Cardiac function associated with home ventilator care in Duchenne muscular dystrophy / 소아과

PURPOSE: Cardiomyopathy is becoming the leading cause of death in patients with Duchenne muscular dystrophy because mechanically assisted lung ventilation and assisted coughing have helped resolve respiratory complications. To clarify cardiopulmonary function, we compared cardiac function between the home ventilator-assisted and non-ventilator-assisted groups. METHODS: We retrospectively reviewed patients with Duchenne muscular dystrophy from January 2010 to March 2016 at Gangnam Severance Hospital. Demographic characteristics, pulmonary function, and echocardiography data were investigated. RESULTS: Fifty-four patients with Duchenne muscular dystrophy were divided into 2 groups: home ventilator-assisted and non-ventilator-assisted. The patients in the home ventilator group were older (16.25±1.85 years) than those in the nonventilator group (14.73±1.36 years) (P=0.001). Height, weight, and body surface area did not differ significantly between groups. The home ventilator group had a lower seated functional vital capacity (1,038±620.41 mL) than the nonventilator group (1,455±603.12 mL). Mean left ventricular ejection fraction and fractional shortening were greater in the home ventilator group, but the data did not show any statistical difference. The early ventricular filling velocity/late ventricular filling velocity ratio (1.7±0.44) was lower in the home ventilator group than in the nonventilator group (2.02±0.62). The mitral valve annular systolic velocity was higher in the home ventilator group (estimated β, 1.06; standard error, 0.48). Patients with Duchenne muscular dystrophy on a ventilator may have better systolic and diastolic cardiac functions. CONCLUSION: Noninvasive ventilator assistance can help preserve cardiac function. Therefore, early utilization of noninvasive ventilation or oxygen may positively influence cardiac function in patients with Duchenne muscular dystrophy.

Ventricular Synchronicity Study in Patients of Idiopathic Pulmonary Arterial Hypertension With Different Heart Function by Echocardiography / 中国循环杂志

Objective:To preliminarily study the characteristics of ventricular synchronicity in patients of idiopathic pulmonary arterial hypertension (IPAH) with different heart function. Methods:Our research included in 2 groups:IPAH group, n=40 patients intermittently collected in our hospital from 2010-10 to 2014-12 and Control group, n=23 normal subjects from the same period of time. Tissue Doppler echocardiography was conducted to compare interventricular systolic and diastolic time to peak (Ts and Te), their differences (Te-Ts) and (Te-Ts) of left ventricle (LV), right ventricle (RV), interventricular septum (IVS) between 2 groups. Results:Ts and Te of RV were longer than Ts and Te of LV and IVS in both groups, PIII>IV, all differences had statistic meaning. Conclusion:IPAH patients with different right heart function may have interventricular systolic and diastolic de-synchronicity;by reduced heart function, interventricular Te-Ts could be specifically shortened.

The Value of Two-dimensional Speckle Tracking Echocardiographic Imaging for Assessing Left Ventricular Function at Pre-and Post-percutaneous Coronary Intervention in Patients With Chronic Total Coronary Occlusion / 中国循环杂志

Objective:To explore the value of two-dimensional speckle tracking echocardiographic imaging (2D-STI) for assessing partial and global left ventricular functional changes at pre-and post-percutaneous coronary intervention (PCI) in patients with chronic total coronary occlusion. Methods:Echocardiograph was conducted in 23 chronic total coronary occlusion patients at pre-PCI and 1 day, 3, 6 months post-PCI to examine left ventricular ejection fraction (LVEF), meanwhile 2D-STI was applied to obtain the global longitudinal strain (GLS) value of left ventricle. Results:In all 23 patients, for LVEF, compared with pre-PCI (59.29±12.15)%, it was increased at 3 and 6 months post-PCI (60.00±12.35)%and (61.37±11.8)%respectively, all P Conclusion:PCI could effectively improve left ventricular function in patients with chronic total coronary occlusion, 2D-STI technology may quantitatively assess those changes at the early stage.

