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

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

INTRODUCTIONMyocardial infarction (MI) is common and affects a significant number of people annually. Death occurs due to either arrhythmia or heart failure. As leucocytosis, especially elevated neutrophil count, is a hallmark of inflammatory reactions in patients with MI, we investigated the relationship between leucocytosis on admission and left ventricular ejection fraction (LVEF) in patients with acute MI (AMI).

METHODSPatients with AMI were enrolled in a case-control study. Blood samples obtained in the first 24 hours after the onset of pain were analysed for cardiac enzyme levels and cell count. Echocardiography was performed on Days 3-5. Patients with LVEF < 45% were assigned to the left ventricular (LV) systolic dysfunction group (n = 69) and those with LVEF ≥ 45% were taken as controls (n = 69). All patients were matched for variables such as hypertension, diabetes mellitus, hyperlipidaemia, family history of cardiac disease, age and gender.

RESULTSLeucocytosis was higher in patients with systolic dysfunction (47.8%) when compared with the controls (20.3%), and was significantly associated with the development of LV systolic dysfunction (p = 0.001). Similarly, neutrophilia was more common in patients with systolic dysfunction than the controls (6.6% vs. 34.8%), and was significantly associated with LV systolic dysfunction (p < 0.001). Monocytosis was higher in the controls than the systolic dysfunction group (40.6% vs. 33.3%; p = 0.378).

CONCLUSIONLeucocytosis and neutrophilia in the acute phase of MI are important predictive factors for the development of LV systolic dysfunction. Leucocytosis can be used for risk stratification of such patients.

Aged ; Case-Control Studies ; Echocardiography ; methods ; Female ; Humans ; Inflammation ; Iran ; Leukocyte Count ; Leukocytosis ; complications ; diagnosis ; Male ; Middle Aged ; Myocardial Infarction ; complications ; diagnosis ; Risk ; Systole ; Ventricular Dysfunction, Left ; complications ; diagnosis ; Ventricular Function, Left

Adult ; Cardiology ; methods ; Cardiomyopathy, Dilated ; diagnosis ; mortality ; Female ; Humans ; Obstetrics ; methods ; Peripartum Period ; Pregnancy ; Pregnancy Complications, Cardiovascular ; diagnosis ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Puerperal Disorders ; diagnosis ; mortality ; Risk Factors ; Ventricular Dysfunction, Left ; diagnosis ; mortality

Idiopathic peripartum cardiomyopathy is an uncommon malady disease. Making the diagnosis is often difficult and it is always necessary to exclude other prior heart disease and other causes of left ventricular dysfunction in pregnant women. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are further amplified when the common complications of pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy. This may be aggravated by making a late diagnosis and providing inappropriate treatment. We experienced a 38-year-primigravida who has diagnosed with idiopathic peripartum cardiomyopathy and underwent elective cesarean section with general anesthesia.
Anesthesia ; Anesthesia, General ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cesarean Section ; Delayed Diagnosis ; Female ; Heart Diseases ; Heart Failure ; Humans ; Hypertrophy ; Peripartum Period ; Pregnancy ; Pregnancy Complications ; Pregnant Women ; Ventricular Dysfunction, 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

Many patients who survive an acute myocardial infarction (AMI) remain at risk of recurrent cardiac events and sudden cardiac death after discharge, despite optimal medical treatment. Assessment of the degree of left ventricular dysfunction and residual myocardial ischaemia is useful to identify the patients at greatest risk. In addition, there is increasing evidence that a number of other cardiovascular tests can be used to detect autonomic dysfunction and myocardial substrate abnormalities postAMI that increase the risk of life-threatening ventricular arrhythmias. These investigations include ECG-based tests (signal averaged ECG and T-wave alternans), Holter-based recordings (heart rate variability and heart rate turbulence) and imaging techniques (echocardiography and cardiac magnetic resonance), as well as invasive electrophysiological testing. This article reviews the current evidence for the use of these additional cardiac investigations among survivors of AMI to aid in their risk stratification for malignant ventricular arrhythmias and sudden cardiac death.
Age Factors ; Death, Sudden, Cardiac ; etiology ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Myocardial Infarction ; complications ; Risk Assessment ; Sex Factors ; Tachycardia, Ventricular ; complications ; diagnosis ; Ventricular Dysfunction, Left ; complications ; diagnosis

