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[Effects of total flavones of fructus Hippophae (TFH) on cardiac function and hemodynamics of anesthetized open-chest dogs with acute heart failure].

This study was carried out employing the model of dog with acute heart failure induced by phenobarbital natricum. It was shown that i.v. TFH 4.8 and 9.7 mg/kg could significantly increase CO, CI, + LVdP/dtmax and LVSP; shorten R-dP/dtmax in 9.7 mg/kg; raise - LVdP/dtmax, reduce LVEDP and T value; decrease MVO2I and TPVR; MAP and HR were not changed significantly. The results suggest that i.v. TFH can strengthen cardiac pump function and myocardial contractility in canine with heart failure; significantly improve myocardial diastolic function and hemodynamic performance; markedly decrease myocardia-used oxygen index and total peripheral vessel resistance, thus proving that TFH is good for heart failure.

Animals↗

Treadmill performance and cardiac function in selected patients with coronary heart disease.

To investigate the cardiac determinants of treadmill performance in patients able to exercise to volitional fatigue, 88 patients with coronary heart disease free of angina pectoris were tested. The exercise tests included supine bicycle radionuclide ventriculography, thallium scintigraphy and treadmill testing with expired gas analysis. The number of abnormal Q wave locations, ejection fraction, end-diastolic volume, cardiac output, exercise-induced ST segment depression and thallium scar and ischemia scores were the cardiac variables considered. Rest and exercise ejection fractions were highly correlated to thallium scar score (r = -0.72 to -0.75, p less than 0.001), but not to maximal oxygen consumption (r = 0.19 to 0.25, p less than 0.05). Fifty-five percent of the variability in predicting treadmill time or estimated maximal oxygen consumption was explained by treadmill test-induced change in heart rate (39%), thallium ischemia score (12%) and cardiac output at rest (4%). The change in heart rate induced by the treadmill test explained only 27% of the variability in measured maximal oxygen consumption. Myocardial damage predicted ejection fraction at rest and the ability to increase heart rate with treadmill exercise appeared as an essential component of exercise capacity. Exercise capacity was only minimally affected by asymptomatic ischemia and was relatively independent of ventricular function.

Adult↗

[Cholinergic mechanism of cardiac function regulation in acute transient coronary failure].

Experiments on 120 non-inbred white male rats weighing 200 +/- 10 g have shown phasic changes in the function of the cholinergic regulation mechanism of cardiac activity under the development of local transitory myocardial ischemia. It was characterized by activation of parasympathetic neuroeffector influences (as evaluated from the myocardial acetylcholine content) within the first 40 minutes of coronary occlusion and during reperfusion after 10 and 40 minutes of ischemia as well as by reduction of the influences by the 120th minute of myocardial ischemia and in the course of subsequent reperfusion. At the same time phasic reconstruction was recorded of cholinoreactive function of the heart: an increase during ischemia and a tendency towards reduction during subsequent reperfusion.

Acetylcholine↗

The sequential effects of estrogen administration and hypertension on cardiac function in ewes.

OBJECTIVE: Our objective was to study the effect of estrogen administration and moderate hypertension on left ventricular size, pump function, and contractility in chronically instrumented ewes. STUDY DESIGN: Ewes were either given 0.06 mg/kg 17beta-estradiol intramuscularly (n = 8) or were made hypertensive (n = 6) by inflation of an occluder around the aorta and were studied weekly. After 3 weeks each ewe received the opposite treatment. RESULTS: Estrogen administration caused an increase in left ventricular chamber size at a given pressure, fractional shortening (21.9% +/- 2.9% to 28.5% +/- 3.7%), and stroke volume (1.4 +/- 0.3 mL/kg to 1.6 +/- 0.3 mL/kg). Subsequent hypertension further increased left ventricular size at a given pressure but decreased fractional shortening (20.0% +/- 4.4%) and stroke volume (1.3 +/- 0.3 mL/kg). With hypertension first, there was no left ventricular enlargement, even with subsequent estrogen administration, and there were no changes in left ventricular pump function. End-systolic pressure and stress-dimension relationships did not change with either treatment. The end-systolic wall stress-fractional shortening relationship was likewise unchanged, suggesting that neither treatment changed contractility. CONCLUSIONS: The left ventricle previously exposed to hypertension does not remodel when exposed to estrogen, and cardiac pump function decreases when the estrogen enlarged heart is faced with moderate, subacute hypertension.

