The present study aimed to investigate the impact of hypothyroidism on left ventricular systolic function using real-time three-dimensional speckle tracking imaging (RT3D-STI). Thirty hypothyroidism patients and forty healthy volunteers were recruited and received RT3DSTI measurement of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS). A comparison of differences between the hypothyroidism patients and those in the healthy group was carried out and we obtained the results as followings. The values of GLS were (-18.93 +/- 3.89) vs. (-21.44 +/- 1.99), with P < 0.01, GRS were (51.13 +/- 11.95) vs. (56.10 +/- 5.76), with P < 0.0; and GAS were (-31.63 +/- 5.38) vs. (-34.40 +/- 2.32), with P < 0.01, i.e. they were lower in hypothyroidism group than those in the health group. While GCS were (-17.75 +/- 1.92) vs. 17.03 +/- 3.45), with P > 0.05, which were not significantly different between the two groups. In linear regres sion, GLS showed significant correlation with both TSH (b = -0.69, P < 0.01) and FT3 (b = 0.71, P < 0.01). Meanwhile, the GRS (b = 2.98, P < 0.05) and GAS (b = 3.11, P < 0.05) linearly correlated with FT3 level. In conclusion, the present study shows that the global longitudinal and radial moves of left ventricular are weaker in patients with hypothyroidism than healthy controls. And the impairment of left ventricular function would aggravate as FSH rises or FT3 declines.
Case-Control Studies ; Echocardiography, Three-Dimensional ; Heart Ventricles ; physiopathology ; Humans ; Hypothyroidism ; complications ; Imaging, Three-Dimensional ; Reproducibility of Results ; Systole ; Ventricular Dysfunction, Left ; complications ; diagnosis ; Ventricular Function, Left

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

Tei-Index is a useful echocardiographic parameter for evaluating global cardiac function. Conventionally, a value and b value, which the calculation of Tei index is based on, are measured in different cardiac cycle. Therefore, accuracy of Tei index is damaged by cycle dependent variation, especially in patients with arrhythmia. The newly established Dual Doppler modality allows a synchronous measurement of both a value and b value. This study was aimed to explore the value of Tei index measured by Dual Doppler in cardiac function estimation in patients with hypertension. One hundred and forty patients with hypertension were recuited and divided into three groups according to cardiac function. The a value and b value were generated from the transmitral and transaortic flow spectrum of the same cardiac cyle by Dual Doppler modality. The results showed that Tei index was significantly higher in the cardiac dysfunction group than in the control group. There was a high correlation between Tei index and NYHA cardiac performance. Tei index measured by Dual Doppler modality is a highly reproducible parameter with high sensitivity and specificity for cardiac function estimation, even for patients with arrthymia.
Adult ; Aged ; Echocardiography, Doppler, Color ; Female ; Humans ; Hypertension ; complications ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; diagnosis ; etiology ; physiopathology ; Ventricular Function ; Young Adult

INTRODUCTIONThe maximal rate of change of pressure-normalised wall stress dσ*/dtmax has been proposed as cardiac index of left ventricular (LV) contractility. In this study, we assessed the capacity of dσ*/dtmax to diagnose heart failure with normal ejection fraction (HFNEF).

MATERIALS AND METHODSOne hundred healthy normal controls and 140 patients admitted with heart failure (100, HFREF and 40, HFNEF) underwent echocardiography for stress-based contractility dσ*/dtmax. Patients with signifi cant valvular heart disease were excluded. Tissue Doppler indices were also measured.

RESULTSdσ*/dtmax was 4.43 ± 1.27 s-1 in control subjects; reduced in HFNEF, 3.02 ± 0.98 s-1; and HFREF, 2.00 ± 0.67 s-1 (P <0.001). In comparison with age- and sex-matched groups (n = 26 each), we found similar trend on reduction of dσ*/dtmax (normal control; 3.91 ± 0.87 s-1; HFNEF, 2.90 ± 0.84 s-1; HFREF, 1.84 ± 0.59 s-1, P <0.001). On multivariate analysis, dσ*/dtmax was found to be the independent predictor of HFNEF and HFREF. The area under the curve of the receiver operating characteristics (ROC) in detecting HFNEF compared with normal controls (dσ*/dtmax>3.2 s-1) was 0.84 (P <0.0001), and in detecting HFREF compared with HFNEF (dσ*/dtmax>2.32 s-1) was 0.88 (P <0.0001).

