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Background: Myocardial infarction (MI) leads to varying levels of left ventricular (LV) function, with different hemodynamic responses. Some patients with small infarcts and increased sympathetic activity may have normal or even supra-normal LV function. As the infarct size increases, LV function tends to decline and shift to the right. Assessing LV function by combining left ventricular end-diastolic pressure (LVEDP) and cardiac output can be valuable. Mean pulmonary capillary wedge pressure provides a reliable estimate of LVEDP, particularly when pulmonary vascular resistance is normal, making pulmonary artery diastolic pressure equivalent to the pulmonary capillary wedge pressure. Objective: To estimate LVEDP in AMI patients, regardless of their LV function status, for prognostic and treatment guidance purposes. Methods: This two-year hospital-based study involved 40 AMI patients admitted to the ICCU of BTGH. Patients with mitral or aortic valve diseases or arrhythmias were excluded. Detailed patient information was recorded using a standardized form, and any complications were documented. Results: In this study, AMI was most common in individuals aged over 60, with a higher prevalence in males than females. Key risk factors included smoking, male gender, hypertension, diabetes mellitus, and a family history of coronary artery disease. The most common symptom of AMI was chest pain, often accompanied by sweating. Other symptoms included vomiting, dyspnea, and syncope. LV Function: Among the patients, 37.5% exhibited LV diastolic dysfunction, 17.5% had systolic dysfunction, 12.5% had combined dysfunction, and 32.5% had normal LV function. LVEDP in 1st and 2nd study: Many patients showed moderate elevation of LVEDP, with values of 32 and 24 in the first and second studies, respectively. Severe elevation was observed in 3 and 6 patients in the first and second studies, respectively, while mild elevation was noted in 4 and 6 patients in the first and second studies, respectively. Conclusion: In patients with AMI in sinus rhythm and LV dysfunction, LVEDP can be reliably assessed from mitral flow velocity curves. Changes in filling pressures may help predict prognosis. [ABSTRACT FROM AUTHOR]

Background: Diastolic dysfunction in humans is an age‐related process with an overrepresentation in women. In rhesus macaques (Macaca mulatta), the incidence and predictors of diastolic dysfunction have yet to be reported. Methods: Data from routine echocardiographic evaluations on clinically healthy rhesus macaques was obtained and used for univariate, bivariate, hypothesis testing, and linear regression statistical analyses interrogating differences and predictors of diastolic function. Results: Rhesus macaques fully recapitulate previously reported human hemodynamic studies. Female monkeys display impaired diastology and are at an increased risk for developing diastolic dysfunction. Age, sex, and proxies of exercise activity are confirmed predictors for measures of diastolic dysfunction, regardless of specific pathogen‐free status. Conclusions: Rhesus macaques share common sex‐ and age‐related echocardiographic findings as humans, therefore, serve as a valuable translational nonhuman primate model for future studies of diastolic dysfunction. These findings confirm the importance of sex‐ and age‐matching within future rhesus macaque cardiovascular research. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is the world's third leading cause of death, posing a significant public health challenge. Heart failure is an important milestone in the natural history of this disease's ever-decreasing course. Cor pulmonale alone is sometimes insufficient to explain the scenario, as many heart failures are refractory even after standard treatment. A possible explanation is involvement of the left ventricle (LV). However, there is currently no consensus on a therapeutic approach to LV dysfunction in COPD. Some previous studies were conducted on COPD patients regardless of the presence or absence of other factors influencing LV function. This study attempted to rule out all known confounding factors/co-morbidities that influence LV function. We discovered that LV diastolic dysfunction was common in subjects at all stages of COPD. We believe that all COPD patients, regardless of stage, should have screening echocardiography.