Animals↗

Effect of pranayam training on cardiac function in normal young volunteers.

Systolic time intervals (STI) are non-invasive and sensitive tests for measuring the ventricular performance. It has been reported that practice of pranayam modulates cardiac autonomic status and improves cardio-respiratory functions. Keeping this in view, the present study was designed to determine whether pranayam training has any effect on ventricular performance as measured by STI and cardiac autonomic function tests (AFT). Twenty four school children were randomly divided into two groups of twelve each. Group I (pranayam group) subjects were given training in nadishuddhi, mukh-bhastrika, pranav and savitri pranayams and practiced the same for 20 minutes daily for a duration of 3 months. Group II (control group) subjects were not given any pranayam training. STI (QS2, LVET and PEP) and AFT (RRIV and QT/QS2) were measured in both the groups at the beginning and again at the end of three months study period. Pranayam training produced an increase in RRIV and a decrease in QT/QS2, suggesting an enhanced parasympathetic and blunted sympathetic activity respectively. QS2, PEP and PEP/LVET increased significantly, whereas LVET was reduced significantly in pranayam group. In contrast, the changes in STI and AFT were much less marked in the control group. Our study shows that three months of pranayam training modulates ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity. Further studies on a larger sample size may illustrate the underlying mechanism(s) involved in this alteration.

Adolescent↗

Automatic assessment of cardiac function from short-axis MRI: procedure and clinical evaluation.

Cardiac magnetic resonance imaging (MRI) provides a wealth of morphological and physiological information. Automatic extraction of this information is possible by implementing various image processing techniques. However, existing procedures mostly rely on extensive human interaction and are seldom evaluated on a clinical scale. In this study, a nearly automatic process that extracts physiological parameters from cardiac MR images has been both developed and clinically evaluated. Raw images were obtained in the short-axis view and acquired by a gradient-cho (GE) protocol. In images selected to be analyzed, the only manual step required is the indication of a point in the center of the left ventricle (LV). From a set of such images, the process extracts endocardial and epicardial contours and calculates left ventricular volumes, mass and ejection fraction (EF). The process implements novel approaches to image processing techniques such as thresholding and shape extraction and can be adapted to other acquisition protocols. The process has demonstrated a clear potential for accurate extraction of the endocardial contour but a lower one with respect to the epicardial contour as a result of the low contrast between myocardium and some surrounding tissues, generated by the gradient-echo protocol. The ability of the process to asses physiological parameters has been subjected to a systematic clinical evaluation, which compared parameters, derived manually and automatically, in 10 healthy subjects and 10 patients. The evaluation has indicated that although individual volumes and mass were not accurately assessed, the automatic process has shown high potential for assessing the ejection fraction with relatively high accuracy and reliability.

Adult↗

Noninvasive assessment of electroconvulsive-induced changes in cardiac function.

Systolic time intervals were used to noninvasively evaluate the cardiac effects of electroconvulsive therapy (ECT) in eight psychiatric patients. ECT produced a hyperdynamic cardiac state in which there was a significant increase in blood pressure, a shortening of the pre-ejection period (PEP), and an increase in rate pressure product (RPP). Changes in the PEP and the RPP are compatible with increased cardiac contractility and oxygen consumption, respectively. These effects were apparently mediated by an ECT-induced increase in circulating catecholamines, particularly epinephrine.

Adolescent↗

Cardiac patch constructed from human fibroblasts attenuates reduction in cardiac function after acute infarct.

