Sevoflurane prevents pulmonary vascular remodeling and right ventricular dysfunction in pulmonary arterial hypertension in rats.

BACKGROUND: The cardioprotective properties of sevoflurane have been reported in studies of the left ventricle. However, whether this volatile anesthetic would also be beneficial for pulmonary vascular remodeling and associated right ventricular hypertrophy (RVH) remained to be explored. Here, we investigated the potential benefit of sevoflurane to right heart function in experimental pulmonary arterial hypertension (PAH). METHODS: Adult Wistar rats received one dose peritoneal injection of monocrotaline (MCT, 60 mg/kg) or the equal volume of normal saline. Two weeks later, rats were treated with sevoflurane or sham exposure. PAH status and cardiac function were assessed by echocardiography weekly, and the body weight (BW) was monitored every week. After 6 weeks of exercise, Fulton's index calculation, histological observation, IL-6 and TNF-α immunohistochemical analyses, evaluation of MDA, SOD and GSH-Px levels and NF-κB and MAPK active determination were performed in lung and RV tissue samples. RESULTS: MCT induced pulmonary vascular remodeling, RVH, increased Fulton's index (P<0.01), and right ventricular failure (RVF) in rats. Animals inhaled sevoflurane had an increased cardiac output (P<0.05) and lower incidence of RVF (P<0.05). Also, these animals had a reduced RVEDD, RVWTd and PAID (P<0.05), increased PV (P<0.05), reduced wall thickness and vascular wall area of pulmonary small vascular (vascular external diameter 50-150 um) (P<0.01), reduced RV fibrosis, and increased RV cardiomyocyte area (P<0.01). Furthermore, sevoflurane reduced IL-6 and TNF-α expression in lungs and heart (P<0.01), decreased level of MDA (P<0.01) and increased activity of SOD and GSH-Px (P<0.01). In addition, it decreased the activities of NF-κB and MAPK pathways (P<0.01). CONCLUSION: Sevoflurane reduces pulmonary vascular remodeling and RVH in PAH induced by MCT in rats. This effect is likely due to down-regulation of inflammatory factors IL-6 and TNF-α, reduced level of oxidative stress and the inhibition of NF-κB and MAPK pathways.

Value of three dimensional-speckle tracking imaging for predicting left ventricular function after non-ST-segment elevation myocardial infarction with percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention (PCI) is the recommended treatment for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). OBJECTIVE: To investigate the application of three dimensional-speckle tracking imaging (3D-STI) on patients diagnosed with NSTEMI undergoing PCI. METHODS: Forty-four NSTEMI patients and 20 healthy subjects that received basic clinical and laboratory examinations were included in our study. NSTEMI patients were divided into three groups: heart failure (HF) with normal ejection fraction (HF-NEF group, n = 19), heart failure with preserved ejection fraction (HF-PEF group, n = 14) and heart failure with a reduced ejection fraction (HF-REF group, n = 11). The global longitudinal peak systolic strain (GLS), global circumferential peak systolic strain (GCS), global radial peak systolic strain (GRS) and left ventricular (LV) torsion of all subjects were measured by 3D-STI before PCI and 1 month, 3 months after PCI. The high-sensitivity troponin T (hs-TNT), high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were measured in each group. Correlations between these parameters and LV ejection fraction (LVEF) were tested by Pearson correlation analysis. RESULTS: GLS, GCS and torsion were significantly decreased in the 3 NSTEMI groups compared with control group (P < 0.05). GLS, torsion were significantly improved in the three NSTEMI groups at postoperative 1 and 3 months (P < 0.05). HF-REF group showed improved GCS on postoperative 1 and 3 month compared with preoperative data, and improved GLS at 3-month follow-up compared with 1-month follow-up (P < 0.05). The hs-TNT, hs-CRP and NT-pro BNP increased in the three NSTEMI groups before PCI (P < 0.05), and decreased at postoperative 1 and 3 month (P < 0.05). LVEF has the positive correlations with LV endsystolic volume (LVESV) and torsion, as well as the negative correlations with LVGLS, LVGCS, NT-pro BNP (P < 0.05). CONCLUSIONS: The combinative detection of 3D-STI and NT-pro BNP is an efficient way to assess the cardiac function in patients diagnosed with NSTEMI undergoing PCI.

Assessment of mitral annulus and mitral leaflet in nonvalvular atrial fibrillation patients with various degrees of mitral regurgitation: Real time 3D transesophageal echocardiography.

