George G.S. Sandor

A stress echocardiography study of cardiac function during progressive exercise in pediatric oncology patients treated with anthracyclines

Anthracycline‐treated patients (AP) are at risk for cardiac dysfunction years after treatment. Cardiac function has not been evaluated during exercise in AP. The purpose of this study was to assess exercise tolerance, left ventricular (LV) function, and hemodynamics during progressive exercise.

left Ventricular Systolic and Diastolic Function After Total Correction of Tetralogy of Fallot

Left ventricular (LV) systolic and diastolic function was assessed in 12 patients after total correction of tetralogy of Fallot (age range 5 to 18 years, mean 10) and compared with 10 control patients. Only 1 patient had a shunt before total correction that was performed at a mean age of 3.5 years, (range 0.3 to 8). At cardiac catheterization the following indexed LV parameters were measured: end-diastolic and end-systolic volumes, wall mass, ejection fraction, stroke volume and end-diastolic and end-systolic pressures and stresses. The rate-corrected mean velocity of fiber shortening was calculated. LV diastolic operant chamber stiffness and myocardial stiffness were calculated from simultaneous diastolic pressures and volumes in mid- and late diastole using monoexponential formulas. The 2 groups were compared by unpaired t tests. The tetralogy group had higher mean end-diastolic (93 vs 74 ml/m2), end-systolic (29 vs 19 ml/m2) and stroke (64 vs 55 ml/m2) volumes than controls. Rate-corrected mean velocity of fiber shortening was lower in the tetralogy group (1.07 vs 1.24). Myocardial stiffness was higher in the tetralogy group (16 vs 11). Other indexes were not significantly different. Thus, LV function after total correction of tetralogy of Fallot may be abnormal with larger than normal LV size, decreased contractile function and increased myocardial stiffness.

ECHO-DOPPLER ASSESSMENT OF AORTIC STIFFNESS IN ADOLESCENT FEMALES WITH ANOREXIA NERVOSA

BACKGROUND: Anorexia nervosa (AN) is associated with cardiovascular complications and abnormalities of biomarkers associated with cardiovascular risk. Arterial stiffness, which is a risk factor for cardiovascular disease, has not been previously studied in patients with AN. This study aimed to determine the biophysical properties of the aorta in adolescent females with AN as compared to control subjects usingDoppler echocardiography. METHODS: This was a retrospective case-control study. Aortic diameter and pulse wave transit time were measured with echoDoppler. Blood pressure was recorded at the time of the echocardiogram. Pulse wave velocity (PWV), aortic input impedance (Zi), characteristic impedance (Zc), arterial pressure-strain elastic modulus (Ep), and arterial wall stiffness index (b-index) were calculated. Patients were divided into those with BMI or > 10th percentile to assess the effect of patient malnutrition on the biophysical properties of the aorta. RESULTS: There were 94 adolescent females with AN and 60 adolescent female controls. There was no difference in age between AN patients and controls (15.5 1.7 vs 15.1 2.6 years, p1⁄40.220). BMI (16.0 2.4vs 19.7 2.7, p 10th percentile. Using multiple linear regression, the only independent predictor of PWV was the presence of AN. CONCLUSION: The increased PWV, which is the most sensitive indicator of vascular dysfunction, indicates increased aortic stiffness in adolescent females with AN compared to controls. Increased PWV was not related to the degree of patient malnutrition. Our study suggests that patients with AN may be at increased risk of future cardiovascular disease. Further studies are required to determine if these changes persist with treatment and to determine long term outcomes.