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Introduction It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Malnutrition and delayed wound healing may occur with a combination of primary and secondary protein-energy undernutrition. Methods Serial transthoracic and transesophageal echocardiographic parameters were measured during perioperative care (ejection fraction, fractional shortening, pericardial fluid) in 8 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting) and a delayed presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients at 2 years post-injury. Acutely-injured patients or those with sepsis were excluded. Results From 2015–2017, echocardiographic measurements were obtained in 8 patients, ages 7–21. The presenting TBSA ranged from 30–82% and included flame injury, electrical burns, and 1 case of pemphigus vulgaris. The initial ejection fraction ranged from 12–45% in patients with a BMI range of 10–25. The mean initial albumin was 2g/dL; the mean prealbumin was 9.5mg/dL. Two patients had mild to moderate pericardial effusions, which resolved after 1 month of proper nutrition. Selenium deficiency was noted in 1 patient. Four patients required perioperative short-term dobutamine. Conclusions Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy; however, the degrees of systolic dysfunction varied significantly. BMI, albumin, and prealbumin all had a strong correlation with the degree of myocardial depression. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and did not require inotropic medications. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year. Applicability of Research to Practice This case series demonstrates the continued need for early recognition of malnutrition and cardiomyopathy in this patient population and the need for early intervention. Echocardiographic diagnosis may improve acute perioperative care. In addition, future studies are needed to determine the chronic cardiac effects of reversible dilated cardiomyopathy. Nutrition, refeeding, and perioperative management require a multidisciplinary team.

Introduction The differential diagnosis between physiological remodeling of the athlete's heart and cardiomyopathies responsible for sudden death is sometimes difficult. Aim Describe the difference between physiological dilatation of cardiac cavities in athletes with pathological dilatation by comparing a group of high-level athletes (athlete group) to a subject group followed for dilated cardiomyopathy (DCM group). Materials and methods We conducted a prospective comparative study including 61 subjects. The group of athletes comprised 31 subjects. The DCM group consisted of 30 subjects. All subjects were paired to age and body surface and had cardiac MRI with late enhancement study. Results Left ventricular systolic function in MRI by left ventricular ejection fraction (LVEF) study, LV shortening fraction and MAPSE (Mitral annular plane systolic excursion) study were normal in the athlete group and impaired in the DCM group. Left and right ventricular dilatation in the athlete group was proportionate with a ratio of LV tele diastolic volume indexed to RV tele-diastolic volume (LV TDVi/RV TDVi) at 1.1 ± 0.1 versus disproportionate dilatation in the patient DCM group (LV TDVi/RV TDVi) at 2 ± 0.8). The ROC curve was used to identify the threshold value of the LV TDVi/RV TDVi ratio. This threshold value corresponds to 1.21 with a 90% sensitivity and a 90.3% specificity. The correlation between the LV TDVi/RV TDVi ratio and the LV ejection fraction (LVEF) was negative (correlation coefficient = −0.55, P Conclusion Cardiac MRI is a major contributor to the Athlete Heart distinction from the DCM. LV TDVi/RV TDVi ratio represents a discriminating role between a normal proportional adaptation of the two ventricles and a pathological dilatation.

Primary objective To know the variability of transthoracic echocardiographic parameters that assess right ventricular systolic function by analyzing interobserver agreement in the early postoperative period of cardiovascular surgery. Secondary objective To assess the feasibility of these echocardiographic measurements. Design A cross-sectional study, double-blind pilot study was carried out from May 2011 to February 2013. Setting Cardiovascular postoperative critical care at the National Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico. Patients Consecutive, non-probabilistic sampling. Fifty-six patients were studied in the postoperative period of cardiac surgery. Intervention The first echocardiographic parameters were obtained between 6 and 8 h after cardiac surgery, followed by blinded second measurements. Main variables Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity on tissue Doppler imaging (VSPAT), diameters and right ventricular outflow area, tract fractional shortening. The agreement was analyzed by the Bland–Altman method, and its magnitude was assessed by the intraclass correlation coefficient (95% confidence interval). Results Both observers evaluated TAPSE and VSPAT in 48 patients (92%). The average TAPSE was 11.68 ± 4.53 mm (range 4–27 mm). Right ventricular systolic dysfunction was observed in 41 cases (85%) and normal TAPSE in 7 patients (15%). The average difference and its limits according to TAPSE were −0.917 ± 2.95 (−6.821, 4.988), with a magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic velocity on tissue Doppler imaging was −0.001 ± 0.015 (−0.031, 0.030), and its magnitude 0.825 (0.708, 0.898), respectively. Conclusions VSPAT and TAPSE were estimated by both observers in 92% of the patients, these parameters exhibiting the lowest interobserver variability.

BackgroundPulmonary hypertension (PH) is common in heart failure patients. Literature on PH in heart failure is sparse in Nigeria. This study was carried out to determine the prevalence of PH in heart failure patients and ascertain the relationship between left ventricular systolic and diastolic function and the degree of PH.MethodsA total of 125 heart failure patients had echocardiography done. PH was diagnosed using tricuspid regurgitation jet and pulmonary ejection jet profile.ResultsPH was present in 70.4% of heart failure patients. Estimated mean pulmonary arterial pressure increased with increasing severity of systolic and diastolic dysfunction and had significantly negative correlation with ejection fraction, fractional shortening, and early mitral annular tissue diastolic velocity ( E′), but positive correlation with left ventricular end-systolic volume, right ventricular dimension, transmitral E to A ratio, and E/E′ ratio.ConclusionPH is very common in heart failure and has significant relationship with left ventricular function.

There are few data regarding the characteristics of premature ventricular contractions (PVCs) in healthy children and their impact on left ventricular (LV) function.The purpose of this study was to assess the prevalence of LV systolic dysfunction in children with frequent PVCs (≥10%) and determine whether it is associated with PVC characteristics (e.g., proportion, coupling interval, width, and/or morphology).We conducted a single-center cohort study of children with structurally normal hearts and PVC burden ≥10% by 24-hour Holter monitoring performed between 2008 and 2012. Clinical, arrhythmic, and echocardiographic data were reviewed at baseline and during follow-up.A total of 47 children (22 female [47%], mean age 8.2 ± 6.5 years) had a mean PVC burden of 20.9 ± 11.9% at baseline. The PVC coupling interval averaged 430 ± 110 ms, with a PVC width of 118 ± 27 ms. PVCs were monomorphic in 44 patients (94%). Although no patient had severe cardiomyopathy, 7 (15%) had reduced shortening fraction (Z-score-2). A strong association was observed between PVC coupling interval and LV shortening fraction Z-score-2.0 (area under the curve 0.95 ± 0.03, P.001). A cutoff value365 ms yielded the greatest discriminatory ability (Youden J-statistic 0.72, sensitivity 85.7%, specificity 86.5%). PVC proportion, width, and morphology were not significantly associated with LV shortening fraction. During 4.0 ± 2.8 years of follow-up, the PVC burden decreased from a median of 18% to 1.5% (P.001).PVCs in children with structurally normal hearts are associated with a relatively benign course, with spontaneous resolution in most children. Mild LV systolic dysfunction, observed in 15%, is strongly correlated with a shorter coupling interval (365 ms).