Pulmonary function and arterial stiffness correlate significantly, attributing to the chronic inflammation of atherosclerosis. However, through the pulmonary or systemic circulation, pulmonary and vascular functions associate hemodynamically with cardiac morphology and function. In the present study, we investigated arterial–cardiac–pulmonary interaction by examining how the pulmonary and vascular functions correlate with the heart. This study investigated 55 consecutive subjects not suffering from pulmonary, vascular and cardiac disease who underwent health screening test at our medical center. First, the presence of atherosclerotic disease (hypertension, dyslipidemia and diabetes) and smoking status of the patients were determined. Next, pulmonary function test, vascular function test including cardio-ankle vascular index, and echocardiography were performed. Then, we examined the correlation among the pulmonary, vascular and the heart. Our results revealed many correlations among these three factors. Especially left atrial dimension (LAD) and E/A ratio (E/A) were important cardiac factors associated with both pulmonary and vascular functions independently. Conventionally, inflammatory responses are known to involve in the correlation between pulmonary and vascular functions. Our study demonstrated that cardiac function and morphology were also involved in this correlation, signifying that LAD and E/A plays important roles in the arterial–cardiac–pulmonary interaction. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence and effects of sepsis-induced myocardial dysfunction (SIMD) in children with septic shock.Methodology: Enrolled children with septic shock (n = 31) and sepsis (n = 30) underwent echocardiography and cardiac troponin-I (cTnI) estimation within first 3 h. SIMD was defined as presence of systolic/diastolic dysfunction by echocardiography.Results: The prevalence of SIMD was 71% in 'septic shock' and 23% in 'sepsis'. Diastolic dysfunction (45.2%) was more prevalent than systolic dysfunction (32.3%). Children with SIMD had higher requirement of inotropes [81 vs. 44%; adjusted odds ratio: 1.41 (1.04-1.92)] in first 48 h. cTnI had low sensitivity (62.5%) and specificity (55.1%) for detecting SIMD. On follow-up at 3 months, there was no residual dysfunction in the majority (71.3%).Conclusion: SIMD, especially diastolic dysfunction, is common in septic shock and may increase inotrope requirement. It is reversible in majority. Sepsis patients may have asymptomatic underlying SIMD. cTnI does not correlate with the degree of SIMD. [ABSTRACT FROM AUTHOR]

To detect potential cardiac abnormalities in asymptomatic methamphetamine abusers using three-dimensional speckle tracking echocardiography (3D STE). Fifty-three male methamphetamine abusers, free of cardiac symptoms/signs, were enrolled in this study. A control group of 53 age-matched male normal subjects was studied for comparison. Standard 3D, flow and tissue Doppler echo with measurements of left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction (LVEF), the ratio of the early to late diastolic transmitral filling velocity (E/A), the ratio of the early diastolic transmitral filling velocity to the early diastolic septal tissue velocity (E/E') and 3D STE with measurements of global area strain (GAS), global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were performed, respectively. These echocardiographic parameters were compared between methamphetamine abusers and normal subjects, and receiver operating characteristic curve (ROC) analysis was done to differentiating methamphetamine abusers from normal subjects. LVESV, LVEDV, LVEF, E/A, E/E' ratios and GRS were not significantly different between methamphetamine abusers and normal subjects (p > 0.05). However, GAS, GLS and GCS were significantly less in methamphetamine abusers than in normal subjects (p < 0.05). The areas under ROC (AUC) for GAS were greatest among all the 3D STE derived LV global strains (GAS vs. GLS, GCS and GRS, 0.95 vs. 0.76, 0.69 and 0.61, respectively). The cutoff value with - 30.3% of GAS had sensitivity of 91.8%, specificity of 91.6% and accuracy of 91.3% for differentiating methamphetamine abusers from normal subjects. The potential myocardial function abnormalities can be detected by 3D STE in asymptomatic methamphetamine abusers, and GAS is a good indicator for indentifying methamphetamine abusers from normal population, which can be used to screening and monitor methamphetamine abuse, detect subclinical LV dysfunction, predict potential methamphetamine-related cardiotoxicity, and to initiate early cardioprotective therapy before the onset of overt heart failure in time. [ABSTRACT FROM AUTHOR]

The Hume-Rothery approach applied in terms of e/a to classify and design quasicrystals and BMG is revisited for the case of HEAs. The results were compared with other parameters used in the literature, namely VEC and delta. The Self-Organizing Map tool is used to classify the experimental results and the experimental map is used to compare the predictions of phases and properties of compositions reported in the literature. According to the Hume-Rothery approach, e/a and the average radius can give a precise rule of thumb to identify the domain of stability of HEAs and to estimate the phases that may occur in the alloy: i) e/a < 1.65: fcc , ii) 1.65 < e/a < 2.05: mixed phases, iii) e/a > 2.05: bcc . Moreover, e/a is to be preferred to VEC to classify phases in HEAs. Self-organizing maps can be used to make interpolative predictions for new compositions of HEAs with suitable phases for specific properties. Thus, simple combination of e/a and r gives an accurate first estimation to identify compositions with simple phases giving simple diffraction patterns, thus true HEAs as opposed to other compositional domains where complex phases occur. [ABSTRACT FROM AUTHOR]

