Impact of Early and Regular Mobilization on Vital Signs and Oxygen Saturation in Patients Undergoing Open-Heart Surgery

Abstract Introduction: This quasi-experimental study aimed to evaluate the impact of early and regular mobilization on vital signs and oxygen saturation in open-heart surgery patients. Methods: The study universe comprised patients undergoing open-heart surgery in the cardiovascular intensive care unit of a heart center. The study sample consisted of patients who underwent open-heart surgery from November 2016 to April 2017, met the inclusion criteria, and voluntarily agreed to participate in the study. The study included 75 patients. Of these, 67 completed the mobilization program in two days, starting on the first postoperative day. Each patient was mobilized three times: twice on the first postoperative day and once on the second postoperative day. Vital signs and oxygen saturation for each patient were measured 10 minutes before and 20 minutes after each mobilization. Results: The difference between pulse and systolic blood pressure values measured before and after the first mobilization was statistically significant (P<0.05). In addition, the difference between the mean systolic blood pressure values before the first mobilization and after the third mobilization (123.43±14.09 mmHg and 117.94±14.05 mmHg, respectively) was statistically significant (P<0.05). The other parameters measured in relation to the mobilizations were in the normal range. Conclusion: Early and frequent mobilization did not cause vital signs and oxygen saturation to deviate from normal limits in open-heart surgery patients.

Congenital supravalvar mitral ring - a case report

Abstract Congenital mitral valve stenosis is a rare and severe disease, usually associated with other heart defects. The appropriate intervention depends on the site and mechanism of valvular obstruction and the aim is to avoid or delay valve replacement since it is associated with significant morbidity and mortality. Early single-stage complete repair is associated with better prognosis. We report the case of a 20-month-old child with a supravalvar mitral ring combined with a ventricular septal defect; pulmonary arterial systolic pressure before the surgery was 79 mmHg. The patient underwent a successful surgical repair with good clinical resolution.

Functional magnetic resonance imaging in the evaluation of the elastic properties of ascending aortic aneurysm

Abstract Objective: To evaluate the aortic wall elasticity using the maximal rate of systolic distension (MRSD) and maximal rate of diastolic recoil (MRDR) and their correlation with the aortic size index (ASI). Methods: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient's age was performed using regression plot. Results: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient's age and the decrease in MRSD and MRDR is observed. Conclusion: MRSD and MRDR are significantly correlated with ASI and the patient's age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta.

Age-wise Variations in the Dimensions of Left atrium and left ventricle in 100 apparently healthy individuals

Introduction: The study on the measurements of the chambers of the heart is very important, which gives details of anatomy, physiology and also pathological conditions of the heart. This knowledge also helps in diagnosis, treatment and follow-up of cardiovascular diseases. Materials & methods: The present study was conducted on 100 apparently normal people attending Out-patient and In-patient sections in Cardiology Department at Osmania General Hospital and CARE hospitals, Hyderabad from October 2012 to September 2013. Results & conclusion: In the present study it was found that the dimensions of left atrium and left ventricle increased with increase in age, which falls in line with previous studies performed on the same criteria.

Relationship of inter-arm systolic blood pressure difference with subclavian artery stenosis and vertebral artery stenosis in patients undergoing carotid endarterectomy

Abstract Introduction: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.

Quantitative assessment of systolic and diastolic right ventricular function by echocardiography and speckle-tracking imaging: a prospective study in 104 dogs

Our aim was (1) to determine the within-day and between-day variability of several indices of systolic and diastolic right ventricular (RV) function by using conventional echocardiography and speckle-tracking echocardiography (STE) (Study 1), (2) to quantify these variables in a large healthy canine population (n = 104) with Doppler-derived estimated systolic pulmonary arterial pressure (SPAP) and left ventricular (LV) function, and (3) to establish the corresponding reference intervals (Study 2). For both studies, RV variables included tricuspid annular plane systolic excursion (TAPSE), right fractional area change (RFAC), STE longitudinal systolic strain (StS) of the RV free wall (RVFW) and of the entire RV (i.e., global RV StS), STE longitudinal systolic RVFW strain rate (SRS), and the diastolic early:late strain rate ratio. All but one within- and between-day coefficients of variation (13/14) were < 15%, the lowest being observed for TAPSE (3.6–9.8%), global RV StS (3.8–9.9%), and RVFW StS (3.7–7.3%). SPAP was weakly and negatively correlated with the TAPSE:body weight ratio (r(s) = −0.26, p = 0.01) and RVFW SRS (r(s) = −0.23, p < 0.05). Reference intervals (lower and upper limits with 90% confidence intervals) were provided for all variables. STE provides a non-invasive evaluation of RV function that may be used for clinical investigations in canine cardiology.