Ventricular systolic dynamics involves the contraction of transverse and longitudinal myocardial fibers. Unfortunately, only the activity of the transverse myocardial fibers is foreseen by the standard systolic echocardiographic parameters. Although strain and strain rate have been used to assess the radial, circumferential and longitudinal planes of cardiac contraction, such analysis requires advanced equipment which is not always available in veterinary medicine. On the contrary, some unusual parameters may be recorded via standard methodology, allowing for the specific evaluation of left ventricular longitudinal contractility. In this study, the longitudinal contractile activity was evaluated using the long-axis fractional shortening and the mitral annulus motion, which were compared with several standard echocardiographic parameters in 14 beagles, including seven with asymptomatic mitral valve disease. The long-axis fractional shortening was positively correlated with both the mitral annulus motion and the end-diastolic left-ventricular diameter. Also, a significant correlation was found to exist between the mitral annulus motion and the left-ventricular end-diastolic diameter, which is likely supportive of its preload dependency. Even though no difference was documented in either mitral annulus motion or long-axis fractional shortening between healthy dogs and dogs with mitral valve disease, the latter only included animals with minimal cardiac remodeling, with no overt compromise of systolic function. Since it is possible to obtain these two parameters with any echocardiographic equipment, their inclusion in the routine exam would probably add information regarding the activity of the longitudinal myocardial fibers, whose functional deterioration supposedly occurs prior to the impairment of transverse fibers.

The circulatory physiology of fetuses differs from that of neonates. The concept of biventricular combined cardiac output is necessary to understand and assess the fetal cardiac function. Fetal cardiac function has been estimated using echocardiographic methods such as M-mode, B-mode and pulsed wave Doppler. In addition, recent studies have reported the utility of tissue Doppler imaging in fetal echocardiography. However, parameters for fetal cardiac function remain to be established. Recently, we developed two novel techniques for assessing fetal cardiac function: an automatic fractional shortening method and E/e' determination using the dual-gate Doppler method. These two techniques are expected to be reliable and useful for assessing the fetal status in various pathological conditions.

This study aims at determining the echocardiographic, radiographic and tomographic parameters of blue-fronted Amazon parrots (Amazona aestiva) with varying body condition scores. Thirty-five birds grown in captivity were included in the study and allocated into groups according to their respective body condition scores: Lean, Ideal and Obese. The echocardiographic evaluation revealed that obese parrots presented lower right ventricle dimensions in diastole than lean parrots. The fractional shortening was considerably lower in obese parrots than in parrots with lean and ideal body condition scores, but without statistical significance. The flow rate and the aortic pressure gradient were lower in the lean group than in the ideal group. No differences were observed between the groups when comparing the radiographic and tomographic measurements. Therefore, as is the case in mammals, we can conclude that alterations in the nutritional state of blue-fronted amazon parrots lead to cardiovascular dysfunctions detected only through an echocardiographic evaluation, which represents an important diagnostic tool for these animals. Computed tomography scans allowed a better identification of the structures of the cardiovascular system without the overlaying structures of the celomatic cavity observed in radiographic images. However, radiographic examinations should still be considered the standard screening examination to identify cardiac alterations such as increased or reduced organ dimensions. Standardizing the technique and describing the measurements obtained in this study may serve as a basis for further research.

Left ventricular (LV) assist devices (LVADs) are known to elicit reverse remodeling by mechanically unloading the left ventricle. Current guidelines target a reduction in LV end-diastolic diameter (LVEDD) of 15% compared with pre-LVAD dimensions; however, there is significant heterogeneity in the degree of unloading achieved. We sought to investigate factors associated with mechanical unloading at 6 months of LVAD support.Data were retrospectively collected for 75 LVAD recipients at five time points: pre-LVAD, within 14 days post-LVAD, and at 1, 3, and 6 months post-LVAD. The percentage change in LVEDD between the pre-LVAD and 6 months post-LVAD time points was termed ΔLVEDD. Optimal LV unloading was defined as ΔLVEDD of ≥15% at 6 months. Patients who achieved optimal unloading (group A, n = 30) were compared with patients who did not (group B, n = 45).At 6 months, optimally unloaded patients (group A) demonstrated higher fractional shortening (15% ± 10% vs 10% ± 7%, P = .007), lower rates of moderate or severe mitral regurgitation (10% vs 33%, P = .02), and lower pulmonary capillary wedge pressure (9 ± 4 vs 16 ± 7 mm Hg, P = .02). Right ventricular dysfunction was more prevalent at 6 months in poorly unloaded (group B) patients (73% vs 43%, P = .008). Between hospital discharge and 6 months, the percentage increase in pump speed (Δ revolutions per minute) was higher in group A patients (4.4% ± 3.7% vs 0.1% ± 2.6%, P .001). In a multivariate analysis, Δ revolutions per minute and tricuspid annular systolic velocity (S') at 6 months were independently associated with 6-month ΔLVEDD.Recipients of LVADs who undergo progressive pump speed up-titration during outpatient follow-up are more likely to sustain optimal LV unloading. Progressive LVAD-related right ventricular failure is prevalent in suboptimally unloaded patients.

Maintaining a good ventricular systolic function is important in the long-term therapy of dogs with supraventricular tachyarrhythmia (SVTA). The objective of this study was to evaluate the inhibitory effect of telmisartan on myocardial injury and the resulting ventricular systolic dysfunction in a canine model of SVTA. A total of 14 dogs were randomly assigned to a Telmisartan (oral telmisartan, 1.0 mg/kg daily, n=7) or a Control (no drug administration, n=7) group; the duration of rapid atrial pacing (RAP) was 3 weeks for both groups. The cardiac troponin I (cTnI) concentration in the Control group was significantly increased after 3 weeks compared to that before RAP initiation (baseline), but no significant difference was observed in the Telmisartan group. Moreover, the cTnI concentration at 3 weeks was significantly lower in the Telmisartan group than in the Control group. The left ventricular fractional shortening was significantly decreased at 3 weeks compared to that at baseline in both groups. However, fractional shortening at 3 weeks was significantly higher in the Telmisartan group than in the Control group. The cardiac output values in the Control group were significantly decreased at 3 weeks compared with those at baseline, but no significant difference was observed in the Telmisartan group. This study demonstrates that telmisartan inhibits the reduction in ventricular systolic function and prevents myocardial injury in a canine model of SVTA. Therefore, telmisartan is suggested as a novel treatment for canine SVTA.