Objectives: The impact of surgical ventricular restoration (SVR) on survival and major adverse cardiac events (MACEs) is still controversial. The purposes of this study were to analyze our surgical experience with SVR for ischemic cardiomyopathy and to determine the effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after SVR. Methods and results: Between April 2010 and May 2016, 19 patients underwent SVR. The mean age was 60 ± 11 years and the mean New York Heart Association functional class was 2.9 ± 0.8. Preoperative mean left ventricular end systolic volume index (LVESVI) and ejection fraction (LVEF) were 134 ± 56 mL/m and 24 ± 7%, respectively. The early-to-late mitral valve flow ratio ( E/A) on echocardiogram was 2.4 ± 1.8 and 9 patients had E/A ≥2, excluding 2 patients with atrial fibrillation. The mean follow-up period was 29 ± 16 months. One patient died of heart failure at 6 months postoperative; the overall survival rate at 3 years was 95%. MACEs requiring hospitalization occurred in 10 patients; E/A ≥2, or restrictive filling pattern, was the only significant predictor of MACE in multivariate analysis. Reverse remodeling was associated with E/A <2, but not E/A ≥2. There was also a significant difference between patients with E/A <2 vs. ≥2 with respect to MACE-free survival rates at 3 years (100 vs. 10%; p = 0.001). Conclusion: The degree of preoperative diastolic dysfunction can influence the outcome after SVR. Patients with E/A ≥2 may not be good candidates for SVR. [ABSTRACT FROM AUTHOR]

Key points In a rat model of ageing that is free of atherosclerosis or hypertension, E/A, a diagnostic measure of diastolic filling, decreases, and isovolumic relaxation time increases, indicating that both active and passive ventricular relaxation are impaired with advancing age., Resting coronary blood flow and coronary functional hyperaemia are reduced with age, and endothelium-dependent vasodilatation declines with age in coronary resistance arterioles., Exercise training reverses age-induced declines in diastolic and coronary microvascular function., Thus, microvascular dysfunction and inadequate coronary perfusion are likely mechanisms of diastolic dysfunction in aged rats., Exercise training, initiated at an advanced age, reverses age-related diastolic and microvascular dysfunction; these data suggest that late-life exercise training can be implemented to improve coronary perfusion and diastolic function in the elderly., Abstract The risk for diastolic dysfunction increases with advancing age. Regular exercise training ameliorates age-related diastolic dysfunction; however, the underlying mechanisms have not been identified. We investigated whether (1) microvascular dysfunction contributes to the development of age-related diastolic dysfunction, and (2) initiation of late-life exercise training reverses age-related diastolic and microvascular dysfunction. Young and old rats underwent 10 weeks of exercise training or remained as sedentary, cage-controls. Isovolumic relaxation time (IVRT), early diastolic filling (E/A), myocardial performance index (MPI) and aortic stiffness (pulse wave velocity; PWV) were evaluated before and after exercise training or cage confinement. Coronary blood flow and vasodilatory responses of coronary arterioles were evaluated in all groups at the end of training. In aged sedentary rats, compared to young sedentary rats, a 42% increase in IVRT, a 64% decrease in E/A, and increased aortic stiffness (PWV: 6.36 ± 0.47 vs.4.89 ± 0.41, OSED vs. YSED, P < 0.05) was accompanied by impaired coronary blood flow at rest and during exercise. Endothelium-dependent vasodilatation was impaired in coronary arterioles from aged rats (maximal relaxation to bradykinin: 56.4 ± 5.1% vs. 75.3 ± 5.2%, OSED vs. YSED, P < 0.05). After exercise training, IVRT, a measure of active ventricular relaxation, did not differ between old and young rats. In old rats, exercise training reversed the reduction in E/A, reduced aortic stiffness, and eliminated impairment of coronary blood flow responses and endothelium-dependent vasodilatation. Thus, age-related diastolic and microvascular dysfunction are reversed by late-life exercise training. The restorative effect of exercise training on coronary microvascular function may result from improved endothelial function. [ABSTRACT FROM AUTHOR]

: ObjectivesThis study evaluated myocardial function in relation to high-energy phosphate (HEP) metabolism in asymptomatic patients with uncomplicated type 2 diabetes mellitus using magnetic resonance (MR) techniques.: BackgroundMyocardial dysfunction may occur in patients with type 2 diabetes mellitus in the absence of coronary artery disease or left ventricular (LV) hypertrophy. The mechanisms underlying this diabetic cardiomyopathy are largely unknown, but may involve altered myocardial energy metabolism.: MethodsWe assessed myocardial systolic and diastolic function and HEP metabolism in 12 asymptomatic normotensive male patients with recently diagnosed, well-controlled type 2 diabetes and 12 controls, using MR imaging and phosphorus-31-nuclear MR spectroscopy (31P-MRS) on a 1.5 T clinical scanner; 31P-MR spectra were quantified, and myocardial HEP metabolism was expressed as phosphocreatine to adenosine-triphosphate (PCr/ATP) ratio.: ResultsNo differences were found in LV mass and systolic function between patients and controls. However, early (E) acceleration peak, deceleration peak, peak filling rate, and transmitral early-to-late diastolic peak flow (E/A) ratio, all indexes of diastolic function, were significantly decreased in patients compared with controls (p < 0.02). In addition, myocardial PCr/ATP in patients was significantly lower than in controls (1.47 vs. 1.88, p < 0.01). Inverse associations were found between myocardial PCr/ATP and E acceleration peak, E deceleration peak, and E peak filling rate (all, p < 0.05).: ConclusionsThese results indicate that altered myocardial energy metabolism may contribute to LV diastolic functional changes in patients with recently diagnosed, well-controlled and uncomplicated type 2 diabetes. [Copyright &y& Elsevier]