Relationship between left ventricular volume parameters and cardiac function in elderly patients with heart failure / 中国综合临床

Objective To explore the relationship between left ventricular volume parameters and cardiac function in elderly patients with heart failure. Methods From January 1st, 2012 to December 31st, 2014,five hundred and twenty-eight heart failure elderly patients with coronary heart disease,hypertension,heart valve disease, dilated cardiomyopathy, and hypertrophic cardiomyopathy in Kailuan General Hospital were collected in this study. The left ventricle diastolic end volume ( LVEDV ) , left ventricle end systolic volume ( LVESV) and left ventricular ejection fraction of the patients were measured. The concentrations of N type brain natriuretic peptide ( NT-proBNP ) and related biochemical indexes were detected. Results Among the 528 patients with cardiac insufficiency,367 were males and 161 were females. Among them,there were 199 cases of heart function I,163 cases of heart function II,99 cases of heart function III and 67 cases of heart function IV. Correlation analysis showed that the correlation coefficients of LVEDV, LVESV and age were 0. 431 ( P=0. 001) ,0. 472 ( P=0. 001 ) and 0. 243 ( P<0. 001 ) , respectively. Logistic regression analysis showed that LVEDV ( OR=2. 654, 95%CI 2. 124-3. 894, P=0. 004 ) , LVESV ( OR=2. 939, 95%CI 2. 539-3. 256, P=0. 001),LVESV),NT-proBNP (OR=2. 921,95%CI 2. 888-3. 562,P=0. 002) were risk factors for heart failure. Conclusion The correlation between LVESV and cardiac function in elderly patients with heart failure is better than that in LVEDV,and the correlation between the two and cardiac function is better than that of age.

Outcomes of Left Ventricular Function According to Treatment Response for a Patent Ductus Arteriosus in Preterm Infants

BACKGROUND: To evaluate the outcomes of left ventricular (LV) function according to treatment response for a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. METHODS: Echocardiograms of 21 preterm infants born at gestational age < 31 weeks obtained at term-equivalent age were retrospectively studied. Among preterm infants with a hsPDA, 9 underwent ligation after failure of pharmacological closure (ligation group) and 6 experienced successful pharmacological closure (medication group). Six preterm infants without hsPDA (no-hsPDA group) were studied as controls. LV peak longitudinal systolic strain (ε) of each infant was retrospectively obtained from echocardiograms using velocity vector imaging, along with neonatal outcomes. RESULTS: Pharmacological closures were attempted at postnatal day 2–3. In the ligation group, the median postnatal age at ligation was 20 days. In the ligation group, LV peak longitudinal systolic ε was significantly decreased at term-equivalent age compared to the other groups. Between the medication and no-hsPDA groups, LV peak longitudinal systolic ε did not differ significantly. Among the neonatal outcomes, infants who experienced necrotizing enterocolitis (NEC) showed significantly decreased LV peak longitudinal systolic ε compared to the infants who did not experience NEC . CONCLUSION: We speculate that in preterm infants with an hsPDA, in cases of medical treatment failure, early PDA ligation at less than 20 days of postnatal age would be beneficial for preserving LV systolic function.

Systolic and Diastolic Ratio and Rate Pressure Product in Anemia.

