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Introduction: Neonatal Respiratory Distress Syndrome (RDS) is a major cause of foetal mortality and morbidity, especially in preterm labour because of concerns about foetal lung maturity. One of the method to assess foetal lung maturity is the Doppler assessment of the foetal Pulmonary Artery. Aim: To assess the accuracy of Doppler findings of the foetal Main Pulmonary Artery (MPA) in foetal lung maturity assessment and prediction of the development of neonatal RDS in preterm deliveries. Materials and Methods: A prospective observational study was conducted in the Department of Radiology, along with the Departments of Obstetrics and the Department of Paediatrics of Rama Medical College, Hospital, and Research Institute in Kanpur, India from May 2022 to December 2022. A total of 76 pregnant women with singleton pregnancies and gestational age <37 weeks were included. Clinical history and relevant clinical examination data were collected from the patients. Ultrasound examination began with a general survey of the gestational sac, foetal biometry, detailed anatomical evaluation for any evident anomalies, and then cardiac evaluation. The Doppler waveform of the MPA was confirmed by its characteristic 'spike and dome pattern'. It was distinguished from the ductus arteriosus waveform, as it shows a triangular waveform with increased diastolic flow. Acceleration Time (AT) was measured from the start of the systolic wave to the first systolic peak. Ejection Time (ET) measurement included the entire systolic wave. The diagnosis of RDS was made by the paediatrician, who was blinded to the Doppler findings. Receiver Operating Characteristic (ROC) curves were drawn using Statistical Package for the Social Sciences (SPSS) software to assess the diagnostic ability of the Doppler findings and to find the cut-off values with maximum sensitivity and specificity. Results: Out of the 76 pregnant women included in this study, 14 were excluded due to inadequate Doppler measurements and not being able to give birth within one week of Doppler evaluation. The study assessed a total of 62 pregnant females who underwent preterm delivery following the Doppler study. In total, 28 neonates developed RDS. Doppler parameters of both groups were compared (the first group included pregnant women whose neonates developed RDS after birth, and the second group included pregnant women whose neonates didn't develop RDS after birth) with the help of the ROC curve. The AT/ET ratio achieved the highest sensitivity and specificity, both at 82%. Conclusion: The AT/ET ratio has produced the best results among all foetal pulmonary artery-derived Doppler parameters and is a promising non invasive method for assessing foetal lung maturity. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal Respiratory Distress Syndrome (RDS) is a major cause of foetal mortality and morbidity, especially in preterm labour because of concerns about foetal lung maturity. One of the method to assess foetal lung maturity is the Doppler assessment of the foetal Pulmonary Artery. Aim: To assess the accuracy of Doppler findings of the foetal Main Pulmonary Artery (MPA) in foetal lung maturity assessment and prediction of the development of neonatal RDS in preterm deliveries. Materials and Methods: A prospective observational study was conducted in the Department of Radiology, along with the Departments of Obstetrics and the Department of Paediatrics of Rama Medical College, Hospital, and Research Institute in Kanpur, India from May 2022 to December 2022. A total of 76 pregnant women with singleton pregnancies and gestational age

Introduction: Aortic stenosis (AS) is considered severe when the aortic valve area (AVA) is < 1.0 cm² and the mean aortic valve gradient (mAVG) exceeds 40 mm Hg. Since many patients with AVA < 1.0 cm² do not manifest an mAVG > 40 mm Hg, we sought to determine the AVA at which mAVG tends to exceed 40 mm Hg in a sample of subjects with varied transvalvular flow rates. Material and methods: Our echocardiography database was queried for subjects with native valve AS. We selected 200 subjects with an AVA < 1.0 cm². The sample was selected to include subjects with varied mean systolic flow (MSF) rates. Linear regression was performed to determine the relationship between MSF and mAVG. Since this relationship varied by AVA, the regression was stratified by AVA (critical < 0.6 cm², severe 0.6-0.79 cm², moderately severe 0.8-0.99 cm²). Results: The study sample was 79 ±12 years old and was 60% female. The MSF rate at which mAVG tended to exceed 40 mm Hg was 120 ml/s for critical AVA, 183 ml/s for severe AVA and 257 ml/s for moderately severe AVA. Those with moderately severe AVA rarely (8%) had an mAVG > 40 mm Hg at a wide range of MSF. In contrast, those with severe AVA typically (75%) had mAVG > 40 mm Hg when MSF was normal (> 200 ml/s). Those with critical AVA frequently (44%) had mAVG > 40 mm Hg, even when MSF was reduced. Conclusions: Subjects with AVA of 0.8 and 0.9 cm² rarely had mAVG > 40 mm Hg, even when the transvalvular flow rate was normal. Using current guidelines, it is not clear if such cases should be classified as severe. [ABSTRACT FROM AUTHOR]