: ObjectivesWe wished to examine the effects of age and gender on plasma brain natriuretic peptide (BNP) concentration in a population-based study.: BackgroundMeasurement of BNP concentration is approved for use in the diagnosis of heart failure and may aid in the detection of left ventricular dysfunction. Although BNP is approved for clinical use, there are few data regarding the range of BNP observed in persons without cardiovascular disease or cardiac dysfunction. These data are essential for the interpretation of BNP.: MethodsIn 2,042 randomly selected residents of Olmsted County, Minnesota, >44 years old, BNP (Shionogi and Biosite assays), Doppler echocardiography, and medical record review were performed. A normal subset of subjects (n = 767) in sinus rhythm without cardiovascular, renal, or pulmonary disease or diabetes; on no cardiovascular medications; and with normal systolic, diastolic, and valvular function was identified.: ResultsWithin the normal subset, the distribution of BNP differed by age, gender, and assay system. With both assays, BNP increased significantly with age and was significantly higher in women than men, leading to age-, gender-, and assay-specific reference ranges. Receiver operating characteristic analysis for the ability of BNP to detect an ejection fraction ≤40% was performed in each age/gender stratum in the entire cohort (n = 2,042) and confirmed that discriminatory values for BNP for detection of reduced ejection fraction were higher in women and older persons and were different between the two assays.: ConclusionsInterpretation of BNP should include consideration of age-, gender-, and assay-specific partition values. [Copyright &y& Elsevier]

: ObjectivesWe analyzed the clinical characteristics and outcomes of 47 patients with severe pulmonary hypertension (PHT) and severe aortic valve stenosis (AS) from 1987 to 1999.: BackgroundThe prognostic implications of severe pulmonary hypertension in patients with severe AS are poorly understood.: MethodsThe mean age of patients was 78 years (range 47 to 91 years), and 37 patients (79%) were in New York Heart Association (NYHA) functional class III or IV. Aortic valve replacement (AVR) was performed in 37 patients (79%) and 10 patients (21%) were treated conservatively.: ResultsIn the group that had AVR, there were six perioperative deaths (16%) and nine late deaths, resulting in a total mortality of 32%. In the conservatively treated group, there were eight deaths (80%) on follow-up. Severe PHT was an independent predictor of perioperative mortality. However, perioperative mortality was independent of the severity of left ventricular systolic dysfunction or concomitant coronary artery bypass grafting. Aortic valve replacement was associated with significant improvement in left ventricular ejection fraction, the severity of PHT and NYHA functional class. The difference between long-term survival of the operative survivors and the expected survival from life tables was not statistically significant.: ConclusionsThe prognosis for patients with AS and severe PHT treated conservatively without AVR is dismal. Although AVR is associated with higher than usual mortality, the potential benefits outweigh the risk of surgery. [Copyright &y& Elsevier]

: ObjectivesThis study was designed to determine a quantitative relationship between right ventricular (RV) pressure overload and left ventricular (LV) diastolic filling characteristics in patients with chronic thromboembolic pulmonary hypertension (CTEPH).: BackgroundRight ventricular pressure overload in patients with CTEPH causes abnormal LV diastolic filling. However, a quantitative relationship between RV pressure overload and LV diastolic function has not been established.: MethodsWe analyzed pre- and postoperative diastolic mitral inflow velocities and right heart hemodynamic data in 39 consecutive patients with CTEPH over the age of 30 (55 ± 11 years) with mean pulmonary artery pressure >30 mm Hg who underwent pulmonary thromboendarterectomy (PTE).: ResultsAfter PTE, mean pulmonary artery pressure (mPAP) decreased from 50 ± 11 to 28 ± 9 mm Hg (p < 0.001) while cardiac output (CO) increased from 4.4 ± 1.1 to 5.7 ± 0.9 l/m (p < 0.001). Mitral E/A ratio (E/A) increased from 0.74 ± 0.22 to 1.48 ± 0.69 (p < 0.001). E/A was < 1.25 in all patients pre-PTE. After PTE, all patients with E/A >1.50 had mPAP <35 mm Hg and CO >5.0 l/min. E/A correlated inversely with mPAP (r = 0.55, p < 0.001) and directly with CO (r = 0.53, p < 0.001).: ConclusionsE/A is consistently abnormal in patients with CTEPH and increases post-PTE. Moreover, E/A varies inversely with mPAP and directly with CO. Following PTE, E/A >1.5 correlates with the absence of severe pulmonary hypertension (mPAP >35 mm Hg) and the presence of normal cardiac output (> 5.0 l/m). [Copyright &y& Elsevier]