The current experiments used a scaffold-based, three-dimensional, human dermal fibroblast culture (3DFC) as a cardiac patch to stimulate revascularization and preserve left ventricular (LV) function of the infarcted LV in severe combined immunodeficient (SCID) mice. The 3DFC contains viable cells that secrete angiogenic growth factors and has been previously shown to stimulate angiogenesis. The hypothesis tested was that a 3DFC cardiac patch would attenuate a reduction in LV function of infarcted hearts. Five groups of mice were studied, including normal SCID mice (n = 13), normal SCID mice with 3DFC (n = 6), infarcted SCID mice (n = 6), infarcted mice with nonviable 3DFC (n = 6), and infarcted SCID mice with 3DFC (n = 6). An occlusion of a branch of the left anterior descending (LAD) coronary artery was performed by thermal ligation, and 3DFC was sized to the damaged area and implanted onto the epicardium at the site of tissue injury. Fourteen days postsurgery, LV mechanics were characterized with the Millar conductance catheter system (CCS). The data demonstrated that 3DFC-treated infarcted myocardium had significantly higher ejection fractions (EFs) compared with infarct-only mice (58.9 +/- 10.8 versus 31.0 +/- 5.8%, respectively; p < 0.05). Preload recruitable stroke work (PRSW) parameters were significantly higher in 3DFC-treated mice compared with infarct-only mice (64.6 +/- 11.9 versus 36.8 +/- 6.4 mmHg, respectively; p < 0.05). These results show that the 3DFC as a cardiac patch functioned to attenuate further loss of LV function accompanying acute myocardial infarct and that this may be related in part to myocardial revascularization.

Animals↗

Dynamic changes in left ventricular wall thickness and their use in analyzing cardiac function in the conscious dog.

The thickness of the left ventricular free wall and internal chamber diameter were continuously measured by pairs of ultrasonic crystals together with left ventricular pressure in normal conscious dogs. During the resting state, wall thickness decreased abruptly with the onset of atrial contraction from 10.5 mm to an average end-diastolic valueof9.8 mm. In contrast to most previous studies, there was no change in wall thickness during isovolumic systole, and with ejection the wall thickened by 31.3 percent of end-diastolic wall thickness. Atrial pacing, phenylephrine, isoproterenol and propranolol produced significant changes in chamber size with reciprocal changes in wall thickness. In addition, changes in the extent and velocity of left ventricular chamber shortening in the minor equator were associated with comparable reciprocal changes in the extent and velocity of free wall thickening (correlation coefficients 0.97 to 0.99). During acute coronary occlusion, progressive reductions in the extent and velocity of regional wall shortening with partial ischemia were associated with comparable changes in systolic wall thickening characteristics (r = 0.96 and 0.95), and holosystolic elongation in fully ischemic areas was associated with holosystolic wall thinning. During chronic pressure overload, despite wall thickening, the relation between chamber shortening and wall thickening were retained and direct computation of dynamic wall stress variations was possible. These measurements allowed precise definition of the dynamics of the left ventricular wall during normal and abnormal cardiac states. The demonstration that in the absence of regional dysfunction analysis of wall thickness in a single region of ventricular free wall can be used to describe myocardial and overall left ventricular function, as well as regional function in the presence of ischemia, constitutes a new approach to the assessment of cardiac function that has potential for echocardiographic applications.

Animals↗

Circulating soluble vascular cell adhesion molecule 1: relationships with residual renal function, cardiac hypertrophy, and outcome of peritoneal dialysis patients.

