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Chen M, Jin JM, Zhang Y, Gao Y, Liu SL. Assessment of left ventricular diastolic dysfunction based on the intraventricular velocity difference by vector flow mapping. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2063-2071. [PMID: 24277887 DOI: 10.7863/ultra.32.12.2063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The diastolic intraventricular velocity difference represents diastolic function of the left ventricle (LV). Here we analyzed the LV diastolic intraventricular velocity difference in patients with impaired LV function based on the ventricular flow rate profile by vector flow mapping. METHODS Patients with LV diastolic dysfunction were divided into 2 groups: chronic heart failure with restricted filling (group 1; n = 27) and hypertension with abnormal relaxation (group 2; n = 34). Healthy participants were identified as controls (group 3; n = 22). Left ventricular inflow color Doppler findings were analyzed by the vector profile model with the vector flow mapping technology offline. The flow velocity rates at the base and apex of the LV were measured from vector profiles with the vector flow mapping technology. The diastolic intraventricular velocity difference was calculated from flow velocity rates. RESULTS The diastolic intraventricular velocity difference calculated from vector flow mapping was significantly lower in both groups with LV diastolic dysfunction than the control group (mean ± SD, 79.95 ± 9.88 cm/s in controls versus 40.35 ± 6.80 cm/s in group 1 and 48.50 ± 6.03 cm/s in group 2; P < .001 for both). The diastolic intraventricular velocity difference had a significant association with the ejection fraction (P = .0002) and deceleration time (P = .0306). The peak atrial contraction velocity was negatively related to the diastolic intraventricular velocity difference (P = .0003). CONCLUSIONS The diastolic intraventricular velocity difference derived from the LV velocity rate by the vector profile model on vector flow mapping can be potentially used for quantitative assessment of LV diastolic function. Vector flow mapping proved to be clinically practical for reflecting LV diastolic dysfunction in pathologic states.
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Affiliation(s)
- Ming Chen
- Division of Noninvasive Cardiac Function, Heart Center, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pu Dong, 200120 Shanghai, China.
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Matyal R, Hess PE, Subramaniam B, Mitchell J, Panzica PJ, Pomposelli F, Mahmood F. Perioperative diastolic dysfunction during vascular surgery and its association with postoperative outcome. J Vasc Surg 2009; 50:70-6. [DOI: 10.1016/j.jvs.2008.12.032] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 12/16/2008] [Accepted: 12/18/2008] [Indexed: 11/30/2022]
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Moon-Grady AJ, Taylor D, Bennett SH, Hornberger LK, Tacy TA. Color M-mode propagation velocity, but not its ratio to early diastolic inflow velocity, changes throughout gestation in normal human fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:535-541. [PMID: 18409181 DOI: 10.1002/uog.5303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Color M-mode propagation velocity (Vp) is a measure of diastolic function in adults and, when combined with early diastolic inflow velocity (E), the ratio E/Vp reflects ventricular filling pressure. Early detection of diastolic compromise may benefit fetal patients at risk for developing heart failure. The objectives of this study were to measure values for Vp and inflow peak E in a group of normal fetuses, to analyze age-dependent alterations in these measurements, and to evaluate the interobserver and intraobserver variability of the measurements. METHODS Thirty-two normal fetuses at between 20 and 35 weeks' gestation underwent echocardiography. Color M-mode Vp was measured from the four-chamber view for the right (RV) and left (LV) ventricles, and mitral and tricuspid inflow velocities were determined by pulsed-wave Doppler ultrasound. The values obtained were compared with previously reported findings in adults. RESULTS Adequate tracings were obtainable in 23 patients for the RV and 29 for the LV. Mean Vp values for the RV (15.3 +/- 3.2 cm/s) and LV (20.8 +/- 5.6 cm/s) were lower than normal adult values, and Vp values were significantly lower for the RV than the LV (P < 0.001). Applying Bazett's heart rate correction, values for RV (23.4 +/- 4.8 cm/s) and LV (31.9 +/- 8.7 cm/s) remained lower than normal adult values. There was a linear correlation of Vp with gestational age for the RV (R = 0.69, P < 0.001), and the ratio of E/Vp corrected for heart rate for the RV (1.51 +/- 0.26) remained constant throughout gestation. Interobserver bias was high but intraobserver bias low, at 19 and 1.1%, respectively. CONCLUSIONS Vp is lower in fetal than in adult life. Vp for the RV changes in a manner indicative of improving diastolic function throughout normal gestation, providing insight into the alterations in diastolic function with gestation that contribute to increases in cardiac output. The use of Vp to assess diastolic function disturbance in fetuses is feasible, but high interobserver variability is problematic.
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Affiliation(s)
- A J Moon-Grady
- Department of Pediatrics, University of California Davis, Sacramento, San Francisco, CA, USA.