Anemia, a common clinical entity is associated with hyperdynamic circulation and may be involved in etiopathology of heart failure. So, the current study was carried out in 30 patients in the age group 20-40 years with hemoglobin level < 6 g/dl and of at least three month duration of anemia (using WHO definition) and compared with 30 age- and sex-matched healthy subjects. Duration of systole and diastole was estimated by recording of electrocardiogram, apex-cardiogram and phonocardiogram on polyrite with the paper speed of 50 mm/sec. Duration of cardiac cycle was reduced (18.22%) and heart rate was increased (p < 0.001) in anemia compared to controls. On comparison of duration of systole and diastole, there was more decrement in diastole (26.76%, p < 0.001) compare to systole (6.45%, p < 0.01) in anemia versus healthy subjects. Similarly, when fraction occupied by systole and diastole in cardiac cycle were compared, the systolic fraction was increased, diastolic fraction in cardiac cycle was reduced and systole/diastole ratio was increased (p < 0.001) in anemics compared to controls. Rate pressure product and double product were elevated (p < 0.001) in anemia versus controls, imposing mechanical load on heart. So, it is concluded that patients of severe anemia are at the brink of heart failure and should be treated promptly.

Métodos não-lineares para avaliar mudanças na variabilidade da frequência cardíaca em pacientes com diabetes tipo 2 / Nonlinear methods to assess changes in heart rate variability in type 2 diabetic patients

FUNDAMENTO: A variabilidade da frequência cardíaca (VFC) é um importante indicador da modulação autonômica da função cardiovascular. A diabetes pode alterar a modulação autonômica danificando as entradas aferentes, dessa forma aumentando o risco de doenças cardiovasculares. Foram aplicados métodos analíticos não lineares para identificar os parâmetros associados com VFC indicativos de alterações na modulação autonômica da função cardíaca em pacientes diabéticos. OBJETIVO: Analisamos as diferenças nos padrões da VFC entre pacientes diabéticos e controles saudáveis pareados por idade, utilizando métodos não-lineares. MÉTODOS: Plot de Poincaré Lagged, autocorrelação e análise de flutuação destendenciada foram aplicados para analisar a VFC em registros de eletrocardiograma (ECG). RESULTADOS: A análise do gráfico de Poincaré lagged revelou alterações significativas em alguns parâmetros, sugestivas de diminuição da modulação parassimpática. O expoente de flutuação destendencionada derivado de um ajuste em longo prazo foi maior que o expoente em curto prazo na população diabética, o que também foi consistente com a diminuição do input parassimpático. A função de autocorrelação do desvio dos intervalos inter-batimento exibiu um padrão altamente correlacionado no grupo de diabéticos em comparação com o grupo controle. CONCLUSÃO: O padrão de VFC difere significativamente entre pacientes diabéticos e indivíduos saudáveis. Os três métodos estatísticos utilizados no estudo podem ser úteis para detectar o início e a extensão da neuropatia autonômica em pacientes diabéticos.

BACKGROUND: Heart rate variability (HRV) is an important indicator of autonomic modulation of cardiovascular function. Diabetes can alter cardiac autonomic modulation by damaging afferent inputs, thereby increasing the risk of cardiovascular disease. We applied nonlinear analytical methods to identify parameters associated with HRV that are indicative of changes in autonomic modulation of heart function in diabetic patients. OBJECTIVE: We analyzed differences in HRV patterns between diabetic and age-matched healthy control subjects using nonlinear methods. METHODS: Methods: Lagged Poincaré plot, autocorrelation, and detrended fluctuation analysis were applied to analyze HRV in electrocardiography (ECG) recordings. RESULTS: Lagged Poincaré plot analysis revealed a decrease in the standard deviation of instantaneous beat-to-beat interval variability (SD1) and in the ratio of SD1 to the continuous long-term R-R interval variability (SD12) in the diabetic group, indicating a decrease in heart rate parasympathetic modulation. The detrended fluctuation exponent derived from long-term fitting was higher than the short-term one in the diabetic population, which was also consistent with decreased parasympathetic input. The autocorrelation function of the deviation of inter-beat intervals exhibited a highly correlated pattern in the diabetic group compared with the control group. CONCLUSIONS: The HRV pattern significantly differs between diabetic patients and healthy subjects. All three statistical methods employed in the study may prove useful to detect the onset and extent of autonomic neuropathy in diabetic patients.

