Assessment of Cardiovascular Health of Children Ages 6 to 10 Years Conceived by Assisted Reproductive Technology.

Importance: Assisted reproductive technology (ART) has been widely used for treatment of infertility and has brought millions of births worldwide. The health of offspring conceived by ART has been of much concern, and adverse cardiovascular health outcomes have been reported by previous studies. Objective: To assess the cardiovascular health of children conceived by ART. Design, Setting, and Participants: This cohort study was conducted among participants recruited from November 2017 to February 2019. Participants were 382 children conceived by ART who were selected from a single reproductive center and 382 children who were naturally conceived, randomly selected from a primary school, and matched by sex, age, and maternal age at the child's birth (2 years older or younger). Data were analyzed from March 2019 through December 2019. Exposures: Conception by ART. Main Outcomes and Measures: Blood pressure was measured, and echocardiography was performed to determine left ventricular structural and functional parameters. Adjusted relative wall thickness (aRWT) was found for age, with high RWT defined as an aRWT of 0.375 or more. Results: Among 764 children aged 6 to 10 years, 382 children were conceived by ART (mean [SD] age, 7.20 [1.21] years; 201 [52.6%] boys) and 382 children were naturally conceived (mean [SD] age, 7.20 [1.21] years; 201 [52.6%] boys). Children conceived by ART had statistically significantly increased mean (SD) height (130.2 [9.5] cm vs 128.5 [8.1] cm; P = .007) and body mass index (17.6 [3.6] vs 17.1 [2.7]; P = .03). Those conceived by ART, compared with children in the matched control group, had statistically significantly increased blood pressure (mean [SD] systolic blood pressure, 105.5 [6.9] mm Hg vs 103.5 [8.4] mm Hg; adjusted P < .001; mean [SD] diastolic blood pressure, 67.2 [5.6] mm Hg vs 62.2 [6.3] mm Hg ; adjusted P < .001), left ventricular systolic dysfunction (mean [SD] left ventricular ejection fraction, 64.61% [3.20%] vs 66.70% [3.89%]; adjusted P < .001), and diastolic dysfunction (mean [SD] early/late mitral/tricuspid diastolic velocities ratio, 1.66 [0.28] vs 2.21 [0.36]; adjusted P < .001). They also had statistically significantly increased parameters of left ventricular structure, including mean (SD) left ventricular mass index (31.97 [5.04] g/m2.7 vs 28.28 [3.54] g/m2.7; adjusted P < .001) and RWT (3.30 [0.41] mm vs 2.98 [0.14] mm; adjusted P < .001). Additionally, children conceived by ART had statistically significantly increased prevalence of left ventricular hypertrophy (9 children [2.4%] vs 2 children [0.5%]; P = .03), high RWT (61 children [16.0%] vs 0 children; P < .001), and left ventricle remodeling patterns, including concentric remodeling (60 children [15.7%] vs 0 children), eccentric hypertrophy (8 children [2.1%] vs 2 children [0.5%]), and concentric hypertrophy (1 child [0.3%] vs 0 children) (P for left ventricle remodeling < .001). Conclusions and Relevance: This study found that children conceived by ART had increased blood pressure and unfavorable changes in left ventricular structure and function compared with children who were naturally conceived. These findings suggest that further studies are needed to investigate the potential mechanisms and long-term outcomes associated with these differences.

Multi-Site Photoplethysmographic and Electrocardiographic System for Arterial Stiffness and Cardiovascular Status Assessment.

The development and validation of a system for multi-site photoplethysmography (PPG) and electrocardiography (ECG) is presented. The system could acquire signals from 8 PPG probes and 10 ECG leads. Each PPG probe was constituted of a light-emitting diode (LED) source at a wavelength of 940 nm and a silicon photomultiplier (SiPM) detector, located in a back-reflection recording configuration. In order to ensure proper optode-to-skin coupling, the probe was equipped with insufflating cuffs. The high number of PPG probes allowed us to simultaneously acquire signals from multiple body locations. The ECG provided a reference for single-pulse PPG evaluation and averaging, allowing the extraction of indices of cardiovascular status with a high signal-to-noise ratio. Firstly, the system was characterized on optical phantoms. Furthermore, in vivo validation was performed by estimating the brachial-ankle pulse wave velocity (baPWV), a metric associated with cardiovascular status. The validation was performed on healthy volunteers to assess the baPWV intra- and extra-operator repeatability and its association with age. Finally, the baPWV, evaluated via the developed instrumentation, was compared to that estimated with a commercial system used in clinical practice (Enverdis Vascular Explorer). The validation demonstrated the system's reliability and its effectiveness in assessing the cardiovascular status in arterial ageing.

