Sufentanil preserves hemodynamics and left ventricular function in patients with ischemic heart disease

Objective: Sufentanil has been reported to provide stable hemodynamics similar to other opioids. However, it has not been reliably established whether this stability can be attributed only to Sufentanil and translates into fully preserved left ventricular (LV) function. The purpose of this study was to evaluate the effect of Sufentanil on hemodynamics and LV systolic and diastolic function using invasive monitoring and echocardiography in patients with ischemic heart disease. Methods: Prospective observational study of thirty patients acting as their own control undergoing echocardiographic imaging before and after bolus Sufentanil 1.5–2.0 μg/kg. Full invasive hemodynamic monitoring was established before Sufentanil administration. Global LV systolic function was evaluated with a global longitudinal peak systolic strain (GLPSS) by speckle tracking ultrasound; systolic displacement by tissue tracking (TT) and diastolic function was evaluated using Doppler tissue imaging and pulse wave Doppler. Results: Hemodynamic monitoring showed a minor decline in systolic blood pressure from 159 to 154 mmHg (P=0.046). No changes were observed in the cardiac index, stroke volume index and heart rate. An unchanged TT score index (9.9 vs. 10.2 mm, P=0.428) and GLPSS (14.3 vs. 14.5%, P=0.658) indicated preserved LV global systolic function and unchanged E'/A' (0.95 vs. 0.89, P=0.110) and E/E' ratio (15.4 vs. 14.9, P=0.612) indicated unchanged diastolic function. Conclusion: Sufentanil preserves hemodynamic parameters as well as echocardiographic indices of LV systolic and diastolic function in patients with ischemic heart disease (IHD).     

Left ventricular function in children and adults after renal transplantation in childhood

Background

Renal transplantation improves left ventricular (LV) function, but cardiovascular mortality remains elevated. The aim of this cross-sectional study was to determine whether subclinical abnormalities of LV longitudinal function also persist in patients who underwent renal transplant in childhood.

Methods

Conventional and speckle tracking echocardiography was performed in 68 renal transplant recipients (34 children and 34 adults, median 9.8?years (range 2.0–28.4?years) after first transplantation and 68 age- and sex-matched healthy controls.

Results

Mean age at first transplantation was 8.8?±?4.8?years. Forty-three percent had a pre-emptive transplant. Of the remaining, 70% received haemodialysis and 30% peritoneal dialysis on average for 6.9?months. Thirty-one percent of paediatric and 35% of adult patients had hypertension. LV mass index was increased in adult patients (92?±?24 vs 75?±?11?g/m², P P?Conclusions Patients who underwent renal transplantation in childhood have abnormal LV diastolic function and impaired exercise capacity, despite preserved LV longitudinal systolic deformation.     

Transoesophageal echocardiographic evaluation of ventricular function during transvenous defibrillator implantation

Background: Intraoperative testing and defibrillation threshold determination may jeopardise patients, scheduled for implantation of a cardioverter-defibrillator (ICD). The purpose of this study was the assessment of the influence of consecutive defibrillation attempts on left ventricular systolic and diastolic function by means of transoesophageal echocardiography (TEE). Methods: Eighteen patients with malignant ventricular arrhythmias that were resistant to antiarrhythmic drugs were monitored with TEE before, during and after implantation of a cardioverter-defibrillator. Left ventricular fractional area contraction as a measure of ejection fraction was assessed before and after each defibrillation attempt. Transmitral and right upper pulmonary venous flow parameters were evaluated before and after the whole implantation procedure. Results: Adequate data were available in 14 patients during 4 consecutive attempts. No major alterations were observed in heart rate or fractional area contraction, measured at 30 s and 3 min after defibrillation. Overall, the ratio of early-to-late transmitral filling decreased significantly after the implantation procedure (from 0.91±0.12 to 0.82±0.14; P<0.05). Systolic pulmonary venous flow velocity decreased from 0.49±0.11 to 0.41±0.10 m/s (P=0.04); this decrease was observed in both groups. A significant increase of the atrial contraction wave (from 0.25±0.06 to 0.34±0.07 m/s; P<0.03) was seen. Subdividing patients related to their preoperative ejection fraction, a significant decrease of the early-to-late transmitral filling of the LV was revealed in patients with ejection fraction less than 35% (group 1). Also, a significantly lower systolic fraction of the pulmonary venous flow after ICD implantation in conjunction with a significantly longer diastolic flow time was shown in this patient group in comparison with patients with a preoperative ejection fraction of more than 35% (group 2). Conclusion: Defibrillation threshold testing of the ICD system changes LV inflow characteristics and impedes diastolic function of the left ventricle and may thus precipitate heart failure by this mechanism. No deleterious effects of threshold testing were observed with respect to fractional area contraction nor any deterioration of LV function was found in a clinically significant amount due to consecutive defibrillation attempts.     

