Detection Of Diastolic Dysfunction Research Articles

Left Ventricular diastolic dysfunction among hypertensive patients.

Objectives: To assess the occurrence of left ventricular diastolic dysfunction among hypertensive patients on echocardiography. Study Design: Cross Sectional study. Setting: South East Hospital and Research Center, Islamabad. Period: August 2021 to January 2022. Material & Methods: By using non probability convenient sampling method technique through pre-structured Performa. We enrolled a two hundred (n=200) patients in our study. Ethical consideration was taken from hospital ethical review board committee. Result: Thirty Six percent respondents were at the age of < 60 years and 64% were at the of > 60 years. Detection of left ventricular diastolic dysfunction shows, 44% had grade I, 40% grade II and 16% grade III. Association of variables towards detection of diastolic dysfunction, Systolic BP, duration of hypertension, EF%, Left ventricular hypertrophy and co-morbidities shows good association towards the detection of diastolic dysfunction at (p-value≤0.01). Conclusion: It is concluded that, Diastolic dysfunction is most common left ventricular functional abnormality in hypertensive patients. Doppler echocardiography is the most important investigational method for the detection of LV diastolic dysfunction. Not only more than 60 years old patients detect left ventricular diastolic dysfunction but less than 60 years old can also develop diastolic dysfunction.

The impact of left atrial strain parameters on systolic and diastolic improvement following TAVI

Abstract Introduction Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and has been shown to improve long term survival. Data on the prognostic value of left atrial (LA) strain following TAVI are scarce. LA strain – a surrogate of LV filling pressure - can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling. Purpose In this multimodality study, we aimed to evaluate the prognostic value of LA function measured before hospital discharge following TAVI and to further elucidate its association with LV and LA reverse remodelling. Methods In this prospective single center study, we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe, symptomatic aortic stenosis (AS) who underwent transthoracic echocardiography immediately after TAVI and 6 months later. LA and LV global longitudinal strain parameters were obtained by speckle tracking echocardiography. CT angiography (CTA) was performed for pre-TAVI planning and repeated at 6 months follow-up. LV mass values were derived from the serial CTA images. We defined LV reverse remodelling as reduction of myocardial mass quantified on CTA and as an improvement of LV global longitudinal strain (GLS). LA reverse remodelling was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV global strain parameters, LA stiffness, systolic and diastolic functional parameters and LV mass based reverse remodelling were analysed using Pearson correlation coefficient and linear regression models. Results The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at follow-up, respectively (p=0.024, p<0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (<20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e', LAVI, all p<0.05). Atrial reverse remodelling based on LAGS change correlated with LVGLS change (p<0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=−0.30). LAGS correlated with the extent of morphological LV remodelling based on LV mass reduction (p=0.002, coeff: 0.36). Elevated LA stiffness at discharge (upper tercile) leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value (1. and 2. tercile): 16.4±10.0 vs 21.9±9.8, p=0.042. Conclusion Patients with reduced LAGS immediately after TAVI showed a larger extent of LV reverse remodelling during follow up. On the other hand, increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function. Funding Acknowledgement Type of funding sources: None.

Presistolik dalga ankilozan spondilitte subklinik sol ventrikül diyastolik disfonksiyonu için bir belirteç olabilir mi?

Purpose: The aim of this study was to evaluate the clinical significance of presystolic wave in the detection of diastolic dysfunction in ankylosing spondylitis patients. Materials and Methods: In this cross-sectional study, 59 patients and 65 healthy controls were included in the study. Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Metrology Index, Maastricht Ankylosing Spondylitis Enthesitis Score and Bath Ankylosing Spondylitis Functional Index was eveluated. The Doppler tissue-imaging and presystolic wave measurements were performed by same cardiologist who was blinded to study details. Results: Presystolic wave was detected in 26.6% of the whole study population; in 37.3% of patients and 16.9% of the control group. When the patient and control groups were divided into two subgroups according to the presence or absence of presystolic wave; myocardial performance index, transmitral E wave velocity, E/A ratio, left ventricular outflow tract velocity and septal e’ wave velocity were statistically significant in subjects with presence presystolic wave in both groups. In the univariate model, high c-reactive protein level, increased BASMI and BASFI scores and elevated myocardial performance index were determined as risk factors for the presence of presystolic wave in ankylosing spondylitis patients. Conclusion: The assessment of presystolic wave on echocardiography examination may provide important information about the left ventricul diastolic function, which has a prognostic impact for ankylosing spondylitis patients.

