Echocardiographic assessment of systolic time intervals in hemodialysis patients with normal ejection fraction

Background: Chronic Kidney Disease (CKD) and Cardiovascular Disease (CVD) have been inextricably linked since the earliest days of hemodialysis. Several statistics accrued since that time attests to the impact of cardiovascular disease in renal patients. Approximately one-half of all deaths in end-stage renal disease patients are attributable to cardiovascular disease, a proportion that is remarkably similar throughout the world. The aim of the study: To Evaluate latent systolic dysfunction and its relation with diastolic dysfunction in hemodialysis patients with normal ejection fraction, using Doppler-derived systolic time intervals. Materials and methods: This retrospective study was conducted in the Department of General Medicine, Government Mohan Kumaramangalam Medical College, Salem in 2017. Patients with systolicand diastolic blood pressures above 140 and 90 mmHg were grouped as hypertensive. According to this classification, 44% of patients were hypertensive. The control group comprised of healthy normotensive persons with no cardiovascular complaints, normal electrocardiogram (ECG) and normal blood chemistries. Results: In our study, 90% of patients with systolic dysfunction had normal IVRT and 84.4% of patients with diastolic dysfunction had normal STI index. However, as in the previous study, the impaired STI index, and prolonged IVRT are independent of the presence of hypertension or left ventricular hypertrophy and IVRT was more sensitive than E/A ratio to diagnose diastolic dysfunction. R. Karthikeyan, V. Ramkumar. Echocardiographic assessment of systolic time intervals in hemodialysis patients with normal ejection fraction. IAIM, 2019; 6(4): 42-48. Page 43 Conclusion: The most common features of uremic cardiomyopathy namely left ventricular hypertrophy, diastolic dysfunction and systolic dysfunction were present in 40%, 24%, and 40% of our hemodialysis patients respectively. The diastolic dysfunction and latent systolic dysfunction (STI>0.4) were randomly distributed. Impaired STI index and prolonged Isovolumetric relaxation time are independent of the presence of hypertension or left ventricular hypertrophy

Clinical characteristics and risk factors of myocardial injury in patients with sepsis / 中华急诊医学杂志

Objective To analyze the clinical characteristics and risk factors of myocardial injury (MI) in patients with sepsis.Methods Totally 160 patients with sepsis in April 2016 to December 2017,divided into the MI group and non-MI group.The clinical data laboratory findings and ultrasonic cardiographic findings were recorded and compared between the two groups.Binary logistic regression analysis was performed to find the independent risk factors of/MI in patients with sepsis.Results Total of 160 patients with sepsis 75 (46.9％) patients developed MI.The MI group had older age and more patients with history of hypertension than the non-MI group (P＜0.05).In patients with sepsis,diastolic dysfunction accounted for 84.1％,systolic dysfunction accounted for 4.3％,and ventricular wall dyskinesia accounted for 17.3％.Compared with the non-MI group,the MI group had more abnormal wall motion (9.6％ vs 25.8％,P=0.012),lower interventricular septal amplitude (0.87±0.16 vs 0.80±0.21,P=0.03) and left ventricular posterior wall amplitude (1.03±0.21 vs 0.96±0.18,P=0.034),and decreased fractional shortening (P=0.033).Binary logistic regression analysis showed that age (RR=1.033,P=0.018) and decreased fractional shortening (RR=0.000,P=0.024) were independent risk factors of MI in patients with sepsis.Conclusions Age and decreased fractional shortening were independent risk factors of myocardial injury in patients with sepsis.