Aim: Knowledge of the human body’s ability to adapt to repeated endurance efforts during swimming is limited. We echocardiographically assessed the impact of an exhausting and repetitive swimming effort on cardiac activity. Materials: Fourteen well-trained amateur swimmers (8 female swimmers aged 16–43 years and 6 male swimmers aged 13–67 years old) participated in an ultramarathon relay. Over 5 days, swimmers swam 500 km in the Warta River (in 5-km intervals). Each swimmer swam seven intervals, each within 44:46 to 60:02 min. Objective difficulties included low water temperatures, strong winds, rain, and night conditions. Methods: Transthoracic echocardiography (TTE) was performed three times: at baseline (the day before exertion), at peak effort, and during recovery (48 h after the event). The heart rate (HR) of each swimmer was monitored. Results: Swimmers completed the ultramarathon relay within approximately 91 h. The average HR value at the end of each interval was 91% HRmax. TTE test results showed no significant changes indicative of deterioration of myocardial function at peak effort or after 48 h. Significant increases in left ventricular (LV) ejection fraction, LV fractional shortening (LVFS), LV myocardial systolic velocity, and right ventricular (RV) fractional area changes observed on day 2 after swimming were compared to baseline values and peak effort values. No significant changes in diastolic heart function were observed. Conclusion: Echocardiography assessment indicated that prolonged intense swimming does not affect LV or RV function. Supercompensation of the post-event RV function and increased global LV systolic function demonstrated ventricular interaction after prolonged intense swimming.

IntroductionLeft ventricular (LV) twist is considered an essential part of LV function due to oppositely directed LV basal and apical rotations. Several factors could play a role in determining LV rotational mechanics in normal circumstances. This study aimed to investigate the relationship between LV rotational mechanics and mitral annular (MA) size and function in healthy subjects.MethodsThe study comprised 118 healthy adult volunteers (mean age: 31.5 ± 11.8 years, 50 males). All subjects had undergone complete two-dimensional (2D) Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE) at the same time by the same echocardiography equipment.ResultsThe normal mean LV apical and basal rotations proved to be 9.57 ± 3.33 and −3.75 ± 1.98°, respectively. LV apical rotation correlated with end-systolic MA diameter, area, perimeter, fractional area change, and fractional shortening, but did not correlate with any end-diastolic mitral annular morphologic parameters. The logistic regression model identified MA fractional area change as an independent predictor of ≤6° left ventricular apical rotation (P < 0.003).ConclusionsCorrelations could be detected between apical LV rotation and end-systolic MA size and function, suggesting relationships between MA dimensions and function and LV rotational mechanics.

OBJECTIVES This study aims to analyze the variability between two trained neonatologists when performing consecutive echocardiograms using tissue Doppler imaging (TDI) and conventional methods in very low birth weight infant (VLBWI). METHODS Two serial echocardiograms were performed in 30 VLBWI infants. The echocardiographic parameters analyzed were tricuspid annular plane systolic excursion (TAPSE), A', E', and S' waves, and myocardial performance index acquired by TDI (MPI-TDI) of both ventricles and shortening fraction (SF). The intra-observer and inter-observer agreements and the intra-operator agreement were analyzed using quantitative and qualitative statistical methods. RESULTS The intra-observer agreement was very good, TAPSE, and TDI-derived parameters had an intra-class correlation (ICC) > 0.8. TDI-derived velocities had a coefficient of variation (COV)

BACKGROUND: The reliability of LV systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been tested in a large cohort of healthy children. The objective of this study was to estimate interobserver variability in standard measurements of left ventricular (LV) size and systolic function in children with normal cardiac anatomy and qualitatively normal function. METHODS: The Pediatric Heart Network Normal Echocardiogram Database collected normal echocardiograms from healthy children ≤18 years old distributed equally by age, gender, and race. A core lab used 2-dimensional echocardiograms to measure LV dimensions from which a separate data coordinating center calculated LV volumes and systolic functional indices. To evaluate interobserver variability, two independent expert pediatric echocardiographic observers re-measured LV dimensions on a subset of studies, while blinded to calculated volumes and functional indices. RESULTS: Of 3215 subjects with measurable images, 552 (17%) had a calculated LV shortening fraction (SF)

Aims Left ventricular (LV) dilatation results in increased sphericity and affects position and orientation of papillary muscles (PMs), which may influence their performed work. The aim of this study was to assess the contribution of PM to LV function and its changes with dilatation. Methods and results Fifteen sheep were investigated. Ten animals were subjected to 8 weeks of rapid (180 bpm) pacing, inducing LV dilatation. Five animals served as controls. High-resolution gated computed tomography was performed to assess LV volumes, left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), sphericity index, and PM angle, width and fractional shortening. 18F-fluorodeoxyglucose positron emission tomography (PET) was used to measure glucose metabolism as surrogate of regional myocardial work. Spatial resolution of PET images was maximized by electrocardiogram- and respiratory-gating. 18F-fluorodeoxyglucose uptake was measured in PM and compared with remaining left ventricular myocardium (MYO) to obtain a PM/MYO ratio. Animals with dilated heart had a more spherical left ventricle, with reduced LVEF (P

Aim The main purpose of this study was to identify myocardial changes in malnourished children. Material and Methods This prospective study included 47 patients with malnutrition and 44 healthy controls. The subjects who had malnutrition were classified according to the method of Gomez and Waterlow. Electrocardiographic and echocardiographic examinations, 24-h Holter monitoring, and biochemical assessments were performed in all subjects. Results The malnutrition group included 20 (42.5%) males, and the control group included 19 (43.1%) males (p

