Drunkenness,Hangover, and the Heart

Cardiac effects of ethanol ingestion (1.75 g/kg within 3 hours) were examined in 8 healthy males by echocardiography and systolic time intervals in a controlled study. Heart rate (HR) was increased by 15% (p<0.05) during intoxication when blood ethanol (mean±SD) was 33.7 ±4.1 mmol/l. Left ventricular (LV) end-diastolic dimension was simultaneously shortened by 4% (p<0.01) and LV end-systolic dimension by 3% (p<0.05). Stroke volume was reduced by 12% (p<0.05). Most subjects experienced hangover symptoms 12 hours after the beginning of ethanol intake; blood ethanol was 8.8 ± 4.0 mmol/l. At this time, HR was raised by 17% (p<0.05), ejection fraction by 7% (p<0.05), and circumferential fiber shortening velocity by 19% (p<0.01); total peripheral resistance was decreased by 17% (p<0.001). The resultant increase in cardiac output amounted to 22% (p<0.01). In short, the main effect of ethanol at modest blood concentrations was to reduce LV preload without detectably impairing myocardial performance. Hangover was characterized by vasodilation as well as intensified LV myocardial and pump performances.     

Acute effects of alcohol on left ventricular dynamics during isometric exercise in normal subjects

The aim of this study was to assess whether drinking social amounts of alcohol impairs myocardial contractility in normal humans. To that end, 17 healthy volunteers performed isometric handgrip exercise before and 60 minutes after an intake of 1 g/kg body weight of ethanol within 60 minutes. Left ventricular M-mode echocardiogram, systolic time intervals, and sphygmomanometric arterial blood pressure were recorded before and at the end of 4-min handgrip at 30% of maximum voluntary contraction. The blood ethanol concentration (mean +/- SD) was 24.4 +/- 2.0 mmol/liter. At rest, ethanol increased heart rate (p less than 0.05), and decreased left ventricular end-diastolic diameter (p less than 0.05), end-systolic diameter (p less than 0.01), and circumferential systolic wall stress (p less than 0.05). The indices of left ventricular performance were unchanged except for the maximum circumferential fiber shortening velocity which was increased after ethanol (p less than 0.001). The cardiac response to isometric exercise was similar before and after ethanol except that the handgrip-induced rise in systolic wall stress was smaller postingestion (p less than 0.05). This study does not support the view that drinking small to moderate amounts of alcohol brings about myocardial depression in normal humans. Although preload, afterload, and heart rate were altered by ethanol at rest, myocardial contractility was not impaired even during the afterload stress imposed by isometric exercise.     

Non-invasive assessment of systolic left ventricular function in systemic sclerosis

Systemic sclerosis is a multisystemic disorder, also affecting the heart. To evaluate its influence on systolic left ventricular (LV) function, we investigated 30 consecutive patients (age 54.5 +/- 2.4 years, 15 men and 15 women) and 48 controls matched for age and sex. All subjects were investigated by phonocardiography, pulse curve recordings, M-mode echocardiography, and by pulsed and continuous wave Doppler. Heart rate, blood pressure and peripheral resistance did not differ, but patients weighed less than controls (P less than 0.01). Systolic time intervals indicated systolic impairment, with an increased pre-ejection period to LV ejection time (LVET) ratio (0.37 +/- 0.02 vs 0.30 +/- 0.01 P less than 0.001), and also an increased isovolumic contraction time to LVET ratio (0.17 +/- 0.02 vs 0.12 +/- 0.01, P less than 0.02). The latter difference remained when LVET was adjusted for heart rate. Echocardiographic E-point to septal separation was increased in patients (8.3 +/- 1.3 vs 4.8 +/- 0.3 mm, P = 0.001), also after adjustment for LV dimension (P = 0.0001), while septal fractional thickening was decreased (P less than 0.01). End systolic wall stress (P = 0.0002) and stress to volume ratio (P = 0.03) were lower in systemic sclerosis. Peak LV emptying rate was also lower in the patient group when measured by echocardiography (P = 0.03). There was no difference between groups regarding LV dimensions, fractional shortening or mean velocity of circumferential fibre shortening. While aortic Doppler peak emptying rate did not differ between groups, it occurred later in systole in the patient group (P less than 0.01) as did peak velocity (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of ibopamine on the failing heart at rest and during isometric exercise: a noninvasive study

