Evaluation of Right Ventricular Volume and Systolic Function by Real-time Three-dimensional Echocardiography

The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV “Full volume” images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpson's rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P<0.25—0.0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P<0.001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0.986, P<0.001; r=0.93, P<0.001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RV's complex shape, apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.

Left Ventricular Regional Systolic Function in Patient with Hypertrophic Cardiomyopathy by Quantitative Tissue Velocity Imaging

The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy （HCM） were assessed by using quantitative tissue velocity imaging （QTVI）. Left ventricular （LV） regional myocardial velocity along long- and short-axis in 31 HCM patients and 20 healthy subjects were analyzed by QTVI, and the regional myocardial systolic peak velocities （MVS） were measured. Mean MVS at each level including mitral annular, basal, middle and apical segments were calculated. The ratio of MVS along long-axis to that along short-axis （Ri） at basal and middle segments of the LV posterior wall and ventricular septum were calculated. The results showed that mean MVS was slower at each level including mitral annular, basal, middle and apical segments in the HCM patients than that in the healthy subjects （P〈0.01）. There were no significant differences in mean MVS between obstructive and non-obstructive groups in HCM patients. MVS of all regional myocardial segments along long-axis in the HCM patients were significantly slower than that in the healthy subjects （P〈0.05）, but there was no significant difference in MVS of all regional myocardial segments along long-axis between hypertrophied and non-hypertrophied group in the HCM patients. Ri was significantly lower in the HCM patients than that in the healthy subjects. The LV regional myocardial contractility along long-axis was impaired not only in the hypertrophied wall but also in the non-hypertrophied one in patients with HCM, suggesting that QTVI can assess accurately LV regional systolic function in patient with HCM and provides a novel means for an early diagnosis before and independent of hypertrophy.

Quantitative Assessment of Right Ventricular Systolic Function by the Analysis of Right Ventricular Contrast Time-intensity Curve

Summary: To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC) with right ventricular contrast, 5 % sonicated human albumin was injected intravenously at a does of 0.08 ml/kg into 10 dogs at baseline status and cardiac insufficiency. Apical four-chamber view was observed for washin and washout of contrast agent from right ventricle. The parameters of TIC were obtained by curve fitting. The differences of parameters were analyzed in different states of cardiac functions. Among the parameters derived from TIC, the time constant (k) was decreased significantly with decline of cardiac function (P<0.001). But half-time of decent of peak intensity (HT) and mean-transit-time (MTT) of washout were increased significantly (P<0.001). The k was strongly related to cardiac output of right ventricle (CO) and ejection fraction (EF) of left ventricle and fractional shortening (FS) of left ventricle. Right ventricular systolic function could be assessed reliably by the parameters derived from TIC with right ventricular contrast echocardiography. The k, HT and MTT are reliable indices for quantitative assessment of right ventricular systolic function.

A very high frequency index of heart rate variability for evaluation of left ventricular systolic function and prognosis in chronic heart failure patients using five-minute electrocardiogram

Objective A novel index based on fi-equency-domain analysis of heart rate variability （HRV） was tested on patients with reduced left ventricular systolic function. This index, namely VHFI, was defined as the very high frequency （VHF） component of the power spectrum normalized to represent its relative value in proportion to the total power minus the very low frequency component. Methods Patients （n = 130） were divided into a study group, consisting 66 patients with decreased left ventricular systolic function, and a control group, consisting 64 patients with normal heart structure and function and without severe coronary artery stenosis （〈 50%）. Results VHFI in the study group was significantly higher than that in the control group （19.17 ± 13.35 vs 11.37 ± 10.77, P 〈 0.001）. Cardiac events occurred in 18 patients during follow-up （33.34 i 3.26 months）. Defining the positive test as VHFI =15 and negative test as VHFI 〈15, achieved a sensitivity of 57.58% and a specificity of78.13% for predicting decreased left ventricular systolic function, and achieved a sensitivity of 66.67% and a specificity of 64.29% for predicting cardiac events. Univariate Cox regression analysis showed that positive VHFI test was an independent variable in predictive cardiac events. Conclusions The results suggest that VHFI is a useful tool for quick evaluation of left ventricular systolic function and prediction of prognosis

BENEFICIAL EFFECTS OF NTG ON LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION IN PATIENTS WITH MYOCARDIAL INFARCTION

