To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.
Echocardiography, Doppler/instrumentation ; Echocardiography, Doppler/*methods ; Heart Ventricles/*ultrasonography ; Myocardial Contraction/*physiology ; Sinoatrial Node/physiology ; Tachycardia/physiopathology ; Tachycardia/ultrasonography

OBJECTIVETo assess left ventricular vortex and flow vector features and the relationship between vector flow and left ventricular systolic function in patients with anterior myocardial infarction by echocardiography-derived vector flow mapping (VFM).

METHODSEchocardiography was performed in 31 patients with anterior myocardial infarction and 20 healthy controls. Flow vector and velocity of left ventricle were analyzed on apical 3 chambers view with color Doppler.

RESULTS(1) Left ventricular intracavitary vortex during isovolumic contraction phase could be detected in both groups. Vortex was detectable also during contraction phase and relaxation phase in patients with myocardial infarction. There was no vortex during contraction phase, and there was only small and transit vortex during relaxation phase in control group. (2)Flow vector of apex and middle segments directed to apex and was opposite to that of basal segment of left ventricle in patients with myocardial infarction and in controls [(10.6 ± 8.3) cm/s vs. -(5.8 ± 7.2) cm/s, (19.5 ± 11.8) cm/s vs. -(16.6 ± 14.7) cm/s]. During rapid relaxation phase, the velocity in apex was lower in patients with myocardial infarction than that in control group [(6.8 ± 9.8) cm/s vs. (17.6 ± 15.8) cm/s, P < 0.01]. (3) There was a negative correlation between velocity in apex and left ventricular ejection fraction (LVEF) during rapid eject phase in patients with anterior myocardial infarction (r = -0.52, P < 0.05). Velocity in apex of patients with LVEF < 50% was higher than that of patients with LVEF ≥ 50% during rapid eject phase [(13.5 ± 9.0) cm/s vs. (5.8 ± 5.1) cm/s, P < 0.05].

CONCLUSIONSVortex period is prolonged in patients with anterior myocardial infarction compared to normal controls during whole cardiac cycle, flow vector of apex and middle segments is directed to apex during eject phase and there is a negative correlation between velocity in apex and LVEF during rapid eject phase in patients with anterior myocardial infarction.

Aged ; Blood Flow Velocity ; Case-Control Studies ; Female ; Heart Ventricles ; physiopathology ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; Myocardial Infarction ; diagnostic imaging ; physiopathology ; Stroke Volume ; Ultrasonography

BACKGROUND: The prevalence and clinical significance of white-coat hypertension (WCHT) and masked hypertension (MHT) are unknown in Koreans. Here we measure the frequency of WCHT and MHT in hypertensive subjects and identify the epidemiologic and/or clinical factors that predict it in Korean subjects. METHDOS: This study is a retrospective analysis of a random sample from February 2004 to October 2005. All patients had measurements of blood pressure (BP) in the clinic and 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were classified into four groups on the basis of daytime ambulatory BP and clinic BP level: 1) Normotension (NT), 2) MHT, 3) WCHT, and 4) sustained hypertension (SHT). RESULTS: For all 967 patients, the mean clinic BP was 157.7+/-22.0/ 95.3+/-13.1 mmHg, and the mean daytime ambulatory BP was 136.4+/-15.0/ 86.2+/-10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively. The left ventricular mass index was significantly higher in SHT than in the other groups, and was positively correlated with BP, especially ABPM. Compared with NT, the factors associated with MHT were younger age, male gender, higher BMI, clinic BP > or =130 mmHg, and alcohol consumption. Compared with SHT, the factors associated with WCHT were female gender, lower BMI, and clinic BP < 150 mmHg. CONCLUSIONS: WCHT and MHT were prevalent in the hypertensive population. ABPM was more predictive of target organ damage than clinic BP, and could be useful in identifying subjects at risk for WCHT and MHT.
Blood Pressure Monitoring, Ambulatory ; Female ; Health Status Indicators ; Heart Ventricles/*physiopathology/ultrasonography ; Humans ; Hypertension/*epidemiology/ultrasonography ; Hypertrophy, Left Ventricular/*physiopathology/ultrasonography ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors

BACKGROUNDUmbilical cord around neck, a common obstetric complication, affects fetal hemodynamics. Does it influence fetal cardiac functions? The purpose of this study was to investigate the left and right ventricular systolic and diastolic functions of fetuses with umbilical cord around neck in the third trimester by applying velocity vector imaging (VVI).

METHODSThirty-five cases of fetuses with umbilical cord around neck whose gestational ages from 35 to 40 weeks were selected, including 20 cases of umbilical artery ratio of the highest systolic velocity (S) to the lowest diastolic velocity (D) (S/D) < 3.0 and 15 cases of umbilical artery S/D ≥ 3.0, while 20 cases of normal fetuses of 35 - 40 gestational weeks were selected as the control group. The changes in longitudinal velocity, strain, and strain rate of fetal left and right ventricle in systole and diastole in two groups, and the changes in fetal cardiac function under the situation of umbilical cord around neck were analyzed.

