BACKGROUND & AIMS: AIM:Anthracycline agents are undermined by their cardiotoxicity. As life expectancy following treatment is greatly improved, techniques that ensure early detection and timely management of cardiotoxicity are essential. The aim of the present study was to evaluate left ventricular (LV) systolic function with LV ejection fraction (LVEF) and two-dimensional myocardial strain up to 12 months after anthracycline chemotherapy, specifically in HER2/neu negative breast cancer patients. METHODS:Seventy-eight consecutive anthracycline naïve breast cancer patients were studied before and immediately after anthracycline chemotherapy. Fifty HER2/neu negative patients were studied over 12 months with serial echocardiograms at four time points. All patients were treated with standard regimens containing anthracyclines. RESULTS:Global systolic strain was significantly reduced immediately after, and 6 months after anthracyclines (-19.0 ± 2.3% to -17.5 ± 2.3% (P<0.001) and -18.2 ± 2.2% (P=0.01) respectively). A non-uniform reduction in strain was observed each time with relative sparing of the LV apex. LVEF remained largely unchanged at both time points. Global strain normalised by 12 months in the majority of patients. Persistently reduced strain was observed in 16% (n=8); these patients had a greater reduction in strain at 6 months (≤ -17.2%), and had received higher cumulative anthracycline doses. CONCLUSION:Myocardial strain imaging is more sensitive than LVEF for the early detection and intermediate term monitoring of LV systolic function following anthracycline chemotherapy in HER2/neu negative breast cancer patients, and may aid in the development of improved monitoring protocols.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Anemia is associated with decreased functional capacity, reduced quality of life, and worsened outcomes among patients with heart failure (HF) due to reduced left ventricular ejection fraction (HFREF). We sought to evaluate the independent effect of anemia on clinical outcomes among those with HFREF. HYPOTHESIS:Anemia is associated with cardiovascular events in patients with heart failure. METHODS:The HF-ACTION trial was a prospective, randomized trial of exercise therapy vs usual care in 2331 patients with HFREF. Patients with New York Heart Association class II to IV HF and left ventricular ejection fractions of ≤ 35% were recruited. Hemoglobin (Hb) was measured up to 1 year prior to entry and was stratified by quintile. Anemia was defined as baseline Hb <13 g/dL and <12 g/dL in men and women, respectively. Hemoglobin was assessed in 2 models: a global prediction model that had been previously developed, and a modified model including variables associated with anemia and the studied outcomes. RESULTS:Hemoglobin was available at baseline in 1763 subjects (76% of total study population); their median age was 59.0 years, 73% were male, and 62% were Caucasian. The prevalence of anemia was 515/1763 (29%). Older age, female sex, African American race, diabetes, hypertension, and lower estimated glomerular filtration rates were all more frequent in lower Hb quintiles. Over a median follow-up of 30 months, the primary outcome of all-cause mortality or all-cause hospitalization occurred in 78% of those with anemia and 64% in those without (P < 0.001). The secondary outcomes of all-cause mortality alone,cardiovascular (CV) mortality or CV hospitalization, and CV mortality or HF hospitalization occurred in 23% vs 15%, 67% vs 54%, and 44 vs 29%, respectively (P < 0.001). Heart failure hospitalizations occurred in 36% vs 22%, and urgent outpatient visits for HF exacerbations occurred in 67% and 55%, respectively (P < 0.001). For the global model, there was an association observed for anemia and all-cause mortality or hospitalization (adjusted hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.01-1.32, P = 0.04), but other outcomes were not significant at P < 0.05. In the modified model, the adjusted HR for anemia and the primary outcome of all-cause mortality or all-cause hospitalization was 1.25 (95% CI: 1.10-1.42, P < 0.001). There were independent associations between anemia and all-cause death (HR: 1.11, 95% CI: 0.87-1.42, P = 0.38), CV death or CV hospitalization (HR: 1.16, 95% CI: 1.01-1.33, P = 0.035), and CV death and HF hospitalization (HR: 1.27, 95% CI: 1.06-1.51, P = 0.008). CONCLUSIONS:Anemia modestly is associated with increased rates of death, hospitalization, and HF exacerbation in patients with chronic HFREF. After adjusting for other important covariates, anemia is independently associated with an excess hazard for all-cause mortality and all-cause hospitalization. Anemia is also associated with combinations of CV death and CV/HF hospitalizations as composite endpoints.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Assessing right ventricular (RV) performance is essential for patients with tetralogy of Fallot (TOF). The aim of this study was to investigate the reliability and validity of tricuspid annular plane systolic excursion (TAPSE) against cardiac magnetic resonance imaging measures and cardiopulmonary exercise testing. METHODS:A retrospective study was performed in 125 outpatients with repaired TOF with available protocol-driven echocardiography, cardiac magnetic resonance imaging, and exercise stress testing obtained as part of a cross-sectional study. TAPSE was measured on the two-dimensional apical four-chamber view on echocardiography by two readers. Multivariate linear regression was used to examine the association between TAPSE and measures of RV function and exercise capacity. RESULTS:The mean age was 12.6 ± 3.3 years, 41 patients (33%) were female, and 104 (83%) were white. TAPSE averaged 1.6 ± 0.37 cm, with an interreader intraclass correlation coefficient of 0.78 (n = 18). TAPSE was significantly associated with cardiac magnetic resonance-based RV stroke volume after adjustment for gender and body surface area (β = 13.8; 95% confidence interval, 2.25-25.30; P = .02). TAPSE was not associated with cardiac magnetic resonance-based RV ejection fraction (P = .77). On exercise testing, TAPSE was not associated with peak oxygen consumption, percentage of predicted oxygen consumption, oxygen pulse, or the ventilatory equivalent for carbon dioxide in patients with maximal exercise stress testing (n = 73 [58%]). CONCLUSIONS:TAPSE is reproducibly measured by echocardiography in patients with TOF. It is not associated with RV ejection fraction or exercise performance, and its association with RV stroke volume may be confounded by body size. On the basis of these results, TAPSE is not representative of global RV performance in patients with TOF.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In recent years the WTMM (wavelet transform modulus maxima) and MDFA (multifractal detrended fluctuation analysis) methods have become widely used techniques for the determination of nonlinear, multifractal heart rate (HR) dynamics. The purpose of our study was to compare multifractal parameters of heart rate calculated using both methods in a group of 90 patients with reduced left ventricular systolic function (rlvs group) and in a group of 39 healthy persons (nsr group). METHODS:For each subject from the rlvs group (LVEF < or =40%) and the nsr group, a 24-hour ECG Holter monitoring was performed. The width of the multifractal spectrum and global Hurst exponent were calculated by means of WTMM and MDFA methods for 5-hour daytime and nighttime subsets. RESULTS:The width of the multifractal spectrum was significantly lower and the Hurst exponent was significantly higher in rlvs group in comparison to nsr group both during diurnal activity and nocturnal rest according to MDFA and only during diurnal activity according to WTMM method. In both groups we observed significant differences of the multifractal spectrum width and the global Hurst exponent between the nighttime and daytime recordings. CONCLUSIONS:MDFA seems to be more sensitive as compared with WTMM method in differentiation between multifractal properties of the heart rate in healthy subjects and patients with left ventricular systolic dysfunction.