Anatomical assessment of intrathoracic cardiovascular structures using fast spin-echo double inversion recovery and steady-state free precession magnetic resonance imaging in a normal cat.

In human medicine, non-contrast cardiac magnetic resonance imaging (CMRI) is routinely used to assess the cardiovascular system. In this study, using non-contrast CMRI, we provide a thorough description of the normal appearance of the intrathoracic cardiovascular structures in one healthy cat using a magnet operating at a field of 1.5-Tesla. The CMRI protocol was based on the use of fast spin-echo double inversion recovery and steady-state free precession pulse sequences in oblique short-axis, vertical long-axis, and horizontal long-axis imaging planes. After imaging the feline heart, four cadaver cats injected with latex substance into their arterial and venous systems were sectioned to facilitate interpretation of the intrathoracic cardiovascular structures to the corresponding CMRI. The fast spin-echo double inversion recovery images showed the best evaluation of gross intrathoracic anatomy, giving excellent contrast of the myocardium and vessels walls as they appeared with intermediate signal intensity compared to the lumen that appeared with low signal intensity. By contrast, steady-state free precession images showed details of the heart cavities and vascular lumen due to the high signal intensity of fast-flowing blood. The results of this study provide some anatomic detail for the heart and associated vessels as seen by non-contrast CMRI in the domestic cat.

Novel insights into in-vivo diffusion tensor cardiovascular magnetic resonance using computational modeling and a histology-based virtual microstructure.

PURPOSE: To develop histology-informed simulations of diffusion tensor cardiovascular magnetic resonance (DT-CMR) for typical in-vivo pulse sequences and determine their sensitivity to changes in extra-cellular space (ECS) and other microstructural parameters. METHODS: We synthesised the DT-CMR signal from Monte Carlo random walk simulations. The virtual tissue was based on porcine histology. The cells were thickened and then shrunk to modify ECS. We also created idealised geometries using cuboids in regular arrangement, matching the extra-cellular volume fraction (ECV) of 16-40%. The simulated voxel size was 2.8 × 2.8 × 8.0 mm3 for pulse sequences covering short and long diffusion times: Stejskal-Tanner pulsed-gradient spin echo, second-order motion-compensated spin echo, and stimulated echo acquisition mode (STEAM), with clinically available gradient strengths. RESULTS: The primary diffusion tensor eigenvalue increases linearly with ECV at a similar rate for all simulated geometries. Mean diffusivity (MD) varies linearly, too, but is higher for the substrates with more uniformly distributed ECS. Fractional anisotropy (FA) for the histology-based geometry is higher than the idealised geometry with low sensitivity to ECV, except for the long mixing time of the STEAM sequence. Varying the intra-cellular diffusivity (DIC ) results in large changes of MD and FA. Varying extra-cellular diffusivity or using stronger gradients has minor effects on FA. Uncertainties of the primary eigenvector orientation are reduced using STEAM. CONCLUSIONS: We found that the distribution of ECS has a measurable impact on DT-CMR parameters. The observed sensitivity of MD and FA to ECV and DIC has potentially interesting applications for interpreting in-vivo DT-CMR parameters.

Development of a rapid and economic in vivo electrocardiogram platform for cardiovascular drug assay and electrophysiology research in adult zebrafish.

