Impact of single chamber and dual chamber permanent pacemaker implantation on left ventricular function:An observational study

BACKGROUND Permanent pacemaker implantation has the potential to impact left ventricular(LV)function and hence quality of life(QoL)in the long term.AIM To assess the effect of single-and dual-chamber pacing on LV function and QoL.METHODS This study included 56 patients who underwent permanent pacing:Dual pacing,dual sensing,dual responsive and rate responsive(DDDR)for the initial 3 months,ventricular sensing,inhibited response and rate responsive(VVIR)for the next 3 months,and DDDR mode for the last 3 months.Throughout the study period,various echocardiographic parameters,functional status,and QoL were measured to assess the impact of pacing on LV function compared with baseline and at every 3 months interval.RESULTS A significant change appeared in cardiac function after VVIR pacing which was in diastolic properties of LV as shown by increase in isovolumic relaxation time from(85.28±9.54 ms)to(89.53±9.65 ms).At the 3-,6-,and 9-month follow-up,reduction in LV ejection fraction was observed to be 62.71±4.66%,61.07±4.41%,and 58.48±3.89%,respectively.An increase in the QoL scores was noted at every follow-up visit.CONCLUSION An apparent depressant effect on LV function due to right ventricular pacing,with a higher incidence of adverse outcomes in the VVIR mode.In addition,an upsurge in QoL scores for the study population was noted,which indicates improvement in the QoL of patients post-pacing,irrespective of the mode.Generally,the DDDR mode is a highly preferable pacing mode.

Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use of the three-dimensional speckle tracking technique(3D-STI)for measuring LVSF in DM patients via meta-analysis.METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023.The current study involved 9 studies,including 970 subjects.We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.RESULTS Night articles including 970 subjects were included.No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group(P>0.05),while differences in global longitudinal strain,global circumferential strain,global radial strain,and global area strain were markedly different between the controls and DM patients(all P<0.05).CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.

Effect of PTCA and stenting on left ventricular diastolic function in patients with CHD

Objective The aim of this study was to determine the effect of successful coronary revascularisation on left ventricular diastolic function.Methods We consecutively studied the diastolic function by Doppler echocardiography in 125 patients with one vessel disease before and 48 hours after selective coronary angioplasty. The following parameters of left ventricular diastolic function were evaluated: peak early (VE, m/s) and peak late diastolic (VA, m/s) flow velocity, E/A ratio, acceleration time (AT, ms), deceleration time (DT, ms) and isovolumetric relaxation time (IVRT, ms). Ejection fraction (EF; %) was determined and used to characterise systolic left ventricular function. Results All of the patients were initially successful treated with coronary angioplasty (residual stenosis <40% ). In 98 patients( 78.4% ) stents were used to improve an inadequate result after coronary angioplasty. Both patient groups (27 patients with coronary angioplasty and 98 patients with combined coronary angioplasty and stent implantation) showed no relevant differences concerning sex, age, atherosclerotic risk factors, exercise capacity and results of exercise electrocardiography. All patients who underwent stent implantation showed an early improvement of left ventricular diastolic function 48 hours after revascularisation. Surprisingly there was no significant short term improvement (48 hours) of diastolic function in patients with initially successful angioplasty.Conclusions We suppose that stent implantation might normalize coronary blood flow faster than that of coronary balloon angioplasty.

Assessment of Regional Left Ventricular Myocardial Function in Rats after Acute Occlusion of Left Anterior Descending Artery by Two-dimensional Speckle Tracking Imaging

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery （LAD） by using two-dimensional speckle tracking imaging （2D-STI）. Sixty Wistar rats were randomly divided into two groups, a myocardial infarction （MI） group, in which 50 rats were subjected to LAD occlusion for 30–45 min, and a sham-operated （SHAM） group that contained 10 rats serving as control. Echo-cardiography was performed at baseline and 1, 4 and 8 week（s） after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain （PRS） and circumferential strain （PCS） were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. Left ventricular internal diameter at diastole （LVIDd） and systole （LVIDs）, fractional shortening （FS）, ejection fraction （EF） and left ventricular mass （LVM） were measured by anatomical M-model echocardiography. Infarct size was measured using triphenyl tetrazolium chloride （TTC） staining 1 week and 8 weeks after the operation. Fibrosis of left ventricu-lar myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories： infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, （1） PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation （P〈0.05） and the low levels lasted 8 weeks; （2） Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant dif-ference 1 week after the operation （P〉0.05）. However, LVIDd, LVIDs and LVM were increased sig-nificantly 4 and 8 weeks after the operation （P〈0.05）, and FS and EF were decreased substantially （P〈0.05）. Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional func-tion of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.