The presystolic wave was not sufficient for diagnosing subclinical left ventricular diastolic dysfunction in hemodialysis patients

Purpose: In hemodialysis patients, detection of left ventricul diastolic dysfunction as early as possible is critically important. The presystolic wave occurs in the left ventricul outflow tract and it’s associated with left ventricul stiffness and compliance. The aim of this study was to evaluate the clinical significance of presystolic wave in the detection of diastolic dysfunction in hemodialysis patients. Materials and Methods: In this cross-sectional study, eighty hemodialysis patients and 88 healthy controls were included in the study. The laboratory parameters were tested before the dialysis. The conventional B-mode, pulsed doppler parameters, doppler tissue-imaging, and presystolic wave measurements were performed at echocardiography. Results: Presystolic wave was detected in 46.0% of patients and 18.1% of the control group. There was no statistically significant difference between patients in terms of MPI, mitral E and A wave velocity, E/A and e’/a’ ratio, deceleration time, septal a’ and e’ wave velocity, and Sao in either presence or absence of presystolic wave. In the univariate model, higher Eao velocity and septal E/e’ ratio, and reduced duration of hemodialysis were determined as risk factors for the presence of presystolic wave.Conclusion: The assessment of presystolic wave on echocardiography examination may provide important information about the left ventricul diastolic function. But we have demonstrated in this study that presystolic wave is not entirely associated with left ventricul diastolic dysfunction in hemodialysis patients.

Echocardiographic assessment of Diastolic Function in patients with Atrial Fibrillation

Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation.
 Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1st July 2018 to 30th June 2019.
 Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e’(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively.
 Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e’ ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.

Subclinical Diastolic Dysfunction in Diabetic Population

Abstract Introduction. Left ventricular dysfunction is very frequent in asymptomatic diabetic population. Tissue Doppler Imaging (TDI) is a new echocardiographic technique, able to record early changes of left ventricular dysfunction and to identify asymptomatic diabetic patients at high risk of developing heart failure. Aim. To assess the role of TDI in early detection of diastolic dysfunction in asymptomatic diabetic patients. Methods. Cross-sectional study that involved a total number of 48 subjects. The target group consisted of 25 asymptomatic diabetic patients and control group was composed of 23 subjects without diabetes. All subjects underwent echocardiography (conventional 2D and Pulsed-Wave Doppler and contemporary-TDI) to analyze left ventricular function. We compared the results from both echo-techniques and analyzed the relation of echo-cardiographic parameters with risk factors. Results. We found statistically significant difference between TDI and PW Doppler (E/E'vs E/A) in target (Z=−3.17, p<0.001) and control group (Z=−2.4, p<0.003). There was no significant difference in E/A between the groups (Z=0.0, p<1.0). TDI identified significantly lower E' (Z= 2.03, p<0.04) and higher E/E' (Z= −2.12, p<0.03) in target vs control group. LVDD strongly correlated with duration of DM (p<0.00001), age (p<0.00001), female gender (p<0.0001) and obesity indices (BMI, BSA) (p<0.00001, p<0.00001) in both groups. Conclusion. TDI unmasks the presence of subclinical LV dysfunction in asymptomatic diabetic patients and has a valuable prognostic importance.

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment.