High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart

Background: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two-dimensional (2D) echocardiography and TDI in patients with ischemic heart disease.
Methods: The effect of a high epidural block (at least Th1–Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early ( E ") and atrial ( A ") peak velocities during diastole.
Results: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 ± 1.53 to 6.86 ± 1.38 ( P <0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E "/ A " ratio increased from 0.75 ± 0.27 to 1.09 ± 0.32 ( P =0.0026), indicating improved relaxation.
Conclusion: A 2D-echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.     

Effects of Low Sodium Dialysate in Chronic Hemodialysis Patients: An Echocardiographic Study

Background. Chronic kidney disease (CKD) and hemodialysis (HD) patients who cannot restrict sodium consumption in their diets sometimes develop significant saline excess and hypertension between dialyses. This study assessed the effect of relatively low sodium dialysate dialysis on changes of echocardiography in hemodialysis patients. Methods and Results. Eighteen patients with end stage renal failure on chronic HD were studied (8 females, 10 males) with a mean age 48.3 ± 14.6 (24–70) years. The mean time on HD was 30.8 ± 14.0 (12–60) months. Patients with hematocrit levels under 24% were excluded from the study. In all patients, echocardiography was performed thrice weekly before and after eight-week HD treatment with low sodium dialysate hemodialysis by the same operator (135 mEq/L for patients with sodium levels less than 137, 137 for patients with sodium levels over 137). Left atrium (LA) and left ventricle (LV) volumes and ejection fractions were measured, specifically: LV systolic diameter (LVSD), LV diastolic diameter (LVDD), interventricular septum (IVS), tricuspid regurgitation (TR), mitral regurgitation (MR), pulmonary artery pressure (PAP), and inferior vein cava diameter (IVCD). Results. In terms of echocardiographic parameters, LVSD, TR, PAP, and IVCD were statistically decreased after low-sodium dialysate treatments (p?=?0.002, 0.04, 0.013, and 0.00, respectively). Predialysis systolic and diastolic blood pressure (BP), post-dialysis systolic blood pressure, and interdialytic weight gain was statistically decreased when compared to basal levels (p?=?0.00, p?=?0.011, p?=?0.022, p?=?0.001, respectively). Conclusion A reduction of the dialysate sodium concentration based on the predialysis sodium levels of the patients could reduce the systolic BP and decrease the volume load on the heart as assessed by echocardiography. Within this short period, postdialysis diastolic BP could not be lowered. The effect of this approach should be studied in broad and lengthy series.     

Comparison of Echocardiographic Changes Associated with Hemodialysis and Renal Transplantation

Abstract: Long-term hemodialysis has been reported to cause progression of left ventricular (LV) hypertrophy with a tendency toward asymmetric septal hypertrophy. Renal transplantation is believed to reverse some of these changes. The aim of this prospective study was to compare the effects of long-term hemodialysis and of successful renal transplantation on cardiac structure and function assessed by echocardiography. Fifty-three patients were submitted to two echocardiographic evaluations separated by a 30 ± 8 month interval. At the first control, all patients were on hemodialysis; at the second, 36 patients remained on dialysis while 17 had been submitted to renal transplantation. Age (44 ± 13 vs. 40 ± 10 years), gender (male, 50% vs 53%), and duration of dialysis at the initiation of the study (43 ± 34 vs. 47 ± 32 months) were comparable in the 2 groups. The prevalences of LV hypertrophy were 83% (first control) and 69% (second control) in the dialysis group and 82% and 71% in the transplant group. Comparisons between the two periods within each group showed that hemodialysis was associated with a significant reduction of the E/A ratio (1.25 ± 0.4 vs. 1.02 ± 0.4, p < 0.001) and systolic (155 ± 28 vs. 137 ± 26 mm Hg, p < 0.001) and diastolic (94 ± 21 vs. 84 ± 16 mm Hg, p < 0.05) blood pressure, and no change in LV mass index (171 ± 51 vs. 156 ± 43 g/m², NS). In the transplanted group, there were reductions in the E/A ratio (1.42 ± 0.6 vs. 1.10 ± 0.4, p < 0.05) and in LV diastolic dimension (50 ± 7 vs. 46 ± 5 mm, p < 0.05), but not in systolic (155 ± 27 vs. 152 ± 31 mm Hg, NS) or diastolic (97 ± 11 vs. 97 ± 20 mm Hg, NS) blood pressure. The LV mass index also did not change significantly (157 ± 51 vs. 133 ± 31 g/m², NS). Left atrium dimension, LV posterior wall thickness, interventricular septum thickness, and fractional shortening were not significantly changed in either group. Asymmetric septal hypertrophy was not observed. It is concluded that patients treated by long-term hemodialysis did not present progression in the degree and prevalence of LV hypertrophy over time while systolic function was preserved and diastolic function deteriorated. Contrary to previous reports, successful renal transplantation did not cause a reduction in LV hypertrophy and also failed to improve LV diastolic function.     

