Prognostic Implications of Left Ventricular Diastolic Dysfunction with Preserved Systolic Function following Acute Myocardial Infarction
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The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73); group B: LV systolic dysfunction with preserved diastolic function (n = 10); group C: LV diastolic dysfunction with preserved systolic function (n = 60); group D: combined LV systolic and diastolic dysfunction (n = 40). The cardiac mortality rate at 1 year was significantly higher in groups C (13%) and D (38%) compared to A (2%) (p < 0.01). Multivariate regression analysis identified LV diastolic dysfunction (p = 0.001), Killip class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved systolic dysfunction is associated with increased morbidity and mortality following acute MI.Keywords:
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Objective To investigate the inhibitive effect and the mechanism of larcidipine on the accentuated myocardial function of systole and diastole enhanced by isoproterenol(Iso),forskolin and MB.Methods The systolic amplitude was measured with a video edge tracker method.The following parameters were recorded by computer:ph(peak height),peak height/baseline percent(ph/bl),maximal velocity of systole(+dL/dt)and maximal velocity of diastole(-dL/dt).Results Iso,forskolin and MB increased electrically-induced systole including ph,ph/bl,+dL/dt and-dL/dt.Iso,forskolin and MB augmented the myocardial function of systole and diastole in a significant sense.Iso in a concentration of 10.0nmol/L augmented electrically-induced systole and ph,ph/bl,+dL/dt and-dL/dt,and these parameters increased by 40%,41%,60% and 50%,respectively.Compared with the control group,forskolin in a concentration of 10.0pmol/L increased ph from(0.12±0.03μm to 0.25±0.06μm,ph/bl from 12%±3% to 28%±6%,+dL/dt from 1.8±0.5μm/s to 3.7±0.8μm/s,-dL/dt from 1.8±0.2μm/s to 3.6±0.6μm/s,and these indexes increased by 89%,120%,106% and 86%,respectively.MB in a concentration of 10μmol/L also significantly increased the ph,ph/bl,+dL/dt and-dL/dt to 0.15±0.03μm,12%±4%,2.3±0.4μm/s and 2.4±0.5μm/s,respectively.Larcidipine in a concentration of 3.0μmol/L significantly decreased the parameters of +dL/dt and-dL/dt,which were increased by Iso,forskolin and MB.Conclusions Iso,forskolin and MB may increase the myocardial function of systole and diastole.These drugs might enrich the intracellular calcium indirectly and directly.The effects of Iso,forskolin and MB might be attenuated by Larcidipine.Larcidipine may not only block the dihydropyridine receptor,but also inhibit the other calcium influx.
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We traced left ventricular contours, frame-by-frame throughout systole and diastole, of normal sinus beats from 30 degrees right anterior oblique ventriculograms from 32 normal patients. We separated both systole and diastole into 19 equal time intervals each and calculated regional lengths (R), normalized by both end-diastole length and relative time interval (T) in systole and diastole and diastole, for the middle inferior wall, distal inferior wall, apex, distal anterior wall, middle anterior wall, and proximal anterior wall. We also computed the relative velocities of R, delta R/ delta T, over each quarter of systole and diastole. Comparing systole with diastole, we found significant differences between paired values of R at all regions except the distal inferior wall, but these differences were not the same between regions. Between regions, mean R and delta R/ delta T values were significantly different as early as the first quarter of systole. Within a region, there were significant differences between mean R and delta R/ delta T values over intervals as short as one-fourth of systole or diastole. Thus, there is no homogeneity between regions in normal wall motion in both systole and diastole. This normal lack of homogeneity has important clinical implications for identifying abnormal wall motion in individual patients from ventriculographic measurements, and for using the information present in the diastole portion of the ventriculogram to characterize normal segmental function.