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Watson LE, Kuo SR, Katki K, Dang T, Park SK, Dostal DE, Tang WJ, Leppla SH, Frankel AE. Anthrax toxins induce shock in rats by depressed cardiac ventricular function. PLoS One 2007; 2:e466. [PMID: 17520025 PMCID: PMC1867860 DOI: 10.1371/journal.pone.0000466] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 05/01/2007] [Indexed: 12/05/2022] Open
Abstract
Anthrax infections are frequently associated with severe and often irreversible hypotensive shock. The isolated toxic proteins of Bacillus anthracis produce a non-cytokine-mediated hypotension in rats by unknown mechanisms. These observations suggest the anthrax toxins have direct cardiovascular effects. Here, we characterize these effects. As a first step, we administered systemically anthrax lethal toxin (LeTx) and edema toxin (EdTx) to cohorts of three to twelve rats at different doses and determined the time of onset, degree of hypotension and mortality. We measured serum concentrations of the protective antigen (PA) toxin component at various time points after infusion. Peak serum levels of PA were in the µg/mL range with half-lives of 10–20 minutes. With doses that produced hypotension with delayed lethality, we then gave bolus intravenous infusions of toxins to groups of four to six instrumented rats and continuously monitored blood pressure by telemetry. Finally, the same doses used in the telemetry experiments were given to additional groups of four rats, and echocardiography was performed pretreatment and one, two, three and twenty-four hours post-treatment. LeTx and EdTx each produced hypotension. We observed a doubling of the velocity of propagation and 20% increases in left ventricular diastolic and systolic areas in LeTx-treated rats, but not in EdTx-treated rats. EdTx-but not LeTx-treated rats showed a significant increase in heart rate. These results indicate that LeTx reduced left ventricular systolic function and EdTx reduced preload. Uptake of toxins occurs readily into tissues with biological effects occurring within minutes to hours of serum toxin concentrations in the µg/mL range. LeTx and EdTx yield an irreversible shock with subsequent death. These findings should provide a basis for the rational design of drug interventions to reduce the dismal prognosis of systemic anthrax infections.
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Affiliation(s)
- Linley E. Watson
- Division of Cardiology, Scott and White Memorial Hospital, Scott, Sherwood and Brindley Foundation, Temple, Texas, United States of America
- Department of Medicine, Texas A&M University System, Health Science Center College of Medicine, Temple, Texas, United States of America
- Division of Molecular Cardiology, Texas A&M University System, Health Science Center College of Medicine, and Central Texas Veterans Health Care System, Temple, Texas, United States of America
| | - Shu-ru Kuo
- Scott and White Cancer Research Institute, Temple, Texas, United States of America
| | - Khurshed Katki
- Department of Medicine, Texas A&M University System, Health Science Center College of Medicine, Temple, Texas, United States of America
| | - Tongyun Dang
- Scott and White Cancer Research Institute, Temple, Texas, United States of America
| | - Seong Kyu Park
- Scott and White Cancer Research Institute, Temple, Texas, United States of America
| | - David E. Dostal
- Department of Medicine, Texas A&M University System, Health Science Center College of Medicine, Temple, Texas, United States of America
- Division of Molecular Cardiology, Texas A&M University System, Health Science Center College of Medicine, and Central Texas Veterans Health Care System, Temple, Texas, United States of America
| | - Wei-Jen Tang
- Ben May Institute for Cancer Research, The University of Chicago, Chicago, Illinois, United States of America
| | - Stephen H. Leppla
- Bacterial Toxins and Therapeutics Section, National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Arthur E. Frankel
- Department of Medicine, Texas A&M University System, Health Science Center College of Medicine, Temple, Texas, United States of America
- Scott and White Cancer Research Institute, Temple, Texas, United States of America
- * To whom correspondence should be addressed. E-mail:
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Hart E, Dawson E, Rasmussen P, George K, Secher NH, Whyte G, Shave R. Beta-adrenergic receptor desensitization in man: insight into post-exercise attenuation of cardiac function. J Physiol 2006; 577:717-25. [PMID: 16973702 PMCID: PMC1890446 DOI: 10.1113/jphysiol.2006.116426] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Desensitization of the beta-adrenoreceptors (beta-AR) may contribute to a post-exercise reduction in left ventricular (LV) function. However, attenuation of the chronotropic and inotropic responses to a beta-AR agonist may depend upon alterations in parasympathetic tone. Furthermore, changes in cardiac output and LV diastolic function in response to a beta-AR agonist, pre- to post-prolonged exercise, remain unclear. Seven trained males (mean+/-s.d., age 27+/-6 years) performed 4 h of ergometer rowing. Peak heart rate (HR) and LV systolic and diastolic functional responses to incremental isoproterenol (isoprenaline) infusion (2, 4 and 6 microg kg min-1) were assessed after vagal blockade (glycopyrrolate, 1.2 mg). LV systolic function was assessed by the pressure/volume ratio (systolic blood pressure/end systolic volume) and , whilst diastolic function was evaluated as peak early and late transmitral filling velocities. Following exercise, the pressure/volume ratio decreased by 25% (P<0.05), whereas was unchanged (P>0.05). The early/late filling ratio was reduced by 36% after exercise, due to an elevation in late LV filling (P<0.01). The increase in HR response to isoproterenol infusion was blunted post-exercise at both 4 and 6 microg kg min-1 (127+/-7 and 132+/-6 beats min-1) compared with pre-exercise (138+/-8 and 141+/-12 beats min-1, P<0.05). Additionally, the pressure/volume ratio and were blunted post-exercise in response to isoproterenol (P<0.05). In contrast, diastolic function was similar before and after exercise during isoproterenol infusion (P>0.05). Desensitization of the beta-AR contributes to an attenuated left ventricular systolic but not diastolic function following prolonged exercise.
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Affiliation(s)
- Emma Hart
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, Middlesex UB8 3PH, UK, and Copenhagen Muscle Research Centre, Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark
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