The effect of sublingual administration and intravenous drip of nitroglycerin (SLNTG and IVNTG) on left ventricular volumes (LVVs) were studied and systolic function was quantitatively assessed with two-dimensional echocardiography (2DE) in 28 patients with myocardial infarction (MI), including 13 cases without heart failure (MI-NHF) in one group and 15 with heart failure (MI-HF) in another. The results showed that after SLNTG and IVNTG in both groups the heart rate (HR) increased significantly (P< 0.05-0.001); the systolic blood pressure (SBP) decreased significantly (P< 0.05-0.001); the diastolic blood pressure (DBP) was not significantly changed (all P>0.05); the left ventricular end-diastolic and end-systolic volumes (EDV and ESV) both significantly reduced [EDV: decreased by 5.8-11.6% (-13.2-19.0 ml), P< 0.05-0.001; ESV: decreased by 9.6-16.6% (-8.6-17.3 ml), P< 0.05-0.001)1; the left ventricular ejection fraction (LVEF) all significantly elevated (increased by 6.6%-9.4% (3.2%-3.4%), P < 0.05-0.001] except in MI-NHF group after IVNTG; the segmental EF of normal and hypokinetic segments also significantly increased (P<0.05-0.001). The results suggest that NTG could beneficially reduce left ventricular EDV and ESV; and improve or strengthen its global and segmental systolic function in MI patients, particularly noticeable in patients with heart failure.

Quantification of Regional Left Ventricular Systolic Dysfunction in Patients With Coronary Artery Disease by Strain Rate Imaging

Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.

Effects of Lead on Systolic and Diastolic Cardiac Functions

In this paper, both systolic and diastolic cardiac functions were cvaluatcd in 54 lead exposed and 24 non-exposed workers by Doppler cchocardiography. With regard to systolic cardiac function, the results suggested that cardiac systolic function increased in exposed groups as a compensatory response for the effecl of lead on myocardium. To study left ventriculaf diastolic function, 2.5 MHz pulsed Doppler analyses of transmitral flow velocity were performed from apical four-chamber view. The results showed that timerelated parameters were comparable among all groups, but blood flow velocity through the mitral valve and Doppler area fractions changed significantly in lead-exposed groups as cvidenced by increased value A, decreased value E and E/A ratio. The decrease of diastolic cardiac function was more significant in lead intoxication group. It was also observed in this study that the activity in serum of thc MB isoenzyme of creatine phosphokinase (CPK-MB), one of the indices of myocardial damage, was significantly highcr in exposed group than that in control (P (0.05), and a positive correlation was found between CPK-MB activity and Pb-B. It denoted that the inereasing of lead burden leads to more release of CPK-MB from the myocardial cells and suggested the existence of slight myocardial damage, which, conceivably, might cause harm to diastolic cardiac function

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

Deep learning echocardiographic intelligent model for evaluation on left ventricular regional wall motion abnormality

Objective To observe the value of deep learning echocardiographic intelligent model for evaluation on left ventricular(LV)regional wall motion abnormalities(RWMA).Methods Apical two-chamber,three-chamber and four-chamber views two-dimensional echocardiograms were obtained prospectively in 205 patients with coronary heart disease.The model for evaluating LV regional contractile function was constructed using a five-fold cross-validation method to automatically identify the presence of RWMA or not,and the performance of this model was assessed taken manual interpretation of RWMA as standards.Results Among 205 patients,RWMA was detected in totally 650 segments in 83 cases.LV myocardial segmentation model demonstrated good efficacy for delineation of LV myocardium.The average Dice similarity coefficient for LV myocardial segmentation results in the apical two-chamber,three-chamber and four-chamber views was 0.85,0.82 and 0.88,respectively.LV myocardial segmentation model accurately segmented LV myocardium in apical two-chamber,three-chamber and four-chamber views.The mean area under the curve(AUC)of RWMA identification model was 0.843±0.071,with sensitivity of(64.19±14.85)%,specificity of(89.44±7.31)%and accuracy of(85.22±4.37)%.Conclusion Deep learning echocardiographic intelligent model could be used to automatically evaluate LV regional contractile function,hence rapidly and accurately identifying RWMA.

Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy

AIM To explore regional systolic strain of midwall and endocardial segments using speckle tracking echocardiography in patients with apical hypertrophic cardiomyopathy(HCM).METHODS We prospectively assessed 20 patients(mean age 53 ± 16 years,range:18-81 years,10 were male),with apical HCM. We measured global longitudinal peak systolic strain(GLPSS) in the midwall and endocardium of the left ventricle. RESULTS The diastolic thickness of the 4 apical segments was 16.25 ± 2.75 mm. All patients had a normal global systolicfunction with a fractional shortening of 50% ± 8%. In spite of supernormal left ventricular(LV) systolic function,midwall GLPSS was decreased in all patients,more in the apical(-7.3% ±-8.8%) than in basal segments(-15.5% ±-6.93%),while endocardial GLPPS was significantly greater and reached normal values(apical:-22.8% ±-7.8%,basal:-17.9% ±-7.5%). CONCLUSION This study shows that two-dimensional strain was decreased mainly confined to the mesocardium,while endocardium myocardial deformation was preserved in HCM and allowed to identify subclinical LV dysfunction. This transmural heterogeneity in systolic strain had not been previously described in HCM and could be explained by the distribution of myofibrillar disarray in deep myocardial areas. The clinical application of this novel finding may help further understanding of the pathophysiology of HCM.

EFFECT OF ELECTROACUPUNCTURE OF THE HEART MERIDIAN ACUPOINTS ON ISCHEMIC CARDIAC FUNCTION IN THE RABBIT

Subjective: To observe the effect of electroacupuncture (EA) of acupoints of the Heart Meridian and Lung Meridian on ischemic cardiac systolic ability for analyzing the relative specific relationship between the Heart Meridian and the heart. Methods: Acute myocardial ischemia (AMI) was produced by intravenous infusion of pituitrin (40 u + 5% glucose injection 500 ml, 60 drips/min) in the rabbit. Left intraventricular pressure (LVP), maximal rising velocity of LVP (dp/dt max), isovolumetric pressure (IP) and end-diastolic pressure (EDP) of the left cardiac ventricle were used as the indexes. Three points of Heart Meridian [HM, from 'Shenmen' (HT 7) to 'Lingdao' (HT 4)] and the three points of Lung Meridian [LM, from 'Taiyuan' (LU 9) to 'Lieque' (LU 7)] were punctured with filiform needles and stimulated with hand-manipulation and electrically with ZY2-1 EA Therapeutic Apparatus. 30 rabbits anesthetized with urethane (1 g/kg) were randomly and evenly divided into control group, HM group and LM group. Result-s: The effects of EA of HM points were evidently superior to those of EA of LM points in promoting the recovery of both AMI-induced decrease of LVP and dp/dtmax, and AMI-induced increase of IP and EDP. Conclusion: Acupoints of Heart Meridian has a relatively specific connection with the heart in comparison with those of Lung Meridian; and the Heart Meridian is a functional whole.

Effect of Systolic Cardiac Function on Passive Leg Raising for Predicting Fluid Responsiveness： A Prospective Observational Study

Background：Passive leg raising （PLR） represents a ＂self-volume expansion （VE）＂ that could predict fluid responsiveness,but the influence of systolic cardiac function on PLR has seldom been reported.This study aimed to investigate whether systolic cardiac function,estimated by the global ejection fraction （GEF） from transpulmonary-thermodilution,could influence the diagnostic value of PLR.Methods：This prospective,observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015.Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF （〈20%） and a near-normal-GEF （〉20%） group.Within each group,baseline hemodynamics,after PLR and after VE （250 ml 5% albumin over 30 min）,were recorded.PLR-induced hemodynamic changes （PLR-△） were calculated.Fluid responders were defined by a 15% increase of stroke volume （SV） after VE.Results：Twenty-five out of 38 patients were responders in the GEF 〈20% group,compared to 26 out of 40 patients in the GEF 〉20% group.The thresholds of PLR-△SV and PLR-△ cardiac output （PLR-△CO） for predicting fluid responsiveness were higher in the GEF 〉20% group than in the GEF 〈20% group （△SV：12% vs.8%;△CO：7% vs.6%）,with increased sensitivity （△SV：92% vs.92%;△CO：81% vs.80%） and specificity （△SV：86% vs.70%;△CO：86% vs.77%）,respectively PLR-△ heart rate could predict fluid responsiveness in the GEF 〉20% group with a threshold value of-5% （sensitivity 65%,specificity 93%） but could not in the GEF 〈20% group.The pressure index changes were poor predictors.Conclusions：In the critically ill patients on mechanical ventilation,the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function.Thus,cardiac systolic function must be considered when using PLR.Trial Registration：Chinese Clinical Trial Register,ChiCTR-OCH-13004027;http：//www.chictr.org.cn/showproj.aspx？proj=5540.