CONCLUSIONThis data confi rms that dσ*/dtmax on echocardiography is a powerful independent predictor in patients with HFNEF. In a population with a high suspicion of HFNEF, dσ*/dtmax may significantly contribute to early diagnosis and hence be useful in the triage and management of HFNEF patients.

Adult ; Aged ; Echocardiography ; Female ; Heart Failure ; complications ; diagnostic imaging ; physiopathology ; Hemodynamics ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; ROC Curve ; Stroke Volume ; Ventricular Dysfunction, Left ; complications ; diagnostic imaging ; physiopathology

PURPOSE: Symptoms of postmyocardial infarction (post-MI) patients at risk for progression to heart failure are often ignored, and lack of symptom recognition or misinterpretation may diminish health-related quality of life (HRQoL). This study was conducted to evaluate the differences in HRQoL by symptom experience and determine factors that predict diminished HRQoL in post-MI patients. METHODS: Using a descriptive correlational study design, post-MI patients with left ventricular dysfunction (ejection fraction < 50%) completed face-to-face interviews for symptoms, HRQoL, covariates including self-care compliance, New York Heart Association class, and demographic and clinical questionnaires. RESULTS: A total of 105 post-MI patients participated (mean age 65 years, 79.0% male, mean ejection fraction 43.6%, New York Heart Association class III/IV 33.3%). Mean length of time after the cardiac event was 48 months. Patients reported four or more symptoms, with fatigue being the most common symptom (63.8%), followed by shortness of breath (56.2%), weakness (54.3%), and dizziness (51.4%). HRQoL was moderately poor, with a mean score of 44.38 +/- 27.66. There was no significant relationship between self-care compliance and HRQoL. Patients who were female, with low monthly income, and had lower functional capacity and more symptoms had worse HRQoL, after controlling for age and length of time after the event (adjusted R2 = 0.53, p < .001). CONCLUSIONS: A need for transitional care that assists post-MI patients take an active involvement in symptom monitoring arises so that they can get into the system earlier and benefit from treatment, and eventually achieve desirable HRQoL.
Adult ; Aged ; Aged, 80 and over ; Female ; *Health Status ; Humans ; Male ; Middle Aged ; Myocardial Infarction/complications/*physiopathology ; *Quality of Life ; Risk Factors ; Surveys and Questionnaires ; Ventricular Dysfunction, Left/complications/*physiopathology

OBJECTIVETo determine the prevalence of sleep disordered breathing (SDB) in elderly patients with chronic congestive heart failure (CHF) and explore the relations between SDB and left ventricular function.

METHODSBy means of polysomnography, 56 elderly patients with CHF were divided into non-SDB, mild SDB, moderate SDB, and severe SDB groups, and the left ventricular ejection fraction (LVEF) was measure by (99)Tc equilibrium radionuclide angiography.

RESULTSIn the 56 elderly patients with CHF, 38 (67.9%) had SDB, including 12 (21.4%) mild SDB, 14 (25.0%) moderate SDB, and 12 (21.4%) severe SDB patients. Thirty (53.6%) of the 56 patients with CHF had obstructive sleep apnea (OSA), 4 (7.1%) had central sleep apnea and 22 (39.2%) had mixed sleep apnea. The moderate and severe SDB groups had lower minimum arterial oxyhemoglobin saturation during sleep than the non-SDB groups, and the apnea-hyponea index was closely related to LVEF (r=-0.74, P<0.01).

CONCLUSIONThe prevalence of SDB, predominantly OSA, is high in elderly patients with CHF. Moderate and severe SDB might affect the left ventricular function in these patients, who require polysomnography monitoring.

