Piezopulsometric analysis of autonomic regulation of the cardiovascular system in an elderly person under stress

Описаны результаты применения нового метода артериальной пьезопульсометрии для неинвазивной оценки функционального состояния и физиологических механизмов автономной регуляции сердечно-сосудистой системы (ССС) у пожилого человека при острой боли, связанной с неожиданной физической травмой. Такое воздействие в первый же день вызвало негативную стресс-реакцию в мышечных эффекторах (МЭ) ССС, провоцируя аномальное усиление и ускорение сократимости миокарда ЛЖ сердца. Анализ графиков волн пульсового АД крови (ПАДК) показал, что максимальная скорость прироста ПАДК - VmaxPP, отражающая сократительную способность миокарда, выросла с 625±74 перед травмой до 2 117±173 мм рт. ст./с после травмы, исказив контур нормального графика. Причиной этого роста могло быть быстрое суммарное воздействие трансмиттеров нейроэндокринной симпатико-адреналовой системы на адренорецепторы кардиомиоцитов. Результаты спектрального анализа вариабельности параметров волн ПАДК подтвердили такую возможность. Было показано, что при стрессе норадреналин из активированных симпатических эфферентов добавляется к характерному для пожилых людей уже повышенному содержанию гуморальных катехоламинов в межклеточной среде миокарда вблизи адренорецепторов кардиомиоцитов. При этом существенно возрастает активность парасимпатических эфферентов, выделяющих ацетилхолин, ингибирующий контрактильную реакцию миокарда и тем самым выполняющий сдерживающую кардиопротекторную функцию. При исследовании механизмов автономной регуляции МЭ ССС в условиях стрессорного воздействия использовали персонализированный подход. The article describes the results of using the method of arterial piezopulsometry for non-invasive assessment of the functional state and physiological mechanisms of autonomous regulation of the cardiovascular system (CVS) in an elderly person with acute pain associated with unexpected physical trauma. On the first day, such an effect caused a negative stress reaction in the muscle effectors (ME) of the CVS, provoking an abnormal increase and acceleration of the contractility of the left ventricular myocardium. Analysis of the arterial blood pressure (PP) pulse wave graphs showed that the maximum rate of PP growth - VmaxPP, which reflects myocardial contractility, increased from 625±74 before injury to 2 117±173 mm Hg/s after injury, distorting the contour of the normal PP waveform. The reason for this growth could be the rapid cumulative effect of transmitters of the neuroendocrine sympathoadrenal system on adrenergic receptors (AR) of cardiomyocytes (CM). The results of the spectral analysis of the variability of the parameters of the PP waves confirmed this possibility. It was shown that under stress, norepinephrine from activated sympathetic efferents is added to the already increased content of humoral catecholamines in the extracellular environment of the myocardium near the AR of the CM, which is characteristic of the elderly. At the same time, the activity of parasympathetic efferents, releasing acetylcholine, which inhibits the contractile reaction of the myocardium and, thereby, performs a restraining cardioprotective function, significantly increases. A personalized approach was used for piezopulsometric study of the mechanisms of autonomous regulation of ME CVS under specific conditions of stress.

Title：Early assessment of ventricular synchronization and function after left bundle-branch-area pacing with right bundle-branch block