Single‐Center Experience With HeartMate II Left Ventricular Assist Device Explantation

In patients with continuous flow left ventricular assist devices (CF‐LVADs) myocardial recovery is uncommon. Given the heterogeneity of the population implanted and low incidence of recovery, the discovery of native left ventricular (LV) recovery and criteria for explantation of CF‐LVAD system is not clearly determined. We sought to analyze the characteristics of the patients who underwent CF‐LVAD explantation at our institution. Prospectively collected data on patients supported with CF‐LVADs were reviewed retrospectively. Patients who underwent CF‐LVAD explants were identified and their characteristics were analyzed with a focus on patient presentation and determinants of explantability. From November 2006 to June 2014, 223 patients (181 male, 42 female) underwent implantation of HeartMate II LVAD. Seven female (16.7%) and one male (0.6%) patients were explanted (P < 0.001). Mean age was 43 ± 9 years and etiology for cardiomyopathy was ischemic in three (37.5%) patients, nonischemic in four (50%) patients, and mixed in the one (12.5%) male patient of the cohort. Five (62.5%) patients presented acutely with significant hemolysis, and were found to have LV improvement as well as reduced, absent, or reversed diastolic flow velocities on echocardiography. Overall, mean lactate dehydrogenase level before explantation was 1709 ± 1168 U/L compared to the mean baseline level of 601 ± 316 U/L (P = 0.048). Mean LV ejection fraction (LVEF) improved from 17 ± 7% preimplant to 56 ± 11% pre‐explantation (P < 0.001). Median number of days on CF‐LVAD support was 870 (interquartile range, 209–975) while mean duration of follow‐up after the CF‐LVAD explantation was 276 ± 240 days. Mean LVEF dropped from 46 ± 19% postexplantation to 34 ± 10% during the most recent follow‐up (P = 0.015). At our institution, patients who underwent LVAD explants were predominantly women with nonischemic cardiomyopathy. Clinical evidence of hemolysis and echocardiographic evidence of reduced or absent diastolic flow velocities were common findings in these patients. Over time, patient's native LV function declined in the absence of LVAD (after LVAD explantation). Significant challenges remain in predicting LV recovery and identifying those individuals who have recovered myocardial function significant enough to be explanted.     

Effects of anesthetic induction in patients with diastolic dysfunction

Purpose

To evaluate the effects of anesthetic induction on bi-ventricular function in patients with known preoperative left ventricular (LV) diastolic dysfunction undergoing coronary artery bypass grafting surgery (CABG).

Methods

Fifty patients with diastolic dysfunction undergoing CABG were studied. Preoperative transthoracic echocardiographic (TTE) examination was performed on the day before surgery and transesophageal echocardiography (TEE) assessment was undertaken after induction of anesthesia with sufentanil, midazolam, isoflurane, and pancuronium. Mean arterial pressure (MAP) and heart rate (HR) were recorded. The diameters of the left atrium (LA) and right atrium (RA) and right ventricular (RV) end-diastolic area (EDA), end-systolic area (ESA) and fractional area change (FAC) were obtained from the apical 4-chamber view. The LV EDA, LV ESA and LV FAC were measured from a transgastric midpapillary view. Pulsed wave Doppler of the transmitral flow (TMF) and transtricuspid flow (TTF), pulmonary venous flow (PVF) and hepatic venous flow (HVF) were measured. Mitral (Em, Am) and tricuspid (Et, At) annulus velocities were assessed by tissue Doppler imaging (TDI). Assessment of diastolic dysfunction was graded from normal to severe using a validated score.