Eleven patients suffering from heart failure were treated with oral ibopamine, a di-isobutyric ester of N-methyldopamine, 100 mg three times a day for 1 week and 200 mg three times a day for 3 weeks. Therapy was discontinued by one patient because of tachycardia. Left ventricular performance was evaluated with echocardiography and systolic time intervals at rest and after 3 minutes of isometric exercise using a handgrip. Six of 10 patients completing the study were in New York Heart Association (NYHA) functional class III, 2 in class IV, and 2 in class II. All patients, except one who remained stable in class II, improved their subjective condition by one functional class during 4 weeks of therapy (p less than 0.01). There were no changes in heart rate, blood pressure, rate-pressure product, cardiac index, or total peripheral vascular resistance. The left ventricular end-systolic diameter decreased after four weeks from 71.2 +/- 12.7 (SD) to 65.9 +/- 13.0 mm (p less than 0.001); the left ventricular end-diastolic diameter did not change. The ejection fraction increased from 26 +/- 8 to 32 +/- 9% (p less than 0.01). Afterload, that is, left ventricular circumferential systolic wall stress, declined as a result of decreased systolic diameter. Systolic time intervals did not vary. There were no changes due to ibopamine during isometric exercise probably owing to increased beta-adrenergic stimulation induced by the handgrip. Neither urine volume nor body weight changed. Side effects were mild except for tachycardia of one patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute effects of alcohol, beta blockade, and their combination on left ventricular function and hemodynamics in normal man

Twenty-three healthy males, aged 23 to 62 years, were examinedby M-mode echocardiography and systolic time intervals for 3h after (1) ethanol 1 g/kg by mouth taken over 60 minutes; (2)atenolol 100 mg by mouth; (3) ethanol (1 g/kg) + atenolol (100mg). The peak mean blood ethanol (± s.e.) was 112 ±4mg/100 ml in test 1 and 104 ± 7 mg/100 ml in test 3.During increasing blood ethanol, heart rate (HR), systolic bloodpressure (BP), cardiac output (CO) and echocardiographic indicesof left ventricular (LV) function were significantly augmented,while total peripheral resistance (TPR) decreased. During decliningblood ethanol, systolic BP, L V end-diastolic and end-systolicdiameters, stroke volume (SV) and circumferential wall stresswere significantly reduced; echocardiographic indices of LVfunction were unaltered, but the pre-ejection period/LV ejectiontime ratio was increased, Atenolol decreased llR, systolic BP,SV, CO, and all estimates of LV function, but increased TPR.Ethanol + atenolol tended to cause smaller depressions in theindices of LV function than did atenolol alone, in spite ofsimilar plasma atenolol concentrations (n = 6). It is concludedthat ingestion of modest doses of ethanol evokes vasodilationand enhances LV function during increasing blood ethanol, andreduces LV preload and afterload during decreasing blood ethanolwithout impairing contractility. Social drinking and beta blockadeseem not to have any harmful acute combined effects on the heartand circulation, at least in normal subjects.     

Use of a personal computer in the measurement,calculation, and reporting of noninvasive cardiac data

Echocardiography, phonocardiography, and carotid pulse tracings enable the cardiologist to measure and calculate over 40 different noninvasive parameters including cardiac chamber size, indices of left ventricular performance, and estimates of mean left atrial pressure. However, the entire procedure requires meticulous measurements and time-consuming calculations, particularly when some of the data must be corrected for heart rate or body size. Because of this, many busy noninvasive cardiac laboratories routinely calculate only a few select parameters in most patients. To solve this problem, we used a personal computer system and developed a program that allows rapid, accurate measurement, calculation, display, reporting, magnetic storage, and retrieval of noninvasive cardiac data. The computer is not dedicated to these tasks alone and with appropriate software can also be used for other clinical, educational, office management, and research purposes.     

Left Ventricular Function in Newly Diagnosed Non-insulin-dependent (Type 2) Diabetics Evaluated by Systolic Time Intervals and Echocardiography

ABSTRACT Systolic time intervals (STI) and echocardiography were recorded in 133 (70 men, 63 women) newly diagnosed non-insulin-dependent diabetics aged 45–64 years and in 144 (62 men, 82 women) non-diabetic control subjects of the same age. Both male and female diabetics had significantly increased pre-ejection period/left ventricular ejection time ratio (PEP/LVET) in STI as compared with the respective non-diabetic control subjects. Male diabetics showed a reduced ejection fraction (EF) in echocardiography, but no significant difference was found in this respect between female diabetics and controls. A significant negative correlation was found between 2-hour postglucose serum insulin level and EF in male and female diabetics. After adjusting for the effect of age, coronary heart disease, hypertension, obesity and haemoglobin concentration, male diabetics still had a higher PEP/LVET ratio and a lower EF than male controls. In women, no significant differences were found between diabetics and controls in the PEP/LVET ratio or EF adjusted for the above factors. The results of this study are compatible with the view that impaired left ventricular function may be an early phenomenon in the clinical course of non-insulin-dependent diabetes.     

