scholarly journals Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta

2020 ◽  
Vol 9 (11) ◽  
pp. 3602
Author(s):  
Ximena Torres ◽  
Mar Bennasar ◽  
Laura García-Otero ◽  
Raigam J. Martínez-Portilla ◽  
Brenda Valenzuela-Alcaraz ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Relative Wall Thickness ◽  
Monochorionic Twins ◽  
Concentric Hypertrophy ◽  
Normal Ranges ◽  
Cardiac Adaptation ◽  
Echocardiographic Parameters ◽  
Z Scores ◽  
And Function ◽  
Right Atria

Cardiovascular dysfunction has been reported in complicated monochorionic diamniotic (MCDA) pregnancies; however, little is known whether hemodynamic changes occur in uncomplicated MCDA twins. A prospective observational study was conducted including 100 uncomplicated MCDA twins matched by gestational age to 200 low-risk singletons. Echocardiography was performed at 26–30 weeks gestation and cord blood B-type natriuretic peptide (BNP) was measured at delivery. In both groups, z-scores for echocardiographic parameters were within normal ranges; however the monochorionic group had larger atrial areas (mean (standard deviation) right atria-to-heart ratio: 17.0 (2) vs. 15.9 (1); p = 0.018; left atria-to-heart ratio: 17.0 (3) vs. 15.8 (2); p < 0.001) and signs of concentric hypertrophy (right relative wall thickness: 0.66 (0.12) vs. 0.56 (0.11); p < 0.001; left relative wall thickness: 0.69 (0.14) vs. 0.58 (0.12); p < 0.001). Longitudinal function was increased in twins, leading to higher tricuspid annular plane systolic excursion (6.9 mm (0.9) vs. 5.9 mm (0.7); p < 0.001) and mitral annular plane systolic excursion (4.9 mm (0.8) vs. 4.4 mm (1.1); p < 0.001. BNP levels at birth were also higher in MCDA twins (median [interquartile range]: 20.81 pg/mL [16.69–34.01] vs. 13.14 pg/mL [9.17–19.84]; p < 0.001). Thus, uncomplicated MCDA fetuses have normal cardiac shape and function, but signs of cardiac adaptation were identified by echocardiographic and biochemical parameters, when compared with singletons.

scholarly journals Changes in Echocardiographic Parameters among Beninese Soccer Referees during the Division 1 Championship in 2016

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Quenum Coffi ◽  
Sonou Arnaud ◽  
Gouthon Polycarpe ◽  
Ahissou Hyacinthe ◽  
Messan Folly ◽  
...  
Keyword(s):  
National Level ◽  
Concentric Hypertrophy ◽  
Division 1 ◽  
National Division ◽  
Eccentric Hypertrophy ◽  
Echocardiographic Parameters ◽  
Lv Ejection Fraction ◽  
A Prospective Study ◽  
And Function ◽  
Intensive Physical Exercise

Introduction. The goal of this study was to describe the echocardiographic parameters of soccer referees and to examine the changes in these parameters after a period of intensive physical exercise. Methods and Patients. We conducted a prospective study that included Beninese soccer referees. The study of the geometry and function of the left ventricle (LV) was made at the beginning and end of the national Division 1 championship, which was held during the course of 10 weeks. Results. There were 37 referees included in this study; 20 at the national level (G1: 27.8 ± 6.6 years) and 17 at the international level (G2: 32.1 ± 6.4 years). Dimensions of the LV were normal for all the referees. At the beginning of the championship, 51.3% of the referees had a normal LV geometry, 37.8% had concentric remodelling, 2.7% had concentric hypertrophy, and 8.1% had eccentric hypertrophy. In the group of referees with normal LV geometry, a modification in concentric remodelling at the end of the championship was seen in 30% of the referees in G1, 33.3% of the referees in G2, and 31.6% of the whole sample. In the group of subjects who presented concentric LV remodelling, a modification in the normal geometry was observed in 37.5% of those in G1, in 0% of those in G2, and in 21.4% of the whole sample. The cases of LV hypertrophy showed no change regardless of the group considered. An LV ejection fraction of more than 50% and an E/E′ ratio less than 8 were found in all referees. Conclusion. All the referees studied had normal cardiac morphology and function. The intensity of the physical load was insufficient to impact this morphology.