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The purpose of this study was to describe a new method for assessing ovarian vascularization using spatiotemporal image correlation (STIC)-high-definition flow (HDF).Thirty healthy premenopausal fertile women were assessed in the follicular part of the menstrual cycle by transvaginal sonography. A 4-dimensional STIC-HDF volume was obtained from the nondominant ovary to assess 3-dimensional (3D) vascular indices (vascularization index [VI] and flow index [FI]) during one cardiac cycle in each women. Using 1-cm(3) spherical sampling, we calculated the VI and FI from the most vascularized part of the ovarian stroma at two different moments of the cardiac cycle (systole and diastole). System settings were kept constant for all of the patients (pulse repetition frequency, 0.9 kHz; gain, 0.8; and depth, 40 mm). We calculated the VI and FI ratios between systole and diastole.The mean VI during systole (11.485%; SD, 6.7%) was significantly higher than during diastole (8.653%; SD, 5.6%; P < .0001). The mean FI values during systole (47.799 [unitless]; SD, 5.8) and diastole (47.791; SD, 6.0) were nearly identical (P = .993). The VI ratio was 1.35 (95% confidence interval, 1.28-1.42), which means that the mean VI was 35% higher during systole compared to diastole, whereas the FI during systole and diastole remained constant (FI ratio, 1.00; 95% confidence interval, 0.96-1.04). There was a high correlation between VI values during systole and diastole (r(2) = 0.94), whereas this correlation was weaker for the FI (r(2) = 0.45).The STIC-HDF method allows assessment of 3D vascular indices throughout the cardiac cycle. Vascularization index calculation is affected by the moment of the cardiac cycle during which the measurement is taken. However, it seems that FI calculation is not affected by the cardiac cycle in the normal nondominant ovary.
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Impaired long-axis motion is a sensitive marker of systolic myocardial dysfunction, but no data are available that relate long-axis changes in systole with those in diastole, particularly in subjects with diastolic dysfunction and a 'normal' left ventricular (LV) ejection fraction. A total of 311 subjects (including 105 normal healthy volunteers) aged 20-89 years with variable degrees of systolic function (LV ejection fraction range 0.15-0.84) and diastolic function were studied using tissue Doppler echocardiography and M-mode echocardiography to determine mean mitral annular amplitude and peak velocity in systole and early and late diastole. The LV systolic mitral annular amplitude (S(LAX), where LAX is long-axis amplitude) and peak velocity (S(m)) correlated well with the respective early diastolic components (E(LAX) and E(m)) and late diastolic (atrial) components (A(LAX) and A(m)). A non-linear equation fitted better than a linear relationship (non-linear model: S(LAX) against E(LAX), r(2)=0.67; S(m) against E(m), r(2)=0.60; S(LAX) against A(LAX) and S(m) against A(m), r(2)=0.42). After adjusting for age, sex and heart rate, linear relationships of early diastolic (E(LAX), r(2)=0.70; E(m), r(2)=0.60) and late diastolic (A(LAX), r(2)=0.61; A(m), r(2)=0.64) long-axis amplitudes and velocities with the respective values for S(LAX) and S(m) were found, even in those subjects with apparently 'isolated' diastolic dysfunction. Long-axis changes in systole or diastole did not correlate with Doppler mitral velocities. We conclude that ventricular long-axis changes in early diastole are closely related to systolic function, even in subjects with diastolic dysfunction. 'Pure' or isolated diastolic dysfunction is uncommon.
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The aim of this study was to compare echocardiographic measurements with non-ECG-gated contrast-enhanced cardiac CT measurements in dogs. Fifty-seven dogs were included in the study. The following echocardiographic parameters were measured: M-mode interventricular septum in diastole and systole, left ventricular internal diameter in diastole and systole, left ventricular free wall in diastole and systole, 2D left atrial maximal diameter, 2D left atrium to aorta ratio in diastole, 2D aortic annulus in systole and 2D pulmonary annulus in diastole and systole. CT measurements were obtained from multiplanar reconstruction images, replicating the imaging planes used for 2D measurements on echocardiography. It was not possible to discriminate between systole and diastole. The results showed moderate Lin's concordance correlation coefficients between the left ventricular internal diameter in systole (0.77), the aortic annuli (0.84) and the pulmonary annuli in diastole (0.78) and systole (0.80). Low coefficients were obtained between the other parameters. Bland-Altman plots for the parameters with highest concordance correlation coefficients were calculated. They suggested equivalence between the measurements of the aortic annuli. Equivalence was not seen between the remaining echocardiographic and CT measurements. Therefore, non-ECG-gated CT is not a reliable way of quantitatively assessing cardiac size.
