Addressing Diastolic Dysfunction in the Congenital Heart Population.

In heart failure with preserved ejection fraction (HFPEF), physiological abnormalities are not solely restricted to diastolic function. Because the tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) offers the advantage of recording systolic and diastolic tissue velocity simultaneously in the same cardiac cycle, this study aimed to determine whether TDI-MPI is an informative index for assessing HFPEF, compared with conventional echo parameters. In patients with HFPEF, TDI-MPI would be an independent predictor for adverse cardiac events. Among 408 patients who had diastolic dysfunction without heart failure (HF) or HFPEF, cardiac function was evaluated by mitral flow (MF) or TDI-MPI. During the median follow-up of 32 months, clinical outcomes, which were defined as the composite of cardiovascular death and admission for HF, were assessed. Mean MF and TDI-MPI were significantly greater in the HFPEF group. TDI-MPI rather than MF had a significant correlation with N-terminal pro-brain natriuretic peptide level. The area under the receiver operating characteristic curve of TDI-MPI for the detection of HFPEF was 0.86. With regard to clinical outcomes, 31 events were identified during follow-up periods. On a multivariate analysis, TDI-MPI >0.66 was the best prognostic predictor of events and provided incremental predictive value. Compared to MF-MPI, TDI-MPI may be a more useful parameter for the evaluation of patients with HFPEF.

Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization

Long Term Efficacy and Safety of Cardiac Resynchronization Therapy in Adult Congenital Heart Disease Patients: A Single Center Cohort Study.

Impact of Baseline Left Ventricular Diastolic Dysfunction in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

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We sought to compare and assess growth in single ventricle children with a systemic right or left ventricle in five time periods: at birth, before neonatal surgery, before the Glenn anastomosis and finally before and after the Fontan operation to 11 years of age. We reviewed medical records on 116 single ventricle patients operated at Rigshospitalet, Denmark from 1987 to 2007. Surgical procedures, feeding route, hemodynamic variables and anthropometric measurements such as weight and height were registered and converted to z-scores. Ninety four single ventricle patients were included for analysis. Gestational age and birth weight was not significantly different between the left and right ventricle group. Before neonatal surgery and before the Glenn anastomosis, both groups showed equal growth retardation. However, a significant difference in catch-up growth was found before the Fontan operation. Thus, patients in the right ventricle group had a smaller median weight-for-age z-score compared with the left ventricle group in the pre-Fontan period (-1.9 and -1.6; p = 0.049) and in the post-Fontan period (-1.1 and -0.7; p = 0.034). After the Glenn anastomosis single ventricle children with a systemic left ventricle have better weight gain compared with children with a systemic right ventricle.

Left ventricular (LV) diastolic dysfunction and diastolic heart failure (DHF) account for approximately 40–50% of all patients with congestive heart failure (CHF). Diastolic dysfunction can be evaluated directly by invasive cardiac catheterisation techniques or non-invasively by transthoracic echocardiography (TTE) or cardiac magnetic resonance (CMR) imaging. Due to its high spatial and temporal resolution, CMR is the accepted gold standard for evaluating ventricular systolic function. Using the cine-phase contrast technique, CMR can interrogate inflow through the mitral valve and pulmonary veins towards evaluation of diastolic dysfunction and has shown good correlation with TTE. Additionally, CMR can evaluate direct myocardial diastolic parameters that have no echo correlate, such as diastolic torsion rate. As CMR has the ability to characterise a range of diastolic impairments, it will likely become an important diagnostic test in the future, capable of comprehensive LV function evaluation. In this article, we focus on LV diastology, and review CMR methodology and parameters for the diagnosis of diastolic dysfunction.

In Response.

Obesity, a multifaceted metabolic disorder, stands out as a significant risk factor in the development of heart failure with preserved ejection fraction (HFpEF). Its involvement in HFpEF pathogenesis encompasses a complex interplay with adipose tissue, particularly epicardial adipose tissue (EAT), and the effects of sleep-disordered breathing (SDB). Understanding these intricate relationships is pivotal for devising targeted therapeutic approaches to alleviate the burden of HFpEF in individuals with obesity. EAT assumes a central role in linking obesity to HFpEF. As it expands in the context of obesity, EAT contributes to systemic inflammation and insulin resistance, fostering an environment conducive to cardiac remodeling and dysfunction. Furthermore, SDB, prevalent comorbidity in the obese population, emerges as a significant mediator in HFpEF pathogenesis through various mechanisms. The convergence of obesity, EAT expansion, and SDB creates a synergistic effect, heightening the risk of HFpEF development. On the pharmaceutical front, ongoing investigations explore novel strategies targeting inflammation, oxidative stress, and metabolic pathways associated with obesity. These include the potential roles of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, offering innovative therapeutic avenues for managing HFpEF in individuals with obesity. In addition, lifestyle modifications such as weight management and interventions addressing SDB and EAT reduction emerge as promising approaches for preventing and managing HFpEF in the obese population. These interventions hold the potential to mitigate obesity-related cardiac risks and improve HFpEF outcomes.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Evaluation of diastolic dysfunction and repolarization dispersion in Behcet’s disease