Aged ; Aged, 80 and over ; China ; epidemiology ; Chronic Disease ; Female ; Heart Failure ; complications ; physiopathology ; Humans ; Male ; Middle Aged ; Polysomnography ; Sleep Apnea Syndromes ; complications ; epidemiology ; Ventricular Dysfunction, Left ; physiopathology

OBJECTIVETo evaluate the left ventricular systolic asynchrony in patients with uremic myocardiopathy (UM) using tissue synchronization imaging (TSI).

METHODSUltrasound system with TSI and Q-analyze software were used. Thirty-five patients with UM were enrolled in the study,and thirty normal subjects were included as the control group.

RESULTThe total and mean time to peak velocity (Tc) corrected by the heart rate of all segments in UM group were longer than those in the control group (P<0.05), and the time to peak velocity of most segments in UM group was also longer (P<0.05). Delayed time to peak velocity was found in 175 (175/420) segments in UM group and left ventricular systolic asynchrony was detected in 65.7% (23/35).

CONCLUSIONTSI can detect the ventricular systolic asynchrony in patients with uremic myocardiopathy and provide reliable parameters for clinical management.

Adult ; Cardiomyopathies ; etiology ; physiopathology ; Case-Control Studies ; Echocardiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Systole ; physiology ; Uremia ; complications ; Ventricular Dysfunction, Left ; diagnostic imaging ; physiopathology

Intraventricular hydrodynamics is considered an important component of cardiac function assessment. Vector flow mapping (VFM) is a novel flow visualization method to describe cardiac pathophysiological condition. This study examined use of new VFM and flow field for assessment of left ventricular (LV) systolic hemodynamics in patients with simple hyperthyroidism (HT). Thirty-seven simple HT patients were enrolled as HT group, and 38 gender- and age-matched healthy volunteers as control group. VFM model was used to analyze LV flow field at LV apical long-axis view. The following flow parameters were measured, including peak systolic velocity (Vs), peak systolic flow (Fs), total systolic negative flow (SQ) in LV basal, middle and apical level, velocity gradient from the apex to the aortic valve (ΔV), and velocity according to half distance (V1/2). The velocity vector in the LV cavity, stream line and vortex distribution in the two groups were observed. The results showed that there were no significant differences in the conventional parameters such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and left atrium diameter (LAD) between HT group and control group (P>0.05). Compared with the control group, a brighter flow and more vortexes were detected in HT group. Non-uniform distribution occurred in the LV flow field, and the stream lines were discontinuous in HT group. The values of Vs and Fs in three levels, SQ in middle and basal levels, ΔV and V1/2 were higher in HT group than in control group (P<0.01). ΔV was positively correlated with serum free thyroxin (FT4) (r=0.48, P<0.01). Stepwise multiple regression analysis showed that LVEDD, FT4, and body surface area (BSA) were the influence factors of ΔV. The unstable left ventricular systolic hydrodynamics increased in a compensatory manner in simple HT patients. The present study indicated that VFM may be used for early detection of abnormal ventricle contraction in clinical settings.
Adult ; Echocardiography, Doppler, Color ; methods ; Female ; Humans ; Hyperthyroidism ; complications ; diagnostic imaging ; physiopathology ; Image Interpretation, Computer-Assisted ; methods ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; diagnosis ; physiopathology ; Ventricular Function, Left ; Young Adult

OBJECTIVETo evaluate the relationship between myocardial systolic, diastolic functions and perfusion in coronary artery stenosis using velocity vector imaging (VVI) and myocardial contrast echocardiography (MCE).

METHODSStenoses in the anterior descending branch of the coronary artery were induced in 8 dogs. Before and after coronary artery stenosis, two-dimensional images of the left ventricular mastoid muscle section on the short axis at rest and in the peak dose of dobutamine were obtained for evaluation of VVI and MCE. The myocardial blood flow A.beta values, peak systolic strain rate (SRsys) and peak diastolic strain rate (SRdia) in the direction of the circumference of the short axis were measured.