Introduction: Autoinflammation and increase in free oxygen radicals due to maternal familial mediterranean fever (FMF) may affect fetal lung maturation and cause changes in fetal pulmonary artery Doppler parameters. We aimed to investigate the fetal pulmonary artery acceleration time/ejection time (PATET) ratio in the pregnancies complicated with familial mediterranean fever (FMF). Methods: This cross-sectional study included 32 pregnant women with FMF, and 64 gestational ages matched healthy pregnant women, between the 29-30 gestational weeks. Maternal characteristics and fetal ultrasonographic information were recorded. Fetal pulmonary artery acceleration time (AT) and ejection time (ET) were measured manually and PATET ratio were calculated in the study groups. The duration of the disease and the AT and PATET measurements were analyzed with the Pearson correlation test. Results: The study groups were similar in terms of maternal characteristics, gravidity, parity and gestational week at the time of examination. AT and ET values were found to be significantly shorter and PATET (AT/ET) was found to be significantly lower in pregnant women complicated with FMF. A moderately significant negative correlation was found between the time elapsed since FMF diagnosis and fetal pulmonary artery acceleration time. (r=-.566, p=.001) and PATET (r=-.533, p=.002) Conclusion: This is the first study to investigate the fetal pulmonary artery Doppler indices in the pregnancies with FMF. In the presented study, it was shown that FMF significantly shortened the fetal pulmonary acceleration and ejection time and significantly reduced the PATET ratio. In addition, as the time elapsed from the diagnosis of the disease increased, it was shown that the shortening in AT and the decrease in PATET were higher, with a significant moderate negative correlation between the duration of the disease and these values. [ABSTRACT FROM AUTHOR]

Background: Ejection time (ET), acceleration time (AT) and time between left ventricular and aortic systolic pressure peaks (T-LVAo) might be of diagnostic and prognostic use in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Aim: We aimed to assess the diagnostic value and prognostic impact of invasively measured ET, AT, and T-LVAo in patients undergoing TAVI. Methods: A total of 1274 patients received invasive measurement of ET, AT and T-LVAo prior to TAVI. Anatomic AS severity was assessed by CT-derived aortic valve calcification density (AVCd). Impact on all-cause mortality was retrospectively analyzed. Results: In multivariable linear regression, T-LVAo showed the strongest correlation with AVCd. No prognostic impact of T-LVAo was found according to uni- and multivariable analyses. In contrast, using an individual C-statistic derived cutoff (CD), patients with ET or AT ≥ CD showed lower mortality rates compared to patients with ET or AT < CD (1-year mortality: ET ≥ vs. < CD: 15.01vs. 33.1%, AT ≥ vs < CD 16.3 vs. 26.5%, p < 0.001). Moreover, multivariable analysis identified ET ≥ CD (HR 0.61 [95% CI 0.43–0.87; p < 0.007]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters. Conclusion: Among the studied hemodynamic parameters T-LVAo provides the highest diagnostic value, whereas ET is an outcome predictor beyond clinical risk factors and echocardiographic parameters in AS patients following TAVI. These parameters could be of considerable use in diagnostic evaluation and risk assessment of patients scheduled for TAVI. T-LVAo (yellow): defined as time between left ventricular and aortic systolic pressure peaks. ET (green): Ejection Time defined as time from the start to flow end. AT (orange): Acceleration time defined as time from the start to the peak flow. AOP: aortic pressure, AVC: aortic valve calcification, CI: confidence interval, HGAS: high-gradient aortic stenosis, LGAS: low-gradient aortic stenosis, LVP: left ventricular pressure, SD: standard deviation. [ABSTRACT FROM AUTHOR]