背景与目标：

BACKGROUND & AIMS: PURPOSE OF REVIEW:To review the evidence for and against imaging as a means of selecting patients for cardiac resynchronization therapy (CRT). RECENT FINDINGS:There is no evidence that either the QRS interval on the surface ECG or dyssynchrony measured by imaging is of any practical value in predicting the clinical response to CRT in patients with a dilated and dysfunctional left ventricle. Careful assessment of the patient, so that therapy can be logically aligned with treatment goals, such as improving symptoms or prognosis, is the only useful method for selecting patients. Simple clinical evaluation may be as effective as, or more effective than, more complex assessments in predicting treatment benefits. Patients with a low blood pressure and moderate functional mitral regurgitation might benefit more, in absolute terms, from CRT. The benefits of adding a defibrillator to CRT are modest and, for many patients, uncertain. SUMMARY:Echocardiography, which was supposed to facilitate the introduction of CRT, may have become the greatest barrier to its appropriate implementation. Cardiac dyssynchrony, measured by echocardiography prior to implantation, may not be the substrate for the effects of CRT.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To evaluate the prevalence of isolated uncontrolled systolic blood pressure (on-treatment isolated systolic hypertension) in treated hypertensive patients and identify the characteristics and treatment strategy in these patients. METHODS:Prospective cross-sectional survey in primary care. Participating physicians enrolled more than 13 consecutive treated hypertensive patients. Patients were considered to have isolated systolic hypertension when systolic blood pressure was at least 140 mmHg and diastolic blood pressure was less than 90 mmHg. RESULTS:On-treatment isolated systolic hypertension occurred in 28% of evaluable patients (n = 11562) and in 36% of uncontrolled patients (n = 9080). Among the isolated systolic hypertension and among other uncontrolled patients, 53% and 47%, respectively, used more than one antihypertensive drug class. beta-Blockers were the most frequently prescribed antihypertensive drugs. Patients with isolated uncontrolled systolic blood pressure were more frequently treated with diuretics (43 vs. 39%) and angiotensin II receptor antagonists (23 vs. 17%). Despite blood pressure being under control in only 21% of the patients, hypertension treatment was not changed in 46% of patients with isolated uncontrolled systolic blood presssure vs. 14% of patients with both uncontrolled systolic and diastolic blood pressure. CONCLUSION:In Belgium, the prevalence of on-treatment isolated systolic hypertension in treated hypertensive patients, was 28%. The goal blood pressure was likely not reached in most patients due to inadequate treatment. The overall control rate was worse for systolic than for diastolic blood pressure. Furthermore, antihypertensive treatment was less frequently adapted in patients with isolated uncontrolled systolic blood pressure than in those patients with both uncontrolled systolic and diastolic blood pressure.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Increased arterial stiffness and early wave reflections have been observed in patients with heart failure and normal ejection fraction (HFNEF). We investigated, whether impaired arterial function is associated with impaired systolic and diastolic function and symptomatic status. METHODS:We prospectively enrolled 336 patients (mean age 63.5 years) undergoing coronary angiography, and assessed pulse wave velocity (PWV) invasively, arterial wave reflections (augmentation index (AIx); pressure augmentation (AP)) noninvasively using radial applanation tonometry and a validated transfer function, and characteristic impedance (Zc) using echocardiography with tonometry. In addition, echocardiography including tissue Doppler of the mitral annulus was performed. RESULTS:Peak systolic velocity (S') varied inversely with AIx (R = -0.38, P < 0.001), AP (R = -0.48, P < 0.0001), PWV (R = -0.39, P < 0.001), and Zc (R = -0.29, P < 0.01). Likewise, early diastolic velocity (E') showed a strong, negative correlation with AP (R = -0.32, P < 0.01), PWV (R = -0.64, P < 0.0001), and Zc (R = -0.50, P < 0.0001). Higher filling pressures were associated with increased wave reflections (AIx, AP) and arterial stiffness (PWV, Zc). All associations were independent of age and gender. Patients suffering from exertional dyspnea had increased AIx, AP, and PWV. CONCLUSIONS:In middle-aged and elderly patients, increased arterial stiffness and wave reflections are consistently and independently associated with impaired systolic and diastolic function and with functional limitations.

