scholarly journals Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000919
Author(s):  
Rine Bakkestrøm ◽  
Ann Banke ◽  
Redi Pecini ◽  
Akhmadjon Irmukhamedov ◽  
Søren Kristian Nielsen ◽  
...  
Keyword(s):  
Diastolic Pressure ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Volume Index ◽  
Regurgitant Volume ◽  
Clinical Trial Registration ◽  
Link Type ◽  
End Diastolic Volume ◽  
Right Heart Catheterisation ◽  
And Function

ObjectiveTo assess the association between cardiac morphology and function assessed with cardiac MRI (CMRI) and haemodynamics at rest and during exercise in patients with primary mitral regurgitation (MR).MethodsIn an observational study, subjects with significant primary MR (N = 46) with effective regurgitant orifice ≥ 0.30 cm2 and left ventricular (LV) ejection fraction > 60% were examined with right heart catheterisation during rest and exercise and CMRI at rest. End-diastolic pressure volume relationship (EDPVR) was assessed using a single beat method using pulmonary capillary wedge pressure (PCWP) and end-diastolic volume. Patients were divided according to normal PCWP at rest (> 12 mm Hg) and with exercise (> 28 mm Hg). Results: Resting regurgitant volume correlated positively with resting PCWP, (r = 0.42, p = 0.002). However, with exercise no association between PCWP and regurgitant volume was seen (r = 0.09, p = 0.55). At rest left atrial (LA) maximal, minimal and volume index at atrial contraction correlated positively with PCWP (r = 0.60; r = 0.55; r = 0.58, all p < 0.001); in contrast none of these correlated with exercise PCWP (all p > 0.2). EDPVR in patients with high PCWP at rest was shifted towards higher volumes for the same pressures. The opposite was seen for patients with high PCWP during exercise where estimated volumes were smaller for the same pressure than patients with normal exercise PCWP.ConclusionIn patients with significant MR the degree of regurgitation and LA dilatation is associated with resting PCWP. However, with exercise this association disappears. Estimation of EDPVR suggests lower LV compliance in patients where PCWP is increased with exercise.Clinical trial registrationURL: https://clinicaltrials.gov/ct2/show/NCT02961647?term=HEMI&rank=1. ID: NCT02961647

scholarly journals Impact of empagliflozin on right ventricular parameters and function among patients with type 2 diabetes

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bradley Sarak ◽  
Subodh Verma ◽  
C. David Mazer ◽  
Hwee Teoh ◽  
Adrian Quan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Volume Index ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Sglt2 Inhibition ◽  
And Function ◽  
The Impact

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibition reduces cardiovascular events in type 2 diabetes (T2DM) and is associated with a reduction in left ventricular (LV) mass index. However, the impact on right ventricular (RV) remodeling is unknown. Accordingly, the objective of this study was to assess the impact of SGLT2 inhibition on RV parameters and function in T2DM and coronary artery disease (CAD). Methods In EMPA-HEART CardioLink-6, 97 patients with T2DM and CAD were randomly assigned to empagliflozin 10 mg (n = 49) once daily or placebo (n = 48). Cardiac magnetic resonance imaging was performed at baseline and after 6 months. RV mass index (RVMi), RV end-diastolic and end-systolic volume index (RVEDVi, RVESVi) and RV ejection fraction (RVEF) were assessed in blinded fashion. Results At baseline, mean RVMi (± SD) (11.8 ± 2.4 g/m2), RVEF (53.5 ± 4.8%), RVEDVi (64.3 ± 13.2 mL/m2) and RVESVi (29.9 ± 6.9 mL/m2) were within normal limits and were similar between the empagliflozin and placebo groups. Over 6 months, there were no significant differences in RVMi (− 0.11 g/m2, [95% CI − 0.81 to 0.60], p = 0.76), RVEF (0.54%, [95% CI − 1.4 to 2.4], p = 0.58), RVEDVi (− 1.2 mL/m2, [95% CI − 4.1 to 1.7], p = 0.41) and RVESVi (− 0.81 mL/m2, [95% CI − 2.5 to 0.90], p = 0.35) in the empaglifozin group as compared with the placebo group. In both groups, there was no significant correlation between RVMi and LVMi changes from baseline to 6 months. Conclusions In this post-hoc analysis, SGLT2 inhibition with empagliflozin had no impact on RVMi and RV volumes in patients with T2DM and CAD. The potentially differential effect of empagliflozin on the LV and RV warrants further investigation. Clinical Trial Registration: URL: https://www.clinicaltrials.gov/ct2/show/NCT02998970?cond=NCT02998970&draw=2&rank=1. Unique identifier: NCT02998970.

