relationship between EL and cardiac structure and function in patients with HFmrEF. Methods: The study includes 28 patients with HFmrEF, compared with 23 normals. HFmrEF patients are divided into 2 groups:group I with diastolic dysfunction, group II without diastolic dysfunction. VFM is used to calculate EL in left ventricle in IVR, RFP, ACP, IVC, REP. Results: The EL at RFP, IVC, REP in left ventricle at every phase decrease in the HFmrEF group. Compared with group II,the EL of group I at IVR and RFP increase (P,0.05).The EL at RFP, IVC, REP in left ventricle decrease in the HFmrEF group (P,0.05). Compared with group II,the EL of group I at IVR and RFP increase (P,0.05). Total EL in LV during RFP is independently associated with E/e' (b5 0.423, P5 0.019).Total EL in LV during ACP is associated with GLS(b5 0.392, P5 0.039).Total EL in LV during IVC is independently associated with GLS (b5 0.546, P5 0.001). Conclusions: In HEmrEF, EL in the left ventricle decreases in RFP, IVC, REP. However, the EL in RFP will increase if accompanied with diastolic dysfunction. The EL in the left ventricle in RFP is related to the diastolic function of the heart, and the EL in ACP and IVC is related to the systolic function of the heart.
Purpose. To: 1) optimize algorithm of stress echocardiography (s-Echo) with intravenous adenosine triphosphate (ATP) infusion taking into account pharmacokinetics and pharmacodynamics of ATP in human body, 2) test new algorithm in patients with coronary and other heart diseases. Materials and methods. In order to determine spectrum of factors influencing the results of stress test with ATP we inspected main scientific data bases and found 48 publications on ATP application for diagnostic purposes. Analysis of these publications allowed us to optimize algorithm of ATP s-Echo. Optimized algorithm was tested on 26 subjects, who underwent ATP 4D strain-stress-echocardiography of the left ventricle. Results and discussion. Optimized algorithm has three stages: registration of Echo data sets before, at the time of ATP infusion, and after 5 min of ATP infusion termination. Registration of Echo parameters at the second stage must begin not earlier than 3 min after the onset of ATP infusion and only in the presence of signs of coronary vasodilation. We think that the main indirect criterion of submaximal coronary vasodilation is 5 mm Hg or more decrease in systolic blood pressure (SBP), but not below SBP level of 90 mm Hg. Initial dose of ATP is 140 µg/kg/min. If after 2 min of infusion SBP do not diminish we increase the infusion rate at first to 175 and then to 210 µg/kg/min. While testing new algorithm in all cases we have achieved criteria of effective vasodilation. Mean SBP decrease was 16.4±13.7 mm Hg, heart rate increase – 12.7±8.1 bpm. In all patients we obtained interpretable 4D LV Echo data sets for visual analysis of local contractility and automatic strain analysis. Conclusion. Optimization of ATP sEcho algorithm was performed. Safety and efficacy of optimized algorythm for registration of echo data was demonstrated. New ATP infusion algorithm can also be recommended for testing with other cardiac imaging modalities in evaluation of myocardial perfusion and contractility (SPECT, CT, MRI, PET).
Background Use of adenosine triphosphate (ATP) instead of adenosine in stress echocardiography is more cost-effective. Earlier we have proposed new ATP stress echocardiography algorithm (Figure). This modified algorithm includes 1) stepwise increase in dose of ATP in the absence of signs of adequate vasodilation (decrease in systolic blood pressure and increase in heart rate), 2) triple registration of echocardiographic data sets (before ATP infusion, during phase of adequate vasodilation and 5 minutes after the termination of ATP infusion). Purpose In this study we aimed to a) assess the safety of ATP high doses infusion algorithm, b) determine the values of left ventricular (LV) systolic global and segmental area strain (AS) during 4D-strain-stress echocardiography with ATP in healthy volunteers. Material and methods 13 healthy subjects (male 9, mean age 35.3±11.0 years) underwent ATP LV 4D strain-stress-echocardiography (Vivid E95, AFI technology). Mean values of global and regional (16 segments model) AS were determined. Results 4 subjects appeared to be “non responders” to initial dose of ATP 140 μg/kg/min. In three subjects it was necessary to increase the dose of ATP to 175 and in one to 210 μg/kg/min in order to achieve adequate vasodilation. No major side effects of ATP infusion (complete heart block, bronchospasm, myocardial infarction) were registered and no aminophylline injections were required. In all cases interpretable 4D LV Echo data sets for automatic strain analysis were obtained. Mean values of global systolic AS in healthy individuals before, at time and after ATP infusion were −25.8±4.8, −27.2±4.4 and −25.7±4.8%, respectively. Mean values of systolic AS in each of 16 segments were also calculated (Table). LV segment AS before ATP (%) AS ATP infusion (%) AS after ATP (%) LV segment AS before ATP (%) AS ATP infusion (%) AS after ATP (%) 1 −29.6±11.3 −31.2±11.1 −28.6±8.3 9 −27.8±6.5 −29.3±6.8 −30.8±6.0 2 −26.6±8.5 −28.2±4.9 −26.2±7.3 10 −26.1±5.2 −274±5.5 −25.8±6.0 3 −25.6±6.8 −29.6±5.2 −27.2±7.2 11 −25.3±6.1 −26.1±7.5 −24.9±5.3 4 −26.2±7.2 −24.9±9.1 −25.2±6.7 12 −28.1±7.3 −28.5±6.1 −25.3±5.6 5 −26.5±6.8 −29.3±10.9 −24.3±7.7 13 −22.9±6.5 −23.4±6.5 −23.2±6.4 6 −25.2±6.7 −26.0±7.9 −25.5±7.0 14 −25.7±7.6 −28.5±6.0 −26.2±6.8 7 −24.8±7.3 −25.6±6.1 −22.8±6.0 15 −26.5±6.5 −29.8±6.0 −28.5±5.5 8 −25.8±6.6 −26.5±5.6 −25.8±5.5 16 −24.2±7.1 −25.4±6.2 −25.1±6.6 Conclusions 4D strain-stress-echocardiography ATP infusion algorithm is safe and well tolerated by patients. Values of LV systolic global and segmental AS in healthy subjects were determined.
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