Clinical application of non-invasive myocardial work imaging in ST-segment elevation myocardial infarction patients with left ventricular remodeling after percutaneous coronary intervention / 中华超声影像学杂志

Objective:To explore the application value of non-invasive myocardial work imaging in evaluating the cardiac function of ST-segment elevation myocardial infarction (STEMI) patients with left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI).Methods:One hundred and twenty-six patients with STEMI undergoing PCI in General Hospital of Ningxia Medical University from December 2021 to September 2022 were prospectively collected and divided into left ventricular remodeling group (LVR group, 34 cases) and non left ventricular remodeling group (NLVR group, 92 cases) according to whether there was left ventricular remodeling 3 months after surgery. General data were collected. Routine echocardiography and noninvasive myocardial work imaging were performed before, 1 week, 1 month, and 3 months after surgery, the differences in the above parameters between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between the indicators.Logistic regression analysis was used to determine the independent risk factors of left ventricular remodeling after STEMI, and a predictive model was obtained. The diagnostic value of the model was judged by ROC curve.Results:①General information comparison: There were statistically significant differences between the two groups in BMI, systolic blood pressure, diastolic blood pressure, average number of stents implanted, and history of hyperlipidemia (all P<0.05), but there was no significant difference in other data (all P>0.05). There was no statistically significant difference in two-dimensional transthoracic echocardiography (2D-TTE) parameters and non-invasive myocardial work (MW) parameters between the two groups before and 1 week after operation (both P>0.05). ②2D-TTE parameter comparison: LVESV and LVEDV at 3 months after PCI in the LVR group were significantly higher than those in the NLVR group, and LVEF and E/A were significantly lower than those in the NLVR group (all P<0.05); There were no significant differences in other indexes between the two groups by conventional echocardiography at 3 months after PCI(all P>0.05). ③Comparisons of noninvasive myocardial work parameters: GLS, GWE, GWI, GCW at 1 month and 3 months after PCI in the LVR group were significantly lower than those in the NLVR group, and GWW were significantly higher than those in the NLVR group ( P<0.001). ④Correlation analysis: GLS, GWE, GCW, GWI and LVEDV were negatively correlated at 1 month after operation ( r=-0.42, -0.38, -0.50, -0.53, all P<0.001), GWW was positively correlated with LVEDV ( r=0.45, P<0.001). ⑤Logistic regression analysis: GLS<17%, GCW<1 900 mmHg%, GWW>105 mmHg%, and GWE<90 mmHg% at 1 month after PCI were independent predictors for LVR in STEMI patients after PCI (all P<0.05). The predictive model was Logit (P)=0.692GLS+ 0.804GCW+ 0.972GWW+ 0.880GWE. The AUC of this model was 0.886, 95% CI=0.845-0.926, which was significantly higher than single index, the sensitivity was 0.86, and the specificity was 0.79. Conclusions:GLS, GWE, GWI, GCW are positively correlated with LVR, while GWW is negatively correlated with left ventricular remodeling. Noninvasive myocardial work parameters are independent risk factors for left ventricular remodeling in patients with STEMI after PCI surgery. This technique can be used to evaluate LVR and has great clinical application value.

Quantitative evaluation of left ventricular systolic function in hyperglycemia during pregnancy by left ventricular pressure-strain loop / 中华超声影像学杂志

