Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis

Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.

Effect of Interval Training for 12 Weeks on Diastolic Filling of Left Ventricle During Mild Exercise / 体力科学

To clarify the mechanism responsible for the increase in stroke volume (SV) due to training, we investigated the effects of interval training on the left ventricle using M-mode echocardiography. Six healthy male subjects volunteered to undergo 48 training sessions for 12 weeks (4 sessions· week<SUP>-1</SUP>) One session consisted of five periods of exercise of 3-min duration on a cycle ergometer at a power output of 100% maximal O<SUB>2</SUB> uptake (Vo<SUB>2</SUB>max), interspersed with 2-min recovery cycling at 50%Vo<SUB>2</SUB>max. The echocardiograms at rest and during mild exercise (100W) were recorded before and after the training. The interval training significantly increased Vo<SUB>2</SUB>max. Although there was no significant difference in SV at rest before and after the training, the training increased SV significantly during exercise. Before the training, there was a significant difference in left ventricular enddiastolic dimension (LVEDD) and left ventricular end-diastolic volume (LVEDV) at rest and during exercise. However, after the training, LVEDD and LVEDV during exercise were significantly larger than those at rest. These results suggest that interval training for 12 weeks increases diastolic filling (elasticity) of the left ventricle during exercise in healthy young men, partly contributing to the increase in SV due to the training.

The Effect of the Administration of Nitroglycerin and Atropine on the Pattern of Left Ventricular Diastolic Filling as Assessed by Doppler Echocardiography in Normal Human Subjects

BACKGROUND: The diastolic transmitral flow velocity pattern has been commonly used to assess left ventricular(LV) diastolic function. The effects of multiple factors(such as, LV preload, afterload and heart rate, etc.) make difficulties in accurate interpretation. METHODS: In order to investigate the diastolic transmitral filling patterns according to the changes of the proload or heart rate, we studied 27 normal subjects with pulsed Doppler echocardiography after the administration of nitroglycerin(0.6mg/tab.) sublingually or atropine(0.5mg/amp.) intravenously. RESULTS: 1) After nitroglycerin administration, the folowings were obtained. ; The systolic blood pressure and LV diastolic filling time(DFT) decreased by 10.1% and 15.3%, respectively(p<0.001), compared with baseline data. The ratio of peak early to late diastolic transmitral flow velocities (E/A) and time-velocity integrals(TVIE/TVIA) decreased by 10.3% and 14.8%, respectively(p<0.01). The early diastolic filling time(Time E) was unchanged. Therefore, we suggest that time E is helpful, compared with the increments of the preload or the diastolic dysfunction. 2) After atropin administration, the heart rate, peak late diastolic transmitral flow velocity(PA) and percent atrial contribution(%AC) significantly increased by 43.6%, 25.1% and 41.4%, respectively(p<0.001). The E/A, TVIE/TVIA and DFT significantly decreased by 42.9%, 38.9% and 43.0%, respectively(p<0.001) compared to the data before drug administration. 3) The heart rate correlated negatively to the E/A, TVIE/TVIA and DFT. It was correlated positively to %AC(r=+0.63; p<0.001). The normalized E/A ratio by DFT(E/A/DFT) didn't correlate. Therefore, E/A/DFT is helpful on the exclusion of the influences of heart rate by the administration of the atropine. CONCLUSION: The decrement of preload or the increment of heart rate changes the diastolic transmitral flow velocity patterns. Therefore, when the diastolic function is assessed by interpretation of the Doppler transmitral flow velocity pattern with pulsed Doppler echocardiogram, the potential influences of preload and heart rate must be taken into account.

Early Doppler Echocardiographic Determination of Left Ventricular Diastolic Filling Defect In Adult Onset Diabetes Mellitus

To determine the early diagnostic parameters of the left ventricular diastolic filling defect in the uncontrolled adult onset diabetes mellitus, 86 diabetics were evaluated from the left ventricular inflow velocity pattern using pulsed Doppler echocardiography compared with normal 21 subjects. The diabetics were divided into 3 groups according to the presence or absence of background diabetic retinopathy(RE or coexisting cardiovascular diseases(group I : 34 cases without RE, group II : 24 cases with RE, group III : 28 cases with CVD). RE was thought to be having microangiopathy, but the cases with persistant massive proteinuria were excluded in this study. The left ventricular inflow velocity patterns were recorded from the apical approach. Peak velocity of the rapid filling phase(PFVE), that in the atrial systole(PFVA), E/A ratio, acceleration time(AT), deceleration time(DT), acceleration rate(ATR) and deceleration rate(DTR) were measured in the left ventricular inflow patterns. The results were ; 1) PFVE, AT and ATR in group I(56.26+/-12.21mm/sec, 70.91+/-14.98msec, 858.5+/-247mm/sec2), group II(51.91+/-14.35mm/sec, 64.84+/-14.98msec, 855.7+/-248.5mm/sec2) and group III(50.07+/-12.45mm/sec, 67.59+/-17.46msec, 817.5+/-266.8mm/sec2) were not significantly changed(p>0.05) compared to the controls(50.24+/-8.24mm/sec, 66.19+/-10.98msec, 784.5+/-221mm/sec2). 2) PFVA and DT in group I(51.21+/-14.86mm/sec, 156.2+/-23.42msec) and group II(64.26+/-13.93mm/sec, 64.84+/-14.13msec) were significantly increased(p0.05). 3) E/A ratio was significantly decreased in group II(0.82+/-0.21) and III(0.75+/-0.23) compared to the controls(1.19+/-0.25, p0.05) was noted. 4) DTR was also decreased in group II(311.9+/-95mm/sec2, p<0.05) and group III(297.7+/-125.8mm/sec2, p<0.05) compared to the controls(370.2+/-88mm/sec2) and group I(379.8+/-126mm/sec2). In conclusion, left ventricular diastolic filling defect in adult onset diabetics could be determined by using a various parameters of the pulsed Doppler echocardiography, which were closely related with diabetic retinopathy(RE). And DT and PFVA could be used as good parameters for early determination of the left ventricular diastolic filling defect in diabetics even without microangiopathy.

Relation of Left Ventricular Diastolic Filling to Age and Left Ventricular Hypertrophy

The purpose of the present study is to assess the effect of aging on left ventricular filling function and the relation between Doppler parameters of LV filling and radius/thickness ratio in an normal population and in hypertensive patients with left ventricular hypertrophy. We underwent M-mode echocardiography and pulsed Doppler measurement of the LV inflow in 123 normal controls and 78 hypertensive patinets with LVH. The results were as follows; 1) In hypertensive patients with LVH, the peak early velocity(60.9+/-13.5cm/sec)was significantly decreased, and the peak atrial velocity(78.9+/-19.6cm/sec)was significantly increased than that in normal controls(78.1+/-15.7cm/sec, 60.2+/-13.1cm/sec, P<0.005, respectively). 2) In the normal controls, peak early velocity correlated well with age(r=-0.388, -0.595, P<0.005, respectively), but not with radius/thickness ratio. 3) In the hypertensive patients with LVH, peak early velocity and the ratio of early to atrial velocity correlated with redius/thickness ratio (r=0.274 P<0.05, r=0.367 P<0.005, respectively), but not with age. In conclusion early LV diastolic filling is reduced and systolic is augmented, probably reflecting alteration in myocardial siffness with normal aging, whereas in chronic LVH, changes in radius/thickness ratio is more important determinants of ventricular compliance, overriding the effects of age.