Zebrafish is a popular and favorable model organism for cardiovascular research, with an increasing number of studies implementing functional assays in the adult stage. For example, the application of electrocardiography (ECG) in adult zebrafish has emerged as an important tool for cardiac pathophysiology, toxicity, and chemical screen studies. However, few laboratories are able to perform such functional analyses due to the high cost and limited availability of a convenient in vivo ECG recording system. In this study, an inexpensive ECG recording platform and operation protocol that has been optimized for adult zebrafish ECG research was developed. The core hardware includes integration of a ready-to-use portable ECG kit with a set of custom-made needle electrode probes. A combined anesthetic formula of MS-222 and isoflurane was first tested to determine the optimal assay conditions to minimize the interference to zebrafish cardiac physiology under sedation. For demonstration, we treated wild-type zebrafish with different pharmacological agents known to affect cardiac rhythms in humans. Conserved electrophysiological responses to these drugs were induced in adult zebrafish and recorded in real time. This economic ECG platform has the potential to facilitate teaching and training in cardiac electrophysiology with adult zebrafish and to promote future translational applications in cardiovascular medicine.

Multi-Modality Imaging in the Assessment of Cardiovascular Toxicity in the Cancer Patient.

Cancer therapy can be associated with both cardiac and vascular toxicity. Advanced multi-modality imaging can be used to stratify patient risk, identify cardiovascular injury during and after therapy, and forecast recovery. Echocardiography continues to be the mainstay in the evaluation of cardiac toxicity. Particularly, echocardiography-based strain imaging is useful for risk stratification of patients at baseline, and detection of subclinical left ventricle (LV) dysfunction during therapy. Cardiac magnetic resonance (CMR) serves a complementary role in the patient with poor echocardiographic or equilibrium radionuclide angiographic image quality or in situations where a more accurate and precise LV ejection fraction measurement is needed to inform decisions regarding discontinuation of chemotherapy. New CMR techniques like T1 and T2 mapping and positron emission tomography (PET) imaging will help us better understand the structural, pathological, and metabolic myocardial changes associated with ventricular dysfunction or release of serum biomarkers. CMR may also be helpful in the evaluation of vascular complications of cancer therapy. Stress echocardiography, stress CMR, computed tomography, and PET are excellent imaging options in the evaluation of ischemia in patients receiving therapies that could potentially cause vasospasm or accelerated atherosclerosis.

Cardiovascular Allometry: Analysis, Methodology, and Clinical Applications.

The classic works of "On Growth and Form" and "The Problem of Relative Growth" that began a century ago have so fittingly, albeit unintentionally, become pertinent to the modern-day clinical treatment strategy of the many patients with cardiovascular disease. This chapter uses allometry, which was established for comparative biology, to explore physiological and pathological differences due to differential growth, which may lead to differing diagnostic and treatment approaches for male versus female patients. Men and women have obvious differences in body and heart weights, as well as different geometries and structures of their blood vessels; the analysis in this chapter extends to their hemodynamic functional differences. This includes dimensional analysis to establish criteria for characterizing functions based on allometric formulations. The clinical applications of sex differences are analyzed for arterial stenosis, aneurysm, atherosclerosis, hypertension, and coronary revascularization. Allometric approaches are applied specifically to isolated cases of systolic hypertension to delineate the intermingled relations of aging and sex differences. This chapter aims to provide some preliminary insights into the usefulness of cardiovascular allometry. Its future impact on clinical diagnosis remains largely unexplored.

Differences in Cardiovascular Aging in Men and Women.

Cardiovascular diseases increase dramatically with age in both men and women. While it is clear that advanced age allows more time for individuals to be exposed to risk factors in general, there is strong evidence that age itself is a major independent risk factor for cardiovascular disease. Indeed, there are distinct age-dependent cellular, structural, and functional changes in both the heart and blood vessels, even in individuals with no clinical evidence of cardiovascular disease. Studies in older humans and in animal models of aging indicate that this age-related remodeling is maladaptive. An emerging view is that the heart and blood vessels accumulate cellular and subcellular deficits with age and these deficits increase susceptibility to disease in older individuals. Aspects of this age-dependent remodeling of the heart and blood vessels differ between the sexes. There is also new evidence that these maladaptive changes are more prominent in older animals and humans with a high degree of frailty. These observations may help explain why men and women are susceptible to different cardiovascular diseases as they age and why frail older adults are most often affected by these diseases.