scholarly journals P744 The main influencing factors of cardiac adaptation effecting the diastolic and right ventricular function in peripubertic athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Szabo ◽  
A Horanyi ◽  
D Nagy ◽  
C S Melczer ◽  
P Acs ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Influencing Factors ◽  
Normal Values ◽  
Structural Parameters ◽  
Age Group ◽  
Training Time ◽  
Normal Ranges ◽  
Cardiac Adaptation ◽  
Echocardiographic Parameters ◽  
And Training

Abstract Introduction Several studies examined the effects of regular training in peripubertic athletes’ heart, focusing on the left ventricle (LV). Their normal LV values are showing significant differences from adult athletes. In contrast, there are no specific normal ranges of the diastolic function and the right ventricular (RV) parameters in this age group. Moreover, the results of the latest studies are inconsistent through the different inclusion criteria and influencing factors. Purpose, methods: The purpose of our study was to examine the specific diastolic and RV parameters of peripubertic athletes and compare them to the available normal values of adult athletes or healthy age-matched non-athletes. Furthermore, we were looking for the effects of the main influencing factors [lean body mass (LBM), body surface area (BSA), age, gender, training time, sporting discipline] on the echocardiographic parameters. 146 children and young adults (athletes, triathletes, basketball players, soccer players) were included between the age of 9 and 20 years (119 males, 27 females, 16,1 ±2,55 years). Specific 2D and tissue Doppler echocardiographic examinations were performed with one-lead continuous ECG gating. Results Examining the LV we did not find any significant differences comparing to the latest normal LV values by age. Significant positive correlation was found between the LV parameters, age and LBM. In comparison to adult athletes’ diastolic parameters, significantly (p&lt; 0,001) higher E, lower A values and higher E/A ratio was detected. However, we found significantly (p&lt; 0,001) higher lateral, septal and average e’ values and significantly (p&lt; 0,001) lower E/e’ ratio compared to both reference groups. Therefore, the supernormal diastolic values of our athletes exceeded not only the diastolic performance of the age-matched non-athletes but also the adult professionals. Moreover, significantly (p&lt; 0,001) lower structural and functional RV parameters were detected in the young athletes than the adult ones. In comparison to the peripubertic non-athletes significantly (p&lt; 0,001) higher structural parameters, higher tricuspid S wave, RV end-diastolic and end-systolic area values were found. Contrary, there was no differences between the tricuspid annular plan excursion (TAPSE) values. Based on multivariate analysis we found remarkable correlation (r= 0,527, p&lt; 0,001) between the diastolic or RV parameters and the common effect of the main influencing factors: LBM, BSA, age and training time. Conclusion There are no clearly defined normal values of diastolic and RV parameters in peripubertic athletes, however we also detected remarkable left and right ventricular changes in this young age group. Well-defined cut-off values should be applied to differentiate pathological conditions. The main influencing factors of the echocardiographic parameters are LBM, BSA, age and training time having additive effects on the cardiac adaptation.

Leptin Attenuates Cardiac Hypertrophy in Patients with Generalized Lipodystrophy

2021 ◽  
Author(s):  
My-Le Nguyen ◽  
Vandana Sachdev ◽  
Thomas R Burklow ◽  
Wen Li ◽  
Megan Startzell ◽  
...  
Keyword(s):  
Cardiac Hypertrophy ◽  
Wall Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Open Label ◽  
Posterior Wall Thickness ◽  
Lv Mass ◽  
Before And After ◽  
Echocardiographic Parameters ◽  
And Function