There is evidence that rheumatoid arthritis (RA) is associated with higher overall and cardiovascular (CV) morbidity and mortality as compared with general population. Increased prevalence of traditional risk factors and chronic inflammation, that has been recognized as independent CV risk factor, may play an important role in atherosclerosis and subsequently ischemic heart disease development. However, myocardial dysfunction as a result of chronic inflammation and secondarily myocardial fibrosis markedly participates on heart failure development. Proinflammatory cytokines, such as C-reactive protein, tumor necrosis factor alpha (TNFα), interleukins 1 and 6, that are markedly increased in RA, play a role in the acceleration of atherosclerosis as well as myocardial fibrosis development. Several studies documented that increased CV risk was associated with seropositivity, disease activity score, citrullination, and duration of RA. Early detection of heart dysfunction is based on echocardiographic detection of diastolic dysfunction resulting from myocardial inflammation and fibrosis. Some studies showed also higher prevalence of left ventricular systolic dysfunction and increased prevalence of cardiac arrhythmias as compared to non-RA population. There are still controversies on the impact of NT-proBNP in predicting cardiac impairment in RA patients. Some authors consider it to be a sensitive noninvasive predictor of subclinical CV disease in these patients and also a predictor of all-cause mortality independently on traditional CV risk factors. However, the correlation with parameters of cardiac function was confirmed only in a few studies. The impact of biological treatment on progression of atherosclerosis and heart failure is still controversial and seems to be not harmful in young patients with normal left ventricular function. The effect of biologics, especially anti-TNFα drugs, is probably related to the cardiac function before treatment. Larger prospective clinical, echocardiographic, and magnetic resonance studies are needed.

Assessment of diastolic dysfunction in hypertensive patients and its association with left ventricular mass index

Objective: Early detection of diastolic dysfunction in hypertensive patients to reduce complications and improve outcome. Place of Study: East Medical and Cardiology wards of Mayo Hospital Lahore. Study Design: A descriptive cross-sectional study. Patients and Methods: 51 hypertensive patients between 50 - 80 years of either sex enrolled through out patient department of Mayo Hospital Lahore underwent Doppler Echocardigraphy and data was analyzed by using Chi-square and Students `t` tests. Results: The percentage of left ventricular hypertrophy (LVH) was 66.66%. On comparing hypertensive patients with and without LVH, E and A wave velocities, E:A ratio, deceleration time and isovolumic relaxation time were similar. Conclusion: 33.33% of patients had no LVH in the presence of diastolic dysfunction so LVH was not an independent factor associated with abnormal flow patterns in hypertensive patients with normal systolic contractility. Impaired relaxation was the predominant pattern of diastolic dysfunction an d increased further with age.

Atrio-ventricular coupling in patients with transposition of the great arteries after atrial switch by Magnetic Resonance Imaging

Background Diastolic function has been little explored in d-transposition of the great arteries palliated by atrial switch (d-TGA). However, early detection of diastolic dysfunction could be of major clinical interest and could explain clinical status in this population. We aimed: 1/ to characterize diastolic function in d-TGA after atrial switch from velocity encoded cardiac magnetic resonance (CMR) data and 2/ to study associations between diastolic function indices and objective measurements of clinical status evaluated by exercise test. Methods Forty five patients (11 females; mean age 32±4 years) with atrially switched d-TGA and 45 healthy subjects matched for age and sex were prospectively included. CMR examination was performed in both groups, and cardio-pulmonary exercise test was performed within 24 hours in patients. CMR tricuspid, mitral inflow and systemic ventricular outflow tract velocities and flow-rates were analyzed using custom software to estimate diastolic parameters (figure). Pulmonary vein baffle, atrial areas and right atrial strain as [(maximal atrial area - minimal atrial area) / maximal atrial area] were also measured. Results CMR diastolic parameters were significantly different in d-TGA patients as compared to controls. In d-TGA patients, parameters of systemic right ventricular (RV) relaxation were markedly impaired compared to left ventricle of controls, as reflected by a significant increase in deceleration and isovolumic relaxation times (p<0.01). Early trans-tricuspid peak filling-rate (Ef) and RV filling duration were negatively correlated with systemic RV remodeling index (Mass/volume) (r=-0.38 and -0.45, respectively, p<0.01). Systemic RV stroke volume and Ef were significantly associated with baffle size (r=0.35 and r=0.33, p≤0.02, respectively). While peak VO2 was not related to systemic RV volumes, RVEF and to RV Mass, it was significantly associated with systemic ventricle filling indices, such as Ef/filling volume, A wave, filling volume. In multivariate analysis, a significant association was found between RA strain and exercise peak oxygen uptake (r=0.42, p<0.01) in d-TGA patients, while systemic RV ejection fraction was not correlated with exercise performances. Such associations were independent of age, gender and body mass index. Conclusions In d-TGA after atrial switch, systemic RV exposed to systolic dysfunction can be also characterized by an early impairment of diastolic function. Systemic RV diastolic dysfunction is characterized by abnormal RV relaxation that limits cardiac output augmentation. Funding