To assess the epicardial fat thickness (EFT) and modified myocardial performance index (Mod-MPI) measurements in fetuses at pregnant women with preterm prelabor rupture of membranes (pPROM) and compare them to healthy pregnant women's fetuses. Forty patients who presented to our clinic at 24–36 + 6 gestational weeks and were diagnosed with pPROM were included in the patient group. During the same period, 40 healthy pregnant women at similar gestational weeks were randomly selected as the control group. The pPROM and control groups were similar in terms of demographics. In the pPROM group, EFT, Mod-MPI, and isovolumetric contraction(ICT) and relaxation times(IRT) were significantly higher and ejection time (ET) was significantly lower compared to the control group. In addition, Mod-MPI z-scores, IRT z-scores, ICT z-scores were significantly higher and ET z-scores was significantly lower in the pPROM. According to the ROC analysis, the optimal cutoff value of EFT was calculated as 1.55 mm, with 68% sensitivity and 71% specificity (AUC: 0.718, 95% CI: 0.550–0.786, p =.018) for predicting NICU requirement and the optimal cutoff value of EFT was calculated as 1.55 mm with 72% sensitivity and 73% specificity (AUC: 0.726, 95% CI: 0.556–0.896, p =.015) for predicting medication use in the pPROM group. This study revealed differences in the EFT and Mod-MPI measurements of the fetuses of pregnant women with pPROM. Considering that EFT is an important energy source for the myocardium, as well as an endocrine structure in which inflammatory and anti-inflammatory markers are secreted, it is recommended to be evaluated in inflammatory conditions such as pPROM. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study was to determine whether pulmonary artery acceleration time (AT) to ejection time (ET) ratio (PATET) was altered in fetuses of mothers with intrahepatic cholestasis of pregnancy (IHCP). The secondary aim was to investigate the association between fetal pulmonary artery Doppler parameters with neonatal outcomes in pregnancies complicated by IHCP. Material and methods: This prospective case control study was conducted in a tertiary perinatal-neonatal center. A total of 18 fetuses whose mothers' pregnancies were complicated by IHCP were included as the study group and a total of 37 fetuses of mothers with healthy pregnancies were selected as controls. Fetal pulmonary artery Doppler parameters (AT; ET; AT/ET ratio) were assessed and neonatal outcomes were evaluated. Results: Mean pulmonary artery AT, ET and PATET were significantly different between the groups (p=0.001, p=0.024 and p=0.003, respectively). The mean PATET value in the IHCP group was 0.217±0.029 while in the control group it was 0.180±0.020. While PATET values were correlated with gestational age at birth, respiratory distress and need for neonatal intensive care admission were not correlated with PATET. Conclusion: Higher values of PATET may be a useful biomarker of fetal lung damage, secondary to IHCP. [ABSTRACT FROM AUTHOR]

Introduction Aortic stenosis (AS) is considered severe when the aortic valve area (AVA) is < 1.0 cm 2 and the mean aortic valve gradient (mAVG) exceeds 40 mm Hg. Since many patients with AVA < 1.0 cm 2 do not manifest an mAVG > 40 mm Hg, we sought to determine the AVA at which mAVG tends to exceed 40 mm Hg in a sample of subjects with varied transvalvular flow rates. Material and methods Our echocardiography database was queried for subjects with native valve AS. We selected 200 subjects with an AVA < 1.0 cm 2 . The sample was selected to include subjects with varied mean systolic flow (MSF) rates. Linear regression was performed to determine the relationship between MSF and mAVG. Since this relationship varied by AVA, the regression was stratified by AVA (critical < 0.6 cm 2 , severe 0.6–0.79 cm 2 , moderately severe 0.8–0.99 cm 2 ). Results The study sample was 79 ±12 years old and was 60% female. The MSF rate at which mAVG tended to exceed 40 mm Hg was 120 ml/s for critical AVA, 183 ml/s for severe AVA and 257 ml/s for moderately severe AVA. Those with moderately severe AVA rarely (8%) had an mAVG > 40 mm Hg at a wide range of MSF. In contrast, those with severe AVA typically (75%) had mAVG > 40 mm Hg when MSF was normal (> 200 ml/s). Those with critical AVA frequently (44%) had mAVG > 40 mm Hg, even when MSF was reduced. Conclusions Subjects with AVA of 0.8 and 0.9 cm 2 rarely had mAVG > 40 mm Hg, even when the transvalvular flow rate was normal. Using current guidelines, it is not clear if such cases should be classified as severe.

Aims: The assessment of aortic stenosis (AS) severity is still challenging, especially in abnormal hemodynamic conditions. Left ventricular ejection time (LVET) has been historically related to AS severity, but it also depends on heart rate (HR) and systolic function. Our aim was to verify if correcting LVET (LVET index, LVETI) by its determinants is helpful for the assessment of AS severity, irrespective of hemodynamic conditions. Methods and results: We retrospectively studied 152 patients with AS and 378 patients with heart failure and no-AS. At multivariate analysis, LVET (assessed with pulsed-wave Doppler) showed a strong correlation with stroke volume index (SVI) (Beta 0.354; p < 0.001), HR (−0.385; p < 0.001), AS grade (Beta 0.301; p < 0.001) and, less significantly, ejection fraction (LVEF) (Beta 0.108; p = 0.001). AS grade was confirmed to be a major determinant of LVET, irrespective of forward flow (assessed by SVI and transvalvular flow rate) and LVEF (above and below 50%). A regression equation was derived to index LVET (LVETI) to HR and SVI. By using this formula, LVETI detected severe AS more accurately (AUC 0.812, p < 0.001) than LVET alone (AUC 0.755, p for difference = 0.005). Similar results were observed in patients with abnormal flow status. As an exploratory finding, we observed that the highest tertile of LVETI was associated with a higher rate of aortic valve interventions during follow-up. Conclusions: LVETI correlates with AS severity better than uncorrected LVET, independently from hemodynamic conditions, and may help to discriminate severe AS. This finding needs confirmation in larger prospective multicenter studies. [ABSTRACT FROM AUTHOR]