Abstract Context Lipodystrophy syndromes are rare disorders of deficient adipose tissue, low leptin, and severe metabolic disease, affecting all adipose depots (generalized, GLD) or only some (partial, PLD). Left ventricular (LV) hypertrophy is common (especially in GLD); mechanisms may include hyperglycemia, dyslipidemia, or hyperinsulinemia. Objective Determine effects of recombinant leptin (metreleptin) on cardiac structure and function in lipodystrophy. Design/Participants/Intervention/Setting Open-label treatment study of 38 subjects (18 GLD, 20 PLD) at the National Institutes of Health before and after 1 (N=27), and 3-5y (N=23) of metreleptin. Outcome Echocardiograms, blood pressure (BP), triglycerides, A1c, HOMA-IR Results In GLD, metreleptin lowered triglycerides (median(IQR) 740(403-1239), 138(88-196), 211(136-558) mg/dL at baseline, 1y, 3-5y, P&lt;0.0001), A1c (9.5±3.0, 6.5±1.6, 6.5±1.9%, P&lt;0.001), and HOMA-IR (34.1(15.2-43.5), 8.7(2.4-16.0), 8.9(2.1-16.4), P&lt;0.001). Only HOMA-IR improved in PLD (P&lt;0.01). Systolic BP decreased in GLD but not PLD. Metreleptin improved cardiac parameters in patients with GLD, including reduced posterior wall thickness (9.8±1.7, 9.1±1.3, 8.3±1.7 mm, P&lt;0.01), and LV mass (140.7±45.9, 128.7±37.9, 110.9±29.1 g, P&lt;0.01), and increased septal e’ velocity (8.6±1.7, 10.0±2.1, 10.7±2.4 cm/s, P&lt;0.01). Changes remained significant after adjustment for BP. In GLD, multivariate models suggested that reduced posterior wall thickness and LV mass index correlated with reduced triglycerides and increased septal e’ velocity correlated with reduced A1c. No changes in echocardiographic parameters were seen in PLD. Conclusion Metreleptin attenuated cardiac hypertrophy and improved septal e’ velocity in GLD, which may be mediated by reduced lipotoxicity and glucose toxicity. The applicability of these findings to leptin-sufficient populations remains to be determined.

DIAGNOSIS AND MANAGEMENT OF SELECTIVE FETAL GROWTH RESTRICTION IN MONOCHORIONIC TWINS

2009 ◽  
Vol 20 (4) ◽  
pp. 269-281 ◽  
Author(s):  
EDUARD GRATACÓS ◽  
ELISENDA EIXARCH ◽  
FATIMA CRISPI
Keyword(s):  
Fetal Growth ◽  
Common Sense ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Fetal Weight ◽  
Abdominal Circumference ◽  
Monochorionic Twins ◽  
Normal Ranges ◽  
Estimated Fetal Weight ◽  
Simple Definition

Selective fetal growth restriction (sFGR) has been reported to occur in about 10–15% of monochorionic (MC) twins. The diagnosis of sFGR has been based on variable criteria including estimated fetal weight (EFW), abdominal circumference and/or the degree of fetal weight discordance. Recent studies tend to use a simple definition which includes the presence of an EFW less than the 10th percentile in the smaller twin. Some would argue that the intertwin fetal weight discordance should be included in the definition. Indeed this factor plays a major role in the complications presented by these cases. While the majority of cases with one fetus below the 10th percentile usually will also present with a large intertwin EFW discordance, the contrary is not always true. Thus, it is possible to find MC twins with remarkable intertwin EFW discordance but the EFW of both fetuses are still within normal ranges. Although it appears to be common sense that a large intertwin discrepancy might represent a higher risk for some of the complications described later in this review, there is no consistent evidence to support this notion. Therefore, due to its simplicity, a definition based on an EFW below 10th percentile in one twin is probably the most useful for clinical and research purposes.