Background: The function of the left atrium (LA) is reduced in many cardiac diseases even with normal size. The assessment of its compliance could represent an added value in an echocardiographic report in case the gold standard technique (speckle-tracking echocardiography [STE]) is not available. We sought to test a simple and quick method as surrogate of STE: the dynamic measurement of the LA anteroposterior diameter (APD) that we called LA fractional shortening (LAFS). Materials and Methods: A total of 153 consecutive patients underwent a transthoracic echocardiography in our echo laboratory between January and June 2017. The only inclusion criteria were the presence of an acoustic window and the informed consent. We chose to not apply exclusion criteria to assess LAFS feasibility. The LAFS was calculated as (maxAPD−minAPD)/(maxAPD) × 100 in parasternal long-axis view. We evaluated the correlation of its value with the peak atrial longitudinal strain (PALS) and the LA emptying fraction (EF). Results: Mean execution time was 32.1 ± 5 s for LAFS, 2.3 ± 0.7 min for LAEF, and 2 ± 1 min for PALS. LAFS, with a feasibility of about 97%, was moderately correlated with PALS and LAEF (R between 0.20 and 0.30, P < 0.05). LAFS fractional shortening also emerged as surrogate for PALS via the relationship PALS = 21.07 + 0.364x (LAFS). Conclusions: LAFS demonstrated a correlation with PALS, a short execution time, a high feasibility, and the possibility to be used as a surrogate of PALS, applying a specific formula.

Objective To evaluate the role of echocardiographic right ventricular function parameters in predicting postoperative vasoactive inotrope requirement after tetralogy of Fallot repair. Design Prospective observational study. Setting A tertiary care hospital. Participants Fifty-two children undergoing elective intracardiac repair. Interventions Comprehensive transesophageal echocardiography was performed before and after surgery. Fractional shortening, fractional area change, tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index, tricuspid annular velocities (S', E', A'), and right ventricular global longitudinal strain and strain rate (RV Gls and RV Glsr) were measured. The ratio of peak systolic pressure of the right and left ventricles (Prv/lv) was measured directly from the surgical field pre- and post-repair. The inotrope requirement during first 24 postoperative hours was calculated using the mean Vasoactive-Inotropic Score (VIS). Pearson correlation analysis was used to study the relation between echocardiographic parameters and VIS as well as Prv/lv and VIS. Receiver operating characteristic analysis was used to study the predictive strength of parameters. Measurements and Main Results Among the measured parameters, both pre- and post-repair TAPSE had significant negative correlation with the mean VIS (p 0.6) for predicting high mean VIS (VIS > 20). Conclusion Tricuspid annular plane systolic excursion, RV Gls, RV Glsr, and Prv/lv could predict a postoperative high mean VIS with significant strength and reasonable sensitivity and specificity.

Background : Echocardiography is one of the tools for the assessment of patients with hypertensive disease. Differences in parameters have been described based on race, gender and environment. Aim : In order to define what should be considered abnormal, we set to find out what the normal cardiac parameters are in our environment. Methods : This was a cross sectional of 80 non hypertensive adults. Transthoracic 2D echocardiography was performed with patients in the left decubitus position using standard techniques. Results : From this study, we found the left ventricular mass to be 129 ± 37.61, the ejection fraction (%) 62.77 ± 10.55 and the fractional shortening (%) to be 34.18 ± 7.49. Values for the intraventricular septal thickness, posterior wall diameter, left ventricle internal diameter (in diastole and systole) are (0.92±0.19, 1.43±0.24), (0.91±0.17, 1.47±0.23) and (4.32±0.50, 2.83±0.42) respectively. All the parameters other than relative wall thickness and ejection fraction showed statistically significant difference (P

ObjectiveThe present study aims to identify the role of inflammatory markers such as C-reactive protein, interleukin-6, and fractalkine in CHD-associated pulmonary hypertension in children.MethodsThis is a prospective review of 37 children with CHD-related pulmonary hypertension, 21 children with congenital heart defects, and 22 healthy children.ResultsSerum C-reactive protein and interleukin-6 levels were significantly higher in the children with CHD-related pulmonary hypertension (respectively, p=0.049 and 0.026). Serum C-reactive protein concentrations correlated negatively with ejection fraction (r=−0.609, p=0.001) and fractional shortening (r=−0.452, p=0.007) in the pulmonary hypertension group. Serum fractalkine concentrations correlated negatively with ejection fraction (r=−0.522, p=0.002) and fractional shortening (r=−0.395, p=0.021) in the children with pulmonary hypertension. Serum interleukin-6 concentrations also correlated negatively with Qs (r=−0.572, p=0.021), positively with Rs (r=0.774, p=0.001), and positively with pulmonary wedge pressure (r=0.796, p=0.006) in the pulmonary hypertension group. A cut-off value of 2.2 IU/L for C-reactive protein was able to predict pulmonary hypertension with 77.5% sensitivity and 77.5% specificity. When the cut-off point for interleukin-6 concentration was 57.5 pg/ml, pulmonary hypertension could be predicted with 80% sensitivity and 75% specificity.ConclusionInflammation is associated with the pathophysiology of pulmonary hypertension. The inflammatory markers C-reactive protein and interleukin-6 may have a role in the clinical evaluation of paediatric pulmonary hypertension related to CHDs.

Background Transverse aortic constriction (TAC) operation is used as an experimental model of left ventricular (LV) hypertrophy and LV failure in mice. The severity of LV remodeling or failure may depend on the degree of TAC, but is variable among operated animals. Therefore, we tried to identify the optimal diameter of TAC to create this model with ease and high reproducibility. Methods and results To produce TAC in C57BL/6J mice (7–9 weeks, body weight 19–26 g, n = 109), a 7–0 nylon suture ligature was tightly tied around the transverse aorta against needles with 3 different diameters (mm); 0.40, 0.385 and 0.375. LV wall thickness, end-diastolic dimension, fractional shortening were measured by echocardiography. At 4 weeks after TAC, no mouse with the 0.400 mm gauge progressed in LV failure. The 0.385 mm pin gauge mouse kept a more survival rate compared with the 0.375 mm (59% vs 48%), representing same efficient in LV failure. With the 0.385 mm pin gauge, hearts of mice remained LV hypertrophy at 1 week after TAC, followed by LV failure at 4 weeks. Conclusion TAC with the diameter of 0.385 mm can effectively induce the transition from LV hypertrophy to failure in mice with relatively preserved survival.