Objective:To detect the changes of left ventricular myocardial work parameters, and evaluate the left ventricular systolic function in patients with hyperglycemia during pregnancy by left ventricular pressure-strain loop (PSL).Methods:From June 2021 to March 2022, 97 pregnant women who were admitted to the Second Affiliated Hospital of Harbin Medical University and clinically diagnosed as gestational hyperglycemia were prospectively and randomly selected. According to the blood glucose level, the patients were divided into gestational dominant diabetes mellitus (ODM) group(39 cases) and gestational diabetes mellitus (GDM) group(58 cases). Meanwhile, another 62 healthy pregnant women were selected as control group. The basic clinical data of the pregnant women were collected, and the conventional two-dimensional parameters of the heart were collected. The global longitudinal strain (GLS) was analyzed by two-dimensional speckle tracking technique. Then the cuff blood pressure was used as the left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. The global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) of each group were calculated and compared. The correlation between myocardial performance parameters and GLS, glycated hemoglobin(HbA 1c) were analyzed, and the independent factors affecting left ventricular systolic function were obtained by Logistic regression analysis. Twenty cases were randomly selected from the study subjects, and the intraclass correlation coefficients(ICC) of within the observers and between observers were calculated for repeatability test. Results:①Conventional ultrasound parameters: There were no significant differences among the three groups (all P>0.05). ②GLS and left ventricular myocardial performance parameters: GWI, GWE, GCW and GLS in GDM and ODM groups were significantly lower than those in control group (all P<0.001), GWW was significantly higher than control group ( P<0.001); GWI, GWE, GCW and GLS in ODM group were lower than those in GDM group (all P<0.001), while GWW was higher than control group ( P<0.001). ③GWE, GWI and GCW were negatively correlated with GLS ( r=-0.525, -0.408, -0.435; all P<0.05), GWW was positively correlated with GLS ( r=0.348, P<0.05). GWE, GWI and GCW were negatively correlated with HbA 1c ( r=-0.325, -0.262, -0.250; all P<0.05), while GWW was positively correlated with HbA 1c ( r=0.175, P<0.05). ④GWE, 1 h oral glucose tolerance test and HbA 1c were the influencing factors of left ventricular systolic function in patients with hyperglycemia during pregnancy. ⑤The predictive values of GWI, GWE, GCW, GWW and GLS for cardiac function in patients with gestational hyperglycemia were high, and the predictive value of GWE was the highest (AUC: 0.87, the best truncation value: 94.5%, specificity: 0.76, sensitivity: 0.82) and better than GLS. ⑥The repeatability of myocardial work parameters was better in both groups. Conclusions:Myocardial work parameters obtained by PSL are early and sensitive parameters for evaluating left ventricular systolic function impairment in patients with hyperglycemia during pregnancy which can provide reliable and objective quantitative indicators for early clinical intervention and improvement of prognosis.

Assessment of early left ventricular function changes after percutaneous coronary intervention by non-invasive myocardial work / 中华超声影像学杂志

Objective:To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF) after percutaneous coronary intervention(PCI) by noninvasive myocardial work technology, and to explore the evolution of left ventricular myocardial function recovery.Methods:A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF (>55%) after PCI were recruited. Echocardiography was performed 1 day before PCI, 1 day, 2 weeks, 1 month, and 3 months after PCI. Global longitudinal strain (GLS) was analyzed, and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global myocardial work efficiency (GWE) among groups were compared and their correlations with strain parameters were explored.Results:GWI, GCW, GWE were improved ( P<0.05) at 1 day after PCI, GLS improved ( P<0.05) and GWW decreased ( P<0.05) at 2 weeks, LVEF improved ( P<0.05) at 1 month. Baseline GWI and GCW had a moderately negative correlation with GLS ( r=-0.67, -0.66; both P<0.05); GWW had a moderately positive correlation with mechanical dispersion(MD) and postsystolic shortening index(PSI) ( rs=0.45, 0.50; both P<0.05); GWE had a moderately negative correlation with GLS, MD and PSI ( rs=-0.47, -0.55, -0.56; all P<0.05). Conclusions:Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI. Myocardial work parameters changes are more sensitive than GLS and LVEF, and can assess early left ventricular myocardial function changes after PCI.

Evaluation of left ventricular function in patients with rheumatoid arthritis by noninvasive pressure-strain loop / 中华超声影像学杂志

Objective:To evaluate the application value of left ventricular pressure-strain loop (PSL) in patients with rheumatoid arthritis (RA) by the PSL.Methods:From April 2020 to June 2021, 75 RA patients(case group) and 35 healthy physical examination person(control group) were selected from the Affiliated Hospital of Inner Mongolia Medical University.According to the disease activity scores 28(DAS28) joint disease range of activity score, the patients were divided into low range of activity group (16 cases), medium range of activity group (35 cases) and high range of activity group (24 cases). Echocardiographic examinations were performed on all patients, conventional ultrasound data were collected and the left ventricular PSL technology was used to analyze the myocardial work parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE). The mean values of myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated. The differences of myocardial work parameters between the case groups and the control group were compared, and the correlation analysis of myocardial work parameters with global longitudinal strain of left ventricle(LVGLS), left ventricular ejection fraction(LVEF) and DAS28 scores were conducted.Results:①There were no statistically significant differences of clinical data between each case group and the control group (all P>0.05). ②Compared with the control group and low disease activity group, the LVGLS of medium and high disease activity groups decreased obviously (all P<0.05). ③The GWI and GCW of the medium and high disease activity groups were significantly lower than those of the control group (all P<0.05), and there were no statistically significant differences of GWW and GWE between the case groups and the control group (all P>0.05). The mid-segment MWI, apical MWI and CW of the medium and high disease activity case groups, and the mid-segment CW of the medium disease activity case group were lower than those of the control group (all P<0.05). ④In the case group, GWI, GCW and LVEF were significantly and positively correlated ( rs1=0.253, P=0.008; rs2=0.261, P=0.024), and were significantly negatively correlated with LVGLS ( rs1=-0.525, P<0.001; rs2=0.455, P<0.001). There were no significant correlations between myocardial work parameters and DAS28 score (all P>0.05). Conclusions:PSL can early reflect to the impaired cardiac function of RA patients with moderate and high disease activity, and provide a new imaging method for clinical evaluation of the cardiac function of patients.

