocoronary bypass surgery were randomly distributed into three groups. Over a period of 25 min after anesthetic induction, 12 received 10 ml/kg of Ringer solution (low dose crystalloid group), 12 received 20 ml/kg of Ringer solution (high dose crystalloid group), and 12 received 10 ml/kg of Ringer solution with 10 ml/kg of hydroxi-ethyl-almidon solution 450,000 D, 0.7 substitution grade (group C-HEA). Minute volume, systemic and pulmonary pressures, osmolality of blood and urine, and plasma and urine sodium concentrations were measured before and after infusion of the assigned liquid. In spite of the volume infused, low dose crystalloid group showed a high incidence of oliguria, increased urinary osmolality and decreased sodium in urine. Cardiac and systolic indices and left ventricular work load remained stable after infusion of the assigned liquid in low and high dose crystalloid groups, whereas they increased significantly ion group C-HEA (+23%, +16% and +20%). Administration of restricted doses of crystalloids after anesthetic induction favors the retention of water and sodium. Higher doses of crystalloids weaken this effect. However, neither of these two regimens leads to a more effective cardiac work load. A combination of crystalloids and colloids administered immediately after anesthetic induction temporarily improves cardiac performance during surgery.

  17. Guiding Hypertension Management Using Central Blood Pressure: Effect of Medication Withdrawal on Left Ventricular Function.

    Science.gov (United States)

    Kosmala, Wojciech; Marwick, Thomas H; Stanton, Tony; Abhayaratna, Walter P; Stowasser, Michael; Sharman, James E

    2016-03-01

    Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance. A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation. Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (∆UC vs. ∆CBP; P = 0.27) and E/e' ratio (∆UC vs. ∆CBP; P = 0.60), and systolic parameters: LV longitudinal strain (∆UC vs. ∆CBP; P = 0.55), circumferential strain (∆UC vs. ∆CBP; P = 0.79), and ejection fraction (∆UC vs. ∆CBP; P = 0.15). Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function. Clinical trials registration: Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Impact of left ventricular volume/mass ratio on diastolic function.

    Science.gov (United States)

    Buakhamsri, Adisai; Popovic, Zoran B; Lin, Jingna; Lim, Pascal; Greenberg, Neil L; Borowski, Allen G; Tang, W H Wilson; Klein, Allan L; Lever, Harry M; Desai, Milind Y; Thomas, James D

    2009-05-01

    To assess the impact of left ventricular (LV) volume/mass ratio on diastolic function parameters in subjects with dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) and healthy controls. We performed echocardiography in 44 healthy controls, 35 HCM subjects, 29 DCM subjects with narrow QRS complex (DCM-n), and 27 DCM subjects with wide QRS complex (DCM-w). Mitral annulus velocity (E(a)) and transmitral E-wave velocity were used to estimate time constant of isovolumic pressure decay (tau). LV flow propagation velocity (V(p)) and early intraventricular pressure gradient (IVPG) were derived from colour M-mode of LV inflow. We calculated LV twist and peak untwisting rate (UntwR) by speckle tracking. Mean LV volume/mass ratio was 0.34 +/- 0.09 mL/g in healthy controls, 0.15 +/- 0.06 mL/g in HCM, 0.6 +/- 0.2 mL/g in DCM-n, and 0.8 +/- 0.3 mL/g in DCM-w patients (P DCM groups). In a multivariate analysis, LV volume/mass ratio remained a strong independent predictor of V(p) (P < 0.001), IVPG (P = 0.009), and UntwR (P < 0.001) but not for E(a) (P = 0.25). LV volume/mass ratio had influences on diastolic function parameters independent of intrinsic diastolic function and filling pressures. It should be considered when assessing patients suspected of LV diastolic dysfunction.

  19. Effects of combined deferiprone with deferoxamine on right ventricular function in thalassaemia major

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    Alpendurada Francisco

    2012-01-01

    Full Text Available Abstract Background Combination therapy with deferoxamine and oral deferiprone is superior to deferoxamine alone in removing cardiac iron and improving left ventricular ejection fraction (LVEF. The right ventricle (RV is also affected by the toxic effects of iron and may cause additional cardiovascular perturbation. We assessed the effects of combination therapy on the RV in thalassaemia major (TM using cardiovascular magnetic resonance (CMR. Methods We retrieved imaging data from 2 treatment trials and re-analyzed the data for the RV responses: Trial 1 was a randomized controlled trial (RCT of 65 TM patients with mild-moderate cardiac siderosis receiving combination therapy or deferoxamine with placebo; Trial 2 was an open label longitudinal trial assessing combination therapy in 15 TM patients with severe iron loading. Results In the RCT, combination therapy with deferoxamine and deferiprone was superior to deferoxamine alone for improving RVEF (3.6 vs 0.7%, p = 0.02. The increase in RVEF was greater with lower baseline T2* 8-12 ms (4.7 vs 0.5%, p = 0.01 than with T2* 12-20 ms (2.2 vs 0.8%, p = 0.47. In patients with severe cardiac siderosis, substantial improvement in RVEF was seen with open-label combination therapy (10.5% ± 5.6%, p Conclusions In the RCT of mild to moderate cardiac iron loading, combination treatment improved RV function significantly more than deferoxamine alone. Combination treatment also improved RV function in severe cardiac siderosis. Therefore adding deferiprone to deferoxamine has beneficial effects on both RV and LV function in TM patients with cardiac siderosis.

  20. IL-18 neutralization during alveolar hypoxia improves left ventricular diastolic function in mice.

    Science.gov (United States)

    Hillestad, V; Espe, E K S; Cero, F; Larsen, K O; Sjaastad, I; Nygård, S; Skjønsberg, O H; Christensen, G

    2015-02-01

    In patients, an association exists between pulmonary diseases and diastolic dysfunction of the left ventricle (LV). We have previously shown that alveolar hypoxia in mice induces LV diastolic dysfunction and that mice exposed to hypoxia have increased levels of circulating interleukin-18 (IL-18), suggesting involvement of IL-18 in development of diastolic dysfunction. IL-18 binding protein (IL-18BP) is a natural inhibitor of IL-18. In this study, we hypothesized that neutralization of IL-18 during alveolar hypoxia would improve LV diastolic function. Mice were exposed to 10% oxygen for 2 weeks while treated with IL-18BP or vehicle. Cardiac function and morphology were measured using echocardiography, intraventricular pressure measurements and magnetic resonance imaging (MRI). For characterization of molecular changes in the heart, both real-time PCR and Western blotting were performed. ELISA technique was used to measure levels of circulating cytokines. As expected, exposure to hypoxia-induced LV diastolic dysfunction, as shown by prolonged time constant of isovolumic relaxation (τ). Improved relaxation with IL-18BP treatment was demonstrated by a significant reduction towards control τ values. Decreased levels of phosphorylated phospholamban (P-PLB) in hypoxia, but normalization by IL-18BP treatment suggest a role for IL-18 in regulation of calcium-handling proteins in hypoxia-induced diastolic dysfunction. In addition, MRI showed less increase in right ventricular (RV) wall thickness in IL-18BP-treated animals exposed to hypoxia, indicating an effect on RV hypertrophy. Neutralization of IL-18 during alveolar hypoxia improves LV diastolic function and partly prevents RV hypertrophy. © 2014 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  1. Evaluation of the left and right ventricular systolic and diastolic function in asthmatic children.

    Science.gov (United States)

    Akyüz Özkan, Esra; Khosroshahi, Hashem E

    2016-07-08

    Asthma is the most common cause of respiratory disorders among children. We aimed to investigate left (LV) and right (RV) ventricular function in asthmatic children as detected by conventional and tissue Doppler echocardiography. Fifty pediatric patients with asthma and forty healthy children were studied. Pulmonary function tests, electrocardiography and echocardiographic examinations were performed on all children. Rate-corrected velocity of circumferential fiber shortening (VCFc) (p = 0.044), the ratio between heights of early and late diastolic flow velocity peaks (E/A) (p = 0.019) and LV end-systolic wall stress (ESWSm) was lower (p = 0.003), RV stroke volume (SV) (p = 0.002), LV SV (p = 0.001), tricuspid annular plane systolic excursion (TAPSE) (p = 0.034), tricuspid annular peak velocity during systole (S') (p = 0.022), tricuspid and mitral early diastolic velocities (E') (p = 0.012, p = 0.003 respectively) were lower in asthmatic children than controls. The mitral valve ejection time (ET) was high in asthmatic group (p = 0.027). FEV1 was positively correlated with isovolumetric relaxation time (IVRT) (p = 0.018) (r = 0.382) and mitral ET (p = 0.018) (r = 0.381). PEF was negatively correlated with the RV work index (p = 0.032) (r = -0.348) and LV work index (p = 0.005) (r = -0.457). Although cardiac systolic function was found to be impaired in asthmatic patients, contrary to the literature, diastolic dysfunction was not observed in these patients, even by tissue Doppler imaging, and this finding may be attributed to using inhaled corticosteroid.

  2. Impact of Major Pulmonary Resections on Right Ventricular Function: Early Postoperative Changes.

    Science.gov (United States)

    Elrakhawy, Hany M; Alassal, Mohamed A; Shaalan, Ayman M; Awad, Ahmed A; Sayed, Sameh; Saffan, Mohammad M

    2018-01-15

    Right ventricular (RV) dysfunction after pulmonary resection in the early postoperative period is documented by reduced RV ejection fraction and increased RV end-diastolic volume index. Supraventricular arrhythmia, particularly atrial fibrillation, is common after pulmonary resection. RV assessment can be done by non-invasive methods and/or invasive approaches such as right cardiac catheterization. Incorporation of a rapid response thermistor to pulmonary artery catheter permits continuous measurements of cardiac output, right ventricular ejection fraction, and right ventricular end-diastolic volume. It can also be used for right atrial and right ventricular pacing, and for measuring right-sided pressures, including pulmonary capillary wedge pressure. This study included 178 patients who underwent major pulmonary resections, 36 who underwent pneumonectomy assigned as group (I) and 142 who underwent lobectomy assigned as group (II). The study was conducted at the cardiothoracic surgery department of Benha University hospital in Egypt; patients enrolled were operated on from February 2012 to February 2016. A rapid response thermistor pulmonary artery catheter was inserted via the right internal jugular vein. Preoperatively the following was recorded: central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, right ventricular ejection fraction and volumes. The same parameters were collected in fixed time intervals after 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours postoperatively. For group (I): There were no statistically significant changes between the preoperative and postoperative records in the central venous pressure and mean arterial pressure; there were no statistically significant changes in the preoperative and 12, 24, and 48 hour postoperative records for cardiac index; 3 and 6 hours postoperative showed significant changes. There were statistically significant changes between the preoperative and

  3. 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

  4. [Influence of leukocytes on coronary flow reserve, left ventricular systolic function, and in-hospital events, in patients with acute anterior myocardial infarction treated by primary angioplasty].

    Science.gov (United States)

    Meimoun, P; Elmkies, F; Boulanger, J; Zemir, H; Benali, T; Espanel, C; Clerc, J; Doutrelan, L; Beausoleil, M; Luycx-Bore, A

    2010-11-01

    To assess the relationship between leukocyte count, non invasive coronary flow reserve (CFR), left ventricular systolic function, and in-hospital adverse events in acute anterior myocardial infarction (AMI) treated by primary angioplasty. Leukocyte count at admission and within 24h after angioplasty, and differential count at admission were obtained in 72 consecutive patients with a first AMI (mean age 56±12 years) successfully treated by primary angioplasty. Transthoracic Doppler echocardiography was performed within 24h after angioplasty and 3 months later to assess the CFR (using intravenous adenosine), in the left anterior descending artery (LAD), left ventricular ejection fraction (LVEF) and the wall motion score index using the nine segments assigned to the LAD territory (WMSi-lad). In hospital events were defined as death, heart failure (Killip≥2) and reinfarction. Leukocyte count was higher before and after angioplasty in patients with impaired acute CFR (leukocyte, neutrophil and monocyte count (PLeukocyte (before and after angioplasty), and neutrophil count, were lower in patients with recovery of global and regional LV function (Pleukocyte count before and after angioplasty, and, initial and follow-up LVEF, and WMSi-lad (all, P≤0.01). Leukocyte (before and after angioplasty) and monocyte count were higher in patients with in-hospital events (n=14), by comparison to patients without events (all, Pleukocyte count after angioplasty was an independent predictor of CFR, and in-hospital events, and neutrophil count of WMSi-lad at follow-up (all, Pleukocyte count is inversely correlated to CFR, and global and regional LV systolic function at follow-up. These links are higher after than before reperfusion. And, leukocyte count after angioplasty is an independent predictor of in-hospital adverse events. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  5. 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

    OBJECTIVES: Abnormal glucose tolerance in patients with acute myocardial infarction (AMI) is associated with greater mortality and adverse cardiovascular effects. As statins possess a range of beneficial pleiotropic effects on the cardiovascular system, we sought to assess the cardioprotective...... 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...... effects of statins on left ventricular function in patients with AMI in relation to glycometabolic state. METHODS: In a prospective, randomized trial, 140 patients with AMI were randomized to intensive statin therapy receiving statin loading with 80 mg of rosuvastatin followed by 40 mg daily or standard...

  6. Improved Left Ventricular Diastolic Function with Exercise Training in Hypertension: A Doppler Imaging Study

    Directory of Open Access Journals (Sweden)

    Huan Zheng

    2011-01-01

    Full Text Available Objective. To study the effects of 6 months’ exercise training on ventricular function in hypertensive patients. Methods. Both groups received routine anti-hypertensive pharmacological therapy and one received a 6 months’ exercise program in addition. All patients underwent incremental cardiopulmonary exercise test and echocardiography in baseline and after 6 months. Results. (1 In 6 months’ follow-up, PeakVO2, Powermax (max workload, AT (anaerobic threshold, VO2AT (VO2 at anaerobic threshold, tAT (time from beginning to anaerobic threshold (<.05, were increased in the exercise group. HRrest (Heart rate at rest was decreased (<.05. LAVI (left atrial volume index, peak mitral filling velocities during early (E and late (A diastole E/A ratio, DT(deceleration time of the mitral E wave, IVST(Interventricular septum thickness in diastole, tissue Doppler indice Mean Ea/Aa ratio (<.05 were also improved. (2 Correlation analysis: 4 variates had significant effect on change of PeakVO2 in the exercise group: age (=−0.39, change of HRrest (=0.59, change of E/A (=0.55, change of Mean Ea/Aa (=0.58; Through analyzing 2 groups patients’ baseline values, their age (=−0.32, VO2AT (=0.29, HRrest (=−0.25, LAVI (=−0.24, E/A (=0.41 were found to be independent predictors of MeanEa/Aa. -value under .05 was considered statistically significant. Conclusion. 6 months’ exercise could enhance hypertensive patients’ aerobic exercise level and diastolic function to a certain extent.

  7. 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

    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). 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. A 12-week diet significantly reduced body mass index from 40.3 ± 6.6 kg/m(2) to 33.2 ± 6.1 kg/m(2) (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. 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.

  8. p38 MAPK Inhibition Improves Heart Function in Pressure-Loaded Right Ventricular Hypertrophy.

    Science.gov (United States)

    Kojonazarov, Baktybek; Novoyatleva, Tatyana; Boehm, Mario; Happe, Chris; Sibinska, Zaneta; Tian, Xia; Sajjad, Amna; Luitel, Himal; Kriechling, Philipp; Posern, Guido; Evans, Steven M; Grimminger, Friedrich; Ghofrani, Hossein A; Weissmann, Norbert; Bogaard, Harm J; Seeger, Werner; Schermuly, Ralph T

    2017-11-01

    Although p38 mitogen-activated protein kinase (MAPK) is known to have a role in ischemic heart disease and many other diseases, its contribution to the pathobiology of right ventricular (RV) hypertrophy and failure is unclear. Therefore, we sought to investigate the role of p38 MAPK in the pathophysiology of pressure overload-induced RV hypertrophy and failure. The effects of the p38 MAPK inhibitor PH797804 were investigated in mice with RV hypertrophy/failure caused by exposure to hypoxia or pulmonary artery banding. In addition, the effects of p38 MAPK inhibition or depletion (by small interfering RNA) were studied in isolated mouse RV fibroblasts. Echocardiography, invasive hemodynamic measurements, immunohistochemistry, collagen assays, immunofluorescence staining, and Western blotting were performed. Expression of phosphorylated p38 MAPK was markedly increased in mouse and human hypertrophied/failed RVs. In mice, PH797804 improved RV function and inhibited cardiac fibrosis compared with placebo. In isolated RV fibroblasts, p38 MAPK inhibition reduced transforming growth factor (TGF)-β-induced collagen production as well as stress fiber formation. Moreover, p38 MAPK inhibition/depletion suppressed TGF-β-induced SMAD2/3 phosphorylation and myocardin-related transcription factor A (MRTF-A) nuclear translocation, and prevented TGF-β-induced cardiac fibroblast transdifferentiation. Moreover, p38 MAPK inhibition in mice exposed to pulmonary artery banding led to diminished nuclear levels of MRTF-A and phosphorylated SMAD3 in RV fibroblasts. Together, our data indicate that p38 MAPK inhibition significantly improves RV function and inhibits RV fibrosis. Inhibition of p38 MAPK in RV cardiac fibroblasts, resulting in coordinated attenuation of MRTF-A cytoplasmic-nuclear translocation and SMAD3 deactivation, indicates that p38 MAPK signaling contributes to distinct disease-causing mechanisms.

  9. Myocardium-derived conditioned medium improves left ventricular function in rodent acute myocardial infarction

    Science.gov (United States)

    2011-01-01

    Background We investigated whether myocardium-derived conditioned medium (MDCM) is effective in preserving left ventricular (LV) function in a rat acute myocardial infarction (AMI) model. Methods Adult male Sprague-Dawley (SD) rats (n = 36) randomized to receive either left coronary artery ligation (AMI induction) or thoracotomy only (sham procedure) were grouped as follows (n = 6 per group): Group I, II, and III were sham-controls treated by fresh medium, normal rat MDCM, and infarct-related MDCM, respectively. Group IV, V, and VI were AMI rats treated by fresh medium, normal MDCM, and infarct-related MDCM, respectively. Either 75 μL MDCM or fresh medium was administered into infarct myocardium, followed by intravenous injection (3 mL) at postoperative 1, 12, and 24 h. Results In vitro studies showed higher phosphorylated MMP-2 and MMP-9, but lower α-smooth muscle actin and collagen expressions in neonatal cardiac fibroblasts treated with MDCM compared with those in the cardiac fibroblasts treated with fresh medium (all p < 0.05). Sirius-red staining showed larger collagen deposition area in LV myocardium in Group IV than in other groups (all p < 0.05). Stromal cell-derived factor-1α and CXCR4 protein expressions were higher in Group VI than in other groups (all p < 0.05). The number of von Willebrand factor- and BrdU-positive cells and small vessels in LV myocardium as well as 90-day LV ejection fraction were higher, whereas oxidative stress was lower in Group VI than in Group IV and Group V (all p < 0.05). Conclusion MDCM therapy reduced cardiac fibrosis and oxidative stress, enhanced angiogenesis, and preserved 90-day LV function in a rat AMI model. PMID:21244680

  10. Spontaneous anatomical and functional recovery of bilateral electric shock maculopathy

    Science.gov (United States)

    Ranjan, Ratnesh; Manayath, George Joseph; Dsouza, Palmeera; Narendran, Venkatapathy

    2017-01-01

    A 12-year-old boy presented with best-corrected visual acuity (BCVA) of 6/9 in both eyes following an episode of electric shock. Optical coherence tomography (OCT) showed disruption of the ellipsoid zone as well as retinal pigment epithelium (RPE) layer. Fundus autofluorescence (FAF) showed increased central hypoautofluorescence in both eyes. At 3-month follow-up, BCVA improved to 6/6 with OCT showing spontaneous resolution of maculopathy in both eyes with reorganized RPE layer and ellipsoid zone. To the best of our knowledge, this is the first case of bilateral electric shock maculopathy (ESM) with spontaneous anatomical as well as functional recovery. Ophthalmologists must be aware of various forms of ESM. OCT and FAF must be done in patients presenting with defective vision and history of electric shock for the diagnostic as well as prognostic evaluation. PMID:29133672

  11. Chlorpheniramine impairs functional recovery in Carassius auratus after telencephalic ablation

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    D.C. Garção

    2009-04-01

    Full Text Available We determined the effect of an H1 receptor antagonist on the functional recovery of Carassius auratus submitted to telencephalic ablation. Five days after surgery the fish underwent a spatial-choice learning paradigm test. The fish, weighing 6-12 g, were divided into four groups: telencephalic ablation (A or sham lesion (S and saline (SAL or chlorpheniramine (CPA, ip, 16 mg/kg. For eight consecutive days each animal was trained individually in sessions separated by 24 h (alternate days. Training trials (T1-T8 consisted of finding the food in one of the feeders, which were randomly blocked for each subject. Animals received an intraperitoneal injection of SAL or CPA 10 min after the training trials. The time spent by the animals in each group to find the food (latency was analyzed separately at T1 and T8 by the Kruskal-Wallis test, followed by the Student Newman-Keuls test. At T1 the latencies (mean ± SEM of the A-SAL (586.3 ± 13.6 and A-CPA (600 ± 0 groups were significantly longer than those of the S-SAL (226.14 ± 61.15 and S-CPA (356.33 ± 68.8 groups. At T8, the latencies of the A-CPA group (510.11 ± 62.2 remained higher than those of the other groups, all of which showed significantly shorter latencies (A-SAL = 301.91 ± 78.32; S-CPA = 191.58 ± 73.03; S-SAL = 90.28 ± 41 compared with T1. These results support evidence that training can lead to functional recovery of spatial-choice learning in telencephalonless fish and also that the antagonist of the H1 receptor impairs it.

  12. Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Gimpel, Charlotte; Pohl, Martin [Medical Center - University of Freiburg, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Freiburg (Germany); Jung, Bernd A. [Inselspital Bern, Institute of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Jung, Sabine [Medical Center - University of Freiburg, Department of Nuclear Medicine, Freiburg (Germany); Brado, Johannes; Odening, Katja E. [University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg (Germany); Schwendinger, Daniel [University Children' s Hospital Zurich, Zurich (Switzerland); Burkhardt, Barbara [University Children' s Hospital Zurich, Pediatric Heart Center, Zurich (Switzerland); Geiger, Julia [University Children' s Hospital Zurich, Department of Radiology, Zurich (Switzerland); Northwestern University, Department of Radiology, Chicago, IL (United States); Arnold, Raoul [University Hospital Heidelberg, Department of Pediatric and Congenital Cardiology, Heidelberg (Germany)

    2017-02-15

    Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. Patients and controls (age: 8 years - 20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (V{sub E}), late diastolic (V{sub A}) and peak systolic (V{sub S}) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vz{sub base} -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vz{sub mid} -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vz{sub apex} -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vr{sub base} -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vr{sub mid} -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vr{sub apex} -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05). Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs. (orig.)

  13. Ramp Study Hemodynamics, Functional Capacity, and Outcome in Heart Failure Patients with Continuous-Flow Left Ventricular Assist Devices

    DEFF Research Database (Denmark)

    Jung, Mette H; Gustafsson, Finn; Houston, Brian

    2016-01-01

    Ramp studies-measuring changes in cardiac parameters as a function of serial pump speed changes (revolutions per minute [rpm])-are increasingly used to evaluate function and malfunction of continuous-flow left ventricular assist devices (CF-LVADs). We hypothesized that ramp studies can predict...... patients (HeartMate II, Thoratec Corporation, Pleasanton, CA). Functional status was evaluated in 70% (31/44); average 6 minute walk test (6MWT) was 312 ± 220 min, New York Heart Association (NYHA) I-II/III-IV (70/30%) and activity scores very low-low/moderate-very high (55/45%). Decrease in pulmonary...

  14. P697New indices for a best quantification of left ventricular function in heart valve diseases.

    Science.gov (United States)

    Hubert, A; Galli, E; Bouzille, G; Samset, E; Donal, E

    2016-12-01

    Aims. The Assessment of left ventricular (LV) function remains a clinical challenge especially in patients with preserved LV ejection fraction (EF) and valvular heart diseases (VHD). Mechanical dispersion is supposed to be a strong predictor of events and, to be related to the extent of fibrosis. Regional cardiac work is a new validated and very promising approach to quantify LV-function. We investigated the differences in mechanical dispersions and global LV work (totW) and wasted work fraction (WWF) in normal subjects and in patients with severe primary mitral regurgitation (MR) and severe aortic stenosis (AS). A complete transthoracic echocardiography was performed in 21 normal subject, 97 patients with severe valvulopathy (47 AS, 50 MR) and preserved LV EF. Segmental strain analysis was performed in all patients and the dispersion of regional LV strain curves was computed automatically considering peaks and integrals. The LV-pressure was estimated non-invasively using a standard waveform fitted to valvular events and scaled to systolic blood pressure. Using pressure-strain loops, regional cardiac work indices were computed. LVEF was 66±12 in controls, 65±9 in MR and 65±4% in AS (p=0.125). Global longitudinal strain was -23±2.7 in controls, -24±2.9 in MR and -18±3.2% in AS (p < 0.001). The mechanical dispersion was 38±7.9 in controls, 36±11 in MR, and much higher in the hypertrophied LV of the AS: 60±19ms (p < 0.001). Cardiac work was 2200±260 in controls, 2100±270 in MR, and much lower in AS: 1700±280 mmHg.% (p < 0.001). The wasted work fraction (WWF) was even more describing how different the LV systolic function is in the 3 groups (figure1). Longitudinal strain data are robusted and new indices might be calculated based on them. These seem especially promising for a more pathophysiological driven analyzing of LV-functions. Abstract P697 Figure. Abstract P697 Figure.