AIM: To study the changes of mitral valve (MV) in patients with nonvalvular atrial fibrillation (NVAF)-related mitral regurgitation (MR) and the relationship between MV parameters and the enlarged left atrium (LA). MATERIALS AND METHODS: A total of 43 patients with NVAF were divided into two groups: (1) the MR1 group with mild MR and (2) the MR2 group with moderate-to-severe MR. Real time 3D transesophageal echocardiography (TEE) was performed to detect the structure of MV. RESULTS: There were no significant differences in the basic characteristics among the three groups. As compared with the control group, anterolateral to posteromedial diameter of the annulus (DALPm), anterior to posterior diameter (DAP), three-dimensional circumference (C3D), two-dimensional area (A2D), three-dimensional area (A3D), exposed area of the leaflets (A3DE), and NPA (nonplanar angle) were significantly increased, whereas height and ellipticity were significantly decreased in the MR1 group and MR2 group. The overall longitudinal strain of left atrium (GLS) was significantly decreased in the MR1 and MR2 groups compared to the control group. Furthermore, GLS was inversely correlated with DALPm, DAP, C3D, A2D, A3D, A3DE, and NPA, whereas positively correlated with height, ellipticity, and the leaflet tenting height in both MR1 and MR2 groups. CONCLUSION: Even in NVAF patients with mild MR, the structure of MV was changed intensively with the expansion and deformation of the "saddle shape" structure. The deformation of MV was associated with the decreased function of LA. Our results may provide novel insight into evaluation risk factors leading to AF recurrence after ablation procedures.

Preliminary study of the application of transthoracic echocardiography-guided three-dimensional printing for the assessment of structural heart disease.

OBJECTIVE: To investigate the feasibility and diagnostic value of a preoperative transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) for the assessment of structural heart disease (SHD). METHODS: Fourty-four patients underwent cardiac surgery at Tianjin Chest Hospital. The patients were preoperatively assessed using TTE-guided 3DPM, which was compared to conventional three-dimensional transthoracic echocardiography (3DTTE) along with direct intraoperative findings, which were considered the "gold standard." Twelve patients had SHD, including four with mitral prolapse, two with partial endocardial cushion defects, two with secondary atrial septal defects, two with rheumatic mitral stenosis, one with tetralogy of Fallot, and one with a ventricular septal defect (VSD). Thirty-two patients who did not have SHDs were designated as the negative control group. RESULTS: The sensitivity and specificity of the TTE-guided 3DPM were greater than or equal to those of the 3DTTE. The P-value of the McNemar test of 3DTTE was >.05, which indicates that the difference was not statistically significant (Kappa = 0.745, P < .001). The P-value of the McNemar test of TTE-guided 3DPM was >.05, which indicates that the difference was not statistically significant (Kappa = 0.955, P < .001). A comparison of 3DTTE and TTE-guided 3DPM resulted in a P-value >.05, which indicates that the difference was not statistically significant (Kappa = 0.879, P < .001). TTE-guided 3DPM displayed the 3D structure of SHDs and cardiac lesions clearly and was consistent with the intra-operative findings. CONCLUSION: Transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) provides essential information for preoperative evaluation and decision making for patients with SHDs.

[Quantitative evaluation of aortic regurgitation by general imaging three-dimensional quantification].

OBJECTIVE: To investigate the feasibility and application value of AR-Vol measured by GI3DQ method directly. METHODS: One hundred and two patients with aortic regurgitation who underwent echocardiographic examination in Tianjin Chest Hospital from February 2014 to October 2014 were selected randomly and divided into two groups: the eccentric group included forty cases with eccentric aortic regurgitation; the central group included sixty and two cases with central aortic regurgitation. AR-Vol were directly measured by GI3DQ method, and then it was calculated by PISA method as the reference standard. RESULTS: (1) In the eccentric group, the AR-Vol measured by GI3DQ method and PISA method were respectively (44±11) ml and (48±10) ml. In the central group, the AR-Vol measured by GI3DQ method and PISA method were respectively (34±13) ml and (33±13) ml. (2) Paired t test analysis showed significant difference in two methods of the eccentric group (P<0.01); no significant difference was found in two methods of the central group (P=0.202). (3) The correlation coefficients of the AR-Vol measurement by GI3DQ method and PISA method are relatively in two groups: r=0.835, r=0.913; consistency analysis showed differences between the two methods of the eccentric group had statistical significance, and differences between the two methods of the central group had no statistical significance. CONCLUSION: In the central aortic regurgitation, AR-Vol measured by GI3DQ method is feasible and accurate compared with the PISA method, which can be used for routine application.