The positive inotropic effect of phosphodiesterase type 8 inhibitor of PF-04957325 in rats and its underlying mechanism / 中国药理学通报

Aim To investigate the inotropic effect of PF-04957325, a phosphodiesterase type 8 inhibitor, in normal rats and its underlying molecular mechanism. Methods The techniques of in vivo rat left ventricular pressure-volume loop (P-V loop) and isolated perfusion rat heart were used to analyze the hemodynamics and positive inotropic effect of rat hearts. The Ca transient induced by field stimulation was used to analyze the hemodynamics of sarcoplasmic reticulum (SR) Ca + uptaking. Western blot was used to analyze the phosphorylation levels of SR phospolamban (PLB) and ryanodine receptor type 2 (RyR2). Results The P-V loop experiment indicated that PF-04957325 (0.5 mg · kg

Systolic aortic regurgitation in rheumatic carditis: Mechanistic insight by Doppler echocardiography

Background Aortic regurgitation (AR) usually occurs in diastole in presence of an incompetent aortic valve. Systolic AR is a rare phenomenon occurring in patients with reduced left ventricular systolic pressure and atrial fibrillation or premature ventricular contractions. Its occurrence is a Doppler peculiarity and adds to the hemodynamic burden. Aim Rheumatic carditis is often characterised by acute or subacute severe mitral regurgitation (MR) due to flail anterior mitral leaflet and elongated chords. In patients with acute or subacute MR, developed left ventricular systolic pressure may fall in mid and late systole due to reduced afterload and end-systolic volume and may be lower than the aortic systolic pressure, causing flow reversal in aorta and systolic AR. Material and methods 17 patients with acute rheumatic fever were studied in the echocardiography lab during the period 2005–2015. Five patients had severe MR of which two had no AR and hence were excluded from the study. Three young male patients (age 8–24 years) who met modified Jones’ criteria for rheumatic fever with mitral and aortic valve involvement were studied for the presence of systolic AR. Results In presence of acute or subacute severe MR, flail anterior mitral valve and heart failure, all three showed both diastolic and late systolic AR by continuous-wave and color Doppler echocardiography. Conclusion Systolic AR is a unique hemodynamic phenomenon in patients with acute rheumatic carditis involving both mitral and aortic valves and occurs in presence of severe MR.

Determination and comparison of organ parameter, blood index, carotid artery blood pressure, heart rate and ventricular pressure in the specific pathogen free New Zealand rabbits / 中国比较医学杂志

Objective To accurately determine the biological characteristics , especially the disease-related indexes of SPF rabbits , and their gender differences .Methods A total of thirty 70-80 day old SPF New Zealand rabbits (male :female=1:1) were fed for a week, and then we weighed the body weight and main organs , determined the blood physiological and biochemical indexes , blood gas and arterial pressure , and measured the ventricular pressure by thoracotomy under respiratory support .Results Comparison of the male and female SPF New Zealand rabbits showed that there were significant differences in the mass of thyroid , adrenal gland, and liver (P<0.05 or P<0.01); the brain, pituitary gland, thyroid gland organ coefficients ( P<0.05 or P<0.01); the thyroid/brain, adrenal/brain, and liver/brain ratios (P<0.05 or P<0.01);the mean erythrocyte volume and mean hemoglobin content (P<0.05 or P<0.01);and in glutamyl transpetidase and amylase ( P<0.05 or P<0.01 ) , but no significant differences in blood gas analysis ,heart rate and carotid artery systolic and diastolic blood pressure , left ventricular systolic and diastolic blood pressure , and right ventricular systolic and diastolic blood pressure .Conclusions The gender has an impact on organ weight and blood physiological and biochemical indexes in New Zealand rabbits , but no significant influence on blood gas , blood pressure , heart rate and ventricular pressure in the rabbits .