  15. Emergency coronary bypass grafting for evolving myocardial infarction. Effects on infarct size and left ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Flameng, W.; Sergeant, P.; Vanhaecke, J.; Suy, R.

    1987-07-01

    Emergency aorta-coronary bypass grafting was performed early in the course of evolving myocardial infarction in 48 patients. The time interval between the onset of symptoms and reperfusion was 169 +/- 80 minutes. Quantitative assessment of postoperative thallium 201 myocardial scans in 19 patients revealed a significant salvage of myocardium after surgical reperfusion: The size of the residual infarction was less than 50% of that in a matched, medically treated, prospective control group (n = 39) (p less than 0.05). Postoperative equilibrium-gated radionuclide blood pool studies (technetium 99m) showed an enhanced recovery of regional and global ejection fraction after operation as compared to after medical treatment (p less than 0.05). Ultrastructural evaluation of biopsy specimens obtained during the operation delineated subendocardial necrosis in the majority of cases (72%), but subepicardial necrosis was found in only 6% of instances. Q-wave abnormalities were observed on the postoperative electrocardiogram in 50% of cases. Operative mortality was 0% in low-risk patients (i.e., hemodynamically stable condition, n = 26) and 18% in high-risk patients (i.e., cardiogenic shock including total electromechanical dysfunction, n = 22). Survival rate at 18 months was 92% +/- 4%, and 95% +/- 4% of the survivors were event free. It is concluded that early surgical reperfusion of evolving myocardial infarction limits infarct size significantly, enhances functional recovery, and may be a lifesaving operation in patients having cardiogenic shock associated with unsuccessful resuscitation.

  16. The influence of low-intensity resistance training versus high-intensity resistance training on left ventricular structure and function of healthy adolescent boys using Echocardiography

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    asghar Kianzadeh

    2013-05-01

    Conclusion: Low-intensity resistance training than high-intensity resistance training in healthy adolescent boys caused some changes in left ventricular structure and function, probably these changes were associated with increased volume and pressure load.

  17. Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients : the ELVERA trial

    NARCIS (Netherlands)

    Terpstra, WF; May, JF; Smit, AJ; De Graeff, PA; Havinga, TK; van den Veur, E; Schuurman, FH; Meyboom-de Jong, B; Crijns, HJGM

    Objective To compare the effects of a calcium antagonist (amlodipine) and an angiotensin converting enzyme inhibitor (lisinopril) on left Ventricular mass and diastolic function in elderly, previously untreated hypertensives. Design A double-blind randomized parallel group trial. Effects of

  18. Endothelial nitric oxide synthase single nucleotide polymorphism and left ventricular function in early chronic kidney disease.

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    Sourabh Chand

    Full Text Available Chronic kidney disease (CKD is associated with accelerated cardiovascular disease and heart failure. Endothelial nitric oxide synthase (eNOS Glu298Asp single nucleotide polymorphism (SNP genotype has been associated with a worse phenotype amongst patients with established heart failure and in patients with progression of their renal disease. The association of a cardiac functional difference in non-dialysis CKD patients with no known previous heart failure, and eNOS gene variant is investigated.140 non-dialysis CKD patients, who had cardiac magnetic resonance (CMR imaging and tissue doppler echocardiography as part of two clinical trials, were genotyped for eNOS Glu298Asp SNP retrospectively.The median estimated glomerular filtration rate (eGFR was 50 mls/min and left ventricular ejection fraction (LVEF was 74% with no overt diastolic dysfunction in this cohort. There were significant differences in LVEF across eNOS genotypes with GG genotype being associated with a worse LVEF compared to other genotypes (LVEF: GG 71%, TG 76%, TT 73%, p = 0.006. After multivariate analysis, (adjusting for age, eGFR, baseline mean arterial pressure, contemporary CMR heart rate, total cholesterol, high sensitive C-reactive protein, body mass index and gender GG genotype was associated with a worse LVEF, and increased LV end-diastolic and systolic index (p = 0.004, 0.049 and 0.009 respectively.eNOS Glu298Asp rs1799983 polymorphism in CKD patients is associated with relevant sub-clinical cardiac remodelling as detected by CMR. This gene variant may therefore represent an important genetic biomarker, and possibly highlight pathways for intervention, in these patients who are at particular risk of worsening cardiac disease as their renal dysfunction progresses.

  19. Effects of commonly used inotropes on myocardial function and oxygen consumption under constant ventricular loading conditions.

    Science.gov (United States)

    DeWitt, Elizabeth S; Black, Katherine J; Thiagarajan, Ravi R; DiNardo, James A; Colan, Steven D; McGowan, Francis X; Kheir, John N

    2016-07-01

    Inotropic medications are routinely used to increase cardiac output and arterial blood pressure during critical illness. However, few comparative data exist between these medications, particularly independent of their effects on venous capacitance and systemic vascular resistance. We hypothesized that an isolated working heart model that maintained constant left atrial pressure and aortic blood pressure could identify load-independent differences between inotropic medications. In an isolated heart preparation, the aorta and left atrium of Sprague Dawley rats were cannulated and placed in working mode with fixed left atrial and aortic pressure. Hearts were then exposed to common doses of a catecholamine (dopamine, epinephrine, norepinephrine, or dobutamine), milrinone, or triiodothyronine (n = 10 per dose per combination). Cardiac output, contractility (dP/dtmax), diastolic performance (dP/dtmin and tau), stroke work, heart rate, and myocardial oxygen consumption were compared during each 10-min infusion to an immediately preceding baseline. Of the catecholamines, dobutamine increased cardiac output, contractility, and diastolic performance more than clinically equivalent doses of norepinephrine (second most potent), dopamine, or epinephrine (P function, either alone or added to a baseline catecholamine infusion. Myocardial oxygen consumption was closely related to dP/dtmax (r(2) = 0.72), dP/dtmin (r(2) = 0.70), and stroke work (r(2) = 0.53). In uninjured, isolated working rodent hearts under constant ventricular loading conditions, dobutamine increased contractility and cardiac output more than clinically equivalent doses of norepinephrine, dopamine, and epinephrine; milrinone and triiodothyronine did not have significant effects on contractility. Copyright © 2016 the American Physiological Society.

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

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    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

  1. Prior exercise improves survival, infarct healing, and left ventricular function after myocardial infarction.

    Science.gov (United States)

    de Waard, Monique C; Duncker, Dirk J

    2009-09-01

    We investigated the effects of voluntary wheel running before an acute myocardial infarction (MI) on survival, left ventricular (LV) remodeling and dysfunction and whether exercise before and after MI provides superior protection compared with either exercise intervention alone. After 2 wk of voluntary wheel running or sedentary housing, MI was induced in C57Bl/6 mice, after which exercise was stopped (EX-MI-SED and SED-MI-SED groups, where EX is exercise and SED is sedentary) or continued (EX-MI-EX and SED-MI-EX groups) for a period of 8 wk. Exercise after MI in SED-MI-EX mice had no effect on survival, the area of infarction, and global LV remodeling, but attenuated fibrosis and apoptosis in the remote myocardium and blunted LV dysfunction and pulmonary congestion compared with SED-MI-SED mice. Exercise before MI in both EX-MI-SED and EX-MI-EX mice decreased post-MI mortality compared with both SED-MI-SED and SED-MI-EX mice. Furthermore, in both pre-MI exercise groups, the infarct area was thicker, whereas interstitial fibrosis and apoptosis in the remote LV myocardium were blunted. In contrast, the ameliorating effects of either pre-MI or post-MI exercise alone on LV dysfunction were lost in EX-MI-EX mice, which may in part be related to the increased daily exercise distance in the first week post-MI in EX-MI-EX versus SED-MI-EX mice. In conclusion, exercise before or after MI blunted LV dysfunction, whereas only exercise before MI improved survival. These findings suggest that even when regular physical activity fails to prevent an acute MI, it can still act to improve cardiac function and survival after MI.

  2. A HAND2 Loss-of-Function Mutation Causes Familial Ventricular Septal Defect and Pulmonary Stenosis

    Directory of Open Access Journals (Sweden)

    Yu-Min Sun

    2016-04-01

    Full Text Available Congenital heart disease (CHD is the most common developmental abnormality, and is the leading noninfectious cause of mortality in neonates. Increasing evidence demonstrates that genetic defects play an important role in the pathogenesis of CHD. However, CHD exhibits substantial heterogeneity, and the genetic determinants for CHD remain unknown in the overwhelming majority of cases. In the current study, the coding exons and flanking introns of the HAND2 gene, which encodes a basic helix-loop-helix transcription factor essential for normal cardiovascular development, were sequenced in 192 unrelated patients with CHD, and a novel heterozygous mutation, p.S65I, was identified in a patient with congenital ventricular septal defect (VSD. Genetic analysis of the index patient’s pedigree revealed that the mutation was present in all seven affected family members available, but absent in the 13 unaffected family members examined. Besides, in addition to VSD, five of the proband’s close relatives also had pulmonary stenosis (PS, and the proband’s son also had double outlet right ventricle (DORV. The missense mutation, which altered an evolutionarily conserved amino acid, was absent in 300 unrelated, ethnically matched healthy individuals. Biological analyses using a dual-luciferase reporter assay system showed that the mutant HAND2 was associated with significantly diminished transcriptional activity. Furthermore, the mutation abolished the synergistic activation between HAND2 and GATA4, as well as NKX2.5—two other cardiac core transcriptional factors that have been causally linked to CHD. These findings indicate that HAND2 loss-of-function mutation contributes to human CHD, perhaps via its interaction with GATA4 and NKX2.5.

  3. Comparison of ventricular function in atrial rate adaptive versus dual chamber rate adaptive pacing during exercise.

    Science.gov (United States)

    Gallik, D M; Guidry, G W; Mahmarian, J J; Verani, M S; Spencer, W H

    1994-02-01

    The hemodynamic effects of two different pacing modes--rate adaptive atrial (AAIR) versus dual chamber (DDDR) pacing--were assessed in 12 patients with DDDR pacemakers during upright bicycle exercise first-pass radionuclide angiography using a multiwire gamma camera with tantalum-178 as a tracer. All patients had sinus node disease with intact AV conduction. Patients exercised to the same heart rate in random order in these two different pacing modes, AAIR and DDDR with AV delay (of 100 msec) selected to maintain 100% ventricular capture. Cardiac output increased significantly above baseline values during exercise in both pacing modes: 154 +/- 41% (mean +/- SEM, P = 0.002) with AAIR, versus 95 +/- 24% (P = 0.004) with DDDR (P = NS between the two modes). The peak filling rate, likewise, increased in both pacing modes (2.3 +/- 0.21 end-diastolic volumes/sec to 3.8 +/- 0.31 end-diastolic volumes/sec in AAIR [P = 0.0004] and 2.2 +/- 0.18 end-diastolic volumes/sec to 3.4 +/- 0.27 end-diastolic volumes/sec in DDDR [P = 0.0008]). LV ejection fraction was normal at rest (60 +/- 4%, SEM) and did not significantly change with submaximal exercise in either pacing mode (both 56%, P = NS). No significant changes in end-diastolic volume or stroke volume indexes occurred with exercise in either pacing mode. Our study demonstrates that in patients with normal resting LV function, AAIR and DDDR pacing are equally effective in attaining appropriate increases in cardiac output and LV filling during exercise.

  4. A comparison of ventricular function during high right ventricular septal and apical pacing after his-bundle ablation for refractory atrial fibrillation.

    Science.gov (United States)

    Mera, F; DeLurgio, D B; Patterson, R E; Merlino, J D; Wade, M E; León, A R

    1999-08-01

    This study compares LV performance during high right ventricular septal (RVS) and apical (RVA) pacing in patients with LV dysfunction who underwent His-bundle ablation for chronic AF. We inserted a passive fixation pacing electrode into the RVA and an active fixation electrode in the RVS. A dual chamber, rate responsive pulse generator stimulated the RVA through the ventricular port and the RVS via the atrial port. Patients were randomized to initial RVA (VVIR) or RVS (AAIR) pacing for 2 months. The pacing site was reversed during the next 2 months. At the 2 and 4 month follow-up visit, each patient underwent a transthoracic echocardiographical study and a rest/exercise first pass radionuclide ventriculogram. We studied nine men and three women (mean age of 68 +/- 7 years) with congestive heart failure functional Class (NYHA Classification): I (3 patients), II (7 patients), and III (2 patients). The QRS duration was shorter during RVS stimulation (158 +/- 10 vs 170 +/- 11 ms, P < 0.001). Chronic capture threshold and lead impedance did not significantly differ. LV fractional shortening improved during RVS pacing (0.31 +/- 0.05 vs 0.26 +/- 0.07, P < 0.01). RVS activation increased the resting first pass LV ejection fraction (0.51 +/- 0.14 vs 0.43 +/- 0.10, P < 0.01). No significant difference was observed during RVS and RVA pacing in the exercise time (5.6 +/- 3.2 vs 5.4 +/- 3.1, P = 0.6) or the exercise first pass LV ejection fraction (0.58 +/- 0.15 vs 0.55 +/- 0.16, P = 0.2). The relative changes in QRS duration and LV ejection fraction at both pacing sites showed a significant correlation (P < 0.01). We conclude that RVS pacing produces shorter QRS duration and better chronic LV function than RVA pacing in patients with mild to moderate LV dysfunction and chronic AF after His-bundle ablation.

  5. Biocompatibility of calcined mesoporous silica particles with ventricular myocyte structure and function.

    Science.gov (United States)

    Aburawi, Elhadi H; Qureshi, Mohammed Anwar; Oz, Deniz; Jayaprakash, Petrilla; Tariq, Saeed; Hameed, Rashed S; Das, Sayantani; Goswami, Anandarup; Biradar, Ankush V; Asefa, Tewodros; Souid, Abdul-Kader; Adeghate, Ernest; Howarth, Frank Christopher

    2013-01-18

    In vivo and in vitro systems were employed to investigate the biocompatibility of two forms of calcined mesoporous silica microparticles, MCM41-cal and SBA15-cal, with ventricular myocytes. These particles have potential clinical use in delivering bioactive compounds to the heart. Ventricular myocytes were isolated from 6 to 8 week male Wistar rats. The distribution of the particles in ventricular myocytes was investigated by transmission electron microscopy and scanning electron microscopy. The distribution of particles was also examined in cardiac muscle 10 min after intravenous injection of 2.0 mg/mL MCM41-cal. Myocyte shortening and the Ca(2+) transient were determined following exposure to 200 μg/mL MCM41-cal or SBA15-cal for 10 min. Within 10 min of incubation at 25 °C, both MCM41-cal and SBA15-cal were found attached to the plasma membrane, and some particles were observed inside ventricular myocytes. MCM41-cal was more abundant inside the myocytes than SBA15-cal. The particles had a notable affinity to mitochondrial membranes, where they eventually settled. Within 10 min of intravenous injection (2.0 mg/mL), MCM41-cal traversed the perivascular space, and some particles entered ventricular myocytes and localized around the mitochondrial membranes. The amplitude of shortening was slightly reduced in myocytes superperfused with MCM41-cal or SBA15-cal. The amplitude of the Ca(2+) transient was significantly reduced in myocytes superperfused with MCM41-cal but was only slightly reduced with SBA15-cal. Overall, the results show reasonable bioavailability and biocompatibility of MCM41-cal and SBA15-cal with ventricular myocytes.

  6. Automated Assessment of Left Ventricular Function and Mass Using Heart Deformation Analysis: Initial Experience in 160 Older Adults.

    Science.gov (United States)

    Lin, Kai; Collins, Jeremy D; Lloyd-Jones, Donald M; Jolly, Marie-Pierre; Li, Debiao; Markl, Michael; Carr, James C

    2016-03-01

    To assess the performance of automated quantification of left ventricular function and mass based on heart deformation analysis (HDA) in asymptomatic older adults. This study complied with Health Insurance Portability and Accountability Act regulations. Following the approval of the institutional review board, 160 asymptomatic older participants were recruited for cardiac magnetic resonance imaging including two-dimensional cine images covering the entire left ventricle in short-axis view. Data analysis included the calculation of left ventricular ejection fraction (LVEF), left ventricular mass (LVM), and cardiac output (CO) using HDA and standard global cardiac function analysis (delineation of end-systolic and end-diastolic left ventricle epi- and endocardial borders). The agreement between methods was evaluated using intraclass correlation coefficient (ICC) and coefficient of variation (CoV). HDA had a shorter processing time than the standard method (1.5 ± 0.3 min/case vs. 5.8 ± 1.4 min/case, P cine images. Copyright © 2015 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  7. An Echocardiography Training Program for Improving the Left Ventricular Function Interpretation in Emergency Department; a Brief Report

    Directory of Open Access Journals (Sweden)

    Mary S. Jacob

    2017-06-01

    Full Text Available Introduction: Focused training in transthoracic echocardiography enables emergency physicians (EPs to accurately estimate the left ventricular function. This study aimed to evaluate the efficacy of a brief training program utilizing standardized echocardiography video clips in this regard. Methods: A before and after design was used to determine the efficacy of a 1 hour echocardiography training program using PowerPoint presentation and standardized echocardiography video clips illustrating normal and abnormal left ventricular ejection fraction (LVEF as well as video clips emphasizing the measurement of mitral valve E-point septal separation (EPSS. Pre- and post-test evaluation used unique video clips and asked trainees to estimate LVEF and EPSS based on the viewed video clips. Results: 21 EPs with no prior experience with the echocardiographic technical methods completed this study. The EPs had very limited prior echocardiographic training. The mean score on the categorization of LVEF estimation improved from 4.9 (95% CI: 4.1-5.6 to 7.6 (95%CI: 7-8.3 out of a possible 10 score (p<0.0001. Categorization of EPSS improved from 4.1 (95% CI: 3.1-5.1 to 8.1 (95% CI: 7.6- 8.7 after education (p<0.0001. Conclusions: The results of this study demonstrate a statistically significant improvement of EPs’ ability to categorize left ventricular function as normal or depressed, after a short lecture utilizing a commercially available DVD of standardized echocardiography clips.

  8. Long-term prognostic importance of diabetes after a myocardial infarction depends on left ventricular systolic function

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Mérie, Charlotte

    2011-01-01

    . Multivariable Cox regression models were used to assess the risk of mortality associated with diabetes, and the importance of diabetes was examined independently within defined left ventricular ejection fraction (LVEF) subgroups. RESULTS A total of 16,912 patients were included; 1,819 (11%) had diabetes......This study was performed to understand how left ventricular function modulates the prognostic importance of diabetes after myocardial infarction (MI). RESEARCH DESIGN AND METHODS Consecutively hospitalized MI patients screened for three clinical trials were followed for a median of 7 years....... Diabetes and 15% unit depression in LVEF were of similar prognostic importance: hazard ratios (HRs) were 1.45 (95% CI 1.37–1.54) and 1.41 (1.37–1.45) for diabetes and LVEF depression, respectively. LVEF modified the outcomes associated with diabetes, with HRs being 1.29 (1.19–1.40) and 1.61 (1...

  9. Qt dispersion has no prognostic information for patients with advanced congestive heart failure and reduced left ventricular systolic function

    DEFF Research Database (Denmark)

    Brendorp, B; Elming, H; Jun, L

    2001-01-01

    .55), or cardiac arrhythmic mortality (risk ratio 1.00, 95% CI 0.99 to 1.01; P=0.38). CONCLUSIONS: QT dispersion has no prognostic value regarding all-cause mortality, cardiac mortality, or cardiac arrhythmic mortality for patients with advanced CHF and reduced left ventricular systolic function.......BACKGROUND: QT dispersion is a potential prognostic marker of tachyarrhythmic events and death, but it is unclear whether this applies to patients with congestive heart failure (CHF). METHODS AND RESULTS: Of the 1518 patients with advanced CHF and left ventricular dysfunction enrolled in the Danish....../155 ms [5%/95% percentiles]), with no difference between survivors and nonsurvivors. Survival analysis revealed no prognostic information derived from QT dispersion regarding all-cause mortality (risk ratio 1.00, 95% CI 1.00 to 1.00; P=0.74), cardiac mortality (risk ratio 1.00, 95% CI 1.00 to 1.01; P=0...

  10. Independent effects of both right and left ventricular function on plasma brain natriuretic peptide

    DEFF Research Database (Denmark)

    Vogelsang, Thomas Wiis; Jensen, Ruben J; Monrad, Astrid L

    2007-01-01

    regression analysis LVEF, LVEDVI and RVEF all correlated significantly with log BNP (panalysis only RVEF and LVEF remained significant. The parameter estimates of the final adjusted model indicated that RVEF and LVEF influence on log BNP were of the same magnitude. CONCLUSION: BNP...... ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVEDVI) were determined in 105 consecutive patients by first-pass radionuclide ventriculography (FP-RNV) and multiple ECG-gated equilibrium radionuclide ventriculography (ERNV), respectively. BNP was analyzed by immunoassay....... RESULTS: Mean LVEF was 0.51 (range 0.10-0.83) with 36% having a reduced LVEF (linear...

  11. Assessment of Myocardial Function During Mechanical Left Ventricular Support Using Serial Echocardiography: A Case Report

    OpenAIRE

    Ishino, Kozo; Murakami, Taiji; Takata, Koji; KINO, Koichi; Senoo, Yoshimasa; Teramoto, Shigeru

    1994-01-01

    A 40-year-old man with valvular heart disease was successfully treated using a left ventricular assist device (LVAD) after open heart surgery. Echocardiography revealed left ventricular ejection fraction (LV-EF) at LVAD on/off: 23.4%/14.6% on the 4th, 23.8%/23.8% on the 5th, and 23.8%/26.8% on the 6th postoperative day (POD), respectively. The patient was weaned from LVAD on the 8th POD and discharged from the hospital on the 58th POD. The LV-EF improved to 54% 6 months after surgery and incr...

  12. 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.

  13. Improvement of impaired diastolic left ventricular function after diet-induced weight reduction in severe obesity

    Directory of Open Access Journals (Sweden)

    Karimian S

    2017-01-01

    Full Text Available Sevda Karimian,1 Juergen Stein,2 Boris Bauer,3 Claudius Teupe1 1Department of Medicine – Cardiology, 2Department of Medicine – Gastroenterology, 3Department of Radiology, Krankenhaus Sachsenhausen, Teaching Hospital of Goethe University Frankfurt, Frankfurt, Germany 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

  14. Impact on left ventricular function of the exercise response of coronary collateral flow in coronary heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Tweddel, A.C.; Martin, W.; McGhie, I.; Hutton, I.

    1985-05-01

    This study was designed to determine the effect of physiological stress on regional myocardial flow, and the effect of collateral circulation on left ventricular function. Myocardial flow was measured by the Xenon clearance technique in 25 patients with stable angina, studied at routine coronary angiography, with normal distribution of flow obtained from 10 patients. Regional wall motion was quantified from the contrast ventriculogram by percentage shortening of radial chords. Twenty collateral distributions were identified angiographically and a further 14 with intracoronary Xenon. Scans were performed at rest and immediately post maximal supine exercise. Collateral flows in response to dynamic exercise were differentiated as follows: in 8 regions identified arteriographically, mean flow fell from 46.3 +- 5.1 to 40 +- 5.1 ml/100g/min (p<0.02) and from 28.9 +- 3.6 to 21.1 +- 1.4 ml/100g/min (p<0.05) in regions of collateral flow seen with Xenon. In these regions, mean left ventricular percentage shortening was 22 +- 6.0% and 35.5 +- 5.0% respectively. In contrast, in 12 regions demonstrated angiographically, collateral flow increased 41.2 +- 4.6 to 63.4 +- 5.8 ml/100g/min (p<0.005), and 6 Xenon collateral distributions where flow increased post exercise from 19.5 +- 7.8 to 37.8 +- 5.1 ml/100g/min (p<0.05). The mean left ventricular percentage shortening was 43.2 +- 7.3% (p<0.02) in these collateral distributions identified arteriographically and 44 +- 4.5% (p<0.05) with Xenon. The authors conclude that collateral flow, which increased in response to stress, appears to be beneficial in the preservation of regional left ventricular function.

  15. Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease

    OpenAIRE

    Engstrand, Christina; Krevers, Barbro; Kvist, Joanna

    2015-01-01

    Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Han...

  16. The detailed assessment of left and right ventricular functions by tissue Doppler imaging in patients with familial Mediterranean fever.

    Science.gov (United States)

    Tavil, Yusuf; Ureten, Kemal; Oztürk, Mehmet Akif; Sen, Nihat; Kaya, Mehmet Güngör; Cemri, Mustafa; Cengel, Atiye

    2008-02-01

    In the contrary to other rheumatologic disorders, there have been limited numbers of studies investigating the cardiac involvement in patients with familial Mediterranean fever (FMF), although the disease may carry a potential for cardiovascular disorders because of sustained inflammation during its course. In the present study, we used high usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in FMF patients. The study population included 30 patients with FMF (11 men, 19 women; mean age, 35 +/- 7 years, mean disease duration, 15.4 +/- 7.6 years) and 30 healthy subjects as controls (12 men, 18 women; mean age, 33 +/- 7 years). The diagnosis of FMF was established according to the Tell-Hashomer criteria. Left and right ventricular functions were measured using echocardiography comprising standard two-dimensional, M-mode, and conventional Doppler as well as tissue Doppler imaging. The conventional echocardiographic paratemeters were similar apart from left ventricular relaxation time was longer (107 +/- 25 vs 85 +/- 10 ms, p < 0.001, respectively) in patients with FMF. According to the tissue Doppler measurements, while systolic velocities of both ventricles were not different, diastolic filling velocities of left ventricle including E'(m) (12.6 +/- 3.4 vs 14.7 +/- 3.3 cm/s, p = 0.04), A'(m) (10.1 +/- 2.6 vs 8.6 +/- 2.0 cm/s, p = 0.015), and E'(m)/ A'(m) (1.24 +/- 0.4 vs 1.71 +/- 0.5 cm/s, p = 0.012) values were statistically different between the groups. Left ventricular myocardial performance indices and right ventricular diastolic functions were found similar between two groups. In addition, there were no significant correlations between the disease duration, clinical features, and echocardiographic parameters. In conclusion, we have demonstrated that although systolic functions were comparable in the patients and controls, left ventricular diastolic function indices were impaired in FMF patients by using tissue Doppler analysis.

