Nature of heart failure in patients with ventricular septal defect

1995 ◽  
Vol 269 (4) ◽  
pp. H1473-H1480
Author(s):  
J. M. Stewart ◽  
T. H. Hintze ◽  
P. K. Woolf ◽  
M. S. Snyder ◽  
K. P. Seligman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Stress Strain ◽  
Maximum Slope ◽  
Strain Relation ◽  
Stress Strain Relation

To assess the contributions of systolic and diastolic dysfunction to congestive heart failure (CHF) in ventricular septal defect (VSD), we studied 13 children with VSD at catheterization using a Millar catheter. Eight children had CHF, whereas five did not. Phenylephrine was infused at a rate of 5 micrograms.kg-1.min-1, and M-mode echocardiography and pressure were measured simultaneously. Systolic left ventricular (LV) function was assessed by maximum LV pressure (LVP), rate of pressure development (dP/dt), and by the end-systolic pressure-diameter relation (ESPDR). Systolic myocardial function was assessed by the end-systolic stress-strain relation. Diastolic chamber function was assessed by the isovolumic relaxation time constant (tau) and by the end-diastolic pressure-diameter relation (EDPDR). Diastolic myocardial function was measured by the end-diastolic stress-strain relationship. With phenylephrine, maximum LVP increased from 99 +/- 5 to 119 +/- 4 mmHg with CHF and from 106 +/- 6 to 149 +/- 10 mmHg without CHF. +dP/dt was lower with CHF (1,582 +/- 96 mmHg/s) than without CHF (2,300 +/- 200 mmHg/s). The maximum slope of the ESPDR was 39 +/- 8 with CHF and 94 +/- 14 mmHg/cm without CHF. The maximum slope of the midwall stress-strain relation was 223 +/- 37 with CHF and 395 +/- 93 g/cm2 without CHF. tau was 25 +/- 2 without CHF compared with 32 +/- 3 ms with CHF. The EDPDR was shifted leftward with failure, whereas the stress-strain relation was similar for all patients. CHF in patients with VSD results primarily from systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Dapagliflozin suppresses ER stress and improves subclinical myocardial function in diabetes: from bedside to bench

2020 ◽  
Author(s):  
Ada Admin ◽  
Jhih-Yuan Shih ◽  
Yu-Wen Lin ◽  
Sudeshna Fisch ◽  
Juei-Tang Cheng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Er Stress ◽  
Myocardial Function ◽  
Sglt2 Inhibitor ◽  
Left Ventricular ◽  
Diabetic Rat ◽  
Lv Function ◽  
Diabetic Patients ◽  
Symptomatic Heart Failure

Dapagliflozin (DAPA) -- a sodium glucose cotransporter 2 (SGLT2) inhibitor, is approved for treatments of diabetic patients. DAPA-HF trial disclosed its benefits in symptomatic heart failure but the underlying mechanism remains largely unknown. In this longitudinal and prospective study, we investigated changes of left ventricular (LV) functions including speckle tracking in diabetic patients free from symptomatic heart failure post DAPA treatment. Using streptozotocin-induce diabetic rat model, we measured the effects of DAPA on myocardial function. In patients with diabetes, following six months of DAPA, despite no significant changes LV ejection fraction, the diastolic function and longitudinal strain improved. Likewise, compared to control, the diabetic rat heart developed pronounced fibrosis, a decline in strain and overall hemodynamics, all of which were mitigated by DAPA treatment. In contrast, despite insulin exerting a glucose lowering effect, it failed to improve myocardial function and fibrosis. In our in vitro study, under high glucose cardiomyocytes showed significant activations of apoptosis, reactive oxygen species and ER stress associated proteins, which were attenuated by the co-incubation of DAPA. Mechanistically, DAPA suppressed ER stress, reduced myocardial fibrosis and improved overall function. The results can lead to further improvement in management of LV function in diabetic patients.

scholarly journals Dapagliflozin suppresses ER stress and improves subclinical myocardial function in diabetes: from bedside to bench

2020 ◽  
Author(s):  
Ada Admin ◽  
Jhih-Yuan Shih ◽  
Yu-Wen Lin ◽  
Sudeshna Fisch ◽  
Juei-Tang Cheng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Er Stress ◽  
Myocardial Function ◽  
Sglt2 Inhibitor ◽  
Left Ventricular ◽  
Diabetic Rat ◽  
Lv Function ◽  
Diabetic Patients ◽  
Symptomatic Heart Failure