背景与目标：

BACKGROUND & AIMS: :Several studies have shown the accuracy of gated single photon emission computed tomography (SPECT) using thallium-201 and technetium tracers in the assessment of myocardial perfusion and function. Gated SPECT has been successfully utilized to detect post-stress left ventricular ejection fraction (LVEF) reduction resulting from post-ischemic stunning in patients with coronary obstruction. The aim of this study was to evaluate whether the post-stress LVEF impairment could be related to the post-stress end-systolic ventricular dilation resulting from post-ischemic endocardial stunning. Two hundred and eighty-two consecutive patients were studied by conventional diagnostic 2 day stress/rest gated SPECT following injection of 925 MBq of 99mTc-tetrofosmin using a dual-headed SPECT camera. One hundred and forty-seven of these patients (52%) showed reversible perfusion defects, 69 (24%) permanent defects and the remaining 66 (24%) had normal perfusion. One hundred and thirty-eight of these patients had a history of myocardial infarction (MI) and 19% underwent coronary angiography without an intervening cardiac event. Perfusion was analysed on ungated images using 20 segments scored on a five-point scale (0, normal; 4, no uptake), while wall thickening (WT) was assessed visually on stress/rest end-systolic images using a four-point score (0, normal; 3, absence of WT). LVEF and volumes were calculated using an automatic algorithm. The post-stress and rest ratios were determined for both end-diastolic (EDV) and end-systolic (ESV) volume. Normal values for all these parameters were obtained using data from 149 patients with a low likelihood (<5%) of coronary artery disease (CAD). In 50 of the 147 (34%) of patients with reversible perfusion defects, post-stress LVEF was >5% lower than rest values (stunned group), while the remaining 97 patients did not show a significant LVEF change (group 2A). The percentage of patients who developed exercise-induced angina, the percentage of patients who underwent coronary angiography and the segmental summed perfusion and WT scores were significantly higher in the stunned group compared with group 2A. Only ESV increased significantly post-stress, and this increase occurred only in stunned patients. Both EDV and ESV ratios were significantly higher in the stunned group compared with normal controls (P=0.008 and P<0.000001, respectively) and with the subgroup 2A (P=0.011 and P<10(-12), respectively). The ESV stress/rest ratio correlated significantly with the summed WT difference score by univariate analysis in stunned patients. It can be concluded that the post-stress ESV dilation, obtained by stress/rest gated SPECT, seems to be due to endocardial post-ischemic stunning. The stunned patients showed more severe clinical, angiographic, perfusion and function parameters.

背景与目标： : 几项研究表明，使用201和锝示踪剂的门控单光子发射计算机断层扫描 (SPECT) 在评估心肌灌注和功能方面的准确性。门控SPECT已成功用于检测冠状动脉阻塞患者缺血后电击引起的应激后左心室射血分数 (LVEF) 降低。这项研究的目的是评估应激后LVEF损伤是否与缺血后心内膜电击引起的应激后收缩末期心室扩张有关。使用双头SPECT相机注射925 MBq 99mTc-tetrofosmin后，通过常规诊断2天压力/休息门控SPECT研究了82例连续患者。这些患者中的一百四十名 (52% 名) 表现出可逆性灌注缺陷，69名 (24% 名) 永久性缺陷，其余66名 (24% 名) 具有正常灌注。这些患者中有138例有心肌梗塞 (MI) 病史，19% 例接受了冠状动脉造影，而没有发生心脏事件。在非门控图像上使用20个片段以五点量表 (0，正常; 4，无摄取) 进行分析，而在压力/静息收缩末期图像上使用四点评分 (0，正常; 3，没有重量)。使用自动算法计算LVEF和体积。确定舒张末期 (EDV) 和收缩末期 (ESV) 的压力后和休息比。使用来自冠状动脉疾病 (CAD) 可能性低 (<5%) 的149患者的数据获得所有这些参数的正常值。在具有可逆性灌注缺陷的147 (34%) 患者中，应激后LVEF> 5% 低于休息值 (惊呆组)，而其余97名患者未显示出明显的LVEF变化 (组2A)。与2A组相比，惊呆组发生运动诱发心绞痛的患者百分比，接受冠状动脉造影的患者百分比以及节段总灌注和WT评分明显更高。只有ESV在应激后显着增加，并且这种增加仅发生在震惊的患者中。与正常对照组 (分别为P = 0.008和P<0.000001) 和亚组2A (分别为P = 0.011和P<10(-12)) 相比，昏迷组的EDV和ESV比率均显着更高。通过单变量分析，震惊患者的ESV压力/休息比与总WT差异得分显着相关。可以得出结论，通过压力/休息门控SPECT获得的应激后ESV扩张似乎是由于心内膜缺血后的电击所致。惊呆的患者表现出更严重的临床，血管造影，灌注和功能参数。