  17. Time elapsed after contrast injection is crucial to determine infarct transmurality and myocardial functional recovery after an acute myocardial infarction.

    Science.gov (United States)

    Rodríguez-Palomares, José F; Ortiz-Pérez, José T; Lee, Daniel C; Bucciarelli-Ducci, Chiara; Tejedor, Paula; Bonow, Robert O; Wu, Edwin

    2015-05-30

    In acute myocardial infarction (MI), late Gadolinium enhancement (LGE) has been proposed to include the infarcted myocardium and area at risk. However, little information is available on the optimal timing after contrast injection to differentiate these 2 areas. Our aim was to determine in acute and chronic MI whether imaging time after contrast injection influences the LGE size that better predicts infarct size and functional recovery. Subjects were evaluated by cardiovascular magnetic resonance (CMR) the first week (n = 60) and 3 months (n = 47) after a percutaneously revascularized STEMI. Inversion-recovery single-shot (ss-IR) imaging was acquired at multiple time points following contrast administration and compared to segmented inversion-recovery (seg-IR) sequences. Inversion time was properly adjusted and images were blinded, randomized and measured for LGE volumes. In acute MI, LGE volume decreased over several minutes (p = 0.005) with the greatest volume occurring at 3 minutes and the smallest at 25 minutes post-contrast injection; however, LGE volume remained constant over time in chronic MI (p = 0.886). Depending on the imaging time, in acute phase, a change in the transmurality index was also observed. A transmural infarction (>75%) at 25 minutes better predicted the absence of improvement in the wall motion score index (WMSI), a higher increase in left ventricular volumes and a lower ejection fraction compared to 10 minutes. A change was observed in LGE volume in the minutes following contrast administration in acute but not in chronic MI. Infarct transmurality 25 minutes post-contrast injection better predicted infarct size and functional recovery at follow-up.

  18. Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of persistent atrial fibrillation with left ventricular systolic dysfunction.

    Directory of Open Access Journals (Sweden)

    Maojing Wang

    Full Text Available To evaluate the effect of catheter ablation vs. direct current synchronized cardioversion (DCC in patients with persistent atrial fibrillation (AF and left ventricular systolic dysfunction, and to define baseline features of patients that will get more benefit from ablation.From July 2013 to October 2014, 97 consecutive single-center patients with persistent AF and symptomatic heart failure (left ventricular ejection fraction (LVEF 20% or to over 55% in 31 (54.39% patients with worse baseline cardiac function and ventricular rate control.Catheter ablation relative to cardioversion of persistent AF with symptomatic heart failure yielded better 12-month SR maintenance and cardiac function. Compared with non-responders, patients with improved LVEF post-ablation had poorer ventricular rate control and cardiac function at baseline, suggesting a significant component of tachycardia-induced cardiomyopathy in this group.

  19. Combining computer modelling and cardiac imaging to understand right ventricular pump function

    NARCIS (Netherlands)

    Walmsley, John; van Everdingen, Wouter; Cramer, Maarten J|info:eu-repo/dai/nl/155240706; Prinzen, Frits W; Delhaas, Tammo; Lumens, Joost

    2017-01-01

    Right ventricular (RV) dysfunction is a strong predictor of outcome in heart failure and is a key determinant of exercise capacity. Despite these crucial findings, the RV remains understudied in the clinical, experimental, and computer modelling literature. This review outlines how recent advances

  20. Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects

    DEFF Research Database (Denmark)

    Kjaergaard, J.; Schaadt, B.K.; Lund, J.O.

    2008-01-01

    Aims The relation of the extent of obstruction of the pulmonary vascutature in pulmonary embolism (PE) and impact on right ventricular (RV) hemodynamics is not well established. This study evaluated the relation of size of perfusion defects and changes in echocardiographic measures of global...

  1. 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...... regurgitation (MR) and LV systolic dysfunction. METHODS AND RESULTS: For the period 1995-2010, the Duke Echocardiography Laboratory and Duke Databank for Cardiovascular Diseases databases were merged to identify patients with moderate or severe functional MR and severe LV dysfunction (defined as LV ejection...

  2. Right ventricular volumes and function in thalassemia major patients in the absence of myocardial iron overload

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    Porter John B

    2010-04-01

    Full Text Available Abstract Aim We aimed to define reference ranges for right ventricular (RV volumes, ejection fraction (EF in thalassemia major patients (TM without myocardial iron overload. Methods and results RV volumes, EF and mass were measured in 80 TM patients who had no myocardial iron overload (myocardial T2* > 20 ms by cardiovascular magnetic resonance. All patients were receiving deferoxamine chelation and none had evidence of pulmonary hypertension or other cardiovascular comorbidity. Forty age and sex matched healthy non-anemic volunteers acted as controls. The mean RV EF was higher in TM patients than controls (males 66.2 ± 4.1% vs 61.6 ± 6%, p = 0.0009; females 66.3 ± 5.1% vs 62.6 ± 6.4%, p = 0.017, which yielded a raised lower threshold of normality for RV EF in TM patients (males 58.0% vs 50.0% and females 56.4% vs 50.1%. RV end-diastolic volume index was higher in male TM patients (mean 98.1 ± 17.3 mL vs 88.4 ± 11.2 mL/m2, p = 0.027, with a higher upper limit (132 vs 110 mL/m2 but this difference was of borderline significance for females (mean 86.5 ± 13.6 mL vs 80.3 ± 12.8 mL/m2, p = 0.09, with upper limit of 113 vs 105 mL/m2. The cardiac index was raised in TM patients (males 4.8 ± 1.0 L/min vs 3.4 ± 0.7 L/min, p Conclusion The normal ranges for functional RV parameters in TM patients with no evidence of myocardial iron overload differ from healthy non-anemic controls. The new reference RV ranges are important for determining the functional effects of myocardial iron overload in TM patients.

  3. Association of Gestational Diabetes Mellitus With Left Ventricular Structure and Function: The CARDIA Study.

    Science.gov (United States)

    Appiah, Duke; Schreiner, Pamela J; Gunderson, Erica P; Konety, Suma H; Jacobs, David R; Nwabuo, Chike C; Ebong, Imo A; Whitham, Hilary K; Goff, David C; Lima, Joao A; Ku, Ivy A; Gidding, Samuel S

    2016-03-01

    Gestational diabetes mellitus (GDM) predicts incident cardiovascular disease (CVD). However, mechanisms linking GDM to CVD beyond intervening incident diabetes are not well understood. We examined the relation of GDM with echocardiographic parameters of left ventricular (LV) structure and function, which are important predictors of future CVD risk. We studied 609 women (43% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who delivered one or more births during follow-up and had echocardiograms in 1990-1991 (mean age 28.8 years) and 2010-2011. During the 20-year follow-up, 965 births were reported, with GDM developing in 64 women (10.5%). In linear regression models adjusted for sociodemographic factors, BMI, physical activity, parity, smoking, use of oral contraceptives, alcohol intake, family history of coronary heart disease, systolic blood pressure, and lipid levels, women with GDM had impaired longitudinal peak strain (-15.0 vs. -15.7%, P = 0.025), circumferential peak strain (-14.8 vs. -15.6%, P = 0.028), lateral e' wave velocity (11.0 vs. 11.8 cm/s, P = 0.012), and septal e' wave velocity (8.6 vs. 9.3 cm/s, P = 0.015) in 2010-2011 and a greater 20-year increase in LV mass indexed to body surface area (14.3 vs. 6.0 g/m(2), P = 0.006) compared with women with non-GDM pregnancies. Further adjustment for incident type 2 diabetes after pregnancy did not attenuate these associations. Pregnancy complicated by GDM is independently associated with increased LV mass and impaired LV relaxation and systolic function. Implementation of postpartum cardiovascular health interventions in women with a history of GDM may offer an additional opportunity to reduce future CVD risk. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  4. 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.

  5. Mediterranean diet score and left ventricular structure and function: the Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Levitan, Emily B; Ahmed, Ali; Arnett, Donna K; Polak, Joseph F; Hundley, W Gregory; Bluemke, David A; Heckbert, Susan R; Jacobs, David R; Nettleton, Jennifer A

    2016-09-01

    Data are limited on the relation between dietary patterns and left ventricular (LV) structure and function. We examined cross-sectional associations of a diet-score assessment of a Mediterranean dietary pattern with LV mass, volume, mass-to-volume ratio, stroke volume, and ejection fraction. We measured LV variables with the use of cardiac MRI in 4497 participants in the Multi-Ethnic Study of Atherosclerosis study who were aged 45-84 y and without clinical cardiovascular disease. We calculated a Mediterranean diet score from intakes of fruit, vegetables, nuts, legumes, whole grains, fish, red meat, the monounsaturated fat:saturated fat ratio, and alcohol that were self-reported with the use of a food-frequency questionnaire. We used linear regression with adjustment for body size, physical activity, and cardiovascular disease risk factors to model associations and assess the shape of these associations (linear or quadratic). The Mediterranean diet score had a slight U-shaped association with LV mass (adjusted means: 146, 145, 146, and 147 g across quartiles of diet score, respectively; P-quadratic trend = 0.04). The score was linearly associated with LV volume, stroke volume, and ejection fraction: for each +1-U difference in score, LV volume was 0.4 mL higher (95% CI: 0.0, 0.8 mL higher), the stroke volume was 0.5 mL higher (95% CI: 0.2, 0.8 mL higher), and the ejection fraction was 0.2 percentage points higher (95% CI: 0.1, 0.3 percentage points higher). The score was not associated with the mass-to-volume ratio. A higher Mediterranean diet score is cross-sectionally associated with a higher LV mass, which is balanced by a higher LV volume as well as a higher ejection fraction and stroke volume. Participants in this healthy, multiethnic sample whose dietary patterns most closely conformed to a Mediterranean-type pattern had a modestly better LV structure and function than did participants with less-Mediterranean-like dietary patterns. This trial was registered at

  6. Right Ventricular Structure and Function in the Veteran Ultramarathon Runner: Is There Evidence for Chronic Maladaptation?

    Science.gov (United States)

    Rothwell, Oliver; George, Keith; Somauroo, John; Lord, Rachel; Stembridge, Mike; Shave, Rob; Hoffman, Martin D; Wilson, Mathew; Ashley, Euan; Haddad, Francois; Eijsvogels, Thijs M H; Oxborough, David

    2018-01-03

    It has been proposed that chronic exposure to prolonged strenuous exercise may result in maladaptation of the right ventricle (RV). The of this study aim was to establish RV structure and function, including septal insertion points, using conventional echocardiography and myocardial strain (ε) imaging in a veteran population of ultramarathon runners (UR) and age- and sex-matched controls. A retrospective study design provided 40 UR (>35 years old; mean ± SD training experience, 18 ± 12 years) and 24 sedentary controls who had previously undergone conventional two-dimensional, tissue Doppler and speckle-tracking echocardiography to measure RV size and function. Peak RV ε and strain rate (SR) were assessed from the base, mid, and apical lateral wall. SR were assessed during systole (SRs'), early diastole (SRe') and late diastole (SRa'). Regional assessment of RV insertion points was made at the basal inferoseptum and apical septum using left ventricular (LV) longitudinal ε and at the anteroseptum and inferoseptum using LV circumferential and radial ε. All structural indices of RV size were significantly larger in UR. RV regional and global peak ε were not different between groups, whereas basal RV SR was significantly lower in UR. UR had significantly higher peak LV circumferential ε (anteroseptum, -26% ± 8% vs -21% ± 6%; inferoseptum, -25% ± 6% vs -16% ± 9%) and higher peak LV longitudinal ε (apical septum, -28% ± 7% vs -22% ± 4%) compared with controls. There was regional heterogeneity in UR that was not observed in controls with significantly lower longitudinal ε at the basal inferoseptal insertion point when compared with the global ε (-19% ± 2% vs -22% ± 4%). Myocardial ε imaging highlights no overt maladaptation in this cohort of veteran UR, although lower insertion point ε, compared with global ε, in UR may warrant further investigation. Copyright © 2017 American Society of Echocardiography. Published by Elsevier

  7. Evaluation of left ventricular function in preterm infants with bronchopulmonary dysplasia using various echocardiographic techniques.

    Science.gov (United States)

    Bokiniec, Renata; Własienko, Paweł; Borszewska-Kornacka, Maria; Szymkiewicz-Dangel, Joanna

    2017-04-01

    Echocardiographic evaluation of left ventricular function in preterm infants with and without bronchopulmonary dysplasia. In 82 preterm infants (32 in no-bronchopulmonary-dysplasia group, 35 in mild-bronchopulmonary-dysplasia group, and 15 in severe-bronchopulmonary-dysplasia group), echocardiography was performed on the first day of life, at 28 days of life, and at 36 weeks postconceptional age. The mean E/A ratio at 36 PCA was 0.94±0.31 and 0.73±0.12 in the mild- and severe-bronchopulmonary-dysplasia groups, respectively (P=.037). The mean E'-wave velocity was 5.62±1.61 cm/s vs 4.32±1.11 cm/s at 1 day of life (P=.006) and 6.40±1.39 cm/s vs 5.34±1.37 cm/s at 28 days of life (P=.030) in the no-bronchopulmonary-dysplasia and mild-bronchopulmonary-dysplasia groups, respectively. This measure tended to be lower in the severe-bronchopulmonary-dysplasia group compared to the no-bronchopulmonary-dysplasia group (5.25±1.29 cm/s at 28 days of life; P=.081). The E/E' ratio differed between the no-bronchopulmonary-dysplasia (7.21±1.85) and mild-bronchopulmonary-dysplasia groups (9.03±2.56; P=.019) at 1 day of life. The left ventricle myocardial performance index decreased between 1 day of life and 36 postconceptional age in infants without bronchopulmonary dysplasia and those with mild bronchopulmonary dysplasia, but not in those with severe bronchopulmonary dysplasia. E/A and E/E' ratios are the most sensitive indicators of impaired left ventricle diastolic function in preterm infants with bronchopulmonary dysplasia. © 2017, Wiley Periodicals, Inc.

  8. [Recovery].

    Science.gov (United States)

    Estingoy, Pierrette; Gilliot, Élodie; Parisot, Clément

    2015-01-01

    The historical fatalism of the impossibility of recovering from psychosis eased from the 1970s with the shaping of the idea of a possible recovery. Recovery is today the objective for the patient and caregivers. The key to achieving this lies in the encounter with Others. A collective approach, on the level of the institution, must be established. The aim is to create opportunities for the patient to express their doubts and feelings. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. Characterization of the phospholemman knockout mouse heart: depressed left ventricular function with increased Na-K-ATPase activity.

    Science.gov (United States)

    Bell, James R; Kennington, Erika; Fuller, William; Dighe, Kushal; Donoghue, Pamela; Clark, James E; Jia, Li-Guo; Tucker, Amy L; Moorman, J Randall; Marber, Michael S; Eaton, Philip; Dunn, Michael J; Shattock, Michael J

    2008-02-01

    Phospholemman (PLM, FXYD1), abundantly expressed in the heart, is the primary cardiac sarcolemmal substrate for PKA and PKC. Evidence supports the hypothesis that PLM is part of the cardiac Na-K pump complex and provides the link between kinase activity and pump modulation. PLM has also been proposed to modulate Na/Ca exchanger activity and may be involved in cell volume regulation. This study characterized the phenotype of the PLM knockout (KO) mouse heart to further our understanding of PLM function in the heart. PLM KO mice were bred on a congenic C57/BL6 background. In vivo conductance catheter measurements exhibited a mildly depressed cardiac contractile function in PLM KO mice, which was exacerbated when hearts were isolated and Langendorff perfused. There were no significant differences in action potential morphology in paced Langendorff-perfused hearts. Depressed contractile function was associated with a mild cardiac hypertrophy in PLM KO mice. Biochemical analysis of crude ventricular homogenates showed a significant increase in Na-K-ATPase activity in PLM KO hearts compared with wild-type controls. SDS-PAGE and Western blot analysis of ventricular homogenates revealed small, nonsignificant changes in Na- K-ATPase subunit expression, with two-dimensional gel (isoelectric focusing, SDS-PAGE) analysis revealing minimal changes in ventricular protein expression, indicating that deletion of PLM was the primary reason for the observed PLM KO phenotype. These studies demonstrate that PLM plays an important role in the contractile function of the normoxic mouse heart. Data are consistent with the hypothesis that PLM modulates Na-K-ATPase activity, indirectly affecting intracellular Ca and hence contractile function.

  10. Impact on Left Ventricular Function and Remodeling and on 1-Year Outcome in Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Carrabba, Nazario; Valenti, Renato; Migliorini, Angela; Marrani, Marco; Cantini, Giulia; Parodi, Guido; Dovellini, Emilio Vincenzo; Antoniucci, David

    2015-07-01

    Conflicting results have been reported about the prognostic impact of left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the impact of LBBB after TAVI on left ventricular (LV) function and remodeling and on 1-year outcomes. Of 101 TAVI patients, 9 were excluded. All complications were evaluated according to the Valve Academic Research Consortium 2 definition. Of 92 patients, 34 developed LBBB without more advanced myocardial damage or inflammation biomarkers in comparison with patients without LBBB. The only predictor of new LBBB was larger baseline LV end-diastolic volume. LBBB plus advanced atrioventricular block was strongly correlated with permanent pacemaker implantation (p <0.0001). Patients with LBBB had a higher rate of permanent pacemaker implantation at 30 days (59% vs 19%, p <0.0001) and less recovery of LV systolic function and a trend toward a lower rate of LV reverse remodeling at 1 year. The development of acute kidney injury and the logistic European System for Cardiac Operative Risk Evaluation score were associated with poor outcomes (all-cause mortality and heart failure) (hazard ratio 6.86, 95% confidence interval 2.51 to 18.74, p <0.0001, and hazard ratio 1.04, 95% confidence interval 1.01 to 1.08, p = 0.021, respectively), but not LBBB. In conclusion, after TAVI, 37% of patients developed new LBBB without more advanced myocardial damage or inflammation biomarkers. LBBB was associated with a higher rate of permanent pacemaker implantation, which negatively affected the recovery of LV systolic function. The development of acute kidney injury, rather than LBBB, increases the 1-year risk for mortality and hospitalization for heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Right atrial pressure affects the interaction between lung mechanics and right ventricular function in spontaneously breathing COPD patients.

    Directory of Open Access Journals (Sweden)

    Bart Boerrigter

    Full Text Available INTRODUCTION: It is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary interactions are influenced by right atrial pressure. METHODS: Twenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during expiration were examined to evaluate changes in right ventricular output. RESULTS: Pulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The decline in pulse pressure was most prominent in patients with a low right atrial filling pressure. During exercise, a similar decline in pulmonary artery pressure was observed. This could be explained by similar increases in intrathoracic pressure and right atrial pressure during exercise, resulting in an unchanged right atrial filling pressure. CONCLUSIONS: We show that in spontaneously breathing COPD patients the pulmonary artery pulse pressure decreases during expiration and that the magnitude of the decline in pulmonary artery pulse pressure is not just a function of intrathoracic pressure, but also depends on right atrial pressure.

  12. Structurally-functional features of left ventricular myocardium and endothelial dysfunction in rheumatoid arthritis depending on presence of hypertension

    Directory of Open Access Journals (Sweden)

    E E Myasoedova

    2007-01-01

    Full Text Available Objective. To study the structure and functional peculiarities of left-ventricular myocardium and endothelial dysfunction in rheumatoid arthritis (RA in connection with the course of disease, concomitant arterial hypertension (AH and cardiovascular risk factors. Material and methods. Before the beginning of regular antihypertensive therapy we observed 55 pts with RA, 30 of them had mild or moderate AH developed in the course of RA and 36 pts with essential hypertension (EH without rheumatic diseases. Wfe evaluated anamnesis, blood pressure level (BPL, echocardiography data, endothelial vasodilation capacity and endothelial dysfunction index. All pts were purely comparable in age; RA with AH pts and EH pts — in BPL, anamnesis duration, SCORE-risk. No one of the observed persons had associated clinical states. 26 healthy subjects made control group. Results. RA with AH pts in comparison with EH had marked left-ventricular hypertrophy. Concentric hypertrophy prevailed in RA. 65,3% of RA-pts had diastolic dysfunction type 1. Endothelial dysfunction in RA-pts was found more often (in 57,9% individuals with RA and normal BPL and in 50% pts with RA and concomitant AH (p<0,05 than in EH-pts (20%. Thus, left-ventricular hypertrophy in RA optionally depended on AH presence but it is closely connected with metabolic (hyperlipidemia, abdominal obesity and endocrine (menopause disorders in pts with chronic autoimmune inflammation.

  13. Severity of structural and functional right ventricular remodeling depends on training load in an experimental model of endurance exercise.

    Science.gov (United States)

    Sanz-de la Garza, Maria; Rubies, Cira; Batlle, Montserrat; Bijnens, Bart H; Mont, Lluis; Sitges, Marta; Guasch, Eduard

    2017-09-01

    Arrhythmogenic right ventricular (RV) remodeling has been reported in response to regular training, but it remains unclear how exercise intensity affects the presence and extent of such remodeling. We aimed to assess the relationship between RV remodeling and exercise load in a long-term endurance training model. Wistar rats were conditioned to run at moderate (MOD; 45 min, 30 cm/s) or intense (INT; 60 min, 60 cm/s) workloads for 16 wk; sedentary rats served as controls. Cardiac remodeling was assessed with standard echocardiographic and tissue Doppler techniques, sensor-tip pressure catheters, and pressure-volume loop analyses. After MOD training, both ventricles similarly dilated (~16%); the RV apical segment deformation, but not the basal segment deformation, was increased [apical strain rate (SR): -2.9 ± 0.5 vs. -3.3 ± 0.6 s -1 , SED vs. MOD]. INT training prompted marked RV dilatation (~26%) but did not further dilate the left ventricle (LV). A reduction in both RV segments' deformation in INT rats (apical SR: -3.3 ± 0.6 vs. -3.0 ± 0.4 s -1 and basal SR: -3.3 ± 0.7 vs. -2.7 ± 0.6 s -1 , MOD vs. INT) led to decreased global contractile function (maximal rate of rise of LV pressure: 2.53 ± 0.15 vs. 2.17 ± 0.116 mmHg/ms, MOD vs. INT). Echocardiography and hemodynamics consistently pointed to impaired RV diastolic function in INT rats. LV systolic and diastolic functions remained unchanged in all groups. In conclusion, we showed a biphasic, unbalanced RV remodeling response with increasing doses of exercise: physiological adaptation after MOD training turns adverse with INT training, involving disproportionate RV dilatation, decreased contractility, and impaired diastolic function. Our findings support the existence of an exercise load threshold beyond which cardiac remodeling becomes maladaptive. NEW & NOTEWORTHY Exercise promotes left ventricular eccentric hypertrophy with no changes in systolic or diastolic function in healthy rats. Conversely, right

  14. [Pre- and post-operative right ventricular functions in valvular heart diseases: the significance of noninvasive assessment].

    Science.gov (United States)

    Uehara, T; Nishimura, T; Hayashida, K; Takamiya, M

    1987-12-01

    This investigation was undertaken to evaluate right ventricular function in valvular heart diseases by calculating right ventricular ejection fraction (RVEF) from first-pass radionuclide angiography (RNA). One hundred cases of valvular heart disease were examined by RNA, 93 of whom underwent cardiac catheterization and contrast left ventriculography, preoperatively. Fifty of the 100 cases were examined by RNA; 18 by cardiac catheterization post-operatively. The results were as follows: 1. In 49 cases of mitral valve disease, there was a correlation (r = -0.75) between pulmonary artery mean pressure (PAm) and RVEF. This suggested that afterload of left atrial pressure elevation induced a decrease in RVEF. 2. Although PAm did not increase so much in aortic valve disease, RVEF decreased in some cases, especially in those having massive aortic stenosis or regurgitation. In 22 cases of aortic regurgitation which had normal PAm and a left ventricular-aortic systolic pressure gradient less than 50 mmHg, there was a correlation (r = -0.69) between the RVEF and the left ventricular end-diastolic volume index (LVEDVI). 3. Although post-operative RVEF did not improve significantly in mitral valve disease, it increased significantly in the early post-operative period in aortic valve disease. Also, the increase in RVEF and the decrease in LVEDVI seemed to correlate closely in aortic valve disease. It was speculated that pre-operative decrease of RVEF is derived from a deformity of the RV caused by pressure from the enlarged or thickened LV, and that post-operative increase of RVEF is dependent upon a decrease of LV size and volume.