Results

Following induction of anesthesia, HR decreased (66 ± 12 vs 55 ± 9 beats·min^?1, P < 0.0001) while MAP remained unchanged (86.1 ± 9.0 vs 85.6 ± 26.5 mmHg, P = 0.94). The diameters of the LA, RA and RV chambers increased, and these increases were associated with opposite changes in LV dimensions. The RV FAC decreased, but the LV FAC remained unchanged. While most Doppler velocities decreased (P < 0.05), a greater reduction in the atrial components of the TMF, TTF and TDI ratios was observed. The LV diastolic function score improved after induction of anesthesia (100% of patients with a score ≥ = 3 pre-induction compared to 58% of patients with a score ≥3 post-induction; P = 0.0004).

Conclusion

In patients with left ventricular diastolic dysfunction, cardiac dimensions and bi-ventricular filling patterns are significantly altered after induction of general anesthesia. These changes can be explained to some extent by a reduction in venous return with general anesthesia, reduced atrial contractility, and the effect of positive pressure ventilation. Although the LV diastolic function score improved after induction of anesthesia, it is difficult to dissociate this effect from that of altered loading conditions.     

Proximal aortic compliance and diastolic function assessed by speckle tracking imaging

Purpose

Speckle tracking imaging (STI) is a recent technique that evaluates an echocardiographic image throughout the cardiac cycle and provides dynamic variables such as tissue velocities and strain rates. The objective of our study was to determine 1) if STI can be used to quantify proximal aortic compliance and 2) if decreased aortic compliance determined by STI will reproduce the previously reported correlation with diastolic function.

Methods

This was a retrospective observational case series using previously obtained intraoperative transesophageal images. Diastolic performance was quantified by STI-based longitudinal velocities of the basal-septal and basal-lateral walls of the left ventricle in early diastole (LV E′). Change in proximal aortic volume was calculated using STI to measure peak longitudinal and radial velocities in early diastole. After normalizing for mean arterial pressure, compliance was calculated and then compared with basal-septal and basal-lateral LV E′ using single regression analysis.

Results

Twenty patients were included in our analysis. Linear regression of basal-septal LV E′ and basal-lateral LV E′ vs proximal aortic compliance during diastole each resulted in an R² value of 0.26 (P < 0.05).

Conclusion

Speckle tracking can be used to describe the physical motion of the aortic wall and to calculate its compliance. We confirm that variation in diastolic function can be attributed, in part, to aortic compliance. Our novel approach of measuring compliance throughout the cardiac cycle, isolating radial and longitudinal contributions, and evaluating previously obtained images retrospectively provides advantages over previously reported measures of aortic compliance. Speckle tracking promises new insights into ventricular function, aortic mechanics, and the interaction between these structures.     

Tissue Doppler is a More Reliable Method in Early Detection of Cardiac Dysfunction in Patients with AA Amyloidosis

Objective. Cardiac deposition of AA amyloidosis may result in increasing left ventricular mass and systolic and diastolic dysfunction (DD). The aim of this study was to investigate the left ventricular systolic and diastolic functions by both tissue Doppler imaging (TDI) and pulsed wave Doppler echocardiography (PWD) in patients with AA amyloidosis without congestive heart failure symptoms or arrthymia. Methods and Results. Twenty-four patients with AA amyloidosis without congestive heart failure symptoms or arrthymia (15 men and nine women; mean age 44.3 ± 16.7 years) and 25 healthy subjects (19 men and six women; mean age 43.1 ± 9.2 years) as controls were included in the study. M-mode, two-dimensional, PWD, and TDI were performed. Peak transmitral filling velocity (E wave), peak transmitral atrial filling velocity (A wave), deceleration time, and isovolumic relaxation time were measured by PWD recordings. Peak myocardial systolic velocity (S_m), peak myocardial early (E_m), and late diastolic velocities (A_m) were also recorded by TDI. E/A ratio less than one was accepted as DD for both methods. Ejection fraction (EF) was calculated by Teicholtz method. The subjects were divided into three groups as follows: healthy controls (group 1), patients without DD (group 2), and patients with DD (group 3) according to the PWD findings. PWD echocardiography showed that DD was present in 50% of the patients, whereas TDI showed DD in 66% of such cases. In subgroup analysis, S_m wave as a systolic function index was lower in group 3 than in groups 1 and 2, whereas mean EF values were similar in all groups. Conclusion. Although AA amyloidosis uncommonly causes cardiac symptoms and findings, according to our results, patients with AA amyloidosis may have systolic and diastolic dysfunction eventhough they are asymptomatic. Also, tissue Doppler imaging is a more reliable method in the early detection of cardiac dysfunction in such patients.     