Effect of Kang-Xian Yi-Xin Formula on Cardiac Ultrasonography of Patients with Dilated Cardiomyopathy / 世界科学技术-中医药现代化

This study was aimed to observe the influence of Kang-Xian Y i-Xin (KXYX) formula on the heart size and cardiac function of patients with dilated cardiomyopathy (DCM). A total of 85 cases were randomly divided into the treatment group (43 cases) and the control group (42 cases, with 1 death case). Both groups were treated with routine western medicine. And the KXYX formula was combined in the treatment group once a day. Six months later, changes of the left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAd), ejection fraction (EF) and fractional shortening (FS) were observed by ultrasonography. The results showed that both groups can reduce the LVEDD and Lad. And the effect was obvious in the treatment group (P< 0.05). There was significant difference in the LVEDD of both groups after treatment (P< 0.05). The EF and FS were raised obviously in both groups. There was significant difference before and after treatment in the treatment group (P < 0.01). There was statistical differ-ence between groups after treatment (P< 0.05). It was concluded that the KXYX formula can decrease the LVEDD, Lad, enhance EF and FS, in order to promote the cardiac function of patients with DCM.

The correlation between midwall function and carotid intima-media thickness in hypertensive patients / 대한내과학회지

BACKGROUND/AIMS: In hypertensive patients, LV ejection fraction may be normal or high, thus limiting assessment of prognosis. This has led to a growing body of research using LV midwall fractional shortening (MWS) instead. The current study aims to assess LV midwall function in hypertension patients and to study its correlation with the intima-media thickness (IMT) of the carotid artery. METHODS: Echocardiography and ultrasonography of the carotid artery were conducted to establish a group of hypertension patients without major complications (n=136) and a control group (n=48). LV MWS was determined using two cylindrical models, and the IMT was measured. RESULTS: Compared with normotensive subjects, hypertensive adults exhibited higher LV mass index and lower LV MWS. A statistically significant correlation was found between the LV MWS and the average IMT in hypertension patients (r=-0.41). There was also a significant negative correlation among the maximum IMT (r=-0.40), LV mass index (r=-0.32), age (r=-0.31), and systolic blood pressure (r=-0.22). Regarding the prevalence of plaque in the carotid artery, the stage 1 hypertension group exhibited 16.7% prevalence, and the stage 2 hypertension group 32.9% prevalence, thereby showing far higher figures than the control group's 4.2%. CONCLUSIONS: The LV MWS in hypertension patients underwent a statistically significant decrease, and the correlation between LV MWS and the IMT of the carotid artery was found to be high compared with the general blood pressure index. LV MWS can be used as an indicator to assess the prognosis of hypertension patients.

Follow-up Study of Children with Anthracycline Cardiotoxicity

PURPOSE: We studied the relationship between anthracycline cumulative dose and anthracycline cardiotoxicity in childhood cancer and followed up 40 children with anthracycline cardiotoxicity. METHODS: A retrospective study was performed in 154 children who received anthracycline chemotherapy between January 1995 to December 2000. Cardiotoxicity was defined when the left ventricular fractional shortening(FS) was below 26%; it was divided into two groups, mild and severe cardiotoxicity, according to the FS. We followed up survivors with cardiotoxicity, and checked their present cardiac function by physical activity, echocardiography, electrocardiography(EKG) and chest X-ray. RESULTS: Of the 154 children treated with anthracyclines, forty(26.0%) were diagnosed as cardiotoxicity. The incidence of cardiotoxicity increased in exponential fashion with increases in the cumulative dose of anthracyclines. There was minimal increase of incidence until a dose of 300 mg/m2 after which the incidence increased rapidly. After mean 3.8+/-1.8 year follow-up of 23 survivors with cardiotoxicity, FS increased significantly. EKG and chest X-rays were not helpful for the diagnosis of cardiotoxicity because of their low sensitivity and specificity. CONCLUSION: Although convenient, non-invasive and inexpensive, EKG and chest X-rays were not helpful for the follow-up of anthracycline cardiotoxicity. Almost all survivors with anthracycline cardiotoxicity have improved in both physical activity and echocardiographic findings after discontinuation of anthracyclines.