  15. Renal function during recovery from minimal lesions nephrotic syndrome.

    Science.gov (United States)

    Koomans, H A; Boer, W H; Dorhout Mees, E J

    1987-01-01

    We followed renal function through the natriuretic phase of 6 occasions of drug-induced recovery from minimal lesions nephrotic syndrome (MLNS). Protein excretion started to fall 1-3 days prior to the start of the natriuresis. The natriuresis was accompanied by a rise in glomerular filtration rate (GFR, inulin clearance). The filtration fraction, calculated from the GFR and the p-aminohippurate clearance, rose steadily in 5 subjects in whom it was low before therapy. Proximal and distal sodium reabsorption fractions, estimated from the changes in maximum free water clearance, fell, and fractional sodium, lithium, uric acid and free water clearance rose. At the time of these changes plasma protein had hardly risen, whereas renin activity was down. These results are in agreement with the notion that the sodium retention of MLNS is due to a renal defect. Repair of the glomerular filter, evident from the disappearance of proteinuria and the rise in filtration fraction, apparently normalizes the elevated tubular sodium reabsorption proximal to the macula densa, which leads to a fall in renin release.

  16. Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures.

    Science.gov (United States)

    Ruder, John A; Hart, Gavin P; Kneisl, Jeffrey S; Springer, Bryan D; Karunakar, Madhav A

    2017-05-01

    Treatment options for periprosthetic distal femur fractures include open reduction internal fixation (ORIF) and distal femoral replacement (DFR). The purpose of this study was to evaluate the complications, and functional recovery (ambulatory status, living situation, mortality) in patients undergoing operative treatment (DFR and ORIF) of periprosthetic distal femur fractures. A retrospective review of 58 patients with distal femoral periprosthetic fractures treated with either ORIF or DFR was conducted. Surgical complications, discharge disposition, ambulatory status, living situation at 1 year, and mortality at 1 year were compared between patients treated with ORIF and DFR. Outcomes at 1 year were also compared between patients older and younger than 85 years of age. Fifty-eight patients with a mean age of 80 years (range, 61-95 years) met inclusion criteria. The mean follow-up was 29.5 months (range, 5-81 months). Patients undergoing DFR were significantly older than those who underwent ORIF (83 vs 78, P femur fractures. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Evaluation of right atrial function by two-dimensional speckle-tracking echocardiography in patients with right ventricular myocardial infarction.

    Science.gov (United States)

    Nourian, Saeed; Hosseinsabet, Ali; Jalali, Arash; Mohseni-Badalabadi, Reza

    2017-01-01

    Right ventricular myocardial infarction (RVMI) damages the systolic and diastolic functions of the RV, so the right atrium interacts with the RV with an acutely altered function. The aim of our study was to compare right atrial function as evaluated by 2D speckle-tracking echocardiography (2DSTE) between patients with inferior wall myocardial infarction (INFMI) and patients affected by both inferior myocardial infarction and right ventricular myocardial infarction (INFMI + RVMI). Our study recruited 70 consecutive patients with INFMI (43 patients without RVMI and 27 patients with RVMI). Right atrial function was evaluated by 2DSTE. Early diastolic strain, systolic strain rate, absolute value of early diastolic strain rate, expansion index, and diastolic emptying index of the right atrium were reduced in the patients with INFMI + RVMI compared to the patients with INFMI. The area under the curve for early diastolic strain for INFMI diagnosis was 0.682 (p value = 0.011, 95 % CI 0.550-0.815). Right atrial early diastolic longitudinal strain right atrial reservoir and conduit functions were impaired in the patients with INFMI + RVMI compared with the patients with INFMI.

  18. The influence of low-intensity resistance training versus high-intensity resistance training on left ventricular structure and function of healthy adolescent boys using Echocardiography

    OpenAIRE

    asghar Kianzadeh; maghsood Peeri; mohammad ali Azarbayjani; bahman Hasanvand; farid Bahrami; hosein Omidi

    2013-01-01

    Background: The study on the influence of different protocol of resistance training on left ventricular of adolescent boys dose have its limitation. The aim of this study was to determine the influence of low-intensity resistance training versus high-intensity resistance training on left ventricular structure and function of healthy adolescent boys by echocardiography. Materials and Methods: Twenty-four subjects volunteers, 15 to 18 years old were randomly assigned to three groups in the e...

  19. Anti-inflammatory effects of triptolide improve left ventricular function in a rat model of diabetic cardiomyopathy

    Science.gov (United States)

    2013-01-01

    Aims Given the importance of inflammation in the onset and progression of diabetic cardiomyopathy, we investigated the potential protective effects of triptolide, an anti-inflammatory agent, in streptozotocin-induced diabetic rat model and in H9c2 rat cardiac cells exposed to high glucose. Methods and results Diabetic rats were treated with triptolide (100, 200, or 400 μg/kg/day respectively) for 6 weeks. At the end of this study, after cardiac function measurements were performed, rats were sacrificed and their hearts were harvested for further histologic and molecular biologic analysis. Enhanced activity and expression of nuclear factor-kappaB (NF-κB) p65 in diabetic hearts were associated with increased inflammatory response, as demonstrated by increased pro-inflammatory cytokines, cell adhesion molecules and invading inflammatory cells, as well as increased fibrosis, in line with impaired left ventricular function. Triptolide attenuated these morpho-functional alterations. Furthermore, triptolide (20 ng/ml) also attenuated high glucose-induced inflammation in H9c2 rat cardiac cells. Conclusion Our data demonstrate that anti-inflammatory effects of triptolide involving the NF-κB signaling pathway can improve left ventricular function under diabetic conditions, suggesting triptolide treatment might be beneficial in diabetic cardiomyopathy. PMID:23530831

  20. The evaluation of right and left ventricular functions in children with episodic wheezing exposed to environmental tobacco smoke.

    Science.gov (United States)

    Doksöz, Önder; Nacaroğlu, Hikmet Tekin; Ceylan, Gökhan; Çeleğen, Mehmet; Aşık-Nacaroğlu, Şenay; Can, Demet; Meşe, Timur; Ünal, Nurettin

    2017-01-01

    Doksöz Ö, Nacaroğlu HT, Ceylan G, Çeleğen M, Aşık-Nacaroğlu Ş, Can D, Meşe T, Ünal N. The evaluation of right and left ventricular functions in children with episodic wheezing exposed to environmental tobacco smoke. Turk J Pediatr 2017; 59: 42-48. The objective of this study is to examine the right and left ventricular functions in children with episodic wheezing at the ages of 1-3 exposed to environmental tobacco smoke (ETS). Thirty-two children monitored at the Pediatric Allergy and Immunology Department of a Research and Training Hospital with the diagnosis of episodic wheezing were included. The prospective assessment of the patients was performed between May 2013 and February 2014. Twenty-five children with episodic wheezing not exposed to ETS formed the control group. The two groups were compared by conducting transthoracic two-dimensional and tissue Doppler echocardiography (TDE) examination in all of the cases. The average age of the study group (24 boys, 8 girls) was 33.1 ± 8.8 months, the average age of the control group (18 boys, 7 girls) was 31.9 ± 11.9 months. There was no statistically significant difference between the two groups in terms of age, gender, weight, height, and body mass index values. There was no statistically significant difference between the two groups for the right and left ventricular systolic and diastolic functions in the conventional echocardiographic measurements, and for the measurements of TDE. Limited number of patients is a major limitation of the study. These results should be supported by more comprehensive studies.

  1. Out-of-hospital sudden coronary death: rest and exercise radionuclide left ventricular function in survivors.

    Science.gov (United States)

    Ritchie, J L; Hallstrom, A P; Troubaugh, G B; Caldwell, J H; Cobb, L A

    1985-03-01

    One hundred fifty-four survivors of out-of-hospital ventricular fibrillation (VF) with coronary artery disease underwent radionuclide ventriculography an average of 4.2 months after VF. All patients were studied at rest, and 91 of these patients were also studied during supine bicycle exercise. Clinical histories and 24-hour ambulatory electrocardiograms were also assessed, and patients were followed for an average of 3.1 years after ventriculography. The mean left ventricular (LV) ejection fraction (EF) at rest was 40 +/- 16%; in 34% of patients, it was 30% or less; in 37%, 31 to 50%; and in 29%, more than 50%. Regional LV wall motion was normal in 18%. The most severe segmental abnormality was hypokinesia in 22%, akinesia in 45% and dyskinesia in 14%. Wall motion abnormalities were usually located at the apex. During exercise, only 3% of patients (3 of 91) had a normal increase in EF of more than 5%, and the mean EF decreased from 42 to 38%. New exercise-induced wall motion abnormalities occurred in 30%. During the follow-up period, 54 patients died (35%): 48 from cardiac causes and 42 from unexpected and sudden causes. Predictors of death included EF at rest, presence of akinesia or dyskinesia on the ventriculogram at rest, the number of abnormal LV segments, history of congestive heart failure, history of acute myocardial infarction, absence of acute myocardial infarction at the time of VF and the presence of ventricular arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters

    Energy Technology Data Exchange (ETDEWEB)

    Marterer, Robert; Tschauner, Sebastian; Sorantin, Erich [Medical University of Graz, Division of Pediatric Radiology, Department of Radiology, Graz (Austria); Zeng, Hongchun [First Affiliated Hospital of Xinjiang Medical University, Department of Ultrasonography, Urumqi (China); Koestenberger, Martin [Medical University of Graz, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Graz (Austria)

    2015-12-15

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. (orig.)

  3. Alterations in left ventricular structure and diastolic function in professional football players: assessment by tissue Doppler imaging and left ventricular flow propagation velocity.

    Science.gov (United States)

    Tumuklu, M Murat; Ildizli, Muge; Ceyhan, Koksal; Cinar, Cahide Soydas

    2007-02-01

    Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler imaging (TDI) and ventricular early flow propagation velocity (Vp) are new tolls in the evaluation of myocardial function. We sought to compare TDI and Vp findings in professional football players and age-adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. Twenty-four professional football players and age-, sex-, and weight-adjusted 20 control subjects underwent standard Doppler echocardiography pulsed TDI, performed parasternal four-chamber views by placing sample volume septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were obtained by measuring the slope delineated by first aliasing velocity from the mitral tips toward the apex by using apical four-chamber color M-mode Doppler images. Age, body surface area, blood pressure, and heart rate were comparable between two groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter, and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal DTI peak early diastolic (e) velocity (0.22 +/- 0.04 vs 0.19 +/- 0.04, P < 0.05), lateral DTI peak e velocity (0.19 +/- 0.03 vs 0.16 +/- 0.02, P < 0.05) and lateral DTI e/a peak velocity ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). The ratio of transmitral peak early diastolic velocity (E) to e in both lateral (4.72 +/- 1.20 vs 5.95 +/- 1.38, P = 0.007) and septal (3.90 +/- 0.80 vs 5.25 +/- 1.50, P = 0.002) side of mitral annulus were significantly lower in athletes. In Vp evaluation, we found higher Vp values (60.52 +/- 6.95 in athletes and 56.56 +/- 4.24 in controls, P = 0.03) in football players. Professional football playing is associated with morphologic alteration in left

  4. Off-pump anteroapical aneurysm plication following left ventricular postinfarction aneurysm: effect on cardiac function, clinical status and survival.

    Science.gov (United States)

    Huang, Xin-sheng; Gu, Cheng-xiong; Yang, Jun-feng; Wei, Hua; Li, Jing-xing; Zhou, Qi-wen

    2013-04-01

    In patients with coronary disease and aneurysm, ventricular reconstruction with revascularization is a surgical option. Details of patient selection and optimal surgical technique are still debated. We report our results with off-pump aneurysm plication after ventricular aneurysm with relative wall thinning. We retrospectively reviewed the records of 248 patients who had an operation for postinfarction left ventricular aneurysm. Reconstruction was accomplished by off-pump anteroapical aneurysm plication. The following variables were recorded: preoperative clinical, angiographic and echocardiographic findings and operative procedures. Outcomes were early mortality, long-term survival and poor 5-year result, defined as the need for transplantation or repeated hospitalization for congestive heart failure. Risk factors were pinpointed using the t test and survival curves. Independent risk factors were identified using Cox regression methods. Hospital mortality was low (2.0%). Mean follow-up was 5.8 (standard deviation [SD] 3.8) years. Actuarial survival at 1 and 5 years was 94% and 84%. Among the 232 survivors, 200 were in functional class I or II, and the average increase in ejection fraction was 14.0% (SD 3.1%). As determined by multivariable analysis, factors predicting poor outcome were advanced age, ejection fraction less than 0.35, conicity index less than 1, end-systolic volume index greater than 80 mL/m2, advanced New York Heart Association functional class and congestive heart failure. Using wall thinning as a criterion for patient selection, the technique of off-pump anteroapical aneurysm plication can be performed with low operative mortality and provides good symptomatic relief and long-term survival.

  5. Assessment of left ventricular diastolic function during trastuzumab treatment in patients with HER2-positive breast cancer.

    Science.gov (United States)

    Honda, Kazunori; Takeshita, Kyosuke; Murotani, Kenta; Mitsuma, Ayako; Hayashi, Hironori; Tsunoda, Nobuyuki; Kikumori, Toyone; Murohara, Toyoaki; Ando, Yuichi

    2017-03-01

    The ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e', E/e' ratio) as estimated by tissue Doppler imaging is a noninvasive surrogate for the left ventricular diastolic function. Because diastolic dysfunction usually precedes systolic dysfunction in cardiovascular diseases, we investigated whether monitoring the E/e' ratio can help to predict the risk of trastuzumab-induced cardiotoxicity. E/e' ratio on tissue Doppler imaging was retrospectively reviewed to assess its value for early detection of the left ventricular ejection fraction (LVEF) decline in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who received trastuzumab with or without cytotoxic chemotherapy. Echocardiography was performed at baseline and every 3 months after treatment began. Among 129 patients, LVEF declined in 25 (19 %) during trastuzumab treatment; the decline was grade 2 in 23 patients and grade 3 in 2. Elevation of the E/e' ratio to more than 15 was detected in 17 patients (13 %), 7 of whom (5.4 % of total) concurrently had LVEF decline. A weak negative correlation was observed between E/e' elevation and the worst LVEF decline (P = 0.0077), which was confirmed by multiple regression analysis (P = 0.023). E/e' ratio at baseline or 3 months after beginning trastuzumab treatment was not significantly associated with the subsequent LVEF decline. Monitoring of the left ventricular diastolic function on the basis of the E/e' ratio at baseline or 3 months after is unlikely to predict LVEF decline in patients who receive trastuzumab. However, there is a potential chronological relation between E/e' elevation and LVEF decline, implying that the degree of E/e' elevation could have a role as a surrogate marker for predicting the LVEF decline characteristic of trastuzumab-induced cardiotoxicity.

  6. Vagal Recovery From Cognitive Challenge Moderates Age-Related Deficits in Executive Functioning

    Science.gov (United States)

    Crowley, Olga V.; Kimhy, David; McKinley, Paula S.; Burg, Matthew M.; Schwartz, Joseph E.; Lachman, Margie E.; Tun, Patricia A.; Ryff, Carol D.; Seeman, Teresa E.; Sloan, Richard P.

    2015-01-01

    Decline in executive functioning (EF) is a hallmark of cognitive aging. We have previously reported that faster vagal recovery from cognitive challenge is associated with better EF. This study examined the association between vagal recovery from cognitive challenge and age-related differences in EF among 817 participants in the Midlife in the U.S. study (aged 35–86). Cardiac vagal control was measured as high-frequency heart rate variability. Vagal recovery moderated the association between age and EF (β = .811, p = .004). Secondary analyses revealed that older participants (aged 65–86) with faster vagal recovery had superior EF compared to their peers who had slower vagal recovery. In contrast, among younger (aged 35–54) and middle-aged (aged 55–64) participants, vagal recovery was not associated with EF. We conclude that faster vagal recovery from cognitive challenge is associated with reduced deficits in EF among older, but not younger individuals. PMID:26303063

  7. Two-dimensional right ventricular strain by speckle tracking for assessment of longitudinal right ventricular function after paediatric congenital heart disease surgery.

    Science.gov (United States)

    Karsenty, Clement; Hadeed, Khaled; Dulac, Yves; Semet, Florent; Alacoque, Xavier; Breinig, Sophie; Leobon, Bertrand; Acar, Philippe; Hascoet, Sebastien

    2017-03-01

    Right ventricular (RV) function is a prognostic marker of cardiac disease in children. Speckle tracking has been developed to assess RV longitudinal shortening, the dominant deformation during systole; little is known about its feasibility in children with congenital heart disease (CHD). To evaluate the feasibility and reproducibility of RV two-dimensional (2D) strain assessed by speckle tracking in infants undergoing CHD surgery compared with conventional markers. In this prospective single-centre study, RV peak systolic strain (RV-PSS) was measured using 2D speckle tracking in 37 consecutive children undergoing CHD surgery. Examinations were performed the day before surgery, a few hours after surgery and before discharge. Relationships with the z score of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TA Sa) were assessed. Median (interquartile range) age was 19 months (5-63); median weight was 9.2 kg (5.3-18.0). RV-PSS analysis was feasible in 92.9% (95% confidence interval [CI]: 86.0-97.1) of examinations. The coefficient of variation was 9.7% (95% CI: 7.4-11.9) for intraobserver variability and 15.1% (95% CI: 12.7-17.6) for interobserver variability. Correlations between RV-PSS and z score of TAPSE and TA Sa were strong (r=0.71, P<0.0001 and r=0.70, P<0.0001, respectively). RV-PSS was significantly reduced after surgery compared with baseline (-10.5±2.9% vs. -19.5±4.8%; P<0.0001) and at discharge (-13.5±4.0% vs. -19.5±4.8%; P<0.0001). Similar evolutions were observed with TAPSE and TA Sa (both P<0.0001). RV longitudinal strain by speckle tracking is a feasible and reproducible method of assessing perioperative evolution of RV function in children with CHD. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Intramyocardial Adipose-Derived Stem Cell Transplantation Increases Pericardial Fat with Recovery of Myocardial Function after Acute Myocardial Infarction.

    Directory of Open Access Journals (Sweden)

    Jong-Ho Kim

    Full Text Available Intramyocardial injection of adipose-derived stem cells (ASC with other cell types in acute myocardial infarction (AMI animal models has consistently shown promising clinical regenerative capacities. We investigated the effects of intramyocardial injections of mouse ASC (mASC with mouse endothelial cells (mEC on left ventricular function and generation of pericardial fat in AMI rats. AMI rat models were created by ligating left anterior descending coronary artery and were randomly assigned into four groups: control (n = 10, mASC (n = 10, mEC (n = 10 and mASC+mEC (n = 10 via direct intramyocardial injections, and each rat received 1x106 cells around three peri-infarct areas. Echocardiography and cardiac positron emission tomography (PET were compared at baseline and on 28 days after AMI. Changes in left ventricular ejection fraction measured by PET, increased significantly in mASC and mASC+mEC groups compared to mEC and control groups. Furthermore, significant decreases in fibrosis were confirmed after sacrifice on 28 days in mASC and mASC+mEC groups. Successful cell engraftment was confirmed by positive Y-Chromosome staining in the transplantation region. Pericardial fat increased significantly in mASC and mASC+mEC groups compared to control group, and pericardial fat was shown to originate from the AMI rat. mASC group expressed higher adiponectin and lower leptin levels in plasma than control group. In addition, pericardial fat from AMI rats demonstrated increased phospho-AMPK levels and reduced phospho-ACC levels. Intramyocardial mASC transplantation after AMI in rats increased pericardial fat, which might play a protective role in the recovery of myocardial function after ischemic myocardial damage.

  9. Echocardiographic assessment of left ventricular function in mitral regurgitation: is the dog a useful model of man?

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Pedersen, Henrik D; Häggström, Jens

    2014-01-01

    yxomatous mitral valve disease (MMVD) is the most common cause of primary mitral regurgitation in humans and the most common cardiac disease in dogs. Many similarities have been described and, therefore, the dog is considered to be a suitable natural model for MMVD in humans. Accurate...... identification of incipient myocardial deterioration is crucial to optimally time interventional surgery. Nonetheless, this issue is still an object of controversy. In this respect, studies of left ventricular (LV) function in dogs with MMVD could potentially be useful. The present review compares the results...... obtained in echocardiographic studies of LV function in humans and dogs with MMVD. Although different study designs pose a limitation and results within the two species are not entirely concordant, it appears that LV function is better preserved in small-sized and medium-sized dogs than in humans. This may...

  10. Validation of normal and pathologic right ventricular function using ultra-short-lived Krypton-81m

    Energy Technology Data Exchange (ETDEWEB)

    Nienaber, C.; Spielmann, R.; Wasmus, B.; Mathey, D.; Montz, R.; Bleifield, W.

    1984-01-01

    Measurement of right ventricular ejection fraction (RVEF) using conventional count-based, non-geometry dependent first-pass radionuclide techniques and technetium labelled compounds (T/2 = 6 hours) implies unnecessary whole body radiation and repeated injections of isotope for sequential RVEF estimate. Kr-81m (T/2 = 13 secs) continuously eluted in 5% glucose from a bed-side rubidium-81 generator is intravenously infused providing high count density and high photon flux for rapid imaging of the right-side chambers in ECG-gated equilibrium acquisition mode. A variable right anterior oblique projection is adjusted for optimal right atrio-ventricular separation. Left-sided heart and lung background is minimized by rapid decay and efficient exhalation of Kr-81m, requiring no algorithm for background correction. RV septal and free wall contours are aligned by a semiautomatic edge detection program; tricuspid and pulmonary valve planes are defined from phase images using variable ROIs to compensate for systolic valve plane motion. To cover a wide range of RVEF (13%-63%) both methods were compared in 10 normals, 11 patients (pts) with pulmonary hypertension (PH), 4 pts with RV outflow tract obstruction (RVOT-OB) and 4 pts with RV infarction (RV-MI) at rest (R) and during dynamic exercise (E). The paper concludes that equilibrium RV imaging using Kr-81m is an accurate and reproducible method with potential for serial assessment of RVEF in a variety of RV abnormalities both at R and during E. Advantages of this method include: extremely low radiation to patients, high photon flux for rapid imaging and clear atrio-ventricular separation without background.

  11. Induction of striatal neurogenesis enhances functional recovery in an adult animal model of neonatal hypoxic-ischemic brain injury.

    Science.gov (United States)

    Im, S H; Yu, J H; Park, E S; Lee, J E; Kim, H O; Park, K I; Kim, G W; Park, C I; Cho, S-R

    2010-08-11

    While intraventricular administration of epidermal growth factor (EGF) expands the proliferation of neural stem/progenitor cells in the subventricular zone (SVZ), overexpression of brain-derived neurotrophic factor (BDNF) is particularly effective in enhancing striatal neurogenesis. We assessed the induction of striatal neurogenesis and consequent functional recovery after chronic infusion of BDNF and EGF in an adult animal model of neonatal hypoxic-ischemic (HI) brain injury. Permanent brain damage was induced in CD-1 (ICR) mice (P7) by applying the ligation of unilateral carotid artery and hypoxic condition. At 6 weeks of age, the mice were randomly assigned to groups receiving a continuous 2-week infusion of one of the following treatments into the ventricle: BDNF, EGF, BDNF/EGF, or phosphate buffered saline (PBS). Two weeks after treatment, immunohistochemical analysis revealed an increase in the number of BrdU(+) cells in the SVZ and striata of BDNF/EGF-treated mice. The number of new neurons co-stained with BrdU and betaIII-tubulin was also significantly increased in the neostriata of BDNF/EGF-treated mice, compared with PBS group. In addition, the newly generated cells were expressed as migrating neuroblasts labeled with PSA-NCAM or doublecortin in the SVZ and the ventricular side of neostriata. The new striatal neurons were also differentiated as mature neurons co-labeled with BrdU(+)/NeuN(+). When evaluated post-surgical 8 weeks, BDNF/EGF-treated mice exhibited significantly longer rotarod latencies at constant speed (48 rpm) and under accelerating condition (4-80 rpm), relative to PBS and untreated controls. In the forelimb-use asymmetry test, BDNF/EGF-treated mice showed significant improvement in the use of the contralateral forelimb. In contrast, this BDNF/EGF-associated functional recovery was abolished in mice receiving a co-infusion of 2% cytosine-b-d-arabinofuranoside (Ara-C), a mitotic inhibitor. Induction of striatal neurogenesis by the

  12. Echocardiographic linear fractional shortening for quantification of right ventricular systolic function-A cardiac magnetic resonance validation study.

    Science.gov (United States)

    Srinivasan, Aparna; Kim, Jiwon; Khalique, Omar; Geevarghese, Alexi; Rusli, Melissa; Shah, Tara; Di Franco, Antonino; Alakbarli, Javid; Goldburg, Samantha; Rozenstrauch, Meenakshi; Devereux, Richard B; Weinsaft, Jonathan W

    2017-03-01

    Echocardiography (echo)-based linear fractional shortening (FS) is widely used to assess left ventricular dysfunction (LV dys ), but has not been systematically tested for right ventricular dysfunction (RV dys ). The population comprised LV dys patients with and without RV dys (EFstepwise vs CMR RVEF tertiles, as did FAC (all Panalysis, FS in RV OT (regression coefficient .51 [CI 0.37-0.65]), RV WD (0.30 [0.19-0.41]), and RV LG (0.45 [0.20-0.71]; all P≤.001) was independently associated with CMR RVEF. FS indices yielded good overall diagnostic performance (AUC: RV OT 0.89 [CI 0.82-0.97] | RV WD 0.87 [0.78-0.96] | RV LG 0.80 [0.70-0.90]; all Plinear FS provides RV functional indices that parallel CMR RVEF. Parasternal long-axis RV OT width, four-chamber RV width, and length are independently associated with RVEF, supporting use of multiple FS indices for RV functional assessment. © 2017, Wiley Periodicals, Inc.

