Intrinsic Wave Velocity Propagation:A Novel Parameter for Assessing the Effect of Anthracycline Chemotherapy Agents on Cardiac Diastolic Function in Breast Cancer Patients

Objective Anthracycline chemotherapeutic agents have significant cardiotoxicity.The present study emphasized the effect of anthracycline chemotherapy drugs on left ventricular(LV)myocardial stiffness in breast cancer patients by measuring the intrinsic wave velocity propagation(IVP),and evaluating the potential clinical value of IVP in detecting early LV diastolic function impairment.Methods A total of 68 newly diagnosed breast cancer patients,who were treated with anthracycline-based chemotherapy,were analyzed.Transthoracic echocardiography was performed at baseline(T0),and after 1,2,3,4 and 8 chemotherapeutic cycles(T1,T2,T3,T4 and T5,respectively).Then,the IVP,LV strain parameters[global longitudinal strain(GLS),longitudinal peak strain rate at systole(LSRs),longitudinal peak strain rate at early diastole(LSRe),longitudinal peak strain rate at late diastole(LSRa),and the E/LSRe ratio],and conventional echocardiographic parameters were obtained and further analyzed.A relative reduction of>15%in GLS was considered a marker of early LV subclinical dysfunction.Results Compared to the T0 stage,IVP significantly increased at the T1 stage.However,there were no significant changes in GLS,LSRs,or LSRe between the T0 and T1 stages.These parameters significantly decreased from the T2 stage.LSRa started to significantly decrease at the T5 stage,and the E/LSRe ratio started to significantly increase at the T3 stage(all P<0.05).At the T0 stage,IVP(AUC=0.752,P<0.001)had a good predictive value for LV subclinical dysfunction after chemotherapy.Conclusions IVP is a potentially sensitive parameter for the early clinical assessment of anthracycline-related cardiac diastolic impairment.

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.

18β-Glycyrrhetinic Acid Improves Cardiac Diastolic Function by Attenuating Intracellular Calcium Overload

Summary:Ranolazine,a late sodium current inhibitor,has been demonstrated to be effective on heart failure.18B-glycyrrhetinic acid(18β-GA)has the similar inhibitory effect on late sodium currents.However,its effect on diastolic function is still unknown.This study aimed to determine whether 18β-GA can improve the diastolic function and to explore the underlying mechanisms.Eighty male Sprague Dawley(SD)rats of Langendorff model were randomly divided into the following groups:group A,normal cardiac perfusion group;group B,ischemia-reperfusion group;group C,ischemia-reperfusion with anemoniasulcata toxinⅡ(ATX-Ⅱ);group D,ranolazine group;and group E,18β-GA group with four different concentrations.Furthermore,a pressure-overloaded rat model induced by trans-aortic constriction(TAC)was established.Echocardiography and hemodynamics were used to evaluate diastolic function at 14th day after TAC.Changes of free intracellular calcium(Ca27)concentration was indirectly detected by laser scanning confocal microscope to confirm the inhibition of late sodium currents.With the intervention of ATX-Ⅱon ischemia reperfusion injury group,5 umol/L ranolazine,and 5,10,20,40μmol/L 18β-GA could improve ATX-I-induced cardiac diastolic dysfunction.630 mg/kg glycyrrhizin tablets could improve cardiac diastolic function in the pressure-overloaded rats.18B-GA and ranolazine had similar effects on reducing the free calcium in cardiomyocytes.The study demonstrates that 18B-GA and glycyrrhizin could improve diastolic dysfunction induced by ischemia-reperfusion injury in Langendorff-perfused rat hearts and pressure-overloaded rats.The mechanism may be attributed to the inhibition of enhanced late sodium currents.

Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester

BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.

Impaired diastolic function in nave untreated human immunodeficiency virus infected patients

AIM:To evaluate cardiac function and structure in un-treated human immunodeficiency virus(HIV) patients without clinical evidence of cardiovascular disease.METHODS:Fifty-three nave untreated HIV-infected patients and 56 healthy control subjects underwent clinical assessment,electrocardiography(ECG) and echocardiography,including tissue doppler imaging.Moreover,a set of laboratory parameters was obtained from all subjects,including HIV-RNA plasma levels,CD4 cell counts and tumor necrosis factor-α levels.RESULTS:The two groups showed normal ECG traces and no differences regarding systolic morphologic parameters.In contrast,a higher prevalence of left ventricular diastolic dysfunction(abnormal relaxation or pseudonormal filling pattern) was found in the HIV patients(36% vs 9% in patients and controls,respec-tively,P <0.001).CONCLUSION:Subclinical cardiac abnormalities ap-pear in an early stage of the HIV infection,indepen-dent of antiretroviral therapy.The data suggest that HIV per se plays a role in the genesis of diastolic dys-function.

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.

Racial Differences in Left Ventricular Filling Pressure Following Acute Aerobic Exercise Between Chinese and Caucasians

Background Left ventricular filling pressure(LVFP)is an important early indicator of heart failure that is more prevalent in Caucasians than Chinese.Exercise-induced change in LVFP may provide more incremental information to assess dias-tolic function.But it was unknown whether there was difference in LVFP following acute exercise between Caucasians and Chinese.Purpose The purpose of this study was to investigate the change of LVFP following an acute 45-min aerobic exercise in healthy Caucasian and Chinese individuals.Methods Sixty participants(30 Caucasians and 30 Chinese,half was male,respectively)performed an acute bout of aero-bic exercise at 70%of heart rate reserve.Hemodynamics,Left ventricle(LV)morphology and function parameters were measured at baseline,then at 30-min and 60-min post-exercise.Results There was a similar LV ejection fraction,LV fraction shorten,lateral E/eʹand lateral eʹbetween Chinese and Caucasians at baseline.There was a significant race-by-time interaction in lateral E/eʹand lateral eʹbetween Chinese and Caucasians from pre-exercise to 30 min and 60 min after acute aerobic exercise.TheΔE/eʹwas significant correlated with baseline systolic blood pressure.Conclusion The change of LVFP was different between Chinese and Caucasians following acute aerobic exercise.The racial differences may be primarily caused by the changes of LV relaxation following exercise,baseline systolic blood pressure may also contribute to the differences.