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Objective The aim of this study was to evaluate the importance of growth-differentiation factor-15 level and tissue Doppler imaging in the detection of cardiomyopathy in children who have type 1 diabetes mellitus. Materials and Methods Thirty-eight patients (11 males and 27 females) with type 1 diabetes mellitus were included in this study. The control group consisted of 40 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an m-mode, pulse Doppler and tissue Doppler imaging; and growth-differentiation factor-15 level was measured. Results In this study, there were significant differences between diastolic function parameters of the heart. The mitral isovolumic contraction time, contraction time, and isovolumic relaxation time values were different in the patients than in the controls (p Conclusion The follow-up of children with type 1 diabetes mellitus in terms of cardiomyopathy and the use of tissue Doppler imaging and growth differentiation factor-15 levels may be useful.

BackgroundMetabolic syndrome is associated with the development of diabetes mellitus and cardiovascular disease. The impact of metabolic syndrome on the progression of atherosclerosis has been well documented. This study was designed to evaluate the impact of metabolic syndrome on global left ventricular function by using left ventricular myocardial performance index (LVMPI).MethodsThe diagnosis of metabolic syndrome was made as per the criteria of the International Diabetes Federation. Echocardiography was performed with a Philips IE33 machine using a 1–5MHz transthoracic probe. LVMPI was calculated by adding isovolumic contraction time with isovolumic relaxation time and dividing it by ejection time.ResultsThe mean LVMPI value in metabolic syndrome was 0.64±0.09, while that in controls was 0.48±0.06 (p

Clinically the isovolumic contraction time (IVCT) can be measured by 3 echocardiographic methods of M-mode, pulse-wave Doppler (PWD), and tissue Doppler imaging (TDI). But IVCT can be clinically different by the 3 methods. This study is to investigate whether there is a potentially unidentified phase causing the discrepancies by analyzing electric mechanical delay time (EMD), IVCT, and pre-ejection period (PEP). A total of 30 healthy subjects were recruited for the study. EMD, IVCT, and PEP were obtained by the 3 methods, respectively. MCT (the interval from the onset of the QRS wave to the closure point of the mitral valve measured by TDI) and ICMC (the interval from the onset of IVC wave S1 to the closure point of the mitral valve measured by TDI) were both measured by color TDI. IVCTt (IVCT measured by TDI) was significantly longer than IVCTm or IVCTd (IVCT measured by M-mode or PWD) (both P .05) and ICMC did not differ significantly from EMDm or EMDd minus EMDt or IVCTt minus IVCTm or IVCTd (P > .05), in other words, ICMC almost equaled to (EMDm or EMDd minus EMDt) or (IVCTt minus IVCTm or IVCTd). There may be an unidentified phase between the end of atrial contraction and the closure of mitral valve causing the discrepancies in IVCT, which is named as the pre-isovolumic contraction phase. It is a non-isovolumic phase and is included in the traditional isovolumic contraction phase.

Objective. Volume unloading of the functional single ventricle after a bidirectional Glenn anastomosis (BDG) prior to 1 year of age leads to improved global ventricular function as measured by the myocardial performance index (MPI), a Doppler-derived measurement of combined systolic and diastolic ventricular function. Systolic function remains unchanged after BDG according to previous studies; however, acute changes in global and diastolic function have not been previously investigated in this cohort. Our objective was to assess the short-term effects of the BDG on global ventricular function in patients with a functional single ventricle. Design. Echocardiograms to obtain MPI, isovolumic contraction time, and isovolumic relaxation time were performed at four time periods: in the operating room, in the operating room prior to BDG, shortly after separation from cardiopulmonary bypass, less than 24 hours postoperatively, and either prior to hospital discharge or at the first clinic follow-up visit. Results. Twenty-six patients were enrolled. There was significant ventricular dysfunction noted shortly after separation from cardiopulmonary bypass, median MPI 0.63 (0.39–0.81), that persisted in the short term postoperatively median MPI 0.50 (0.40–0.63). Isovolumic contraction time did not change, however, isovolumic relaxation time was significantly prolonged following BDG. Conclusion. In the postoperative patient after BDG, systolic function is preserved; however, there is evidence of diastolic and global ventricular dysfunction, at least in the short term.