Effect of autophagy and mitochondrial coenzyme Q on cardiac function of rats with acute sepsis / 中华实用儿科临床杂志

Objective To investigate the effects of autophagy on cardiac function and to determine whether the mitochondrial coenzyme Q (MitoQ) prevents cardiac dysfunction,mediated by autophagy,in rats with acute sepsis.Methods Forty-five Sprague Dawley (SD) rats were randomly divided into 9 groups (n =5,each group):control group,4 h lipopolysaccharide(LPS) group,6 h LPS group,12 h LPS group,4 h LPS + Wortmannin group,4 h LPS + MitoQ group,6 h LPS + MitoQ group,MitoQ group and Wortmannin group.Rats in LPS + Wortmannin group and LPS + MitoQ group were intraperitoneally given LPS(10 mg/kg) and followed by an injection of Wortmannin(2 mg/kg) and MitoQ (6.5 μmol/kg) via tail vein 1 hour later,respectively.Rats in each group were given the same amount of normal sodium in addition to different intervention drugs.The cardiac function parameters were measured by a BL-420E + biosignal collection system.Blood samples from abdominal aorta were taken at each time point,and creatine kinase MB isoenzyme (CK-MB) content was detected by using the velocity method.The content of reactive oxygen species (ROS) in isolated myocardial tissues in rats was measured by enzyme-linked immunoadsorbent assay(ELISA).The protein expression of microtubule-associated protein 1 light chain 3 (LC3) was detected by Western blot method.The pathological changes of myocardial tissue were observed by light and electronic microscopy.Results Compared with the control group,the left ventricular systolic pressure(LVSP),the rate of the rise in left ventricular pressure (± dp/dt max) were significantly decreased in 6 h LPS group,6 h LPS + MitoQ group and 4 h LPS + Wortmannin group(P ＜0.05),left ventricular end-diastolic pressure(LVEDP) was significantly increased in these 3 groups(P ＜0.05).The contents of CKMB and ROS in 6 h LPS group,6 h LPS =MitoQ group and 4 h LPS + Wortmannin group were higher than those in the control group(P ＜ 0.05).Electron microscopy showed that the number of autophagic vacuoles increased 6 h after LPS was administered,but did not increase significantly thereafter to 12 h.There was no difference at any time point in the number of autophagic vacuoles in the group given MitoQ and LPS.Immunoblotting demonstrated that the levels of LC3Ⅱ protein in the LPS 6 h group and LPS + MitoQ 6 h group were higher than those in the control group(P ＜0.05),but there was no difference between the LPS 12 h and LPS 6 h groups (P ＞ 0.05).Conclusions The mitochondria-targeted antioxidant MitoQ does not prevent cardiac dysfunction.However,autophagy prevents cardiac dysfunction,and the autophagic capacity or autophagosome-formation rate may determine whether cardiac dysfunction develops.

Diagnóstico oportuno del daño al miocardio en pacientes tratados con antraciclinas: un reto para el siglo XXI / Timely diagnosis of myocardial damage in patients treated with anthracyclines: a challenge for the 21st century

Introducción. Los métodos utilizados actualmente para la valoración del daño miocárdico en pacientes tratados con antraciclinas presentan deficiencias para la detección del daño incipiente. La troponina I forma parte de las proteínas reguladoras de la maquinaria de contracción en la miofibrilla y se ha utilizado como biomarcador específico de daño miocárdico. El objetivo de este trabajo fue comparar los niveles de troponina I en pacientes tratados con antraciclinas, antes y después de un nuevo ciclo de quimioterapia. Métodos. Se incluyeron pacientes con diagnóstico de cáncer, de 9 a 18 años, que recibían tratamiento con antraciclinas en el Hospital Infantil de México Federico Gómez. Se midieron los niveles séricos de troponina I (antes y después de un nuevo ciclo de quimioterapia) y se compararon los resultados obtenidos. Resultados. El promedio de la dosis acumulada de antraciclinas en la población estudiada fue de 234 mg/m²SC para daunorrubicina y 269 mg/m²SC para doxorrubicina. No se observó una disfunción sistólica importante mediante el ecocardiograma pero, mediante uso de SPEC-CT, sí se observaron alteraciones en la movilidad de las paredes ventriculares izquierdas. No se evidenció un aumento de niveles de troponina I en el suero después de la aplicación de una nueva dosis de antraciclinas. Conclusiones. Se ha investigado mucho acerca de biomarcadores que ayuden al diagnóstico temprano de la cardiopatía secundaria a antraciclinas, pero se han obtenido resultados contradictorios. Tomar en cuenta la cinética de la troponina I en el daño miocárdico, es un paso fundamental para su evaluación. Bajo esta premisa, no se observaron aumentos de este biomarcador en sangre después del daño miocárdico secundario al uso de antraciclinas.