Non-invasive Evaluation of Anthracycline-induced Cardiotoxicity in Man

ABSTRACT. Measurements of radionuclide first-pass left ventricular ejection fraction (LVEF_m) were carried out in 37 patients receiving doxorubicin and/or daunorubicin treatment for their malignant disease. The validity of the systolic time intervals (STI) and echocardiography (ECHO) in the detection of left ventricular dysfunction was evaluated using LVEF_m as reference method. LVEF_m showed a significant decrease in left ventricular function with cumulative anthracycline doses in patients with and without previous clinical evidence of cardiovascular disease. A multiple regression analysis showed that the impairment in LVEF_m was significantly correlated with the cumulative anthracycline dose, patient's age and previous cardiovascular disease. In five patients (one without previous cardiac disease, one with coronary artery disease, three with hypertension) the drug had to be withdrawn due to signs or symptoms of cardiac dysfunction. The sensitivity and the specificity of STI and ECHO in the detection of left ventricular dysfunction remained rather low as compared with the results by LVEF_m.     

Hemodynamic effects of pindolol and atenolol at rest and during isometric exercise: A noninvasive study with healthy volunteers

Summary Hemodynamic effects of intravenous and oral pindolol and atenolol were assessed in ten healthy volunteers by left ventricular echocardiography and systolic time intervals. Measurements were made at rest and during hand-grip-induced isometric exercise. Drug doses were pindolol 0.015 mg/kg intravenously and 10 mg/day orally, atenolol 0.1 mg/kg intravenously, and 50 mg/day orally.Heart rate at rest was reduced by both drugs. The reduction caused by atenolol during oral treatment was significantly greater (p<0.01). Intravenously only pindolol reduced mean arterial pressure. During oral treatment atenolol reduced the mean arterial pressure nonsignificantly. Both drugs lowered heart rate during isometric exercise, atenolol being significantly more effective. During oral treatment atenolol blunted the heart-rate reaction to exercise. Mean arterial pressure during isometric exercise rose slightly with both drugs after intravenous administration. During oral treatment only atenolol reduced the mean arterial pressure significantly. Intravenous atenolol reduced cardiac contractility at rest, indicated by significant decreases in fractional shortening, ejection fraction, and the mean velocity of circumferential fiber shortening. In contrast, intravenous pindolol and oral therapy with either drug did not change contractility. Intravenous atenolol raised total peripheral resistance. The preejection period/left ventricular ejection time ratio decreased with intravenous pindolol, while atenolol increased it.In conclusion, atenolol had more negative inotropic and chronotropic effects, especially after acute intravenous administration. Only atenolol reduced cardiac output and increased peripheral resistance. After repeated oral administration, these effects were less apparent.     

Good agreement between echocardiography and impedance cardiography in the assessment of left ventricular performance in hypertensive patients

Background: Impedance cardiography (ICG) is a noninvasive hemodynamic monitoring tool which can define hypertensive patients’ hemodynamic profiles and help to tailor antihypertensive therapy. This study assesses the concordance between ICG-derived indexes used to evaluate left ventricular performance and transthoracic echocardiography (TTE) in hypertensive patients. Methods: In this IMPEDDANS post-hoc analysis, the ICG-derived indexes are compared with TTE by Bland–Altman method. Statistical significance of the relationship between the values obtained was assessed by generalized linear mixed-effects models. Results: In supine position, Bland–Altman analysis showed good concordance for cardiac output (CO) (mean difference of 0.006 mL/min [?0.120; 0.133]), cardiac index (CI) (mean difference of 0.016 mL/min/m² [?0.471; 0.504]), pre-ejection period (PEP) (mean difference of ?0.216 ms [?4.510; 4.077]), left ventricular ejection time (LVET) (mean difference of ?0.140 ms [?6.573; 6.293]), and systolic time ratio (STR) (mean difference of ?0.00004 [?0.008; 0.008]). In orthostatic position, good concordance was found for CO (mean difference 0.028 mL/min [?2.036; 1.980]), CI (mean difference ?0.012 mL/min/m² [?1.063; 1.039]), and STR (mean difference ?0.101 [0.296; 0.094]). No significant difference between methods was identified by the linear mixed-effects models. Conclusion: The ICG-derived indexes CO, CI, PEP, LVET, and STR in supine position have good agreement with TTE. Therefore, ICG can be used to accurately evaluate left ventricular performance.     