WOS: 000251636700015, PubMed ID: 18029333, 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%. 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 lVCT was found to be significantly higher (P

Seismocardiogram, SCG, can be detected over the 24 hours in ambulant subjects by a textile-based wearable system together with the electrocardiogram, ECG and respiration. In this pilot study we explored the possibility to derive 24 h profiles of cardiac time intervals, i.e. indexes of heart mechanical function, from the SCG recordings performed in daily life conditions by the above wearable system. Two healthy subjects were recruited for the study. They worn the system for 24 hours during a working day. From each recording, every 30 minutes the following parameters were derived from the ECG and SCG signals: RR interval, RRI, Pre-Ejection Period, PEP, Isovolumic Contraction Time, ICT, Left Ventricular Ejection Time, LVET, Isovolumic Relaxation Time, IRT. From the analysis it appears that 1) all parameters are characterized by a coefficient of variation in the same order of magnitude, and 2) 24 h LVET time profiles mirrors the long term RRI behavior. Common trends in PEP and ICT profiles were observed in one subject. This study indicates that indexes of cardiac mechanics can be derived from SCG recordings performed over the 24 hours. The obtained positive results encourage further studies to refine this methodology and confirm the present findings.

The accuracy of tissue Doppler parameters of right ventricular function including Isovolumic relaxation time (IVRT) and Isovolumic contraction time (IVCT) have not been validated sufficiently in pulmonary hypertensive patients (pts). To assess the ability of tissue Doppler imaging (TDI) - as a

Background: The aim of this study was to evaluate normal subjects with isolated left bundle branch block (LBBB) using tissue Doppler imaging (TDI) for the presence of intraventricular asynchrony. Methods and Results: For this purpose, 23 subjects with isolated LBBB were compared with age-matched asymptomatic healthy subjects without LBBB with respect to global ejection fraction (EF) and isovolumic contraction time (ICTm) in separate left ventricular segments. TDI evaluation revealed prolongation of the ICTm in all of the segments in the LBBB group. Moreover, the ICTm differed significantly in each segment in the LBBB group. The ICTm in the lateral segments were shown to be longer compared to the anteroseptal segments. Conclusion: Our results indicate the presence of intraventricular asynchrony in isolated LBBB. This fact may play a role in the decreased global EF and increased cardiac mortality in patients with isolated LBBB.

Background Myocardial performance index (MPI) has been shown to be a reliable indicator of ventricular performance. This study determined MPI values in pediatric patients after cardiac transplantation without endomyocardial rejection. Methods MPI was determined in 41 pediatric patients after cardiac transplantation, without evidence of microscopic rejection, and in 31 pediatric control subjects. Results MPI in the transplantation group (0.41 ± 0.12) was higher than in the control group (0.31 ± 0.09; P = .0003). Isovolumic relaxation time and isovolumic relaxation time/ejection time were higher in the transplant group (55 ± 20 milliseconds and 0.22 ± 0.07, respectively) compared with the control group (41 ± 10 milliseconds and 0.16 ± 0.06, respectively; P = .0002). Isovolumic contraction time and isovolumic contraction time/ejection time were similar in the transplant group (48 ± 23 milliseconds and 0.19 ± 0.09, respectively) and control group (43 ± 21 milliseconds and 0.16 ± 0.08, respectively; P = not significant). Conclusions Pediatric patients after cardiac transplantation without endomyocardial rejection have a higher MPI compared with a normative pediatric control population. The difference appears to be related to abnormal diastolic function.

A Doppler index of myocardial performance (IMP) has been recently proposed in human cardiology, which is calculated from the isovolumic contraction time (ICT), isovolumic relaxation time (IRT), and the ejection time (ET) using the following formula: (ICT+IRT)/ET. In this study, IMP was measured and evaluated in Newfoundland dogs categorized in four groups: Normal dogs (n = 31), dilated cardiomyopathy (DCM) (n = 34), depressed fractional shortening (dFS) (n = 27), and left ventricular enlargement (LVE) (n = 7). IMP was found to be independent of age, sex, body surface area, and the R-R interval in the Normal group. There were significant differences in IMP between the DCM group and the Normal and dFS groups (P < 0.05) and between Newfoundlands with overt vs. occult DCM. IMP is a Doppler index which appears to correlate with severity of disease and may be of use in the early diagnosis of affected dogs during screening for the presence of DCM.

