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

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

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

BACKGROUNDAmong patients with advanced multivessel coronary disease, left ventricular (LV) function is widely variable, and clinical and angiographic correlates of ventricular dysfunction remain to be defined.

METHODSAmong 73 339 patients undergoing diagnostic cardiac catheterization at a single center in China, patients with left ventriculographic assessment were identified with three-vessel coronary disease with or without left main involvement. Clinical and angiographic characteristics were examined among patients with normal or varying extent of LV dysfunction, and predictors of LV impairment (ejection fraction (EF): < 25%, 25% - 40% or > 40%) were determined.

RESULTSAmong 11 950 patients identified with three-vessel coronary disease, the sample distribution of LVEF was > 40%, n = 10 776; 25% - 40%, n = 948; < 25%, n = 226. Patients with reduced LV function (< 40%) more commonly were male and had a history of myocardial infarction (MI), diabetes or unstable angina. Hypertension was more frequent in those with LVEF ≥ 40%. In a multivariate Logistic regression analysis, prior MI (odds ratio (OR), 3.37; 95% confidence interval (CI), 2.96 - 3.84) was most predictive of LVEF < 40%, followed by male gender, diabetes, and presentation with unstable angina. For LVEF < 25%, only prior MI was identified as a significant correlate of severe LV dysfunction (OR 4.06, 95%CI 3.06 - 5.39). Following exclusion of patients with previous MI (n = 7416), male gender and diabetes were predictive of LVEF < 40%, yet presentation with unstable angina was the only factor significantly associated with LVEF < 25%.

CONCLUSIONAmong individuals identified with three-vessel coronary disease with or without left main involvement, previous MI was the most significant risk factor of LV dysfunction.

Aged ; Coronary Angiography ; Coronary Disease ; pathology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; pathology ; physiopathology

OBJECTIVETo evaluate the accuracy of the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e') measured by dual Doppler echocardiography in the diagnosis of diastolic dysfunction.

METHODSSeventy-seven coronary heart disease patients with preserved systolic function underwent a echocardiographic study. Early transmitral flow velocity E and early diastolic mitral annular velocity e' were simultaneously recorded by dual Doppler echocardiography. The E/e' and TE-e' were calculated and compared with the left ventricular end diastolic pressure (LVEDP), which was measured invasively. The validity of TE-e', E/e' and their combination was analyzed in estimating left ventricular dysfunction (LVEDP ≥12 mmHg).

RESULTSThe single-beat E/e' and TE-e' were correlated with the LVEDP (r=0.79 and 0.42, respectively, P<0.001). Receiver-operating characteristic analysis showed that the optimal cut-off for TE-e' was 38 ms (sensitivity 54%, specificity 79%, AUC 0.71) and that for E/e' was 9.2 (sensitivity 74%, specificity 81%, AUC 0.87) for diagnosis of left ventricular diastolic dysfunction. The combined cut-offs of TE-e'≥38 ms and E/e'≥9.2 had a sensitivity of 100% and a specificity of 62% in diagnosing left ventricular diastolic dysfunction with an AUC of 0.96.

CONCLUSIONIn patients with coronary heart disease, the simultaneous recording of TE-e' by dual Doppler echocardiography can accurately estimate diastolic dysfunction, and its combination with E/e' can further improve the diagnostic accuracy.

Aged ; Coronary Disease ; diagnostic imaging ; physiopathology ; Echocardiography, Doppler, Pulsed ; Female ; Humans ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; diagnostic imaging ; physiopathology