Prognostic Indices after Mitral Valve Replacement in Patients with Chronic Mitral Regurgitation

Chronic mitral regurgitation may be well tolerated for decades because of favorable conditions like increased preload and decreased afterload. However, in some patients with underlying overt myocardial dysfunction, opertive correction of mitral regurgitation may result in persistent left ventricular dysfunction. Myocardial dysfunction in mitral regurgitation initially occurs subclinically and may becoma irreversible before symptoms of congestive heart failure develop. In order to identify latent myocardial dysfunction, we evaluated prognostic values of several indices from patient's characteristics, echocardiogram, cardiac catheterization data and contrast left ventriculogram in 49 patients with chronic mitral regurgitation who received mitral valve replacement. The patients were defined as Groups I who had improved symptoms with decreased left ventricular end-diastolic dimension after operation and Group II who had persistent symptoms and progressed left ventricular end-diastolic dimension, or not decreased until left ventricular end-diastolic dimension 60mm after operation. The results were as follows: 1) There was no significant difference in age, sex, duration of symptoms, preoperative NYHA functional status, and aortic cross clamping time during operation between Group I and Group II. 2) There was no significant difference in echocardiographic left ventricular end-diastolic dimension between group I and group II. There were significantly more dilated left ventricular end-diastolic dimension of Group II than that of Group I and significantly more depressed fractional shortening of Group II than that of Group I. There was significantly more increased end-diastolic wall stress of Group II than of Group I. 3) There was no significant difference in cardiac index, mean pulmonary artery pressure, mean pulmonary capillary wedge pressure and left ventricular end-diastoic pressure between Group I and Group II. 4) There were significantly more increased end-diastolic volume index and end-diastolic volum index of Group II than those of Group I, but no significant difference in ejection fraction between Group I and Group II. There was significantly more decreased ratio of end-diastolic circumferential midwall stress to end-diastolic volume index of Group II than that of Group I. 5) In Group I, end-systolic dimension, end-systolic dimension and end-systolic wall stress were decreased significantly after operation. In Group II, end-systolic dimension was decreased significantly after operation. 6) Values for combination of end-systolic left ventricular dimension greater than 28mm/m2 and end-systolic wall stress greater than 190mmHg predicted a Group II outcome with a sensitivity of 88.2%, a specificity of 93.8%, positive predictive value of 88.2% and negative predictive value of 93.8%. Values of combination of end-systolic left ventricular dimension greater than 28mm/m2 and fractional shortening less than 32% predicted a Group II outcome with a sensitivity of 88.2% a specificity of 90.6%, positive predictive value of 83.3% and negative predictive value of 93.5%, a specificity of 90.6%, positive predictive valve of 83.3% and negative predictive value of 93.5%. According to the above results, noninvasive hemodynamic variables such as end-systolic left ventricular dimension, fractional shortening and end-systolic wall stress would be useful guideline for follow-up and determining the optimal time for surgical intervention in patients with chronic mitral regurgitation.

Echocardiographic study of left ventricular function in infants and children

The Echocardiography is a useful non-invasive diagnostic tool for cardiac evaluation without known risk, and its application in the diagnosis and management of congenital heart disease in infants and children has become indispensable. Especially left ventricular echocardiogram appears to be a effective technique for determination of left ventricular dimensions and volume, other echocardiographic index of left ventricular function. There are numerous echocardiographic studies for normal and abnormal heart of adult, but few in Korean infants and children. Echocardiographic studies were performed on 103 normal infants and children to obtain the normal value of stroke volume, cardiac index, ejection fraction, cardiac out put, percent of fractional shortening which were related to left ventricular function. The result obtained were as follows: 1) Normal mean stroke volume was 39.2314.49ml. 2) Normal mean cardiac index was 4.111.20L/min./m2. 3) Normal mean ejection fraction was 69.4411.31%. 4) Normal mean cardiac output was 3.481.10L. 5) Normal mean percent of fractional shortening was 38.908.07%. The normal values of stroke volume, cardiac output were increased by aging,but no significant differences were found in cardiac index, ejection fraction, percent of fractional shortening.