English

BACKGROUND: Several clinical studies have reported that 30% to 50% of patients with congestive heart failure have preserved left ventricular systolic function and isolated diastolic dysfunction. Detection of diastolic dysfunction is important factor in cardiac evaluation of hypertensives. MATERIAL AND METHODS: retrospective study carried out in Medicine department, SIMS, Shimoga for one year from Jan 2013 to Jan 2014. 50 patients who are hypertensive without any abnormality were studied general and systemic examination done, 2d echocardiography done in which transmitral flow velocity (E/A) and pulmonary venous A duration- mitral A duration (∆d) is measured. RESULT: 32% of subjects were newly diagnosed hypertensives in our study. 56% of cases had normal diastolic function as defined by E/A ratio (>1), 18% of cases in our study with normal E/A ratio were found to have pseudonormal pattern of diastolic function. LVDD of 62% is found in this study. CONCLUSION: The abnormal diastolic function as assessed by abnormal E/A ratio was seen in 44% of cases. Abnormal ∆d was found in 18% of cases out of 56% who had normal E/A ratio. These cases are said to have 'pseudonormal' pattern of diastolic function. The current study demonstrated that the presence of LV diastolic dysfunction in hypertensive patients is actually greater than previously reported by studies that analyzed transmitral flow velocity curves alone. To avoid overlooking patients with diastolic dysfunction, the combined analysis of transmitral and

Tissue Doppler Imaging in the Early Detection of Diastolic Dysfunction in Asymptomatic Diabetic Patients

Tissue Doppler Imaging in the Early Detection of Diastolic Dysfunction in Asymptomatic Diabetic Patients

Association between p-wave and diastolic function

Background: Electrocardiogram (ECG) is a simple tool that may be used to diagnose and staging diastolic dysfunction. The aim of this study was to evaluate the association between P-wave morphology and the severity of diastolic dysfunction. Methods: Transmitral inflow pulsed Doppler and deceleration time were used to categorize the stage of diastolic dysfunction (DD) into stage 0, 1, 2 and 3. P dispersion (PD) was the difference between the maximum of P-wave duration and minimum of P-wave duration in any leads. Results: The study consists of 729 patients. DD was found in 707 patients (97%); 606 had stage I, 101 had stage II, and none had stage III DD. PD was 48.80±5.31 in patients with DD and 44.82±5.44 in the stage 0 group (P=0.001). When patients were grouped according to the stage of DD, PD was 44.82±5.44 in stage 0, 47.96±4.61 in stage 1, 53.84±6.34 in stage 2 (P = <0.0001). Receiver operating characteristic (ROC) curve showed PD ≤ 37 ms was 100% sensitive for normal diastolic function, while PD ≥ 57 ms has 100% specific for DD. Conclusion: P wave dispersion was associated with the severity of diastolic dysfunction and may be used as a simple tool for detection of diastolic dysfunction.

Early and simple detection of diastolic dysfunction during weaning from mechanical ventilation.

Weaning from mechanical ventilation imposes additional work on the cardiovascular system and can provoke or unmask left ventricular diastolic dysfunction with consecutive pulmonary edema or systolic dysfunction with inadequate increase of cardiac output and unsuccessful weaning. Echocardiography, which is increasingly used for hemodynamic assessment of critically ill patients, allows differentiation between systolic and diastolic failure. For various reasons, transthoracic echocardiographic assessment was limited to patients with good echo visibility and to those with sinus rhythm without excessive tachycardia. In these patients, often selected after unsuccessful weaning, echocardiographic findings were predictive for weaning failure of cardiac origin. In some studies, patients with various degrees of systolic dysfunction were included, making evaluation of the diastolic dysfunction to the weaning failure even more difficult. The recent study by Moschietto and coworkers included unselected patients and used very simple diastolic variables for assessment of diastolic function. They also included patients with atrial fibrillation and repeated echocardiographic examination only 10 minutes after starting a spontaneous breathing trial. The main finding was that weaning failure was not associated with systolic dysfunction but with diastolic dysfunction. By measuring simple and robust parameters for detection of diastolic dysfunction, the study was able to predict weaning failure in patients with sinus rhythm and atrial fibrillation as early as 10 minutes after beginning a spontaneous breathing trial. Further studies are necessary to determine whether appropriate treatment tailored according to the echocardiographic findings will result in successful weaning.