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Results Two of the original 46 volunteers were excluded due to ECG irregularities. Data from one further volunteer was incomplete and therefore excluded from the final analysis. Results from the remaining 43 volunteers are in table 1. Global FA was higher in diastole than systole (0.56 v 0.47; p < 0.001). The global endocardial HA was significantly more right-handed in systole than diastole (34° v 25°; p < 0.001). The global mesocardial HA was circumferentially orientated and similar in both diastole and systole (-3° v -2°; p = 0.42). The global epicardial HA was slightly more left-handed in systole than diastole (-35° v -30°; p < 0.001). Global MD was higher in diastole than systole (1.11 v 0.93 × 10mm/s; p < 0.001).
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Aim:The aim of this study was to establish M-mode echocardiographic reference values in Pantja goats and to study the effect of gender and body weight (BW) on these parameters. Materials and Methods:A total of 18, clinically healthy, adult Pantja goats of either sex, aged 2-4 years and weighing 10-44 kg were included in the study.Echocardiographic examination was performed in the standing unsedated animal.All measurements were made from the right parasternal long-axis left ventricular outflow tract view of the heart.The following parameters were recorded: Left ventricular internal diameter at diastole and systole, interventricular septal thickness at diastole and systole, left ventricular posterior wall (LVPW) thickness at diastole and systole, end diastolic and systolic volumes, stroke volume, fractional shortening, ejection fraction, percent systolic thickening of interventricular septum, percent systolic thickening of LVPW, cardiac output, left atrial (LA) diameter at diastole and systole, aortic (AO) root diameter at diastole and systole, LA/AO, LA posterior wall thickness at diastole and systole, left ventricular ejection time, DE amplitude, EF slope, AC interval and e-point to septal separation.Results: This study demonstrated specific reference ranges of M-mode echocardiographic parameters and indices in healthy Pantja goats.Normal echocardiographic values obtained in Pantja goats were quite different from other goat breeds.Gender had no influence on echocardiographic parameters, while high correlations were found between most echocardiographic parameters and BW. Conclusion:The echocardiographic values obtained in the study may serve as a reference for future studies in this breed, for cardiovascular disease diagnosis and for utilizing the goat as a model for cardiac disorders in humans.
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There is need of a practical method of determining the condition of the heart muscle in man. The contraction period of other muscles is lengthened if they are fatigued or degenerated, and this may be true of heart muscle. An accurate determination of the length of systole might be of use, provided its normal relationship to the heart rate and the ordinary variations were known. At the Minneapolis meeting of the American Physiological Society December 28, 1917, the writers reported that they had studied the length of systole and diastole in man, by recording the carotid pulse and measuring the systole from the beginning of the upstroke to the dicrotic notch. The subjects were 20 normal men, and 1,600 cycles were measured. A curve in which the average duration of systole and of diastole were plotted in relation to pulse gave a striking picture of the shortening of systole and diastole by increasing heart rate. The great variation in the length of systole and diastole which may occur within a single minute was emphasized. Both are affected by respiration, and diastole, at least, by vaso-motor influences. It can now be definitely stated that the changes in the length of the systole and the diastole observed in succeeding cycles have no constant relation to each other, and therefore are probably brought about in different ways. The special object of this communication is to attract attention to the great difference in the average length of systoles and diastoles caused by a change in the position of the human body. It has been found that, in sitting the systoles average by pulse rates from 50-95.9 per cent. longer than in standing, and in lying down 17 per cent. longer than in standing.
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