Live/real time three-dimensional transthoracic echocardiographic assessment of left ventricular volumes, ejection fraction, and mass compared with magnetic resonance imaging

Due to reliance upon geometric assumptions and foreshortening issues, the traditionally utilized transthoracic two-dimensional echocardiography (2DTTE) has shown limitations in assessing left ventricular (LV) volume, mass, and function. Cardiac magnetic resonance imaging (MRI) has shown potential in accurately defining these LV characteristics. Recently, the emergence of live/real time three-dimensional (3D) TTE has demonstrated incremental value over 2DTTE and comparable value with MRI in assessing LV parameters. Here we report 58 consecutive patients with diverse cardiac disorders and clinical characteristics, referred for clinical MRI studies, who were evaluated by cardiac MRI and 3DTTE. Our results show good correlation between the two modalities.     

Aortic Valve Closure: Relation to Tissue Velocities by Doppler and Speckle Tracking in Patients with Infarction and at High Heart Rates

Aim: To resolve the event in tissue Doppler (TDI)‐ and speckle tracking‐based velocity/time curves that most accurately represent aortic valve closure (AVC) in infarcted ventricles and at high heart rates. Methods: We studied the timing of AVC in 13 patients with myocardial infarction and in 8 patients at peak dobutamine stress echo. An acquisition setup for recording alternating B‐mode and TDI image frames was used to achieve the same frame rate in both cases (mean 136.7 frames per second [FPS] for infarcted ventricles, mean 136.9 FPS for high heart rates). The reference method was visual assessment of AVC in the high frame rate narrow sector B‐mode images of the aortic valve. Results: The initial negative velocities after ejection in the velocity/time curves occurred before AVC, 44.9 ± 21.0 msec before the reference in the high heart rate material, and 25.2 ± 15.2 msec before the reference in the infarction material. Using this time point as a marker for AVC may cause inaccuracies when estimating end‐systolic strain. A more accurate but still a practical marker for AVC was the time point of zero crossing after the initial negative velocities after ejection, 5.4 ± 15.3 msec before the reference in high heart rates and 8.2 ± 12.9 msec after the reference in the infarction material. Conclusion: The suggested marker of AVC at high heart rate and in infarcted ventricles was the time point of zero crossing after the initial negative velocities after ejection in velocity/time curves. (Echocardiography 2010;27:363‐369)     

Left ventricular wall thickness and plasma catecholamines in borderline and stable essential hypertension

It has been suggested that sympathetic overactivity has a pathogeneticrelevance to left ventricular hypertrophic development, evenapart from its effect on and in essential hypertension. To evaluate this possibility by echocardiographic and polygraphicmethods, we studied left ventricular wall thickness and functionand their possible relationship to plasma renin activity andplasma catecholamines in 11 normal subjects, 13 borderline hypertensivesand 11 stable hypertensives without radiological or electrocardiographicsigns of left ventricular hypertrophy. Compared with normal, borderline hypertensives showed an increasein interventricular septum (IVS) thickness (P < 0.01) andIVS/posterior wall (PW) thickness ratio (P < 0.01) togetherwith an increased supine and upright plasma norepinephrine (NE;P < 0.01); there was also a decreased pre-ejection period(PEP; P < 0.01), PEP/left ventricular ejection time ratio(P < 0.01) and total electromechanical systole (P < 0.05). In stable hypertensives, PW thickness was greater than it wasboth in normals (P < 0.01) and in borderline hypertensives(P < 0.01) and IVS thickness was higher than in normals (P< 0.05). Positive correlations between supine (P < 0.001), upright(P < 0.05) NE and both IVS thickness and IVS/PW thicknessratio were found in borderline but not in stable hypertensives. These results support the hypothesis recently put forward thatIVS hypertrophy may represent an early stage of essential hypertension-inducedLVH, which afterwards extends to the left PW; furthermore theresults suggest that the sympathetic overactivity may play arole in the IVS hypertrophy development in borderline hypertensives.     