scholarly journals Echocardiographic evaluation of left ventricular morphology and function in active sportsmen

2006 ◽  
Vol 59 (11-12) ◽  
pp. 526-530
Author(s):  
Bojan Vujin ◽  
Dragan Benc ◽  
Nikola Grujic ◽  
Svetozar Srdic ◽  
Biljana Radisic ◽  
...  
Keyword(s):  
Posterior Wall ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Football Players ◽  
Compensatory Mechanism ◽  
Ventricular Ejection Fraction ◽  
End Diastolic Volume ◽  
And Function ◽  
Left Ventricular Morphology

Introduction. Echocardiography is a noninvasive, reliable method for evaluation of left ventricular morphology and function. Judo and wrestling are sports characterized by intensive and high physical and isometric effort, while football is characterized by long-term physical isotonic effort. The key compensatory mechanism with both groups of sportsmen is left ventricular hypertrophy. The aim of this study is evaluate left ventricular morphology and function in a group of judo players, wrestlers and football players during competition season and their interactive comparation. Material and Methods. 42 judo players and wrestlers and 43 football players were examined. Results. An increase in thickness of the septum and posterior wall was established in both groups of sportsmen, but the thickness was statistically more significant in judo players. On the other hand, in football players, a statistically significant left ventricular end-diastolic volume index enlargement was found, compared to reference values and compared to end-diastolic volume index in judo players and wrestlers. High left ventricular ejection fraction was established in both groups, but it was statistically significantly higher in football players. Left ventricular mass index was statistically increased in both groups, but it was higher in judo players and wrestlers.

scholarly journals Regurgitant volume to left ventricular end-diastolic volume ratio: another step to risk stratification in patients with secondary mitral regurgitation?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Lopes ◽  
F Albuquerque ◽  
P Freitas ◽  
E Horta ◽  
C Reis ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Volume Ratio ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Regurgitant Volume ◽  
Ventricular Ejection Fraction ◽  
End Diastolic Volume ◽  
All Cause Mortality ◽  
Secondary Mr

Abstract Funding Acknowledgements Type of funding sources: None. Background  Quantitative evaluation of secondary mitral valve regurgitation (MR) remains an important yet challenging step in the evaluation of this entity. Its severity can be underestimated when using the proximal isovelocity surface area (PISA) method, which does not take left ventricular (LV) volume into account. Normalizing mitral regurgitant volume (Rvol) for the LV end-diastolic volume (EDV) might overcome this key limitation. This study aimed to investigate the prognostic implication of Rvol/EDV ratio in patients with secondary MR. Methods  Patients with at least mild secondary MR and reduced left ventricular ejection fraction (&lt;50%) under optimal guidelines-directed medical therapy were retrospectively identified at a single-center. The cohort was divided into terciles according to the RVol/EDV ratio. The primary endpoint was all-cause mortality. Results  A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Median measures of secondary MR were EROA 14 mm2 (IQR 8-22) and RegVol 23 ml (12-34). During a median follow-up of 3.8 years (interquartile range 1.8 to 6.2 years) there were 254 deaths (44%). The unadjusted mortality incidence increases across terciles distribution. Patients at the 2nd and 3rd terciles of the RVol/EDV ratio showed significantly higher mortality when compared to those at the 1st one (baseline reference) (figure 1). After multivariable analysis, terciles of the Rvol/EDV ratio remained independently associated with increased all-cause mortality (considering the 1st tercile as the reference; adjusted HR for the 2nd tercile 1.46 [95% CI 1.05- 2.02]  p = 0.023; adjusted HR for 3rd tercile 1.56 [95% CI 1.09 – 2.22], p = 0.015). Conclusion  In patients with secondary MR, Rvol/EDV ratio is independently associated with all-cause mortality. However, the appropriate cut-off to determine any kind of clinical decision remains to be determined. Abstract Figure.