Background. Currently used methods for assessment of myocardial damage in patients treated with anthracyclines are deficient in detecting mild myocardial damage. Troponin I is part of the protein contractile machinery in the myofibril and is used as a specific biomarker of myocardial damage. The aim of the study was to compare troponin I levels in patients with prior anthracycline use after a new cycle of chemotherapy. Methods. We included patients from 9 to 18 years of age who were diagnosed with cancer and being treated with anthracyclines at the Hospital Infantil de Mexico Federico Gomez. We analyzed serum troponin I prior to and after the new cycle of chemotherapy and compared the results, always in a blinded manner. Results. The mean cumulative dose of anthracyclines in the study population was 234 mg/m² SC for daunorubicin and 269 mg/m² SC for doxorubicin. There was no significant systolic dysfunction according to echocardiography. Impaired mobility of left ventricular walls was observed using SPECT-CT. There was no evidence of increased levels of troponin I in serum after application of a new dose of anthracyclines. Conclusions. Extensive research has been carried out in regard to biomarkers that aid in the early diagnosis of cardiomyopathy secondary to anthracycline, with mixed results. Taking into account the kinetics of troponin I in myocardial damage is a critical step for evaluation. Using this premise, we did not find an increase of this biomarker in blood after myocardial damage secondary to administration of anthracyclines.

El ecocardiograma y su papel en niños con cáncer / Role of echocardiogram in children with cancer

Introducción. Actualmente las antraciclinas se han incorporado en más de 50% de los protocolos de tratamiento para cáncer en la población infantil. La utilidad clínica de estos agentes queda limitada por la aparición de cardiomiopatías, cuya presencia depende de la dosis total del fármaco y suele ser irreversible. El ecocardiograma es el estudio más utilizado para la detección de cardiotoxicidad por antraciclinas. El objetivo de este trabajo fue describir la evolución de los índices de funcionamiento cardiaco reportados por ecografía durante el tratamiento de niños con cáncer con esquemas que contenían antraciclinas. Métodos. Se incluyeron pacientes pediátricos con diagnóstico de osteosarcoma y leucemia mieloide aguda tratados entre enero del 2006 y mayo del 2011 en el Hospital Infantil de México Federico Gómez. En el expediente clínico se documentaron los valores de las fracciones de eyección y acortamiento reportadas antes de cada ciclo. Se utilizó estadística descriptiva para el reporte de los resultados. Resultados. La fracción de eyección prácticamente no sufrió variaciones hasta el sexto ciclo de tratamiento a una dosis acumulada de 332.5 mg/m²SC, para posteriormente decaer de forma acelerada. En la fracción de acortamiento el mayor cambio se produjo después del séptimo ciclo, a una dosis acumulada de 450 mg/m²SC. Conclusiones. Reconocer el daño que se produce en etapas tempranas es un paso fundamental en la prevención de complicaciones. El reto es implementar nuevas herramientas que nos permitan alcanzar el objetivo de prevención o de diagnóstico de enfermedad subclínica.

Background. Currently, anthracyclines have been used in >50% of cancer treatment protocols in children. The clinical usefulness of these agents is limited by the onset of cardiomyopathy whose presence depends on the total dose of drug and usually is irreversible. Echocardiography is used to study anthracycline cardiotoxicity detection. The aim of this study was to describe the evolution of cardiac function reported by echocardiography for treatment of children with cancer whose medications contain anthracyclines. Methods. We included pediatric patients diagnosed with osteosarcoma and acute myeloid leukemia treated between January 2006 and May 2011 in the Hospital Infantil de México Federico Gómez. In the clinical files, values were documented for ejection fraction and shortening reported before each cycle, using descriptive statistics for reporting results. Results. The ejection fraction experiences virtually no changes until the 6th cycle of treatment to a cumulative dose of 332.5 mg/m²/sc, afterwards it demonstrates an accelerated decline. According to the shortening fraction, the most significant change occurs after the seventh cycle to a cumulative dose of 450 mg/m²/sc. Conclusions. Recognizing the damage that occurs during the early stages is a critical step in preventing complications. The challenge is to implement new tools that will allow us to achieve the objective of preventing or diagnosing subclinical disease.