(89.3±14.5 vs 74.7±13.1 ms, p

Purpose:The object of this study was to determine the difference between two methods for myocardial performance index(MPI) in children, using the conventional and pulsed Doppler echocardiography. Methods:A total of 27 children with anatomically normal hearts were enrolled for the study. all were examined by conventional and pulsed Doppler echocardiography at Gangneung Asan Hospital between December, 2005 and February, 2006. First, we measured the time interval(a1) between the mitral inflows from apical 4-chamber view, and the ejection time(ET1) from apical 5-chamber view. And then, we calculated MPI1, isovolumic contraction time(ICT1) and isovolumic relaxation time (IRT1). Secondly, we measured ICT2, ET2 and IRT2 from apical 5-chamber view with a Dopper signal placed at just below junction between mitral and aortic valve at the same cardiac cycle. And then, we calculated MPI2. We compared MPI1 to MPI2. All MPIs were calculated by using the formula, MPI=(ICT＋IRT)/ET. Results:The mean age was 5.7±2.2 years old(M:F=15:12). The MPI2 was higher than MPI1: 0.277±0.083 vs. 0.428±0.081(MPI1 vs MPI2, P=0.000). Also, the ICT2 was higher than ICT1: 56±15 msec vs 97±18 msec(ICT1 vs ICT2, P=0.000) and the IRT2 was higher than IRT1: 42±8 msec vs 53±9 msec(IRT1 vs IRT2, P=0.000). But, the ET2 was lower than ET1: 260±16 msec vs 254±14 msec (ET1 vs ET2, P=0.01). There was, as well, positive linear correlation between MPI1 and MPI2. Conclusion:This study showed that there is a difference between MPI1 and MPI2 in connection with estimating methods. However, the two MPIs had a positive linear correlation. Judging from our results, the MPI of the new method might be a useful index of venticular global function in children

The effects of sustained preload reduction have been demonstrated for several nitrates but not for erythrityl titranitrate. In seven patients with coronary heart disease, a randomized double-blind crossover clinical trial showed that chewable erthrityl tetranitrate, 10 mg, produced significant changes in systolic time intervals consistent with preload reduction and lasting for at least four hours. As compared with placebo, ejection time index (ETI) fell and remained significantly low between 6 and 90 minutes after administration, and pre-ejection period (PEP), isovolumic contraction time IVCT), and pre-ejection period/left ventricular ejection time (PEP/LVET) rose and remained significantly increased between 22 minutes and the four-hour endpoint. We conclude that erythrityl tetranitrate is a physiologically effective long-acting agents in patients with coronary heart disease.

Left ventricular systolic time intervals (STI) were recorded by non-invasive technique from the axillary artery in fifteen normal newborns from 10–15 min to 70–74 hours after birth. The observed changes in the diflerent STI could almost entirely be related to changes in the isovolumic contraction time (ICT). At the early postnatal recording ICT was only 21.0 msec suggesting an enhanced left ventricular performance compared to prenatal observations. During the following hours ICT increased to 31.6 msec which in some infants may imply a reduced left ventricular performance. This is suggested to coincide with ductal closure.

The echographic isovolumic contraction time (ICT) of the left ventricle (LV) was measured in order to assess alterations of LV performance in children with various forms of cardiac disease. The echographic ICT was defined as the interval between coaptation of the anterior and posterior mitral valve leaflets and aortic cusp opening. Four groups of patients were evaluated: normal (48); LV myocardial disease (20); patent ductus arterosus (PDA) (19); and aortic stenosis (AS) (15). In normal children ICT shortened with decreasing age and increasing heart rate. Isovolumic contraction time was more influenced by heart rate (HR) than age, but the relationship was still weak (r = 0.61). In patients with LV myocardial disease ICT was markedly prolonged, while in children with patent ductus arteriosus and aortic stenosis it was shortened as compared with normal children (P less than 0.01).