Effects of avertin versus xylazine-ketamine anesthesia on cardiac function in normal mice

2001 ◽  
Vol 281 (5) ◽  
pp. H1938-H1945 ◽  
Author(s):  
Chari Y. T. Hart ◽  
John C. Burnett ◽  
Margaret M. Redfield
Keyword(s):  
Cardiac Function ◽  
Diastolic Pressure ◽  
Systolic Function ◽  
Pressure Rise ◽  
Left Ventricular ◽  
Lv Function ◽  
Ketamine Anesthesia ◽  
The Difference ◽  
And Function ◽  
Derivatives Of

Anesthetic regimens commonly administered during studies that assess cardiac structure and function in mice are xylazine-ketamine (XK) and avertin (AV). While it is known that XK anesthesia produces more bradycardia in the mouse, the effects of XK and AV on cardiac function have not been compared. We anesthetized normal adult male Swiss Webster mice with XK or AV. Transthoracic echocardiography and closed-chest cardiac catheterization were performed to assess heart rate (HR), left ventricular (LV) dimensions at end diastole and end systole (LVDd and LVDs, respectively), fractional shortening (FS), LV end-diastolic pressure (LVEDP), the time constant of isovolumic relaxation (τ), and the first derivatives of LV pressure rise and fall (dP/d t max and dP/d t min, respectively). During echocardiography, HR was lower in XK than AV mice (250 ± 14 beats/min in XK vs. 453 ± 24 beats/min in AV, P < 0.05). Preload was increased in XK mice (LVDd: 4.1 ± 0.08 mm in XK vs. 3.8 ± 0.09 mm in AV, P < 0.05). FS, a load-dependent index of systolic function, was increased in XK mice (45 ± 1.2% in XK vs. 40 ± 0.8% in AV, P < 0.05). At LV catheterization, the difference in HR with AV (453 ± 24 beats/min) and XK (342 ± 30 beats/min, P < 0.05) anesthesia was more variable, and no significant differences in systolic or diastolic function were seen in the group as a whole. However, in XK mice with HR <300 beats/min, LVEDP was increased (28 ± 5 vs. 6.2 ± 2 mmHg in mice with HR >300 beats/min, P < 0.05), whereas systolic (LV dP/d t max: 4,402 ± 798 vs. 8,250 ± 415 mmHg/s in mice with HR >300 beats/min, P < 0.05) and diastolic (τ: 23 ± 2 vs. 14 ± 1 ms in mice with HR >300 beats/min, P < 0.05) function were impaired. Compared with AV, XK produces profound bradycardia with effects on loading conditions and ventricular function. The disparate findings at echocardiography and LV catheterization underscore the importance of comprehensive assessment of LV function in the mouse.

Abstract P135: Hyperpolarized Carbon-13 Magnetic Resonance Reveals Early- and Late-Onset Changes to Metabolism in the Failing Heart

2011 ◽  
Vol 109 (suppl_1) ◽  
Author(s):  
Marie Schroeder ◽  
Angus Z Lau ◽  
Albert P Chen ◽  
Jennifer Barry ◽  
Damian J Tyler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Magnetic Resonance ◽  
Late Onset ◽  
Krebs Cycle ◽  
Left Ventricular ◽  
Cine Mri ◽  
Cardiac Structure ◽  
End Diastolic Volume ◽  
Myocardial Energetics ◽  
And Function