Abstract 16018: Impaired Intrinsic Myocardial Shortening in Both Two Directions and Compensatory Mechanism to Maintain Left Ventricular Ejection Fraction in Patients With Hypertensive Heart Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Satoshi Yamada ◽  
Kazunori Okada ◽  
Hisao Nishino ◽  
Hiroyuki Iwano ◽  
Daisuke Murai ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ejection Fraction ◽  
Wall Thickness ◽  
Circumferential Strain ◽  
Hypertensive Heart Disease ◽  
Wall Stress ◽  
Left Ventricular ◽  
Relative Wall Thickness ◽  
Left Ventricular Ejection ◽  
Compensatory Mechanism

Background: Longitudinal myocardial shortening is known to be reduced even if left ventricular (LV) ejection fraction (EF) is preserved in patients with hypertensive heart disease (HHD). However, the compensatory mechanism remains to be elucidated. Thus layer-specific longitudinal and circumferential strain as well as stress-strain relationship was observed in HHD patients. Methods: In 46 HHD patients with preserved EF (>50%) and 29 age-matched control subjects, global longitudinal strain (LS) and layer-specific circumferential strain (CS) were measured from the apical 4-chamber view and mid-ventricular short-axis view, respectively, by using speckle tracking echocardiography. LS was measured at innermost LV wall layer, and CS at innermost, midwall, and outermost layers. Layer-specific end-systolic circumferential wall stress (CWS) according to Mirsky’s formula and endocardial meridional wall stress (MWS) were calculated. Results: Systolic blood pressure (147±20 mm Hg), interventricular septal thickness (13±2 mm), and LV dimension (48±4 mm) were greater in HHD than controls, whereas EF was comparable (66±8 vs 66±5%). LS was smaller in HHD than controls (-13±3 vs -17±3%, p<0.001) in spite of reduced MWS (520±141 vs 637±164 dyn·mm -2 , p<0.01), suggesting impaired longitudinal myocardial function in HHD. Similarly, CS was smaller in HHD than controls at outer layer (-6.8±2.2 vs -8.8±2.2%, p<0.01) and at midwall (-11.3±3.4 vs -13.9±3.2%, p<0.01) in spite of reduced CWS (outer: 238±82 vs 336±110 dyn·mm -2 , p<0.001; mid: 360±107 vs 473±131 dyn·mm -2 , p<0.001). In contrast, at the innermost layer, both CS (-26±5 vs -25±5%, p=0.41) and CWS (979±153 vs 992±139 dyn·mm -2 , p=0.72) were comparable between groups. Furthermore, the difference of CS between inner and outer layers significantly correlated with relative wall thickness (r=-0.33, p<0.01). Finally, CS at inner layer significantly correlated with EF (r=-0.43, p<0.001), whereas LS did not. Conclusions: In patients with HHD, intrinsic myocardial shortening was impaired both longitudinally and circumferentially. Some compensatory mechanism associated with increased relative wall thickness might work to maintain subendocardial CS, resulting in preserved EF.

scholarly journals Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification

2018 ◽  
Vol 9 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Jiahui Li ◽  
Aili Li ◽  
Jiali Wang ◽  
Yu Zhang ◽  
Ying Zhou
Keyword(s):  
Wall Thickness ◽  
Speckle Tracking ◽  
Heart Function ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Subtle Change ◽  
Lv Mass ◽  
And Function