Cardiovascular magnetic resonance assessment of acute cardiovascular effects of voluntary apnoea in elite divers.

BACKGROUND: Prolonged breath holding results in hypoxemia and hypercapnia. Compensatory mechanisms help maintain adequate oxygen supply to hypoxia sensitive organs, but burden the cardiovascular system. The aim was to investigate human compensatory mechanisms and their effects on the cardiovascular system with regard to cardiac function and morphology, blood flow redistribution, serum biomarkers of the adrenergic system and myocardial injury markers following prolonged apnoea. METHODS: Seventeen elite apnoea divers performed maximal breath-hold during cardiovascular magnetic resonance imaging (CMR). Two breath-hold sessions were performed to assess (1) cardiac function, myocardial tissue properties and (2) blood flow. In between CMR sessions, a head MRI was performed for the assessment of signs of silent brain ischemia. Urine and blood samples were analysed prior to and up to 4 h after the first breath-hold. RESULTS: Mean breath-hold time was 297 ± 52 s. Left ventricular (LV) end-systolic, end-diastolic, and stroke volume increased significantly (p < 0.05). Peripheral oxygen saturation, LV ejection fraction, LV fractional shortening, and heart rate decreased significantly (p < 0.05). Blood distribution was diverted to cerebral regions with no significant changes in the descending aorta. Catecholamine levels, high-sensitivity cardiac troponin, and NT-pro-BNP levels increased significantly, but did not reach pathological levels. CONCLUSION: Compensatory effects of prolonged apnoea substantially burden the cardiovascular system. CMR tissue characterisation did not reveal acute myocardial injury, indicating that the resulting cardiovascular stress does not exceed compensatory physiological limits in healthy subjects. However, these compensatory mechanisms could overly tax those limits in subjects with pre-existing cardiac disease. For divers interested in competetive apnoea diving, a comprehensive medical exam with a special focus on the cardiovascular system may be warranted. TRIAL REGISTRATION: This prospective single-centre study was approved by the institutional ethics committee review board. It was retrospectively registered under ClinicalTrials.gov (Trial registration: NCT02280226 . Registered 29 October 2014).

Assessment of strain and dyssynchrony in normal fetuses using speckle tracking echocardiography - comparison of three different ultrasound probes.

OBJECTIVE: To evaluate segmental left (LV-S) and right (RV-S) ventricular strain as well as longitudinal mechanical myocardial dyssynchrony as a time difference between peaks in strain of both ventricles in fetuses (two-chamber-dyssynchrony, 2C-DYS) using speckle tracking echocardiography (STE). The aim of our study was to evaluate the influence of data acquisition on the results of STE measurement using different ultrasound probes. METHODS: We prospectively recorded cardiac cycles of four-chamber views of 56 normal fetuses with three different ultrasound probes and analyzed them offline with speckle tracking imaging software. Furthermore, we looked at a possible influence of heartbeat variability (beat-to-beat variability). RESULTS: The evaluation of the parameters was feasible with all three probes in 53 cases. There was no influence of heartbeat variability and no noticeable differences in 2C-DYS, LV-S and RV-S in all cases and for all three probes determined. CONCLUSION: Assessment of strain and dyssynchrony using STE with three different probes is comparable. Further research is needed to validate dyssynchrony as a predictor for fetal outcome.

Computational medical imaging and hemodynamics framework for functional analysis and assessment of cardiovascular structures.

