Evaluation of Cardiac Functions in Children and Adolescents with Type 1 Diabetes

BACKGROUND: Cardiac dysfunction in patients with type 1 diabetes (T1D) represents one of the serious complications. To evaluate the cardiac function in children with T1D by conventional echocardiography and tissue Doppler imaging (TDI). METHODS: The study included 40 T1D patients (age between 6 and 16 years) with > 5 years duration of diabetes and 42 healthy control children. The patients were subjected to clinical evaluation and laboratory investigations [glycosylated hemoglobin A1c (HbA1c), serum lipids and lipoproteins]. Conventional echocardiography and TDI were performed to patients and controls. RESULTS: The patients had lower early diastolic filling velocity (E wave) of the tricuspid valve and mitral valves with a p value of (0.000 and 0.006, respectively). TDI revealed that patients had lower S′velocity of the T1D, shorter isovolumic contraction time, longer isovolumic relaxation time and lower E/E′ of the right ventricle than controls (p value 0.002, 0.001, 0.004, 0.003, and 0.016, respectively). The left ventricle (LV)-T1D of the patients was significantly higher (p value 0.02). Twenty eight patients had poor glycemic control without significant differences between them and those with good glycemic control regarding echocardiographic data. Patients with dyslipidemia (13 patients) had higher late diastolic filling velocity of the mitral valve (A) and the lower LV late tissue velocity (A′) (p wave 0.047 and 0.015). No correlation existed between the duration of illness or the level of HbA1c and the echocardiographic parameters. CONCLUSION: Diabetic children have evidence of echocardiographic diastolic dysfunctions. Periodic cardiac evaluation with both conventional and tissue Doppler echocardiography is recommended for early detection of this dysfunction.

Assessment of the left ventricular function in normotensive prediabetics: a tissue Doppler echocardiography study

ABSTRACT Objective Several studies have shown that left ventricular (LV) dysfunction is increased in individuals with diabetes. However, there are scarce data about LV function in prediabetics. This study assessed the early changes in LV diastolic and systolic myocardial function in normotensive prediabetics using tissue Doppler echocardiography (TDE). Subjects and methods We evaluated 94 patients with prediabetes (mean age of 50.8 ± 6.9 years, 78 female) without known cardiovascular diseases and 70 healthy volunteers with similar demographic characteristics. Systolic and diastolic function of the left ventricle was evaluated with transthoracic echocardiography according to the latest consensus recommendations including TDE. Results The mean results of septal and lateral parts of the mitral annulus Pulsed wave TDE showed that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em to atrial peak velocity (Am) ratio were significantly lower whereas early diastolic peak flow velocity (E) to Em ratio, myocardial isovolumetric relaxation time (IVRTm), myocardial isovolumetric contraction time (IVCTm) and myocardial performance index (MPI) values were significantly higher in patients with prediabetes (preDM). In addition, mean left atrium (LA) diameter measured with M-mode echocardiography was significantly higher in prediabetics than controls. Conclusion PreDM is associated with subclinical LV systolic and diastolic dysfunction as evaluated by TDE.

The Tissue Doppler Imaging Derived Post-Systolic Velocity Notch Originates at the Aortic Annulus

BACKGROUND: A distinct velocity pattern represented by a "notch" is observed during the time interval between the end of the systolic and the onset of the early diastolic velocity wave on longitudinal myocardial velocity curve. The origin of the post-systolic velocity notch (PSN) has not been resolved. METHODS: The high frame rate color tissue Doppler imaging of the apical longitudinal axis was performed in 32 healthy subjects. RESULTS: The time delays of the PSN onset at the posterior aortic wall (AW), the mid anteroseptal wall (MAS) and the posterior mitral annulus (MA) relatively to the anterior aortic annulus (AA) were found to be significantly longer than zero (5.1 +/- 2.2, 6.0 +/- 2.3, 6.8 +/- 2.8 ms; p < 0.001). The amplitude was the highest at the AA when compared to the AW, the MAS and the MA (4.77 +/- 1.28 vs. 2.88 +/- 1.11, 2.15 +/- 0.73, 2.44 +/- 1.17 cm/s; p < 0.001). A second PSN spike was identifiable in 10/32 (31%) of the studied subjects at the AA. Of these, 9 (28%) exhibited a second PSN spike at the AW, 3 (9%) at the MAS and no one at the MA. CONCLUSION: The AA represents the site of the earliest onset and maximal amplitude of the PSN on the longitudinal velocity curve suggesting its mechanism to be that of an energy release at the instant of the aortic valve closure causing an apically directed acceleration of the myocardium. A substantial number of healthy subjects exhibit a second PSN spike predominantly at the level of the AA. Its mechanism remains to be elucidated.