Calcium infusion and left ventricular diastolic function in patients with chronic renal failure

Background. Left ventricular (LV) function is sensitive to disorders in calcium metabolism. Most previous reports have focused on the effects of calcium on systolic performance. We studied the acute effect of calcium infusion on LF diastolic function in patients with moderate to severe chronic renal failure (CRF) and secondary hyperparathyroidism (SHP). Methods. We infused calcium gluconate at a constant rate of 45 &mgr;mol/kg/h to 14 patients with severe to moderate CRF and SHP. Our aim was to reach slightly supranormal levels of serum ionized calcium (1.35-1.45 mmol/l). LV diastolic function was assessed by pulsed Doppler echocardiography before and after the calcium infusion. The echocardiographic indices were compared to those of 14 age- and sex-matched healthy controls. Results. Before calcium infusion the patients had significantly greater LV dimensions than the controls, but there was no differences in the diastolic indices. During calcium infusion, serum ionized calcium increased from 1.18±0.03 to 1.40±0.03 mmol/l (P<0.0001) and plasma intact PTH decreased from 38.6±5.6 to 9.0±2.2 pmol/l (P<0.0001). Calcium infusion did not affect the LV dimensions or fractional shortening. The peak early diastolic velocity (Emax) decreased and peak late diastolic velocity (Amax) increased, and their relationship decreased significantly (1.552±0.586 vs 1.414±0.535 m/s, P=0.03). These changes reflect impairment of LV diastolic function. Conclusions. Induction of acute hypercalcaemia by calcium infusion impairs LV diastolic function in patients with CRF and SHP.     

Volume depletion provided by blood donation alters twist mechanics of the heart: Preload dependency of left ventricular torsion

Objectives: The crucial role of twisting motion on both left ventricular (LV) contraction and relaxation has been clearly identified. However, the reports studying the association between LV torsion and loading conditions have revealed conflicting outcomes. Previously normal saline infusion was shown to increase LV rotation. Our aim was to test this phenomenon after volume depletion in healthy volunteer blood donors. Design: A total of 26 healthy male volunteers were included in the study. LV end-diastolic and end-systolic diameter, LV ejection fraction, LV diastolic parameters, LV apical and basal rotation and peak systolic LV torsion were measured by speckle-tracking echocardiography before and after 450 mL blood donation. Results: Blood donation led to a significant decrease in end-diastolic LV internal diameter (48.7?±?0.4 versus 46.4?±?0.4?mm; p?<?0.001) and cardiac output (6.2?±?1.0 versus 5.1?±?0.7 L/min; p?<?0.001). There was a significant decrease in the magnitude of peak systolic apical rotation (4.4?±?1.9° versus 2.9?±?1.5°; p?<?0.001) but no change in basal rotation (2.6?±?1.4° versus 2.7?±?1.6°; p?=?0.81). Peak systolic LV Torsion decreased after blood donation (6.9?±?1.9° versus 5.7?±?2.1°; p?=?0.028). Conclusions: LV apical rotation and peak systolic LV torsion seem to be preload dependent. Preload reduction provided by 450-mL blood donation decreased LV torsion in healthy male volunteers. Volume dynamics should be taken into account in the evaluation of LV torsion.     

The effects of maintenance recombinant human erythropoietin therapy on ambulatory blood pressure recordings: conventional, Doppler, and tissue Doppler echocardiographic parameters

