The volume-time curve change in patients with normal left ventricular (LV) diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography (RT3DE). LV diastolic dysfunction was defined by E'ventricular septal (IVS) of mitral annulus. In 24 patients with LV diastolic dysfunction, including 12 patients with delayed relaxation (delayed relaxation group) and 12 patients with pseudo-normal function (pseudo-normal group) and 24 normal volunteers (control group), data of full-volume image were acquired by real-time three-dimensional echocardiography and subjected to volume-time curve analysis. EDV (end-diastolic volume), ESV (end-systolic volume), LVEF (left ventricular ejection fraction), PER (peak ejection rate), PFR (peak filling rate) from RT3DE were examined in the three groups. Compared to the control group, PFR (diastolic filling index of RT3DE) was significantly reduced in the delayed relaxation group and pseudo-normal group (P<0.05). There were no significant differences in EDV, ESV, LVEF, PER (P>0.05). It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.
Diastole/physiology ; Echocardiography, Three-Dimensional/*methods ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Dysfunction, Left/*ultrasonography ; Ventricular Function, Left/*physiology

OBJECTIVETo study the role of Tei index in the evaluation of left ventricular dysfunction in neonates with hypoxemia.

METHODSFifty-two neonates with hypoxemia (20 mild, 16 moderate, 16 severe) and 40 normal neonates (control group) were enrolled. On postnatal days 1, 3 and 7, Doppler echocardiography was used to measure the indexes reflecting systolic and diastolic cardiac functions: ejection fraction of left ventricular (LVEF), E/A ratio of mitral value and Tei index of left ventricular (LV-Tei).

RESULTSLVEF and E/A ratio of left ventricular in the moderate hypoxemia group were significantly lower than those in the control group on postnatal days 1 and 3 (P<0.01). LVEF and E/A ratio of left ventricular in the severe hypoxemia group were significantly lower than those in the control group on postnatal days 1, 3 and 7 (P<0.01 or 0.05). Compared with the control group, LV-Tei increased significantly in the mild hypoxemia group on postnatal day 1 and increased significantly in the moderate and severe hypoxemia groups on postnatal days 1 and 3 (P<0.01). There was a negative correlation between PaO2 and LV-Tei in the hypoxemia group on postnatal days 1 and 3 (r=-0.50, P<0.05; r=-0.71, P<0.01 respectively).

CONCLUSIONSLV-Tei can be used as a sensitive indicator for the evaluation of left ventricular dysfunction in neonates with hypoxemia.

Echocardiography, Doppler ; Female ; Humans ; Hypoxia ; physiopathology ; Infant, Newborn ; Male ; Ventricular Dysfunction, Left ; diagnosis ; Ventricular Function, Left

OBJECTIVETo evaluate the left ventricular (LV) radial and longitudinal systolic function in hypertrophic cardiomyopathy (HCM) patients by 3.0 T MR.

METHODSSixteen HCM (HCM group) and twenty normal adults (normal group) were examined with fast imaging employing steady-state (FIESTA) acquisition sequence of cardiac MRI. LV ejection fraction (LVEF), longitudinal shortening (LS) and fractional shortening (FS) in three standard levels were measured to analyze LV radial and longitudinal systolic function.

RESULTSAsymmetric hypertrophy was detected in all HCM patients. The LVEF and FS were significantly higher while LS was significantly lower in HCM group than those in normal group (P < 0.05 or 0.01). FS at basal and middle levels were significantly higher in HCM group than in normal group (both P < 0.01). FS in apex level was similar in the two groups (P = 0.057). Pearson correlation analysis showed that LS was negatively related with the number of hypertrophy segments in HCM patients (r = -0.537, P = 0.032). But there was no correlation between FS and the number of hypertrophy segments as well as FS and LS in HCM patients (r = -0.090, P = 0.739; r = 0.049, P = 0.856).

CONCLUSIONThe LV longitudinal systolic function was reduced but the LV radial systolic function remained unchanged in HCM patients, thus, LS changes could better reflect myocardial systolic function in HCM patients.

Adult ; Cardiomyopathy, Hypertrophic ; physiopathology ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Myocardium ; Systole ; Ventricular Dysfunction, Left ; Ventricular Function, Left

OBJECTIVEThis study aimed to investigate the feature of D(L)CO (Diffusion Lung Capacity for Carbon Monoxide) in CHF (left ventricular heart failure) patients, underlying pathophysiological mechanism and clinical significance.

METHODSWe retrospectively studied the D(L)CO, pulmonary ventilation function, cardiopulmonary exercise testing and related clinical information in severer HF patients.

RESULTSPeak VO2 severely decreased to 34 ± 7 percentage of predicted(%pred) and anaerobic threshold to 48 ± 11%pred in all patients. D(L)CO moderately decreased to 63 ± 12%pred and there were 25 patients lower than 80%pred. FVC, FEV1, FEV1/FVC and TLC were 75 ± 14%pred, 71 ± 17%pred, 97 ± 11%pred, and 79 ± 13%pred, which indicated borderline or mild restrictive ventilatory dysfunction. The decrease of D(L)CO was more severe than those of TLC, FEV1 and FVC.