Purpose: Cardiac valve calcification (VC) is very common in patients on hemodialysis. However, the definite effect of VC on left ventricular (LV) geometry and function in this population is unknown, especially when LV ejection fraction (LVEF) is normal. The aim of this study was to determine the effect of VC on LV geometry and function in long-term hemodialysis patients by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). Methods: A total of 47 hemodialysis patients (2–3 times weekly for 5 years or more) were enrolled in this study. Cardiac VC was defined as bright echoes of more than 1 mm on one or more cusps of the aortic valve or mitral valve or mitral annulus using echocardiography as the screening method. LV longitudinal global strain (GLS) was assessed on the apical four-chamber view and calculated as the mean strain of 6 segments. LV global circumferential strain was acquired on the LV short axis view at the level of papillary muscles. Results: Twenty-five patients with VC had higher mean values of interventricular septum thickness, LV posterior wall thickness, LV mass index, relative wall thickness, and LV mass/end-diastolic volume than 22 patients without VC (p < 0.05, respectively), indicating more obvious LV hypertrophy (LVH). VC patients had higher mitral annular E/E′ values, especially at the septal side representing increased LV filling pressure compatible with diastolic dysfunction, while only the E/E′ ratio of the septal side was significantly different between the 2 groups (16.7 ± 4.1 vs. 12.3 ± 4.4, p < 0.01). When assessed by GLS, LV longitudinal systolic function was also lower in in patients with VC compared with those without VC (–0.18 ± 0.03 vs. –0.25 ± 0.04; p < 0.01). Conclusions: Cardiac VC diagnosed by echocardiography when it occurs in long-term hemodialysis patients may indicate more severe LVH, myocardial damage, and worse heart function in comparison to those without VC. Tissue Doppler imaging and 2D-STE can detect the subtle change of heart function in this population in the early stage of LV dysfunction when LVEF is normal.

scholarly journals THE 5-YEAR DYNAMICS OF CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH CORONARY ARTERY DISEASE AFTER MYOCARDIAL REVASCULARIZATION

2020 ◽  
Vol 73 (4) ◽  
pp. 728-732
Author(s):  
Roksolana R. Guta ◽  
Olena M. Radchenko ◽  
Olga Ya. Korolyuk
Keyword(s):  
Myocardial Revascularization ◽  
Myocardial Mass ◽  
Co Morbidity ◽  
Geometry Estimation ◽  
Echocardiographic Parameters ◽  
Atrial Enlargement ◽  
Group 2 ◽  
Artery Disease ◽  
And Function ◽  
Group 1

The aim: To estimate the dynamics of echocardiographic parameters in patients with CAD within 5 years after revascularization. Material and methods: 50 persons (males/females 39/11; mean age 59.9±9.3 years; STEMI 76%, non-STEMI 24%) were divided into two groups: n=38 after PCI with stenting (PCIwS); n=12 after CABG. Observation included regular echocardiography with LV myocardial mass (LVMM) and geometry estimation. Results: Groups were comparable by age, co-morbidity, BP, heart rate and BMI. Significantly severe baseline LV hypertrophy (LVH) and left atrial enlargement (LAE) in group 2 explained by spread coronary atherosclerosis. Later progressive LAE (4.37±0.22 cm, P0-60<0.05) in group 1, and aortic/LV dilatation (+0.4/+1.0 cm, respectively, both P0-60<0.05) in group 2 developed. In two years LVMM index increased by 13.4/17.5% in groups 1/2, respectively. Normal geometry and concentric remodeling completely disappeared in 3/1.5 years after PCIwS/CABG, respectively. Conclusions: Within the 1st year after revascularization, patients with CABG had more severe LVH. In 5 years after PCIwS the ratio between concentric/eccentric LVH was 2:1, whereas after CABG – 1:2.

scholarly journals p38δ genetic ablation protects female mice from anthracycline cardiotoxicity

2020 ◽  
Author(s):  
Sharon A George ◽  
Alexi Kiss ◽  
Sofian N Obaid ◽  
Aileen Venegas ◽  
Trisha Talapatra ◽  
...  
Keyword(s):  
Cardiac Injury ◽  
Mapk Signaling ◽  
Anthracycline Cardiotoxicity ◽  
Genetic Ablation ◽  
Female Mice ◽  
Echocardiographic Parameters ◽  
The Individual ◽  
And Function ◽  
First Time ◽  
Dose Dependent