Efecto inotrópico positivo ejercido por el derivado de brucina en un modelo de corazón aislado de rata / Inotropic effect exerted by the brucine derivativein an isolated rat heart mode / Efeito inotrópico exercida pelo derivado de brucinaem um modelo de corações isolados de ratos

Existen pocos datos con respecto a los efectos de la brucina y sus derivados en el aparato cardiovascular; además, el mecanismo molecular y su sitio de acción celular no son claros. Para proporcionar información adicional acerca de este fenómeno, en este trabajo fue evaluado el efecto inducido por un derivado de la brucina sobre la presión de perfusión, la resistencia vascular y la presión ventricular izquierda en corazón aislado de rata a flujo constante (modelo de Langendorff). Los resultados mostraron que; 1) el derivado brucina (1×10-9 mM) incrementa la presión de perfusión y la resistencia vascular en comparación con la brucina (1×10-9 mM) y las condiciones de control; 2) los efectos del derivado de brucina en dosis de 1×10-9 a 1×10-4 mM sobre la presión intraventricular no fueron inhibidos por metoprolol, prazosina o nifedipino a dosis de 1×10-6 mM; y 3) la furosemida a dosis de 1×10-6 mM bloquea los efectos ejercidos por el derivado de brucina (1×10-9 a 1×10-4 mM) sobre la presión intraventricular. En conclusión, la actividad ejercida por el derivado de brucina sobre la presión ventricular izquierda, involucra inhibición de la bomba Na+/K+-ATPasa, lo que trae indirectamente cambios en los niveles de calcio intracelular y subsecuentemente un efecto inotrópico positivo.

Few data exist with respect to the effects of brucine and its derivatives at a cardiovascular level; furthermore, the molecular mechanism and its site of cellular action are still unclear. In order to provide additional information about this phenomenon, the effect induced by a brucine derivative on perfusion pressure, vascular resistance and left ventricular pressure was evaluated in anisolated rat heart at constant flow (Langendorff model). The results showed that: 1) The brucine derivative [1×10-9 mM] increased perfusion pressure and vascular resistance in comparison with the brucine [1×10-9 mM] and the control conditions; 2) the effects of brucine derivative [1×10-9 to 1×10-4 mM] on intraventricular pressure were not inhibited by metoprolol, prazosin or nifedipine at a 1×10-6 mM dose; 3) furosemide [1×10-6 mM] blocked the effects exerted by the brucine derivative [1×10-9 a 1×10-4 mM] on intraventricular pressure. In conclusion, the activity exerted by the brucine derivative on perfusion pressure, vascular resistance and left ventricular pressure, involves inhibition of Na+/K+-ATPase, consequently resulting in indirect changes in intracellular calcium levels and subsequently inducing a positive inotropic effect.

Existem poucos dados no que diz respeito aos efeitos da brucina e seus derivados no nível cardiovascular; além disso, o mecanismo molecular e seu local de ação celular não são claros. Para fornecer informações adicionais sobre este fenômeno, neste trabalho foi avaliado o efeito induzido por um derivado de brucina sobre a pressão de perfusão, a resistência vascular e a pressão ventricular esquerda em coração isolado de ratos em fluxo constante (modelo Langendorff). Os resultados mostraram que: 1) o derivado brucina (1×10-9 mM) aumenta a pressão de perfusão e a resistência vascular em comparação com a brucina (1×10-9 mM) e as condições de controle; 2) os efeitos do derivado de brucina em doses de 1×10-9 a 1×10-4 mM sobre a pressão intraventricular não foram inibidos por metoprolol, prazosina ou nifedipino em doses de 1×10-6 mM; e 3) a furosemida, em doses de 1×10-6 mM, bloqueia os efeitos exercidos pelo derivado de brucina (1×10-9 a 1×10-4 mM) sobre a pressão intraventricular. Em conclusão, a atividade exercida pelo derivado de brucina sobre a pressão ventricular esquerda, envolve a inibição da bomba de Na+/K+-ATPase, o que indiretamente traz alterações nos níveis de cálcio intracelular e, subsequentemente, um efeito inotrópico positivo.