Cardiac dysfunction constitutes common cardiovascular health issues in the society, and has been an investigation topic of strong focus by researchers in the medical imaging community. Diagnostic modalities based on echocardiography, magnetic resonance imaging, chest radiography and computed tomography are common techniques that provide cardiovascular structural information to diagnose heart defects. However, functional information of cardiovascular flow, which can in fact be used to support the diagnosis of many cardiovascular diseases with a myriad of hemodynamics performance indicators, remains unexplored to its full potential. Some of these indicators constitute important cardiac functional parameters affecting the cardiovascular abnormalities. With the advancement of computer technology that facilitates high speed computational fluid dynamics, the realization of a support diagnostic platform of hemodynamics quantification and analysis can be achieved. This article reviews the state-of-the-art medical imaging and high fidelity multi-physics computational analyses that together enable reconstruction of cardiovascular structures and hemodynamic flow patterns within them, such as of the left ventricle (LV) and carotid bifurcations. The combined medical imaging and hemodynamic analysis enables us to study the mechanisms of cardiovascular disease-causing dysfunctions, such as how (1) cardiomyopathy causes left ventricular remodeling and loss of contractility leading to heart failure, and (2) modeling of LV construction and simulation of intra-LV hemodynamics can enable us to determine the optimum procedure of surgical ventriculation to restore its contractility and health This combined medical imaging and hemodynamics framework can potentially extend medical knowledge of cardiovascular defects and associated hemodynamic behavior and their surgical restoration, by means of an integrated medical image diagnostics and hemodynamic performance analysis framework.

[Measurements of Pulmonary Artery Size for Assessment of Pulmonary Hypertension by Cardiovascular Magnetic Resonance and Clinical Application].

BACKGROUND: Pulmonary hypertension (PH) often leads to dilatation of main pulmonary artery (MPA). MPA measurements can be used to predict PH. This aim of this study is to investigate power of MPA vessel indices, which are acquired from cardiovascular magnetic resonance, to evaluate PH. METHODS: Cardiovascular-magnetic-resonance-determined parameters of MPA were acquired and calculated in 83 PH patients, whose diagnosis were confirmed with right heart catheterization and 49 healthy volunteers; these parameters included MPA diameter (DPA), ratio of DPA and ascending aorta diameter (DPA/DAo), max mean diameter (MDmax), min mean diameter (MDmin), fraction transverse diameter (fTD), fraction longitudinal diameter (fLD), and distensibility. RESULTS: Compared with control group, DPA, DPA/DAo, MDmax, and MDmin were significantly higher in patients with PH (P<0.001); fTD, fLD, and distensibility significantly decreased (P<0.001). fTD was lesser than fLD in control group (P<0.001), whereas difference was not observed in PH (P=0.305). MPA indices were significantly correlated with mean pulmonary arterial pressure (mPAP) (P<0.05), and strongest correlation was observed for DPA/DAo (r=0.534, P<0.001). By receiver operating characteristic analysis, MDmin>28.4 mm, and MDmax>32.4 mm (area under the curve, AUC=0.979, 0.981) showed best performance in predicting PH, yielding highest specificity at 100%. CONCLUSIONS: Noninvasive cardiovascular-magnetic-resonance-derived MPA measurements provide excellent and practical reference in clinical settings for detecting PH.

Impact of heavy load activity on cardiovascular system: echocardiographic assessment of informal construction workers heart in Cameroon.

INTRODUCTION: Physiological cardiac hypertrophy and dilation are common findings in heavy physical load activity. We carried out this study to investigate the relationship between construction work and cardiac parameters adaptations, by comparing healthy masons to office workers on heart ultrasound. METHODS: The study was carried out on, 50 construction workers and 50 office workers matched for their weight, height and age. Systolic and Diastolic blood pressures, Left Ventricular diameter and thickness, Septum wall thickness and Left ventricular mass index were measured and calculated. RESULTS: Heart rate, systolic and diastolic blood pressures were lower in construction workers, as compared to office workers: respectively 63±7 bpm vs. 75±6 bpm (p = 0.000); 120.1±7 mmHg vs. 130.5±9 mmHg (p = 0.000) and 68.5±7 mmHg vs. 77.0 ±9 mmHg (p = 0.000). Construction workers had a thicker septum and posterior wall: respectively 10.3 ± 1.1 mm vs. 8.9 ± 0.9 mm (p = 0.000); and 9.0 ± 1.2 mm vs. 8.1 ± 0.8 mm (p = 0.000). CONCLUSION: Conclusion We deducted that heavy load work has an impact on the heart mensuration. The past occupational history has to be taken into consideration during initial medical assessing of a worker in for a new job so as to avoid erroneous conclusions.

Cardiovascular imaging-reflecting on 2006 predictions and new predictions for 2016.