BACKGROUND: Vascular cell adhesion molecule 1 (VCAM-1) is involved in leukocyte-endothelial cell interaction and has a pivotal role in inflammation. Whether it contributes to excessive mortality in dialysis patients remains uncertain. In this study, we examined circulating soluble VCAM-1 (sVCAM-1) in relation to different clinical and biochemical parameters, as well as mortality and cardiovascular events, in peritoneal dialysis (PD) patients. METHODS: Values for serum sVCAM-1, together with C-reactive protein (CRP), homocysteine, albumin, lipid profile, blood hemoglobin, and indices of dialysis adequacy, were determined at study baseline, and echocardiography was performed in 160 long-term PD patients. Patients were followed up for a mean of 35 +/- 16 (SD) months. RESULTS: Serum sVCAM-1 levels were elevated in our continuous ambulatory PD (CAPD) patients and showed a negative correlation with residual glomerular filtration rate (GFR; P < 0.001) and low-density lipoprotein (LDL) cholesterol level (P = 0.004), but a positive correlation with left ventricular mass index (P = 0.025). Using Kaplan-Meier analysis, overall survival rates at 2 years were 96.2%, 75.2%, and 50.6% for patients in the lower, middle, and upper tertiles of sVCAM-1 levels, respectively (P < 0.0001). Fatal and nonfatal cardiovascular event-free survival rates were 58.2%, 56.9%, and 19.4% for patients in the lower, middle, and upper tertiles, respectively (P < 0.0001). Using Cox regression analysis with adjustment for confounding covariates, every 100-ng/mL increase in sVCAM-1 level was associated with 8% (95% confidence interval, 1.03 to 1.13) and 5% (95% confidence interval, 1.00 to 1.10) increases in risk for death and fatal and nonfatal cardiovascular events, respectively. Its significance for all-cause mortality remained with additional adjusting for LDL cholesterol level, but was lost when adjusting for residual GFR. Its association with cardiovascular events became insignificant when adjusting for LDL cholesterol level or residual GFR. Furthermore, patients with both sVCAM-1 and CRP levels elevated at the 50th percentile or greater were associated with the greatest death and fatal and nonfatal cardiovascular event rates compared with those with either CRP or sVCAM-1 level elevated at the 50th percentile or greater. CONCLUSION: Circulating sVCAM-1 levels show an important link with residual renal function, LDL cholesterol level, and cardiac hypertrophy in CAPD patients. Furthermore, residual renal function, which correlates inversely with circulating sVCAM-1 level, shows an important association with all-cause mortality and cardiovascular events and displaces sVCAM-1 level from the models for all-cause mortality and future cardiovascular events in CAPD patients. Additional study is needed to explore possible mechanistic links between inflammation, soluble adhesion molecules, residual renal function, and cardiac hypertrophy in CAPD patients.

Aged↗

Intensive blood pressure reduction is beneficial in patients with impaired cardiac function coexisting with chronic renal insufficiency.

Both in CHF (congestive heart failure) and CRI (chronic renal insufficiency), blood pressure reduction is beneficial for preservation of cardiac and renal function. However, it is uncertain how much blood pressure reduction is appropriate in patients with both CHF and coexisting CRI. In the present study, we examined whether intensive blood pressure reduction is more beneficial in these patients than the usually accepted level of reduction. Thirty-five men and 21 women of average age 63+/-5 years suffering from both CHF and CRI were selected from 316 patients attending the Kidney Disease Center of Saitama Medical School Hospital. All participants had an ejection fraction (EF) of less than 55% as determined by echocardiography. Renal function was evaluated by 24-h creatinine clearance (GFR), and a GFR of less than 50 ml/min was regarded as indicating renal insufficiency. Patients were divided into 2 groups according to the target blood pressure: in group I, blood pressure (BP) was lowered to less than 120/75 mmHg and in group II, blood pressure was lowered to less than 130/80 but more than 121/76 mmHg. The daily doses of basic antihypertensive agents were amlodipine 5 to 20 mg, benazepril 2.5 to 5 mg, guanabenz 2 to 8 mg and furosemide 20 to 60 mg. At the end of a 2-year follow-up period, the BP in group I was controlled at the level of 118+/-4/73+/-3 mmHg with good maintenance of EF (46+/-4 to 60+/-4%) and GFR (44+/-4 to 40+/-3 ml/min). In group II, BP was maintained at 128+/-4/81+/-2 mmHg, accompanied by a reduction of EF (46+/-4 to 42+/-3%) and a significant reduction of GFR (44+/-3 to 35+/-3 ml/min). These results suggest that intensive blood pressure reduction might be beneficial in cases complicated by cardiorenal failure.