: ObjectivesThis study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF).: BackgroundIn severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear.: MethodsWe randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization.: ResultsLeft ventricular end-systolic volume at baseline and at follow-up was 188 ± 94 ml and 171 ± 97 ml in group 1 and 173 ± 71 ml and 168 ± 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 ± 7% and 36 ± 9% in group 1 and 34 ± 7% and 34 ± 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 ± 5.2 vs. 18.5 ± 5.9 and 19.1 ± 5.6 vs. 17.9 ± 5.3, respectively; analysis of variance, p = 0.01).: ConclusionsSpironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF. [Copyright &y& Elsevier]

: ObjectivesWe sought to assess the prognostic value of alterations in left ventricular (LV) diastolic function in patients with essential hypertension.: BackgroundAlterations in LV diastolic function are frequent in patients with hypertension, even in the absence of LV hypertrophy, but their prognostic significance has never been investigated.: MethodsIn the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, we followed, for up to 11 years (mean: 4.4 years), 1,839 Caucasian hypertensive patients (50 ± 12 years, 53% men, blood pressure (BP) 156/98 mm Hg) without previous cardiovascular events, who underwent Doppler echocardiography and 24-h BP monitoring before therapy. The early/atrial (E/A) mitral flow velocity ratio was calculated and corrected for age and heart rate (HR).: ResultsDuring follow-up, there were 164 major cardiovascular events (2.04 per 100 patient-years). The incidence of cardiovascular events was 2.47 and 1.65 per 100 patient-years in patients with an age- and HR-adjusted E/A ratio below (n = 919) and above (n = 920) the median value, respectively (p < 0.005 by the log-rank test). In Cox analysis, controlling for age, gender, diabetes, cholesterol, smoking, LV mass and 24-h systolic BP (all p < 0.05), a low age- and HR-adjusted E/A ratio conferred an increased risk of cardiovascular events (odds ratio 1.57, 95% confidence interval [CI] 1.11 to 2.18, p < 0.01). A 21% excess risk was found for each 0.3 decrease of the adjusted E/A ratio (95% CI from +2% to +43%; p = 0.03).: ConclusionsImpaired LV early diastolic relaxation, detected by pulsed Doppler echocardiography, identifies hypertensive patients at increased cardiovascular risk. Such association is independent of LV mass and ambulatory BP. [Copyright &y& Elsevier]

: ObjectivesWe sought to investigate whether pseudonormal (PN) filling was associated with death or hospital admission in patients with congestive heart failure (CHF).: BackgroundThe high mortality rate associated with CHF is related to many clinical and echocardiographic variables. In particular, a short mitral deceleration time and restrictive diastolic filling predict death and/or hospital admission. We hypothesized that differentiating patients with nonrestrictive filling might identify an intermediate PN group that may be associated with intermediate risk.: MethodsA total of 115 patients admitted to the hospital for exacerbation of CHF symptoms underwent pre-discharge Doppler echocardiography to determine mitral inflow (before and after preload reduction) and pulmonary venous return. Patients were followed up for one year, and all-cause mortality and re-admission data were analyzed.: ResultsThe classification of filling patterns was: abnormal relaxation (AR) in 46 (40%) patients, pseudonormal (PN) filling in 42 (36.5%) patients and restrictive filling pattern (RFP) in 27 (23.4%) patients. When comparing the RFP group with the AR group, all-cause mortality was higher (38.4% vs. 17.4%, p = 0.033), hospital admission was higher (70.3% vs. 54.3%, p = 0.073), death/hospital admission was higher (77.8% vs. 56.5%, p = 0.02), CHF hospital admission was higher (40.7% vs. 15.2%, p = 0.01) and death/CHF hospital admission was higher (62.9% vs. 26.1%, p = 0.0005). Mortality in the PN group was not significantly different from that in the two other groups, but re-admissions were higher than the AR group (76.2% vs. 54.3%, p = 0.006), as was death/re-admission (78.6% vs. 56.5%, p = 0.004) and death/CHF re-admission (47.6% vs. 26.1%, p = 0.03). Re-admissions in the PN and RFP groups were comparable.: ConclusionsIn a general hospital population of older patients with CHF, PN filling was associated with hospital admission rates similar to those seen with restrictive filling. The combined end point of death/CHF hospital admission was similar for restrictive filling and AR. Measurement of these variables is easy to add to routine clinical echocardiography and may provide important prognostic information in a wide range of patients with CHF. [Copyright &y& Elsevier]

