Cardiovascular findings in very low birthweight schoolchildren with and without bronchopulmonary dysplasia

BACKGROUND: With the introduction of new therapies in peri- and neonatology, the clinical picture of bronchopulmonary dysplasia (BPD) seems to alter. The consequences of this "new BPD" are of interest. AIM: To evaluate cardiovascular findings during the surfactant era in very low birthweight (VLBW, birth weight < 1500 g) schoolchildren with and without BPD. METHODS: At 7-8 years of age, 34 VLBW children with BPD born in one hospital underwent blood pressure (BP) measurement, electrocardiography (ECG), two-dimensional Doppler and M-mode echocardiography, flow-volume spirometry and whole-body plethysmography. The age- and sex-matched control groups comprised 34 VLBW children without BPD (no-BPD group) and 34 term children (term group). RESULTS: The mean(SD) diastolic BP was significantly higher in the no-BPD than in the BPD group (65(9) vs. 59(8) mm Hg, p < 0.05). No clinically significant tricuspid regurgitations were found. The groups did not differ with respect to right ventricular systolic time intervals corrected for heart rate. The results of all M-mode measurements were within normal range. Compared to term controls, the BPD cases had lower mean(SD) forced expiratory flow in 1 s (90(14)% vs. 99(11)% of ref., p < 0.05) and more often high ratio of residual volume to total lung capacity (15(52%) vs. 4(13%), p < 0.01). No clinically significant correlations were found between current lung function and echocardiographic findings. CONCLUSION: In the surfactant era, school-aged VLBW survivors with and without BPD do not seem to evince indirect signs of elevated pulmonary pressure. The increased pulmonary vascular resistance associated with BPD appears to resolve with time more rapidly than abnormalities in respiratory function.     

非洛地平缓释片与福辛普利逆转左心室肥厚及对舒张功能影响的效应对比

目的 观察非洛地平缓释片对高血压左室肥厚的逆转作用和改善左室舒张功能。方法 应用彩色多普勒超声心动图仪测定58例高血压伴左室肥厚者口服非洛地平缓释片(5～15mg/d)6个月前后左定形态结构及左定舒张功能变化,并与58例应用福辛普利(10～20mg/d)治疗者对比。结果 两组治疗后血压均明显下降(P<0.01),舒张期室内隔厚度及在室后壁厚度、左室重量指数均明显减少(P<0.001),E/A比值显著升高(P<0.002),治疗前后组间各参数差异无显著性(P>0.05)。结论 非洛地平缓释片和福辛普利均能有效逆转左室肥厚和改善左室舒张功能。     

Pulmonary venous flow velocity patterns in 143 normal subjects aged 20 to 80 years old: An echo 2D colour Doppler cooperative study

In order to find out the normal values and to evaluate the effectsof age, heart rate, sex, and haemodynamic and standard echocardiographicparameters on pulmonary venous flow velocity obtained by thetransthoracic approach, Doppler pulmonary venous flow parameterswere measured in 143 healthy subjects aged from 20 to 80 years. Doppler pulmonary venous flow parameters which had the bestcorrelation with age were: the peak velocity of the systolicwave (r=0·39) and its integral (r=0·5), the peakvelocity of the diastolic wave (r=–0·6) and itsintegral (r=–0·44); the systolic (r=0·68)and diastolic fractions (r=–0·68); the systolic/diastolicpeak velocity ratio (r=0·73) and the systolic/diastolicintegral ratio (r=0·7). The atrial reversal wave didnot correlate with age; the atrial reversal wave was more difficultand probably less reliable to measure than the systolic anddiastolic waves. The correlations of pulmonary venous flow parameters with mitralflow parameters were also examined. This study showed that,in healthy subjects, despite an increase in the early and atrialwaves from the annulus to the tips of the mitral leaflets, thereis a similar association between pulmonary venous flow and mitralflow measured at the annulus or at the tips of the mitral leaflets. The intra-observer reproducibility of all the pulmonary venousflow parameters considered were found to be excellent. Moderateinter-observer variability was observed for the systolic, diastolicand atrial reversal wave peak velocities and integrals; however,the systolic/diastolic ratio improved the precision of the measurements. Multivariate analysis showed that age is the principal determinantof the Doppler parameters of pulmonary venous flow; heart rate,sex, body surface area, the size of the left atrium in systoleand the left ventricular ejection fraction all influence theDoppler parameters of pulmonary venous flow, even if only slightly.     