Acute exposure to lead increases myocardial contractility independent of hypertension development

We studied the effects of the acute administration of small doses of lead over time on hemodynamic parameters in anesthetized rats to determine if myocardial contractility changes are dependent or not on the development of hypertension. Male Wistar rats received 320 µg/kg lead acetate iv once, and their hemodynamic parameters were measured for 2 h. Cardiac contractility was evaluated in vitro using left ventricular papillary muscles as were Na+,K+-ATPase and myosin Ca2+-ATPase activities. Lead increased left- (control: 112 ± 3.7 vs lead: 129 ± 3.2 mmHg) and right-ventricular systolic pressures (control: 28 ± 1.2 vs lead: 34 ± 1.2 mmHg) significantly without modifying heart rate. Papillary muscles were exposed to 8 µM lead acetate and evaluated 60 min later. Isometric contractions increased (control: 0.546 ± 0.07 vs lead: 0.608 ± 0.06 g/mg) and time to peak tension decreased (control: 268 ± 13 vs lead: 227 ± 5.58 ms), but relaxation time was unchanged. Post-pause potentiation was similar between groups (n = 6 per group), suggesting no change in sarcoplasmic reticulum activity, evaluated indirectly by this protocol. After 1-h exposure to lead acetate, the papillary muscles became hyperactive in response to a β-adrenergic agonist (10 µM isoproterenol). In addition, post-rest contractions decreased, suggesting a reduction in sarcolemmal calcium influx. The heart samples treated with 8 µM lead acetate presented increased Na+,K+-ATPase (approximately 140%, P < 0.05 for control vs lead) and myosin ATPase (approximately 30%, P < 0.05 for control vs lead) activity. Our results indicated that acute exposure to low lead concentrations produces direct positive inotropic and lusitropic effects on myocardial contractility and increases the right and left ventricular systolic pressure, thus potentially contributing to the early development of hypertension.

Utility of Global Strain by Two-Dimensional and Three-Dimensional Speckle Tracking for Assessing Left Ventricular Diastolic Function: Comparison with Pressure Wire Analysis

BACKGROUND AND OBJECTIVES: We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance. SUBJECTS AND METHODS: Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated. RESULTS: dP/dt(min) were related to early mitral annular velocity (e'), 2D-SRe(long), 2D-SRe(radial), as well as 3D-DI(long), and 3D-DI(as). Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to 2D-SRe(long), 2D-SRe(circ), 2D-SRe(radial), 3D-DI(long), 3D-DI(circ), and 3D-DI(as). E/2D-SRe(long), E/2D-SRe(radial), E/3D-DI(long), and E/3D-DI(as) were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, E/3D-DI(long) provided incremental value in identifying those with LVEDP > or =15 mm Hg. CONCLUSION: 2D-SRe(long), 2D-SRe(radial), 3D-DI(long), and 3D-DI(as) were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', E/3D-DI(long) offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.

Effects of Electroacupuncture on Cardiac Performance in Spontaneously Hypertensive Rats / 日本温泉気候物理医学会雑誌

<B>Purpose</B><br> We assessed the effect of Electroacupuncture (EA) at Zusanli (ST36) acupoint on cardiac perfor-mance of spontaneously hypertensive rat (SHR), analyzing left ventricular pressure-volume (PV) relationship.<br><b>Methods</b><br> SHR and Wistar-Kyoto rat (WKY) were anesthetized with isoflurane (1%). Conductance catheter (SPR-838, Millar instruments, Houston, Texas) was inserted into left ventricle via carotid artery. Steady state was maintained for at least 5 min before EA was started. <br> EA stimulation point was set on the right anterior side of hindlimb, corresponding to Zusanli (ST36) acupoint in humans. SHR and WKY underwent EA stimulation in a frequency of 2Hz and intensity of 6mA with a pulse generator (Han’s Healthronics Likon,Taipei, Taiwan) for 15 min. PV relationship was measured at baseline, 10min after the start of EA stimulation and at 0, 5, 10, 15 min after the end, then analyzed to obtain parameters for cardiac performance.<br><b>Result</b><br> In the basic state before EA stimulation, ESP, SW, PVA, Ea, dp/dtmax, dp/dtmin, Pmax, ESPVR and EDPVR in SHR was significantly higher than those in WKY(ESP, 109.6±8.3 vs. 175.0±14.6mmHg, p<0.01 ; SW, 5.7±1.6 vs. 8.8±3.7mmHg·ml, p<0.05 ; PVA, 11.7±4.0 vs. 19.3±6.4mmHg· ml, p<0.01 ; Ea, 1804.2±382.4 vs. 2625.3±629.3 mmHg/ml, p<0.01 ; dp/dtmax, 7512.9±1628.8 vs. 13406.3±1771.4mmHg/s, p<0.01 ; dp/dtmin, -7159.7±1236.8 vs. -12082.5±1280.2 mmHg/s, p<0.01 ; Pmax, 116.7±6.8 vs. 176.8±14.6mmHg, p<0.01 ; ESPVR, 1013.8±320.3 vs. 1520.1±494.8mmHg/ml, p<0.05 ; EDPVR 70.0±39.3 vs. 178.3±130.2 mmHg/ml, p<0.05, respectively), indicating increased systolic function and decreased diastolic function in SHR.<br> Significant change in parameters of WKY could not be observed after EA stimulation.In SHR, ESP, EDP, Ea, dp/dtmax, dp/dtmin, Pmax was significantly decreased at 10 min after EA started. ESPVR was not significantly affected by EA in both WKY and SHR, however, ESPVR tended to be increased in WKY and decreased in SHR at 10min after the start of EA stimulation.<br><b>Conclusion</b><br> EA decreased indicators of systolic function in SHR that is significantly higher than WKY. This study suggests that EA improved enhanced systolic function in SHR, compared with WKY.