BACKGROUND & AIMS: :Myocardial substrate metabolism provides the energy needed for cardiac contraction and relaxation. The normal adult heart uses predominantly fatty acids (FAs) as its primary fuel source. However, the heart can switch and use glucose (and to a lesser extent, ketones, lactate, as well as endogenous triglycerides and glycogen), depending on the metabolic milieu and superimposed conditions. FAs are not a wholly better fuel than glucose, but they do provide more energy per mole than glucose. Conversely, glucose is the more oxygen-efficient fuel. Studies in animal models of heart failure (HF) fairly consistently demonstrate a shift away from myocardial fatty acid metabolism and toward glucose metabolism. Studies in humans are less consistent. Some show the same metabolic switch away from FA metabolism but not all. This may be due to differences in the etiology of HF, sex-related differences, or other mitigating factors. For example, obesity, insulin resistance, and diabetes are all related to an increased risk of HF and may complicate or contribute to its development. However, these conditions are associated with increased FA metabolism. This review will discuss aspects of human heart metabolism in systolic dysfunction as measured by the noninvasive, quantitative method-positron emission tomography. Continued research in this area is vital if we are to ameliorate HF by manipulating heart metabolism with the aim of increasing energy production and/or efficiency.

背景与目标： : 心肌底物代谢提供心脏收缩和舒张所需的能量。正常的成人心脏主要使用脂肪酸 (FAs) 作为其主要燃料来源。然而，心脏可以切换和使用葡萄糖 (在较小程度上，酮，乳酸，以及内源性甘油三酯和糖原)，这取决于代谢环境和叠加条件。FAs并不是比葡萄糖更好的燃料，但它们确实比葡萄糖每摩尔提供更多的能量。相反，葡萄糖是氧气效率更高的燃料。对心力衰竭 (HF) 动物模型的研究相当一致地表明，从心肌脂肪酸代谢转向葡萄糖代谢。对人类的研究不太一致。有些人显示出与FA代谢相同的代谢开关，但并非全部。这可能是由于HF的病因差异，性别相关差异或其他缓解因素所致。例如，肥胖，胰岛素抵抗和糖尿病都与HF风险增加有关，并可能使其复杂化或促进其发展。然而，这些情况与FA代谢增加有关。这篇综述将讨论通过无创，定量方法-正电子发射断层扫描测量的收缩功能障碍中人体心脏代谢的各个方面。如果我们要通过控制心脏代谢以增加能量产生和/或效率来改善HF，那么在该领域的持续研究至关重要。

BACKGROUND & AIMS: :Pressure-volume analysis has provided critical insight into ventricular mechanics, and it has elucidated the underlying mechanisms of heart failure (HF). Renewed interest in ventriculovascular coupling, the interaction of the left ventricle and the arterial system, has developed from recent investigations focusing on the importance of heart rate control in systolic HF, blood pressure lability in the elderly, and acute pulmonary edema in patients with HF and a normal ejection fraction. These data suggest that abnormal ventriculovascular coupling may be an additional pathophysiologic mechanism underlying the development of HF with a normal ejection fraction and may provide a target for novel therapies.

背景与目标： : 压力-容积分析为心室力学提供了重要的见解，并阐明了心力衰竭 (HF) 的潜在机制。最近的研究对心室血管耦合，左心室与动脉系统的相互作用产生了新的兴趣，这些研究的重点是心率控制在收缩期HF中的重要性，老年人的血压不平和急性肺水肿。HF和正常的射血分数。这些数据表明，异常的心室血管耦合可能是射血分数正常的HF发展的另一种病理生理机制，并可能为新型疗法提供靶标。

BACKGROUND & AIMS: :The purpose of the present trial was to evaluate safety, tolerability, and effect on systolic blood pressure (SBP) of SER100 in a small group of patients with isolated systolic hypertension (ISH) in treatment with at least 1 antihypertensive drug. Eligible patients were randomized to either SER100 (10 mg) or placebo in a crossover design, and 2 doses were given subcutaneously (SC), 8 hours apart, on 2 consecutive days. On all treatment days patients were monitored with an ambulatory blood pressure measurement device for 12 daytime hours. Seventeen patients completed treatment. There were no serious or severe adverse events. Relative to placebo SER100 induced an average reduction of SBP during the 2 treatment days of 7.0 mm Hg (P = 0.0032), whereas the average reduction of diastolic blood pressure (DBP) over the same period was 3.8 mm Hg (P = 0.0011). For patients with ISH, this short-term cross-over study of SC SER100 demonstrated an acceptable safety profile and consistent, significant lowering of SBP and DBP. As initial clinical proof of concept for a new class of drugs, a nociceptin agonist peptide, the results were encouraging and warrant further research.