Ultrasound Speckle Tracking Imaging Contributes to Early Diagnosis of Impaired Left Ventricular Systolic Function in Patients with Type 2 Diabetes Mellitus

To investigate the value of ultrasound speckle tracking imaging （STI） in the assessment of the short-axis and long-axis systolic function of the left ventricle （LV） in patients with type 2 diabetes mellitus （DM）, 100 subjects with normal ejection fraction were studied, including 41 patients with DM only （DM group）, 22 patients with both DM and left ventricular hypertrophy （DH group）, and 37 healthy subjects （control group）. Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations, and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group （P〈0.001 for each）. The parameters in DH group were significantly lower than those in DM group （P〈0.01 for each）. There were no significant differences in average radial peak strain in the short axis at different levels, and global peak strain among the three groups （P〉0.05）. Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group （P〈0.01 for each）. Basal LV rotation and LV twist were greater in DH group than those in DM group （P〈0.01）. It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.

CLINICAL RESEARCH ON THE EFFECT OF ACUPUNCTURE ON THE LEFT VENTRICULAR CONTRACTION FUNCTION IN SYMPTOMLESS CARDIAC FAILURE PATIENTS

Objective: To observe the effect of acupuncture therapy on the function of myocardial contraction in symptomless cardiac failure patients.Methods: A total of 60 cases of symptomless cardiac insufficiency inpatients were randomly divided into medication and acupuncture groups, with 30 cases in each group. For patients of acupuncture group, Neiguan (PC 6), Ximen (PC 4), Tanzhong (CV 17), Xinshu (BL 15), Jueyinshu (BL 14) and Geshu (BL 17) were punctured, twice daily, with 30 days being a therapeutic course. In medication group, patients were asked to take Capoten 25 mg (t.i.d.). The left ventricular ejection fraction (LVEF) and its fractional shortening (FS) of the minor axis were used as the indexes for assessing the therapeutic effect and detected by using a color ultrasonic Doppler apparatus. Results: After one course of treatment, of the each 30 cases of acupuncture and medication groups, 13 (43.3%) and 16 (53.3%) had marked improvement, 16 (53.3%) and 14 (46.7%) had improvement, and 1 (3.3%) and 0 had no any effect respectively. No significant difference was found between two groups in the therapeutic effect. It shows acupuncture therapy can improve myocardial contraction function. Conclusion: Acupuncture has a similar effect in enhancing the systolic function of the myocardium.

Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Beneficial Effects of Delayed Opening the Infarct - related Artery on Late Phase Left Ventricular Function in Acute Anterior Myocardial Infarction

Objectives To assess the effect of delayed opening the infarct - related artery (IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute ante- rior myocardial infarction. Methods 64 patients with initial Q - wave anterior myocardial infarction and the infarct - related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group ( not re- ceiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6 months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion ab- normality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Re- sults VWMA scores, left ventricular ejection frac- tion (LVEF) , left ventricular end - diastolic and end - systolic volume indices ( LVEDVI and LVDSVI) were similar in 2 groups at early phase and 2 months. There were no differences between early phase and 2 months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months ( P > 0. 05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P < 0.01, P < 0. 05). The congestive heart failure events were taken place in 19% of patients in control group com- pared with 2% in successful PCI group ( P > 0. 05 ). Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acuteanterior myocardial infarction.

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.