RESULTSLongitudinal strain and strain rate overall of fetal left and right ventricle in systole and diastole were less in fetuses with umbilical artery S/D (3)3.0 and umbilical cord around neck than those in fetuses with umbilical artery S/D < 3.0 and those in control group (P < 0.05); there was no significant difference (P > 0.05) in longitudinal strain and strain rate overall of fetal left and right ventricle in systole and diastole between fetuses with umbilical artery S/D < 3.0 and those in control group.

CONCLUSIONSLeft and right ventricular systolic and diastolic dysfunction was detected in fetuses with umbilical cord around neck and umbilical artery S/D (3)3.0. VVI could sensitively respond to cardiac function changes in fetuses with umbilical cord around neck, which provides another valuable method in the evaluation of fetal cardiac function.

Adult ; Female ; Fetus ; abnormalities ; physiopathology ; Gestational Age ; Heart Ventricles ; diagnostic imaging ; pathology ; physiopathology ; Humans ; Myocardium ; pathology ; Pregnancy ; Pregnancy Complications ; Ultrasonography, Prenatal ; Umbilical Arteries ; diagnostic imaging ; pathology ; physiopathology ; Umbilical Cord ; diagnostic imaging ; physiopathology ; Young Adult

OBJECTIVERight ventricular apical pacing may induce cardiac desynchronize and deteriorate left ventricular systolic performance. We hypothesized that right ventricular outflow tract (RVOT) pacing could produce better mechanical synchrony and left ventricular contraction.

METHODSWe enrolled nine patients without structural heart disease who underwent electrophysiological studies. The pacing sites (right apex, low septum, free wall and septum of RVOT of the right ventricle) were defined with fluoroscopy and ECG. The atrioventricular sequential pacing was applied every 5 minutes in a random order at a rate of 120 bpm. Tissue Doppler imaging was carried out with GE VIVID 7 for off-line analysis at each pacing site. The global systolic contraction amplitude (GSCA) was calculated as the average shortening amplitude of all 16 segments of left ventricle.

RESULTSThe GSCA during pacing was 5.76 mm +/- 0.66 mm at free wall of RVOT and 5.66 mm +/- 1.00 mm at septum of RVOT, respectively. The GSCA at both sites was significantly higher than that at apical pacing 4.82 mm +/- 0.94 mm (P < 0.05) or low septum pacing 4.82 mm +/- 1.06 mm (P < 0.05). Moreover, segmental displacement analysis showed that the longitudinal displacement of lateral, posterior, and inferior walls significantly decreased at apical pacing compared with RVOT pacing, although no difference could be demonstrated in anterior and septum walls. Accordingly, the curve of the myocardial displacement at apical or low septum pacing was M-shaped, and had a negative wave at the end of the diastole in lateral, posterior, and inferior walls. The tissue velocity during isovolumic contraction period was also higher than systolic tissue velocity in these walls. The phenomenon could seldom be seen at RVOT pacing.

CONCLUSIONRVOT pacing in patients without structural heart disease is associated with more favorable immediate myocardial contraction and mechanical synchrony compared with right apical pacing or low septum pacing.

Adult ; Cardiac Pacing, Artificial ; methods ; Female ; Heart Ventricles ; diagnostic imaging ; physiopathology ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; physiology ; Ultrasonography, Doppler ; Ventricular Function, Left

OBJECTIVE: To quantitatively detect variation in regional myocardial systolic function in heart failure rat model induced by myocardial infarction by strain and strain rate imaging. METHODS: Seventy 2-month-old adult male SD rats were randomly assigned to 4 groups: a 4-week and a 8-week group after the operation (each n = 25) had thoracotomy, the pericardium opened and the anterior descending branch of left coronary artery ligated; a sham operation group (n = 10) had thoracotomy and the arcula cordis opened, but did not ligate the artery; a control group (n = 10) had no treatment. The changes of general state of health of the rats were observed and recorded every day. To assess the change of heart function, echocardiography was used at the end of the 4th week and 8th week after the surgery. To evaluate the change of heart function in heart failure rats, we quantitatively analyzed the regional myocardial systolic function in all rats by strain and strain rate imaging and myocardium to detect the level of MMP-9 at the end of the 4th week and 8th week. The repeatability and discrepancies of the results were all analyzed. RESULTS: Obviously objective signs of heart failure manifested themselves in the survived mice 10 to 14 days after the surgery. Compared with the control group and the sham operation group, the fraction shortening (FS) and ejection fraction (EF) of the 4-week group after the operation were lower (P < 0.05), the left ventricle index (LV index) of the 8-week group after the operation was higher, left ventricle posterior wall index (LVPW index), interventricular septum index (IVS index), FS, and EF of the 8-week group after the operation were lower (P < 0.05), EF and FS of the 8-week group after the operation were lower than those of the 4-week group. Except the mid-inferior wall and base-inferior wall, the systolic peak strain, systolic peak strain rate, the strain of end-systole in all segments of the operation group were lower than those of the other 2 groups (P < 0.05). The post-systolic strain index of the operation group was higher than that of the other 2 groups (P < 0.05). CONCLUSION Strain and strain rate imaging of echocardiography can quantitatively evaluate the changing of regional myocardial systolic function in the heart failure rat model induced by myocardial infarction, with good repeatability.
Animals ; Heart Failure ; diagnostic imaging ; etiology ; physiopathology ; Heart Ventricles ; diagnostic imaging ; Male ; Myocardial Infarction ; complications ; diagnostic imaging ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Systole ; Ultrasonography ; Ventricular Function, Left ; physiology