Abstract: Cardiovascular disease is the major cause of mortality in maintenance hemodialysis patients. Left ventricular dysfunction is present in approximately 80% of these patients and is highly predictive of future ischemic heart disease, cardiac failure, and death. Anemia has been identified as one of several risk factors responsible for cardiac complications. The treatment of renal anemia with recombinant human erythropoietin (rHuEpo) and consequent improvement of cardiac performance may reverse pathological changes in left ventricular geometry. In this study, the acute and chronic effects of rHuEpo administration on 24‐hour ambulatory blood pressure recordings and echocardiographic parameters in 30 rHuEpo‐naïve maintenance hemodialysis patients were examined. Twenty‐four‐hour ambulatory blood pressure monitoring was performed prior to and after 1 week and 6 months of rHuEpo administration. The patients underwent echocardiographic examination prior to and after 6 months of rHuEpo administration. One week treatment with rHuEpo did not cause any significant change in 24‐hour ambulatory blood pressure recordings. After 6 months of therapy, serum hemoglobin levels increased from 8.8 ± 0.66 g/dL to 10.8 ± 0.70 g/dL (P < 0.05). Echocardiographic examination revealed elevation in ejection fraction (62.26 ± 6.84% vs. 69.90 ± 8.98%, P < 0.05) with reductions in fractional shortening (36.70 ± 4.96% vs. 35.96 ± 6.32%, P < 0.05), interventricular septum thickness (1.21 ± 0.16 vs. 1.00 ± 0.16 cm, P < 0.05), and left ventricular mass index (148.2 ± 46.5 g/m² vs. 93.6 ± 17.2 g/m², P < 0.05). Doppler echocardiography and tissue Doppler imaging provided additional information in comparison with conventional echocardiography. Before treatment, mitral flow E wave (E, 0.64 ± 0.27 vs. 0.82 ± 0.17 cm/s), mitral flow A wave (A, 0.80 ± 0.21 vs. 0.70 ± 0.21 cm/s), early diastolic velocity of lateral wall (Lateral E′, 11.2 ± 2.8 vs. 12.4 ± 2.3 cm/s), late diastolic velocity of lateral wall (Lateral A′, 6.7 ± 2.5 vs. 7.8 ± 2.1 cm/s), early diastolic velocity of septal wall (Septal E′, 9.7 ± 2.9 vs. 11.3 ± 1.1 cm/s), and late diastolic velocity of septal wall (Septal A′, 6.4 ± 2.1 vs. 7.8 ± 2.0 cm/s) were significantly lower in patients than in the controls. Patients and controls have similar deceleration time of mitral flow E wave (E Dec, 186 ± 57.8 vs. 192 ± 62.4 ms), isovolumic left ventricular relaxation time (IVRT, 111.9 ± 30.7 vs. 91.1 ± 32 ms), systolic velocity of lateral wall (Lateral S′, 7.8 ± 2.3 vs. 8.1 ± 2.0 cm/s), and systolic velocity of septal wall (Septal S′, 7.5 ± 1.9 vs. 7.7 ± 1.4 cm/s) values. Therapy with rHuEpo did not cause significant changes in E (0.64 ± 0.27 vs. 0.76 ± 0.29 cm/s), A (0.80 ± 0.21 vs. 0.79 ± 0.23 cm/s), E Dec (186 ± 57.8 vs. 165.8 ± 60.1 ms), IVRT (111.9 ± 30.7 vs. 101.6 ± 36.2 ms), Lateral E′ (11.2 ± 2.8 vs. 11.5 ± 4.4 cm/s), Lateral A′ (6.7 ± 2.5 vs. 7.4 ± 2.1 cm/s), Lateral S′ (7.8 ± 2.3 vs. 8.1 ± 2.0 cm/s), Septal E′ (9.7 ± 2.9 vs. 10.0 ± 1.1 cm/s), Septal A′ (6.4 ± 2.1 vs. 6.6 ± 2.0 cm/s), and Septal S′ (7.5 ± 1.9 vs. 7.9 ± 1.4 cm/s) indicating persistence of diastolic dysfunction. In 6 months time, 24‐hour ambulatory blood pressure recordings, however, tended to be higher (systolic: 125.16 ± 21.02 mm Hg vs. 134.36 ± 23.98 mm Hg; diastolic: 77.40 ± 14.47 mm Hg vs. 83.26 ± 14.89 mm Hg, P < 0.05). Correction of anemia with rHuEpo results in the elevation of blood pressure and reduction in left ventricular mass index. Myocardial contraction and relaxation velocities did not improve following regression of left ventricular hypertrophy, suggesting the persistance of diastolic dysfunction. Doppler echocardiography with tissue Doppler imaging reflects the real situation of diastolic function in patients on maintenance hemodialysis.     

