scholarly journals Effects of glossopharyngeal insufflation on cardiac function: an echocardiographic study in elite breath-hold divers

2007 ◽  
Vol 103 (3) ◽  
pp. 823-827 ◽  
Author(s):  
Ralph Potkin ◽  
Victor Cheng ◽  
Robert Siegel
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Wall Motion ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Breath Hold ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
End Diastolic Volume

Glossopharyngeal insufflation (GI), a technique used by breath-hold divers to increase lung volume and augment diving depth and duration, is associated with untoward hemodynamic consequences. To study the cardiac effects of GI, we performed transthoracic echocardiography, using the subcostal window, in five elite breath-hold divers at rest and during GI. During GI, heart rate increased in all divers (mean of 53 beats/min to a mean of 100 beats/min), and blood pressure fell dramatically (mean systolic, 112 to 52 mmHg; mean diastolic, 75 mmHg to nondetectable). GI induced a 46% decrease in mean left ventricular end-diastolic area, 70% decrease in left ventricular end-diastolic volume, 49% increase in mean right ventricular end-diastolic area, and 160% increase in mean right ventricular end-diastolic volume. GI also induced biventricular systolic dysfunction; left ventricular ejection fraction decreased from 0.60 to a mean of 0.30 ( P = 0.012); right ventricular ejection fraction, from 0.75 to a mean of 0.39 ( P < 0.001). Wall motion of both ventricles became significantly abnormal during GI; the most prominent left ventricular abnormalities involved hypokinesis or dyskinesis of the interventricular septum, while right ventricular wall motion abnormalities involved all visible segments. In two divers, the inferior vena cava dilated with the appearance of spontaneous contrast during GI, signaling increased right atrial pressure and central venous stasis. Hypotension during GI is associated with acute biventricular systolic dysfunction. The echocardiographic pattern of right ventricular systolic dysfunction is consistent with acute pressure overload, whereas concurrent left ventricular systolic dysfunction is likely due to ventricular interdependence.

scholarly journals Analysis of cardiac involvement in patients recovered from Covid-19 without troponin elevation, evaluated by cardiovascular magnetic resonance.

2021 ◽  
Author(s):  
Adrian Carlessi ◽  
Leonel Perello ◽  
Cristian Pantaley ◽  
Armando Borsini ◽  
Lucia Rossi ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Cardiac Involvement ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Troponin Elevation

Abstract Background The disease caused by coronavirus (COVID-19) affects the cardiovascular system, whether by direct viral aggression or indirectly through systemic inflammation and multiple organ compromise. A widely used method to determine cardiac injury is troponin measurement. The aim of this study is to evaluate the prevalence of cardiac involvement (CINV) in a population recovered from COVID-19, referred to cardiac MRI (CMR), who did not present troponin elevation. Methods There were 156 patients that recovered from COVID-19 and who did not present troponin elevation referred to CMR. CINV was considered to be the presence of: late gadolinium enhancement (LGE), edema, myocarditis, pericarditis, left ventricular systolic dysfunction (LVSD) and/or depressed right ventricular systolic dysfunction (RVSD). Results Prevalence of CINV was 28.8%, being more frequent in men (p = 0.002), in patients who required hospitalization (p = 0.04) and in those who experienced non-mild cases of infection (p = 0.007). RVSD (17.9%) and LVSD (13.4%) were the most frequent findings. The rate of myocarditis was 0.6%. LGE manifested in 7.1% of patients and its presence was related to less left ventricular ejection fraction (LVEF) (p = 0.0001) and right ventricular ejection fraction (RVEF) (p = 0.04). Conclusion In patients who recovered from COVID-19, 28.8% of CINV was found. It was more frequent in men, in patients who required admission and in patients with cases of non-mild infection. The patients that presented LGE had less LVEF and RVSF.

scholarly journals Treatable cardiac disease in hospitalised COPD exacerbations

2021 ◽  
Vol 7 (1) ◽  
pp. 00756-2020
Author(s):  
Paul Leong ◽  
Martin I. MacDonald ◽  
Paul T. King ◽  
Christian R. Osadnik ◽  
Brian S. Ko ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Antiplatelet Agent ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Dynamic Ct ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

IntroductionAcute exacerbations of COPD (AECOPD) are accompanied by escalations in cardiac risk superimposed upon elevated baseline risk. Appropriate treatment for coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) could improve outcomes. However, securing these diagnoses during AECOPD is difficult, so their true prevalence remains unknown, as does the magnitude of this treatment opportunity. We aimed to determine the prevalence of severe CAD and severe HFrEF during hospitalised AECOPD using dynamic computed tomography (CT).MethodsA cross-sectional study of 148 patients with hospitalised AECOPD was conducted. Dynamic CT was used to identify severe CAD (Agatston score ≥400) and HFrEF (left ventricular ejection fraction ≤40% and/or right ventricular ejection fraction ≤35%).ResultsSevere CAD was detected in 51 of 148 patients (35%), left ventricular systolic dysfunction was identified in 12 cases (8%) and right ventricular systolic dysfunction was present in 18 (12%). Clinical history and examination did not identify severe CAD in approximately one-third of cases and missed HFrEF in two-thirds of cases. Elevated troponin and brain natriuretic peptide did not differentiate subjects with severe CAD from nonsevere CAD, nor distinguish HFrEF from normal ejection fraction. Undertreatment was common. Of those with severe CAD, only 39% were prescribed an antiplatelet agent, and 53% received a statin. Of individuals with HFrEF, 50% or less received angiotensin blockers, beta blockers or antimineralocorticoids.ConclusionDynamic CT detects clinically covert CAD and HFrEF during AECOPD, identifying opportunities to improve outcomes via well-established cardiac treatments.