背景与目标： : 本试验的目的是评估一小群接受至少1种降压药治疗的单纯收缩期高血压 (ISH) 患者中SER100的安全性，耐受性和对收缩压 (SBP) 的影响。符合条件的患者在交叉设计中随机分配至SER100 (10 mg) 或安慰剂，并在连续2天的时间间隔8小时皮下注射2剂 (SC)。在所有治疗日中，使用动态血压测量设备对患者进行了12个白天的监测。17名患者完成了治疗。没有严重或严重的不良事件。相对于安慰剂SER100，在2个治疗日期间SBP平均降低7.0毫米Hg (P = 0.0032)，而同期舒张压 (DBP) 的平均降低为3.8毫米Hg (P = 0.0011)。对于ISH患者，SC SER100的这项短期交叉研究显示出可接受的安全性以及SBP和DBP的持续显着降低。作为一类新型药物 (伤害肽激动剂肽) 的初步临床概念证明，结果令人鼓舞，值得进一步研究。

BACKGROUND & AIMS: :Acute respiratory failure is followed by decreased left ventricular performance probably due to the right ventricle dilatation induced by pulmonary hypertension and intraventricular septal shift to the left. An anacrotic notch on the upstroke slope of the carotid curve was detected in 22 of 36 hemodynamic studies with simultaneous ECG, PCG and external pulse carotid curve recording in 7 burned patients with acute respiratory failure. Comparing the values (x +/- SEM) obtained in group with notch and in group without notch, PAPs, PAPm, PVRI were higher (56 +/- 2.30 mmHg; 32 +/- 0.99 mm Hg; 543 +/- 56.8 dyn x s/cm5/m2 versus 32 +/- 1.08 mm Hg; 20 +/- 0.9 mm Hg; 173 +/- 14.7 dyn x s/cm5/m2) and CI and LVSWI were lower (2.6 +/- 0.17 l/min/m2; 25.8 +/- 2.41 g x m/m2; versus 3.8 +/- 0.26 l/min/m2; 38.3 +/- 2.82 g x m/m2) in group with notch. As it is shown by 11 paired measurements where the notch disappeared immediately after starting vasodilator therapy PAPs, PAPm, PVRI decreased (from 54 +/- 3.1, 35 +/- 0.8 mm Hg, 498 +/- 64.1 dyn x s/cm5/m2 to 35 +/- 0.8, 21 +/- 1.1 mmHg, 189 +/- 18.4 dyn x s/cm5/m2 respectively) and heart performance improved. Since the left ventricle contractility (characterized by EF, PCWP, ICT) was normal in both groups, our findings suggest that critically high PAPs values (over 40 mmHg) cause a septal bulging at the beginning of the systole which in turn narrows the left ventricle outflow tract. Regarding to the clinical importance of the deteriorated biventricular function at the critically high PAPs evidenced by notch phenomenon on carotid curve but measurable only by indwelling pulmonary arterial catheterization always being a source of infection, the noninvasive parameters as independent variables were entered into canonical discriminant analysis. The ratio of the correctly classified cases was 89%.