  13. THE EFFECT OF AEROBIC CONTINUOUS TRAINING AND DETRAINING ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN MALE STUDENTS

    Directory of Open Access Journals (Sweden)

    Javad Mahdiabadi

    2017-04-01

    Full Text Available Purpose. Regular exercise training induces cardiac physiological hypertrophy. The aim of this study was to determine the effect of aerobic continuous training and a detraining period on left ventricular structure and function in non-athlete healthy men. Material. Ten untrained healthy male students (aged 18-22 years were volunteered and participated in countryside continuous jogging programme (3days/week, at 70% of Maximum Heart Rate for 45 min, 8-weeks and four weeks detraining afterwards. M-mode, 2-dimensional, colour and Doppler transthoracic echocardiography were performed, during resting conditions, before and after the training and after detraining period. Results. Using t-test, we found significant difference in end systolic diameter and the posterior wall thickness, percentage shortening and ejection fraction after eight weeks training compared to before training. It was found no significant difference in end diastolic diameter, interventricular septum thickness, left atrium diameter, aortic root diameter, heart rate, systolic and diastolic blood pressures. Following four weeks detraining after training, compared with eight weeks of training was a significant difference in end diastolic diameter, percentage shortening and ejection fraction and no significant difference in end systolic diameter, posterior wall thickness, interventricular septum thickness, left atrium diameter, aortic root diameter, heart rate, systolic and diastolic blood pressures. Conclusions. In general, eight-week aerobic continuous training and a detraining period can affect left ventricular structure and function.

  14. The Association of Long-Functioning Hemodialysis Vascular Access with Prevalence of Left Ventricular Hypertrophy in Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Aureliusz Kolonko

    2014-01-01

    Full Text Available Left ventricular hypertrophy (LVH is frequently observed in chronic dialysis patients and is also highly prevalent in kidney transplant recipients. This study evaluates the impact of long-functioning hemodialysis vascular access on LVH in single center cohort of kidney transplant recipients. 162 patients at 8.7 ± 1.8 years after kidney transplantation were enrolled. Echocardiography, carotid ultrasound, and assessment of pulse wave velocity were performed. LVH was defined based on left ventricular mass (LVM indexed for body surface area (BSA and height2.7. There were 67 patients with and 95 without patent vascular access. Both study groups were comparable with respect to gender, age, duration of dialysis therapy, and time after transplantation, kidney graft function, and cardiovascular comorbidities. Patients with patent vascular access were characterized by significantly elevated LVM and significantly greater percentage of LVH, based on LVMI/BSA (66.7 versus 48.4%, P=0.02. OR for LVH in patients with patent vascular access was 2.39 (1.19–4.76, P=0.01. Regression analyses confirmed an independent contribution of patent vascular access to higher LVM and increased prevalence of LVH. We concluded that long-lasting patent hemodialysis vascular access after kidney transplantation is associated with the increased prevalence of LVH in kidney transplant recipients.

  15. Noninvasive evaluation of global and regional left ventricular function using computed tomography and magnetic resonance imaging: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kaniewska, Malwina; Schuetz, Georg M.; Willun, Steffen; Dewey, Marc [Charite - Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Schlattmann, Peter [Jena University Hospital, Department of Medical Statistics, Informatics and Documentation, Jena (Germany)

    2017-04-15

    To compare the diagnostic accuracy of computed tomography (CT) in the assessment of global and regional left ventricular (LV) function with magnetic resonance imaging (MRI). MEDLINE, EMBASE and ISI Web of Science were systematically reviewed. Evaluation included: ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and left ventricular mass (LVM). Differences between modalities were analysed using limits of agreement (LoA). Publication bias was measured by Egger's regression test. Heterogeneity was evaluated using Cochran's Q test and Higgins I{sup 2} statistic. In the presence of heterogeneity the DerSimonian-Laird method was used for estimation of heterogeneity variance. Fifty-three studies including 1,814 patients were identified. The mean difference between CT and MRI was -0.56 % (LoA, -11.6-10.5 %) for EF, 2.62 ml (-34.1-39.3 ml) for EDV and 1.61 ml (-22.4-25.7 ml) for ESV, 3.21 ml (-21.8-28.3 ml) for SV and 0.13 g (-28.2-28.4 g) for LVM. CT detected wall motion abnormalities on a per-segment basis with 90 % sensitivity and 97 % specificity. CT is accurate for assessing global LV function parameters but the limits of agreement versus MRI are moderately wide, while wall motion deficits are detected with high accuracy. (orig.)

  16. Recovery of semantic word processing in global aphasia: a functional MRI study.

    Science.gov (United States)

    Zahn, Roland; Drews, Eva; Specht, Karsten; Kemeny, Stefan; Reith, Wolfgang; Willmes, Klaus; Schwarz, Michael; Huber, Walter

    2004-02-01

    One important issue concerning the recovery of higher cognitive functions-such as word comprehension in aphasia-is to what extent impairments can be compensated for by intact parts of the network of areas normally involved in a closely related function ("redundancy recovery"). In a previous functional MRI investigation, we were able to show that left hemispheric redundancy recovery within a distributed system of related lexical-semantic functions was the most probable basis of recovery of comprehension from transcortical sensory aphasia. The question remained, however, whether redundancy recovery may play a more general role in the recovery of comprehension after large left hemispheric lesions and severe aphasia. We had the possibility, using the same fMRI paradigm, to study seven cases with left middle cerebral artery (MCA) infarction and partial recovery of comprehension > or =6 months after presentation with global aphasia on acute assessment. Lateralization of activation did not differ significantly between patients and controls. The most consistent regions of activation included the left extrasylvian posterior temporal and the right posterior parietal cortex. Recovery of language comprehension was associated predominantly with activations in regions, which were also activated in several normal subjects. We suggest that a redundancy recovery mechanism within multiple representations of closely related functions was more important than take-over of function by previously unrelated areas (vicariation) as the basis of recovery of word comprehension in our patients in spite of extensive left hemispheric damage. We conclude that redundancy within the lexical-semantic system seems to make an important contribution to recovery of comprehension even in severe aphasia.

  17. The impact of a hyperdynamic left ventricle on right ventricular function measurements in preterm infants with a patent ductus arteriosus.

    Science.gov (United States)

    Breatnach, Colm R; Franklin, Orla; James, Adam T; McCallion, Naomi; El-Khuffash, Afif

    2017-09-01

    Right ventricular (RV) functional assessment in premature infants includes basal longitudinal strain (RV BLS), RV systolic tissue Doppler velocity (RV s'), tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (FAC). A hyperdynamic left ventricle (LV) may influence RV measures of displacement (TAPSE) and velocity (RV s') but not measures of relative change of length (RV BLS) or area (FAC). We aimed to explore this hypothesis in preterm infants with a patent ductus arteriosus (PDA). We measured LV function (ejection fraction (LV EF); left ventricular output) and RV function (RV BLS; RV s'; TAPSE; FAC) on days 1, 2 and 5-7 in infants function measurements were compared between the groups using two-way analysis of variance with repeated measures. 121 infants with a mean (SD) gestation and birth weight of 26.8 (1.4) weeks and 968 (250) g were enrolled. By days 5-7, the PDA remained open in 83 (69%), with evidence of hyperdynamic LV function. There was no difference in RV s' (5.3 (0.9) vs 5.1 (1.0) cm/s, p=0.3) or TAPSE (6.2 (1.3) vs 6.1 (1.2) mm, p=0.7) between infants with and without a PDA, but infants in the PDA group had lower RV FAC (41 (8) vs 47 (10) %, pfunctional parameters must be taken into account when interpreting of RV function using those techniques. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Prediction of improvement in left ventricular function with iodine-123-IPPA after coronary revascularization.

    Science.gov (United States)

    Hansen, C L; Heo, J; Oliner, C; Van Decker, W; Iskandrian, A S

    1995-11-01

    Iodine-123-phenylpentadecanoic acid (IPPA) is a synthetic fatty acid suitable for myocardial imaging. This study is the result of a Phase I/II trial to evaluate IPPA's ability to predict functional recovery in patients undergoing coronary revascularization. Twenty-three patients with documented coronary disease underwent sequential SPECT imaging with IPPA before and radionuclide ventriculography both before and 8 wk after revascularization. Software was developed to evaluate myocardial IPPA metabolism and to determine the fraction of the left ventricle with intermediate metabolism. There was a significant correlation between initial IPPA uptake and final LVEF. The fractional area of the left ventricle demonstrating IPPA metabolism in the intermediate metabolic range was significantly higher in patients who demonstrated a 5% or greater increase in EF after revascularization (0.90 +/- 0.08 versus 0.78 +/- 0.17, p = 0.04). When only the patients who received complete revascularization were evaluated, there was a more significant difference (improved 0.92 +/- 0.05 versus 0.74 +/- 0.17, p = 0.011). Taking a lower limit of 1 s.d. from the mean, (87%) the six patients who had > or = 5% increase in LVEF after revascularization had more than 87% of the left ventricle in the intermediate metabolic range, whereas seven of ten patients whose change in LVEF was < 5% had less than 87% in the intermediate metabolic range (p = 0.011). In this initial experience, the amount of myocardium in the intermediate metabolic range is associated with improvement in LVEF after revascularization, especially in patients receiving complete revascularization.

  19. Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord Injury

    Science.gov (United States)

    2015-10-01

    therapy maneuvers involving force or torque applied to specific muscle groups) on functional recovery after spinal cord injury in a rat model. We have...animals show a similar time course of recovery. Finally, in very preliminary studies, we have found that the torque being applied during stretching of...situation. Key Words: spinal cord injury, locomotor recovery, physical therapy, muscle stretch, joint range- of-motion, rat. Overall Project Summary

  20. The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction.

    Science.gov (United States)

    Kocaman, Sinan Altan; Taçoy, Gülten; Ozdemir, Murat; Açıkgöz, Sadık Kadri; Cengel, Atiye

    2010-12-01

    Autonomic dysfunction is an important marker of prognosis in congestive heart failure (CHF) and may determine the symptoms and progression of CHF. The aim of our study was to investigate whether preserved autonomic function assessed by heart rate variability (HRV) analyses is related to absence of CHF symptoms despite prominently reduced systolic function. The study had a cross-sectional observational design. Fifty patients with left ventricular ejection fraction (EF) below 40% were enrolled. The patients were divided into two groups according to their CHF symptomatic status as Group 1 (NYHA functional class I, asymptomatic group) and Group 2 (NYHA functional class ≥ II, symptomatic group). Plasma C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) levels, echocardiographic parameters and HRV indices were measured while the patients were clinically stable in each group. Possible factors associated with the development of CHF symptoms were assessed by using multiple regression analysis. Baseline clinical characteristics and left ventricular EF were similar in the two groups. Serum CRP (15 ± 21 vs 7 ± 18 mg/L, p=0.011) and NT-proBNP levels (1935 ± 1088 vs 1249 ± 1083 pg/mL, p=0.020) were significantly higher in symptomatic group. The HRV parameters (SDNN: 78 ± 57 vs 122 ± 42 ms, p=0.001; SDANN: 65 ± 55 vs 84 ± 38 ms, p=0.024; SDNNi: 36 ± 41 vs 70 ± 46 ms, p<0.001; triangular index [Ti]: 17 ± 12 vs 32 ± 14, p<0.001) were also significantly depressed in symptomatic group. When multiple regression analysis was performed, only HRV indices of autonomic function were significantly associated with the asymptomatic status (SDNN, OR: 1.016, 95%CI: 1.002-1.031, p=0.028; SDNNi, OR: 1.030, 95%CI: 1.008-1.052, p=0.006; TI, OR: 1.088, 95%CI: 1.019-1.161, p=0.011). Preserved autonomic functions were shown to be associated with absence of CHF symptoms independently of angiotensin converting enzyme inhibitor/angiotensin receptor blocker

  1. Interobserver agreement on the echocardiographic parameters that estimate right ventricular systolic function in the early postoperative period of cardiac surgery.

    Science.gov (United States)

    Olmos-Temois, S G; Santos-Martínez, L E; Álvarez-Álvarez, R; Gutiérrez-Delgado, L G; Baranda-Tovar, F M

    2016-11-01

    To know the variability of transthoracic echocardiographic parameters that assess right ventricular systolic function by analyzing interobserver agreement in the early postoperative period of cardiovascular surgery. To assess the feasibility of these echocardiographic measurements. A cross-sectional study, double-blind pilot study was carried out from May 2011 to February 2013. Cardiovascular postoperative critical care at the National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico. Consecutive, non-probabilistic sampling. Fifty-six patients were studied in the postoperative period of cardiac surgery. The first echocardiographic parameters were obtained between 6-8hours after cardiac surgery, followed by blinded second measurements. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity on tissue Doppler imaging (VSPAT), diameters and right ventricular outflow area, tract fractional shortening. The agreement was analyzed by the Bland-Altman method, and its magnitude was assessed by the intraclass correlation coefficient (95% confidence interval). Both observers evaluated TAPSE and VSPAT in 48 patients (92%). The average TAPSE was 11.68±4.53mm (range 4-27mm). Right ventricular systolic dysfunction was observed in 41 cases (85%) and normal TAPSE in 7 patients (15%). The average difference and its limits according to TAPSE were -0.917±2.95 (-6.821, 4.988), with a magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic velocity on tissue Doppler imaging was -0.001±0.015 (-0.031, 0.030), and its magnitude 0.825 (0.708, 0.898), respectively. VSPAT and TAPSE were estimated by both observers in 92% of the patients, these parameters exhibiting the lowest interobserver variability. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  2. Exacerbated pulmonary arterial hypertension and right ventricular hypertrophy in animals with loss of function of extracellular superoxide dismutase.

    Science.gov (United States)

    Xu, Dachun; Guo, Haipeng; Xu, Xin; Lu, Zhongbing; Fassett, John; Hu, Xinli; Xu, Yawei; Tang, Qizhu; Hu, Dayi; Somani, Arif; Geurts, Aron M; Ostertag, Eric; Bache, Robert J; Weir, E Kenneth; Chen, Yingjie

    2011-08-01

    Studies have demonstrated that increased oxidative stress contributes to the pathogenesis and the development of pulmonary artery hypertension (PAH). Extracellular superoxide dismutase (SOD3) is essential for removing extracellular superoxide anions, and it is highly expressed in lung tissue. However, it is not clear whether endogenous SOD3 can influence the development of PAH. Here we examined the effect of SOD3 knockout on hypoxia-induced PAH in mice and a loss-of-function SOD3 gene mutation (SOD3(E124D)) on monocrotaline (40 mg/kg)-induced PAH in rats. SOD3 knockout significantly exacerbated 2 weeks of hypoxia-induced right ventricular (RV) pressure and RV hypertrophy, whereas RV pressure in SOD3 knockout mice under normoxic conditions is similar to wild-type controls. In untreated control rats at age of 8 weeks, there was no significant difference between wild-type and SOD3(E124D) rats in RV pressure and the ratio of RV weight:left ventricular weight (0.25±0.02 in wild-type rats versus 0.25±0.01 in SOD3(E124D) rats). However, monocrotaline caused significantly greater increases of RV pressure in SOD3(E124D) rats (48.6±1.8 mm Hg in wild-type versus 57.5±3.1 mm Hg in SOD3(E124D) rats), of the ratio of RV weight:left ventricular weight (0.41±0.01 versus 0.50±0.09; Prats (55.2±2.3% versus 69.9±2.6%; P<0.05). Together, these findings indicate that the endogenous SOD3 has no role in the development of PAH under control conditions but plays an important role in protecting the lung from the development of PAH under stress conditions.

  3. Structural and functional reorganization of propriospinal connections promotes functional recovery after spinal cord injury

    Directory of Open Access Journals (Sweden)

    Linard Filli

    2015-01-01

    Full Text Available Axonal regeneration and fiber regrowth is limited in the adult central nervous system, but research over the last decades has revealed a high intrinsic capacity of brain and spinal cord circuits to adapt and reorganize after smaller injuries or denervation. Short-distance fiber growth and synaptic rewiring was found in cortex, brain stem and spinal cord and could be associated with restoration of sensorimotor functions that were impaired by the injury. Such processes of structural plasticity were initially observed in the corticospinal system following spinal cord injury or stroke, but recent studies showed an equally high potential for structural and functional reorganization in reticulospinal, rubrospinal or propriospinal projections. Here we review the lesion-induced plastic changes in the propriospinal pathways, and we argue that they represent a key mechanism triggering sensorimotor recovery upon incomplete spinal cord injury. The formation or strengthening of spinal detour pathways bypassing supraspinal commands around the lesion site to the denervated spinal cord were identified as prominent neural substrate inducing substantial motor recovery in different species from mice to primates. Indications for the existence of propriospinal bypasses were also found in humans after cortical stroke. It is mandatory for current research to dissect the biological mechanisms underlying spinal circuit remodeling and to investigate how these processes can be stimulated in an optimal way by therapeutic interventions (e.g., fiber-growth enhancing interventions, rehabilitation. This knowledge will clear the way for the development of novel strategies targeting the remarkable plastic potential of propriospinal circuits to maximize functional recovery after spinal cord injury.

  4. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery.

    Directory of Open Access Journals (Sweden)

    Leela K Lella

    Full Text Available The significance of right ventricular ejection fraction (RVEF, independent of left ventricular ejection fraction (LVEF, following isolated coronary artery bypass grafting (CABG and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR, independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered 30 days outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.Forty-eight patients had reduced RVEF (mean 25% and 61 patients had normal RVEF (mean 50% (p<0.001. Fifty-four patients had reduced LVEF (mean 30% and 55 patients had normal LVEF (mean 59% (p<0.001. Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05. Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03. Reduced LVEF did not influence long-term cardiac re-hospitalization.Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.

  5. Left Ventricular Longitudinal Function Assessed by Speckle Tracking Ultrasound from a Single Apical Imaging Plane

    Directory of Open Access Journals (Sweden)

    Thomas Bagger

    2012-01-01

    Full Text Available Background. Transthoracic ultrasonography of the heart is valuable in monitoring and treatment of critically ill patients. Speckle tracking ultrasound (STU has proven valid in estimating left ventricular systolic deformation. The aims of the study were to compare conventional and automated STU and to determine whether left ventricular systolic deformation could be estimated from one single imaging plane. Methods. 2D-echocardiography cine-loops were obtained from 20 patients for off-line speckle tracking analysis, consisting of manually tracing of the endocardial border (conventional method or automatically drawn boundaries (automated method. Results. We found a bias of 0,6 (95% CI −2.2−3.3 for global peak systolic strain comparing the automated and the conventional method. Comparing global peak systolic strain of apical 4-chamber cine-loops with averaged Global Peak Strain obtained from apical 4, 2 and long axis cine-loops, showed a bias of 0.1 (95% CI −3.9−4.0. The agreement between subcostal 4-chamber and apical 4-chamber global peak systolic strain was 4.4 (95% CI −3.7−12.5. Conclusion. We found good agreement between the conventional and the automated method. STU applied to single apical 4-chamber cine-loops is in excellent agreement with overall averaged global peak systolic strain, while subcostal 4-chamber cine-loops proved less compliant with speckle tracking ultrasound.

  6. 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.

  7. Left Ventricular Longitudinal Systolic Function in Septic Shock Patients with Normal Ejection Fraction: A Case-control Study.

    Science.gov (United States)

    Zhang, Hong-Min; Wang, Xiao-Ting; Zhang, Li-Na; He, Wei; Zhang, Qing; Liu, Da-Wei

    2017-05-20

    Septic cardiomyopathy is a common finding in septic shock patients. The accepted definition of septic cardiomyopathy is often based on the left ventricular ejection fraction (LVEF). The aim of this study was to determine whether the left ventricular longitudinal systolic function was more sensitive than the LVEF in heart function appraisal of septic shock patients. This was a case-control study conducted at a 40-bed Intensive Care Unit (ICU) of Peking Union Medical College Hospital. Septic shock patients admitted to the ICU were consecutively enrolled in the study group from March 1, 2016 to September 1, 2016. The control group was selected from nonsepsis patients who were admitted to the ICU and were comparable to the study group. Transthoracic echocardiography was performed to obtain the LVEF measurement, mitral annular plane systolic excursion (MAPSE), tissue Doppler velocity measurement of mitral annulus (Sa), and tricuspid annular plane systolic excursion. The study group consisted of 45 septic shock patients. Another 45 nonsepsis patients were selected as the control group. There was no difference in the LVEF between the two groups (64.6% vs. 67.2%, t= -1.426, P= 0.161). MAPSE in the study group was much lower than in the control group (1.2 cm vs. 1.5 cm, t= -4.945, Pstudy group was also lower than in the control group (10.2 cm/s vs. 11.8 cm/s, t = -2.796, P= 0.014). Compared to the LVEF, longitudinal systolic function might be more sensitive in the detection of cardiac depression in septic shock patients. In the heart function appraisal of septic shock patients with a normal ejection fraction, more attention should be given to longitudinal function parameters such as MAPSE and Sa.

  8. [Evaluation of left ventricular diastolic function by TE-e' measurement using dual Doppler echocardiography in coronary heart disease patients with preserved systolic function].

    Science.gov (United States)

    Wang, Jingjing; Chen, Yundai; Wang, Jing; Zhi, Guang; Mu, Yang; Xu, Yong

    2014-03-01

    To evaluate the accuracy of the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e') measured by dual Doppler echocardiography in the diagnosis of diastolic dysfunction. Seventy-seven coronary heart disease patients with preserved systolic function underwent a echocardiographic study. Early transmitral flow velocity E and early diastolic mitral annular velocity e' were simultaneously recorded by dual Doppler echocardiography. The E/e' and TE-e' were calculated and compared with the left ventricular end diastolic pressure (LVEDP), which was measured invasively. The validity of TE-e', E/e' and their combination was analyzed in estimating left ventricular dysfunction (LVEDP ≥12 mmHg). The single-beat E/e' and TE-e' were correlated with the LVEDP (r=0.79 and 0.42, respectively, PTE-e' was 38 ms (sensitivity 54%, specificity 79%, AUC 0.71) and that for E/e' was 9.2 (sensitivity 74%, specificity 81%, AUC 0.87) for diagnosis of left ventricular diastolic dysfunction. The combined cut-offs of TE-e'≥38 ms and E/e'≥9.2 had a sensitivity of 100% and a specificity of 62% in diagnosing left ventricular diastolic dysfunction with an AUC of 0.96. In patients with coronary heart disease, the simultaneous recording of TE-e' by dual Doppler echocardiography can accurately estimate diastolic dysfunction, and its combination with E/e' can further improve the diagnostic accuracy.

  9. The sigma-1 receptor enhances brain plasticity and functional recovery after experimental stroke

    DEFF Research Database (Denmark)

    Ruscher, Karsten; Shamloo, Mehrdad; Rickhag, Karl Mattias

    2011-01-01

    Stroke leads to brain damage with subsequent slow and incomplete recovery of lost brain functions. Enriched housing of stroke-injured rats provides multi-modal sensorimotor stimulation, which improves recovery, although the specific mechanisms involved have not been identified. In rats housed in ...

  10. Integrated versus sealed-over recovery in schizophrenia: BORRTI and executive function.

    Science.gov (United States)

    Bell, Morris D; Zito, Wayne

    2005-01-01

    Ego functioning of 222 outpatients with a diagnosis of schizophrenia or schizoaffective disorder was evaluated using the Bell Object Relations and Reality Testing Inventory (BORRTI). Sixty-one of these had BORRTI profiles identified as sealed-over recovery style, and 36 had profiles interpreted as integrated recovery style. Groups were compared on demographic characteristics, symptom profiles, and the Wisconsin Card Sorting Test, a performance measure of executive function. Groups had comparably low levels of positive symptoms, but the integrated recovery group had higher scores on the BORRTI uncertainty of perception scale. The integrated recovery group had significantly fewer minority patients, higher IQ, and higher levels of emotional discomfort. The sealed-over recovery group had higher levels of cognitive disorganization. When differences in ethnicity and IQ were controlled for, the integrated recovery group had better executive functioning. Wisconsin Card Sorting Test categories completed emerged as the significant predictor in a logistic regression, explaining 19% of the variance. These findings support the discriminant validity of these two recovery styles and reveal the importance of executive function in a recovery style that allows for investment in relationships, affect tolerance, and acknowledgment of symptoms.

  11. Effect of Commiphora mukul extract on cardiac dysfunction and ventricular function in isoproterenol-induced myocardial infarction.

    Science.gov (United States)

    Ojha, Shreesh K; Nandave, Mukesh; Arora, Sachin; Mehra, Raj D; Joshi, Sujata; Narang, Rajiv; Arya, D S

    2008-09-01

    In present study, hydroalcoholic extract of C. mukul significantly improved the cardiac function and prevented myocardial ischemic impairment manifested in the form of increased heart rate, decreased arterial pressure, increased left ventricular end diastolic pressure, and altered myocardial contractility indices. C. mukul treatment additionally also produced a significant increase in lactate dehydrogenase levels and prevented decline of protein content in heart. C. mukul preserved the structural integrity of myocardium. Reduced leakage of myocyte enzyme lactate dehydrogenase and maintenance of structural integrity of myocardium along with favorable modulation of cardiac function and improved cardiac performance indicate the salvage of myocardium with C. mukul treatment. Guggulsterones which are considered to be responsible for most of the therapeutic properties of C. mukul may underlie the observed cardioprotective effect of C. mukul against cardiac dysfunction in isoproterenol-induced ischemic rats.