Objectives: Fetal cardiac function can be evaluated using a variety of parameters. Among these, cardiac cycle time‐related parameters, such as filling time fraction (FTF) and ejection time fraction (ETF), are promising but rarely studied. We aimed to report the feasibility and reproducibility of fetal FTF and ETF measurements using pulsed‐wave Doppler, to provide reference ranges for fetal FTF and ETF, after evaluating their relationship with heart rate (HR), gestational age (GA) and estimated fetal weight (EFW), and to evaluate their potential clinical utility in selected fetal conditions. Methods: This study included a low‐risk prospective cohort of singleton pregnancies and a high‐risk population of fetuses with severe twin–twin transfusion syndrome (TTTS), aortic stenosis (AoS) or aortic coarctation (CoA), from 18 to 41 weeks' gestation. Left ventricular (LV) and right ventricular inflow and outflow pulsed‐wave Doppler signals were analyzed, using valve clicks as landmarks. FTF was calculated as: (filling time/cycle time) × 100. ETF was calculated as: (ejection time/cycle time) × 100. Intraclass correlation coefficients (ICC) were used to evaluate the intra‐ and interobserver reproducibility of FTF and ETF measurements in low‐risk fetuses. The relationships of FTF and ETF with HR, GA and EFW were evaluated using multivariate regression analysis. Reference ranges for FTF and ETF were then constructed using the low‐risk population. Z‐scores of FTF and ETF in the high‐risk fetuses were calculated and analyzed. Results: In total, 602 low‐risk singleton pregnancies and 54 high‐risk fetuses (nine pairs of monochorionic twins with severe TTTS, 16 fetuses with AoS and 20 fetuses with CoA) were included. Adequate Doppler traces for FTF and ETF could be obtained in 95% of low‐risk cases. Intraobserver reproducibility was good to excellent (ICC, 0.831–0.905) and interobserver reproducibility was good (ICC, 0.801–0.837) for measurements of all timing parameters analyzed. Multivariate analysis of FTF and ETF in relation to HR, GA and EFW in low‐risk fetuses identified HR as the only variable predictive of FTF, while ETF was dependent on both HR and GA. FTF increased with decreasing HR in low‐risk fetuses, while ETF showed the opposite behavior, decreasing with decreasing HR. Most recipient twins with severe TTTS showed reduced FTF and preserved ETF. AoS was associated with decreased FTF and increased ETF in the LV, with seemingly different patterns associated with univentricular vs biventricular postnatal outcome. The majority of fetuses with CoA had FTF and ETF within the normal range in both ventricles. Conclusions: Measurement of FTF and ETF using pulsed‐wave Doppler is feasible and reproducible in the fetus. The presented reference ranges account for associations of FTF with HR and of ETF with HR and GA. These time fractions are potentially useful for clinical monitoring of cardiac function in severe TTTS, AoS and other fetal conditions overloading the heart. © 2020 International Society of Ultrasound in Obstetrics and Gynecology [ABSTRACT FROM AUTHOR]

Radial applanation tonometry is a well-established method for clinical hemodynamic assessment and is also becoming popular in wrist-worn fitness trackers. The time difference between the foot and the dicrotic notch of the arterial pressure waveform is a well-accepted approximation for the left ventricular ejection time (ET). However, several clinical studies have shown that ET measured from the radial pressure waveform deviates from that measured centrally. In this work, we consider the systolic wave and the dicrotic wave as two independent traveling waves and hypothesize that their wave speed difference leads to the intersite differences of measured ET (DET). Accordingly, we derived a mathematical dicrotic wave decomposition model and identified the most influential factors on DET via global sensitivity analysis. In our clinical validation on a heterogeneous cohort (N = 5,742) from the Framingham Heart Study (FHS), the local sensitivity analysis results resembled the sensitivity variation patterns of DET from model simulations. A regression analysis on FHS data, using morphological features of radial pressure waveforms to estimate the carotid ET, produced a root mean square error of 3.76 ms and R2 of 0.91. The proposed dicrotic wave decomposition model can explain the intersite ET measurement discrepancies observed in the clinical data of FHS and can facilitate the precise identification of ET with radial pressure waveforms. Therefore, the proposed model will improve various physics-based pulse wave analysis methods as well as prospective artificial intelligence methods for tackling the subsequent big data produced from widespread wearable radial pressure monitoring. [ABSTRACT FROM AUTHOR]