Aged↗

Cardiac function by magnetic resonance imaging.

Gated magnetic resonance imaging of the heart displays cardiac structures with excellent resolution. This ability should be useful for assessment of cardiac physiology where acquisition of systolic and diastolic images is required. In this study, left ventricular ejection fraction was determined in 50 patients from oblique long axis views of the left ventricle using the area length formula. Angulated views were obtained by electronic gradient angulation. For comparison, all patients had monoplane angiocardiography in the RAO position. Forty-five patients were also studied by radionuclide ventriculography. Ejection fractions determined by MRI and angiocardiography were closely correlated (r = 0.90). Correlation between MRI and radionuclide ventriculography was also acceptable (r = 0.79). In addition to global left ventricular function, MR images provide information about regional wall motion. In order to acquire a three-dimensional set of images at various phases of the cardiac cycle, shorter imaging times are mandatory. A new imaging technique with potential for functional studies uses low flip angles, short repetition times and gradient refocused echoes. Up to 40 images can be obtained within one cardiac cycle. When displayed in a looped fashion, visual assessment of cardiac motion, intracardiac blood flow, and systolic wall thickening is possible. Potential advantages of functional studies by MRI are the concomitant acquisition of anatomical information and the three dimensional frame of reference.

Angiocardiography↗

[An echocardiographic study of cardiac function in chronic hemodialysis patients].

Echocardiography was studied in 83 uremic patients on maintenance hemodialysis and 18 normal subjects. Cardiac systolic and diastolic functions were evaluated according to Yamaguchi's method. Systolic functions such as ejection fraction and fractional shortening decreased in the patients receiving hemodialysis for less than 3 months. However, they remained within normal range in the patients under hemodialysis for more than 3 months. There were no significant correlations between systolic functions and mean blood pressure or various serum biochemical parameters such as urea nitrogen, creatinine, Na, K, Ca, P, hematocrit and PTH-C. Diastolic functions such as rapid filling rate/endosystolic volume, mean velocity of circumferential fiber lengthening during rapid filling, diastolic descent rate and diastolic posterior wall velocity also decreased in the patients receiving hemodialysis for less than 3 months. However, they increased slightly in the patients under hemodialysis for more than 3 months, although they were still lower than those in normal subjects. They were not related to mean blood pressure or various serum biochemical parameters. Hemodialysis patients had left ventricular hypertrophy regardless of duration of hemodialysis. Diastolic dysfunction in hemodialysis patients seemed to be due to systolic dysfunction, left ventricular hypertrophy and diminished ventricular compliance with myocardial degeneration. It was also suggested that increasing slow filling and atrial contraction in diastole might be related to diastolic dysfunction. These cardiac changes may be compensatory reactions of cardiac muscle to various uremic environments such as anemia, hypertension, fluid retention, electrolytes disturbance or uremic toxins.

Adult↗

Exercise improves postischemic cardiac function in males but not females: consequences of a novel sex-specific heat shock protein 70 response.

Exercise is a physiological inducer of the cardioprotective heat shock protein, Hsp70. The putative biological events involved in signaling this response exhibit sexual dimorphism. Thus, it was hypothesized that exercise-mediated induction of Hsp70 would demonstrate sex specificity. After treadmill running, male rats exhibited 2-fold greater levels of cardiac Hsp70 relative to the levels in gonadally intact female rats (P<0.001). Ovariectomized female rats exhibited exercise-mediated induction of Hsp70 similar to that observed for male rats, and estrogen treatment in these female rats reversed this effect (P<0.001). Attenuation of Hsp70 signaling by estrogen was non-receptor-mediated, possibly involving a cellular membrane-stabilizing mechanism of action. The physiological importance of this sex-specific hormone-mediated stress response is underscored by the disparity in functional adaptation in response to exercise between male rats and female rats. Exercise markedly improved postischemic left ventricular developed pressure, the maximal rate of contraction, and maximal rate of relaxation, and it reduced left ventricular end-diastolic pressure in male rats (P<0.001). No such benefit of exercise was observed in intact female rats. A causal role for Hsp70 in this sex-specific cardioprotective adaptation was indicated, inasmuch as ablation of Hsp70 induction with antisense oligonucleotides designed against Hsp70 transcripts attenuated improvement in the recovery of cardiac function in exercised male rats (P<0.05). Thus, the sex-specific hormone-mediated Hsp70 response to exercise results in cardioprotective adaptation, preferentially in male rats relative to female rats. These findings suggest that exercise may be more important for males than for females in defending against the effects of heart disease and offer a novel manner by which males may reduce the sex gap in susceptibility to adverse cardiac events.