背景与目标： : 急性呼吸衰竭后，左心室性能下降，可能是由于肺动脉高压和室间隔向左移位引起的右心室扩张。在36项血流动力学研究中，有22项同时记录了7例急性呼吸衰竭烧伤患者的ECG，PCG和外脉冲颈动脉曲线，在颈动脉曲线的上冲程斜率上检测到一个明显缺口。比较notch组和无notch组的值 (x/- SEM)，PAPm，PVRI较高 (56/- 2.30 mmHg; 32/-0.99毫米Hg; 543 +/- 56.8 dyn x s/cm5/m2与32 +/-1.08毫米Hg; 20 +/-0.9毫米Hg; 173 +/- 14.7 dyn x s/cm5/m2) 和CI和LVSWI较低 (2.6 +/- 0.17 l/min/m2; 25.8/- 2.41g x m/m2; 与3.8/- 0.26 l/min/m2相比; 38.3/- 2.82g x m/m2)。如11对测量结果所示，在开始血管扩张治疗后，PAPs、PAPm、PVRI立即消失 (从54 +/- 3.1、35 +/-0.8毫米Hg、498 +/- 64.1 dyn x s/cm5/m2降至35 +/- 0.8，分别为21/- 1.1 mmHg，189/- 18.4 dyn x s/cm5/m2) 和心脏性能得到改善。由于两组的左心室收缩力 (以EF，PCWP，ICT为特征) 均正常，因此我们的发现表明，极高的PAPs值 (超过40 mmHg) 会导致收缩期开始时间隔膨胀，从而使左心室变窄流出道。关于在颈动脉曲线上的notch现象证明但仅通过留置肺动脉导管才能测量的临界高PAPs上的双心室功能恶化的临床重要性始终是一个传染源，将非侵入性参数作为独立变量输入到典型判别分析中。正确分类的病例比例为89%。

BACKGROUND & AIMS: :Astaxanthin has strong antioxidant properties. We conducted a prospective pilot study on heart failure (HF) patients with left ventricular (LV) systolic dysfunction to investigate improvements in cardiac function and exercise tolerance in relation to suppression of oxidative stress by 3-month astaxanthin supplementation. Oxidative stress markers-serum Diacron reactive oxygen metabolite (dROM), biological antioxidant potential (BAP), and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) concentrations, LV ejection fraction (LVEF), and 6-min walk distance (6MWD) were assessed before and after 3-month astaxanthin supplementation. Finally, the data of 16 HF patients were analyzed. Following 3-month astaxanthin supplementation, dROM level decreased from 385.6 ± 82.6 U.CARR to 346.5 ± 56.9 U.CARR (p = 0.041) despite no changes in BAP and urinary 8-OHdG levels. LVEF increased from 34.1 ± 8.6% to 38.0 ± 10.0% (p = 0.031) and 6MWD increased from 393.4 ± 95.9 m to 432.8 ± 93.3 m (p = 0.023). Significant relationships were observed between percent changes in dROM level and those in LVEF. In this study, following 3-month astaxanthin supplementation, suppressed oxidative stress and improved cardiac contractility and exercise tolerance were observed in HF patients with LV systolic dysfunction. Correlation between suppression of oxidative stress and improvement of cardiac contractility suggests that suppression of oxidative stress by astaxanthin supplementation had therapeutic potential to improve cardiac functioning.

背景与目标： : 虾青素具有很强的抗氧化性能。我们对患有左心室 (LV) 收缩功能障碍的心力衰竭 (HF) 患者进行了一项前瞻性初步研究，以研究与补充3个月虾青素抑制氧化应激有关的心功能和运动耐力的改善。氧化应激标志物-血清Diacron活性氧代谢物 (dROM)，生物抗氧化潜能 (BAP) 和尿中8-羟基-2 '-脱氧鸟苷 (8-OHdG) 浓度，左室射血分数 (LVEF) 和6分钟步行距离 (6MWD) 在补充虾青素3个月之前和之后进行评估。最后，对16例心衰患者的资料进行分析。补充虾青素3个月后，尽管BAP和尿8-OHdG水平没有变化，但dROM水平从385.6 ± 82.6 U.CARR降至346.5 ± 56.9 U.CARR (p = 0.041)。LVEF从34.1 ± 8.6% 增加到38.0 ± 10.0% (p = 0.031)，6MWD从393.4 ± 95.9 m增加到432.8 ± 93.3 m (p = 0.023)。观察到dROM水平的百分比变化与LVEF的百分比变化之间存在显着关系。在这项研究中，在LV收缩功能障碍的HF患者中，在补充虾青素3个月后，观察到氧化应激受到抑制，心脏收缩力和运动耐力得到改善。抑制氧化应激与改善心脏收缩力之间的相关性表明，补充虾青素抑制氧化应激具有改善心脏功能的治疗潜力。