DIASTOLIC FUNCTION IN ARTERIAL HYPERTENSION: IMPACT OF DIFFERENT ECHOCARDIOGRAPHIC CRITERIA ON DIAGNOSIS: PP.22.371

Aim: To evaluate the sensitivity of different echocardiographic parameteres in order to estimate diastolic dysfunction prevalence in arterial hypertension. Methods: We studied 308 essential hypertensives (mean age ± standard deviation 49.8 ± 11 years; SBP/DBP 140.4 ± 15/84.9 ± 10 mmHg). Every subject underwent clinical evaluation, echocardiography with ultrasound systems (ATL 5000) equipped with multiple frequency phased array transducers (2 to 4 MHz) to study left ventricular morphology and function. Transmitralic Doppler (Dopp mitr), Doppler of pulmonary veins (PVarD, Adur) flow, tissue Doppler of mitral annulus (E’ sep, E’ lat) and left atrial volume (LAV ind) were acquired for each patient. Results: Transmitralic Doppler alone (Figure 1), allows the detection of diastolic dysfunction in 34% of hypertensives. When this parameter was combined with Tissue Doppler, Pulmonary veins Doppler and LAV ind, about 40% of subjects previously classified as normal, resulted affected by diastolic dysfunction (p < 0.001). Left atrial volume, indexed for body surface area, appears to be the most sensitive criteria. Conclusion: Prevalence of diastolic dysfunction changes according to limits and criteria used for its detection. Systematic use of recent parameters (e.g. atrial volume or TDI) represents a sensitive tool to identify diastolic dysfunction in hypertensive patients.

Masked diastolic dysfunction caused by exercise testing in hypertensive heart failure patients with normal ejection fraction and normal or mildly increased LV mass

Introduction — It is not clear whether in patients with the clinical suspicion of heart failure with normal ejection fraction (HFNEF) exercise assessment of diastolic function may help to unmask abnormalities not detected by resting measurements.Methods and results — A combined radionuclide angiographic and haemodynamic exercise study was performed to confirm definite diastolic dysfunction in hypertensive patients with exertional dyspnoea and no other detectable cause of their symptoms. Only patients with normal baseline left ventricular (LV) systolic and diastolic function parameters as evaluated by routine cardiac catheterization and transmitral Doppler echocardiography were accepted (n = 38).All parameters were compared to a control group (n = 10).Twenty-eight patients showed an abnormal elevation in pulmonary capillary wedge pressure with exercise.As a consequence of a reduced exercise stroke volume (58 ± 13 vs. 70 ± 12 ml/m2; P = 0.01) peak cardiac output was reduced in HFNEF (9.3 ± 1.7 vs. 7.6 ± 2.0 l/min/m2; P = 0.02).These changes were equally demonstrable in patients with and without ventricular hypertrophy. LV end-systolic wall stress (ESWS) was increased at rest and during exercise in HFNEF patients without hypertrophy. However, a positive relationship between ESWS and the corresponding exercise stroke volume (r = 0.57; P = 0.002) was observed in the entire HFNEF group.Conclusion — Detection of diastolic dysfunction in suspected HFNEF is not only a question of the diagnostic methods used, but of the conditions under which the patients are investigated.