Effect of burden and origin sites of premature ventricular contractions on left ventricular function by 7-day Holter monitor

Recent studies have shown that premature ventricular contractions （PVCs） could enlarge the heart, but its risk factors are incompletely understood as a single 24-hour recording cannot reflect the true PVC burden due to day-to-day variability. Our purpose was to investigate the effect of burden and origin sites on left ventricular （LV） function in patients with PVCs by 7-day Holter electrocardiography （ECG）. From May 2012 to August 2013, 112 consecutive patients with PVCs were recruited from the authors＇ affiliated hospital. All patients received 2-dimensional transthoracic echocardiography, 12-lead routing ECG and 7-days Holter ECG. Serum N-terminal pro- brain natriuretic peptide （NT-proBNP） levels were measured. A total of 102 participants with PVCs were included in the final analysis. Origin of PVCs from the tricuspid annulus had the highest burden and NT-proBNP level. LV papillary muscle had a higher LV ejection fraction （EF） level and a lower LV end-systolic dimension （ESD） than other PVC foci （P〈0.05）. The high burden group had a higher LV end-diastolic dimension （EDD） and LVESD but lower LVEF than the other two groups （P〈0.05）. Female, older age, physical work, and history of PVCs had a significantly positive correlation with symptoms. Male, older age, physical work, and high burden were positive predictors of enlarged LVEDD, LVESD and higher serum NT-proBNP level, but lower LVEF. Seven-day dynamic ECG Holter monitor showed the true PVC burden on patients with PVCs. PVCs with a lower burden or origin from the LV papillary muscle and the fascicle were relatively benign, while PVCs with a higher burden or origin from the tricuspid annulus may lead to cardiac dysfunction.

Evaluation of Left Ventricular Function after Percutaneous Recanalization of Chronic Coronary Occlusions: The Role of Two-Dimensional Speckle Tracking Echocardiography

Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evaluate the role of 2D speckle tracking in evaluation of the left ventricular (LV) systolic function in chronic total occlusion (CTO) patients before and at 1 day as well as 3 months after percutaneous coronary intervention (PCI). Patients and Methods: A prospective observational study included 40 patients diagnosed with coronary angiography to have a chronic total occlusion. Percutaneous coronary revascularization was performed according to standard practices with the femoral approach. Conventional 2D echocardiography was used to assess LV functions and wall motion abnormalities scoring index (WMAI). Using speckle-tracking echocardiography was to measure global longitudinal strain (GLS) and. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Forty patients were included in this study, with a mean age of 58.55 ± 7.98 years. GLS and WMAI difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p Conclusion: The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in GLS was more sensitive predictors for LV function improvement at 3-month follow-up.

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012‒2015)

Background Heart failure(HF)is a leading cause of hospitalization and mortality for older chronic kidney disease(CKD)patients.However,the epidemiological data is scarce.We aimed to determine the prevalence of left ventricular(LV)dysfunction and HF,and to explore the risk factors for HF among those patients.Methods This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015.A total of 5,808 participants aged≥65 years were included in the analysis.Self-reported history of HF and any other cardiovascular diseases was acquired.2-D and Doppler echocardiography were used to assess LV dysfunction.CKD was defined as either estimated glomerular filtration rate(eGFR)<60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio(ACR)≥30 mg/g.Results Among CKD patients aged≥65 years,the weighted prevalence of HF,heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with reduced ejection fraction(HFrEF)was 4.8%,2.5%,0.8%,and 1.7%,respectively.The weighted prevalence of HF was 5.0%in patients with eGFR<60 mL/min per 1.73 m2,and was 5.9%in patients with ACR≥30 mg/g.The prevalence of LV systolic dysfunction was 3.1%,and while it was 8.9%for moderate/severe diastolic dysfunction.Multivariate analysis showed that smoking was significantly associated with the risk of HF.Furthermore,age,smoking,and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.Conclusions The prevalence of HF and LV dysfunction was high in older patients with CKD,suggesting that particular strategies will be required.

Effect of Fish Oil on Left Ventricular Function in Anes-thetized Rats

The effect of fish oil on the basal left ventricular function and changes of left ventricular function induced by isoproterenol(ISO)were demonstrated in our study. The detennina-tion of cardiac perfonnance in vivo showed that supplementation with fish oil(EPA and DHA,70%,1.4 ml / kg) had no significant effect on basal cardiac perfonnance,while it could significantly inhibit changes of+ dp / dt_(max),V_(pm) and HR induced by ISO(0.4μg/ kg,4.0μg/ kg,40μg/ kg)intrave-nously.The results suggested that supplementation with fish oil perhaps affected the function of β-adrenoceptors on rat myocardial membrane.