Disfunção diastólica e sua importância para o anestesiologista / Diastolic dysfunction and its importance to the anesthesiologist

O objetivo deste artigo é fazer uma revisão das alterações fisiopatológicas da disfunção diastólica (DD), além de indicar as causas que originam esta doença, mostrar a importância de se conhecerem as interações dos agentes anestésicos e as repercussões das alterações hemodinâmicas nos pacientes portadores de DD...

The aim of this paper is to review the pathophysiological changes of diastolic dysfunction (DD), besides pointing out the causes of this disease, showing the importance of knowing the interactions of anesthetics and the effects of hemodynamic changes in patients with DD...

Evaluación de resultados quirúrgicos de la miectomía como tratamiento de la miocardiopatía hipertrófica obstructiva: experiencia de un centro en Uruguay / Evaluation of surgical results of myectomy in the treatment of hypertrophic obstructive cardiomyopathy: experience of a single center in Uruguay

Introducción: la miectomía quirúrgica del septum interventricular es el gold standard en el tratamiento de la miocardiopatía hipertrófica (MH) que requiere cirugía para alivio sintomático. No se encontró publicada ninguna serie de pacientes tratados mediante miectomía en Uruguay, lo que motivó analizar una serie de nuestro centro, valorando variables para su comparación con series de referencia. Material y método: se incluyeron todos los pacientes con miectomía entre enero de 2001 y enero de 2008. Se consignaron variables demográficas, ecocardiográficas y sobrevida a los 18 y 72 meses. Resultados: se incluyeron 23 pacientes, 14 mujeres. Edad promedio 59 años. Siete presentaban familiar de primer grado con MH. Seis presentaban lesiones coronarias significativas. El promedio del gradiente intraventricular máximo fue 96,32 mmHg, SIVD 21,4 mm y FEVI 66%. 17 tenían SAM, y de ellos, 15 presentaban insuficiencia mitral severa. En el preoperatorio, 14 presentaban CF NYHA III y nueve CF IV; 20 recibieron algún procedimiento asociado. La mortalidad operatoria fue de 8,7% (dos pacientes). El gradiente máximo postoperatorio promedio fue 12 mmHg, SIVD 16,65 mm y FEVI 64%. A los 18 meses, 20 estaban vivos y en CF I. La sobrevida actuarial a seis años fue 76,7%. Conclusiones: en 20 de los 23 pacientes se asoció otro procedimiento, mayormente sustitución valvular mitral. La miectomía redujo significativamente los gradientes intraventriculares, el espesor del SIVD y los síntomas en todos los pacientes (p < 0,0001). La mortalidad operatoria fue de 8,7% (dos pacientes) y la sobrevida actuarial a seis años de 76,7%. Estos resultados se equiparan a series de referencia.

Introduction: surgical septum myectomy remains the gold standard for the treatment of obstructive hypertrophic cardiomyopathy requiring surgery forsymptomatic relief. Wasn’t found in the literature, any series of patients underwent myectomy in Uruguay.Our objetive was the analysis of our center series, assessing variables for comparison with reference series.Materials and methods: were included all patients with myectomy from january 2001 to 2008. Demographicsand ultrasonographics variables, and survival at 18 and 72 months were consignated. Results: Were included 23 patients, 14 women. Mean age 59 years. Seven with a first grade relativeaffected of hypertrophic cardiomyopathy (HM). Six with coronary lessions. The mean maximum intraventricular gradient was 96,32 mmHg, dyastolic interventricular septum wide 21,4 mm, EF 66%. 17with systolic anterior motion, 15 with severe mitral insufficience. Before surgery, 14 shows NYHA functionalclass (FC) III, and 9 FCIV. 20 with one additional surgical procedure. Operative mortality was 8,7% (two patients). The mean maximum intraventriculargradient after surgery was 12 mmHg, dyastolic interventricular septum wide 16,65mmand EF 64%. At 18 months, survival was 20 patients, all in FC I. Actuarial survival at 6 years was 76,7%. Conclussions: 20 of 23 patients with an additional procedure, mainly mitral valve substitution. Myectomyimproved intraventricular gradients, DIVS wide and symptoms in all patients (p<0,0001). Operative mortality was 8,7% (two patients), and actuarialsurvival at 6 years was 76,7%. This results are comparable with reference series.