ABSTRACTBACKGROUNDThe efficacy of an anthracycline antibiotic doxorubicin (DOX) as a chemotherapeutic agent is limited by dose-dependent cardiotoxicity. DOX is associated with activation of intracellular stress signaling pathways including p38 MAPKs. While previous studies have implicated p38 MAPK signaling in DOX-induced cardiac injury, the roles of the individual p38 isoforms, specifically, of the alternative isoforms p38γ and p38δ, remain uncharacterized.OBJECTIVESTo determine the potential cardioprotective effects of p38γ and p38δ genetic deletion in mice subjected to acute DOX treatment.METHODSMale and female wild-type (WT), p38γ-/-, p38δ-/- and p38γ-/-δ-/- mice were injected with 30 mg/kg DOX and their survival was tracked for ten days. During this period cardiac function was assessed by echocardiography and electrocardiography and fibrosis by PicroSirius Red staining. Immunoblotting was performed to assess the expression of signaling proteins and markers linked to autophagy.RESULTSSignificantly improved survival was observed in p38δ-/- female mice post-DOX relative to WT females, but not in p38γ-/- or p38γ-/-δ-/- male or female mice. The improved survival in DOX-treated p38δ-/- females was associated with decreased fibrosis, increased cardiac output and LV diameter relative to DOX-treated WT females, and similar to saline-treated controls. Structural and echocardiographic parameters were either unchanged or worsened in all other groups. Increased autophagy, as evidenced by increased LC3-II level, and decreased mTOR activation was also observed in DOX-treated p38δ-/- females.CONCLUSIONSp38δ plays a crucial role in promoting DOX-induced cardiotoxicity in female mice by inhibiting autophagy. Therefore, p38δ targeting could be a potential cardioprotective strategy in anthracycline chemotherapy.NEW AND NOTEWORTHYThis study for the first time identifies the roles of the alternative p38γ and p38δ MAPK isoforms in promoting DOX-cardiotoxicity in a sex-specific manner. While p38γ systemic deletion did not affect DOX-cardiotoxicity, p38δ systemic deletion was cardioprotective in female but not in male mice. Cardiac structure and function were preserved in DOX-treated p38δ-/- females and autophagy was increased.

Abstract 4197: Does Relative Wall Thickness or Left Ventricular Mass Index Best Predict Mortality Risk in Patients With Preserved Systolic Function?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dharmendrakumar A Patel ◽  
Carl J Lavie ◽  
Sangeeta Shah ◽  
Yvonne Gilliland ◽  
Richard V Milani
Keyword(s):  
Wall Thickness ◽  
Systolic Function ◽  
Age Groups ◽  
Left Ventricular ◽  
Relative Wall Thickness ◽  
Prognostic Impact ◽  
Geometric Patterns ◽  
Lv Mass ◽  
Mortality Table ◽  
The Impact

Background: Several studies have indicated that left ventricular (LV) geometric patterns predict cardiovascular events. However, little data is available that compares the relative prognostic impact of LV mass index (LVMI) and relative wall thickness (RWT) on mortality in a large cohort of patients with preserved systolic function. Methods: The impact of LVMI and RWT on mortality during an average follow-up of 1.7±1.0 years was examined in a sample of 47,701 patients (mean age: 61.6 ± 15.4; females=54.6 %) with preserved ejection fraction(EF), as well as in age groups of <50 yrs(n=10,864; mean age=39.9 ± 8.1; females=58.4 %), 50 –70 yrs (n=20,181; mean age=59.9 ± 5.7; females=52.2 %) and >= 70 yrs (n=16,836; mean age=77.7 ± 5.5; females=55.1 %). Results: With increasing age (<50, 50 –70, >=70 yrs), both LVMI (78.5 ± 23.4, 84.3 ± 25.4, 90.3 ± 27.6; p<0.0001) and RWT (0.37 ± 0.08, 0.41 ± 0.08, 0.43 ± 0.09; p<0.0001) as well as mortality (2.2%, 5.0%, 14.2%; p<0.0001) showed significant linear trends and were independent predictors of mortality (Table , Figure ). Conclusion: Although, both LVMI and RWT were independently associated with increased mortality in all groups, RWT was by far the strongest independent predictor of all-cause mortality, especially in younger patients.

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