Dapagliflozin (DAPA) -- a sodium glucose cotransporter 2 (SGLT2) inhibitor, is approved for treatments of diabetic patients. DAPA-HF trial disclosed its benefits in symptomatic heart failure but the underlying mechanism remains largely unknown. In this longitudinal and prospective study, we investigated changes of left ventricular (LV) functions including speckle tracking in diabetic patients free from symptomatic heart failure post DAPA treatment. Using streptozotocin-induce diabetic rat model, we measured the effects of DAPA on myocardial function. In patients with diabetes, following six months of DAPA, despite no significant changes LV ejection fraction, the diastolic function and longitudinal strain improved. Likewise, compared to control, the diabetic rat heart developed pronounced fibrosis, a decline in strain and overall hemodynamics, all of which were mitigated by DAPA treatment. In contrast, despite insulin exerting a glucose lowering effect, it failed to improve myocardial function and fibrosis. In our in vitro study, under high glucose cardiomyocytes showed significant activations of apoptosis, reactive oxygen species and ER stress associated proteins, which were attenuated by the co-incubation of DAPA. Mechanistically, DAPA suppressed ER stress, reduced myocardial fibrosis and improved overall function. The results can lead to further improvement in management of LV function in diabetic patients.

Stresses in Left Ventricular Wall and Biaxial Stress-Strain Relation of the Cardiac Muscle Fiber for the Potassium-Arrested Heart

1978 ◽  
Vol 100 (3) ◽  
pp. 116-121 ◽  
Author(s):  
H. Abe´ ◽  
T. Nakamura ◽  
M. Motomiya ◽  
K. Konno ◽  
S. Arai
Keyword(s):  
Strain Energy Function ◽  
Spherical Geometry ◽  
Left Ventricular ◽  
Biaxial Stress ◽  
Stress Strain ◽  
Strain Relation ◽  
Stress Strain Relation ◽  
Volume Relationship ◽  
Pressure Volume Relationship ◽  
Large Elastic Deformation

Wall stresses and pseudo-strain energy function (W) were determined analytically from the pressure-volume relationships taken from (6 hypertrophied and 5 normal) canine hearts on the basis of large elastic deformation theory by assuming a spherical geometry of the left ventricles. The biaxial stress-strain relation of the myocardium was obtained from the function W. This relation was found to be more appropriate than the uniaxial relations for comparison of ventricles having different pressure-volume relationships and/or different sizes, since the uniaxial relation cannot be determined uniquely only from the pressure-volume relationship.

scholarly journals Dapagliflozin suppresses ER stress and improves subclinical myocardial function in diabetes: from bedside to bench

2020 ◽  
Author(s):  
Ada Admin ◽  
Jhih-Yuan Shih ◽  
Yu-Wen Lin ◽  
Sudeshna Fisch ◽  
Juei-Tang Cheng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Er Stress ◽  
Myocardial Function ◽  
Sglt2 Inhibitor ◽  
Left Ventricular ◽  
Diabetic Rat ◽  
Lv Function ◽  
Diabetic Patients ◽  
Symptomatic Heart Failure

Dapagliflozin (DAPA) -- a sodium glucose cotransporter 2 (SGLT2) inhibitor, is approved for treatments of diabetic patients. DAPA-HF trial disclosed its benefits in symptomatic heart failure but the underlying mechanism remains largely unknown. In this longitudinal and prospective study, we investigated changes of left ventricular (LV) functions including speckle tracking in diabetic patients free from symptomatic heart failure post DAPA treatment. Using streptozotocin-induce diabetic rat model, we measured the effects of DAPA on myocardial function. In patients with diabetes, following six months of DAPA, despite no significant changes LV ejection fraction, the diastolic function and longitudinal strain improved. Likewise, compared to control, the diabetic rat heart developed pronounced fibrosis, a decline in strain and overall hemodynamics, all of which were mitigated by DAPA treatment. In contrast, despite insulin exerting a glucose lowering effect, it failed to improve myocardial function and fibrosis. In our in vitro study, under high glucose cardiomyocytes showed significant activations of apoptosis, reactive oxygen species and ER stress associated proteins, which were attenuated by the co-incubation of DAPA. Mechanistically, DAPA suppressed ER stress, reduced myocardial fibrosis and improved overall function. The results can lead to further improvement in management of LV function in diabetic patients.