Carga vascular y valvular en la estenosis aórtica grave con bajo flujo, bajo gradiente y fracción de eyección normal / Vascular and Valvular Load in Low-Flow/Low-Gradient Severe Aortic Stenosis and Normal Ejection Fraction

Introducción Algunos pacientes con estenosis aórtica (EAo) pueden presentar disminución del volumen sistólico (VS) y gradientes bajos a pesar de tener una fracción de eyección (Fey) normal. La disminución del área valvular aórtica (AVA) y el aumento de la carga vascular contribuyen a la disminución del VS. Objetivo Analizar la carga vascular y valvular en la EAo grave con bajo flujo, bajo gradiente y Fey normal. Material y métodos Se estudiaron 53 pacientes (70 ± 12 años) con EAo grave (AVA < 1 cm²) y Fey ≥ 50%. La carga valvular se estimó por medio del AVA y del índice de pérdida de energía (IPE). La carga vascular se evaluó mediante la elastancia arterial efectiva (Ea) y la resistencia vascular sistémica (RVS). La impedancia valvuloarterial (Zva) se calculó como una estimación de la poscarga global del VI. La Ea se calculó dividiendo la presión de fin de sístole por el VS. La presión de fin de sístole se obtuvo por tonometría. La Zva se calculó como: (presión sistólica + gradiente medio neto) / índice de VS. Los pacientes se dividieron en dos grupos según si tenían flujo normal (FN) (n = 35), definido como índice de VS > 35 ml/m², o bajo flujo (BF) (n = 18), con índice de VS ≤ 35 ml/m². Resultados Comparados con el grupo FN, los pacientes con BF tuvieron menor AVA (0,59 ± 0,18 versus 0,76 ± 0,22 cm²; p < 0,01), gradiente medio (28 ± 5 versus 45 ± 4 mm Hg; p < 0,01) e IPE (0,35 ± 0,13 versus 0,47 ± 0,16 cm²/m²; p < 0,01). Con respecto a la carga vascular, los pacientes con BF tuvieron mayor Ea (1,91 ± 0,42 versus 1,24 ± 0,33 mm Hg/ml; p < 0,00001), RVS (2.119 ± 506 versus 1.625 ± 443 mm Hg • min/L; p < 0,001) y poscarga global evaluada mediante Zva (5,45 ± 1,39 versus 3,95 ± 1,10 mm Hg/ml/m²; p < 0,001). En el análisis univariado, el VS se correlacionó con la Ea (r = -0,87, p < 0,0001), la RVS (r = -0,73, p < 0,0001) y la Zva (r = -0,71, p < 0,0001). En el análisis multivariado, la Ea fue el único predictor independiente de VS disminuido. Conclusiones En pacientes con EAo grave, la fisiopatología del BF parece estar relacionada con un aumento significativo de la carga vascular.

Background Some patients with aortic stenosis (AS) may present reduced stroke volume (SV) and low transvalvular gradients despite normal ejection fraction (EF). The reduction in the aortic valve area (AVA) and the increase in the vascular load contribute to decrease the SV. Objective To analyze the vascular and valvular load in low-flow/lowgradient severe aortic stenosis and normal ejection fraction. Material and Methods A total of 53 patients (70±12 years) with severe AS (AVA <1 cm²) and EF ≥50% were studied. Valvular load was estimated using the AVA and the energy loss index (ELI). Vascular load was evaluated by means of the effective arterial elastance (Ea) and systemic vascular resistance (SVR). Valvulo-arterial impedance (Zva) was calculated as an estimation of global left ventricular (LV) afterload. Ea was estimated as the ratio between end-systolic pressure and SV. End-systolic pressure was obtained by tonometry. Zva was calculated as: (systolic arterial pressure + mean net pressure gradient) / SV index. Patients were divided in two groups: normal flow (NF) (n=35), defined as a SV index >35 ml/m², or low flow (LF) (n=18), with a SV index ≤35 ml/m². Results Compared to NF patients, LF patients had lower AVA (0.59±0.18 versus 0.76±0.22 cm²; p<0.01), mean pressure gradient (28±5 versus 45±4 mm Hg; p<0.01) and ELI (0.35±0.13 versus 0.47±0.16 cm²/m²; p<0.01). Vascular load was greater in LF patients than in NF patients, with higher values of Ea (1.91±0.42 versus 1.24±0.33 mm Hg/ml; p<0.00001), SVR (2.119±506 versus 1.625 ± 443 mm Hg • min/L; p<0.001) and global afterload measured by Zva (5.45±1.39 versus 3.95±1.10 mm Hg/ml/m²; p<0.001). At univariate analysis, SV correlated with Ea (r= -0.87, p<0.0001), SVR (r= -0.73, p<0.0001) and Zva (r= -0.71, p<0.0001). Ea was the only independent predictor of reduced SV at multivariate analysis. Conclusions In patients with severe AS, the physiopathology of LF seems to be related to a significant increase in the vascular load.

