Preoperative assessment of left ventricular diastolic function and right ventricular systolic function have independent and incremental prognostic value in prediction of early postoperative mortality in redo valve surgery.

Assess the acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function stratified by pre-transcatheter pulmonary valve implantation physiology. Transcatheter pulmonary valve implantation is a widely available option to treat residual or recurrent pulmonary stenosis and pulmonary insufficiency. Transcatheter pulmonary valve implantation acutely increases pulmonary artery size and diastolic pressure in patients with pulmonary insufficiency and acute pulmonary edema has been reported after transcatheter pulmonary valve implantation, possibly related to acute left ventricular volume loading. However, the impact of transcatheter pulmonary valve implantation on left ventricular diastolic function has not been established. Patients who underwent transcatheter pulmonary valve implantation from 2010 to 2017 at our centre were grouped by indication for transcatheter pulmonary valve implantation as pulmonary stenosis, pulmonary insufficiency, or mixed disease. Separate analysis was performed on those who underwent transcatheter pulmonary valve implantation for pulmonary stenosis versus pulmonary insufficiency or mixed disease. Intracardiac haemodynamics immediately before and after transcatheter pulmonary valve implantation and echocardiographic assessment of left ventricular systolic and diastolic function at baseline, 1-day post transcatheter pulmonary valve implantation, and 1-year post transcatheter pulmonary valve implantation were compared between groups. In 102 patients who underwent transcatheter pulmonary valve implantation, the indication was pulmonary stenosis in 29 (28%), pulmonary insufficiency in 28 (29%), and mixed disease in 44 (43%). There were no significant differences in left ventricular systolic or diastolic function between groups at baseline, immediately after transcatheter pulmonary valve implantation, or 1-year post implantation. The mean pulmonary artery wedge pressure increased equally across groups. While patients with pulmonary insufficiency likely have acute left ventricular volume loading following transcatheter pulmonary valve implantation, this does not appear to be haemodynamically significant as transcatheter pulmonary valve implantation was not associated with measurable changes in left ventricular systolic or diastolic function acutely or 1-year post implantation.

Assessment of left ventricular systolic and diastolic function by doppler tissue imaging in patients with preinfarction angina

Like all fluids, blood tends to flow from areas of high pressure to low pressure. This seemingly trite observation hides a great deal of sophisticated pathophysiology that we are only beginning to exploit diagnostically and potentially therapeutically. In this issue of Circulation , Yotti and colleagues have exploited a new noninvasive technique to measure the small pressure differences generated within the normal left ventricular outflow tract in systole, demonstrating the utility of such measurements in quantifying ventricular systolic function.1 Because the fluid dynamics concepts behind these methods remain obscure to many cardiologists, it is worth reviewing the theoretical underpinnings in the hope that they will be more widely applied on the basis of articles like those of Yotti et al and others. See p 1771 Cardiologists have become comfortable with the use of the Gorlin equation in the cardiac catheterization laboratory and the simplified Bernoulli equation in the echocardiography laboratory to characterize the severity of valvular stenosis. Both equations are based on the principle of conservation of energy, relating the pressure drop (potential energy) across the valve to the rise in velocity (kinetic energy) as blood rushes through it. Several special circumstances combine to make these simple equations particularly applicable to flow through a restrictive orifice, including lack of a significant friction factor (viscosity) and a lack of pressure recovery as the blood rushes out of the abrupt obstruction. One of the most important simplifications is the absence of a significant “inertial” component to flow through a restrictive orifice. That is, the amount of blood actually moving at high velocity is tiny compared with the volume of the overall column of blood in the left ventricular outflow tract. Thus, very little pressure is expended in getting that small mass moving, and all of the potential energy lost across the …

Apelin--a novel multifunction peptide implicated in regulation of the cardiovascular system, including blood pressure and cardiac function control - has been postulated to be involved in the pathophysiology of hypertension and hypertensive heart disease. We investigated the circulating apelin level and its relationship to left ventricular function in patients with essential hypertension. We enrolled 232 hypertensive patients without concomitant diseases affecting cardiovascular functions and 76 healthy controls. Each patient underwent plasma apelin measurement and echocardiographic assessment of left ventricular systolic and diastolic function using myocardial velocities and deformation parameters, and myocardial reflectivity using calibrated integrated backscatter. Hypertensive patients demonstrated lower plasma apelin than the controls (265 ± 127 vs. 330 ± 159 pg/ml; P<0.001). Patients with the lowest plasma apelin, that is, from the first tertile, exhibited more severe left ventricular systolic and diastolic function abnormalities than their peers from the other two tertiles. In multivariable regression analysis, apelin was, in addition to patient age, BMI, blood pressure, left ventricular mass index and calibrated integrated backscatter in the basal septum, an independent correlate of left ventricular systolic function parameters (β=0.18; P<0.001 for strain and β=0.12; P<0.03 for systolic strain rate) and diastolic function parameters (β=0.13; P<0.01 for early diastolic strain rate, β=0.11; P<0.04 for early diastolic myocardial velocity, and β=-0.11; P<0.04 for the ratio of mitral inflow to mitral annular early diastolic velocity). In patients with essential hypertension, circulating apelin levels are reduced, and lower plasma apelin is independently associated with more profound left ventricular systolic and diastolic function impairment.