276 Arterial stiffness and diastolic dysfunction in patients with systemic sclerosis

s S33 Eur J Echocardiography Abstracts Supplement, December 2006 276 Arterial stiffness and diastolic dysfunction in patients with systemic sclerosis J. Bozo 1 ; R. Faludi 1 ; G. Kumanovics 1 ; L. Czirjak 1 ; A. Cziraki 1 ; T. Simor 1 ; L. Papp 1 1Univ. Pecs, Heart Institute, Faculty of Med., Pecs, Hungary Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impaired relaxation of the left ventricle is also characteristic for scleroderma heart disease. The aim of our study was to determine whether parameters of arterial stiffness correlate with echocardiographic indices of left ventricular relaxation impairment. Material: 21 patients with limited and diffuse scleroderma (18 women, mean age: 55±9 years) were studied. Methods: Parameters of local and systemic arterial stiffness (pulse wave velocity: PWV; augmentation index: Aix) were determined by automatic brachial pulse wave analysis (Arteriograph®). The same parameters and elastic modulus (Ep), stiffness index (s), arterial compliance (AC) were measured on left brachial and common carotid arteries by echo-tracking (Aloka ProSound 5500). Indices of diastolic function were also determined with the same ultrasound system: in addition to the conventional Doppler parameters of the transmitral flow early (E) and late (A) diastolic velocities, deceleration time (DT), isovolumic relaxation time (IVRT) myocardial early (Ea) and late (Aa) diastolic velocities were measured at the lateral border of the mitral annulus using tissue Doppler imaging. E/A and E/Ea ratios were calculated. Simple associations between the variables were estimated by Pearson’s method. Results: Carotid Ep showed significant correlations with both A (r=0.537, p<0.05) and E/A (r=-0.500, p<0.05) values, and correlated with IVRT also significantly (r=0.489, p<0.05). Carotid s correlated with A (r=0.479, p<0.05), E/A (r=-0.548, p<0.05) and IVRT (r=0.564, p<0.01). Carotid AC correlated with A (r=-0.512, p<0.05), E/A (r=0.551, p<0.05) and IVRT values (r=-0.436, p<0.05). Carotid PWV and Aix showed similarly significant correlations with A, E/A, IVRT and with A and E/A values, respectively. Ep, s and PWV determined by pulse-wave analysis and brachial artery echo-tracking did not correlate with the echocardiographic parameters of the left ventricular diastolic function. Brachial AC showed a significant correlation with A (r=-0.478, p<0.05) and DT (r=0.469, p<0.05). Significant correlation was found between Aix measured by pulse-wave analysis and Aa (r=0.560, p<0.05). Conclusion: Distensibility of elastic arteries correlates well with the echocardiographic indices of the left ventricular diastolic function, but stiffness of muscular type arteries is less useful to predict the degree of diastolic impairment. Selected parameters of arterial stiffness are good predictors of diastolic dysfunction in scleroderma patients ±. 277 Tissue Doppler analysis of regional myocardial dysfunction in patients with systemic sclerosis M. Hirata 1 ; A. Takagi 2 ; K. Shimamoto 3 ; S. Ihara 1 ; H. Watanabe 1 ; K. Mizuochi 1 ; M. Endou 1 ; M. Kawana 3 1Institute of Geriatrics, TWMU, Cardiology Dept., Tokyo, Japan; 2Tokyo Women’s Medical University Hospital, Cardiology Dept., Tokyo, Japan; 3TWMU Aoyama Hospital, Cardiology Dept., Tokyo, Japan Purpose: Systemic sclerosis (SSc) is a multi-system disorder characterized by connective tissue fibrosis resulting in poor cardiac prognosis. Tissue Doppler imaging (TDI) might be useful in early detection of regional myocardial dysfunction. The aim of this study is to estimate the early myocardial dysfunction in SSc patients by using TDI. Methods: Twenty patients with SSc without obvious wall motion abnormalities were compared to 25 age-matched control subjects. E/A ratio and deceleration time (DCT) of trnasmitral inflow were recorded. Peak systolic strain (A) and diastolic strain at the first 30% of diastolic duration (B) were measured on strain curve at midventricular septum. Strain diastolic index was calculated as (A-B)/A×100(%). Results: There was no difference between the two groups in E/A, DCT and peak systolic strain. In contrast, strain diastolic index in SSc was significantly lower than those of control (p<0.01) (Table 1). Conclusion: TDI derived strain diastolic index appeared to be useful in early detection of diastolic dysfunction in patients with SSc.