scholarly journals Systolic left ventricular dysfunction in patients with clinically suspected myocarditis

2020 ◽  
Vol 17 (4) ◽  
pp. 452-460
Author(s):  
N. P. Mitkovskaya ◽  
E. M. Balysh ◽  
T. V. Statkevich ◽  
N. A. Ladygina ◽  
E. B. Petrova ◽  
...  
Keyword(s):  
Heart Rate ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

The aim of the study was to investigate the features of clinically suspected myocarditis complicated by the left ventricular systolic dysfunction development. 93 patients with clinically suspected myocarditis were examined. The average age was 36.63 ± 1.15 years. In 43.01 % of patients the disease was accompanied by a decrease in left ventricular systolic function. In the group of patients with left ventricular systolic dysfunction in comparison with those with preserved left ventricular ejection fraction, a significantly lower proportion of men (75 % versus 81 %, respectively, χ2 = 9.3, p < 0,01) and a higher average group age (40.7 ± 1.87 versus 33.6 ± 1.3 years, respectively, p <  0,01) were revealed. The course of the disease in patients with left ventricular systolic dysfunction was characterized by a more frequent development of rhythm disturbances (65 % versus 43.3 %, respectively, χ2  = 4.3, p  < 0,05) and a higher heart rate at admission (94.5 (75‒100) and 85 (70‒89) beats per minute, respectively, p = 0.006). The structural and functional state of the heart according to echocardiography in patients with a reduced left ventricular ejection fraction versus comparison group was characterized by larger heart chambers sizes, more pronounced violations of local left ventricular contractility, more frequent involvement of the right ventricle in the pathological process (56.3  % versus 22.2  %, respectively, χ2   =  6.4, p  < 0,05). The relationships between the left ventricular ejection fraction Весці Нацыянальнай акадэміі навук Беларусі. Серыя медыцынскіх навук. 2020. Т. 17, № 4. C. 452–460 453 and the patient’s age (r = ‒0.36), the value of the heart rate at admission (r = ‒0.32), the severity of heart failure at admission, the degree of impaired local contractility of the left ventricle, the degree of right ventricular function (TAPSE, r  =  0.58), the severity of myocardial fibrosis according to cardiovascular magnetic resonance imaging (r = ‒0.32) were revealed.

scholarly journals THE EXTRACELLULAR MATRIX DEGRADATION MARKERS AS PREDICTORS OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION AMONG PATIENTS WITH STEMI

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
I. M. Fushtey ◽  
E. V. Sid
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Matrix Metalloproteinase ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

Abstract The purpose of the study. To determine predictor value of the extracellular matrix degradation markers relative to the occurrence of left ventricular systolic dysfunction among patients with STEMI determined. Materials and methods. The results of the study are based on data obtained from a comprehensive survey of 162 patients with STEMI. The first group consisted of 145 patients with STEMI and left ventricular ejection fraction > 45% (median age – 59 (52–64) years); the second group consisted of 17 patients with STEMI and left ventricular ejection fraction < 45% (median age 61 (55–63) years). All persons were comparable in age, social status, and gender. The sample of patients was carried out in the period from 2015 to January 2018 on the basis of the MI «Regional medical center of cardiovascular diseases» of the Zaporizhzhia regional Council. Results. Significantly, the level of 5816,3 (5487,7–6538,6) PG/ml of matrix metalloproteinase-9 was higher in the left ventricular ejection fraction group < 45% compared to 5129,6 (3984,6–5975,8) PG/ml in the left ventricular ejection fraction group > 45%, (p < 0,05). The level of tissue inhibitor of matrix metalloproteinase-2 among patients with left ventricular ejection fraction < 45% was 524,8 (484,6–648,7) PG/ml and was considerably higher compared to 459,7 (368,3–549,2) PG/ml in the left ventricular ejection fraction group > 45%, (p < 0,05). The largest area under the ROC curve (AUC = 0,694, 95% CI 0,617 to 0,764) among the analyzed markers of extracellular matrix degradation was tissue inhibitor of matrix metalloproteinase-2. At the distribution point > 483,7 PG/ml, the sensitivity was 76,47% and the specificity was 62,07% for left ventricular systolic dysfunction among patients with STEMI. The calculated relative risk was for matrix metalloproteinase-9 > 5247,9 PG/ml for the development of left ventricular systolic dysfunction was 7,139, 95% CI 1,686–30,218. For the level of tissue inhibitor of matrix metalloproteinase-2 > 483,7 PG/ml, the relative risk was 4,271, 95% CI 1,455–12,536 for the development of left ventricular systolic dysfunction. Conclusions. Patients having STEMI with left ventricular ejection fraction < 45% had essentially higher levels of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-2. At matrix metalloproteinase-9 > 5247.9 PG/ml level relative risk of the developing left ventricular systolic dysfunction in patients with STEMI increases by 7.139 times. Keywords: acute myocardial infarction, matrix metalloproteinase-9, tissue inhibitor of matrix metalloproteinase-2, left ventricular systolic dysfunction.

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