Assessing Coarctation of the Aorta With Fetal Heart Quantification Technology

Objective:To use fetal heart quantification(fetal HQ)technology to compare the coarctation of the aorta(CoA)and normal fetal heart structure and systolic function and to assess whether there are abnormalities in the fetal heart structure and systolic function associated with CoA.Methods:This prospective cohort study was conducted from May 2020 to December 2022 and involved 18–40-week-old singleton pregnancies and 30 fetuses diagnosed with CoA using fetal echocardiography at the General Hospital of Ningxia Medical University and Peking University First Hospital Ningxia Women’s andChildren’s Hospital,China.The control group contained 60 normal fetuses.The following parameters were recorded and analyzed statistically:four-chamber view(4CV)end-diastolic long diameter,4CV epicardial–contralateral epicardial transverse maximum diameter,4CV global sphericity index(GSI),left ventricular(LV)and right ventricular(RV)24-segment end-diastolic diameter(EDD),24-segment sphericity index(SI),LV-fractional area change(LV-FAC),LV-longitudinal strain(LV-LS),RV-fractional area change(RV-FAC),RV-longitudinal strain(RV-LS),and LV and RV 24-segment transverse fractional shortening(FS).Measurement data were compared between the two groups using an independent sample t test,with P<0.05 indicating statistically significant differences.Moreover,the correlation between gestational age and GSI,LV-FAC,LV-LS,RV-FAC,and RV-LS was assessed.Results:Within and between observer comparisons of the parameters associated with major cardiac function revealed an intragroup correlation coefficient of>0.9,indicating high consistency,and a coefficient of variable of<1%,indicating low variability.Correlation analysis revealed no obvious correlation between gestational age and GSI,LV-FAC,LV-LS,RV-FAC,and RV-LS.A comparison of the fourchamber morphological structural parameters of the hearts in the two groups revealed that when compared with the control group,the 4CV end-diastolic long diameter was shortened in fetuses in the CoA group and the epicardial–contralateral epicardial transverse maximum diameter was wider,while the GSI was lower(P<0.05).A comparison of the LV and RV morphological structure parameters between the two groups revealed that when compared with the control group,the LV’s 24-segment EDD was smaller in the CoA group,the RV’s 24-segment EDD was greater in the control group,the SI of the LV’s segments 16–24 was greater than in the control group,and the SI of the RV’s segments 7–24 was less than in the control group(all P<0.05).When comparedwith fetuses in the control group,the LV’s segments16–24 were greater in the CoA group,whereas the RV’s segment 6–24 was smaller(P<0.05).When comparedwith the control group,LV-FAC,RV-FAC,and LS were lower in the CoA group(P<0.05).The FS of the LV segments 1–24 and the FS of the RV segments 1–16 were smaller in the CoA group than in the normal group(P<0.05).Conclusion:Fetal HQ,a new simple technique that offers rapid analysis and high repeatability,can quantitatively evaluate structural and systolic function changes in fetuses with CoA.

Protection of Shengmai Recipe on Improving Cardiac Function and Attenuating Kidney Injury in Pressure Overload Rats

Objective Shengmai Recipe （SMR） is a Chinese patent medicine used for the treatment of chronic heart disease. In order to further assess the renal-protective effect against ischemia lesion of SMR, the cardioprotective effect of SMR on pressure overload-induced left ventricular （LV） systolic dysfunction and the potential mechanism on alleviating myocardial damage, myocardial fibrosis, and renal ischemia lesion in chronic heart failure （CHF） rats were investigated. Methods Rats with partially ligated abdominal aorta were randomly divided into model, Sham, and SMR groups. One week after recovery from surgery, animals were preventively ig administered with SMR at the dose of 810 mg/kg once daily for 8 weeks. Cardiac function and structure, endogenous biomarkers （CK-MB and LDH）, myocardial fibrosis, and organ pathological change were estimated by echocardiography, immunodepression and velocity method, hematoxylin- eosin staining, and masson＇s trichrome staining, respectively. Results The administration of SMR significantly decreased serum CK-MB and LDH levels and reduced myocardial fibrosis. Interestingly, SMR not only improved cardiac function but also ameliorated kidney injury induced by ischemia in CHF rats. Conclusion SMR could enhance the LV contractile function, reduce myocardial necrosis, and reverse LV remodeling in CHF rats, and most importantly, SMR could be used to treat the renal ischemia injury in pressure overload rats.