Detection of Diastolic Dysfunction Using Color Kinesis in the Absence of Systolic Dysfunction: Experimental and Clinical Studies

Detection of Diastolic Dysfunction Using Color Kinesis in the Absence of Systolic Dysfunction: Experimental and Clinical Studies

HEART RATE RECOVERY FOLLOWING PEAK EXERCISE IS ASSOCIATED WITH RESTING DIASTOLIC DYSFUNCTION IN HIV+ SUBJECTS

Objectives The objective was to examine the relationship between heart rate recovery (HRR) (peak HR-HR at each minute post-exercise) and diastolic function in HIV+ subjects (HIV+) and HIV-negative controls (Cntl). Methods HIV+ (n=20, 40 ± 7 yrs) and Cntl subjects (n=10, 41 ± 10 yrs) underwent maximal exercise testing on a cycle ergometer with oxygen consumption and EKG monitoring. Resting 2D and Doppler echocardiography was performed on a separate day. Results Although no significant differences between groups, peak HR and peakVO2 was significantly associated with 3, 4, and 5min HRR, and were used as covariates for comparison between groups. HRR at 3min(HIV+= 50.7 ± 3 vs. Cntl= 64.2 ± 4 bpm, p<0.007), 4min(HIV+= 56.5 ± 2 vs. Cntl=68.9 ± 4, p<0.01) and 5min (HIV+= 61.9 ± 3 vs. Cntl= 72.0 ± 4, p<0.06) was significantly lower in HIV+ than Cntl. HRR at 3min was associated with septal em (r=0.37, p<0.05), left ventricular mass index (LVMI)(r=-0.42, p<0.03), and fasting glucose (r=-0.37, p<0.04). HRR at 4min was associated with LVMI (r=-0.32, p<0.009), fasting glucose (r=-0.43, p<0.02) and serum triglycerides (TG)(r=-0.39, p<0.04). HRR at 5min was associated with septal em (r=0.40, p<0.03), SBP (r=0.35, p<0.07), fasting glucose (r=0.40, p<0.03) and serum TG (r=0.50, p<0.007). HRR at 6- and 7min were also associated with septal em (r=0.46, p<0.001 and r=-0.42, p<0.03, respectively). Conclusion Lower HRR following maximal exercise may predict diastolic dysfunction in HIV+ subjects and may be a useful screening tool in the detection of diastolic dysfunction in HIV+. Supported by the NIH.

Detection of diastolic dysfunction: acoustic quantification (AQ) in comparison to Doppler echocardiography.

To evaluate the potential of acoustic quantification (AQ) in detection of diastolic dysfunction in comparison to Doppler analysis, we investigated, as a model of restrictive filling pattern, nonrejecting heart transplant recipients early postoperatively. AQ, an ultrasonic backscatter imaging system, enables instantaneous calculation of cavity areas and thus provides a new approach to diastolic function. Of 27 pts who have undergone heart transplantation, echocardiography has been performed at the day of biopsy. During a time course of 8 weeks echocardiographic data have been analysed at 3 different time points (early, mid and late) in 16 nonrejecting pts. Indexes of the area-change waveform and its 1. derivative (dA/dt) obtained by AQ were opposed to usual Doppler indexes. In comparing data of the early and late time point of investigation, significant changes of early diastolic filling were detectable by AQ as well as by Doppler: End-diastolic areas have increased (p < 0.001), while peak filling rate (p < 0.0001), slope of area change during rapid filling (p < 0.001) and amount of relative area change during rapid filling (p < 0.001) have decreased. Complementary, Doppler derived pressure half-time (p < 0.0001) and isovolumic relaxation time (p < 0.0001) have increased while the peak early filling velocity (p < 0.0001) and its time velocity integral (p < 0.001) have decreased. An initial restrictive filling pattern has improved 8 weeks postoperatively. Since multiple indexes, obtained from the area change waveforms, in particular the for end-diastolic area normalized peak filling rate, seem to be highly sensitive in detecting changes of diastolic function, AQ may play an important complementary role in non-invasive evaluation of restrictive filling pattern.