Summary Simultaneous echocardiograms, phonocardiograms and electrocardiograms were performed on 16 foals at the following times after birth: 15 mins, 60 mins, 2, 4, 12, 24, 48 h, four, seven, 14 days and four, eight and 12 weeks. Positive correlations were found between both age and body weight and the following measurements: left ventricular end-diastolic dimension, right ventricular end-diastolic dimension, left atrial dimension and aortic root dimension, posterior left ventricular wall thickness and interventricular septal thickness. Heart rate was negatively correlated with left ventricular electromechanical systole, ejection time and isovolumic contraction time. Means and standard deviations are presented for 29 echocar-diographic parameters and the results are discussed against the background of the transitional neonatal circulation.

Systolic time intervals in the supine and upright positions were obtained in 16 antepartum subjects at maximal expansion of blood volume (27 to 33 weeks) and six weeks postpartum. Isovolumic contraction time (IVCT) was determined by 2 methods: (1) first heart sound to carotid upstroke interval (I m -CAR u ) and minus pulse transmission time (I m -CAR u -PTT), and by (2) upstroke of apexcardiogram to upstroke of carotid (ACG u -CAR u ) and minus pulse transmission time (ACG u -CAR u -PTT). The IVCT was short in the antepartum supine subject (I m -CAR u was 60.5, SD 4.3 msec.) and 31.7 msec. when corrected for PTT) and became longer in the upright position (63.7 msec. [SD 6.1] and 35.6 msec., respectively). In the postpartum state the supine IVCT was significantly longer than in the antepartum state (72.2 msec. [SD 9.3] and 42.2 msec. when corrected for PTT) (P The left ventricular ejection time index was 425.1 msec. (SD 13.5) in the antepartum supine subject and demonstrated corresponding shortening in the erect position (412.8 msec., SD 14.2). In the postpartum period the LVETI was shorter (407.0 msec. [SD 17.4]) and shortest in the upright position (392.9 msec. [SD 11.6]).

A sensitive technic for frequency analysis of the first heart sound (S 1 ) during isovolumic contraction time (ICT) was developed. Recorded heart sounds were filtered with a dynamic analyzer. Amplitudes of frequencies between 30 and 70 cps were plotted as a percentage of peak total energy of S 1 against frequency. A consistent and reproducible frequency "fingerprint" was obtained in 74 normal subjects. Frequencies of S 1 were shown to be directly proportional to ventricular elasticity (VE) and inversely proportional to combined ventricular mass (VM). VM is constant during ICT. Amplitude at 40 cps was less than at 30 cps because of reduced VE (myocardial infarction), increased VM (athletes), or combined reduction in VE and increased VM (myocardiopathy). Normal patterns were found in aortic insufficiency (increased VE and VM). Diagnostic patterns were found in 21 of 24 patients with acute myocardial infarction (MI) but were similar to patterns found in patients with healed infarcts and myocardiopathy and athletes. Acute pulmonary embolism could be differentiated from MI.

One hundred patients admitted to a cardiac care unit had indirect serial determinations of left ventricular systolic ejection times. Patients were divided into groups with transmural infarction, nontransmural infarction, and no infarction, according to clinical, biochemical, and electrocardiographic criteria. Total electromechanical systole and left ventricular ejection time were shortened in acute myocardial infarction, whereas the pre-ejection period and its components, the Q-S 1 and isovolumic contraction time intervals, were prolonged. The most abnormal measurements were observed in patients with transmural infarction. Patients with nontransmural infarction demonstrated less severe abnormalities of the systolic ejection times, and the patients without infarction were the least affected. Some of the greatest deviations in the measured intervals were observed in the transmural infarction patients who died. Indirect measurement of left ventricular systolic ejection time is a valuable adjunct in the bedside assessment of left ventricular performance and provides a prognostic index for patients with acute myocardial infarction.