Quantitative analysis of left ventricular systolic strain and strain rate in hypertrophic cardiomyopathy patients by velocity vector imaging / 第二军医大学学报

Objective: To observe the changes of left ventricular (LV) systolic strain(e) and strain rate(SR) in patients with hypertrophic cardiomyopathy (HCM) and normal healthy subjects by velocity vector imaging(VVI). Methods: Twenty patients with HCM and 20 age-matched healthy adults were enrolled in this study. The peak systolic ε, SR of 18 segments in the 4,3 and 2-chamber views were measured by VVI. Results: It was found that the systolic SR was (- 1.06±0.09)/s in the healthy control group and (- 0.74±0.16)/s in the HCM group(P

Normal Ranges and Physiological Changes of Midwall Fractional Shortening in Healthy Korean Population

BACKGROUND AND OBJECTIVES: Left ventricular (LV) midwall fractional shortening (FSmw) reflects systolic function more accurately than LV endocardial fractional shortening (eFS) in patients with increased LV wall thickness. Although the normal reference ranges of LV-FSmw have been suggested in Western population studies, its reference values and age-related physiological changes in Eastern populations remain unknown. SUBJECTS AND METHODS: Conventional echocardiographic parameters, LV-FSmw, and stress-corrected LV-FSmw were assessed in 160 healthy and clinically normal subjects with a mean age of 45 (range, 11-72 years; 104 males, 56 women), all of whom were confirmed to be free of disease, based on laboratory investigations, clinical and physical examination findings and computed tomographic coronary angiographic examinations. RESULTS: LV-FSmw was higher in women compared to men. However, the differences were without statistical significance (18.2+/-1.5% for male gender and 19.4+/-2.5% for female gender, p=0.07). In contrast to LV-eFS that progressively increased with age (p=0.001), LV-FSmw and stress-corrected LV-FSmw was not influenced by changes in age (p=0.88 and 0.29, respectively). The results remained unchanged when analyses were performed adjusting for gender. CONCLUSION: The results of this study provide normal reference values for LV-FSmw and stress-corrected LV-FSmw and their natural physiological changes with advancing age. These measures can be used as reference standards for research on LV systolic function in the setting of pressure or volume overload.

Evaluation of left ventricular global systolic function with two-dimensional speckle tracking of mitral annular displacement / 中国医学影像技术

Objective To investigate the preliminary value of mitral annular displacement (MAD) with two-dimensional speckle tracking in evaluating left ventricular systolic function. Methods Forty-nine patients with dilated cardiomyopathy, aged 51±14 years (DCM group), and 43 age-matched (46±14 years) normal subjects (control group) were enrolled in this study. Two-dimensional and real-time three-dimensional (RT3D) imaging were obtained all at the apical four-chamber view. The parameters of MAD and RT3D-LVEF were obtained using off-line QLAB software. Results Compared with control group, MAD reduced significantly in DCM group (P＜0.01). The parameters of MAD correlated positively with LVEF (P＜0.01). The intra- and inter-observer variabilities for measurement of MAD were low. When one point was placed at the chest wall, the ratio of long axis shortening correlated best with LVEF among all the data of MAD. Conclusion Based on two-dimensional speckle tracking imaging, MAD is a rapid and reproducible method of determining LV global systolic function, may even replace LVEF in the future.