BACKGROUND & AIMS: This study evaluates long-term ( > 10 years since surgery) right ventricular (RV) systolic function in patients who had previously undergone intraatrial baffle surgery for transposition of the great arteries. Studies suggest these patients are clinically stable and lead satisfactory lifestyles, but long-term ventricular performance is not known. Radionuclide angiocardiography was used to estimate RV ejection fraction in 58 patients a mean of 14 years after the Mustard operation. Repeat studies were performed in 32 patients. The absolute RV ejection fraction of 0.53 +/- 0.10 in our patients did not differ from normal values. Nine patients had a value < 0.42, placing them > 2 SDs below normal. Repeat RV ejection fraction decreased from 0.54 +/- 0.11 to 0.51 +/- 0.11 (p < 0.1) in 32 patients, and > 0.10 in 6. Thus, RV ejection fraction was abnormal in 9 of 58 patients (16%) evaluated > 10 years after a Mustard operation. Repeat studies demonstrate worsening in at least 6 of 32 patients (19%). These postoperative Mustard patients require continued evaluation, even in the absence of overt symptomatology.

背景与目标： 这项研究评估了先前接受过大动脉转位的房内挡板手术的患者的长期 (自手术以来> 10年) 右心室 (RV) 收缩功能。研究表明，这些患者临床稳定，生活方式令人满意，但长期心室性能尚不清楚。放射性核素心血管造影用于估计芥末手术后平均14年的58例患者的RV射血分数。对32例患者进行了重复研究。在我们的患者中，0.53 +/- 0.10的RV绝对射血分数与正常值没有差异。9名患者的值 <0.42，使他们> 2 SDs低于正常。32例患者的RV射血分数从0.54 +/- 0.11降至0.51 +/- 0.11 (p <0.1)，6例患者> 0.10。因此，在芥末手术后10年以上评估的58名患者 (16% 名) 中有9名RV射血分数异常。重复研究表明32例患者中至少有6例 (19% 例) 恶化。即使没有明显的症状，这些术后芥末患者也需要继续评估。

BACKGROUND & AIMS: OBJECTIVE:The objective of this study is to determine the reference ranges for filling time (FT) and systolic-to-diastolic time index (SDI) of the left ventricle (LV) by using spectral Doppler, and FT' and SDI' of the LV, right ventricle, and interventricular septum (IVS) by using tissue Doppler of the fetal heart. STUDY DESIGN:This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. The SDI/SDI' is the sum of the ejection time, isovolumic contraction time, and isovolumic relaxation time (IRT) divided by the FT. We measured FT/FT' from the beginning of the opening click of the E wave of the mitral valve to the closing click of the A wave of the mitral valve. We used regression analysis to obtain the best-fit model polynomial equation for the parameters. Additionally, we assessed intra- and inter-observer reproducibility by using concordance correlation coefficient (CCC). RESULTS:There was a weak correlation among FT LV (r = 0.31, p < 0.0001), SDI LV (r = -0.23, p < 0.0001), and gestational age (GA). Additionally, there was a very weak positive correlation among FT' RV (r = 0.09, p = 0.0001), FT' LV (r = 0.07, p < 0.0001), FT' IVS (r = 0,08, p < 0.0001), and GA. In contrast, there was a very weak negative correlation among SDI' LV (r=-0.09, p < 0.0001), SDI' IVS (r=-0.05, p < 0.0021), and GA. There was no significative correlation between SDI' RV (r=-0.06, p < 0.081) and GA. Poor/very poor intra- and inter-observer reliability was observed for all the parameters (CCC = 0.19-0.79), whereas moderate intra- and inter-observer agreement was observed for all parameters (CCC = 0.37-0.72). CONCLUSIONS:The reference ranges for FT and SDI were determined by using spectral and tissue Doppler of the fetal heart and showed a poor reproducibility.

背景与目标：