The phases of the cardiac cycles were studied in eight normal volunteers on a specially assembled table which permitted access to the precordium in the prone, as well as in the conventional supine position. There were no significant changes over supine values for mechanical systole, external isovolumic contraction time, pre-ejection components, ejection time, ejection time indices and the isovolumic relaxation preiod, despite a highly significant (p

Sixty normal men, aged 26 to 64, had simultaneous external phonocardiograms at the apex, external right carotid arterial pulse tracings and electrocardiograms obtained in the supine position at rest, immediately after exercise and 3 minutes after exercise. Each subject exercised in the upright position on a bicycle ergometer at a load of 60 watts. The mean external isovolumic contraction time (EICT) was 0.041 ± 0.006 second at rest, 0.025 ± 0.005 second immediately after exercise and 0.036 ± 0.006 second 3 minutes after exercise. The mean left ventricular ejection time/external isovolumic contraction time (LVET/EICT) ratio was 7.4 ± 1.3 at rest, 11.0 ± 2.2 immediately after exercise and 8.2 ± 1.5 3 minutes after exercise.

Left ventricular systolic time intervals, plasma norepinephrine concentration, hematocrit, and blood pressure were recorded in infants delivered vaginally and by cesarean section from mothers under epidural or general anesthesia. Each group comprised 12 infants. Left ventricular ejection time and the preejection period were longer in infants delivered vaginally, although the concentrations of norepinephrine found were greater than those found in the cesarean section groups. Hematocrit and blood pressure were unrelated to the mode of delivery or the anesthetic technique. The isovolumic contraction time, however, was significantly shorter after epidural anesthesia 15.6 +/- 7.6 msec (mean +/- 1 SD) than after general anesthesia 20.5 +/- 8.0 msec at 30 minutes (p less than 0.05), 14.8 +/- 6.2 msec, and 20.9 +/- 5.7 msec at 2 hours respectively (p less than 0.001). These differences in left ventricular dynamics are probably related to the effects of anesthetics that have traversed the placenta rather than to mode of delivery.

Systolic time intervals (STI) were measured in 469 normal children, aged 5.0 to 16.9 years, using simultaneous recordings of the electrocardiogram, phonocardiogram and an external carotid pulse tracing. The data were analyzed to define the influence of sex, age, cardiac cycle length, body weight (BW), body length (BL), and body surface area (BSA) on the left ventricular STI. Regression, equations were evaluated for the calculation of normal standards for the following STI: electromechanical systole (QS2), left ventricular ejection time (LVET), pre-ejection period (PEP) systolic quotient (PEP/LVET), isovolumic contraction time (IVCT), electroacustical delay (QS1), and additionally for the so-called tension time (TT), upstroke time (UT), and the ascending index (UT/LVET) of the carotid pulse wave. Heart rate was found to influence all of the STI but the ratio UT/LVET, which revealed to be independent of any variable. Besides heart rate, BSA proved to be a second relevant independent variable for QS2 and LVET, respectively BL for PEP, PEP/LVET and QS1. These findings are in accordance to the results of comparable echocardiographic studies but disagree previous mechanocardiographic studies in smaller groups of children in whom age and not the above-mentioned parameters of the individual development seemed to influence the STI. A second set of equations was evaluated for the calculation of 95%-prediction intervals for the particular STI permitting to define abnormalities of the STI in individual children.

The effect of cardioversion of atrial fibrillation to normal sinus rhythm on systolic time intervals was evaluated in 18 patients. Variable results in the left ventricular ejection time index, the external isovolumic contraction time (EICT), and the ratio of the left ventricular ejection time over the EICT (LVET/EICT) and shortening of the preejection period (PEP) (P less than 0.01), the PEP index (PEPI) (P less than 0.005), and the ratio of PEP/LVET (P less than 0.001) occurred at five hours after cardioversion. Six (33 percent) of the 18 patients developed recurrent atrial fibrillation within one month after cardioversion, and the hearts of 12 (67 percent) of the 18 patients remained in sinus rhythm for one to ten months after cardioversion. Four of five patients in whom the EICT became worse at five hours after cardioversion and two of two patients in whom the PEPI became worse at five hours after cardioversion developed recurrent atrial fibrillation. The EICT and PEPI at five hours after cardioversion may be helpful in predicting subsequent recurrence of atrial fibrillation.