Aortic acceleration time (AAT) and the ratio of AAT to ejection time (AAT/ET) are relatively new echocardiographic measures of the severity of aortic stenosis (AS). This study investigated the utility of transesophageal echocardiography (TEE) measurements of AAT and AAT/ET to predict the severity of AS under intraoperative conditions. Retrospective diagnostic accuracy study. St. Vincent's Hospital, Melbourne, Australia, from July 2007 to February 2017. The study comprised 199 patients who underwent aortic valve replacement (AVR) and whose aortic valves were evaluated with spectral Doppler analysis in both preoperative transthoracic echocardiography (TTE) and intraoperative TEE studies fewer than three months apart. Exclusion criteria included AVR for only aortic regurgitation, AVR of prosthetic aortic valves, and known left ventricular outflow tract obstruction. Standard echocardiography assessment of AS and the AAT and AAT/ET measurements was performed using preoperative TTE and intraoperative TEE. The intraoperative AAT and AAT/ET were increased significantly in patients with both high- and low-gradient severe AS compared with patients without severe AS (p < 0.01). Comparing preoperative TTE and intraoperative TEE measurements showed that the AAT was significantly prolonged during general anesthesia (mean difference 9.67 msec [95% confidence interval –13.54 to –5.81]), whereas the AAT/ET was preserved (mean difference –0.0018 [95% confidence interval –0.013 to 0.0091]). An intraoperative TEE cutoff of 109 msec for AAT and 0.35 for AAT/ET had a 74% and 67% sensitivity and 72% and 78% specificity, respectively, to differentiate severe from non-severe AS. The AAT and AAT/ET may be useful adjuncts for the intraoperative measurement of AS. The agreement between intraoperative TEE and preoperative TTE was better with AAT/ET compared with AAT alone. [ABSTRACT FROM AUTHOR]

Aims: The assessment of aortic stenosis (AS) severity is still challenging, especially in abnormal hemodynamic conditions. Left ventricular ejection time (LVET) has been historically related to AS severity, but it also depends on heart rate (HR) and systolic function. Our aim was to verify if correcting LVET (LVET index, LVETI) by its determinants is helpful for the assessment of AS severity, irrespective of hemodynamic conditions. Methods and results: We retrospectively studied 152 patients with AS and 378 patients with heart failure and no-AS. At multivariate analysis, LVET (assessed with pulsed-wave Doppler) showed a strong correlation with stroke volume index (SVI) (Beta 0.354; p < 0.001), HR (−0.385; p < 0.001), AS grade (Beta 0.301; p < 0.001) and, less significantly, ejection fraction (LVEF) (Beta 0.108; p = 0.001). AS grade was confirmed to be a major determinant of LVET, irrespective of forward flow (assessed by SVI and transvalvular flow rate) and LVEF (above and below 50%). A regression equation was derived to index LVET (LVETI) to HR and SVI. By using this formula, LVETI detected severe AS more accurately (AUC 0.812, p < 0.001) than LVET alone (AUC 0.755, p for difference = 0.005). Similar results were observed in patients with abnormal flow status. As an exploratory finding, we observed that the highest tertile of LVETI was associated with a higher rate of aortic valve interventions during follow-up. Conclusions: LVETI correlates with AS severity better than uncorrected LVET, independently from hemodynamic conditions, and may help to discriminate severe AS. This finding needs confirmation in larger prospective multicenter studies.

Objective: To evaluate the time of ureteral ejection of intravenous sodium fluorescein in the assessment of ureteral patency in patients undergoing total laparoscopic hysterectomy (TLH). Material and Methods: Fifty-four women undergoing TLH were studied in a public teaching hospital in Culiacan, Sinaloa, Mexico. They underwent cystoscopic evaluation of ureteral patency after intravenous administration of 100 mg of sodium fluorescein. The present study analyzed the time elapsed in minutes from the intravenous administration of fluorescein to the outflow of stained urine by one or both ureteral meatus, the degree of urine staining, and the impact of body mass index (BMI) (BMI; normal, overweight, and obesity) on ejection time. Results: The overall average time elapsed to visualize the ejection of fluorescein through at least one ureteral meatus was 7.5 minutes [95% confidence interval (CI): 6.3-8.7]. There were no significant differences in the time of ureteral ejection of fluorescein taking BMI into account (p=0.579), with a mean time for normal BMI of 8.1 minutes (95% CI: 5.1-11.2), for overweight of 7.0 minutes (95% CI: 5.5-8.5), and for obesity of 7.8 minutes (95% CI: 5.3-10.3). Conclusion: Intravenously administered 10% sodium fluorescein dye is rapidly eliminated and strongly stains urine, which makes it useful for identifying ureteral patency during cystoscopy after TLH. Fluorescein excretion is not affected by patient BMI. [ABSTRACT FROM AUTHOR]