Disordered metabolic substrate utilisation has been implicated in the pathogenesis of heart failure (HF). Hyperpolarised (HYP) 13C magnetic resonance, a technique in which the fate of 13C-labelled metabolites can be followed using MR imaging or spectroscopy, has enabled non-invasive assessment of metabolism. The aim of this study was to monitor carbohydrate metabolism alongside cardiac structure, function, and energetics, throughout HF progression. HF was induced in pigs (n=5) by right ventricular pacing at 188 bpm for 5 weeks. Pigs were examined at weekly time points: cine MRI assessed cardiac structure and function, HYP 13C2-pyruvate was administered intravenously and 13C MRS was used to assess 13C-glutamate production via Krebs cycle, 31P MRS assessed myocardial energetics, and HYP 13C1-pyruvate was administered to enable MRI of H13CO3- production from pyruvate dehydrogenase (PDH). At baseline, pigs had a normal left ventricular (LV) cardiac index (CI) and end diastolic volume (EDVi). The PCr/ATP was 2.3 ± 0.2. The 13C-glutamate/13C2-pyruvate was 4.3 ± 0.9%, and the H13CO3-/13C1-pyruvate ratio was 1.6 ± 0.2%. After 1–2 weeks of pacing, CI decreased to 3.3 ± 0.5 l/min/m2, PCr/ATP decreased to 1.7 ± 0.1, and 13C-glutamate/13C2-pyruvate decreased to 2.1 ± 0.6%. With the onset of HF, EDVi increased to 140.3 ± 14.1 ml/m2 and H13CO3-/13C1-pyruvate decreased to 0.5 ± 0.2%. In conclusion, we observed an early defect in Krebs' cycle that occurred alongside impaired cardiac energetics and function. Carbohydrate oxidation via PDH was maintained until the onset of HF. These results encourage use of metabolic therapies to delay/prevent the onset of heart failure in patients.

scholarly journals Ventricular interaction and external constraint account for decreased stroke work during volume loading in CHF

2001 ◽  
Vol 281 (6) ◽  
pp. H2385-H2391 ◽  
Author(s):  
Thomas D. Moore ◽  
Michael P. Frenneaux ◽  
Rozsa Sas ◽  
J. J. Atherton ◽  
Jayne A. Morris-Thurgood ◽  
...  
Keyword(s):  
Diastolic Pressure ◽  
Left Ventricular ◽  
Negative Slope ◽  
Segment Length ◽  
Stroke Work ◽  
Volume Loading ◽  
End Diastolic Volume ◽  
Pulmonary Capillary ◽  
Apparent Decrease ◽  
Pericardial Pressure

The slope of the stroke work (SW)-pulmonary capillary wedge pressure (PCWP) relation may be negative in congestive heart failure (CHF), implying decreased contractility based on the premise that PCWP is simply related to left ventricular (LV) end-diastolic volume. We hypothesized that the negative slope is explained by decreased transmural LV end-diastolic pressure (LVEDP), despite the increased LVEDP, and that contractility remains unchanged. Rapid pacing produced CHF in six dogs. Hemodynamic and dimension changes were then measured under anesthesia during volume manipulation. Volume loading increased pericardial pressure and LVEDP but decreased transmural LVEDP and SW. Right ventricular diameter increased and septum-to-LV free wall diameter decreased. Although the slopes of the SW-LVEDP relations were negative, the SW-transmural LVEDP relations remained positive, indicating unchanged contractility. Similarly, the SW-segment length relations suggested unchanged contractility. Pressure surrounding the LV must be subtracted from LVEDP to calculate transmural LVEDP accurately. When this was done in this model, the apparent decrease in contractility was no longer evident. Despite the increased LVEDP during volume loading, transmural LVEDP and therefore SW decreased and contractility remained unchanged.