In a patient with intermittent type A Wolff-Parkinson-White (WPW) syndrome, the echocardiogram revealed late "double peaked " anterior motions (the former in the late systole, the latter in the early diastole) of left ventricular posterior wall during WPW conduction. In the same condition, phonocardiographic and mechanocardiographic observations indicated a prolonged electromechanical interval, but the external isovolumic contraction time (EICT) and left ventricular ejection time/EICT ratio remained unaltered. In addition, definite but slight alteration in the spatial ventricular gradient was observed. These observations by non-invasive methods present additional informations supporting the concept that conduction abnormalities per se are not responsible for abnormalities of ventricular function unless there is severe underlying heart disease.

The effects of posture on time-based noninvasive measurements were determined utilizing the sequence supine-sitting-standing in a formal protocol in which observer biases were eliminated by blinding the measurement and calculation phases. Compared to the supine posture, the sitting and standing postures produced significant increases in heart rate, isovolumic contraction time, pre-ejection period and pre-ejection periog/left-ventricular ejection time and significant decreases in ejection time and ejection time index. The response patterns are consistent with their hemodynamic correlates cited in the literature which show increased adrenergic activity and decreased venous return in the sitting and standing postures, the effect on venous return being dominant.

International audience; The pre-ejection period of the right ventricle in d-transposition of the great arteries is known to be prolonged, compared with the same interval of the left ventricle of normal subjects. In the present study, the echocardiographic measurement of the components of the pre-ejection period of the right ventricle of 14 patients with d-transposition of the great arteries shows that the isometric contraction time of the right ventricle in d-transposition of the great arteries is similar to the same interval calculated on the left ventricle of 76 normal children of comparable age. On the other hand, the electromechanical delay was significantly greater for the right ventricle of d-transposition of the great arteries than for the left ventricle of the normal subjects. It is concluded that the prolonged pre-ejection period of the right ventricle in d-transposition of the great arteries is not the result of right ventricular dysfunction but solely of a longer electromechanical delay.

Plasma catecholamines were obtained and systolic time intervals recorded in five normal subjects and five patients with coronary disease in the supine position at 8 AM, 12 PM, 4 PM, 8 PM, 10 PM, 12 AM, 2 AM, 4 AM, and 8 AM. Systolic time intervals were later obtained in ten additional patients with coronary disease every 30 minutes from 12 AM through 4 AM and from 8 AM through 12 PM. A significant diurnal variation in plasma norepinephrine was found in two of ten subjects and a significant diurnal variation in plasma epinephrine in a third subject No correlation was found between plasma catecholamine levels and systolic time intervals. The external isovolumic contraction time (EICT) was significantly prolonged in 9 of IS patients (60 percent) with coronary disease during 12 AM through 4 AM. These findings suggest a decrease in left ventricular contractility occurring in many patients with coronary disease during 12 AM through 4 AM.

(1) By the use of polygraphic tracing including apex cardiogram, phonocardiogram and indirect carotid tracing, an almost full and precise phasic analysis of the cardiac cycle may be obtained. (2) New methods for the measurement of the ejection period and mechanical systole are presented.

Phonocardiograms were recorded in 25 patients with chronic complete left bundle branch block (LBBB) and were compared with findings in 29 normal subjects of comparable age. Two additional patients with intermittent left bundle branch block served as their own controls. In left bundle branch block: 1. 1. The common auscultatory impression of diminished intensity of the first heart sound was demonstrated in patients with intermittent LBBB. 2. 2. The average Q-M 1 interval was significantly prolonged in chronic LBBB but was unchanged in intermittent LBBB. 3. 3. The average Q-A 2 interval was significantly prolonged, resulting in paradoxical splitting of the second heart sound in 84 per cent of patients. 4. 4. Isovolumic contraction time of the left ventricle was significantly prolonged and was mainly responsible for delayed aortic valve closure. 5. 5. Left ventricular ejection time was significantly shortened which may reflect a decreased stroke volume. Prolonged isovolumic contraction of the left ventricle is the most important alteration in the time relationships of ventricular contraction in patients with LBBB. It may be associated with asynchronous contraction which results in diminished force and velocity of contraction of an already compromised left ventricle in many patients.