Role of speckle tracking imaging in the assessment of myocardial regional ventricular function in experimental blunt cardiac injury

Purpose: To evaluate the usefulness and information collecting ability of speckle tracking imaging techniques in the assessment of myocardial regional ventricular contractility in a rabbit model with blunt cardiac injury. Methods: Fifteen healthy New Zealand rabbits weighing (2.70±0.28) kg were anesthetized (3% pentobarbital sodium/i.v) and impacted using the BIM-II biological impact machine to induce myocardial contusion (MC). Hemodynamic parameters, such as heart rate, systolic pressure, mean arterial pressure, diastolic pressure and central venous pressure, were determined before and after MC. Further, parameters reflecting left ventricular functions, such as left ventricular end systolic pressure, left ventricular end diastolic pressure, isovolumic pressure (IP) and the maximal increasing/decreasing rate of left intraventricular pressure (±dp/dtmax), were also determined before and after MC. Left ventricular functions were determined either by two dimensional transthoracic echocardiography or by speckle tracking imaging for segmental abnormal ventricular wall motions. Results: Heart rate, systolic pressure, diastolic pressure and mean arterial pressure decreased significantly but transiently, while central venous pressure markedly increased after MC. In contrast to significant changes in diastolic functions, there was no significant change in cardiac systolic functions after MC. The speckle tracking imaging demonstrated that strain values of different myocardial segment significantly decreased post impact, and that of the ventricular segment decreased from segment to segment. Conclusion: Speckle tracking imaging is useful and informative to assess myocardial regional dysfunctions post MC.     

Experimental Study of a New Operative Procedure for Nonischemic Dilated Cardiomyopathy: Overlapping Cardiac Volume Reduction Operation

Purpose: To assess a newly devised procedure for cardiac volume reduction without resecting any cardiac muscle and evaluate its effectiveness in an experimental settings. Methods: Ten beagle dogs underwent a rapid pacing leading to heart failure for 3 weeks and then underwent left ventricular reduction by a procedure called the overlapping cardiac volume reduction operation (OLCVR), which consisted of a longitudinal incision in the left ventricular (LV) free wall, sutures from the left margin to the septal wall, and the right margin to the LV free wall. A slope of the linear preload recruitable stroke work relationship (M _w), with an X-intercept (V _o) were calculated as precise indicators of the LV systolic function. The constant of isovolumic pressure decay (Tau) and the peak filling rate (PFR) were also calculated as indicators of the LV diastolic function. Results: The LV end-diastolic dimensions significantly decreased by OLCVR (43 ± 2 to 25 ± 1 mm). Fractional shortening significantly improved by OLCVR (11% ± 2% to 30% ± 4%). M _w (erg · cm⁻³ · 10³) also significantly improved (21 ± 2 to 33 ± 3 (P < 0.001)), whereas V _o, Tau, and PFR did not show any significant changes. Conclusion: The OLCVR significantly increased the early LV systolic function without any detrimental effects on the diastolic function. This procedure may therefore be a useful therapeutic option for end-stage cardiomyopathy. Received: April 8, 2002 / Accepted: September 3, 2002 Reprint requests to: Y. Matsui, Department of Cardiovascular Surgery, NTT East Corporation Sapporo Hospital, South 1 West 15, Sapporo 060-0061, Japan     

Challenges for ‘diastology’: contributions from Japanese researchers

Diastology is a study to treat diastole of the heart. Transmitral flow and pulmonary venous flow velocities recorded by pulsed Doppler echocardiography provide more important information about left ventricular (LV) diastolic dysfunction [left atrial (LA)?LV coupling] than cardiac catheterization in clinical practice; however, these waveforms are influenced by loading conditions, particularly preload. The early diastolic mitral annular and LV wall motion indices measured by tissue Doppler echocardiography can evaluate LV relaxation abnormality and filling pressure by being relatively preload independent. In addition, the role of concomitant systolic longitudinal dysfunction is well characterized in asymptomatic patients and in patients with heart failure and preserved ejection fraction. Two-dimensional speckle tracking echocardiography is an angle-independent method, and has the potential to evaluate the contraction and relaxation abnormalities in the longitudinal, circumferential, and radial directions of the LV myocardium as well as LV torsion/untwisting and, moreover, deformation of the LA myocardium and large arterial wall. As a result, this new technique can facilitate the early detection of impaired LA?LV?arterial coupling in patients before occurrence of overt heart failure symptoms.     