BackgroundPatients with hypertrophic cardiomyopathy may develop symptoms of shortness of breathing due to diastolic dysfunction which is not related to the severity of left ventricular outflow tract obstruction. As these patients usually develop a non-ischemic pattern of myocardial fibrosis, this may represent a mechanism for increased myocardial stiffness leading to impaired diastolic filling. The study aimed to determine the prevalence of myocardial fibrosis assessed by magnetic resonance imaging in children with hypertrophic cardiomyopathy and to evaluate its relationship with echocardiographic parameters including left ventricle diastolic dysfunction and to find echocardiographic indices which correlates with myocardial fibrosis as detected by cardiac magnetic resonance. A cross-sectional study was done for data of 50 children with hypertrophic cardiomyopathy from July 2018 to July 2021, patients were divided into (group 1) having myocardial fibrosis and (group 2) with no myocardial fibrosis, and results of echocardiographic parameters were compared between the two groups.ResultsResults showed strong relationship between presence of myocardial fibrosis and each of the following: Interventricular septum thickness, lower lateral and septal early diastolic tissue velocities (E′), E/E′ ratio, presence of left ventricular out flow tract obstruction and the grade of diastolic dysfunction.ConclusionsThe trans-mitral lateral and septal E/E′ (early mitral inflow to early diastolic mitral annular velocity ratio) allows early detection of left ventricular diastolic dysfunction in children with hypertrophic cardiomyopathy. The prevalence of diastolic dysfunction is higher in obstructive hypertrophic cardiomyopathy. The diastolic dysfunction severity is higher in patients with myocardial fibrosis.

The purpose of this review is to summarize recent studies of coronary artery disease (CAD) and diastolic dysfunction. Myocardial ischemia slows ventricular relaxation and can impair ventricular distensibility resulting in diastolic dysfunction apparent as abnormal left ventricular (LV) filling dynamics that can be recognized noninvasively. As such, the development of diastolic dysfunction during stress testing may improve the recognition of CAD. The noninvasive recognition of diastolic dysfunction indicates a poor prognosis in patients with an acute coronary syndrome and chronic CAD. Patients with heart failure with preserved ejection fraction (HFpEF) frequently have CAD, and it may contribute to the heart failure. Myocardial ischemia produces diastolic dysfunction. The evaluation of diastolic dysfunction has diagnostic and prognostic roles in the management of CAD. CAD is a frequent and important comorbidity of HFpEF.

Introduction: Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, carries a 50% mortality rate within 3 years of diagnosis with evidence to support early lifestyle behavioral modification as beneficial. Developing an understanding of markers that identify patients early, promotes early recognition and treatment. Objective: Use of a predictive marker, ventricular elastance, enables early identification of patients at-risk for HFpEF. Methods: Patients previously diagnosed with HFpEF were retrospectively identified. Through case-control and hierarchical linear regression modeling, biomarkers were identified that preceded the onset of HFpEF. Using Cox regression, we conducted a survival analysis to determine time to onset of HFpEF for each biomarker. Using repeated measures logistic regression, continuous variables were tested for interval progression toward disease onset, controlling for co-variates: age, race and sex. Results: Through retrospective analysis, 251 patients and 775 echocardiograms spanning nearly 20 years were identified. Through mixed linear regression, for the entire model, 7 biomarkers were identified as statistically significant and 1 biomarker, ventricular elastance (Ees), progressively increased leading to the time of HFpEF hospitalization. Conclusion: This study provides the methodology for testing a predictive marker, ventricular elastance, that enables early recognition of HFpEF.

AimsThe purpose of this retrospective analysis was to examine the association of left atrial (LA) strain (i.e. LA reservoir function) with left ventricular diastolic dysfunction (DD) in patients with heart failure with reduced and preserved left ventricular ejection fraction (LVEF).Methods and resultsWe analysed the baseline echocardiographic recordings of 300 patients in sinus rhythm from the SOCRATES‐PRESERVED and SOCRATES‐REDUCED studies. LA volume index was normal in 89 (29.7%), of whom 60.6% had an abnormal LA reservoir strain (i.e. ≤23%). In addition, the extent of LA strain impairment was significantly associated with the severity of DD according to the 2016 American Society of Echocardiography recommendations (DD grade I: LA strain 22.2 ± 6.6, rate of abnormal LA strain 62.9%; DD grade II: LA strain 16.6 ± 7.4, rate of abnormal LA strain 88.6%; DD grade III: LA strain 11.1 ± 5.4%, rate of abnormal LA strain 95.7%; all P < 0.01). In line with these findings, LA strain had a good diagnostic performance to determine severe DD [area under the curve 0.83 (95% CI 0.77–0.88), cut‐off 14.1%, sensitivity 80%, specificity 77.8%], which was significantly better than for LA volume index, LA total emptying fraction, and the mitral E/e′ ratio.ConclusionsThe findings of this analysis suggest that LA strain could be a useful parameter in the evaluation of DD in patients with heart failure and sinus rhythm, irrespective of LVEF.