scholarly journals Ebstein anomaly, left ventricular hypertrabeculation and ventricular septal defect associated with a myh7 mutation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Korkmaz ◽  
U Aydogdu ◽  
D Inan ◽  
N Keles ◽  
O Yildirimturk
Keyword(s):  
Heart Failure ◽  
Ventricular Septal Defect ◽  
Medical Treatment ◽  
Congenital Heart ◽  
Septal Defect ◽  
Heart Diseases ◽  
Left Ventricular ◽  
Congenital Heart Diseases ◽  
Splice Acceptor ◽  
Ebstein Anomaly

Abstract Funding Acknowledgements Type of funding sources: None. Ebstein anomaly is an extremely rare anomaly of <1% among all congenital heart diseases. Pathologically, the septal and / or posterior leaflet of the tricuspid valve has abnormal locations towards the right ventricular apex. Ebstein anomaly is especially accompanied by atrial septal defect, patent ductus arteriosus, wolf parkinson white syndrome and pulmonary atresia. Defects located in the interventricular septum are called the ventricular septal defect (VSD). They can be single or multiple and congenital or acquired. Isolated VSDs are the most common congenital anomaly in childhood and constitute 20-30% of all congenital heart diseases. VSD can be a part of major congenital malformations ,such as, fallot tetralogy, transposition of the major arteries, double ventricular right ventricle. Left ventricular noncompaction (LVNC) is a relatively common genetic cardiomyopathy, characterized by prominent trabeculations with deep intertrabecular recesses in mainly the left ventricle. Although LVNC often occurs in an isolated entity, it may also be present in various types of congenital heart disease . A combination of Ebstein anomaly, hypertrabeculation and ventricular septal defect is a rare condition. Case Report A 49-year-old male patient presented to the emergency room with shortness of breath and swelling of the legs. The patient had diagnosed an Ebstein anomaly while the military examination in 1988. Already it ‘s known that he has gout disease and uses colchicine but no family history of any disease. On examination of the patient, bilateral ral in respiratory sounds and +++ / +++ pretibial edema in the lower extremity were detected. On his electrocardiogram, the sinus rhythm with first-degree atrioventricular block was observed. The findings on his echocardiographic examination are ejection fraction 30-35% with global left ventricular hypokinesia, Ebstein anomaly (Figure ), perimembranous type VSD, atrial septal aneurysm type 2 and left ventricular hypertrabeculation. His blood table was normal. Medical treatment of heart failure was started for the patient who was interneed to the service. After getting clinical relief, the patient was discharged under medical treatment. Genetic tests were studied while  following up at the heart failure outpatient clinic. In the MYH7 gene, splice-acceptor-2 (PVS1) variation heterozygous was detected. This variant has not been seen in national data banks of genetics. Conclusion The MYH7 gene, localized on chromosome 14p12, is composed of 41 exons and encodes the b-myosin heavy chain, expressed in cardiac muscle. Mutations in the MYH7 gene have been identified in association with left ventricular hypertrabeculation and Ebstein anomaly. In conclusion, this is the first known report of Ebstein anomaly associated with the splice-acceptor-2 variation heterozygous of the MYH7 gene. Abstract Figure

scholarly journals Left Ventricular Non-Compaction Cardiomyopathy, Ventricular Septal Defect and Pre-excitation: A Rare Coexistence of Three Abnormities in an Adult Patient.