Objectives To objectively and subjectively describe the normal spectrum of two-dimensional echocardiographic findings in the central bearded dragon (Pogona vitticeps). Animals Sixteen central bearded dragons. Methods Central bearded dragons were prospectively evaluated under manual restraint in right and left lateral recumbency to identify imaging planes for reproducible measurements of cardiac chambers, subjective two-dimensional analysis and color Doppler assessment. Results Echocardiography can be performed through windows in the left and right axillae. The window in the left axilla allows for a subjective and objective assessment of cardiac structure and function. The right axillary window allows for evaluation of pulmonary artery flow. Both views provide data for the presence of pericardial effusion or valvular insufficiency. With optimized imaging planes, cardiac chambers and fractional area change along with fractional shortening in the longitudinal and transverse planes can be calculated. Body weight and cardiac chamber dimensions of males were significantly larger than females. Ventricular fractional area change was the most consistent functional assessment. The majority of animals were found to have no evidence of valvular insufficiency, while approximately half had evidence of pericardial fluid. Pulmonary artery flow was assessed in all patients. Left and right aortic velocities cannot be reliably obtained. Conclusions This study is the first to generate reference values for cardiac structure and function in clinically healthy central bearded dragons. Valvular insufficiency is not a normal finding in central bearded dragons, while mild pericardial effusion may be.

Aim The aim of this work was to determine whether ethanol-associated myocardial apoptosis and cardiac dilation are related to myocardial telomere shortening in rats. Methods and Results Sprague-Dawley (SD) rats received either drinking water with (ethanol: n = 19) or without (control: n = 19) 5% (v/v) ethanol ad libitum, for 4 months. Left ventricular (LV) dimensions and function (echocardiography and isolated perfused heart preparations), cardiomyocyte apoptosis (terminal deoxynucleotide transferase–mediated dUTP nick-end labeling), and leukocyte and myocardial telomere length (real-time polymerase chain reaction) were determined at the end of the study. Ethanol administration resulted in a marked increase in cardiomyocyte apoptosis (ethanol 0.85 ± 0.13% vs control 0.36 ± 0.06%; P = .0021) and LV dilation (LV end-diastolic diameter: ethanol 8.20 ± 0.14 mm vs control 7.56 ± 0.11 mm [ P = .0014]; volume intercept at 0 mm Hg (V 0 ) of the LV end-diastolic pressure-volume relationship: ethanol 0.40 ± 0.03 mL vs control 0.31 ± 0.02 mL [ P = .020]). However, there were no changes in systolic chamber function as indexed by LV endocardial fractional shortening or the slope of the LV systolic pressure-volume relationship (end systolic elastance). The percentage of myocardial apoptosis was correlated with the degree of LV dilation (% apoptosis vs LV EDD: r = 0.39; n = 38; P = .021; vs V 0 : r = 0.44; n = 19; P = .046). No differences in leukocyte or cardiac telomere length were noted between the ethanol and control groups. Furthermore, cardiac telomere length was not associated with indexes of LV dilation (LVEDD and V 0 ) or cardiomyocyte apoptosis. Conclusions Chronic ethanol-associated myocardial apoptosis and adverse remodeling occurs independently from changes in cardiac telomere length. Telomere shortening may not be a critical mechanism responsible for cardiomyocyte apoptosis and adverse cardiac remodeling.

Background Cardiac complications contribute significantly to morbidity and mortality in children with HIV/AIDS. These rates have been under-reported in sub-Saharan African children. Methods This was an observational, cross-sectional Doppler echocardiographic study of ventricular systolic function, performed at a tertiary clinic on children with HIV/AIDS. Results Left ventricular systolic dysfunction was present in 27.0% of the children with HIV infection and 81.2% of those with AIDS. The mean fractional shortening in the AIDS group (31.6 ± 9.5%) was significantly lower than in the HIV-infected group (35.3 ± 10.5%, p = 0.001). A significant correlation was found with CD4(+) cell count and age, and these were the best predictors of left ventricular systolic dysfunction in the stepwise multiple regression analysis (r = 0.396, p = 0.038; r = -0.212, p = 0.025, respectively). Conclusion Left ventricular systolic dysfunction is common in Nigerian children with HIV/AIDS.

Background/Aims: Celiac disease (CD)-associated cardiologic disorders is a growing concern. However, data regarding cardiac affection in children with CD are few. This study aimed at assessing the subclinical impact of CD on the global myocardial performance in Saudi children with CD using Doppler tissue imaging (DTI). Patients and Methods: Conventional two-dimensional echocardiography was performed among 20 Saudi children with CDas well as 20 age and sex-matched healthy controls. DTI were used to determine right ventricular (RV) and left ventricular (LV) Tei indexes. These findings were correlated with the Modified Marsh Classification of the histologic findings in CD. Results: LV and RV Tei indexes were significantly higher in children with CD than the control group (mean ± standard deviation: 0.47 ± 0.05 vs. 0.31 ± 0.18; P < 0.0005 and 0.51 ± 0.04 vs. 0.32 ± 0.05; P < 0.0001, respectively). RV Tei index was found to be positively correlated with the Modified Marsh Classification of CD (r = 0.7753, P < 0.0001). LV Tei index tended to be more affected in patients with more severe histologic findings, however, such relation did not reach statistical significance (r = 0.2479, P = 0.292). Fractional shortening did not correlate with the Modified Marsh Classification of histologic findings in CD patients (r= −0.11, P = 0.641). Conclusions: Subclinical myocardial dysfunction of both ventricles occurs in children with CD. The DTI method appears to be more sensitive than conventional two-dimensional echocardiography in the early detection of myocardial dysfunction in children with CD.

This study investigated the potential associations of dog characteristics with serum serotonin (5HT) concentration in dogs with degenerative mitral valve disease (DMVD). Client-owned dogs were prospectively recruited at the Veterinary Medical Teaching Hospital of Chungnam National University between 2010 and 2011. Forty-two dogs (22 females and 20 males) were enrolled in this study. DMVD dogs included Maltese (n=12), followed by Shih-tzu (n=10), mixed breed (n=5), Chihuahua (n=4), Miniature schnauzer (n=3), Miniature poodle (n=3), Miniature pinscher (n=1), Pomeranian (n=1), Yorkshire terrier (n=2), and Spitz (n=1). As inclusion criteria for the study, dogs had to show either direct or echocardiographic evidence of DMVD. Platelet count significantly differed among the three groups, as the moderate (P