: ObjectivesThe aim of this study was to determine whether in patients with congestive heart failure (CHF) a distensibility (Dist) reduction: 1) similarly occurs in different arteries; 2) is related to CHF severity; and 3) is reversible with treatment.: BackgroundSeveral studies suggest that CHF is accompanied by a reduced arterial Dist.: MethodsWe measured diameter in radial artery, carotid artery (CA) and abdominal aorta (AO) by echotracking. Distensibility was obtained by relating it to blood pressure. Data were collected in 30 patients with CHF (New York Heart Association functional class I to III) under standard treatment with diuretic, digitalis and angiotensin-converting enzyme (ACE) inhibitor in whom CHF severity was assessed by maximum oxygen consumption (Vo2max) percentage and in 30 age- and gender-matched controls. Patients with CHF were then randomized to maintain standard treatment (n = 10), double the ACE inhibitor dose (n = 10) or add an angiotensin II antagonist (n = 10) and restudied after two months.: ResultsDistensibility was markedly reduced in the CHF group in all three vessels (p < 0.01), CA and AO Dist being related to CHF severity (p < 0.05). After two months, Dist did not change in the group maintained under standard treatment, but it increased significantly (p < 0.05) and similarly when the ACE inhibitor dose was doubled or an angiotensin II antagonist was added.: ConclusionsCongestive heart failure is characterized by a reduction of Dist of large-elastic and middle-sized muscular arteries. The reduction of large-elastic artery Dist is related to the CHF severity. These alterations can be reversed by drugs, effectively interfering with the renin-angiotensin system either at the ACE or at the angiotensin receptor level. [Copyright &y& Elsevier]

High Entropy Alloys (HEA) can be classified in three domains according to their e/a and r values, with e/a, the number of itinerant valence electrons and r the average radius for a 12 nearest atoms neighborhood. The phase composition, thermal stability and possible phase transformations of a series of HEA alloys, CoCr z FeNi-XY (with X and Y = Al, Cu, Pd, Ru, Ti and z = 0 or 1), selected according to their e/a ratio were investigated in cast conditions (T0), after 3 h homogenization at 1100 °C (T1) and after 3 h annealing at 700 °C (T3). When observing the behavior of the different Domains of HEAs as classified by electronic structure it is observed that for the alloys from Domain I which contain fcc structures, the microstructure transforms from multi-to almost single-phase under homogenization (T1). In Domain III alloys containing cubic (bcc and/or B2) structures, very small multi-structural changes are observed. Alloys in Domain II have a mixed structure, i.e. several different structures in the diffraction pattern, which changes during heat treatments. • The cooling rate after 1100 °C and 700 °C annealing influences HEA phase composition. • HEAs have specific phase composition depending of their e/a and radius values. • The influence of 1100 °C and 700 °C annealing depends on HEAs e/a and r values. [ABSTRACT FROM AUTHOR]

According to a recent Hume-Rothery approach, the electron concentration, e/a, and the average radius can be used to identify the domain of stability of HEAs and to estimate the phases that may occur in the alloy. The present study investigates the influence of the electronic polymorphism of nickel on the efficiency of the classification and on the design of HEAs for magnetic applications. Many different compositions were used, based on 4 to 7 elements out of a total 13 different elements (Co, Cr, Fe, Ni, Al, Cu, Pd, Ti, Mn, V, Nb, Sn, Ru). Phases have been determined by X-ray and neutron diffraction as well as in some cases high energy X-ray diffraction. The e/a for the constituent elements is calculated according to Massalski. The two polymorphic electronic structure of nickel, namely (e/a) Ni = 1 or (e/a) Ni = 2 are considered. The average e/a for the alloy is calculated assuming a solid solution case. The electronic structure [Ar] 3d9 4s1 seems to be more appropriate for the classification of HEAs. Based on a Self-organising Map predictions are made for the average magnetic moment at saturation for this electronic structure of Ni. Non-saturated values and data from the literature are compared with the predictions. The consequences of such results when modelling the structure and properties of Ni containing HEAs are presented, in particular the consideration of the shape and transformation of the Brillouin zone. Image 1 • The Ni electronic structure [Ar] 3d9 4s1 should be considered for Ni containing HEAs. • The HEA phases Domains are: I-fcc e/a<1.53; II-mixed 1.531.88. • The Brillouin zone of HEAs has to be investigated in calculations and modelling. • The average magnetic moment at saturation and the phases can be predicted for HEAs. [ABSTRACT FROM AUTHOR]

Background: Patients with type 2 diabetes mellitus (T2DM) are at increased risk for impairment in heart failure and diastolic relaxation while preserving ejection fraction (EF). Recently, several sodium glucose cotransporter-2 (SGLT2) inhibitors have demonstrated to decrease cardiovascular disease (CVD) events in elderly diabetic patients, although gender difference in the effect of SGLT2 inhibitors is unknown. The objective of the present study was to evaluate gender difference in the effect of tofogliflozin, one of the SGLT2 inhibitors, on CVD function in patients with diabetes mellitus., Methods: This was a retrospective study. Patients received 20 mg of tofogliflozin daily for 3 months. EF, ratio of early filling to atrial filling (E/A), a change in mitral inflow E and mitral e' annular velocities (E/e'), left atrial dimension (LAD) and maximal diameter of inferior vena cava (IVC max ), including various physiological parameters were measured between baseline, 1 month and 3 months after administration of tofogliflozin. Interaction between gender and time after administration was evaluated using mixed effect model., Results: The results showed significant decrease in E/e' (P < 0.01) and significant interaction between time and gender in E/A (P < 0.01), following administration of tofogliflozin for 3 months. EF was constantly higher significantly in women (P < 0.01)., Conclusion: It is concluded that 3-month administration of tofogliflozin decreased E/e' with gender difference in EF and E/A., Competing Interests: None to declare., (Copyright 2020, Higashikawa et al.)