Cardiovascular imaging has advanced at breakneck speed over the past five years. With the steadily improving capability to image the cardiovascular system has come the appreciation that imaging is not an end in itself, but must lead to more effective and appropriate therapy in order to be clinically justified. Current economic challenges are particularly relevant to healthcare and will have major influence on further technical development and clinical application of advanced cardiovascular imaging modalities.

Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates.

Perinatal asphyxia commonly results in multi-organ damage, and cardiovascular dysfunction is a frequent association. Myocardial damage, right ventricular dysfunction, abnormal circulatory transition, and impaired autoregulation may all contribute to postnatal neurological damage. Adequate monitoring and appropriate targeted treatment therefore are essential after an asphyxial insult. Standard methods of cardiovascular monitoring in the neonate have limitations. Point of care ultrasound scanning or functional echocardiography offers extra information to assist the clinician in identifying when there is significant cardiovascular impairment, classifying the underlying abnormal physiology and potentially targeting appropriate therapy, thereby optimizing the post-insult cerebral blood flow and oxygen delivery.

Avaliação prospectiva do sistema cardiovascular em adolescentes jogadores de futebol / Prospective assessment of the cardiovascular system among teenage soccer players

Avaliar o efeito cardiovascular do treinamento físico em adolescentes jogadores de futebol da categoria infantil de um time profissional da cidade de Salvador. Métodos: Estudo prospectivo realizado durante o período de maio de 2004 a outubro de 2005 em 27 atletas do sexo masculino com a idade variando de 13 a 16 anos e um grupo de 11 adolescentes com prática esportiva a nível escolar. O grupo de atletas foi submetido em duas oportunidades e o grupo controle em uma, á avaliação clínica e a exames complementares como o ECG, Teste ergométrico, Ecocardiograma e a Espirometria. Estatística: a diferença entre as médias foi avaliada com o T de Teste Student para amostra pareadas. Resultados: Quando comparadas as duas avaliações funcionais (Anos 2004 a 2005 dos atletas, detectou-se um aumento significativo do V02 (p<0,009). A comparação entre os dois grupos mostrou um V02 superior nos jogadores (p<0,004). a comparação com os dois ecocardiogramas de 2004 e 2005 feitos nos atletas mostrou um aumento nos diâmetros das câmaras cardíacas (p<0,002), como também na massa ventricular (p<0,007). Já as espessuras musculares das paredes do ventrículo esquerdo não mostram uma diferença significativa (p<0,06). a comparação dos achados ecocardiográficos entre os dois grupos não demonstrou diferença em nenhuma das variáveis estudadas (p<0,4). Conclusão: A comparação das duas avaliações dos atletas mostrou um aumento significativo da superfície corporal, do V02, das câmaras cardíacas e massa ventricular. O estudo realizado com esta amostra sugere que o treinamento físico realizado nos atletas de futebol não causa um aumento significativo da massa ventricular ou das câmaras cardíacas quando comparado com outros esportes.

To evaluate the cardiovascular effect of regular physical training in adolescent football players of infantile category of professional teams of Salvador city. Methods: Prospective study carried from May 2004 to October 2005, in 27 men athletes, age ranging from 13 to 16 years, matched to 11 adolescents with exercise training by school level. The athlete group was evaluated twice and the control once clinical evaluation and the complementary examination as ECG, Ergometric Test, Echocardiogram and Spirometry. Statistics: The difference between averages was a significant of V02 (p<0,009). The comparison between group showed higher V02 in athletes (p<0,004). The comparasion of the two echocardiograms (Years 2004, 2005) in athletes showed an increase in the cardiac chambers diameters (p<0,002), as well as in the ventricular mass (p<0,007). Muscular thicknesses of the left ventricle walls did not show difference (p<0,6). The comparison of echocardiographic findings between groups did not demonstrate difference in none of the studied variables (p<0,4). Conclusion: The comparison of the two evaluations of the thçetes showed a significant increase of the corporal surface, V02, cardiac chambers and ventricular mass. the study suggests that physical training in the soccer athletes do not lead to significant of the ventricular mass or cardiac chambers when compared with other sports.