老年阵发性心房颤动复律后左心室舒张功能的变化

目的观察阵发性心房颤动(房颤)老年患者左心室舒张功能的变化,探讨多指标评价左心室舒张功能的价值。方法选自2004年9月至2006年2月贵阳医学院附属医院住院及门诊阵发性房颤34例老年患者,采用彩色多普勒二维超声心动图仪测定阵发性房颤复律后左心功能的各项指标,并与健康老年人进行对照。结果左心室等容舒张期时间(IVRT)、二尖瓣血流舒张早期最大流速(EV)、二尖瓣血流心房收缩期最大流速(AV)及E波与A波流速比值(EV/AV)各项指标:阵发性房颤恢复窦律组与正常对照组比较,依次为[(99±11)ms对(75±13)ms]、[(0.65±0.14)m/s对(0.84±0.15)m/s]、[(0.77±0.12)m/s对(0.55±0.13)m/s]及[(0.84±0.13)(1,(1.52±0.16)(1],差异均有显著性意义(P(0.01)。结论老年阵发性房颤患者复律后存在较明显的左心室舒张功能障碍;多指标评价左心室舒张功能更客观。     

Impact of essential hypertension and diabetes mellitus on left ventricular systolic and diastolic performance.

AIMS: To investigate left ventricular systolic and diastolic function in patients with essential hypertension and diabetes mellitus associated with hypertension by the myocardial performance index (MPI). METHODS AND RESULTS: The study included 45 patients with essential hypertension, 45 patients with diabetes mellitus and hypertension and 45 normal subjects, who underwent a complete two-dimensional and Doppler echocardiography including assessment of the isovolumetric Doppler time intervals for the estimation of the Doppler-derived MPI.The MPI was significantly higher in patients with essential hypertension and diabetes with hypertension, compared to controls (Essential hypertension=0.51+/-0.12; Diabetes=0.51+/-0.12 vs. controls 0.40+/-0.05, P=0.001). The isovolumetric contraction time was significantly prolonged in essential hypertension (56+/-26 msec vs. 40+/-17 msec, P<0.01 respectively) and among diabetes patients isovolumetric relaxation time was prolonged compared to normal subjects (100+/-20 ms vs. 87+/-16 ms, P<0.01, respectively). The index was not related to left ventricular mass, age or ejection fraction, but significantly correlated to E-wave deceleration time (rho=0.48, P<0.001). CONCLUSIONS: The MPI is increased, in both essential hypertensive patients and diabetes patients with associated hypertension, despite normal ejection fraction.     

Childhood Obesity: Impact on Cardiac Geometry and Function

ObjectivesThe aim of our study was to assess geometric and functional changes of the heart in obese compared with nonobese children and adolescents.BackgroundObesity in children and adolescents has increased over the past decades and is considered a strong risk factor for future cardiovascular morbidity and mortality. Obesity has been associated with myocardial structural alterations that may influence cardiac mechanics.MethodsWe prospectively recruited 61 obese (13.5 ± 2.7 years of age, 46% male sex, SD score body mass index, 2.52 ± 0.60) and 40 nonobese (14.1 ± 2.8 years of age, 50% male sex, SD score body mass index, −0.33 ± 0.83) consecutive, nonselected Caucasian children and adolescents. A standardized 2-dimensional (2D) echocardiography and 2D speckle-tracking analysis was performed in all children. Furthermore, blood chemistry including lipid and glucose metabolism was assessed in all children.ResultsCompared with nonobese children, blood pressure, low-density lipoprotein cholesterol, and parameters of glucose metabolism were significantly increased in obese children, whereas high-density lipoprotein cholesterol was significantly lower. Compared with nonobese children, obese children were characterized by enlarged left- and right-sided cardiac chambers, thicker left ventricular walls, and, consequently, increased left ventricular mass. Despite a comparable left ventricular ejection fraction, decreased tissue Doppler–derived peak systolic velocity and regional basoseptal strain were found in obese children compared with nonobese children. Beyond that, 2D speckle tracking–derived longitudinal (−18.2 ± 2.0 vs. −20.5 ± 2.3, p < 0.001) and circumferential (−17.0 ± 2.7 vs. −19.5 ± 2.9, p < 0.001) strain of the left ventricle was reduced in obese children compared with nonobese children. Diastolic function was also impaired in obese compared with nonobese children. Both longitudinal strain and circumferential strain were independently associated with obesity.ConclusionsThe results of this study demonstrate that childhood obesity is associated with significant changes in myocardial geometry and function, indicating an early onset of potentially unfavorable alterations in the myocardium.     

