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Emerging Clinical and Mechanistic Support for CBD Treatment of Autism Spectrum Disorder
Published in Betty Wedman-St Louis, Cannabis as Medicine, 2019
Kaylee Martig, Keelee Reid, Joshua S. Kaplan
An elevated E/I ratio could reflect increased excitatory signaling by the neurotransmitter, glutamate, or reduced inhibitory signaling by the neurotransmitter, GABA. Reduced GABAergic signaling is a common neurological substrate of the ASD brain6 that may reflect various genetic or environmental etiologies and is a marker that predicts symptom severity.7 Impairments to GABAergic signaling may result from factors that perturb the development of neural circuits,8 reduce the excitability of GABAergic neurons,9–11 or impair modulatory neurochemical systems, such as the endocannabinoid system.12 As discussed in the following section, the resulting elevation in the E/I ratio can drive ASD symptoms and represents a targetable mechanism for pharmacological intervention.
Cardiac Damage from Left Ventricular Hypertrophy to Heart Failure
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Enrico Agabiti Rosei, Maria Lorenza Muiesan, Cesare Cuspidi
The analysis of myocardial velocities at the mitral annulus may reveal an increase in left ventricular filling pressure; in respect to Doppler transmitral flow velocities, DTI velocities show no ‘pseudonormalisation’ pattern (91,92). The average value of DTI velocities at the septal and lateral sides of the mitral annulus should be used for the assessment of global LV diastolic function. The E/e′ ratio represents a reliable estimate of LV filling pressures, and different cutoff values have been proposed for the definition of normal or progressively higher LV filling pressure. E/e′ ratio >13 indicates a severe increase in LV filling pressure. In the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) echocardiographic sub-study, E/e′ ratio was the strongest predictor of first cardiac events, independent of LVM and geometry (93). The combination of transmitral flow velocities, mitral annulus DTI velocities and LA volume should be used for diastolic dysfunction diagnosis and stratification (92). The grading suggested by the EAE/ASE recommendations is an important predictor of all-cause mortality, as shown in the Olmsted County Epidemiological Study (Figure 29.2).
Cardiomyopathies in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
John Arthur McClung, Srihari S. Naidu, Wilbert S. Aronow
The classic echocardiographic presentation of amyloid heart disease includes LVH with characteristic sparkling of the myocardium (65). Mitral inflow velocities in patients with diastolic dysfunction vary depending on the extent of the disease. E/A ratios in the elderly customarily become less than one in most normal individuals. The first sign of diastolic dysfunction is often pseudonormalization of the Doppler spectral display in which the E/A ratio once again becomes greater than one associated with increasing prominence of the diastolic filling velocity in the pulmonary vein (66,67). Active restrictive physiology results in a very steep, high-velocity mitral E wave with a short deceleration time, followed by a very small or absent A wave (31). B-natriuretic peptide assay has been used to enhance the diagnosis of diastolic dysfunction in patients who present with normal systolic function on echocardiography (68).
Meta-analysis examining phosphodiesterase-5 inhibitors in heart failure with preserved ejection fraction
Published in Baylor University Medical Center Proceedings, 2022
Govinda Adhikari, Nischit Baral, Rohit Rauniyar, Gary Tse, Sandip Karki, Basel Abdelazeem, Kirolos Gergis, Pramod Savarapu, Sakiru Isa, Parul Sud, Arvind Kunadi
Mitral annular E/e′ ratio is an estimator of left ventricular filling pressure, an important parameter for assessing left ventricular diastolic dysfunction. A mitral E/e′ ratio >12 suggests elevated left ventricular filling pressure. E/e′ ratio has prognostic significance and has been used to predict all-cause mortality and cardiovascular death in heart failure.18 PDE-5i decreased the E/e′ ratio in patients with heart failure with reduced ejection fraction compared to placebo but with no improvement in heart failure with preserved ejection fraction.8 This study included three randomized controlled trials in the heart failure group. Our meta-analysis of four trials showed a nonsignificant reduction in mitral E/e′ ratio compared to control. Although the data for mitral E/e′ ratio postintervention was not available in the study by Anderson et al, there was no significant reduction in left ventricular filling pressure estimated by pulmonary capillary wedge pressure or improvement in diastolic dysfunction measured by echocardiogram.12
Association between fragmented QRS and left ventricular dysfunction in acromegaly patients
Published in Acta Cardiologica, 2020
Seçkin Dereli, Hatice Özer, Nurtaç Özer, Adil Bayramoğlu, Ahmet Kaya
All echocardiographic examinations were performed by two cardiologists who were blinded to the clinical data of study population. Echocardiographic images were obtained using a 3.75 MHz standard probe (GE, Vivid S5) in reference to the guidelines of the American Society of Echocardiography [10]. Early (E) and late (A) peak velocity, deceleration time (DT) and IVRT values were calculated from the Doppler scan of mitral inflow and aortic outflow. Then the E/A ratio was calculated. MPI was introduced by Tei and is defined as the sum of isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT) divided by the ejection time (ET) [11]. Pulse wave was performed using the TDI function of the same device. Through the apical four chamber view, the early diastolic (E') and late diastolic velocity (A') were measured on the septal side of the mitral annulus.
Comparison of questionnaire and accelerometer-based assessments of physical activity in patients with heart failure with preserved ejection fraction: clinical and prognostic implications
Published in Scandinavian Cardiovascular Journal, 2020
Cristine Schmidt, Mário Santos, Lucimere Bohn, Bruno Miguel Delgado, Daniel Moreira-Gonçalves, Adelino Leite-Moreira, José Oliveira
Echocardiography evaluation: Supine transthoracic echocardiography was performed using a cardiovascular ultrasound Vivid E95® (GE Healthcare, Chicago, IL). All quantitative echocardiographic measurements were performed by a single reader blinded to the results of the other evaluations, using a computerized off-line analysis station. Peak early diastolic tissue velocity was measured at the septal and lateral mitral annulus. Mitral inflow velocity was assessed by pulsed wave Doppler from the apical four-chamber view, positioning the sample volume at the tip of the mitral leaflets. E/e′ ratio was calculated as E wave divided by e′ velocities. LV mass was estimated from LV linear dimensions and indexed to body surface area as recommended by ESC guidelines [24]. LV volumes were estimated by the modified Simpson method using the apical four- and two-chamber views, and LVEF was derived from volumes in the standard manner. LA volume was estimated by the method of disks using apical four- and two-chamber views at an end-systolic frame preceding mitral valve opening and was indexed to body surface area (calculated according to Mosteller's formula) to derive LA volume index.