Left ventricular (LV) filling impairment is present in patients with chronic obstructive pulmonary disease (COPD). Airflow obstruction is related to reduced LV end-diastolic volume, stroke volume, and cardiac output. The ratio of peak early diastolic filling velocity of the mitral inflow to peak early diastolic velocity of the mitral annulus (E/e'), an echocardiographic parameter, can be applied as a surrogate marker of LV filling pressures. Forty-seven individuals with suspected COPD underwent pulmonary function tests and echocardiography. The ratio of forced expiratory volume in 1s to forced vital capacity (FEV1/FVC) and the E/e' ratio were determined. Multivariate linear regression analysis showed that the FEV1/FVC ratio (β=0.01; 95% confidence interval, 0.001-0.019; p=0.036) independently predicted the log transformed E/e' ratio. An increase of FEV1/FVC ratio (in percentage) by 1 unit was associated with an increase of the E/e' ratio multiplied by 1.01. Airflow obstruction inversely predicts LV filling pressure in suspected COPD cases., (Copyright © 2013 Elsevier B.V. All rights reserved.)

During the life cycle of heterothallic tetrapolar Agaricomycetes such as Lentinula edodes (Berk.) Pegler, the mating type system, composed of unlinked A and B loci, plays a vital role in controlling sexual development and resulting formation of the fruit body. L. edodes is produced worldwide for consumption and medicinal purposes, and understanding its sexual development is therefore of great importance. A considerable amount of mating type factors has been indicated over the past decades but few genes have actually been identified, and no complete genetic structures of L. edodes B mating-type loci are available. In this study, we cloned the matB regions from two mating compatible L. edodes strains, 939P26 and 939P42. Four pheromone receptors were identified on each new matB region, together with three and four pheromone precursor genes in the respective strains. Gene polymorphism, phylogenetic analysis and distribution of pheromone receptors and pheromone precursors clearly indicate a bipartite matB locus, each sublocus containing a pheromone receptor and one or two pheromone precursors. Detailed sequence comparisons of genetic structures between the matB regions of strains 939P42, 939P26 and a previously reported strain SUP2 further supported this model and allowed identification of the B mating type subloci borders. Mating studies confirmed the control of B mating by the identified pheromone receptors and pheromones in L. edodes., (© 2013 Elsevier B.V. All rights reserved.)

Purpose: In acute respiratory distress syndrome (ARDS) and acute lung injury (ALI), a conservative fluid management strategy improves lung function but could jeopardize extrapulmonary organ perfusion. The objective was to evaluate the diagnostic accuracy of echocardiography to predict tolerance of negative fluid balance (NFB) in patients with ARDS/ALI., Materials and Methods: A prospective and observational study in an adult intensive care unit of a university hospital was conducted. All hemodynamically stable patients with ARDS/ALI were included. Echocardiography was performed before NFB and again after 24 hours. Tolerance of NFB was evaluated by the presence of hypotension, acute kidney injury, or need for fluid expansion. The 2 patient groups (tolerating and not tolerating NFB) were compared., Results: Forty-five patients were included. Median age (Q1-Q3) was 58 (52-66) years, and the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen was 205 (163-258) mm Hg. Negative fluid balance was 1950 (1200-2200) mL within 24 hours in the tolerant group. Complications of NFB were observed in 35% cases. After univariate and multivariate logistic regression analyzes, 2 criteria was independently associates with poor tolerance: mitral inflow E wave to early diastolic mitral annulus velocities ratio (E/Ea ratio; odds ratio, 2.02 [1.02-4.02]; P = .04) and weight gain (odds ratio, 1.2 [1.03-1.4]; P = .02). The area under receiver operating characteristic curves was 0.74 for E/Ea and 0.77 for weight gain., Conclusions: The ratio of E/Ea accurately predicted tolerance of NFB in patients with ARDS/ALI., (© 2013.)