  12. Right ventricular function assessed by tissue Doppler echocardiography in older subjects without evidence for structural cardiac disease.

    Science.gov (United States)

    Laszlo, Roman; Baumann, Tobias; Konz, Hanna; Dallmeier, Dhayana; Klenk, Jochen; Denkinger, Michael; Koenig, Wolfgang; Rothenbacher, Dietrich; Steinacker, Juergen Michael

    2017-06-01

    The aim of our study was to obtain right ventricular (RV) tissue Doppler imaging (TDI) data in older subjects (n = 95, mean age: 74.5 ± 4.6 years) without evidence of hemodynamically significant structural heart disease recruited from a large population-based cohort (ActiFE-Ulm study). Our data indicate that aging may be accompanied by decreasing RV diastolic function and at most little alterations of RV systolic function. Mean values of all parameters were still within the guideline-suggested reference range with most of them closer to the abnormality thresholds. On an individual basis, respective thresholds were also exceeded in some subjects (almost all parameters right heart.

  13. Changes in left ventricular systolic function in patients with chronic heart failure with preserved ejection fraction and cardiorenal anemic syndrome

    Directory of Open Access Journals (Sweden)

    Vasylenko V.A.

    2015-09-01

    Full Text Available The feature of chronic heart failure (CHF in elderly people is increasing incidence of heart failure with preserved left ventricular ejection fraction (LVEF which is associated with age. Such patients account for almost half of the total number of patients with heart failure. Cardiorenal syndrome (CRS is associated with an increased risk of mortality in patients with CHF. The impact of CRS on the structural and functional condition of the heart in these patients is studied insufficiently. The study involved 103 patients with CHF II-IV NYHA with preserved LVEF (>45% and CRS (hemoglobin <120 g/l and function, namely by the increase of end-systolic volume and decrease in the degree of LV fractional shortening size.

  14. Mitral valve annuloplasty rings: review of literature and comparison of functional outcome and ventricular dimensions.

    Science.gov (United States)

    Khamooshian, Arash; Buijsrogge, Marc P; de Heer, Frederiek; Gründeman, Paul F

    2014-01-01

    In the past decades, more than 40 mitral valve annuloplasty rings of various shapes and consistency were marketed for mitral regurgitation (MR), although the effect of ring type on clinical outcome remains unclear. Our objective was to review the literature and apply a simplification method to make rings of different shapes and rigidity more comparable. We studied relevant literature from MEDLINE and EMBASE databases related to clinical studies as well as animal and finite element models. Annuloplasty rings were clustered into 3 groups as follows: rigid (R), flexible (F), and semirigid (S). Only clinical articles regarding degenerative (DEG) or ischemic/dilated cardiomyopathy (ICM) MR were included and stratified into these groups. A total of 37 rings were clustered into R, F, and S subgroups. Clinical studies with a mean follow-up of less than 1 year and a reported mean etiology of valve incompetence of less than 60% were excluded from the analysis. Forty-one publications were included. Preimplant and postimplant end points were New York Heart Association class, left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), and left ventricular end-diastolic dimension (LVEDD). Statistical analysis included paired-samples t test and analysis of variance with post hoc Bonferroni correction. P < 0.05 indicated statistical difference. Mean ± SD follow-up was 38.6 ± 27 and 29.7 ± 13.2 months for DEG and ICM, respectively. In DEG, LVEF remained unchanged, and LVESD decreased in all subgroups. In our analysis, LVEDD decreased only in F and R, and S did not change; however, the 4 individual studies showed a significant decline. In ICM, New York Heart Association class improved in all subgroups, and LVEF increased. Moreover, LVESD and LVEDD decreased only in F and S; R was underpowered (1 study). No statistical difference among R, F, and S in either ICM or DEG could be detected for all end points. Overall, owing to underpowered data sets

  15. Right ventricular function during one-lung ventilation: effects of pressure-controlled and volume-controlled ventilation.

    Science.gov (United States)

    Al Shehri, Abdullah M; El-Tahan, Mohamed R; Al Metwally, Roshdi; Qutub, Hatem; El Ghoneimy, Yasser F; Regal, Mohamed A; Zien, Haytham

    2014-08-01

    To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function. A prospective, randomized, double-blind, controlled, crossover study. A single university hospital. Fourteen pairs of consecutive patients scheduled for elective thoracotomy. Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia. Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (p<0.001) and compliance and lower ESV, EDV and airway pressures (p<0.05) than during the use of VCV. Oxygenation indices were similar during the use of VCV and PCV. The use of PCV offers more improved RV function than the use of VCV during OLV for open thoracotomy. These results apply specifically to younger patients with good ventricular and pulmonary functions. © 2014 Elsevier Inc. All rights reserved.

  16. Accuracy of contrast-enhanced cine-MR sequences in the assessment of left ventricular function: comparison with precontrast cine-MR sequences. Results of a bicentric study

    Energy Technology Data Exchange (ETDEWEB)

    Lasalarie, Jean-Christophe; Carre, Christophe [Centre Hospitalier Sud Reunion, Department of Radiology, Saint-Pierre (France); Serfaty, Jean-Michel; Schouman-Claeys, Elisabeth; Laissy, Jean-Pierre [Hopital Bichat AP-HP, Department of Radiology, Paris Cedex 18 (France); Messika-Zeitoun, David [Hopital Bichat, Department of Cardiology, Paris Cedex 18 (France); Jeannot, Christophe [Centre Hospitalier Sud Reunion, Department of Cardiology, Saint-Pierre (France)

    2007-11-15

    The accuracy of contrast-enhanced cine magnetic resonance (cine-MR) imaging to determine left ventricular function was assessed by comparison with the established noncontrast cine-MR sequences. Contrast-enhanced balanced steady-state free precession (cine-SSFP) sequences were compared with precontrast cine-SSFP sequences in the assessment of left ventricular contractile function in 30 consecutive patients with various cardiac diseases. Five to eight short-axis image sections were obtained in each patient. Quantitative data were analyzed using a paired t-test and linear regression analysis. Qualitative assessment of images was made following a 16-segment analysis. There was no significant difference between the two sequences in regional wall motion, end-diastolic volumes (EDV) and end-systolic volumes (ESV), stroke volume, left ventricular mass, as well as left ventricular ejection fraction (LVEF), despite slight delayed subendocardial enhancement in ten patients with myocardial infarction. All the values studied above were closely correlated between both cine-SSFP sequences (Spearman r=0.85-0.97, P<0.0001 for all comparisons). Contrast-enhanced cine-SSFP sequences can be used as a similar diagnostic tool as precontrast cine-MR sequences in the assessment of left ventricular contractile function. (orig.)

  17. Prediction of functional recovery in patients with myocardial infarction after revascularization. Comparison of low-dose dobutamine stress echocardiography with fluorine-18 fluorodeoxyglucose positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tani, Tomoko; Teragaki, Masakazu; Watanabe, Hiroyuki; Muro, Takashi; Yamagishi, Hiroyuki; Akioka, Kaname; Takeuchi, Kazuhide; Yoshikawa, Junichi [Osaka City Univ. (Japan). Medical School

    2001-03-01

    The present study investigated the agreement between low-dose dobutamine stress echocardiography (LDDSE) and fluorine-18 fluorodeoxyglusose positron emission tomography (FDG-PET) and compared each technique's ability to detect myocardial viability and predict functional recovery in 30 patients. All patients underwent revascularization, followed by echocardiography 5{+-}3 months. Of the 390 segments analyzed by echocardiography before revascularization, 110 (28%) had abnormal wall motion. LDDSE showed viability in 66 sites of the 110 dyssynergic segments and 58 of these viable segments recovered their wall motion. With FDG-PET, 78 of the 110 dyssynergic segments were diagnosed as viable and 62 of these showed improvement of the wall motion. The sensitivities for LDDSE and FDG-PET to assess functional recovery were 84% and 90%, respectively; specificities were 80% and 64%, respectively. Positive predictive values for LDDSE and FDG-PET were 88% and 79%; negative predictive values were 75% and 78%, respectively. Both methods had good sensitivity for detecting improvement in regional function after revascularization, but LDDSE had a higher specificity for detecting viability and a better positive predictive value for left ventricular functional recovery. (author)

  18. Enhancing Propriospinal Relays to Improve Functional Recovery after SCI

    Science.gov (United States)

    2016-10-01

    time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this...information will allow us to determine in plasticity rostral to the injury site participates in the recovery. However, corticospinal axons could sprouting...400,000 patients with SCI in the United States. Experimental therapies to treat SCI have focused on approaches that promote neural regeneration, but

  19. Exercise-Induced Ventricular Fibrillation: Seven Years Follow-Up

    Directory of Open Access Journals (Sweden)

    Gökmen Gemici

    2011-11-01

    Full Text Available We present a 7-year follow-up of a 55-year-old male who experienced ventricular fibrillation during the recovery period of exercise testing and refused implantation of an ICD. Normal left ventricular systolic function was found on echocardiographic examination, and coronary angiography revealed only a side branch disease with a vessel diameter of less than 2 millimeters. The patient was discharged on metoprolol and ASA in addition to his previous treatment with lisinopril and simvastatin. Outpatient cardiac evaluation by repeated 24-hour ECG monitorizations (Holter revealed normal findings. On follow up visits every six months for the past seven years, the patient was found to be asymptomatic.

  20. Evaluation of a miniature CdTe detector for monitoring left ventricular function.

    Science.gov (United States)

    Harrison, K S; Liu, X; Han, S T; Camargo, E E; Wagner, H N

    1982-01-01

    A miniature CdTe probe interfaced to a microcomputer was used to measure left ventricular ejection fraction (LVEF) in 25 patients. LVEF obtained with the CdTe module, in the beat-to-beat mode, or the integrated gated mode agreed well with LVEF obtained with a gamma camera (r = 0.80; r = 0.82 respectively). Similarly, LVEF by CdTe probe agreed with LVEF obtained by gated equilibrium studies performed with a computerized NaI probe. The CdTe probe can provide comparable measurement of LVEF at a fraction of the cost of a camera-computer system and, being small and lightweight, the CdTe probe is adaptable for monitoring patients in intensive care facilities.

  1. Consequences of obstructive sleep apnoea syndrome on left ventricular geometry and diastolic function.

    Science.gov (United States)

    Bodez, Diane; Damy, Thibaud; Soulat-Dufour, Laurie; Meuleman, Catherine; Cohen, Ariel

    2016-01-01

    Obstructive sleep apnoea syndrome (OSAS) is a frequent sleep disorder that is known to be an independent risk factor for arterial hypertension (AHT). Potential confounding factors associated with both OSAS and AHT, such as age, diabetes mellitus and obesity, have been explored extensively, and are considered as independent but additive factors. However, these factors are also contributors to left ventricular (LV) hypertrophy (LVH) and LV diastolic dysfunction, both of which are important causes of cardiovascular morbidity, and have been reported to be associated with OSAS for decades. In this review, we present an overview of how OSAS may promote changes in LV geometry and diastolic dysfunction through its best-known cardiovascular complication, arterial hypertension. We also summarize the epidemiological links between OSAS and LVH, outline diastolic dysfunction in OSAS patients, and try to highlight the mechanisms responsible, focusing on the effect of confounding factors. Copyright © 2016. Published by Elsevier Masson SAS.

  2. Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Schantz, Daryl I. [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); University of Manitoba, Variety Children' s Heart Centre, Winnipeg, MB (Canada); Dragulescu, Andreea [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); Memauri, Brett [University of Manitoba, Department of Radiology, St. Boniface General Hospital, Winnipeg, MB (Canada); Grotenhuis, Heynric B. [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); Wilhelmina Children' s Hospital, Utrecht (Netherlands); Seed, Mike; Grosse-Wortmann, Lars [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

    2016-10-15

    Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. To evaluate the effects of volume administration on cardiac chamber volumes. Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a ''variable'' that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient. (orig.)

  3. Associations among left ventricular systolic function, tachycardia, and cardiac preload in septic patients.

    Science.gov (United States)

    Lanspa, Michael J; Shahul, Sajid; Hersh, Andrew; Wilson, Emily L; Olsen, Troy D; Hirshberg, Eliotte L; Grissom, Colin K; Brown, Samuel M

    2017-12-01

    In sepsis, tachycardia may indicate low preload, adrenergic stimulation, or both. Adrenergic overstimulation is associated with septic cardiomyopathy. We sought to determine whether tachycardia was associated with left ventricular longitudinal strain, a measure of cardiac dysfunction. We hypothesized an association would primarily exist in patients with high preload. We prospectively observed septic patients admitted to three study ICUs, who underwent early transthoracic echocardiography. We measured longitudinal strain using speckle tracking echocardiography and estimated preload status with an echocardiographic surrogate (E/e'). We assessed correlation between strain and heart rate in patients with low preload (E/e' intermediate preload (E/e' 8-14), and high preload (E/e' > 14), adjusting for disease severity and vasopressor dependence. We studied 452 patients, of whom 298 had both measurable strain and preload. Abnormal strain (defined as >-17%) was present in 54%. Patients with abnormal strain had higher heart rates (100 vs. 93 beat/min, p = 0.001). After adjusting for vasopressor dependence, disease severity, and cardiac preload, we observed an association between heart rate and longitudinal strain (β = 0.05, p = 0.003). This association persisted among patients with high preload (β = 0.07, p = 0.016) and in patients with shock (β = 0.07, p = 0.01), but was absent in patients with low or intermediate preload and those not in shock. Tachycardia is associated with abnormal left ventricular strain in septic patients with high preload. This association was not apparent in patients with low or intermediate preload.

  4. Early repair of moderate ischemic mitral regurgitation reverses left ventricular remodeling: a functional and molecular study.

    Science.gov (United States)

    Beeri, Ronen; Yosefy, Chaim; Guerrero, J Luis; Abedat, Suzan; Handschumacher, Mark D; Stroud, Robert E; Sullivan, Suzanne; Chaput, Miguel; Gilon, Dan; Vlahakes, Gus J; Spinale, Francis G; Hajjar, Roger J; Levine, Robert A

    2007-09-11

    Mitral regurgitation (MR) doubles postmyocardial infarction (MI) mortality. We have shown that moderate MR augments remodeling in an apical MI model (no intrinsic MR) with independent left ventricle-to-left atrial MR-type flow. We hypothesized that repairing moderate MR 1 month after MI reverses this remodeling. Anteroapical MIs were created in 18 sheep, and a left ventricle-to-left atrial shunt implanted in 12 (regurgitant fraction, 30%). Six sheep had the shunt closed at 1 month (repair group). Sheep were compared at baseline, and at 1 and 3 months. Sheep in the MI+MR (unrepaired) and repaired groups remodeled during the first month (120% increased left ventricular end-systolic volume [ESV; P<0.01]), but shunt closure reversed remodeling at 3 months, with end-diastolic volume (EDV) and ESV 135% and 128% of baseline versus 220% and 280% without repair (P<0.001). At 3 months, dP/dt and preload-recruitable stroke work were relatively maintained in the repaired and MI-only groups versus nearly 50% decreases without repair. Prohypertrophic gp130 and antiapoptotic pAkt increased followed by exhaustion below baseline without repair, but remained elevated at 3 months with repair or MI only. With repair, matrix metalloproteinase-2 decreased to < or = 50% that without repair in remote and border zones at 3 months, and the matrix metalloproteinase inhibitor TIMP-4 increased dramatically. Early repair of moderate MR in the setting of apical MI substantially reverses the otherwise progressive remodeling process, with reduced left ventricular volumes, relatively maintained contractility, persistently activated intracellular signals promoting hypertrophy and opposing apoptosis, and reduced matrix proteolytic activity. These findings are of interest for the current controversy regarding potential benefits of repair of MR after MI.

  5. Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings

    Energy Technology Data Exchange (ETDEWEB)

    Busch, S.; Johnson, T.R.C.; Wintersperger, B.J.; Minaifar, N.; Bhargava, A.; Rist, C.; Reiser, M.F.; Becker, C.; Nikolaou, K. [University of Munich, Department of Clinical Radiology, Munich (Germany)

    2008-03-15

    Cardiac magnetic resonance imaging and echocardiography are currently regarded as standard modalities for the quantification of left ventricular volumes and ejection fraction. With the recent introduction of dual-source computedtomography (DSCT), the increased temporal resolution of 83 ms should also improve the assessment of cardiac function in CT. The aim of this study was to evaluate the accuracy of DSCT in the assessment of left ventricular functional parameters with cardiac magnetic resonance imaging (MRI) as standard of reference. Fifteen patients (two female, 13 male; mean age 50.8 {+-} 19.2 years) underwent CT and MRI examinations on a DSCT (Somatom Definition; Siemens Medical Solutions, Forchheim, Germany) and a 3.0-Tesla MR scanner (Magnetom Trio; Siemens Medical Solutions), respectively. Multiphase axial CT images were analysed with a semiautomatic region growing algorithms (Syngo Circulation; Siemens Medical Solutions) by two independent blinded observers. In MRI, dynamic cine loops of short axis slices were evaluated with semiautomatic contour detection software (ARGUS; Siemens Medical Solutions) independently by two readers. End-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined for both modalities, and correlation coefficient, systematic error, limits of agreement and inter-observer variability were assessed. In DSCT, EDV and ESV were 135.8 {+-} 41.9 ml and 54.9 {+-} 29.6 ml, respectively, compared with 132.1 {+-} 40.8 ml EDV and 57.6 {+-} 27.3 ml ESV in MRI. Thus, EDV was overestimated by 3.7 ml (limits of agreement -46.1/+53.6), while ESV was underestimated by 2.6 ml (-36.6/+31.4). Mean EF was 61.6 {+-} 12.4% in DSCT and 57.9 {+-} 9.0% in MRI, resulting in an overestimation of EF by 3.8% with limits of agreement at -14.7 and +22.2%. Rank correlation rho values were 0.81 for EDV (P = 0.0024), 0.79 for ESV (P = 0.0031) and 0.64 for EF (P = 0.0168). The kappa value of inter

  6. Systolic left ventricular function is preserved during therapeutic hypothermia, also during increases in heart rate with impaired diastolic filling.

    Science.gov (United States)

    Kerans, Viesturs; Espinoza, Andreas; Skulstad, Helge; Halvorsen, Per Steinar; Edvardsen, Thor; Bugge, Jan Frederik

    2015-12-01

    Systolic left ventricular function during therapeutic hypothermia is found both to improve and to decline. We hypothesized that this discrepancy would depend on the heart rate and the variables used to assess systolic function. In 16 pigs, cardiac performance was assessed by measurements of invasive pressures and thermodilution cardiac output and with 2D strain echocardiography. Left ventricle (LV) volumes, ejection fraction (EF), transmitral flow, and circumferential and longitudinal systolic strain were measured. Miniaturized ultrasonic transducers were attached to the epicardium of the LV to obtain M-mode images, systolic thickening, and diastolic thinning velocities and to determine LV pressure-wall dimension relationships. Preload recruitable stroke work (PRSW) was calculated. Measurements were performed at 38 and 33°C at spontaneous and paced heart rates, successively increased in steps of 20 up to the toleration limit. Effects of temperature and heart rate were compared in a mixed model analysis. Hypothermia reduced heart rate from 87 ± 10 (SD) to 76 ± 11 beats/min without any changes in LV stroke volume, end-diastolic volume, EF, strain values, or PRSW. Systolic wall thickening velocity (S') and early diastolic wall thinning velocity decreased by approximately 30%, making systolic duration longer through a prolonged and slow contraction and changing the diastolic filling pattern from predominantly early towards late. Pacing reduced diastolic duration much more during hypo- than during normothermia, and combined with slow myocardial relaxation, incomplete relaxation occurred with all pacing rates. Pacing did not affect S' or PRSW at physiological heart rates, but stroke volume, end-diastolic volume, and strain were reduced as a consequence of reduced diastolic filling and much more accentuated during hypothermia. At the ultimate tolerable heart rate during hypothermia, S' decreased, probably as a consequence of myocardial hypoperfusion due to

  7. Congenital heart defects and left ventricular non-compaction in males with loss-of-function variants in NONO.

    Science.gov (United States)

    Scott, Daryl A; Hernandez-Garcia, Andres; Azamian, Mahshid S; Jordan, Valerie K; Kim, Bum Jun; Starkovich, Molly; Zhang, Jinglan; Wong, Lee-Jun; Darilek, Sandra A; Breman, Amy M; Yang, Yaping; Lupski, James R; Jiwani, Amyn K; Das, Bibhuti; Lalani, Seema R; Iglesias, Alejandro D; Rosenfeld, Jill A; Xia, Fan

    2017-01-01

    The non-POU domain containing octamer-binding gene (NONO) is located on chromosome Xq13.1 and encodes a member of a small family of RNA-binding and DNA-binding proteins that perform a variety of tasks involved in RNA synthesis, transcriptional regulation and DNA repair. Loss-of-function variants in NONO have been described as a cause of intellectual disability in males but have not been described in association with congenital heart defects or cardiomyopathy. In this article, we seek to further define the phenotypic consequences of NONO depletion in human subjects. We searched a clinical database of over 6000 individuals referred for exome sequencing and over 60 000 individuals referred for CNV analysis. We identified two males with atrial and ventricular septal defects, left ventricular non-compaction (LVNC), developmental delay and intellectual disability, who harboured de novo, loss-of-function variants in NONO. We also identified a male infant with developmental delay, congenital brain anomalies and severe LVNC requiring cardiac transplantation, who inherited a single-gene deletion of NONO from his asymptomatic mother. We conclude that in addition to global developmental delay and intellectual disability, males with loss-of-function variants in NONO may also be predisposed to developing congenital heart defects and LVNC with the penetrance of these cardiac-related problems being influenced by genetic, epigenetic, environmental or stochastic factors. Brain imaging of males with NONO deficiency may reveal structural defects with abnormalities of the corpus callosum being the most common. Although dysmorphic features vary between affected individuals, relative macrocephaly is a common feature. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. PLANKTON RESPIRATION AND BIOMASS AS FUNCTIONAL INDICATORS OF RECOVERY IN RESTORED PRAIRIE WETLANDS

    Science.gov (United States)

    Reliable ecological indicators of wetland integrity are necessary for assessing recovery of restored wetlands, yet little consensus currently exists on which indicators are most appropriate. We employed indicators derived from simple, standard measures of ecosystem function selec...

  9. The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population.

    Science.gov (United States)

    Park, Sung Keun; Moon, Kanghee; Ryoo, Jae-Hong; Oh, Chang-Mo; Choi, Joong-Myung; Kang, Jeong Gyu; Chung, Ju Youn; Young Jung, Ju

    2017-04-27

    The adverse effect of heavy alcohol intake on cardiovascular disease is well established. However, there is only limited information about the risk of subclinical left ventricular (LV) abnormality according to alcohol consumption. Thus, this study was to investigate the association between alcohol consumption and LV functional and structural abnormality. Study participants were 49 714 Korean adults received echocardiogram as an item of health check-up program. They were stratified into 6 groups according to alcohol consumption; non (life time never drinker), occasional (60 g/day) drinker. Multiple logistic regression analysis was used to assess the odd ratios (ORs) for LV hypertrophy (LVH), increased relative wall thickness (RWT) and impaired LV diastolic (LVD) function with a reference of non-drinker. Additionally, the adjusted mean values of echocardiographic parameters were evaluated to assess LV diastolic function and structure. In logistic regression analysis, very heavy alcohol drinker had the highest adjusted ORs for LVH, increased RWT and impaired LVD function in all participants and male subgroup (P consumption and impaired LVD function in all participants and gender subgroups. There was no specific pattern of relationship to suggest the favourable effect of light alcohol drinking on heart. Increased alcohol intake had the adverse effect on LV function and structure. However, potential favourable effect of light alcohol intake was not observed. Prospective studies are required to investigate long-term effect of alcohol consumption on subclinical LV change.

  10. Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury.

    Science.gov (United States)

    Sadowsky, Cristina L; Hammond, Edward R; Strohl, Adam B; Commean, Paul K; Eby, Sarah A; Damiano, Diane L; Wingert, Jason R; Bae, Kyongtae T; McDonald, John W

    2013-11-01

    To examine the effect of long-term lower extremity functional electrical stimulation (FES) cycling on the physical integrity and functional recovery in people with chronic spinal cord injury (SCI). Retrospective cohort, mean follow-up 29.1 months, and cross-sectional evaluation. Washington University Spinal Cord Injury Neurorehabilitation Center, referral center. Twenty-five people with chronic SCI who received FES during cycling were matched by age, gender, injury level, and severity, and duration of injury to 20 people with SCI who received range of motion and stretching. Lower extremity FES during cycling as part of an activity-based restorative treatment regimen. Change in neurological function: motor, sensory, and combined motor-sensory scores (CMSS) assessed by the American Spinal Injury Association Impairment scale. Response was defined as ≥ 1 point improvement. FES was associated with an 80% CMSS responder rate compared to 40% in controls. An average 9.6 CMSS point loss among controls was offset by an average 20-point gain among FES subjects. Quadriceps muscle mass was on average 36% higher and intra/inter-muscular fat 44% lower, in the FES group. Hamstring and quadriceps muscle strength was 30 and 35% greater, respectively, in the FES group. Quality of life and daily function measures were significantly higher in FES group. FES during cycling in chronic SCI may provide substantial physical integrity benefits, including enhanced neurological and functional performance, increased muscle size and force-generation potential, reduced spasticity, and improved quality of life.