Aim To evaluate ventricular synchronization and function in patients with right bundle-branch block after left bundle-branch-area pacing (LBBAP) by echocardiography. Methods Forty patients who successfully received LBBAP were selected and divided into the right bundle-branch block group (RBBB group) and the non-RBBB group by pre-operation ECG. Echocardiography and follow-up were performed 1 month after operation. Interventricular synchronization was evaluated by tissue Doppler (TDI), tissue mitral annular displacement (TMAD), and interventricular mechanical delay (IVMD). The ventricular longitudinal strain and the standard deviation of peak time of longitudinal strain were analyzed by two-dimensional speckle tracking imaging (2D-STI) to evaluate intraventricular synchronization and ventricular function. Results (1) The deviation of systolic time to the peak of the tricuspid and mitral valves, namely ΔPTTV-MV measured by TMAD and ΔTsTV-MV measured by TDI, were statistically different between the two groups (P < 0.05). (2) Compared with the non-RBBB group, there were no statistically significant differences in longitudinal strain (LS), peak strain time, standard deviation of peak strain time (SDt), and global longitudinal strain (GLS) in the right and left ventricle in the RBBB group (P > 0.05). Conclusion Echocardiography technology including 2D-STI, TDI, and TMAD can effectively analyze interventricular synchronization, intraventricular synchronization, and ventricular function. Although the movement of the right ventricular myocardium in the RBBB group treatment was slightly later than that of the left ventricular myocardium after LBBAP, LBBAP is still an effective pacing therapy for RBBB patients with pacing indication.

Multi-Omics Approach Profiling Metabolic Remodeling in Early Systolic Dysfunction and in Overt Systolic Heart Failure

Metabolic remodeling plays an important role in the pathophysiology of heart failure (HF). We sought to characterize metabolic remodeling and implicated signaling pathways in two rat models of early systolic dysfunction (MOD), and overt systolic HF (SHF). Tandem mass tag-labeled shotgun proteomics, phospho-(p)-proteomics, and non-targeted metabolomics analyses were performed in left ventricular myocardium tissue from Sham, MOD, and SHF using liquid chromatography–mass spectrometry, n = 3 biological samples per group. Mitochondrial proteins were predominantly down-regulated in MOD (125) and SHF (328) vs. Sham. Of these, 82% (103/125) and 66% (218/328) were involved in metabolism and respiration. Oxidative phosphorylation, mitochondrial fatty acid β-oxidation, Krebs cycle, branched-chain amino acids, and amino acid (glutamine and tryptophan) degradation were highly enriched metabolic pathways that decreased in SHF > MOD. Glycogen and glucose degradation increased predominantly in MOD, whereas glycolysis and pyruvate metabolism decreased predominantly in SHF. PKA signaling at the endoplasmic reticulum–mt interface was attenuated in MOD, whereas overall PKA and AMPK cellular signaling were attenuated in SHF vs. Sham. In conclusion, metabolic remodeling plays an important role in myocardial remodeling. PKA and AMPK signaling crosstalk governs metabolic remodeling in progression to SHF.

Changes of Cardiac Magnetic Resonance T1 and ECV Values in Healthy Adults of Different Gender and Age

purposeThe correlation between T1 and ECV value and myocardial fibrosis has been confirmed. In healthy adult, many disease may change T1 and ECV value. The purpose of this reseach is to clarify the T1 mapping and extracellular volume (ECV) value of healthy adults in 3 Tesla (T) magnetic resonance imaging (MRI), and to study the relationship between the values with age and gender.Methods We recruited 87 healthy adult subjects (mean age 38 ± 11 years; 61% were females) for cardiac magnetic resonance examination at 3T MRI. The left ventricular function parameters were obtained from functional imaging. T1 mapping was performed using an improved Look-Locker reversal recovery sequence after motion correction. resultsUnder 3T field strength, T1 value of the myocardium of healthy adults was 1,261 ± 52, and the ECV value was 28.3% ± 2.9%. T1 value and ECV values of female myocardium were higher than those of males (1,274 ± 56 vs. 1,241 ± 40, P = 0.003; 29.6% ± 2.6% vs. 26.2% ± 2.1%, P < 0.001). Only gender (Beta = 0.311, P = 0.003) was independently related to the native T1 mapping of left ventricular myocardium, while gender (Beta = 0.572, P < 0.001) and age (Beta = 0.501, P = 0.003) were related to the ECV value of left ventricular myocardium. T1 value (P = 0.002) and ECV value (P = 0.013) increased significantly from the base to the apex. There were significant differences in the T1 and ECV value between each segment (P < 0.001) in the base of the left ventricle. Significant differences were observed between the middle segments of T1 value (P = 0.001) but not between the middle of the ECV value of each segment (P = 0.068). Lastly, there was no statistical difference between each segment in the apical of the T1 (P = 0.756) and ECV value (P = 0.344).ConclusionsUnder 3T MRI, the T1 value of the myocardium of healthy adults was 1,261 ± 52, and the ECV value was 28.3% ± 2.9%. T1 and ECV values of females were significantly higher than those of males. The ECV values of males increased with age, while T1 value in males and T1 and ECV values in females had no significant relationship with age.