Assessment of cardiac function in absence of congenital and acquired heart disease in patients with Down syndrome

Background:Extra genetic material in patients with Down syndrome(DS)may affect the function of any organ system.We evaluated cardiac functions using conventional tissue Doppler and two-dimensional speckle tracking echocardiography in patients with DS in the absence of congenital and acquired heart disease in patients.Methods:A total of 115 patients with DS between 6 and 13 years of age with clinically and anatomically normal heart and 55 healthy children were included in this cross-sectional study.DS was diagnosed by a karyotype test.Patients with mosaic type were not included in this study.Systolic and diastolic functions were evaluated by echocardiography.Results:Pulsed waved Doppler transmitral early/late inflow velocity(E/A),tissue Doppler mitral annular early/late diastolic peak velocity(Ea/Aa),transtricuspid E/A and tricuspid valve annulus Ea/Aa,pulmonary venous Doppler systolic/diastolic(S/D)wave ratio were lower in patients with Down syndrome than in the control group(P=0.04,P=0.001,P<0.05,P<0.001,P<0.001,respectively).Mitral and tricuspid annular Ea were lower in patients with DS(P<0.001).The right and left ventricular myocardial performance indexes were higher in patients with DS than in the controls(P<0.01).They had significantly higher left ventricular mass,ejection fraction,the mitral annular plane systolic excursion values.However,the Down syndrome group compared with the controls had a lower strain values examined by two-dimensional longitudinal speckle-tracking strain echocardiography.Conclusion:These findings suggest conventional tissue Doppler and two-dimensional longitudinal speckletracking strain echocardiography were useful methods of investigating ventricular function and identifying a higher incidence of biventricular dysfunction in patients with Down syndrome compared with the healthy controls.

Multiple hemodynamic effects of endogenous hydrogen sulfide on central nervous system in rats

Background Endogenous hydrogen sulfide is a new neuromodulator which takes part in the regulation of central nervous system physiology and diseases. Whether endogenous hydrogen sulfide in the central nervous system regulates cardiovascular activity is not known. In the present study, we observed the hemodynamic changes of hydrogen sulfide or its precursor by intracerebroventricular injection, and investigate the possible roles of endogenous digitalis like factors and sympathetic activity in the regulation. Methods Ninety-four Sprague-Dawley rats underwent a right cerebroventricular puncture, then the hydrogen sulfide saturation buffer or its precursor injected by intrcerebroventricular catheter. A heperin-filled catheter was inserted into the right femoral artery or into the left ventricle, and changes of blood pressure or cardiac function recorded by a Powerlab/4S instrument. Phentolamine or metoprolol were pre-injected to observe the possible role in autonomic nerve activity. After rats were sacrificed, plasma was collected and endogenous digitalis-like factors were measured with a commercial radioimmunoassay kit. The aortic, cardiac sarcolemmal vesicles were isolated and the activity of Na＋-K＋-ATPase was measured as ouabain-sensitive ATP hydrolysis under maximal velocity conditions by measuring the release of inorganic phosphate from ATP. Unpaired Student＇s ttest for two groups or analysis of variances （ANOVA） for multiple groups were used to compare the differences of the changes. Results Intracerebroventricular injection of hydrogen sulfide induced a transient hypotension, then dramatic hypertenive effects in a dose-dependent manner. Bolus injection of L-cysteine or beta-mercaptopyruvate also increased mean arterial pressure （P 〈0.01）, whereas hydroxylamine-a cystathionine beta synthase inhibitor decreased the arterial pressure （P 〈0.01）. Hydrogen sulfide and L-cysteine increased mean arterial pressure, left ventricular develop pressure and left-ventricle maximal rate of systolic and diastolic pressure; these functions were decreased by hydroxylamine （P 〈0.01）. Glibenclamide （a KATP channel blocker） blocked the transient hypotensive effect, phentolamine （an alpha-adrenergic receptor blocker） blocked the hypertensive effect, and metoprolol （a selective beta 1 receptor blocker） blocked the positive inoptropic effect of central nervous system hydrogen sulfide. The endogenous digitalis-like factors in plasma were elevated （P 〈0.01） after treatment with L-cysteine, association with decreasing Na＋-K＋-ATPase activity in cardiac or aortic sarcolemmal vesicles （P 〈0.01）. Hydroxylamine injection reduced the endogenous digitalis-like factors level in plasma association with increasing Na＋-K＋-ATPase activity in cardiac and aortic sarcolemmal vesicles. Conclusion Central nervous system endogenous hydrogen sulfide upregulated mean arterial pressure and cardiac systolic function by activation of sympathetic nerves or release of endogenous digitalis-like factors.