Left ventricle filling abnormalities prior to and following treatment of thyrotoxicosis -- is diastolic dysfunction implicated in thyrotoxic cardiomyopathy?

Despite cardiac failure being a well recognised complicationofthyrotoxicosis, systolic function has generally been reportedas maintained or enhanced. In this study, left ventricular diastolicfunction was assessed in 16 thyrotoxic patients and 18 age-matchedcontrols by pulsed-Doppler echocardiography. Patients were re-studiedafter 3 and 12 months of treatment. Prior to treatment all standardDoppler-;derived indices of diastolic function were significantlydifferent to control (isovolumic relaxation time (IVRT) 63±18.9vs 84.0±14.8 ms, peak early filling velocity (E_max) 79.2±15.2vs 61.9±10.7 cm . s^–1, peak atrial filling velocity(A_max) 68.2±17.9 vs42.2±9.4 cm . s^–1, decelerationof early filling (E/F slope) 6.1±1.8 vs3.7±1.1m . s^–1, thyrotoxic vs control). However, these fillingabnormalities appear likely to reflect the tachycardia and reducedsystemic vascular resistance (SVR) found in the patients (heartrate 102±15 vs 76 ± 9, SVR 874 ± 207 vs1293 ± 362 dynes .s^–1. cm^–5, both P<0.001).After 3 months of treatment haemodynamics were similar in thetwo groups but filling remained abnormal in patients with apattern suggesting increased transmitral pressure gradients(E_max 73.1 ± 15.1 cm.s^–1, A_max 55.8 ± 19.2cm.s^–1,E/F slope 4.9 ± 2.0m . s^–1, all P<0.05 comparedto controls). After 12 months of treatment most parameters hadreturned to normal but the atrial contribution to left ventricularfilling remained high (A_max54.7 ± 13.9 vs control 42.2± 9.4 cm . s^–1 .flow velocity integral of atrialfilling 4.7 ± 1.3 vs 3.6±11 control, both P0.01).Left ventricular filling is therefore highly abnormal beforeand during the treatment ofthyrotoxicosis. However, these changesappear unlikely to reflect an intrinsic thyrotoxic cardiomyopathyand are more likely to represent a combination of prolongedincreases in left ventricular filling pressures along with abnormalitiesof left atrial function. The abnormal Doppler parameters emphasisethe importance of sinus rhythm in maintaining left ventricularfilling in thyrotoxicosis and may explain why marked haemodynamicdeterioration may result from the development of atrial fibrillationin these patients.     

左室舒张末压、外周阻力与甲襞微循环的相关性

为探讨甲襞微循环在判断心脏前后负荷中的意义，以微循环图像仪定量检测６０例慢性充血性心衰病人的甲襞微循环，同时以二维超声心动图按改良Ｓｉｍｐｓｏｎ氏法测定左室舒张末压、外周阻力加以对照。结果表明：随着左室舒张末压的增高，甲襞微血管输出枝及袢顶直径、面积增大，流速显著减慢。而在高外周阻力状态中，则相应微血管输入枝及袢顶直径、面积缩小，管袢数显著减少。所有指标差异均具显著性。结果提示，甲襞微循环的检测是估计心脏前后负荷功能的可靠指标     

不同期高血压病左室舒张功能的变化

采用多普勒超声心动图技术，对１６例临界高血压病，１８例伴左房增大的高血压病，及２８例正常健康人的左室舒张功能进行测定。结果：不同期搞血压病患者的左室舒张功能有不同程度的减退，减退的规律是；有左房增大的高血压病－临界高血压病－正常健康人。