A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.
Aged ; Cardiac Surgical Procedures ; methods ; Cardiology ; instrumentation ; methods ; Catheters ; Echocardiography ; methods ; Equipment and Supplies ; Female ; Heart Ventricles ; physiopathology ; Humans ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; surgery ; Pulmonary Disease, Chronic Obstructive ; complications ; Risk ; Ultrasonography, Doppler ; methods ; Ventricular Dysfunction, Left ; surgery

BACKGROUND/AIMS: Increased left atrial (LA) size has been proposed as a predictor of poor cardiovascular outcome in the elderly. In the present study, we evaluated the relationship between LA size and stroke in subjects of all ages who presented with preserved left ventricular systolic function (LVSF) and sinus rhythm (SR), and investigated the relationships between LA size and other echocardiographic parameters of diastolic function. METHODS: A total of 472 subjects were enrolled in the study (161 men, 311 women) and divided into the stroke group (n=75) and control group (n=397). A conventional echocardiographic study was then performed. Subjects with valvular heart disease, atrial fibrillation, or coronary heart disease were excluded. RESULTS: The mean subject age was 65.2+/-5.1 years in the stroke group and 65.6+/-5.9 years in the control group. Mitral inflow pattern and E & A velocity showed no significant relationship with stroke (p=NS, p=NS, respectively). Left ventricular mass index and LA dimension were significantly related to stroke (p=0.003, p=0.023, respectively), and hypertension showed a marginal relationship with stroke (p=0.050). Age was not related to stroke in the present study (p=NS). CONCLUSIONS: The LA dimension is significantly related to the incidence of stroke. Therefore, strategies for prevention of stroke in patients with preserved LVSF and SR should be considered in cases of LA enlargement.
Adult ; Aged ; Echocardiography, Doppler, Pulsed ; Female ; Heart Atria/*ultrasonography ; Heart Rate/*physiology ; Heart Ventricles/physiopathology/ultrasonography ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Myocardial Contraction/*physiology ; Retrospective Studies ; Risk Factors ; Stroke/*epidemiology/etiology ; Stroke Volume/*physiology ; Systole ; Ventricular Function, Left/*physiology

BACKGROUND/AIMS: There are few data on the effects of low hemoglobin levels on the left ventricle (LV) in patients without heart disease. The objective of this study was to document changes in the echocardiographic variables of LV structure and function after the correction of anemia without significant cardiovascular disease. METHODS: In total, 34 iron-deficiency anemia patients (35 +/- 11 years old, 32 females) without traditional cardiovascular risk factors or cardiovascular disease and 34 age- and gender-matched controls were studied. Assessments included history, physical examination, and echocardiography. Of the 34 patients with anemia enrolled, 20 were followed and underwent echocardiography after correction of the anemia. RESULTS: There were significant differences between the anemia and control groups in LV diameter, left ventricular mass index (LVMI), left atrial volume index (LAVI), peak mitral early diastolic (E) velocity, peak mitral late diastolic (A) velocity, E/A ratio, the ratio of mitral to mitral annular early diastolic velocity (E/E'), stroke volume, and cardiac index. Twenty patients underwent follow-up echocardiography after treatment of anemia. The follow-up results showed significant decreases in the LV end-diastolic and end-systolic diameters and LVMI, compared with baseline levels. LAVI, E velocity, and E/E' also decreased, suggesting a decrease in LV filling pressure. CONCLUSIONS: Low hemoglobin level was associated with larger cardiac chambers, increased LV, mass and higher LV filling pressure even in the subjects without cardiovascular risk factors or overt cardiovascular disease. Appropriate correction of anemia decreased LV mass, LA volume, and E/E'.
Adult ; Anemia, Iron-Deficiency/blood/diagnosis/*drug therapy/physiopathology ; Biological Markers/metabolism ; Case-Control Studies ; Echocardiography, Doppler ; Female ; Heart Ventricles/*physiopathology/ultrasonography ; Hematinics/*therapeutic use ; Hemoglobins/metabolism ; Humans ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Time Factors ; Treatment Outcome ; *Ventricular Function, Left ; *Ventricular Pressure ; *Ventricular Remodeling ; Young Adult