Study of ventricular function in patients with rheumatic valvular heart disease.

Objective: In India, the commonest cardiovascular ailment encountered in hospitals is rheumatic heart disease, mitral valve being most commonly affected. Rheumatic mitral valve disease affects left-ventricular performance as a result of myocardial and functional factors. This study is aims to review the use of Tissue Doppler Echocardiography over conventional echocardiography in assessment of ventricular functions in patients having rheumatic heart disease. Material and Methods: This is a cross sectional study carried out at Shree Sayajirao General Hospital and Medical College Baroda. Total of 35 patients with an established diagnosis of rheumatic MS, and 30 age-matched healthy individuals were included in this study. Echocardiography equipped with TDE function was performed on each participant. The mitral valve area, gradient across mitral valve, Left atrial size, ejection fraction, isovolumic contraction time of ventricles, myocardial velocity of ventricular walls were measured. Discussion: The average age of study population was 33 years with 57% females patients and 43% males patients. There was maximum correlation between Systolic myocardial velocity and ejection fraction calculated by Simpson’s Four Chamber method . Regional distribution of systolic dysfunction occur in rheumatic mitral valve disease with maximum maximum affection of posterior and lateral wall and minimal affection of interventricular septum. LV systolic and diastolic dysfunction can occur in pure mitral stenosis independent of severity of mitral stenosis & Tissue Doppler echocardiography appears to be feasible in the prediction of subclinical LV dysfunction.

Evaluating myocardial function of a cardiomyopathy rabbit model following bone marrow stromal cell transplantation by tissue Doppler echocardiography / 中国组织工程研究

BACKGROUND: Tissue Doppler echocardiography (TDE) has been proved to evaluate general and local function of heart but less reported on adriamycin-induced cardiomyopathy following bone marrow stromal cell (BMS) transplantation.OBJECTIVE: To evaluate myocardial function of an adriamycin-induced cardiomyopathy rabbit model following BMS transplantation using TDE.DESIGN, TIME AND SETTING: A randomized animal control study was performed at Laboratory of Ultrasound, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from September 2002 to December 2003.MATERIALS: A total of 28 male adult Japanese rabbits weighing (2.0+0.2) kg were used in this study. Adriamycin was used to induce cardiomyopathy model in 20 rabbits.METHODS: Twenty-eight male Japanese rabbits were randomly divided into three groups: cell transplantation group (n=10),PBS group (n=10), and sham operation group (n=8). BMSs were isolated from cell transplantation group at the 8th day. On the 12th week, cells were labeled with 4, 6-diamidino-2-phenylindole (DAPI), and then epicardial directly injected into the myocardium of the same rabbits in thoracotomy surgery. Non-cell only culture fluid PBS was injected in PBS group. Sham operation group underwent thoracotomy surgery with the same volume of saline injection.MAIN OUTCOME MEASURES: Left ventricular function was assessed by conventional and tissue Doppler echocardiography before and 4 weeks after surgery. Histological examination including apotisis study and DAPI fluorescent were assessed after sacrificed.from (4.0+1.1) cm/s to (5.3+1.2) cm/s (P ＜ 0.05) around the inject site, but the improvement of global myocardial function was not found by conventional echocardiography. In PBS and sham operation group there were no differences in global and myocardium at 4 weeks after transplantation. Histological findings showed that the injury of the myocardium around the injection site was relieved with less apoptosis.

Treatment of Acute Myocardial Infarction by Allogeneic Transplantation of Rat Bone Marrow Mesenchymal Stem Cells / 中国康复理论与实践

@#Objective To investigate the feasibility of acute myocardial infarction(AMI)treated with transplantation of bone marrow mesenchymal stem cells(MSCs).Methods Fifty female Wistar rats were randomly divided into the transplant group and control group with 25 animals in each group.The AMI animal model was made by liquid nitrogen freezing.Rat MSCs cultured and induced repeatedly was prepared for transplantation and injected into the infarcted parts of the transplant group.The same volume of DMEM solution was injected into the infarcted parts of the control group.Echocardiography was applied one day preoperation,and one week and four weeks postoperation to evaluate cardiac function.The animals of the transplanted group were executed in the fourth week after operation and the tissues of transplant part were examined by BrdU immunofluorescent stain.Results Some transplant cells expressed the cardiac-specific proteins,α-actin and troponin T.The cardiac function of the transplant group had better than that of the control group(P>0.05)in the fourth week postoperation.The BrdU-labeled cells were found in the histological sections of the transplant parts.Conclusion Rat MSCs cultured generation by generation and repeatedly induced by 5-aza in vitro can differentiate into cardiomyocyte-like cells,which if transplanted into the rat infarcted cardiac muscles will survive and help to improve the host's cardiac function.