Effect of endurance training on cardiac morphology in Alaskan sled dogs

1998 ◽  
Vol 85 (4) ◽  
pp. 1368-1375 ◽  
Author(s):  
R. L. Stepien ◽  
K. W. Hinchcliff ◽  
P. D. Constable ◽  
J. Olson
Keyword(s):  
Endurance Training ◽  
Morphological Changes ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Weight ◽  
Wall Thickening ◽  
Cardiac Morphology ◽  
End Diastolic Volume ◽  
Sled Dogs ◽  
Lv Mass

The cardiac morphology of 77 conscious Alaskan sled dogs before and after 5 mo of endurance training (20 km/day team pulling a sled and musher) was studied using two-dimensional and M-mode echocardiography. Subgroups included dogs with at least one season of previous training (“veterans”) and dogs undergoing their first season of training (“rookies”). Training resulted in a significant ( P< 0.05) decrease in resting heart rate (−15%) and significant increases in interventricular septal thickness (systole, 15%; diastole, 13%), left ventricular (LV) internal dimension in diastole (LVIDd, 4%), LV free wall thickness in systole (9%) and diastole (LVWd, 9%), and left atrial diameter (5%) in all dogs, but the increase in LVWd was greater in rookies (16%) than in veterans (7%). Training increased end-diastolic volume index (8%), LV mass index (24%), and heart weight index (24%) and decreased the LVIDd-to-LVWd ratio (−6%) but did not alter cardiac index. We conclude that increased LV mass attributable to LV dilation and hypertrophy is associated with endurance training in Alaskan sled dogs. Disproportionate LV wall thickening accompanying LV dilation suggests that cardiac morphological changes are due to volume and pressure loading. These training-induced changes are similar to those documented in human athletes undergoing combined isometric and isotonic training and differ from studies of dogs trained on treadmills.

Algorithm for diagnosis and typing of ALCAPA syndrome

2021 ◽  
Vol 3 (2) ◽  
pp. 01-07
Author(s):  
Mariela Céspedes Almira ◽  
Adel Eladio González Morejón ◽  
Giselle Serrano Ricardo ◽  
Tania Rosa González Rodríguez ◽  
Judith Escobar Bermúdez
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Left Coronary Artery ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Volume Index ◽  
Cross Sectional ◽  
End Diastolic Volume ◽  
Congenital Origin ◽  
Diagnostic Modalities

ALCAPA syndrome was characterized by anomalous origin of left coronary artery from pulmonary artery. Its clinical presentation is varied and although it is an anomaly of congenital origin, it is not exclusive to pediatric ages. Its epidemiological documentation is difficult. We aimed to make the non-invasive diagnosis of the ALCAPA syndrome and its variants. An observational, prospective and cross-sectional study was conducted with 31 patients with a positive echocardiographic diagnosis of ALCAPA syndrome at Pediatric Cardio Center “William Soler” from 2005 to 2018. The variables with significance for diagnosis were the echocardiographic visualization of the anomalous connection and the reversed flow in the left coronary artery. The variables with significance for typing were age at diagnosis, ischemia in the electrocardiogram, echocardiographic visualization of left ventricle papillary muscles fibrosis, presence of severe mitral regurgitation, left ventricle spheroidal remodeling, left ventricle ejection fraction, left ventricular end-diastolic volume index, and left ventricular end-diastolic diameter index. An algorithm integrated by various diagnostic modalities associated with echocardiography as a tool for the detection of ALCAPA was developed. The documentation of the diagnostic and classificatory aspects of the syndrome is possible by detecting echocardiographic elements in conjunction with electrocardiographic and radiological aspects.

Abstract 31: Impact of Acculturation on Cardiac Structure and Function Among Latinos in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): The ECHO-SOL Ancillary Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Lenny Lopez ◽  
Katrina Sweet ◽  
Fátima Rodríguez ◽  
Jorge R Kizer ◽  
Frank J Penedo ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Structure And Function ◽  
Volume Index ◽  
Cardiac Structure ◽  
Length Of Residence ◽  
The Us ◽  
Cardiac Structure And Function ◽  
And Function