RESULTSAt rest, only severe coronary stenosis resulted in significantly lowered SRsys, SRdia and A.beta value of the stenotic bed compared to the values before the stenosis (-1.1-/+0.50 vs -1.62-/+0.50, 1.19-/+0.48 vs 1.75-/+0.51, 0.4-/+0.21 vs 0.80-/+0.47, P<0.05). In stress, SRsys, SRdia and A.beta value of the stenotic bed gradually decreased as coronary stenosis worsened (-4.31-/+1.14 vs -3.20-/+0.98 vs -1.18-/+0.64, 4.51-/+1.13 vs 3.39-/+0.98 vs 1.37-/+0.64. 3.54-/+1.95 vs 1.81-/+0.89 vs 0.82-/+0.42, P<0.05). Both at rest and in stress, good correlations were noted between SRsys and SRdia (r(rest)=0.88, r(stress)=0.96, P<0.01), between SRsys and the standard A.beta values (r(rest)0.56, r(stress)=0.71, P<0.01), and between SRdia and A.beta (r(rest)=0.57, r(stress)=0.72, P<0.01) in the direction of the circumference of the short axis.

CONCLUSIONSUsing VVI and MCE, the changes in myocardial perfusion and the systolic and diastolic functions in the direction of the circumference can be observed dynamically. VVI may help assess the condition of myocardial perfusion by evaluating the systolic and diastolic function.

Animals ; Blood Flow Velocity ; physiology ; Coronary Circulation ; Coronary Stenosis ; complications ; diagnostic imaging ; physiopathology ; Diastole ; Dogs ; Echocardiography ; methods ; Female ; Male ; Myocardial Contraction ; Ventricular Dysfunction, Left ; diagnostic imaging ; etiology ; physiopathology ; Ventricular Function, Left ; physiology

Our study was aimed to evaluate the left ventricular (LV) global longitudinal systolic function of patients with diabetes mellitus (DM) using real-time three-plane speckle tracking imaging (RT-3P STI). The case group was the patients of type 2 DM with normal LV ejection fraction (EF). Then according to glycated hemoglobin (HbAlc) control level, the case group was divided into two groups, including DM1 (HbAlc<7%, n=31) and DM2 (HbAlc >or=7%, n= 37); 63 matched volunteers were chosen as control group. Conventional measurements of the LV size and function were performed. We then applied the automatic function imaging to analyze the global longitudinal systolic peak strain (GLPS) of the three apical views online, including the GLPS of apical four chamber view (GLPS-A4C), the GLPS of apical two chamber view (GLPS-A2C), the GLPS of apical long axis view (GLPS-LAX), and then generating the average GLPS (GLPS-Avg). The experimental results showed that there was no statistical difference in clinical baseline characteristics among the three groups (P>0.05). However, there were statistical differences in the ventricular wall thickness and the LV mass index of the DM1 and DM2 groups compared with that of the control (P<0. 05). No significant differences were found in LV diameters, volumes, LVEF among the three studied groups (P>0. 05). We also found significant differences in GLPS-LAX, GLPS-A2C, GLPS-Avg when we compared DM2 group with those of the DM1 group or the control (P<0. 05). We found a statistical difference in GLPS-A4C only when we compared the DM2 group with the control(P<0. 05), and no statistical difference in the strains of the three views between DM1 group and control (P>0. 05). RT-3P STI could not only accurately be used to evaluate the LV global longitudinal systolic function, but could also reflect the reduction of sub-clilical systolic function in DM patients with poor blood glucose control in the early stage.
Aged ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; complications ; diagnostic imaging ; physiopathology ; Echocardiography, Three-Dimensional ; methods ; Female ; Heart Ventricles ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Myocardial Contraction ; physiology ; Stroke Volume ; Systole ; Ventricular Dysfunction, Left ; diagnostic imaging ; etiology ; Ventricular Function, Left