Background: Functional iron deficiency (FID) is an independent risk factor for poor outcome in advanced heart failure with reduced EF, but its role in heart failure with preserved EF (HFPEF) remains unclear. We aimed to investigate the impact of FID on cardiac performance determined by pressure-volume loop analysis in HFPEF., Methods: 26 HFPEF patients who showed an increase in LV stiffness by pressure-volume (PV) loop analysis obtained by conductance-catheterization, performed exercise testing, echocardiographic examination including tissue Doppler and determination of iron metabolism: serum iron, ferritin and transferrin saturation. HFPEF patients who provided ferritin <100 μg/l or ferritin of 100-299 μg/l in combination with transferrin saturation <20% were defined as having FID. In 14 patients the expression of transferrin receptor was determined from available endomyocardial biopsies., Results: Fifteen out of 26 HFPEF patients showed FID without anemia. Compared to control subjects and HFPEF patients without FID, HFPEF patients with FID showed an up-regulation of the myocardial transferrin receptor expression (p<0.05). No differences between HFPEF patients with and without iron deficiency were found in heart dimensions, systolic and diastolic function obtained by PV-loop and echocardiography analysis. According to the linear regression analysis, LV stiffness was correlated with peak oxygen uptake (r=-0.636, p<0.001) but not with the ferritin level or transferrin saturation. No relation was found between FID and exercise capacity. The association of LV stiffness with exercise performance was independent from the level of iron deficiency., Conclusion: In non-anemic HFPEF patients, cardiac dysfunction and impaired exercise capacity occur independently of FID., (© 2013.)

Background: We assessed the global and regional ventricular septal functions using conventional echocardiography and two-dimensional speckle tracking imaging in children with postoperative multiple ventricular septal defects., Methods: Thirty-six children were studied: 16 with postoperative multiple ventricular septal defects and 20 normal control subjects. In children with multiple ventricular septal defects, 60 ventricular septal defects were closed using one of three different techniques (patch closure, the sandwich technique, direct closure). Speckle tracking imaging was applied to three short-axis echocardiographic images., Results: The total patch area used in the multiple ventricular septal defects group was correlated with the postoperative ejection fraction (r=0.703) and Tei index (r=0.778). The global septal peak systolic radial displacement and global septal peak systolic radial strain in the multiple ventricular septal defects group were significantly lower than those observed in the control subjects. The peak systolic radial strain in the segments closed with patches and the peak systolic radial displacement in the segments closed with the felt sandwich technique were significantly lower than those observed in the intact septal segments. No significant regional functional depressions were identified in the segments that were closed directly., Conclusions: The postoperative ventricular global and septal functions were significantly reduced in children with multiple ventricular septal defects, especially in the cases with complex congenital heart disease and that were closed with large prosthetic materials. These results suggest that an effort to minimize the use of patch materials may lead to preserved postoperative ventricular function., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Kawasaki disease (KD) is a common cause of acquired heart disease in children. Recent studies have focused on the biochemical markers of the myocardium, their high sensitivity and specificity and significance in the diagnosis of KD. This study aimed to determine the serum level of brain natriuretic peptide (BNP) and its relation with the heart function of children with KD and to explore its clinical value in diagnosis of KD., Methods: Forty-three KD children, aged from 5 months to 8 years (mean 2.3±0.6 years), were admitted to Qingdao Children's Hospital from February 2007 to April 2009. Among them 27 were male, and 16 female. The 43 patients served as a KD group. Patients with myocarditis, cardiomyopathy, congenital heart disease and other primary heart diseases were excluded. Thirty healthy children, aged from 3 months to 15 years (mean 2.5±0.8 years) or 17 males and 13 females served as a control group. There were no significant differences in age and gender between the two groups (P>0.05). In the KD group, ELISA was used to measure the levels of serum BNP in acute and convalescent stages; and in the control group, the levels of serum BNP were measured once randomly. Left ventricular ejection fraction (LVEF), left ventricular shorten fraction (LVSF), cardiac index (CI) and left ventricular inflow velocity through the mitral annulus (including E-velocity and A-velocity) were measured by two-dimensional echocardiography in the acute and convalescent stages in the KD group. All data were expressed as mean±SD. The methods of analysis included Student's t test and the linear regression analysis test. P<0.05 was considered statistically significant., Results: The level of serum BNP in the acute stage (517.26±213.40) ng/ml was significantly higher than that in the convalescent stage (91.56±47.97) ng/ml in the control group (37.55±7.56) ng/ml (P<0.01). The levels of LVEF, LVSF and CI in the acute stage were significantly lower than those in the convalescent stage (P<0.05), but the E/A level was not significantly different between the acute and convalescent stages (P>0.05). Linear regression analysis showed that the BNP level was negatively correlated with the levels of LVEF, LVSF and CI(r=-0.63, -0.52, -0.53, P<0.05), but not significantly correlated with the E/A level (r=-0.18, P>0.05)., Conclusion: The levels of serum BNP are significantly increased in KD patients, and are negatively correlated with the levels of LVEF, LVSF, and CI. The detection of serum BNP level is of clinical significance in the diagnosis of KD.