Insuficiência cardíaca com fração de ejeção normal: novos critérios diagnósticos e avanços fisiopatológicos / Insuficiencia cardiaca con fracción de eyección normal: nuevos criterios diagnósticos y avances fisiopatológicos / Heart failure with normal ejection fraction: new diagnostic criteria and pathophysiological advances

A insuficiência cardíaca (IC) é uma complexa síndrome cardiovascular com elevada prevalência, sendo que seu quadro clínico frequentemente é associado à dilatação do ventrículo, à diminuição da contratilidade e à reduzida fração de ejeção do ventrículo esquerdo (FE). Porém, nas últimas duas décadas, estudos têm mostrado que muitos pacientes com sintomas e sinais de IC apresentam FE normal (maior que 50 por cento). A grande dificuldade dos médicos estaria na identificação desses pacientes que apresentam insuficiência cardíaca com fração de ejeção normal (ICFEN). Esta dificuldade parece estar relacionada principalmente a alta complexidade da síndrome e a falta de um método padrão para confirmar ou excluir o diagnóstico, que pudesse ser utilizado rotineiramente na prática clínica. Diferentemente da insuficiência cardíaca com fração de ejeção reduzida (ICFER), em que um único parâmetro - a FE menor que 50 por cento - confirma o diagnóstico da síndrome, na ICFEN diferentes índices diastólicos têm sido empregados para caracterizar a presença ou não da disfunção diastólica (DD). Esta revisão tem o propósito de mostrar novos conceitos relacionados à função diastólica que irão auxiliar no entendimento da fisiopatologia cardiovascular presente na ICFEN. O presente trabalho tem também o objetivo de discutir a nova diretriz da Sociedade Européia de Cardiologia para o diagnóstico e exclusão da ICFEN, baseada nos índices de função cardíaca obtidos pelo ecocardiograma com Doppler tecidual (EDT) e na dosagem do peptídeo natriurético.

Heart failure (HF) is a highly prevalent complex cardiovascular syndrome, and its clinical presentation is usually associated with ventricular dilatation, decreased contractility and reduced left ventricular ejection fraction (EF). However, in the past two decades studies have demonstrated that many patients with signs and symptoms of HF have normal EF (higher than 50 percent). The great challenge for doctors lies in the identification of patients presenting heart failure with normal ejection fraction (HFNEF) and this challenge seems to be mainly related to the high complexity of the syndrome and to the lack of a standardized method to confirm or exclude the diagnosis that could be used in the daily clinical practice. Unlike in heart failure with reduced ejection fraction (HFREF) in which one single parameter - EF lower than 50 percent, is sufficient to confirm the diagnosis of the syndrome, in HFNEF different diastolic indexes have been used to characterize the presence or absence of diastolic dysfunction (DD). The purpose of this review is to show new concepts related to the diastolic function that will help understand the cardiovascular pathophysiology of HFNEF, and to discuss the new guideline of the European Society of Cardiology for the diagnosis and exclusion of HFNEF based on cardiac function indices obtained using tissue Doppler imaging (TDI) and natriuretic peptide determination.

La insuficiencia cardiaca (IC) es un complejo síndrome cardiovascular con elevada prevalencia, y su cuadro clínico se asocia frecuentemente a la dilatación del ventrículo, la disminución de la contractilidad y la reducida fracción de eyección del ventrículo izquierdo (FE). Sin embargo, en las últimas dos décadas, estudios han evidenciado que muchos pacientes con síntomas y señales de IC presentan FE normal (mayor que el 50 por ciento). La gran dificultad de los médicos estaría en la identificación de esos pacientes que presentan insuficiencia cardiaca con fracción de eyección normal (ICFEN). Esta dificultad parece estar relacionada principalmente a alta complejidad del síndrome y la falta de un método estándar para que se confirme o excluya el diagnóstico que pudiera utilizarse rutinariamente en la práctica clínica. Diferentemente de la insuficiencia cardiaca con fracción de eyección reducida (ICFER), en la que un único parámetro - la FE menor que el 50 por ciento- confirma el diagnóstico del síndrome, en la ICFEN diferentes índices diastólicos se han empleado para que se caracterice la presencia o no de la disfunción diastólica (DD). Esta revisión tiene el propósito de revelar nuevos conceptos relacionados a la función diastólica que auxiliarán la comprensión de la fisiopatología cardiovascular presente en la ICFEN. El presente trabajo tiene también por objeto que se discuta la nueva directriz de la Sociedad Europea de Cardiología para el diagnóstico y exclusión de la ICFEN, basada en los índices de función cardiaca obtenidos por el ecocardiograma con Doppler tisular (EDT) y en la dosificación del péptido natriurético.