Each stroke volume ejected by the heart is distributed along the arterial system as a pressure waveform. How far the front of the pressure waveform travels within the arterial system depends both on the pulse wave velocity (PWV) and the ejection time (ET). We tested the hypothesis that ET and PWV are coupled together, in order to produce a pulse wave travel distance (PWTD = PWV × ET) which would match the distance from the heart to the most distant site in the arterial system. The study was conducted in 11 healthy volunteers. We recorded lead II of the ECG along with pulse plethysmography at ear, finger and toe. The ET at the ear and pulse arrival time to each peripheral site were extracted. We then calculated PWV followed by PWTD for each location. Taken into account the individual subject variability PWTDToe in the supine position was 153 cm (95% CI 146–160 cm). It was not different from arterial pathway distance from the heart to the toe (DToe 153 cm). The PWTDFinger and PWTDEar were longer than the distance from the heart to the finger and ear irrespective of body position. ETEar and PWVToe appear to be coupled in healthy subjects to produce a PWTD that is roughly equivalent to the arterial pathway distance to the toe. We propose that PWTD should be evaluated further to test its potential as a noninvasive parameter of ventricular-arterial coupling in subjects with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background: When the heart faces a hemodynamic burden, increasing mass assumes a key role in the compensation for hemodynamic overload. A strong confounding factor in this relation is the altered ascending aortic haemodynamics in hypertensives due to altered ascending aortic diameter at annulus. Objectives: Ascending aortic diameter has an effect on the after load which may affect the left ventricular function. We studied to investigate the influence of the ascending aortic diameter on the left ventricular function in hypertensives. Improving the haemodynamics in such conditions may reduce mortality rates and result in better quality of life. Material and methods: We conducted a case control study involving hypertensive patients (n=25) and normotensive subjects (n=25) of same age group acting as controls. Ascending aortic diameter was measured at annulus and using M mode echocardiography we measured the thickness of the interventricular septum & posterior wall. Diameter of the ventricle during systole and diastole were obtained. All measurements were taken according to the American Society of Echocardiography recommendation. Results: The measured parameter ejection time(r=0.545, n=25, p= 0.005) and left ventricular internal diameter during diastole (r=0.348, n=25, p= 0.02) showed a very high significant positive correlation with the ascending aortic diameter. Conclusion: We would conclude to say that the reduced ascending aortic diameter has a significant effect on left ventricular wall and left ventricle function in hypertensives. The Doppler evaluation of ascending aortic diameter in hypertensives may help in achieving a reduction in morbidity and mortality due to hypertension induced cardiovascular disorders.

Elevated blood pressure (BP) is a major risk factor for atherosclerosis. As the studies concerning vascular alterations in pediatric patients are rare, we aimed to study the relationship between hypertension and arterial stiffness in adolescence by novel method independent from BP during examination. Twenty nonobese adolescent boys (16.5 ± 0.4 years) with newly diagnosed essential hypertension, 20 adolescent boys (16.7 ± 0.4 years) with newly diagnosed white-coat hypertension, and 20 healthy controls matched to age and body mass index were examined. Cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (baPWV), pre-ejection period (PEP), and ejection time (ET) were evaluated. CAVI was significantly increased in essential hypertension patients compared with controls ( p < 0.05) with no significant difference in white-coat hypertension patients. Significantly higher baPWV was found in essential and white-coat hypertension patients compared with controls (both p < 0.001). White-coat hypertension patients showed significantly shortened PEP and ET compared with controls ( p < 0.01 and p < 0.001, respectively) and essential hypertension patients (both p < 0.05). For the first time, the arterial stiffness in adolescents with newly diagnosed essential and white-coat hypertension was studied using BP-independent index CAVI combined with conventional baPWV. Our study revealed significantly increased CAVI in adolescents with newly diagnosed essential hypertension compared with controls. Our findings could help to understand hypertension-atherosclerosis interaction. [ABSTRACT FROM AUTHOR]

Purpose The pre-ejection period-derived myocardial performance index measured from tissue Doppler echocardiography (PEPa-derived MPI) was reported to be associated with left ventricular systolic and diastolic function in atrial fibrillation (AF). However, its relationship with cardiovascular outcomes in AF has never been evaluated. This study sought to examine the ability of PEPa-derived MPI in predicting adverse cardiovascular events in AF patients. Methods In 196 persistent AF patients, we performed comprehensive echocardiography with measurement of PEPa-derived MPI using index beat method. The index beat was defined as the beat following the nearly equal preceding (RR1) and pre-preceding (RR2) intervals. The cycle length of index beat and RR1 and RR2 must be >500 ms and the difference between RR1 and RR2 must be <60 ms. Cardiovascular events were defined as cardiovascular death, nonfatal stroke, and hospitalization for heart failure. Results In the multivariate analysis, chronic heart failure and increased ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity ( E /Ea) and PEPa-derived MPI (per 0.1 increase, hazard ratio, 1.104; 95% confidence interval, 1.032–1.182, p = 0.004) were associated with increased cardiovascular events. The addition of PEPa-derived MPI to a Cox model containing chronic heart failure, systolic blood pressure, age, diabetes, prior stroke, left ventricular ejection fraction, and E /Ea provided an additional benefit in prediction of adverse cardiovascular events ( p = 0.015). Conclusions In AF patients, the PEPa-derived MPI was a useful predictor of adverse cardiovascular events and could offer an additional prognostic benefit over conventional clinical and echocardiographic parameters. [ABSTRACT FROM AUTHOR]