Characterizing Neonatal Heart Maturation, Regeneration, and Scar Resolution Using Spatial Transcriptomics

The neonatal mammalian heart exhibits a remarkable regenerative potential, which includes fibrotic scar resolution and the generation of new cardiomyocytes. To investigate the mechanisms facilitating heart repair after apical resection in neonatal mice, we conducted bulk and spatial transcriptomic analyses at regenerative and non-regenerative timepoints. Importantly, spatial transcriptomics provided near single-cell resolution, revealing distinct domains of atrial and ventricular myocardium that exhibit dynamic phenotypic alterations during postnatal heart maturation. Spatial transcriptomics also defined the cardiac scar, which transitions from a proliferative to secretory phenotype as the heart loses regenerative potential. The resolving scar is characterized by spatially and temporally restricted programs of inflammation, epicardium expansion and extracellular matrix production, metabolic reprogramming, lipogenic scar extrusion, and cardiomyocyte restoration. Finally, this study revealed the emergence of a regenerative border zone defined by immature cardiomyocyte markers and the robust expression of Sprr1a. Taken together, our study defines the spatially and temporally restricted gene programs that underlie neonatal heart regeneration and provides insight into cardio-restorative mechanisms supporting scar resolution.

Case Report: A Giant Left-Ventricular Intramural Pseudoaneurysm Arise From Ruptured Left Sinus of Valsalva Aneurysm

In this report, we present a case study of an extremely rare left sinus Valsalva aneurysm (SVA) rupture into the left-ventricular myocardium. Acute ozone inhalation and long-term hypertension are possible contributors to the condition. Utilizing multimodal cardiovascular imaging techniques [echocardiogram, computed tomography (CT), and cardiac magnetic resonance (CMR)], a large, left-ventricular, intramural pseudoaneurysm (IPA) arising from the ruptured left SVA, was clearly observed anatomically and functionally. Subsequently, our patient underwent patch repair and valvoplasty which offered an excellent prognosis. This report describes the manifestation of the ruptured left SVA and its possible etiology. This case also emphasizes the need for multimodal imaging for subsequent surgical repair.

NT pro- B-type Natriuretic Peptide in the Small Ventricular Septal Defect in Children

Background: Brain natriuretic peptide is a cardiac hormone secreted from the left ventricular myocardium due to ventricular expansion and volume overload. A recent study shows that small VSD will have risk of ventricular dysfunction in adulthood. Another complications such as endocarditis, congestive heart failure, aortic regurgitation, arrhythmia also we should be aware. Evaluations of the plasma B-type natriuretic peptide level (NT pro BNP) are currently being considered as methods to identify the possible presence of ventricular dilation in small VSD. Objective: To evaluate the change in plasma B-type natriuretic peptide after transcatheter closure of VSD. Methods: A pretest-posttest design was conducted on VSD patients before and after transcatheter closure. Plasma B-type natriuretic peptide level were measured before and 30 days after the transcatheter closure of VSD. Result: A total of 32 peri membranous VSD patients were included in this study with 62.5 % female patients (n=20) and 37.5 % male patients (n=12). A significant decrease was observed in the median NT pro BNP level when the level before closure of 1.08 (0.74 – 3.47) ng/ml was compared to the level after closure of 0.91 (0.68 – 2.07) ng/ml (p<0.05). Conclusion: Significant decreases in NT pro BNP level are seen in small VSD patients 30 days after transcatheter closure. Patients with small peri membranous VSD are generally considered to need occlusion for their childhood defect.