Comprehensive and precise assessment of left ventricular (LV) systolic and diastolic function is necessary to establish, or exclude, heart failure as a cause or component of dyspnea. Echocardiography with Doppler readily assesses LV diastolic function; advantages include that echocardiography is non-invasive, does not require radiation, is portable, rapid, readily available, and in competent hands, can provide an accurate and comprehensive assessment of LV systolic and diastolic function. Correct assessment of LV diastolic function is relevant in patients with both depressed and preserved LV ejection fraction (EF ≥ 50%, and < 50%, respectively). Tissue Doppler (TD) imaging has been useful in demonstrating impaired LV relaxation in the setting of preserved LVEF, which, in the setting of increased cardiac volume, can result in elevated LV filling pressures, and dyspnea due to diastolic heart failure. TD imaging is not always critical in patients with depressed LVEF, since such patients by definition have impaired LV relaxation, and thus significant increases in volume will result in increases in LV filling pressure due to impaired LV compliance. Thus, in depressed LVEF, transmitral flow velocities (E and A, and E/A) and deceleration time, pulmonary venous Doppler, left atrial volume, and pulmonary artery (PA) pressures suffice for the accurate assessment of LV filling pressures. Overall, diastolic assessment by echo-Doppler can be readily achieved in by using a comprehensive diastolic assessment—incorporating many 2-dimensional, conventional and tissue Doppler variables—as opposed to relying on any single, diastolic parameter, which can lead to errors.

An increased incidence of myocardial infarction (MI) has recently emerged as the cause of cardiovascular morbidity and mortality worldwide. In this study, cardiac function was investigated in a rat myocardial ischemia/reperfusion (I/R) model using echocardiography. Metformin administration significantly increased ejection fraction and fractional shortening values on Days 3 and 7 when MI occurred, indicating that metformin improved left ventricular systolic function. In the Sham + MET and MI + MET groups, the E’ value was significantly different up to Day 3 but not at Day 7. This may mean that left ventricular diastolic function was effectively restored to some extent by Day 7 when metformin was administered. These results suggest that diastolic dysfunction, assessed by echocardiography, does not recover in the early phase of ischemic reperfusion injury in the rat myocardial I/R model. However, administering metformin resulted in recovery in the early phase of ischemic reperfusion injury in this model. Further gene expression profiling of left ventricle tissues revealed that the metformin-treated group had notably attenuated immune and inflammatory profiles. To sum up, a rat myocardial I/R injury model and ultrasound-based assessment of left ventricular systolic and diastolic function can be used in translational research and for the development of new heart failure-related drugs, in addition to evaluating the potential of metformin to improve left ventricular (LV) diastolic function.

OBJECTIVEThe influence of diabetes on cardiac resynchronization therapy (CRT) remains unclear. The aims of the current study were to 1) assess the changes in left ventricular (LV) systolic and diastolic function and 2) evaluate long-term prognosis in CRT recipients with diabetes.RESEARCH DESIGN AND METHODSA total of 710 CRT recipients (171 with diabetes) were included from an ongoing registry. Echocardiographic evaluation, including LV systolic and diastolic function assessment, was performed at baseline and 6-month follow-up. Response to CRT was defined as a reduction of ≥15% in LV end-systolic volume (LVESV) at the 6-month follow-up. During long-term follow-up (median = 38 months), all-cause mortality (primary end point) and cardiac death or heart failure hospitalization (secondary end point) were recorded.RESULTSAt the 6-month follow-up, significant LV reverse remodeling was observed both in diabetic and non-diabetic patients. However, the response to CRT occurred more frequently in non-diabetic patients than in diabetic patients (57 vs. 45%, P < 0.05). Furthermore, a significant improvement in LV diastolic function was observed both in diabetic and non-diabetic patients, but was more pronounced in non-diabetic patients. The determinants of the response to CRT among diabetic patients were LV dyssynchrony, ischemic cardiomyopathy, and insulin use. Both primary and secondary end points were more frequent in diabetic patients (P < 0.001). Particularly, diabetes was independently associated with all-cause mortality together with ischemic cardiomyopathy, renal function, LVESV, LV dyssynchrony, and LV diastolic dysfunction.CONCLUSIONSHeart failure patients with diabetes exhibit significant improvements in LV systolic and diastolic function after CRT, although they are less pronounced than in non-diabetic patients. Diabetes was independently associated with all-cause mortality.