Background: When the heart faces a hemodynamic burden, increasing mass assumes a key role in the compensation for hemodynamic overload. A strong confounding factor in this relation is the altered ascending aortic haemodynamics in hypertensives due to altered ascending aortic diameter at annulus. Objectives: Ascending aortic diameter has an effect on the after load which may affect the left ventricular function. We studied to investigate the influence of the ascending aortic diameter on the left ventricular function in hypertensives. Improving the haemodynamics in such conditions may reduce mortality rates and result in better quality of life. Material and methods: We conducted a case control study involving hypertensive patients (n=25) and normotensive subjects (n=25) of same age group acting as controls. Ascending aortic diameter was measured at annulus and using M mode echocardiography we measured the thickness of the interventricular septum & posterior wall. Diameter of the ventricle during systole and diastole were obtained. All measurements were taken according to the American Society of Echocardiography recommendation. Results: The measured parameter ejection time(r=0.545, n=25, p= 0.005) and left ventricular internal diameter during diastole (r=0.348, n=25, p= 0.02) showed a very high significant positive correlation with the ascending aortic diameter. Conclusion: We would conclude to say that the reduced ascending aortic diameter has a significant effect on left ventricular wall and left ventricle function in hypertensives. The Doppler evaluation of ascending aortic diameter in hypertensives may help in achieving a reduction in morbidity and mortality due to hypertension induced cardiovascular disorders. [ABSTRACT FROM AUTHOR]

Background Tissue Doppler imaging ( TDI) may be useful in identifying subjects at higher risk among patients with chronic heart failure ( CHF). The clinical role of new developed TDI parameters, however, still needs to be documented. Methods A total of 113 consecutive patients with CHF enrolled in the Daunia heart failure registry underwent echocardiography assessment and were followed prospectively for 234 ± 262 days. Conventional echocardiography and TDI parameters were calculated. We also calculated peak myocardial acceleration during isovolumic relaxation time ( pIVA[r]) derived from TDI ( pIVV(r)/AT). Results Subjects readmitted for worsening HF were characterized by lower levels of pIVA(r) (0.8 ± 0.3 vs. 1.3 ± 0.5 m/s2, P < 0.001). pIVA(r) levels predicted the incidence of readmission for worsening HF during follow-up (HR 0.78, 95% confidence interval 0.64-0.96, P < 0.05), even after multivariable analysis. The assessment of pIVA(r) in addition to left ventricular ejection fraction (LVEF) and E/E′ provided additional prognostic value (Log Rank P < 0.05). The presence of abnormal pIVA(r), LVEF, and E/E′ levels identified subjects with a higher risk of hospitalization for worsening dyspnea during follow-up than those with 2 abnormal marker levels or 0-1 (Log Rank P < 0.05). Conclusions Peak myocardial acceleration during isovolumic relaxation time may represent an independent adjunctive tool for the risk stratification of patients with CHF. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic heart failure (HF) are often rehospitalized; rehospitalization identifies subjects with a poorer quality of life and a worse prognosis. Estimates of the time intervals by tissue Doppler imaging (TDI) in patients with chronic HF has not been fully investigated, despite recent studies having explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as HF. We, therefore, aimed to assess the prognostic value of time intervals evaluated by TDI in patients with chronic HF. Methods: A total of 249 patients with chronic HF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and were followed prospectively for a mean 284 ± 210 days. Conventional echocardiography and TDI parameters were calculated; time intervals were calculated by TDI: ST (systolic time), ET (ejection time), FT (filling time), and ICT (isovolumic contraction time). We also have calculated ICT/ET and tissue myocardial performance index ([ICT+IRT]/ET). Results: At univariate analysis, ET (RR: 0.80, 95% confidence interval [CI] 0.71-0.90, P < 0.001), ST (RR: 0.88, 95% CI 0.78-0.99, P < 0.05), FT (RR: 0.88, 95% CI 0.78-0.99, P < 0.05), ICT/ET (RR: 1.21, 95% CI 1.07-1.37, P < 0.01) were related to the occurrence of rehospitalization during follow-up. At multivariate Cox regression analysis, correlations remained significant for ET and ST (P < 0.05 and P < 0.01, respectively). Conclusions: Time intervals assessed by TDI may be helpful in predicting the risk of rehospitalization in subjects with chronic HF. [ABSTRACT FROM AUTHOR]