CONCLUSIONFor patients with severe CHF, cardiopulmonary exercise function is extremely limited, D(L)CO generally moderately declines and ventilation function is merely mildly limited. D(L)CO is the parameter for cardiopulmonary coupling, reflecting limitation of the cardiovascular dysfunction while without ventilatory limit.

Blood Gas Analysis ; Heart Failure ; physiopathology ; Humans ; Respiratory Function Tests ; Retrospective Studies ; Ventricular Dysfunction, Left ; physiopathology

OBJECTIVETo evaluate transient deceleration wave intensity (W2) of carotid artery on left ventricular diastolic function.

METHODS40 patients with hypertension and 43 healthy volunteers were enrolled and W2 of carotid artery of the both sides were measured. The parameters of left ventricular diastolic function by traditional and tissue Doppler imaging and NT-proBNP (N-terminal probrain natriuretic peptide) were measured.

RESULTS(1) W2 is not different between two sides of carotid artery. W2 in hypertension was lower than the control, especially in left side(1126 +/- 996 mmHg x m/s3 vs 1690 +/- 1126 mmHg x m/s3, P < 0.01). (2) The correlation of W2 and else parameters were analyzed. There were notably decreasing in left ventricular diastolic function of the hypertensive group than the control, for example, the ratio of peak velocity of early filling of mitral flow to peak early diastolic motion velocity of mitral annulus (E/Em, 9.37 +/- 3.32 vs 7.39 +/- 1.83, P < 0.01) and NT-proBNP (94.6 +/- 48.5 vs 45.2 +/- 13.8, P < 0.01). (3) The correlation analysis showed negative relation between W2 and E/Em (r = - 0.46, P < 0.05) and negative relation between W2 and NT-proBNP (r = -0.21, P < 0.05).

CONCLUSIONNew carotid W2 by non-invasive technology for hemodynamics is a deserving parameter in early evaluating left ventricular diastolic function.

Adult ; Carotid Artery, Common ; physiopathology ; Female ; Humans ; Hypertension ; physiopathology ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Ventricular Dysfunction, Left ; diagnosis ; physiopathology ; Ventricular Function, Left

There are many differences between cardiac resynchronization therapy (CRT) and conventional pacing therapy in terms of indications and implant techniques. Generally speaking, CRT requires implanting 3 pacing leads in heart failure patients with ventricular dysynchrony. A left ventricular lead is implanted via intravenous coronary sinus. The pacing site of left ventricle has important influence on therapy response. Sometimes open chest implant or other pacing modes are adopted to compensate the anatomical limitation of coronary sinus and its branches. In addition, the pacing sites and modes of right atrium and right ventricle are also under research to further improve CRT response.
Cardiac Pacing, Artificial ; methods ; Electrodes, Implanted ; Heart Atria ; Heart Failure ; physiopathology ; therapy ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; physiopathology ; Ventricular Dysfunction, Right ; physiopathology

OBJECTIVETo investigate the correlation between left atrial size and left ventricular filling pressure (LVFP) and the value of left atrial size assessment on detecting diastolic dysfunction in hypertensive patients with preserved LVEF by echocardiography.

METHODSEchocardiography was performed in 346 hypertensive patients with preserved LVEF(≥ 50%), left atrial size including left atrial diameter (LAD) and left atrial area (LAA) was measured and indexed to body surface area (LADI, LAAI). The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) was determined and LVFP was calculated with the formula: LVFP = 1.24×E/Em + 1.9. Patients were divided into diastolic dysfunction group [DD group, LVFP > 15 mm Hg (1 mm Hg = 0.133 kPa), n = 81] and normal diastolic function group (NDF group, LVFP ≤ 15 mm Hg, n = 265).

RESULTSAs compared to patients in NDF group, the patients in DD group had larger LA [LADI: (21.4 ± 2.6) mm/m(2) vs. (19.6 ± 2.4) mm/m(2); LAAI: (12.1 ± 2.6) cm(2)/m(2) vs. (10.4 ± 1.7)cm(2)/m(2); all P < 0.01]. LA size parameters were positively correlated with LVFP (r = 0.211-0.450, all P < 0.01), LAAI was best correlated with LVFP (r = 0.450, P < 0.01). ROC analysis showed that LAAI ≥ 11.4 cm(2)/m(2) diagnosed DD with a sensitivity of 63%, specificity of 74% and accuracy of 72%.

CONCLUSIONLeft atrium dilation correlates positively with LVFP in hypertensive patients with preserved LVEF. The LAAI is a more accurate parameter for identifying patients with diastolic dysfunction in this cohort.