N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a useful marker for left ventricular (LV) dysfunction in patients without kidney disease. This study was conducted to clarify the relationship between NT-proBNP and LV systolic function in patients with decreased renal function. We studied 256 chronic kidney disease (CKD) patients, patients on dialysis were excluded. The median glomerular filtration rate was 24 (13-36) mL/min/1.73 m(2) and the median NT-proBNP was 4,849 (1,310- 19,009) pg/mL. The prevalence of LV systolic dysfunction increased from the lower to the upper NT-proBNP quartiles (I, 17%; II, 34%; III, 61%; and IV, 72%; p<0.001 for trend). The NT-proBNP quartile was an independent predictor of LV systolic dysfunction after adjustment for renal function, compared with quartile I: II, odds ratio (OR) 3.99 (95% confidence interval [CI],1.34-11.93); III, OR 11.28 (95% CI, 3.74-33.95); and IV, OR 36.97 (95% CI, 11.47-119.1). Area under the curve and optimum cut points for NT-proBNP to detect LV systolic dysfunction were 0.781 and 2,165 pg/mL in CKD stage 3, 0.812 and 4,740 pg/mL in CKD stage 4, and 0.745 and 15,892 pg/ mL in CKD stage 5. The NT-proBNP level was a predictor of LV systolic dysfunction in CKD patients. Optimum cut points should be stratified according to renal function.
Aged ; Area Under Curve ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/*complications/pathology ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Peptide Fragments/diagnostic use ; Prevalence ; Protein Structure, Tertiary ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/complications/diagnosis ; *Ventricular Function, Left

Little is known regarding long-term survival and changes in systolic function following surgery after the occurrence of a severe left ventricular (LV) dysfunction in patients with severe aortic stenosis. Inclusion criteria were an aortic valve area less than 1 cm2 and an LV ejection fraction (EF) less than 35%. Between January 1990 and July 2007, 41 (male: 30) patients were identified. The pre-operative mean EF and mean aortic valve area were 26.7+/-6.1% and 0.54+/-0.2 cm2, respectively. Concomitant coronary artery bypass surgery was performed in 8 patients (19.6%). Immediate post-operative echocardiogram showed to be much improved in LV EF (27.2+/-5.5 vs. 37.4+/-11.3, P<0.001), LV mass index (244.2+/-75.3 vs. 217.5+/-71.6, P=0.006), and diastolic LV internal diameter (62.5+/-9.3 vs. 55.8+/-9.6, P<0.001). Post-operative LV changes were mostly complete by 6 months, and were maintained thereafter. There was one in-hospital mortality (2.4%) and 12 late deaths including one patient diagnosed with malignancy in whom LV function was normal. Multivariate analysis showed pre-operative atrial fibrillation and NYHA FC IV to be significant risk factors for cardiac-related death. Aortic valve replacement in patients with significant aortic stenosis and severe LV dysfunction showed acceptable surgical outcomes. Moreover, LV function improved significantly in many patients.
Adult ; Aged ; Aortic Valve/*surgery ; Aortic Valve Stenosis/complications/*mortality/surgery ; Atrial Fibrillation/diagnosis ; Coronary Artery Bypass/methods ; Coronary Artery Disease/diagnosis ; Echocardiography ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Risk Factors ; Severity of Illness Index ; Treatment Outcome ; Ventricular Dysfunction, Left/complications/*mortality/surgery

OBJECTIVETo study the characteristics of the TCM syndrome and the changes of ventricular structure and function in heart failure (HF) rats after- myocardial infarction (MI).

METHODSRats were randomly divided in to the model group and the sham-operative group. The HF rat with MI model was induced by ligation of the left coronary artery. Eight weeks after operation, appraisal on TCM syndrome revealed in the model was made from the aspects of general status, breathing frequency, heart rate, exhausting swimming time and electrocardiogram, and left ventricular structure and function were observed with echocardiography.

RESULTSEight weeks after operation, as compared with those in the sham group, in the model group, the heart rate and breathing frequency were accelerated, the exhausting swimming time shortened, the echocardiogram parameters such as interventricular septum end-diastole thickness (IVSTd), posterior wall end-diastole thickness (PWTd), posterior wall end-systolic thickness (PWTs), ejection fraction (EF) and fractional shortening (FS) of the left ventricular reduced (P < 0.01), while left ventricular end-diastolic dimension (LVDd) and end-systolic dimension (LVDs) obviously increased (P < 0.01). In 12 leads electrocardiogram, the leads of ST segment elevated and abnormal Q wave increased. Additionally, the ratio of whole heart weight/body weight increased (P < 0.05).

CONCLUSIONThe HF rats after MI manifests Xin-qi deficiency and blood stasis syndrome, and shows the pathological changes of left ventricular remodeling and function impairment.

Animals ; Diagnosis, Differential ; Echocardiography, Doppler ; Heart Failure ; diagnosis ; diagnostic imaging ; etiology ; Male ; Medicine, Chinese Traditional ; Myocardial Infarction ; complications ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Syndrome ; Ventricular Dysfunction, Left ; diagnosis ; diagnostic imaging ; etiology