Relationship between model for end-stage liver disease score and left ventricular function in patients with end-stage liver disease

BACKGROUND:Decreased cardiac contractility has been observed in cirrhosis,suggesting a latent cardiomyopathy in these patients.This study was designed to evaluate left ventricular structure and function in patients with end-stage liver disease by the model for end-stage liver disease(MELD) scoring system. METHODS:We recruited 82 patients(72 male,10 female; mean age 50.3±8.9 years)with end-stage liver disease who underwent orthotopic liver transplantation between January 2002 and May 2008.Seventy-eight patients had cirrhosis and 4 had primary liver cancer.Patients were categorized into three groups on the basis of MELD score:≤9(27 patients, 33%);10-19(40,49%);and≥20(15,18%).The relationship between MELD score and cardiac structure and function was determined.Preoperative assessments of blood biochemistry, blood coagulation,serum virology,echocardiography and electrocardiography were performed. RESULTS:MELD score was positively correlated with enlarged left atrial diameter,increased interventricular septum thickness(IVST),increased aortic flow,corrected QT interval (QTc)extension and cardiac output(P=0.033,0.002,0.000, 0.000 and 0.009,respectively).International normalized ratio also had a correlation with the above parameters and enlarged left ventricular end-diastolic diameter(P=0.043,0.010,0.000, 0.001,0.016 and 0.008,respectively).Serum creatinine was positively correlated with IVST(r=0.257,P=0.020),but negatively correlated with early maximal ventricular filling velocity/late diastolic or atrial velocity ratio(r=-0.300, P=0.006).A difference of QTc>440 ms among the three groups was statistically significant(χ2=9.791,P=0.007).CONCLUSIONS:Abnormalities in cardiac structure and function are common in patients with end-stage liver disease. MELD score is a practically useful approach for the assessment of cardiac function in such patients.

Assessment of Left Atrial Function by Full Volume Real-time Three-dimensional Echocardiography and Left Atrial Tracking in Essential Hypertension Patients with Different Patterns of Left Ventricular Geometric Models

Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.

ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN HEALTHY SUBJECTS BY PUSLED WAVE DOPPLER TISSUE IMAGING

Objective To examine the clinical application of pulsed Doppler tissue imaging(DTI)for regional left ventricular function assessment in normal subjects. Methods We examined 50 healthy subjects(range 12-42 years,mean age 28.3 ± 6.9 years)using pulsed Doppler tissue imaging to characterize the diastolic and systolic velocity profiles of mitral annulus. Recordings were made along the long axis in the apical 4-chamber, 2-chamber, and long apical views of 6 sites(posterior-septum, lateral, anterior, inferior, anterior-septum, posterior)at the mitral annulus. Myocardial velocities were determined with use of variance F statistical analysis. Correlation analysis was employed to test the relationship between age and mitral annular velocities. Results Both early diastolic and systolic velocities at the septum were lower than other sites. There were no differences in mitral annulus late diastolic velocities. Mean early diastolic and systolic velocities was negatively correlated with age. Conclusions Doppler tissue imaging can directly reflect regional left ventricular function.

Effect of amlodipine combined with telmisartan or compound amiloride on plasma ET-1 concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy

Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride

EFFECT OF AROTINOLOL ON LEFT VENTRICULAR FUNCTION IN PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY

Objective To evaluate the efficacy and safety of long-term treatment with arotinolol in patients with idiopathic dilated cardiomyopathy(IDCM).Methods Sixty-three patients with IDCM were evaluated at baseline and after 12-month therapy with arotinolol.The conventional therapy for congestive heart failure was continued throughout the study with arotinolol as the only β-blocker.Left ventricular function was assessed with the New York Heart Association functional class and two-dimensional echocardiography.Results After 12-month arotinolol treatment,there was a significant improvement in left ventricular systolic function.Left ventricular end-systolic dimension significantly decreased from 59.52±8.83 mm to 50.89±8.17 mm(P<0.001).Left ventricular ejection fraction significantly increased from 27.39%±7.94% to 41.13%±9.45%(P<0.001).Left ventricular mass index decreased from 150.47±42.42 g/m2 to 141.58±34.36 g/m2(P<0.01).No adverse events leading to premature discontinuation of study drug occurred.Conclusion In this preliminary study,12-month arotinolol treatment has a favorable effect on left ventricular function in patients with IDCM,and it is safe and well tolerated.