Effect of metoprolol on rest and exercise left ventricular systolic and diastolic function in idiopathic dilated cardiomyopathy

Echocardiographic Doppler Evaluation of Ventricular Function in Children With an Atrial Septal Defect

BackgroundExercise training is effective in improving functional capacity and quality of life in patients with coronary artery disease, but its effects on left ventricular systolic and diastolic function are controversial. Diastolic dysfunction is a major determinant of adverse outcome after myocardial infarction and, contrary to systolic function, no therapy or intervention has proved to significantly improve diastolic function. Data from animal studies and from patients with diastolic heart failure has suggested that exercise training can have a positive effect on diastolic function parameters.This trial aims to evaluate if a structured exercise training program can improve resting left ventricular diastolic and systolic function in patients who have had an acute myocardial infarction.Methods/DesignThis is a phase II, prospective, randomized, open-label, blinded-endpoint trial that will include at least 96 consecutive patients who have had an acute myocardial infarction one month previously. Patients will be randomized (1:1) to an exercise training program or a control group, receiving standard of care. At enrolment, and at the end of the follow-up period, patients will be submitted to an echocardiography (with detailed assessment of diastolic and systolic function using recent consensus guidelines), cardiopulmonary exercise testing, an anthropometric assessment, blood testing, and clinical evaluation. Patients randomized to the intervention group will be submitted to an eight-week outpatient exercise program, combining endurance and resistance training, for three sessions per week. The primary endpoint will be the change in lateral E’ velocity immediately after the eight-week exercise training program. Secondary endpoints will include other echocardiographic parameters of left ventricular diastolic and systolic function, cardiac structure, metabolic and inflammation biomarkers (high-sensitivity C-reactive protein and pro-BNP), functional capacity (peak oxygen consumption and anaerobic threshold) and anthropometric measurements.DiscussionNew strategies that can improve left ventricular diastolic function are clinically needed. This will be the first trial to evaluate, in patients who have had an acute myocardial infarction, the effects of a structured program of exercise training on diastolic and systolic function, assessed by novel echocardiographic parameters.Trial registrationRegistered with ClinicalTrials.gov (reference: NCT02224495) on 21 August 2014.

The aim of this prospective study was to investigate the prediction of all-cause mortality from global longitudinal strain (GLS) in two groups of chronic kidney disease patients (CKD): predialysis and dialysis. In 89 patients undergoing echocardiography, 37.2 % predialysis (16/43) and 58.6 % dialysis patients (27/46) died during the mean follow-up 70.2 ± 35 months. In addition to conventional echocardiographic measurements, GLS was assessed by velocity vector imaging from three standard apical views. Cox proportional hazards regression enter model showed the following variables to predict survival: the only significant predictor of survival in predialysis patients, among the set of conventional echocardiographic parameters was GLS (HR, 0.58; 95 % CI, 0.39-0.87; p = 0.01). In the group of dialysis patients GLS with E/Em ratio remained as significant predictors of survival (HR, 0.72; 95 % CI, 0.56-0.92; p = 0.01, and HR, 1.02; 95 % CI, 1.004-1.04; p = 0.01, respectively). GLS ≥ - 13.2 % had 58.3 % sensitivity and 91.7 % specificity for prediction of mortality in predialysis patients, and GLS ≥ - 12.02 % had 73.3 % sensitivity and 78.9 % specificity for prediction of mortality in dialysis patients. In dialysis group E/Em ratio ˃ 17.02 had 71.4 % sensitivity and 84.2 % specificity for prediction of mortality. Our study demonstrates the incremental value of GLS in prediction of all-cause mortality during a long follow-up period in CKD patients. GLS together with E/Em ratio may be used for the assessment of left ventricular systolic and diastolic function and risk stratification of CKD patients in different stages of renal failure.

Assessment of left ventricular systolic and diastolic function with Doppler echocardiography in hypertensive patients receiving intravenous medroxalol

Left ventricular systolic and diastolic function in pregnant patients with sickle cell disease

The aim of the present study was assessment of the relationship of silent myocardial ischemia with clinical, coronary angiography findings, and left ventricular systolic and diastolic function, and its prognostic significance in patients early after myocardial infarction. One hundred nineteen male patients (mean age 48.2+/-1.2 years) with first Q wave myocardial infarction entered the study. Routine coronary angiography, 24-hour Holter electrocardiographic recordings, and two-dimensional and Doppler echocardiography with assessment of left ventricular systolic and diastolic function were performed in all the patients. Prospective follow-up was done during 1 year. Patients with signs of silent myocardial ischemia early after myocardial infarction had more severe coronary artery disease, pronounced disturbances of left ventricular systolic and diastolic performance, and adverse prognosis than those without ischemia appearance during Holter recordings.

Clinical topic: Nuclear imaging in hypertrophic cardiomyopathy