Background Subgroups of pacemaker (PM)–treated children with isolated complete atrioventricular block are at risk of developing left ventricular (LV) dysfunction. Objectives We aimed to compare the long-term outcome in anti-SSA-Ro/SSB-La antibody-exposed (AB+) and unexposed (AB−) patients and identify preimplantation variables associated with poor outcome. Methods In total, 127 PM-treated patients aged 0–17 years with isolated complete atrioventricular block were studied retrospectively. Results Sixty-three patients were diagnosed prenatally, of whom 92% were AB+. Before PM treatment, fractional shortening (FS) z-score was significantly lower in AB+ patients than in AB− patients (−0.14 ± 3.6 vs 2.03 ± 2.3). Before PM implantation, there were sex differences (male/female) in median time from diagnosis to PM implantation (0.2 years vs 1.0 years), median neonatal heart rate (50 beats/min vs 60 beats/min), left ventricular end-diastolic dimension (LVEDD) z-score (2.68 ± 1.41 vs 1.74 ± 1.40), and FS (−0.19 ± 3.38 vs 1.42 ± 2.98). The median age at PM implantation was 3.2 years, and median follow-up was 8.7 years. At follow-up, LVEDD and FS did not differ significantly between AB+ and AB− patients, but LVEDD was higher in patients diagnosed before 1 month of age. Nine patients (8%) developed LV dysfunction, and 4 died. LV dysfunction was associated with diagnosis before 1 month of age and abnormal LV function before PM implantation. Conclusion LV dysfunction at follow-up was seen only in cases diagnosed before 1 month, with abnormal echocardiography before PM implantation. Boys had a more compromised cardiac status and were paced at an earlier age than girls. Fetal AB exposure and male sex were related to abnormal LV function before PM therapy, but not at follow-up.

Introduction Alterations in cardiac contractility can have significant clinical implications, highlighting the need for early detection of potential liabilities. Pre-clinical methods to assess contractility are typically invasive and their translation to human measures of cardiac function are not well defined. Clinically, cardiac function is most often measured non-invasively using echocardiography. The objective of these studies was to introduce echocardiography into standard large animal cardiovascular safety pharmacology studies and determine the feasibility of this combination. Methods A consortia of laboratories combined their data sets for evaluation. At each site, telemetered beagle dogs, in a 4 × 4 Latin square crossover study design (n = 4), were administered either pimobendan (positive inotrope) or atenolol (negative inotrope) orally at clinically relevant dose levels. Standard telemetry parameters were collected (heart rate, mean arterial blood pressure, etc.) continuously over 24 h, as well as derived contractility endpoints: QA interval and LV +dP/dtmax. At Tmax, echocardiography was performed in conscious dogs with minimal restraint to collect contractility parameters: ejection fraction (EF) and fractional shortening (FS). Results Correlations between telemetry and echo contractility endpoints showed that, in general, a change in LV +dP/dtmax of 1000 mmHg/s translates to a 5.2% change in EF and a 4.2% change in FS. Poor correlations were shown between QA interval derived simultaneously, to both EF and FS. Discussion Comparing data from telemetry-only groups to those that included echocardiography collections showed no effect in the ability to interpret test article-related effects, providing the foundation for the inclusion of echocardiography without compromising standard telemetry data quality.

Anthracyclines are commonly used anticancer drugs with well-known and extensively studied cardiotoxic effects in humans. In the clinical setting guidelines for assessing cardiotoxicity are well-established with important therapeutic implications. Cardiotoxicity in terms of impairment of cardiac function is largely diagnosed by echocardiography and based on objective metrics of cardiac function. Until this day, cardiotoxicity is not an endpoint in the current general toxicology and safety pharmacology preclinical studies, although other classes of drugs apart from anthracyclines, along with everyday chemicals have been shown to manifest cardiotoxic properties. Also, in the relevant literature there are not well-established objective criteria or reference values in order to uniformly characterize cardiotoxic adverse effects in animal models. This in depth review focuses on the evaluation of two important echocardiographic indices, namely ejection fraction and fractional shortening, in the literature concerning anthracycline administration to rats as the reference laboratory animal model. The analysis of the gathered data gives promising results and solid prospects for both, defining anthracycline cardiotoxicity objective values and delineating the guidelines for assessing cardiotoxicity as a separate hazard class in animal preclinical studies for regulatory purposes.

espanolIntroduccion: El proceso de control biomedico del entrenamiento deportivo, constituye una de las esferas de trabajo fundamentales al valorar la adaptacion funcional del rendimiento fisico. El estudio se propone evaluar la correlacion variables ecocardiograficas y antropometricas en luchadores de primer nivel producto de las cargas de entrenamiento al final de la preparacion especial. Metodos: La muestra estuvo constituida por 19 deportistas (14 competidores del estilo grecorromano y 5 del estilo libre). Se agruparon segun sus pesos corporales en las categorias: ligeros, medianos, pesados y superpesados. Se efectuo ecocardiograma trans-toracico estandar bidimensional en reposo al final de la preparacion especial. Se emplearon las variables: Edad, Edad deportiva, Estatura, Peso Corporal, Superficie Corporal, Septum Interventricular, Pared Posterior del VI, Diametro diastolico del VI, Diametro de la raiz de la Aorta, Diametro de la Auricula izquierda y Diametro del Ventriculo derecho, Indice h/r, Indice de Hipertrofia Septal Asimetrica, Indice de Hipertrofia Concentrica del VI, Frecuencia cardiaca, Volumen diastolico, Volumen de eyeccion o Stroke Volumen, Indice del gasto cardiaco, Fraccion de eyeccion y Fraccion de acortamiento. Resultados: La edad media fue de 26,1 anos y 21,6 respectivamente con una experiencia deportiva de 16,0 y 14,4 anos Los indicadores promedio fueron: Septum Interventricular (12,32±1,26), Pared Posterior del VI (13,15±1,27), Diametro diastolico del VI (21,13±3,21), Stroke Volumen (78,22±9,93mL), Indice del gasto cardiaco (2,60± 0,15) e indice h/r (0,48±0,02). Los menores registros se encontraron en los luchadores de menor peso. La valores minimos y maximos de los se encontraron en los ligeros y superpesados respectivamente. Los valores absolutos de los indicadores funcionales se correspondieron con las caracteristicas antropometricas. Conclusiones: Los luchadores tienen un corazon estructural y funcionalmente sano con un adecuado balance aerobico-anaerobico de su remodelacion. La mayor correlacion se establece entre el peso corporal y las variables ecograficas estructurales, funcionales y de remodelado. EnglishIntroduction: The echocardiographic monitoring process works fundamentally by assessing the functional adaptation of physical performance. The study aims to evaluate the correlation between echocardiographic and anthropometric variables in first level fighters as a result of the training loads at the end of the special preparation. Methods: The sample was constituted by 19 sportsmen (14 com petitors of the Greco-Roman style and 5 of the free style). They were grouped according to their body weights in the categories: light, medium, heavy and superheavy. Standard two-dimensional transthoracic echocardiography was performed at rest at the end of the special preparation. Variables were used: Age, Sporting Age, Height, Body Weight, Body Surface, Interventricular Septum, Posterior Wall of the LV, Diastolic Diameter of the LV, Diameter of the Aortic Root, Diameter of the Left Auricle and Diameter of the Right Ventricle, h/r Index, Asymmetric Septal Hypertrophy Index, Concentric LV Hypertrophy Index, Heart Rate, Diastolic Volume, Ejection Volume or Stroke Volume, Cardiac Output Index, Ejection Fraction and Shortening Fraction. Results: Mean age was 26.1 year s and 21.6 years respectively with a sports experience of 16.0 and 14.4 years. Mean indicators were: Interventricular Septum (12.32±1.26), Posterior LV Wall (13.15±1.27), Diastolic LV Diameter (21.13±3.21), Stroke Volume (78.22±9.93mL), Cardiac Output Index (2.60±0.15) and h/r index (0.48±0.02). The lowest records were found in the lowest weight wrestlers. The lowest and highest values were found in light and super-heavyweight wrestlers respectively. The absolute values of the functional indicators corresponded to the anthropometric characteristics. Conclusions: Wrestlers have a structurally and functionally healt hy heart with an adequate anaerobic balance of its remodeling according to the state of the high school. The highest correlation is established between body weight and structural, functional and remodeling ultrasound variables.