Background: Abnormalities of cardiac structure and function are part of the spectrum of heart failure risk and progression. Acculturation is the process whereby an individual adopts the beliefs and practices of a host culture. Increasing acculturation has been associated with increased psychosocial stress and the adoption of deleterious health behaviors. The extent to which acculturation contributes to cardiovascular disease among Latinos is not well defined, and its association with cardiac structure and function in particular has not been studied among Latinos. Hypothesis: We hypothesized that higher acculturation is associated with worse left ventricular structure and function. Methods: The HCHS/SOL cohort included 16,415 Latino adults age 18-74 years from Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds. A random subsample of 1350 also underwent detailed echocardiographic assessment for the following primary outcome measures: left atrial volume index (LAVI), left ventricular mass index (LVMI) and LV ejection fraction (LVEF), LV end diastolic volume (LVEDV) and diastolic dysfunction (Grade 0 vs. Grade 1-3). Acculturation was measured by length of residence in the US categorized as (< 5 years, 5-10 years, >10 years). Chi-square and ANOVA were used to assess differences across acculturation level and dependent variables. Separate linear and logistic regression analyses were used with sequential modeling for age and sex followed by models including diabetes, hypertension, body mass index, tobacco use, and estimated glomerular filtration rate. Results: The mean age of the Echocardiographic Cohort was 56 years (S.D. ±0.5). Length of residence among first generation immigrants (n=1239) was as follows: 9.7% ≤ 5 years; 14.8% 5-10 years; and 75.5% ≥10 years. Fully adjusted models demonstrated abnormal cardiac structure was significantly higher with increasing years of US residence: increasing LAVI (1.6 ml/m 2 higher ≥10 years vs. ≤ 5 years), increasing LVEDV (5.6 ml higher ≥10 years vs. ≤ 5 years), and LVMI (4.9g/m 2 higher ≥10 years vs. ≤ 5 years) (p<0.01 each). Increasing length of residence in the US was also associated with higher prevalence of diastolic dysfunction in models adjusted for age and gender (54.2% ≤ 5 years vs. 63.7% ≥10 years; p=0.04), though this became marginally non-significant in our fully adjustment models (p=0.07). There were no significant differences in systolic cardiac function as measured by LVEF. Conclusions: Among a diverse Latino population, higher acculturation defined as greater length of residence in the US, a proxy measure for acculturation, was associated with larger LA volume, larger LV cavity, higher LV mass and a tendency to higher prevalence of diastolic dysfunction independent of traditional risk factors. Acculturation may be a significant process that impacts cardiac structure and function among Latinos.

Chronic exercise and left ventricular structure and function in healthy human subjects

1985 ◽  
Vol 58 (2) ◽  
pp. 409-415 ◽  
Author(s):  
L. A. Wolfe ◽  
R. P. Martin ◽  
D. D. Watson ◽  
R. D. Lasley ◽  
D. E. Bruns
Keyword(s):  
Human Subjects ◽  
Exercise Program ◽  
Left Ventricular ◽  
Control Group ◽  
Healthy Human ◽  
Mean Values ◽  
End Diastolic Volume ◽  
Supervised Exercise ◽  
Fitness Training ◽  
And Function

Twelve healthy well-trained participants in a supervised exercise program (mean age, 41.3 yr) were compared with 12 sedentary control subjects (mean age, 38.9 yr) with physical characteristics similar to the exercised group (EG) before training. Resting echocardiograms revealed significantly lower heart rates (HR) in the EG compared with control group (CG) but no evidence for cardiac structural differences between groups. Radionuclide angiograms performed at rest and during two levels of supine cycling (HR targets: 120 and 140 beats X min-1) resulted in increases in background-corrected end-diastolic counts [EDC(bc)] and confirmed use of the Frank-Starling mechanism in the majority of subjects. Mean values (+/- SD) for ejection fraction (EF) and normalized peak systolic ejection rate (PSER) (P greater than 0.05 between groups) were the following. (Formula: see text) The results suggested that fitness training does not induce significant cardiac enlargement as apparent from measurements at rest or important changes in contractile state during exercise. Increases in exercise stroke volume with such training may be the result of an increased end-diastolic volume.

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