Background: Detection of markers of incipient syncope in patients with vasovagal syncope (VVS), without prodromal symptom, is still an open issue. The aim of this study was to assess the behavior of heart rate (HR) and ejection time, expressed as the percentage of the corresponding cardiac cycle (ET%), in patients with bradycardic VVS with a view to providing an alarm before the event. Methods: In 33 patients with syncope and positive tilt testing and in 33 control patients, we collected beat-to-beat data on HR, ET%, stroke volume (SV), and blood pressure (BP). The trends of HR and ET% were analyzed. A set of combined changes of HR and ET% were tested in order to select the most appropriate algorithm for detecting the incipient syncope within the 3 minutes preceding the event. Results: In patients with positive tilt testing, BP significantly decreased at 3 minutes before and at the time of syncope (P < 0.0001). HR slowly rose at 3 minutes before syncope and then suddenly decreased at the time of syncope (P < 0.0001). The correlation between SV and ET% was r = 0.79 (P < 0.0001). SV and ET% significantly decreased throughout tilt testing (P < 0.0001). The selected setting for the algorithm provided sensitivity of 97% and specificity of 73%. The theoretical alarm was generated at least 9 and 5 seconds before syncope, respectively, in 76% and 85% of the subjects. Conclusion: The combined trends in HR and ET% may provide a marker of incipient bradycardic VVS in the majority of patients. (PACE 2011; 34:954-962) [ABSTRACT FROM AUTHOR]

Aims: The evoked QT interval can be detected beat by beat through an implanted pacing system. The correlation between the right ventricular paced QT interval and the left ventricular systolic interval is not known. The aim of our study was to collect data on the correlation between QT and systolic and diastolic indexes at different heart rates in patients with dual-chamber rate-responsive pacemakers. [ABSTRACT FROM PUBLISHER]

Myocardial performance index (MPI) has been regarded as an important parameter in the evaluation of ventricular systolic function in congestive heart failure. This study was designed to investigate the relationship between the ratio of isovolumic contraction time/left ventricular ejection time (IVCT/LVET), MPI, and LV systolic function. A total of 43 patients (patient group) with LV ejection fractions (LVEFs) <55% were compared with 43 patients (control group) with LVEF values ≥55%. LVEF was measured in all cases by 2-dimensional echocardiography via the modified Simpson method. Isovolumic relaxation time (IVRT), IVCT, LVET, ratio of IVCT/LVET, and MPI ([IVRT+IVCT]/LVET) were measured via Doppler echocardiography. The mean value for IVCT was found to be significantly higher (P<.001) and concomitant mean LVET value significantly lower (P=.027) in the patient group. Similarly, the mean value of MPI and the ratio of IVCT/LVET were found to be significantly higher (P<.001 for both) in the patient group. The value of the ratio of IVCT/LVET was found to have a significant negative correlation with the value of LVEF (r=-.947; P<.001) and a significant positive correlation with the value of MPI (r=.796; P<.001). The study reported here clearly demonstrates the noninferiority of the ratio of IVCT/LVET to MPI and the possibility of its substitution for MPI in the evaluation of LV systolic function. [ABSTRACT FROM AUTHOR]

Using inducible nitric oxide (NO) synthase (iNOS) knockout mice (iNOS-/-), we tested the hypotheses that 1) lack of iNOS attenuates cardiac remodeling and dysfunction and improves cardiac reserve postmyocardial infarction (MI), an effect that is partially mediated by reduction of oxidative stress due to reduced interaction between NO and reactive oxygen species (ROS); and 2) the cardioprotection afforded by iNOS deletion is eliminated by Nω-nitro-L-arginine methyl ester (L-NAME) due to inhibition of endothelial NOS (eNOS) and neuronal NOS (nNOS). MI was induced by ligating the left anterior descending coronary artery. Male iNOS-1 mice and wild-type controls (WT, C57BL/6J) were divided into sham MI, MI+vehicle, and MI+L-NAME (100 mg·kg-1·day-1 in drinking water for 8 wk). Cardiac function was evaluated by echocardiography. Left ventricular (LV) maximum rate of rise of ventricular pressure divided by pressure at the moment such maximum occurs (dP/dt/instant pressure) in response to isoproterenol (100 mg·kg-1·min-1 iv) was measured with a Millar catheter. Collagen deposition, myocyte cross-sectional area, and expression of nitrotyrosine and 4-hydroxy-2-nonenal (4-HNE), markers for ROS, were determined by histopathological and immunohistochemical staining. We found that the MI-induced increase in LV chamber dimension and the decrease in ejection fraction, an index of systolic function, were less severe in iNOS-/- compared with WT mice, L-NAME worsened LV remodeling and dysfunction further, and these detrimental effects were also attenuated in iNOS-/- mice, associated with better preservation of cardiac function. Lack of iNOS also reduced nitrotyrosine and 4-HNE expression after MI, indicating reduced oxidative stress. We conclude that iNOS does not seem to be a pathological mediator of heart failure; however, the lack of iNOS improves cardiac reserve post-MI, particularly when constitutive NOS isoforms are blocked. Decreased oxidative stress and other adaptive mechanisms independent of NOS may be partially responsible for such an effect, which needs to be studied further. [ABSTRACT FROM AUTHOR]

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