Usefulness of Peritoneal Dialysis (PD) in Patients with Refractory Heart Failure (RHF) / 대한신장학회잡지

BACKGROUND:Though PD has served as a treatment method for metabolic derangement in acute or chronic renal failure, it has also been used as a palliative therapy or as a bridge to definite surgery or transplantation in patients with RHF. Some studies have demonstrated that PD reduced hospitalization rates and improved functional capacity in these patients, but changes in echocardiographic findings after PD have not been thoroughly explored. In this study, the effects of PD on hospitalization rates and days, functional status, and echocardiographic parameters were evaluated. METHODS:Thirteen patients, in whom PD was performed to treat heart failure, were enrolled. Patients with serum creatinine levels more than 3.0 mg/dL and with acute cardiac event within 1 month before the start of PD were excluded. The clinical, laboratory, and echocardiographic findings before and after the start of PD were compared by carrying out a paired t-test or Wilcoxon signed rank test. RESULTS:Among 13 patients, 11 patients experienced improvement in functional status after the initiation of PD, and the mean NYHA class improved from 3.5+/-0.5 to 2.3+/-0.9 after PD treatment (p<0.005). Significant reductions in hospitalization rates (from 1.7+/-0.4 to 0.2+/-0.4 episodes/patient-year, p<0.001) and in hospitalization days (from 62.1+/-26.5 to 3.8+/-8.9 days/patient-year, p<0.001) were also observed since the start of PD. Echocardiographic findings revealed that right ventricular pressure was significantly reduced in both right-sided and left-sided heart failure patients (p<0.05), whereas there were no significant changes in left ventricular end-diastolic diameter and left ventricular ejection fraction after PD therapy. CONCLUSION:PD treatment improved quality of life, shortened hospitalization period, and reduced right ventricular pressure in patients with RHF. These findings suggest that PD should be considered as an alternative therapeutic modality for RHF.

Usefulness of B-type Natriuretic Peptide in Congestive Heart Failure

BACKGROUND AND OBJECTIVES: B-type natriuretic peptide (BNP) is released from the cardiac ventricles in response to increased wall tension. Early diagnosis of congestive heart failure (CHF) and assessment of the left ventricular end diastolic pressure (LVEDP) are thought to be important in the diagnosis, treatment and follow up of patients with CHF. SUBJECTS AND METHODS: Between March, 2002 and November, 2002, 50 patients, who were admitted for treatment and hemodynamic monitoring, were studied. For the BNP measurement, 3 to 5ml blood samples were collected into tubes containing EDTA. The BNP was measured with a fluorescence immunoassay kit (Triage, Biosite, San Diego, U.S.A.). Cardiac Catheterization was performed for the assessment of the LVEDP. RESULTS: Of the 50 subjects, 34 with CHF had a mean BNP level of 483.1+/-77.8 pg/mL, whereas those without CHF had a level of 79.2+/-24.0 pg/mL. The difference between the groups was statistically significant (p=0.005). A significant positive correlation was seen between the BNP and the LVEDP (r=0.53, p=0.001). The correlation between the BNP and the left ventricular ejection fraction (LVEF) was not statistically significant (r=-0.226, p=0.198). CONCLUSION: The plasma BNP was significantly increased in CHF, and might reflect the LVEDP. Further study will be required to see whether the BNP is a useful parameter for the staging and treatment of CHF.