  11. Impact of Severe Obesity and Weight Loss on Systolic Left Ventricular Function and Morphology: Assessment by 2-Dimensional Speckle-Tracking Echocardiography

    Directory of Open Access Journals (Sweden)

    Sevda Karimian

    2016-01-01

    Full Text Available Obesity is associated with an increased risk of heart failure. Little is known about the impact of dietary changes on the cardiac sequelae in obese patients. Twenty-one obese subjects underwent a 12-week low calorie fasting phase of a formula diet. Transthoracic two-dimensional speckle-tracking echocardiography was performed to obtain systolic left ventricular strain before and after weight loss. Body mass index decreased significantly from 38.6±6.2 to 31.5±5.3 kg/m2, and the total percentage fat loss was 19%. Weight reduction was associated with a reduction in blood pressure and heart rate. Left ventricular longitudinal global peak systolic strain was in the lower normal range (−18.7±3.2% before weight loss and was unchanged (−18.8±2.4% after 12 weeks on diet with substantial weight loss. Also, no significant change in global radial strain after weight loss was noted (41.1±22.0 versus 43.9±23.3, p=0.09. Left atrial and ventricular dimensions were in normal range before fasting and remained unchanged after weight loss. In our study obesity was associated with normal systolic left ventricular function. A 12-week low calorie diet with successful weight loss can reduce blood pressure and heart rate. Systolic left ventricular function and morphology were not affected by rapid weight reduction.

  12. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function.

    Science.gov (United States)

    Meluzín, J; Spinarová, L; Bakala, J; Toman, J; Krejcí, J; Hude, P; Kára, T; Soucek, M

    2001-02-01

    Rapid, accurate, and widely available non-invasive evaluation of right ventricular function still presents a problem. The purpose of the study was to determine whether the parameters derived from Doppler tissue imaging of tricuspid annular motion could be used as indexes of right ventricular function in patients with heart failure. Standard and pulsed Doppler tissue echocardiography were obtained in 44 patients with heart failure (mean left ventricular ejection fraction 24 +/- 7%) and in 30 age- and sex-matched healthy volunteers. The tricuspid annular systolic and diastolic velocities were acquired in apical four-chamber views at the junction of the right ventricular free wall and the anterior leaflet of the tricuspid valve using Doppler tissue imaging. Within 2 h of Doppler tissue imaging, the first-pass radionuclide ventriculogram, determining right ventricular ejection fraction and equilibrium gated radionuclide ventriculography single photon emission computed tomography, were performed in all patients. In patients with heart failure, the peak systolic annular velocity was significantly lower and the time from the onset of the electrocardiographic QRS complex to the peak of systolic annular velocity was significantly greater than the corresponding values in healthy subjects (10.3 +/- 2.6 cm. s(-1) vs 15.5 +/- 2.6 cm.s(-1), P heart failure. Copyright 2001 The European Society of Cardiology.

  13. [The recovery process of motor function in elderly patients with cerebrovascular disease].

    Science.gov (United States)

    Fujimura, Masahiko

    2010-01-01

    To investigate the recovery process in elderly patients with cerebrovascular disease for 10 months, from beginning 3 months after the onset of disease. This was done according to the evaluation of exercise capacity described in the interim-report on preventive long-term care services in city, town and village model research. Fourteen patients in whom cerebrovascular disease had been diagnosed within the previous 3 months, and who were still receiving rehabilitation treatment (8 men, 6 women, average age 76.4+/-8.3, and average number of hospitalization days 164.6+/-33.1) were enrolled. Evaluation items were: the grip power, one-leg standing time with eyes open, functional reach, timed up and go test (TUGT) and falling bar test. The maximum recovery value of individual measurements in each patient was considered 100%, in order to calculate the recovery rate. The maximum recovery value of the grip power test was obtained on both unaffected and affected body sides 6 months after the onset of disease, but the recovery values of both the unaffected and affected sides decreased to 76.1% and 68.6% respectively, after 12 months. The maximum recovery value of the one-leg standing time with eyes open test was 72.8% 7 months after the onset of disease, but it had decreased to 24.5% after 12 months. The maximum recovery value of the functional reach test was 86.9% 4 months after the onset of disease, but it had decreased to 57.5% after 12 months. The maximum recovery value of the falling bar test was 83.5% 6 months after the onset of disease, but had it decreased to 63.8% after 12 months. The maximum recovery value of the TUGT was 90.4% 5 months after the onset of disease, but it had decreased to 64.1% after 12 months. The TUGT reached the recovery peak level first, however, the one-leg standing test reached the maximum recovery value 7 months after the onset of disease, slightly later than the other measurements. After achieving the maximum recovery value, the grip power test

  14. The impact of anabolic androgenic steroids abuse and type of training on left ventricular remodeling and function in competitive athletes.

    Science.gov (United States)

    Ilić, Ivan; Djordjević, Vitomir; Stanković, Ivan; Vlahović-Stipac, Alja; Putniković, Biljana; Babić, Rade; Nesković, Aleksandar N

    2014-04-01

    Long-term intensive training is associated with distinctive cardiac adaptations which are known as athlete's heart. The aim of this study was to determine whether the use of anabolic androgenic steroids (AAS) could affect echocardiographic parameters of left ventricular (LV) morphology and function in elite strength and endurance athletes. A total of 20 elite strength athletes (10 AAS users and 10 non-users) were compared to 12 steroid-free endurance athletes. All the subjects underwent comprehensive standard echocardiography and tissue Doppler imaging. After being indexed for body surface area, both left atrium (LA) and LV end-diastolic diameter (LVEDD) were significantly higher in the endurance than strength athletes, regardless of AAS use (p steroid-free endurance athletes, showing that 75% of LA size variability depends on variability of LVEDD (p steroid-free athletes, regardless of training type (p abuse.

  15. Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Boman, Kurt; Gerdts, Eva; Wachtell, Kristian

    2009-01-01

    BACKGROUND: Exercise lowers blood pressure and improves cardiovascular function, but little is known about whether exercise impacts cardiovascular morbidity and mortality independent of left ventricular hypertrophy (LVH) and LV geometry. DESIGN: Observational analysis of prospectively obtained...... (never exercise), intermediate (30 min twice/week). During 4.8-year follow-up, 105 patients suffered the primary composite endpoint of myocardial infarction (MI), stroke, or cardiovascular death. MI occurred in 39, stroke in 60, and cardiovascular death in 33 patients. RESULTS: Sedentary individuals (n...... echocardiographic data within the context of a randomized trial of antihypertensive treatment. METHODS: A total of 937 hypertensive patients with ECG LVH were studied by echocardiography in the Losartan Intervention For Endpoint reduction in hypertension study. Baseline exercise status was categorized as sedentary...

  16. Estudo da função ventricular na técnica de plicatura da parede livre do ventrículo esquerdo em cães Left ventricular function after plication of the left ventricular free wall in dogs

    Directory of Open Access Journals (Sweden)

    James Newton Bizetto Meira de Andrade

    2004-06-01

    Full Text Available OBJETIVO: Avaliar os efeitos da técnica na função ventricular esquerda em cães hígidos e com cardiomiopatia dilatada induzida pela doxorrubicina. MÉTODO: De 13 cães, oito receberam doxorrubicina até que a fração de encurtamento (FE fosse menor que 20%. Destes, quatro animais e os cinco não induzidos foram submetidos à plicatura da parede livre do ventrículo esquerdo (PPLVE. Os demais cães não foram operados. Foram avaliados débito cardíaco (DC, pressão arterial, exame físico, eletrocardiografia, sistema "Holter" e ecocardiografia, por 180 dias. RESULTADOS: Houve redução do volume ventricular esquerdo. Os cães induzidos melhoraram após a operação e a fração de ejeção (FEj retornou aos valores normais para a espécie. O DC e a FE aumentaram após a operação. Um cão foi a óbito. Nos cães não operados, a FE diminuiu e foram a óbito em torno de 40 dias após a indução; nos cães não induzidos, esta não se alterou. Houve extra-sístoles ventriculares, que se resolveram espontaneamente. CONCLUSÕES: A PPLVE sem circulação extracorpórea reduz o volume ventricular esquerdo e melhora a função cardíaca dos cães com cardiomiopatia dilatada induzida pela doxorrubicina, demonstrando baixa morbidade e mortalidade tardia.OBJECTIVE: We tested a new surgical technique, the plication of the left ventricular free wall, to reduce left ventricular area and volume and improve left ventricular systolic function, without using a cardiopulmonary bypass. METHODS: Dilated cardiomyopathy was induced in eight dogs by the injection of doxorubicin. Plication of the left ventricular free wall was performed in four dogs with induced cardiomyopathy and in five control dogs. Two dogs not submitted to surgery. The other two dogs died during the induction phase. Cardiac output, 2-dimensional and M-mode echocardiography, arterial blood pressure and electrocardiography were recorded over a 180 days period. Ambulatory electrocardiography

  17. Comparison between Radionuclide Ventriculography and Echocardiography for Quantification of Left Ventricular Systolic Function in Rats Exposed to Doxorubicin

    Directory of Open Access Journals (Sweden)

    Luciano Fonseca Lemos de Oliveira

    Full Text Available Abstract Background: Radionuclide ventriculography (RV is a validated method to evaluate the left ventricular systolic function (LVSF in small rodents. However, no prior study has compared the results of RV with those obtained by other imaging methods in this context. Objectives: To compare the results of LVSF obtained by RV and echocardiography (ECHO in an experimental model of cardiotoxicity due to doxorubicin (DXR in rats. Methods: Adult male Wistar rats serving as controls (n = 7 or receiving DXR (n = 22 in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO performed with a Sonos 5500 Philips equipment (12-MHz transducer and RV obtained with an Orbiter-Siemens gamma camera using a pinhole collimator with a 4-mm aperture. Histopathological quantification of myocardial fibrosis was performed after euthanasia. Results: The control animals showed comparable results in the LVSF analysis obtained with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p > 0.05. The animals that received DXR presented lower LVSF values when compared with controls (p < 0.05; however, the LVSF values obtained by RV (60.6 ± 12.5% were lower than those obtained by ECHO (71.8 ± 10.1%, p = 0.0004 in this group. An analysis of the correlation between the LVSF and myocardial fibrosis showed a moderate correlation when the LVSF was assessed by ECHO (r = -0.69, p = 0.0002 and a stronger correlation when it was assessed by RV (r = -0.79, p < 0.0001. On multiple regression analysis, only RV correlated independently with myocardial fibrosis. Conclusion: RV is an alternative method to assess the left ventricular function in small rodents in vivo. When compared with ECHO, RV showed a better correlation with the degree of myocardial injury in a model of DXR-induced cardiotoxicity.

  18. POOR FUNCTIONAL RECOVERY AFTER A CRITICAL ILLNESS: A LONGITUDINAL STUDY

    NARCIS (Netherlands)

    van der Schaaf, Marike; Beelen, Anita; Dongelmans, Dave A.; Vroom, Margreeth B.; Nollet, Frans

    2009-01-01

    Objective: To determine the time course of functional health status, and to inventory impairments in body functions, limitations in activities, and restrictions in participation after critical illness. Design: Prospective observational cohort study. Setting: Mixed medical and surgical closed format;

  19. Pineapple fruit bromelain recovery using recyclable functionalized ordered mesoporous silica synthesized from sugarcane leaf ash

    Directory of Open Access Journals (Sweden)

    A. Arumugam

    2013-09-01

    Full Text Available Bromelain, a protease enzyme found in Ananas comosus (Pineapple, was recovered from the fruit juice by adsorption using recyclable functionalized Santa Barbara Acid-15 (SBA-15 synthesized from sugarcane leaf ash. In this work, highly ordered mesoporous silica was synthesized from sugarcane leaf ash by a template-assisted method. It was successfully used as an adsorbent for the recovery of bromelain from pineapple fruit pulp. Amine-functionalized mesoporous silica exhibited a recovery efficiency of 97.89% and a 6.2-fold purification. It was also established that the adsorbent could be easily regenerated by adjusting the pH. In this study, the adsorbent was reused for three cycles without noticeable loss in recovery efficiency. Thus, adsroption using functionalized SBA-15 appears to be a promising alternate separation technique for the recovery of fruit bromelain.

  20. Inhibition of CXCL12 signaling attenuates the postischemic immune response and improves functional recovery after stroke

    DEFF Research Database (Denmark)

    Ruscher, Karsten; Kuric, Enida; Liu, Yawei

    2013-01-01

    cell-derived factor-1 (CXCL12). To mimic beneficial effects of EE, we studied the impact of inhibiting CXCL12 action on functional recovery after transient MCAO (tMCAO). Rats treated with the specific CXCL12 receptor antagonist 1-[4-(1,4,8,11-tetrazacyclotetradec-1-ylmethyl)phenyl]methyl]-1......After stroke, brain inflammation in the ischemic hemisphere hampers brain tissue reorganization and functional recovery. Housing rats in an enriched environment (EE) dramatically improves recovery of lost neurologic functions after experimental stroke. We show here that rats housed in EE after......,4,8,11-tetrazacyclo-tetradecan (AMD3100) showed improved recovery compared with saline-treated rats after tMCAO, without a concomitant reduction in infarct size. This was accompanied by a reduction of infiltrating immune cells in the ischemic hemisphere, particularly cluster of differentiation 3-positive (CD3...

  1. Assessment of ventricular function with first-pass radionuclide angiography using technetium 99m hexakis-2-methoxyisobutylisonitrile: A European multicentre study

    Energy Technology Data Exchange (ETDEWEB)

    Bisi, G.; Sciagra, R. (Florence Univ. (Italy). Dipt. di Fisiopatologia Clinica); Buell, U. (Technische Hochschule Aachen (Germany, F.R.). Medizinische Fakultaet); Britton, K.E. (Saint Bartholomew' s Hospital, London (UK). Dept. of Nuclear Medicine); Eilles, C. (Luitpoldkrankenhaus, Wuerzburg (Germany, F.R.)); Eissner, D.; Hahn, K. (Mainz Univ. (Germany, F.R.). Klinikum); Hoeffken, H.; Joseph, K. (Marburg Univ. (Germany, F.R.). Klinikum); McKillop, J.H. (Royal Infirmary, Glasgow (UK). Dept. of Medicine); Larock, M.P.; Rigo, P. (Centre Hospitalier Universitaire Sart-Tilman, Tilman (Belgium). Service de Medecine Nucleaire); Mueller, S.P.; Reiners, C. (Essen Univ. (Gesamthochschule) (Germany, F.R.). Klinikum)

    1991-03-01

    In the context of a multicentre study on the use of technetium 99m hexakis-2-methoxyisobutylisonitrile ({sup 99m}Tc-Sestamibi), we evaluated the accuracy of the ventricular function assessed at rest by means of first-pass radionuclide angiocardiography acquired during the injection of the tracer for myocardial perfursion scintigraphy. The results were compared with first-pass studies performed using reference tracers sodium pertechnetate Tc 99m or technetium 99m diethylene triamine penta-acetic acid or with gated radionuclide angiocardiography. A total of 66 patients of the 105 enrolled in the study could be evaluated. The comparison of the first-pass studies was possible in 33 subjects with regard to the left ventricular ejection fraction, yielding r=0.909 (P<10{sup -6}), and in 22 cases with regard to the right ventricular ejection fraction, yielding r=0.712 (P<0.001). The comparison between the first-pass study using {sup 99m}Tc-Sestamibi and the equilibrium gated radionuclide angiocardiography was possible for the left ventricular ejection fraction in 26 cases, with r = 0.937 (P<10{sup -6}), and for the right ventricular ejection fraction in 15 subjects, with r=0.783 (P<0.001). In conclusion, the assessment of ventricular function performed by acquiring a first-pass radionuclide angiocardiograph during the injection of {sup 99m}Tc-Sestamibi for perfusion myocardial scintigraphy can be considered reliable and accurate, when compared with the usually employed techniques. This result confirms the feasibility of a combined evaluation of perfusion and function at rest and during stress testing, which represents one of the most interesting advantages offered by the use of {sup 99m}Tc-Sestamibi. (orig.).

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

    Science.gov (United States)

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

    2016-12-01

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

  3. Epidermal growth factor and erythropoietin infusion accelerate functional recovery in combination with rehabilitation.

    Science.gov (United States)

    Jeffers, Matthew S; Hoyles, Amy; Morshead, Cindi; Corbett, Dale

    2014-06-01

    Rehabilitation is the only treatment option for chronic stroke deficits, but unfortunately, it often provides incomplete recovery. In this study, a novel combination of growth factor administration and rehabilitation therapy was used to facilitate functional recovery in a rat model of cortical stroke. Ischemia was induced via injection of endothelin-1 into the sensorimotor cortex. This was followed by either a 2-week infusion of epidermal growth factor and erythropoietin or artificial cerebrospinal fluid into the ipsilateral lateral ventricle. Two weeks after ischemia, animals began an 8-week enriched rehabilitation program. Functional recovery was assessed after ischemia using the Montoya staircase-reaching task, beam-traversing, and cylinder test of forelimb asymmetry. The combination of growth factor infusion and rehabilitation led to a significant acceleration in recovery in the staircase task. When compared with controls, animals receiving the combination treatment attained significant recovery of function at 4 weeks after stroke, whereas those receiving rehabilitation alone did not recover until 10 weeks. Significant recovery was also observed on the beam-traversing and cylinder tasks. Combining behavioral rehabilitation with growth factor infusion accelerates motor recovery. These data suggest a promising new avenue of combination therapies that may have the potential to reduce the rehabilitation time necessary to recover from sensorimotor deficits arising from stroke. © 2014 American Heart Association, Inc.

  4. The overloaded right heart and ventricular interdependence.

    Science.gov (United States)

    Naeije, Robert; Badagliacca, Roberto

    2017-10-01

    The right and the left ventricle are interdependent as both structures are nested within the pericardium, have the septum in common and are encircled with common myocardial fibres. Therefore, right ventricular volume or pressure overloading affects left ventricular function, and this in turn may affect the right ventricle. In normal subjects at rest, right ventricular function has negligible interaction with left ventricular function. However, the right ventricle contributes significantly to the normal cardiac output response to exercise. In patients with right ventricular volume overload without pulmonary hypertension, left ventricular diastolic compliance is decreased and ejection fraction depressed but without intrinsic alteration in contractility. In patients with right ventricular pressure overload, left ventricular compliance is decreased with initial preservation of left ventricular ejection fraction, but with eventual left ventricular atrophic remodelling and altered systolic function. Breathing affects ventricular interdependence, in healthy subjects during exercise and in patients with lung diseases and altered respiratory system mechanics. Inspiration increases right ventricular volumes and decreases left ventricular volumes. Expiration decreases both right and left ventricular volumes. The presence of an intact pericardium enhances ventricular diastolic interdependence but has negligible effect on ventricular systolic interdependence. On the other hand, systolic interdependence is enhanced by a stiff right ventricular free wall, and decreased by a stiff septum. Recent imaging studies have shown that both diastolic and systolic ventricular interactions are negatively affected by right ventricular regional inhomogeneity and prolongation of contraction, which occur along with an increase in pulmonary artery pressure. The clinical relevance of these observations is being explored. Published on behalf of the European Society of Cardiology. All rights

  5. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and Ventricular Enlargement.

    Science.gov (United States)

    Mitchell, G F; Moyé, L A; Braunwald, E; Rouleau, J L; Bernstein, V; Geltman, E M; Flaker, G C; Pfeffer, M A

    1997-12-16

    There is increasing evidence of a link between conduit vessel stiffness and cardiovascular events, although the association has never been tested in a large post-myocardial infarction patient population. We evaluated the relationship between baseline pulse pressure, measured by sphygmomanometry 3 to 16 days after myocardial infarction, and subsequent adverse clinical events in the 2231 patients enrolled in the SAVE Trial. Increased pulse pressure was associated with increased age, left ventricular ejection fraction, female sex, history of prior infarction, diabetes, and hypertension and use of digoxin and calcium channel blockers. Over a 42-month period, there were 503 deaths, 422 cardiovascular deaths, and 303 myocardial infarctions. Pulse pressure was significantly related to each of these end points as a univariate predictor. In a multivariate analysis, pulse pressure remained a significant predictor of total mortality (relative risk, 1.08 per 10 mm Hg increment in pulse pressure; 95% CI, 1.00 to 1.17; Pmyocardial infarction (relative risk, 1.12; 95% CI, 1.01 to 1.23; Pmyocardial infarction, diabetes, or hypertension; and treatment with beta-blockers, calcium channel blockers, digoxin, aspirin, or thrombolytic therapy. These data provide strong evidence for a link between pulse pressure, which is related to conduit vessel stiffness, and subsequent cardiovascular events after myocardial infarction in patients with left ventricular dysfunction.

  6. Right ventricular function assessed by 2D strain analysis predicts ventricular arrhythmias and sudden cardiac death in patients after acute myocardial infarction

    DEFF Research Database (Denmark)

    Risum, Niels; Valeur, Nana; Søgaard, Peter

    2017-01-01

    ) or malignant ventricular arrhythmias (VAs) after acute myocardial infarction (MI). Methods and results: A total of 790 patients with acute MI were prospectively included. All patients had 2D strain echocardiography performed to evaluate right ventricular (RV) free wall strain (RVS) and RV mechanical dispersion...... (MD) defined as the standard deviation of time to peak negative strain in all myocardial segments. The primary composite end point [SCD, admission with VA or appropriate therapy from a primary prophylactic implantable cardioverter-defibrillator (ICD)] was analysed with Cox models. Mean age was 69 ± 12.......08, 95% confidence interval (CI) 1.01-1.15; P = 0.038]. Patients in the lower tertile (poor strain) showed a 10-fold risk of an event compared with the upper tertile (HR 9.8, 95% CI 2.23-42.3; P = 0.002). RV MD was not independently associated with VA/SCD (HR 0.99, 95% CI 0.91-1.09; P = 0.93). RVS proved...

  7. Study on the effects of six intravenous anesthetic agents on regional ventricular function in dogs (thiopental, etomidate, propofol, fentanyl, sufentanil, alfentanil)

    NARCIS (Netherlands)

    de Hert, S. G.

    1991-01-01

    This study evaluates the effects of 30 min increasing doses infusions of six intravenous anesthetic agents (thiopental, etomidate, propofol, fentanyl, sufentanil and alfentanil) on regional ventricular function in a normal and an acute ischemic heart segment in dogs. Part 1 discusses the methodology

  8. 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...... without. The importance of LVMI increased, but the importance of systolic blood pressure decreased with higher FPG category....

  9. Feasibility of free-breathing, GRAPPA-based, real-time cardiac cine assessment of left-ventricular function in cardiovascular patients at 3T.

    Science.gov (United States)

    Zhu, Xiaomei; Schwab, Felix; Marcus, Roy; Hetterich, Holger; Theisen, Daniel; Kramer, Harald; Notohamiprodjo, Mike; Schlett, Christopher L; Nikolaou, Konstantin; Reiser, Maximilian F; Bamberg, Fabian

    2015-05-01

    To determine the feasibility of free-breathing, GRAPPA-based, real-time (RT) cine 3T cardiac magnetic resonance imaging (MRI) with high acceleration factors for the assessment of left-ventricular function in a cohort of patients as compared to conventional segmented cine imaging. In this prospective cohort study, subjects with various cardiac conditions underwent MRI involving two RT cine sequences (high resolution and low resolution) and standard segmented cine imaging. Standard qualitative and quantitative parameters of left-ventricular function were quantified. Among 25 subjects, 24 were included in the analysis (mean age: 50.5±21 years, 67% male, 25% with cardiomyopathy). RT cine derived quantitative parameters of volumes and left ventricular mass were strongly correlated with segmented cine imaging (intraclass correlation coefficient [ICC]: >0.72 for both RT cines) but correlation for peak ejection and filling rates were moderate to poor for both RT cines (ICCcines significantly underestimated peak ejection and filling rates (>103.2±178 ml/s). Among patient-related factors, heart rate was strongly predictive for deviation of measurements (pcine MRI at 3T is feasible for qualitative and quantitative assessment of left ventricular function for low and high-resolution sequences but results in significant underestimation of systolic function, peak ejection and filling rates. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Assessment of left ventricular functions in patients with type 2 diabetes mellitus using tissue Doppler imaging and its correlation with a novel cardiac biomarker

    Directory of Open Access Journals (Sweden)

    Ebtissam Zakria

    2017-01-01

    Conclusion Diabetic cardiomyopathy is an important diabetes complication. It varies from subclinical ventricular dysfunction to overt HF. Echocardiography is the standard diagnostic tool for diabetic cardiomyopathy. TDI can be used to quantitatively assess global, regional, systolic, and diastolic myocardial functions. Plasma BNP can be a prognostic rather than diagnostic test.