Subclinical hyperthyroidism impacts left ventricular deformation: 2D and 3D echocardiographic study

Abstract

Background. We sought to investigate left ventricular (LV) function and mechanics assessed by three-dimensional echocardiography (3DE) and speckle tracking in patients with subclinical hyperthyroidism (SCH). Methods. We included 35 untreated women with SCH and 35 healthy control women matched by age. All participants underwent laboratory analyses which included thyroid hormone levels, and complete 2DE and 3DE examination. Results. 2DE LV longitudinal and circumferential strain was significantly decreased in the SCH subjects. 2DE LV systolic and early diastolic strain rates in longitudinal and circumferential directions were reduced, whereas late diastolic strain rates were increased in SCH individuals. 3DE LV end-diastolic volume and cardiac output were significantly elevated in the SCH patients. 3DE LV deformation in all three directions, as well as 3DE area strain, were significantly lower in the SCH group. Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels correlated with 2DE LV mass index, 2DE longitudinal strain, and 3DE LV area strain in the whole study population. Conclusion. LV deformation evaluated by 3DE and speckle tracking imaging are significantly impaired in SCH subjects. TSH and FT4 levels correlate with 2DE and 3DE LV structure and mechanics.     

Acute stunning effect of hemodialysis on myocardial performance: A three-dimensional speckle tracking echocardiographic study

The effects of acute changes during hemodialysis (HD) on the myocardium are not yet known. The invention of three-dimensional speckle tracking echocardiography (3DSTE) has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study was to evaluate the effect of first weekly standard HD process on the left ventricle (LV) and right ventricle (RV) global and regional myocardial function in patients with normal left ventricle ejection fraction using 3DSTE-derived indices. Patients (n=38) receiving maintenance HD in our clinic who have no known cardiovascular disease are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics, and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential area and radial peak systolic strain, as well as RV septum and free-wall longitudinal strain and fractional area change. Patients are aged 52.8 ± 13.6 years and 52.6% of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD (GLS: −14.2 ± 5.2, −11.1 ± 4.6 [P < .001], GCS: −14.8 ± 4.2, −12.4 ± 5.28 [P < .009]; GRS: 41.5 ± 16, 33.3 ± 16.5 [P = .003]; AREA −24.7 ± 7.2, −20.1 ± 7.6 [P = .001], respectively). We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (P < .001, P < .01, respectively). HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD.     

Assessment of left ventricular function from M‐mode measurement of circumflex artery motion recorded by coronary angiography

Objective—To evaluate the usefulness of M‐mode measurement of circumflex artery motion (CAM) for assessment of left ventricular (LV) function.

Design—Seventy‐two patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and systolic and diastolic parameters of CAM were measured by M‐mode from coronary angiography. Twenty‐three patients, examined by echocardiography of mitral annulus motion (MAM) within 24?h before the angiographic examination, formed a subgroup for comparison between angiographic M‐mode of CAM and echocardiographic M‐mode of MAM.

Results—In addition to previous reported CAM amplitude and longitudinal fractional shortening (FS _L ) the maximal systolic velocity of CAM can be reliably recorded by M‐mode. The diastolic indices, atrial contribution to the total amplitude and maximal early and late diastolic velocities, are also well monitored by M‐mode of CAM in comparison with echocardiographic MAM.

Conclusion—LV systolic and diastolic function can be assessed by M‐mode of CAM.     

Dominance of free wall radial motion in global right ventricular function of heart transplant recipients

Assessment of right ventricular (RV) function using conventional echocardiography might be inadequate as the radial motion of the RV free wall is often neglected. Our aim was to quantify the longitudinal and the radial components of RV function using three‐dimensional (3D) echocardiography in heart transplant (HTX) recipients. Fifty‐one HTX patients in stable cardiovascular condition without history of relevant rejection episode or chronic allograft vasculopathy and 30 healthy volunteers were enrolled. RV end‐diastolic (EDV) volume and total ejection fraction (TEF) were measured by 3D echocardiography. Furthermore, we quantified longitudinal (LEF) and radial ejection fraction (REF) by decomposing the motion of the RV using the ReVISION method. RV EDV did not differ between groups (HTX vs control; 96 ± 27 vs 97 ± 2 mL). In HTX patients, TEF was lower, however, tricuspid annular plane systolic excursion (TAPSE) decreased to a greater extent (TEF: 47 ± 7 vs 54 ± 4% [?13%], TAPSE: 11 ± 5 vs 21 ± 4 mm [?48%], P < .0001). In HTX patients, REF/TEF ratio was significantly higher compared to LEF/TEF (REF/TEF vs LEF/TEF: 0.58 ± 0.10 vs 0.27 ± 0.08, P < .0001), while in controls the REF/TEF and LEF/TEF ratio was similar (0.45 ± 0.07 vs 0.47 ± 0.07). Current results confirm the superiority of radial motion in determining RV function in HTX patients. Parameters incorporating the radial motion are recommended to assess RV function in HTX recipients.