Clinic study to evaluate left ventricular chamber stiffness by catherization and simultaneous echocardiography / 中华超声影像学杂志

Objective To establish the method of depict ing the left ventricular (LV) pressure-volume loop automatically by computer which incorporates LV catherization simultaneous with LV acoustic quantification echocardiography and to assess echocardiography non-invasive evaluation LV chamber stiffness. Methods Thirteen patients with hypertrophic cardiomyopathy (HCM) underwent LV catherization simultaneously with echocardiography. LV pressure and volume curves were sent to computer, and LV pressure-volume loop was depicted automatically and modulus of LV chamber stiffness (Kc) was obtained. Pulsed Doppler echocardiography of mitral intraventricular flows was obtained in patients with HCM. Results Patients with HCM had significantly higher Kc obtained from LV pressure-volume loop ( 0.43 ? 0.11 vs 0.27 ). R-E 3/R-E 0, (R-E 2)-(R-E 1), (R-A 3)-(R-A 2) were correlated to Kc(r= 0.61 , 0.57 , 0.58 ,respectively). Conclusions This method provides a simple and reliable technique for automatically tracing pressure-volume loop and should facilitate further investigation of the left ventricular diastolic function in clinical practice. R-E 3/ R-E 0, (R-E 2)-(R-E 1), (R-A 3)-(R-A 2) offer new non-invasive indices in evaluating LV chamber stiffness.

Echocardiographic Indices Associated with Left Ventricular End-Diastolic Pressure

BACKGROUND AND OBJECTIVES: It has been suggested that the indices based on tissue doppler and color M-mode echocardiography reflect the left ventricular end-diastolic pressure. These include the early diastolic transmitral velocity (E) to early myocardial velocity ratio measured by tissue doppler (E') and the E to the wave propagation velocity (Vp) ratio measured from color M-mode images. However, these indices have not been well validated in congestive heart failure patients. SUBJECTS AND METHODS:Thirty one congestive heart failure patients who underwent simultaneous cardiac catheterization and echocardiography, and had normal sinus rhythm were enrolled in this study. The left ventricular end-diastolic pressure obtained from the left heart catheterization was compared with the diastolic indices using pulsed doppler, tissue doppler and color M-mode echocardiography. RESULTS: The left ventricular end-diastolic pressure (LVEDP) ranged from 3.3 to 23 mmHg. Some parameters showed a significant correlation with the LVEDP. The propagation velocity showed a significant correlation with the LVEDP (r=0.382, p=0.034), and the E to propagation velocity ratio (E/Vp) showed a good correlation with the LVEDP(r=0.408, p=0.023). In addition, the E to early diastolic velocity of the mitral annulus (E') ratio had an insignificant correlation with the LVEDP(r=0.322, p=0.078). Among the patients with ischemic congestive heart failure, the E to the propagation velocity ratio (E/Vp) showed a marginal correlation with the LVEDP (r=0.461, p=0.047). CONCLUSION: In patients with congestive heart failure, the Vp and E/Vp showed a good correlation with the LVEDP. In the subgroup of patients with ischemic congestive heart failure, only the E/Vp showed a significant correlation with the LVEDP.

The Effects of Diltiazem with Desflurane on Coronary Blood Flow and Contractility in Isolated Rat Heart / 대한마취과학회지

BACKGROUND: Calcium channel blockers and volatile anesthetics have depressant effects on cardiac function. Both groups of drugs appear to exert both qualitatively and quantitatively different effects on electrophys-iologic and mechanical function. The authors examined the direct in-vitro effects of diltiazem in the presence of a desflurane using an isolated rat heart. METHODS: Isolated Sprague-Dawley rat hearts (N = 40) were perfused at a constant pressure with an oxygenated modified Krebs' solution. After the stabilization period, they were subdivided into two groups. The groups were subjected to different concentrations of desflurane (6, 12, 18 vol%) alone or 100 ng/ml diltiazem with the same concentrations of desflurane, respectively. Isovolumetric left ventric ular pressure (LVP), heart rate and rate of change of ventricular pressure (dp/dt) were measured via a thin, saline-filled latex balloon and transducer. Coronary flow and oxygen tension were measured at the coronary inflow and outflow sites. Oxygen delivery, myocardial oxygen consumption and percent oxygen extraction were calculated with each measurement. RESULTS: The combination of diltiazem and desflurane (6, 12 and 18 vol%) dose-dependently depressed LVP and dp/dt more than desflurane alone. Coronary flow and oxygen delivery increased in a dose- dependent fashion, but there was no statistical difference between the groups. The decreases of heart rate, myocardial oxygen consumption and percentage of oxygen extraction were dependent on the concentration of desflurane. Arrhythmias occurred only with a high desflurane (18 vol%) concentration and the high desflurane concentration plus diltiazem. CONCLUSIONS: These results demonstrate that the myocardial depressant effect of diltiazem plus desflurane is greater than desflurane alone. The authors suggest that administration of diltiazem during high concentrations of desflurane anesthesia could result in deleterious cardiac depression and arrhythmias.