运动负荷对左室收缩时间间期的影响

用多道生理记录仪对６７例被检者（其中正常人３７例，高血压病人３０例）分别测定双倍二级梯运动前、运动后１、３、５、７ｍｉｎ的收缩时间同期（ＳＴＩ）。结果显示，运动后１ｍｉｎ和运动前相比，表现为ＥＭＴＬＶＥＴ、ＰＥＰ、ＥＭＬ、ＩＣＴ、ＨＷＴ缩短，ＰＥＰ／ＬＶＥＴ、ＩＣＴ／ＬＶＥＴ、ＴＨ／ＴＨ比值减小。运动停止后，以上各指标逐渐恢复，但正常人组的恢复过度较高血压病组快，提示高血压病人尽管安静休息时ＳＴＩ正常，但心功能代偿能力和调节能力已有所下降。本文分析了运动负荷对ＳＴＩ影响的可能机理，并认为，测定动态下的ＳＴＩ能更好地显示心脏的储备和调节能力。     

Assessment of ventricular mechanical synchronization after left bundle branch pacing using 2-D speckle tracking echocardiography

BackgroundThe left bundle branch pacing (LBBP) makes the ventricular depolarization closer to the physiological state and shortens QRS duration. The purpose of this study is to explore the ventricular systolic mechanical synchronization after LBBP in comparison with traditional right ventricular pacing (RVP) using two‐dimensional strain echocardiography (2D‐STE).MethodsThirty‐two patients who received LBBP (n = 16) or RVP (n = 16) from October 2018 to October 2019 and met the inclusion criteria were included in this retrospective study. Electrocardiogram (ECG) characteristics, pacing parameters, pacing sites, and safety events were assessed before and after implantation. Acquisition and analysis of ventricular systolic synchronization were implemented using 2D‐STE.ResultsIn RVP group, ECG showed left bundle branch block patterns. At LBBP, QRS morphology was in the form of right bundle branch block, and QRS durations were significantly shorter than that of the RVP QRS (109.38 ± 12.89 vs 149.38 ± 19.40 ms, P < .001). Both the maximum time differences (TD) and SDs of the 18‐segments systolic time to peak systolic strain were significantly shorter under LBBP than under RVP (TD, 66.62 ± 37.2 vs 148.62 ± 43.67 ms, P < .01; SD, 21.80 ± 12.13 vs 52.70 ± 17.72 ms, P < .01), indicating that LBBP could provide better left ventricular mechanical synchronization. Left and right ventricular pre‐ejection period difference was significantly longer in RVP group than in LBBP group (10.23 ± 3.07 vs 39.94 ± 14.81 ms, P < .05), indicating left and right ventricular contraction synchronization in LBBP group being better than in RVP group.ConclusionLBBP is able to provide a physiologic ventricular activation pattern, which results in ventricular mechanical contraction synchronization.     

Evaluation of Left Ventricular Mechanical Efficiency in the Human Heart by Echocardiography

It has been proved that ventricular systolic wall stress and myocardial mass are two major determinants of myocardial oxygen consumption (MVO₂) in the intact human heart. The product of stress and mass, which we named the stress-mass-index (SMI), has the correct unit for work (cm X dyns/cm = dyns x cm), and is very similar to the pressure-volume work of the heart. To examine whether SMI might be used as a predictor of MVO₂, left ventricular mean systolic wall stress (Mσ_c,Mσ_m), left ventricular wall mass (Mm), and stroke work (SW) were measured by echocardiography in normal and diseased human hearts. The area bounded by the end-diastolic and end-systolic pressure-volume lines, and the systolic segment of the pressure-volume loop (PVA) were also measured in each subject. It has been proved repeatedly in the past that PVA correlates significantly with MVO₂. Our results showed that there was a close correlation between PVA and SMI in every group (r ? 0.76-0.91, P < 0.001 all), which proved indirectly that SMI may reflect MVO₂. On this basis, left ventricular efficiency (Eff) was estimated as SW/SMI × 100%. Effin 30 patients with essential hypertension (17.1%± 1.6%) was normal compared to the control subjects (19.9%± 2.4%). However, Eff of 22 hypertensive patients with mild left ventricular dysfunction (13.3%± 2.1%), 33 coronary artery heart disease patients (10.8%± 1.8%), and 11 chronic congestive heart failure patients (6.6%± 2.1%) was significantly decreased compared to the control. These changes in Eff were in agreement with clinical findings and left ventricular ejection fractions (EF). For the first time, we have measured Eff noninvasively; the results are very close to those evaluated invasively in human hearts by others. This reflects the fact that it is possible to calculate Eff noninvasively. We conclude that the product of left ventricular systolic wall stress could reflect the change in MVO₂ at rest. SW/SMI may be a useful method in evaluating Eff and ventricular function.