2021 ◽  
Vol 18 (1) ◽  
pp. 57-59
Author(s):  
Tufan Çınar ◽  
Vedat Çiçek ◽  
Sahhan Kılıç ◽  
Emre Yalçınkaya ◽  
Murat Selçuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Septal Defect ◽  
Adult Patient ◽  
Septal Defect ◽  
Left Ventricular ◽  
Thromboembolic Events ◽  
Mortality And Morbidity ◽  
Progressive Heart Failure ◽  
First Case ◽  
Cardiac Condition

A congenital cardiac condition characterized by ventricular trabeculations and intertrabecular recesses is described as a non-compaction cardiomyopathy. In clinical practice, since it can be associated with severe mortality and morbidity due to progressive heart failure, thromboembolic events, and fatal arrhythmias, it is important to consider non-compaction cardiomyopathy. In this case, we have an adult patient who underwent surgery due to a ventricular septal defect (VSD) and who was later diagnosed with left ventricular non-compaction cardiomyopathy (LVNC) and pre-excitation. To our knowledge, this is the first case of VSD, LVNC, and pre-excitation simultaneously present in an adult patient.

scholarly journals Challenges in treatment of postinfarction ventricular septal defect and heart failure

2015 ◽  
Vol 72 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Ljupco Mangovski ◽  
Rainer Kozlik-Feldmann ◽  
Miodrag Peric ◽  
Ljiljana Jovovic ◽  
Mihajlo Farkic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Angiography ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Surgical Closure ◽  
Direct Stenting ◽  
Septal Occluder Device

Introduction. Acquired ventricular septal defect (VSD) is uncommon, but serious mechanical complication of acute myocardial infarction with poor outcome and high mortality rate in surgically or medically treated patients. Case report. We report a 58-year-old male patient admitted to our hospital six days following acute inferior myocardial infarction complicated by ventricular septal rupture with signs of heart failure. Coronary angiography revealed 3-vessel disease, with proximally occluded dominant right coronary artery. Transthoracic echo exam revealed aneurysm of a very thin inferior septum and the basal portion of the inferior left ventricular wall, with septal wall rupture. One of the VSD dimensions was 15 mm and left- to right shunt was calculated 2 : 1. Since the patient was at too high risk for surgical closure, transcatheter closure of VSD was chosen as a better option. Under short intravenous sedation, 24 mm Amplatzer device was implanted percutaneously with transesophageal echo guidance. The post-procedural result revealed a small residual shunt, but it was followed by significant improvement of the patient?s clinical status. A 24h Holter ECG monitoring did not show cardiac rhythm or conduction disturbances. Coronary angiography was repeated ten days following the procedure, after hemodynamic stabilization of the patient, with direct stenting of the circumflex artery and the intermediate artery. Ostial left descending artery lesion was left for further functional significance assessment. Conclusion: Percutaneous closure with a septal occluder device can be definitive primary treatment for anatomically suitable patients or it can serve as a bridge to surgical treatment.

Abstract 12494: Optimal Timing for Echocardiographic Assessment of Left Ventricular Function During Reduced Left Ventricular Assist Device Support

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ayesha Salahuddin ◽  
Kana Fujikura ◽  
Emma J Birks ◽  
Chris Cunningham ◽  
Faouzi Kallel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Speckle Tracking ◽  
Circumferential Strain ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Walk Test ◽  
Ventricular Assist ◽  
Full Support ◽  
Left Ventricular Assist

Introduction: In some circumstances left ventricular assist devices (LVAD) can be used to bridge patients with advanced heart failure to myocardial recovery or “remission”. Evaluation of the underlying myocardial function in patients supported with an LVAD is often performed with the pump speed turned down to minimal support for 15 minutes, to simulate unassisted ventricular loading conditions. Longer duration of reduced support and performance of exercise may allow for a more realistic evaluation of myocardial function to assess for recovery. Methods: Nine turn-down exams from 4 patients were analyzed. Subjects were participants in a multi-center prospective non-randomized study of LV recovery with HeartMate II LVAD together with a standardized protocol of pharmacological therapy (REmission from STAGE D Heart Failure (RESTAGE-HF)). LVEF and speckle tracking parameters were measured during full support, at 15 minutes of reduced support (6000 rpm) and again after a 6-min walk test. Averaged radial and circumferential strain, and global circumferential strain were analyzed from papillary muscle level short-axis view using speckle-tracking. Results: LV systolic parameters for each of these patients are shown, (Table). Improvement in LV function was not evident at 15 minutes of reduced support, compared to full support but was evident after the 6-min walk test. Conclusions: After 15 minutes of LVAD turndown, LV systolic parameters did not differ from full support values. Improvement in LV function compared to full support became evident when the protocol was extended to include imaging after a longer period of turndown with the addition of a 6-min walk test.

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