Adult ; Aged ; Aged, 80 and over ; Female ; Heart Atria ; diagnostic imaging ; physiopathology ; Humans ; Male ; Middle Aged ; Ultrasonography ; Ventricular Dysfunction, Left ; diagnostic imaging ; physiopathology ; Ventricular Function, Left

The methods for evaluating left ventricular diastolic function completely and simply are lacking in our country at present. To solve this problem, we presents in this paper a novel method, which is developed according to certain algorithms and mathematic models and is carried out by a MATLAB program. This method mainly obtains dP/dt loops, and calculates four important indices, including left ventricular end-diastolic pressure (LVEDP), Maximal decrease in velocity of left ventricular pressure (--(dP/dt)max), Time constant of ventricular isovolumic relaxation (tau) and Chamber stiffness (Kd), according to the changes of left ventricular pressure. The results obtained from the experiment of isolated rat hearts during ischemia/reperfusion have demonstrated the usefulness and validity of this method. Therefore, with the use of tau and Kd as indicators, this is a sensitive and effective method for evaluating the left ventricular diastolic function, and it can be applied to early detection of left ventricular diastolic dysfunction.
Algorithms ; Animals ; Blood Pressure ; Diastole ; Humans ; In Vitro Techniques ; Male ; Models, Cardiovascular ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; physiopathology ; Ventricular Dysfunction, Left ; diagnosis ; physiopathology ; Ventricular Function, Left ; physiology

In order to verify the hypothesis that left ventricular epicardial (LV-Epi) pacing and biventricular (BiV) pacing unavoidably influence the myocardial electrophysiological characters and may result in high risk of malignant ventricular arrhythmia, we calculated, in both normal mongrel dogs and dog models with rapid-right-ventricular-pacing induced dilated cardiomyopathy congestive heart failure (DCM-CHF), the monophasic action potential duration (MAPD) and the transmural dispersion of repolarization (TDR) in intracardiac electrogram together with the QT interval and T(peak)-T(end) (T(p(-T(e)) interval in surface electrocardiogram (ECG) during LV-Epi and BiV pacing, compared with those during right ventricular endocardial (RV-Endo) pacing. To prepare the DCM-CHF dog model, rapid right ventricular pacing (250 bpm) was performed for 23.6+/-2.57 days to the dog. All the normal and DCM-CHF dogs were given radio frequency catheter ablation (RFCA) to His bundle with the guide of X-ray fluoroscopy. After the RFCA procedures, the animals were under the situation of complete atrioventricular block so that the canine heart rates could be voluntarily controlled in the following experiments. After a thoracotomy, ECG and monophasic action potentials (MAP) of subendocardial, subepicardial and mid-layer myocardium were recorded synchronously in 8 normal and 5 DCM-CHF dogs during pacing from endocardium of RV apex (RV-Endo), epicardium of LV anterior wall (LV-Epi) and simultaneously both of the above (biventricular, BiV), the later was similar to the ventricular resynchronization therapy to congestive heart failure patients in clinic. The Tp-Te) meant the interval from the peak to the end of T wave, which was a representative index of TDR in surface ECG. The TDR was defined as the difference between the longest and the shortest MAPD of subendocardial, subepicardial and mid-layer myocardium. Our results showed that in normal dogs, pacing participating of LV (LV-Epi, BiV) prolonged MAPD of all the three layers of the myocardium (P<0.05) with the character that mid-layer MAPD was the longest and subepicardial MAPD was the shortest following subendocardial MAPD. At the same time, TDR prolonged from 26.75 ms at RV-Endo pacing to 37.54 ms at BiV pacing and to 47.16 ms at LV-Epi pacing (P<0.001). Meanwhile in surface ECG, BiV and LV-Epi pacing resulted in a longer Tp-Te) interval compared with RV-Endo pacing (P<0.01), without parallel QT interval prolongation. Furthermore, all the DCM-CHF model dogs showed manifestations of congestive heart failure and enlargement of left ventricles. Based on the lengthening of mid-layer MAPD from 257.35 ms to 276.30 ms (P<0.0001) and increase of TDR from 27.58 ms to 33.80 ms (P equals;0.002) in DCM-CHF model due to the structural disorders of myocardium compared with the normal dog, LV-Epi and BiV pacing also led to the effect of prolonging MAPD of three layers of the myocardium and enlarging TDR. From these results we make the conclusions that prolongation of MAPD of subendocardial, subepicardial and mid-layer myocardium and increase in TDR during pacing participating of LV (LV-Epi, BiV) may contribute to the formation of unidirectional block and reentry, which play roles or at least are the high risk factors in the development of malignant ventricular arrhythmia, especially in case of structural disorders of myocardium. These findings must be considered seriously when ventricular resynchronization therapy is performed to congestive heart failure patients.
Action Potentials ; Animals ; Bundle-Branch Block ; complications ; physiopathology ; Cardiomyopathy, Dilated ; complications ; physiopathology ; Dogs ; Female ; Heart Conduction System ; physiopathology ; Heart Failure ; etiology ; physiopathology ; Heart Ventricles ; physiopathology ; Male ; Torsades de Pointes ; physiopathology ; Ventricular Dysfunction, Left ; physiopathology ; Ventricular Function, Left

No abstract available.
Cardiomyopathy, Dilated/etiology/*pathology ; Endomyocardial Fibrosis/*radiography ; Gadolinium ; Heart Ventricles/*physiopathology ; Humans ; Magnetic Resonance Imaging/*methods ; Ventricular Dysfunction, Left/*physiopathology