  11. Quantitative right and left ventricular functional analysis during gated whole-chest MDCT: A feasibility study comparing automatic segmentation to semi-manual contouring

    Energy Technology Data Exchange (ETDEWEB)

    Coche, Emmanuel, E-mail: Emmanuel.coche@uclouvain.b [Department of Medical Imaging, Universite Catholique de Louvain, Cliniques Universitaires St-Luc (UCL), Avenue Hippocrate, 10, 1200 Brussels (Belgium); Walker, Matthew J. [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States); Zech, Francis [Department of Internal Medicine, Universite Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels (Belgium); Crombrugghe, Rodolphe de [Department of Medical Imaging, Universite Catholique de Louvain, Cliniques Universitaires St-Luc (UCL), Avenue Hippocrate, 10, 1200 Brussels (Belgium); Vlassenbroek, Alain [Philips Healthcare, Brussels (Belgium)

    2010-06-15

    Purpose: To evaluate the feasibility of an automatic, whole-heart segmentation algorithm for measuring global heart function from gated, whole-chest MDCT images. Material and methods: 15 patients with suspicion of PE underwent whole-chest contrast-enhanced MDCT with retrospective ECG synchronization. Two observers computed right and left ventricular functional indices using a semi-manual and an automatic whole-heart segmentation algorithm. The two techniques were compared using Bland-Altman analysis and paired Student's t-test. Measurement reproducibility was calculated using intraclass correlation coefficient. Results: Ventricular analysis with automatic segmentation was successful in 13/15 (86%) and in 15/15 (100%) patients for the right ventricle and left ventricle, respectively. Reproducibility of measurements for both ventricles was perfect (ICC: 1.00) and very good for automatic and semi-manual measurements, respectively. Ventricular volumes and functional indices except right ventricular ejection fraction obtained from the automatic method were significantly higher for the RV compared to the semi-manual methods. Conclusions: The automatic, whole-heart segmentation algorithm enabled highly reproducible global heart function to be rapidly obtained in patients undergoing gated whole-chest MDCT for assessment of acute chest pain with suspicion of pulmonary embolism.

  12. Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis

    NARCIS (Netherlands)

    Delewi, Ronak; Hirsch, Alexander; Tijssen, Jan G.; Schächinger, Volker; Wojakowski, Wojciech; Roncalli, Jérôme; Aakhus, Svend; Erbs, Sandra; Assmus, Birgit; Tendera, Michal; Goekmen Turan, R.; Corti, Roberto; Henry, Tim; Lemarchand, Patricia; Lunde, Ketil; Cao, Feng; Huikuri, Heikki V.; Sürder, Daniel; Simari, Robert D.; Janssens, Stefan; Wollert, Kai C.; Plewka, Michal; Grajek, Stefan; Traverse, Jay H.; Zijlstra, Felix; Piek, Jan J.

    2014-01-01

    The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized

  13. Impact of ischemic time on post-infarction left ventricular function in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

    NARCIS (Netherlands)

    Ng, S.; Ottervanger, J.P.; Hof, A.W. van 't; Boer, M.J. de; Reiffers, S.; Dambrink, J.H.; Hoorntje, J.C.A.; Gosselink, A.T.M.; Suryapranata, H.

    2013-01-01

    BACKGROUND: Myocardial necrosis is a time-dependent event. Nevertheless, clinical studies on association between ischemic time and left ventricle function showed inconsistent findings. Aim of current study is to evaluate the association between ischemic time and the post-infarction left ventricular

  14. 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

  15. Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved Left Ventricular Function.

    Science.gov (United States)

    Shacham, Yacov; Gal-Oz, Amir; Ben-Shoshan, Jeremy; Keren, Gad; Arbel, Yaron

    2016-02-01

    Only limited data is present regarding the incidence and prognostic implications of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients with preserved left ventricular (LV) function in the primary percutaneous coronary intervention (PCI) era. We conducted a retrospective study of 842 consecutive STEMI patients with preserved LV function (ejection fraction ≥50%, assessed by echocardiography) who underwent primary PCI between January 2008 and January 2015. AKI was defined as an increase of ≥0.3 mg/dl in serum creatinine within 48 h following admission. Patients were assessed for all-cause mortality up to 5 years. Fifty-two patients (6.2%) developed AKI. Patients with AKI were older, had impaired baseline renal function, and presented more often with heart failure throughout their hospitalization. Patients with AKI had a higher 5-year all-cause mortality (13.4 vs. 2.4%, p < 0.001). Compared to patients with no AKI, the adjusted hazard ratio for all-cause mortality was 2.64 (95% CI 1.25-5.56, p = 0.01). Among STEMI patients with preserved LV function undergoing primary PCI, AKI is associated with a higher long-term mortality.

  16. 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. PMID:23562031

  17. 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.

  18. [Effects of long-term endurance training on left ventricular dimensions and function in female distance runners].

    Science.gov (United States)

    Nakata, H; Mimura, K; Sakuyama, K; Tanaka, K; Miyamoto, T; Maeda, K

    1994-01-01

    Ultrasoundcardiogram (UCG) was measured to evaluate the effects of 2 years of endurance training on left ventricular dimensions and function in 3 female collegiate runners (mean age 19.7 years). All subjects had had an experience in endurance training as athletes and underwent the endurance training at the college for two years. Training consisted mainly of about 2 hours of running, 3 to 4 days a week. Training effects were found as measured by a 5000m-run pretraining (mean 19: 40.3 min) and post-training (mean 18: 49.3 min). The average increase in maximal oxygen uptake (VO2max/kg) after training was 9.4% (P < 0.05). UCG's dimensional variables such as LVDd, LVPWT and IVST in the post-training period did not reveal any increase. However, LVDs as a cardiac dimension showed a tendency to decrease, and functional variables such as SV, EF, FS showed a tendency to increase. This functional improvement appeared to be due to a decrease in LVDs. From these results, it is likely that the endurance training prior to this study might have helped an effective adaptation in their cardiac dimensions. Thus, we suggest that prior to this study cardiac dimensions had extended and enlarged to a certain extent, and then cardiac function might be improved as the subsequent physiological phenomenon.

  19. Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hwanjeong; Choi, Sehun; Han, Yeonhee [Research Institute of Chonbuk National Univ. Medical School and Hospitial, Jeonju (Korea, Republic of); Lee, Dong Soo; Lee, Hoyoung; Chung, Junekey [Seoul National Univ., Seoul (Korea, Republic of)

    2013-09-15

    This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function. Methods Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-{sup 99m} sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed. Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P<0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P=0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P<0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event. The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.

  20. Feasibility of free-breathing, GRAPPA-based, real-time cardiac cine assessment of left-ventricular function in cardiovascular patients at 3 T

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Xiaomei, E-mail: xiaomeizhunanjing@163.com [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, 210029 Nanjing, Jiangsu (China); Schwab, Felix, E-mail: flixschwab@googlemail.com [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); Marcus, Roy, E-mail: Roy.Marcus@med.uni-muenchen.de [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); Hetterich, Holger, E-mail: Holger.Hetterich@med.uni-muenchen.de [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); Theisen, Daniel, E-mail: daniel.theisen@me.com [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); Kramer, Harald, E-mail: Harald.Kramer@med.uni-muenchen.de [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); Notohamiprodjo, Mike, E-mail: Mike.Notohamiprodjo@med.lmu.de [Department of Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Schlett, Christopher L., E-mail: Christopher.Schlett@med.uni-heidelberg.de [Department of Radiology, University of Heidelberg, Neuenheimer Feld 110, 69120 Heidelberg (Germany); Nikolaou, Konstantin, E-mail: Konstantin.Nikolaou@med.uni-tuebingen.de [Department of Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Reiser, Maximilian F., E-mail: Maximilian.Reiser@med.uni-muenchen.de [Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich (Germany); and others

    2015-05-15

    Highlights: • Grappa-based real time cine cardiac MRI is feasible for assessment of left ventricular function. • Significant underestimation of systolic function, peak ejection and filling rates needs to be considered. • Heart rate is the only positive predictor of the deviation of obtained parameters. - Abstract: Objectives: To determine the feasibility of free-breathing, GRAPPA-based, real-time (RT) cine 3 T cardiac magnetic resonance imaging (MRI) with high acceleration factors for the assessment of left-ventricular function in a cohort of patients as compared to conventional segmented cine imaging. Materials and methods: In this prospective cohort study, subjects with various cardiac conditions underwent MRI involving two RT cine sequences (high resolution and low resolution) and standard segmented cine imaging. Standard qualitative and quantitative parameters of left-ventricular function were quantified. Results: Among 25 subjects, 24 were included in the analysis (mean age: 50.5 ± 21 years, 67% male, 25% with cardiomyopathy). RT cine derived quantitative parameters of volumes and left ventricular mass were strongly correlated with segmented cine imaging (intraclass correlation coefficient [ICC]: >0.72 for both RT cines) but correlation for peak ejection and filling rates were moderate to poor for both RT cines (ICC < 0.40). Similarly, RT cines significantly underestimated peak ejection and filling rates (>103.2 ± 178 ml/s). Among patient-related factors, heart rate was strongly predictive for deviation of measurements (p < 0.05). Conclusions: RT cine MRI at 3 T is feasible for qualitative and quantitative assessment of left ventricular function for low and high-resolution sequences but results in significant underestimation of systolic function, peak ejection and filling rates.

  1. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study.

    Science.gov (United States)

    Kronborg, Mads B; Mortensen, Peter T; Poulsen, Steen H; Gerdes, Jens C; Jensen, Henrik K; Nielsen, Jens C

    2014-08-01

    To compare left ventricular function after a long-term His or para-His pacing (HP) and right ventricular septal pacing (RVSP) in patients with atrioventricular block (AVB). We included consecutive patients with AVB, a narrow QRS 0.40, in a prospective, randomized, double-blinded, crossover design. All patients were treated with 12 months HP and 12 months RVSP. A total of 38 patients [mean age, 67 ± 10 years; 30 (79%) men] were included. The primary endpoint was LVEF, which was significantly lower after a 12 months RVSP (0.50 ± 0.11) than after 12 months of HP (0.55 ± 0.10), P = 0.005. We measured the difference in time-to-peak systolic velocity between opposite basal segments in the apical views by using tissue Doppler imaging. In the four-chamber view, the difference was 58 (±7) ms after RVSP and 49 (±7) ms after HP, P = 0.27; in the two-chamber view, the difference was 45 (±5) ms after RVSP and 31 ±(4) ms after HP, P = 0.02, and in the apical long-axis view, the difference was 63 (±6) after RVSP and 44 (±7) after HP, P = 0.03. There was no difference in New York Heart Association class, 6-min hall walk test, quality-of-life assessments, or device-related complications. The mean threshold was significantly higher in HP leads than in RVSP leads. His or para-His pacing preserves LVEF and mechanical synchrony as compared with RVSP after 12 months pacing in patients with AVB, narrow QRS, and LVEF > 0.40. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  2. Pharmacokinetics of intravenously and orally administered sotalol hydrochloride in horses and effects on surface electrocardiogram and left ventricular systolic function.

    Science.gov (United States)

    Broux, B; De Clercq, D; Decloedt, A; De Baere, S; Devreese, M; Van Der Vekens, N; Ven, S; Croubels, S; van Loon, G

    2016-02-01

    Arrhythmias are common in horses. Some, such as frequent atrial or ventricular premature beats, may require long-term anti-arrhythmic therapy. In humans and small animals, sotalol hydrochloride (STL) is often used for chronic oral anti-arrhythmic therapy. STL prolongs repolarization and the effective refractory period in all cardiac tissues. No information on STL pharmacokinetics or pharmacodynamics in horses is available and the aim of this study was to evaluate the pharmacokinetics of intravenously (IV) and orally (PO) administered STL and the effects on surface electrocardiogram and left ventricular systolic function. Six healthy horses were given 1 mg STL/kg bodyweight either IV or PO. Blood samples to determine plasma STL concentrations were taken before and at several time points after STL administration. Electrocardiography and echocardiography were performed at different time points before and after IV STL administration. Mean peak plasma concentrations after IV and PO administration of STL were 1624 ng/mL and 317 ng/mL, respectively. The oral bioavailability was intermediate (48%) with maximal absorption after 0.94 h, a moderate distribution and a mean elimination half-life of 15.24 h. After IV administration, there was a significant increase in QT interval, but no significant changes in other electrocardiographic and echocardiographic parameters. Transient transpiration was observed after IV administration, but no adverse effects were noted after a single oral dose of 1 mg/kg STL in any of the horses. It was concluded that STL has an intermediate oral bioavailability in the horse and might be useful in the treatment of equine arrhythmias. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Functioning after a major depressive episode : complete or incomplete recovery?

    NARCIS (Netherlands)

    Buist-Bouwman, MA; Ormel, J; de Graaf, R; Vollebergh, WAM

    2004-01-01

    Background: Numerous studies have shown improved functioning after a depression, but often substantial limitations at follow-up remained. The goal of this study is to examine (1) whether functioning returns to pre-morbid levels after a major depressive episode (MDE), (2) predictors of incomplete

  4. Interaction between physical activity and continuous-flow left ventricular assist device function in outpatients.

    Science.gov (United States)

    Hu, Sharon X H; Keogh, Anne M; Macdonald, Peter S; Kotlyar, Eugene; Robson, Desiree; Harkess, Michelle; Granger, Emily; Dhital, Kumud; Jansz, Paul; Spratt, Phillip; Hayward, Christopher S

    2013-03-01

    Studies have shown that pump output by continuous-flow left ventricular assist devices (LVADs) increases with graded exercise testing. However, data on pump behavior during activities of daily living and sleep, where cardiac output requirements vary markedly, are lacking. We sought to determine pump parameters and activity levels in stable patients receiving outpatient LVAD therapy. Eleven outpatients (mean age 51 ± 14 years, 9 male) with centrifugal continuous-flow LVADs underwent monitoring of LVAD flow, heart rate (HR), energy expenditure, and physical activity over 1 week in an outpatient setting. Physical activity was recorded with the use of a combined pedometer, accelerometer, and calorimeter Sensewear armband. Pump, HR, and physical activity parameters were time matched for correlation analysis. Outpatients had an average pump flow of 5.67 ± 1.27 L/min and engaged predominately in low levels of physical activity (mean daily step count 3,249/day). Across the entire cohort, pump flow exhibited strong univariate relationships with patients' energy expenditure (r = 0.73), step count (r = 0.69), HR (r = 0.73), sleep (r = -0.89), and skin temperature (r = -0.85; P < .0001 for all). Multivariate analysis suggested that pump output was predominantly affected by recumbent position, energy expenditure and skin temperature (r(2) = 0.84; P < .0001). Pump flow and power consumption were significantly lower during sleep than during wake periods (5.48 ± 1.31 L/min vs 5.80 ± 1.26 L/min; P < .001). Pump output from continuous-flow LVADs is adaptive to changes in activities of daily living. Circadian variation in pump flow is mostly explained by recumbency and activity levels. Despite adequate pump flow, many LVAD patients continue to live sedentary lifestyles. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  5. Cine MR imaging after myocardial infarction--assessment and follow-up of regional and global left ventricular function.

    Science.gov (United States)

    Sandstede, J J; Lipke, C; Kenn, W; Beer, M; Pabst, T; Hahn, D

    1999-12-01

    Myocardial infarction often leads to regional wall motion defects and in case of large defects to remodeling of the left ventricle. With this study, changes in regional and global myocardial function of 12 patients 3 weeks after myocardial infarction and after revascularization therapy were determined using MRI. Cine MRI was performed at study entry at rest and during low-dose dobutamine stimulation. All patients were re-examined at rest 3 and 6 months after the revascularization, including analysis of wall thickening and of left ventricular end-diastolic volume index (LVEDVI), end-systolic volume index (LVESVI), ejection fraction (LVEF), and mass index. After revascularization. 6 patients with stress-induced improvement of regional wall thickening recovered, 4 patients without improvement did not, but 2 patients without stress-induced improvement of wall thickening also recovered. Concerning global cardiac function, patients with mainly improved regional wall motion also showed a lower LVESVI and a higher LVEF than patients without improvement of regional contractility 6 months after revascularization in comparison to study entry. In conclusion, improvement of global myocardial function after revascularization is higher in patients with improved contractility in the infarcted region. The extent of the response of regions with wall motion defects to dobutamine stress correlates with the actual improvement after revascularization, and, therefore, dobutamine stress MRI may be helpful in selecting patients that will have a higher benefit from a revascularization therapy.

  6. Left ventricular long axis function assessed during cine-cardiovascular magnetic resonance is an independent predictor of adverse cardiac events.

    Science.gov (United States)

    Rangarajan, Vibhav; Chacko, Satish Jacob; Romano, Simone; Jue, Jennifer; Jariwala, Nikhil; Chung, Jaehoon; Farzaneh-Far, Afshin

    2016-06-07

    Left ventricular pump function requires a complex interplay involving myocardial fibers orientated in the longitudinal, oblique and circumferential directions. Long axis dysfunction appears to be an early marker for a number of pathological states. We hypothesized that mitral annular plane systolic excursion (MAPSE) measured during cine-cardiovascular magnetic resonance (CMR) reflects changes in long axis function and may be an early marker for adverse cardiovascular outcomes. The aims of this study were therefore: 1) To assess the feasibility and reproducibility of MAPSE measurements during routine cine-CMR; and 2) To assess whether MAPSE, as a surrogate for long axis function, is a predictor of major adverse cardiovascular events (MACE). Four hundred consecutive patients undergoing CMR were prospectively enrolled. MAPSE was measured in the 4-chamber cine view. Patients were prospectively followed for major adverse cardiac events (MACE) - death, non-fatal myocardial infarction, hospitalization for heart failure or unstable angina, and late revascularization. Cox proportional hazards regression modeling was used to identify factors independently associated with MACE. Net reclassification improvement (NRI) was calculated to assess whether addition of MAPSE resulted in improved risk reclassification of MACE. Seventy-two MACE occurred during a median follow-up of 14.5 months. By Kaplan-Meier analysis, patients with lateral MAPSE cine-CMR is an independent predictor of MACE.

  7. Recovery of Vestibular Ocular Reflex Function and Balance Control after a Unilateral Peripheral Vestibular Deficit

    OpenAIRE

    John eAllum

    2012-01-01

    This review describes the effect of unilateral peripheral vestibular deficit (UPVD) on balance control for stance and gait tests. Because a UPVD is normally defined based on vestibular ocular reflex (VOR) tests, we compared recovery observed in balance control with patterns of recovery in VOR function. Two general types of UPVD are considered; acute vestibular neuritis (AVN) and vestibular neurectomy. The latter was subdivided into vestibular loss after cerebellar pontine angle tumor surgery ...

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

    Science.gov (United States)

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

    2017-08-01

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

  9. Serial changes in anatomy and ventricular function on dual-source cardiac computed tomography after the Norwood procedure for hypoplastic left heart syndrome.

    Science.gov (United States)

    Goo, Hyun Woo

    2017-12-01

    Accurate evaluation of anatomy and ventricular function after the Norwood procedure in hypoplastic left heart syndrome is important for treatment planning and prognostication, but echocardiography and cardiac MRI have limitations. To assess serial changes in anatomy and ventricular function on dual-source cardiac CT after the Norwood procedure for hypoplastic left heart syndrome. In 14 consecutive patients with hypoplastic left heart syndrome, end-systolic and end-diastolic phase cardiac dual-source CT was performed before and early (average: 1 month) after the Norwood procedure, and repeated late (median: 4.5 months) after the Norwood procedure in six patients. Ventricular functional parameters and indexed morphological measurements including pulmonary artery size, right ventricular free wall thickness, and ascending aorta size on cardiac CT were compared between different time points. Moreover, morphological features including ventricular septal defect, endocardial fibroelastosis and coronary ventricular communication were evaluated on cardiac CT. Right ventricular function and volumes remained unchanged (indexed end-systolic and end-diastolic volumes: 38.9±14.0 vs. 41.1±21.5 ml/m2, P=0.7 and 99.5±30.5 vs. 105.1±33.0 ml/m2, P=0.6; ejection fraction: 60.1±7.3 vs. 63.8±7.0%, P=0.1, and indexed stroke volume: 60.7±18.0 vs. 64.0±15.6 ml/m2, P=0.5) early after the Norwood procedure, but function was decreased (ejection fraction: 64.2±2.6 vs. 58.1±7.1%, P=0.01) and volume was increased (indexed end-systolic and end-diastolic volumes: 39.2±14.9 vs. 68.9±20.6 ml/m2, Pfunction after the Norwood procedure in patients with hypoplastic left heart syndrome.

  10. Impact of flow, gradient, and left ventricular function on outcomes after transcatheter aortic valve replacement.

    Science.gov (United States)

    Carreras, Edward T; Kaneko, Tsuyoshi; Ramirez-Del Val, Fernando; Pelletier, Marc P; Sobieszczyk, Piotr S; Bhatt, Deepak L; Shah, Pinak B

    2017-10-08

    To assess the impact of low flow with and without preserved left ventricular ejection fraction (LVEF) on outcomes after transcatheter aortic valve replacement (TAVR). Prior studies have shown that patients with low flow, AVG, and LVEF have worse outcomes after TAVR. It is unclear whether low AVG and LVEF remain prognostic after adjusting for flow, and how the outcomes of patients with low flow with and without preserved LVEF compare after TAVR. The goal of this study was to provide insight into these open questions. Data from 340 TAVR patients at Brigham and Women's Hospital from 2011 through 2015 were analyzed. Low flow was defined as stroke volume index (SVI) ≤35 mL/m(2) , low AVG as mean gradient < 40 mmHg, and reduced LVEF as < 50%. Low flow was present in 96 (28.2%) patients, 48 (50.0%) of whom also had reduced LVEF. At 1 year, low flow was associated with increased mortality (21.9 vs 7.4%; P = 0.0002) and heart failure (HF) (20.8 vs 5.3%; P = 0.0113). Among patients with low flow, those with preserved LVEF had increased mortality (HR 5.17, 95% CI 2.73-9.80; P < 0.001) and HF (HR 7.69, 95% CI 3.86-15.31; P < 0.001). After adjusting for clinical factors, patients with low flow had increased mortality (HR 6.51, 95% CI 2.98-14.22; P < 0.001) and HF (HR 5.52, 95% CI 2.34-12.98; P < 0.001), while neither low AVG nor low LVEF were associated with increases in mortality or HF. In patients undergoing TAVR, low flow was an independent predictor of 1-year mortality and HF, and a stronger predictor than either low AVG or LVEF. Patients with low flow and preserved EF had increased mortality and HF at 1-year, while those with low flow and reduced EF had outcomes similar to patients with normal flow. © 2017 Wiley Periodicals, Inc.

  11. Partial functional recovery after complete spinal cord transection by combined chondroitinase and clenbuterol treatment.

    Science.gov (United States)

    Bai, Fusheng; Peng, Hong; Etlinger, Joseph D; Zeman, Richard J

    2010-08-01

    Spinal cord injury not only disrupts axonal tracts but also causes gliotic, fibrotic, and Schwannotic scarring with resulting deposition of chondroitin sulfate proteoglycans (CSPGs) which prevent axonal reconnection and recovery of locomotor function. Here, we determined whether recovery of locomotor function could be promoted after complete transection, by degrading CSPGs enzymatically within the injury site with chondroitinase ABC (chABC) together with treatment with the beta(2)-adrenoceptor agonist, clenbuterol, a neuroprotective agent which can promote regrowth of lower motoneurons. Partial recovery of locomotor function was observed 8-12 weeks postinjury only after combined chABC and clenbuterol treatment. The recovery of locomotor function coincided with the presence of axons caudal to the injury site arising from neurons of the reticular, vestibular, and red nuclei also only with combined chABC and clenbuterol treatment. Axons myelinated by Schwann cells were most prominent in the transection site in the combined treatment group. Clenbuterol treatment activated cAMP response element binding protein within retrogradely traced neurons which has been associated with axonal regrowth. ChABC treatment decreased scarring due to both CSPG and collagen deposition as well as the gap between intact regions of the spinal cord. ChABC also increased numbers of phagocytic cells which remove myelin debris as well as populations of astrocytes thereby aiding blood-spinal cord barrier reformation. Together the results suggest that chABC and clenbuterol can act synergistically to promote recovery of locomotor function.

  12. Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism.

    Science.gov (United States)

    McCully, Belinda H; Connelly, Christopher R; Fair, Kelly A; Holcomb, John B; Fox, Erin E; Wade, Charles E; Bulger, Eileen M; Schreiber, Martin A

    2017-07-01

    Altered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients. Secondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value coagulation recovery (a significant change compared with 2 hours) of K-value (48 vs 24 hours), α-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p coagulation that can potentiate VTE formation require additional investigation. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Predicting recovery of cognitive function soon after stroke: differential modeling of logarithmic and linear regression.

    Science.gov (United States)

    Suzuki, Makoto; Sugimura, Yuko; Yamada, Sumio; Omori, Yoshitsugu; Miyamoto, Masaaki; Yamamoto, Jun-ichi

    2013-01-01

    Cognitive disorders in the acute stage of stroke are common and are important independent predictors of adverse outcome in the long term. Despite the impact of cognitive disorders on both patients and their families, it is still difficult to predict the extent or duration of cognitive impairments. The objective of the present study was, therefore, to provide data on predicting the recovery of cognitive function soon after stroke by differential modeling with logarithmic and linear regression. This study included two rounds of data collection comprising 57 stroke patients enrolled in the first round for the purpose of identifying the time course of cognitive recovery in the early-phase group data, and 43 stroke patients in the second round for the purpose of ensuring that the correlation of the early-phase group data applied to the prediction of each individual's degree of cognitive recovery. In the first round, Mini-Mental State Examination (MMSE) scores were assessed 3 times during hospitalization, and the scores were regressed on the logarithm and linear of time. In the second round, calculations of MMSE scores were made for the first two scoring times after admission to tailor the structures of logarithmic and linear regression formulae to fit an individual's degree of functional recovery. The time course of early-phase recovery for cognitive functions resembled both logarithmic and linear functions. However, MMSE scores sampled at two baseline points based on logarithmic regression modeling could estimate prediction of cognitive recovery more accurately than could linear regression modeling (logarithmic modeling, R(2) = 0.676, Plinear regression modeling, R(2) = 0.598, P<0.0001). Logarithmic modeling based on MMSE scores could accurately predict the recovery of cognitive