Assessment of Right Ventricle by Echocardiogram

Assessment of right ventricular (RV) function is important to ascertain clinical outcome in patients with symptoms of right ventricular failure manifested as lower extremity swelling and abdominal congestion. RV function is not routinely assessed and reported in clinical practice. Unlike the bullet‐shaped left ventricle (LV), RV has a complex geometry with a triangular shape. RV is further divided into the inlet, trabecular apex, and infundibulum or conus. RV evaluation involves quantifying afterload and preload, assessing the mechanism and severity of tricuspid regurgitation (TR), and quantitative evaluation of RV performance. For quantification of RV size and function, we can use intravenous contrast for endocardial tracing of RV border to measure RV dimensions, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), Doppler index of myocardial performance (Tei index or myocardial performance index), pulsed wave or color Doppler tissue imaging systolic velocity [s\u27], or strain imaging. For qualitative evaluation of RV, the RV size is compared to the LV size in parasternal, short axis, and subcostal projections

901-25 The Paradox of Donor Stimulation of Endothelial-induced Smooth Muscle Growth

Cardiac allograft vasculopathy (CAV) is the major cause of long-term morbidity and mortality in cardiac transplant recipients. It appears to be related to immune damage to the coronary endothelial cells, resulting in intimal proliferation. In order to delineate the mechanisms by which CAY can occur, a co-culture model of human endothelial cells (EC) and smooth muscle cells (SMC) obtained from the donor at the time of organ procurement was utilized. These cells were separated by collagenase digestion, and cultured for four passages. EC and SMC were then grown to confluence in the separate chambers of a co-culture plate separated by a 0.45 micron Millipore filter. Preserved lymphocytes (LYMPH) obtained from the donor and pooled blood lymphocytes from the recipient 3-4 weeks following transplant were added to the EC well so as to cause an immunologic stimulation of the EC. None of the recipients were exposed to monoclonal or polyclonal antibodies to lymphocytes. All cultures and assays were done in triplicate. Results are as follows:Patient#% Increase in donor lymph H3thymidinep ValueDonor 1+510.04Donor 2+450.05Donor 3+1040.05Donor 4+250.01Donor 5-19NSThe donor EC/donor LYMPH co-culture stimulated SMC growth measured by H3thymidine incorporation in 4 of 5 patients. The donor EC/recipient LYMPH co-culture did not result in significant SMC H3thymidine incorporation.ConclusionThese paradoxical findings of a lack in significant SMC proliferation in the recipient stimulated donor cells continue to raise questions in relation to the effects of circulating lymphocytes on the development of cardiac allograft vasculopathy

Energy drinks and their adverse health effects: A systematic review of the current evidence.

PURPOSE: With the rising consumption of so-called energy drinks over the last few years, there has been a growing body of literature describing significant adverse health events after the ingestion of these beverages. To gain further insight about the clinical spectrum of these adverse events, we conducted a literature review. METHODS: Using PubMed and Google-Scholar, we searched the literature from January 1980 through May 2014 for articles on the adverse health effects of energy drinks. A total of 2097 publications were found. We then excluded molecular and industry-related studies, popular media reports, and case reports of isolated caffeine toxicity, yielding 43 reports. CONCLUSION: Energy drink consumption is a health issue primarily of the adolescent and young adult male population. It is linked to increased substance abuse and risk-taking behaviors. The most common adverse events affect the cardiovascular and neurological systems. The most common ingredient in energy drinks is caffeine, and it is believed that the adverse events are related to its effects, as well as potentiating effects of other stimulants in these drinks. Education, regulation, and further studies are required

An intravascular ultrasound study of the influence of angiotensin-converting enzyme inhibitors and calcium entry blockers on the development of cardiac allograft vasculopathy

In conclusion, this intravascular ultrasound study suggests that treatment of cardiac transplant recipients with either ACE inhibitors or CEBs is associated with a decrease in the degree of vascular intimal hyperplasia at 1 year after transplantation. Thus, early intervention with CEBs or ACE inhibitors offers a preventive option for the devastating consequences of cardiac allograft vasculopathy

Predictive model to assess risk of cardiac allograft vasculopathy: An intravascular ultrasound study

Objectives.This study was performed to assess the influence and interdependence of immunologic and nonimmunologic risk factors in the development of cardiac allograft vasculopathy. Another primary objective was to establish a clinically useful model for risk assessment of cardiac allograft vasculopathy that would facilitate identifying those heart transplant recipients likely to have severe intimal proliferation and thereby at greatest risk for adverse clinical events.Background.To our knowledge, no comprehensive intravascular ultrasound study has assessed the relative influences of both nonimmunologic and immunologic factors in the development of cardiac allograft vasculopathy, currently the major limitation to long-term cardiac allograft survival.Methods.Using a computer-assisted model of stepwise logistic regression, immunologic and nonimmunologic risk factors were evaluated to help identify the development of severe intimal thickening in 101 subjects who underwent intravascular ultrasound. Prospective validation of the findings was performed in a separate consecutive cohort of 37 heart transplant recipients, and the accuracy of this model to predict a relative risk >1 for the development of severe intimal hyperplasia was assessed.Results.Significant independent predictors of severe intimal hyperplasia in this model included a donor age >35 years, a first-year mean biopsy score > 1 (a measure not only of severity of rejection, but also of frequency of insidious rejection) and hypertriglyceridemia at two incremental levels of risk (150 to 250 mg/dl [1.70 to 2.83 mmol/liter] and >250 mg/dl [2.83 mmol/liter]). Based on the absence (0) or presence (1) of these factors, 12 individual categories of risk were ascertained with increasing relative risks and predicted probabilities for severe intimal hyperplasia. Prospective validation of this model revealed a sensitivity and specificity of 70% and 90%, respectively, and the positive and negative predictive values were 85% and 80%, respectively. Additionally, subjects with severe intimal thickening had a fourfold higher cardiac event rate than those without severe intimal proliferation on intravascular ultrasound.Conclusions.This study establishes a clinically useful predictive model that can be applied to individual heart transplant recipients to assess their risk for developing significant cardiac allograft vasculopathy and, thus, aids in the identification of patients at risk for cardiac events in whom closer surveillance and risk factor modification may be warranted