Animals↗

[Pulmonary hemodynamics and cardiac function in severe arterial hypertension].

The central and pulmonary hemodynamics and contractility of the cardiac ventricles were studied using catheterization and cine-angiocardiography in 11 patients with high arterial hypertension and 10 patients with no cardiovascular pathology. Pulmonary hypertension was not recorded in the patients with high arterial hypertension having no clinical symptoms of the heart failure. The pressure in the pulmonary circulation is determined only by the level of the left ventricular end-diastolic pressure, which is moderately elevated in the patients with arterial hypertension due to manifest myocardial hypertrophy. Higher pressure in the pulmonary circulation system in the patients with high arterial hypertension as compared with the control group is explained by the increased left ventricular rigidity due to compensatory hypertrophy. It was shown that diastolic pulmonary arterial pressure reflected left ventricular end-diastolic pressure with sufficient accuracy, exceeding it by an average 2.5 mm Hg. The functional interrelationship has been shown between the cardiac ventricles both in health and in high arterial hypertension.

Adult↗

The role of a hydroxyl radical scavenger (nicaraven) in recovery of cardiac function following preservation and reperfusion.

We investigated the efficacy in reducing myocardial preservation and reperfusion (P/R) injury of direct hydroxyl radical scavenging by nicaraven as compared with scavenging of both superoxide radicals and hydrogen peroxides by superoxide dismutase (SOD) and catalase (CAT), respectively. Isolated rat hearts were mounted on a Langendorff (L) apparatus to estimate the baseline aortic flow (AF), coronary flow (CF), cardiac output (CO), systolic pressure (SP), aortic mean pressure (MP), rate pressure product, and LV dp/dt. They were divided into 3 groups: group 1, 12 hr storage in HTK solution; group 2, 12 hr storage in HTK solution containing 2.5x10(5) U/L SOD and 2x10(5) U/L mg/L CAT; and Group 3, 12 hr storage in HTK solution containing 10(-3) M nicaraven. SOD, CAT, and nicaraven were administered intraperitoneally before harvesting. Hearts were stored in each preservation solution at 4, and then reperfused. Postpreservative function and concentrations of leaked enzymes were measured. The hearts were switched back to the L-mode and paced at 330 beats/min. CF following perfusion with Krebs-Henseleit bicarbonate buffer (KHB) solution containing 10(-6) M 5-hydroxytryptamine (5-HT) or 10(-5) M nitroglycerin (NTG) then evaluated. The myocardial water content also was measured. The recovery of CF, CO, SP, MP, and LV dp/dt was significantly greater in group 3 than in group 1. The recovery of CF was superior to that in group 2 (P<0.05). There were no significant differences in the recovery of cardiac function between groups 1 and 2. 5-HT caused a decrease in CF in each group, however, CF in group 3 was higher than that in group 1 (P<0.05). NTG caused no significant differences among the groups. There were no significant differences in leaked enzymes and myocardial water content among the three groups. These results suggest that nicaraven protects against myocardial P/R injury through its hydroxyl radical scavenging activity, and that therapy with oxygen-free radical scavengers should be directed toward inactivation of hydroxyl radicals rather than superoxide radicals and/or hydrogen peroxides.

Animals↗