Myocardial infarction (MI) remains a major cause of mortality worldwide. Despite significant advances in MI treatment, many who survive the acute event are at high risk of chronic cardiac morbidity. Here we developed a cell-free therapeutic that capitalizes on the antifibrotic effects of micro(mi)RNA-101a and exploits the multi-faceted regenerative activity of mesenchymal stem cell (MSC) extracellular nanovesicles (eNVs). While the majority of MSC eNVs require local delivery via intramyocardial injection to exert therapeutic efficacy, we have developed MSC eNVs that can be administered in a minimally invasive manner, all while remaining therapeutically active. When loaded with miR-101a, MSC eNVs substantially decreased infarct size (9.2 ± 1.7% vs. 20.0 ± 6.5%) and increased ejection fraction (53.6 ± 7.6% vs. 40.3 ± 6.0%) and fractional shortening (23.6 ± 4.3% vs. 16.6 ± 3.0%) compared to control. These findings are significant as they represent an advance in the development of minimally invasive cardio-therapies.

OBJECTIVES: Human epidermal growth factor receptor 2 positive (HER2+) breast cancer (BC) is characterized by overexpression of the HER2 receptor. Although targeted HER2 drugs such as trastuzumab (TRZ) are effective for some patients, many patients experience resistance and cardiotoxicity, highlighting the need for additional therapies. The objective of this study was to determine the effects of a polyphenol-rich muscadine grape skin/seed extract (MGE) on TRZ-sensitive and –resistant HER2 + BC and TRZ cardiotoxicity. METHODS: Human HER2 + BC cells were treated with MGE and/or TRZ and proliferation was analyzed using the IncuCyte® ZOOM. Synergy was assessed using the Chou-Talalay method. Tumor growth and cardiotoxicity were measured in HER2 + xenografts treated with MGE and/or TRZ. TRZ-resistant JIMT-1 cells (2 × 10(6)) were injected in the fourth mammary fat pad of female nude mice and, when tumors reached 50 mm(3), mice were divided into four groups: control, MGE, TRZ, MGE + TRZ (n = 10/group, five week treatment). Cardiac parameters were measured using echocardiography and markers of proliferation/oxidative stress were measured by immunohistochemistry. RESULTS: The combination of MGE and TRZ inhibited proliferation to a greater extent than either agent alone and was synergistic in TRZ-sensitive SKBR3 cells at five dose combinations. MGE reduced TRZ-resistant JIMT-1 tumor volume by 35% (p ≤ 0.05); however MGE + TRZ inhibited tumor growth to a greater extent (62%) than either agent alone [combination vs. MGE (p ≤ 0.05); combination vs. TRZ (p ≤ 0.01)]. In tumors, MGE + TRZ reduced Ki-67 and activated AKT to a greater extent than MGE or TRZ alone [combination vs. MGE (p ≤ 0.05); combination vs. TRZ (p ≤ 0.0001)]. TRZ significantly reduced left ventricular ejection fraction and fractional shortening, which was prevented by MGE (p ≤ 0.01). Additionally, MGE significantly attenuated the 3-fold TRZ-induced increase in the oxidative stress marker 4-hydroxynonenal in the left ventricle (p ≤ 0.0001). CONCLUSIONS: MGE inhibited the proliferation of HER2 + BC and was synergistic when combined with TRZ while protecting against TRZ cardiotoxicity. Thus, MGE may serve as an effective therapeutic either administered singly or in combination with TRZ for the treatment of HER2 + BC. FUNDING SOURCES: Chronic Disease Research Fund.

Reptiles can suffer from infectious and noninfectious cardiac pathologies, requiring the need for standardized diagnostic approaches and reference intervals. Despite the popularity of ball pythons (Python regius) as pets, echocardiographic measurements are unknown in this species. Twenty healthy adult ball pythons were evaluated to identify imaging planes, establish reference intervals for cardiac assessment by two-dimensional echocardiography, and study the effects of sex, body length, and body mass on heart rate, fractional shortening, and vascular, atrial, and ventricular dimensions. Echocardiography was performed under manual restraint. Most cardiac measurements were positively correlated with body length and mass, with the strongest correlation between ventricular end-systolic measurements and body length. The only significant difference found between sexes was for right and left atrial lengths. This study provides guidelines and reference intervals for two-dimensional echocardiographic measurements in adult healthy ball pythons.