Effect of Propofol and Thiopental on the Isolated Stunned Rat Heart / 대한마취과학회지

BACKGROUND: Propofol(2,6-diisopropyl phenol) is an intravenous anesthetic agent, which was first introduced in 1986. It has 178.27 molecular weight and 1.8 fold stronger action of induction than that of thiopental. The effect of propofol, lowering blood pressure by depressing the cardiovascular system, has been mentioned in many papers, but its effect on myocardium is still in controversy and differs according to the method and interpretation of experiments used. This animal experiment was conducted to compare the effects of propofol and thiopental on myocardial contractility and coronary flow in isolated stunned rat hearts. METHOD: The hearts were isolated from twenty-four Sprague-Dawley rats and were perfused with modified Krebs solution. After isolation, the hearts were left in stabilizing period for 30 minutes. Then, myocardial stunning was induced by global ischemia for 15 minutes. In Group I, propofol was added to modified Krebs solution, which was used to perfuse the hearts at 40, 80, 120, 160, and 200micrometer concentration. In Group II, thiopental was added to perfusate at same concentration. Between each perfusion with anesthetic-added solution, the hearts in both groups were perfused with normal Krebs solution for 30 minutes to eliminate cumulative effect of anesthetics added. Left ventricular pressure, rate of ventricular pressure generation(dP/dt), and coronary flow were measured. RESULT: In both groups, anesthetics reduced left ventricular pressure and dP/dt in a dose dependent fashion. These changes were not statistically significant between two groups. However, at the 40 and 80micrometer concentration, the increment of coronary flow by propofol was significantly larger than that by thiopental. At the 120, 160, and 200micrometer concentration of propofol, coronary flow was gradually decreased with increasing concentration, and these decrease in coronary flow were not statistically significant between two groups. CONCLUSION: The effects of propofol on myocardial function were similar to those of thiopental in isolated stunned rat hearts and the increment of coronary flow might develop the coronary stealphenomenon. So, propofol may not have the benefit compare to thiopental for cardiac function.

Exercise tolerance tests in patients with tetralogy of Fallot repaired earlier: correlation with 2-dimensional echocardiography and cardiac catheterization

No abstract available.

Biventricular pressure-volume change in acute pulmonary embolism model / 中国病理生理杂志

AIM: To establish the experimental acute pulmonary embolism(APE) model and observe the left and right ventricular pressure-volume relationship in different overload situations. METHODS: The present study consisted of seven anesthetized mongrel dogs that were divided into the control group, moderate APE group and severe APE group according to the various phase and different pressure load during the experiment. APE model was induced by suture piece injection through right cardiac catheterization. The hemodynamic indexes were measured by the simultaneous cardiac catheterization and echocardiography.RESULTS: (1) In the group with moderate APE, the pressure-volume relationship of right ventricle tended to right-upward shift, the area of chart increased, the shape of chart transformed form triangle to rectangle. The mild parallel leftward shift, the area of chart decreased mildly and no change of chart shape was observed in the pressure-volume relationship of left ventricle. (2) In the group with severe APE, the chart of right ventricular pressure-volume relationship tended to right-upward shift continuously, the area of chart decreased. The chart of the left ventricle tended to left-downward shift and no change of chart shape was observed in the pressure-volume relationship of left ventricle, the area of chart decreased. The erose shape of charts was also found.CONCLUSION: The chart of ventricular pressure-volume relationships is a practical and reliable method to evaluate left and right ventricular hemodynamic in APE.

EFFECTS OF BERBAMINE HCL ON ISOLATED WORKING HEART OF GUINEA PIG / 中国药理学通报

The isolated working heart of guinea pig perfused with Tyrode's solution could work normally for at least 60 min. It was shown that berbamine ( BA ) could depress the function of isolated working heart of guinea pig in dose-dependent manner. BA 3 mol/L could decrease the left ventricular pressure, aortic pressure, -dP/dtmax, aortic blood flow and coronary blood flow, and increase left ventricular end-diastolic pressure. BA 100 mol/L could result in the ventricular asystole, however, no obvious influence the contraction of atrium.It was also demonstrated that BA could antagonise the arrhythmias induced by the adrenaline in isolated working heart of guinea Pig.