Índice de dissincronia ventricular: comparação com a fração de ejeção bidimensional e tridimensional / Ventricular dyssynchrony index: comparison with two-dimensional and three-dimensional ejection fraction

FUNDAMENTO: O acoplamento eletromecânico (sincronia) do ventrículo esquerdo (VE) tem importância na análise da performance sistólica, especialmente para a indicação da terapia de ressincronização cardíaca em pacientes com ICC avançada. OBJETIVO: Comparar a sincronia do VE analisada com ecocardiograma (eco) tridimensional (3D) em tempo real com medidas de FEVE obtidas com ECO 2D e 3D. MÉTODOS: Estudo prospectivo de 92 indivíduos (56 homens, 47±10 anos), 60 com anatomia cardíaca (eco) e ECG normais (Grupo N), 32 com cardiomiopatia dilatada (Grupo CMD). Com o emprego do ECO 3D foram aferidos FEVE, volumes e índice de dissincronia (ID) por cento para 16 segmentos do VE; com o ECO 2D foram medidos FEVE (método de Simpson) e volumes sistólico e diastólico do VE. Análise estatística: coeficiente de correlação (Pearson), 95 por cento IC, teste de regressão linear, teste de Bland & Altman, p<0,05. RESULTADOS: O ID por cento variou de 0,2900 a 28,1000 (5,2014±6,3281), a FEVE 3D variou de 0,17 a 0,81 (0,52±0,17); a FEVE 2D variou de 0,3 a 0,69 (0,49±0,11). A correlação entre ID e FEVE 3D foi (r): -0,7432, p<0,0001, IC: -0,8227 a -0,6350, a relação linear entre ID (x) e FEVE 3D (y) foi y = 19,8124 + (-27,9578) x , p<0,0001. A correlação entre ID e FEVE 2D foi (r): -0,7012, p<0,0001, IC: -0,7923 a -0,5797. CONCLUSÃO: Nesta casuística foi observada boa correlação negativa entre o acoplamento sistólico tridimensional eletromecânico do VE e a FEVE medida ao ecocardiograma (3D e 2D).

BACKGORUND: Left ventricular (LV) electromechanical coupling (synchrony) is important in the analysis of the systolic performance, especially for the indication of cardiac resynchronization therapy in patients with advanced CHF. OBJECTIVE: To compare LV synchrony as analyzed by real-time three-dimensional (3D) echocardiography (ECHO) with LVEF measurements as obtained with 2D and 3D ECHO. METHODS: Prospective study of 92 individuals (56 men, 47 ± 10 years of age), of which 60 had normal heart structure (ECHO) and ECG (N group), and 32 had dilated cardiomyopathy (DCM group). Using 3D ECHO, LVEF, volumes and dyssynchrony index ( percentDI) for 16 LV segments were measured. Using 2D ECHO, LVEF (Simpson's method), and LV systolic and diastolic volumes were measured. Statistical analysis: Pearson's correlation coefficient, 95 percent CI, linear regression model, Bland & Altman analysis, p<0.05. RESULTS: percentDI ranged from 0.2900 to 28.1000 (5.2014±6.3281), 3D LVEF ranged from 0.17 to 0.81 (0.52±0.17); and 2D LVEF ranged from 0.3 to 0.69 (0.49±0.11). The correlation between DI and 3D LVEF was (r): -0.7432, p<0.0001, CI: -0.8227 to -0.6350, the linear relation between DI (x) and 3D LVEF (y) was y = 19.8124 + (-27.9578) x, p<0.0001. The correlation between DI and 2D LVEF was (r): -0.7012, p<0.0001, CI: -0.7923 to -0.5797. CONCLUSION: In this case series, a good negative correlation was observed between LV electromechanical three-dimensional systolic coupling and LVEF as measured by echocardiography (3D and 2D).