Aim: The morphological dimension of the masseter muscle is largely influenced by physical and habitual activities, which may impact directly on its performance. This study assessed the effects of playing wind musical instruments on the masseter muscle thickness in a male Nigerian adult population. Materials and Methods: Equal numbers of male wind instrument players (WIP) were recruited and compared with nonwind instrument players (non-WIP) of the same age. Information on the sociodemographic characteristics, history, and type of wind instrument played was obtained. The masseter muscle thickness and fractional shortening were determined during relaxation and contraction using a linear probe of 7.5 MHz on ultrasound machine (Biosound Esaote MyLab40 Ultrasound machine; 2012; Italy, Rome). Reliability test demonstrated an excellent intrarater correlation (Cronbach's alpha; 0.98). Data were analyzed using SPSS version 17. Statistical significance was set at P Results: The overall mean thickness of the masseter muscle at relaxation, contraction, and fractional shortening in WIP group was 9.21 ± 1.43 mm, 14.22 ± 1.95 mm, and 35.06% ± 5.07%, respectively, while 8.92 ± 1.12 mm, 13.97 ± 1.44 mm, and 36.08% ± 4.48%, respectively, in non-WIP group. No statistically significant differences were observed between the groups (P > 0.05). Type of instrument played, duration, and frequency of play did not significantly affect the muscle thickness except for the number of years of play. There was also a significant right/left side dichotomy in each group. Conclusions: Playing a wind instrument showed no significant effect on the thickness of the masseter muscle, however there was a significant increase in the muscle thickness with increasing years of play of wind instruments.

Quantification guidelines for pediatric echocardiograms were published in 2010 establishing consensus regarding standard measurements. However, a standard protocol for performance and analysis of pediatric echocardiograms was not defined. This study aims to identify practice variations among pediatric laboratories. A survey was sent to 85 North American pediatric laboratory directors. The survey included 29 questions assessing: demographics, methods of image acquisition, parameters routinely evaluated and reported, and methods used to assess chamber sizes, valves, and ventricular function. There were 47/85 (55%) responses; 83% were academic centers and 77% in an urban setting. Wide variations exist in acquisition method (clips versus sweeps) and color scale settings. The most commonly used methods for left ventricular (LV) function are M-mode shortening fraction, qualitative assessment, and Doppler Tissue Imaging. The most commonly used parameter for right ventricular function is qualitative. LV mass is routinely measured by the majority of centers with variations in methods of calculation. Conversely, while a minority measure left atrial volume, there is consensus regarding the preferred method. While multiple techniques exist for assessing valves, qualitative assessment is reported to be the preferred method. Despite quantification guidelines, there is a lack of uniformity in performance and analysis of pediatric echocardiograms. Further studies are needed to determine why variations exist and whether development of consensus guidelines might improve interpretation, consistency and quality of reports, patient care, and provide a standardized system allowing for comparative research among centers.

Dilated cardiomyopathy (DCM) is myocardial disease that is characterized by the left ventricular (LV) enlargement and LV systolic dysfunction in the absence of other causes of volume overload or increased afterload. LV end-diastolic and end-systolic dimensions, as well as LV end-diastolic volumes and overall LV mass, are increased (with normal or sometimes thinned walls), and the global ejection fraction (EF) is reduced and sub-normal (LVEF < 45%, fractional shortening

Duchenne muscular dystrophy (DMD) is characterized by myocardial fibrosis and left ventricular (LV) dysfunction. Implantable cardioverter defibrillator (ICD) use has not been characterized in this population but is considered for symptomatic patients with severe LV dysfunction (SLVD) receiving guideline-directed medical therapy (GDMT). We evaluated ICD utilization and efficacy in patients with DMD. Retrospective cohort study of DMD patients from 17 centers across North America between January 2, 2005 and December 31, 2015. ICD use and its effect on survival were evaluated in patients with SLVD defined as ejection fraction (EF)

Background: Although the safety and efficacy of left atrial (LA) appendage (LAA) closure (LAAC) in nonvalvular atrial fibrillation (NVAF) patients have been well documented in randomized controlled trials and real-world experience, there are limited data in the literature about the impact of LAAC on cardiac remodeling. The aim of the study was to examine the impact of LAAC on cardiac functional and structural remodeling in NVAF patients. Methods: Between March 2014 and November 2016, 47 NVAF patients who underwent LAAC were included in this study (LAAC group). A control group (non-LAAC group) was formed from 141 NVAF patients without LAAC using propensity score matching. The difference-in-difference analysis was used to evaluate the difference in cardiac remodeling between the two groups at baseline and follow-up evaluations. Results: The LAAC group had a larger increase in LA dimension, volume and volume index than the non-LAAC group (+3.9 mm, p = 0.001; +9.7 mL, p = 0.006 and +5.9 mL/m2, p = 0.011, respectively). Besides, a significant increase in E and E/e’ ratio was also observed in the LAAC group (+14.6 cm/s, p = 0.002 and +2.3, p = 0.028, respectively). Compared with the non-LAAC group, left ventricular (LV) ejection fraction and fractional shortening decreased in LAAC patients, but were statistically insignificant (–3.5%, p = 0.109 and –2.0%, p = 0.167, respectively). Conclusions: There were significant increases in LA size and LV filling pressure among NVAF patients after LAAC. These impacts of LAAC on cardiac functional and structural remodeling may have some clinical implications that need to be addressed in future studies.

Background Digoxin has long been prescribed in children with heart failure, but its efficacy has not been evaluated. A previous study at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital revealed that plasma digoxin levels, following a maintenance dose of 15 μg/kg/d, were sub-therapeutic. Regarding its narrow margin of safety, the trend is to use digoxin in even lower dose. Thus, the drug’s impact on cardiac performance need to be evaluated. Objective To evaluate whether a lower maintenance dose of digoxin (10 μg/kg/d) is sufficient to achieve a therapeutic level and to assess for possible correlations between plasma digoxin level and left ventricular ejection fraction (LVEF) as well as fractional shortening (LVFS). Methods A cross-sectional study was conducted on 20 pediatric heart failure patients at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, from January to May 2012. Plasma digoxin levels were measured by ELISA method after one month or more of treatment; LVEF and LVFS were measured by echocardiography. Correlations between plasma digoxin level and LVEF or LVFS were analyzed by Spearman’s correlation test. The LVEF before and after digoxin treatment were compared by paired T-test. Results Thirteen out of 20 patients had plasma digoxin levels within therapeutic range (0.5-1.5 ng/mL; 95%CI 0.599 to 0.898) and 7 had sub-therapeutic levels (

Results of Influence of calcium channel Inhibitor - amlodipine on hemodynamic Indicators of ventricular systolic and diastolic function In patients with CCP In combination with Ischemic heart disease (IHD) In comparison with Indicators of patients without using of amlodipine for treatment's optimization were analyzed In the article.Researches demonstrated that In patients with CCP In combination with IHD complex therapy with using of amlodipine according to results of Doppler echocardiography Improves hemodynamic Indicators of ventricles of the heart more slgnlflcantiy than In patients of control group (without prescription of amlodipine). It Is confirmed by high level of correlation between right ventricular shortening fraction, left ventricular ejection fraction and endothelial dysfunction, It Is evidence of medicinal effect of amlodipine.