Determinant Of Diastolic Dysfunction Research Articles

Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction.

To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain. Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode. During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample. Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

Utility of left atrial strain imaging for the determination of diastolic dysfunction in patients with STEMI

Abstract Introduction Since echocardiographic parameters indicating increased left ventricular filling pressure were validated in patients with stable coronary artery disease and patients with acute coronary syndrome were excluded, the utility of these parameters in ACS patients is not clarified. Recent studies suggest that left atrial strain imaging is a reliable method for the assessment of left ventricular diastolic dysfunction. Purpose In this study, we aimed to investigate the clinical utility of left atrial strain imaging for the detection of increased LVFP. Methods We prospectively included patients diagnosed with ST-segment elevation myocardial infarction who were treated with primary percutaneous intervention (pPCI). Left ventricular end-diastolic pressure was measured following the procedure. Comprehensive echocardiographic evaluation was performed within 24 hours of pPCI. Patients with atrial fibrillation and severe valvular heart disease were excluded. Normal LV end-diastolic pressure was accepted as <18 mmHg. Results 76 patients were enrolled. Patients were divided into two groups according to LVEDP value. Group 1 patients included patients with normal LVEDP (42 patients) and the rest of the patients included into group 2 (27 patients). Comorbidities including hypertension (p: 0.408), diabetes (p: 0.696) and dyslipidaemia (p: 0.336) were similar between groups. Anterior myocardial infarction was more prevalent in group 2 patients (p: 0.012). Troponin and pro-BNP values were significantly higher in group 2 patients (p: 0.001 and p: 0.03 respectively). Left ventricular ejection fraction and left ventricular global strain values were significantly lower in group 2 patients (p: 0.048 and p: 0.025 respectively). Table 1 represents the comparison of strain values between groups. Left atrial reservoir strain rates were lower in group 2 patients (p: 0.09). Correlation analyses revealed that there is a statistically significant relationship between left atrial strain values and LVEDP (p: 0.003 and r: 0.238). Conclusion In conclusion, our study has demonstrated that left atrial strain imaging is a useful non-invasive method for the assessment of increased LVEDP in patients with STEMI. Funding Acknowledgement Type of funding sources: None. Echocardiographic variables

Prevalence and determinants of systolic and diastolic cardiac dysfunction and heart failure in acute ischemic stroke patients: The SICFAIL study.

AimsIschaemic stroke (IS) might induce alterations of cardiac function. Prospective data on frequency of cardiac dysfunction and heart failure (HF) after IS are lacking. We assessed prevalence and determinants of diastolic dysfunction (DD), systolic dysfunction (SD), and HF in patients with acute IS.Methods and resultsThe Stroke‐Induced Cardiac FAILure in mice and men (SICFAIL) study is a prospective, hospital‐based cohort study. Patients with IS underwent a comprehensive assessment of cardiac function in the acute phase (median 4 days after IS) including clinical examination, standardized transthoracic echocardiography by expert sonographers, and determination of blood‐based biomarkers. Information on demographics, lifestyle, risk factors, symptoms suggestive of HF, and medical history was collected by a standardized personal interview. Applying current guidelines, cardiac dysfunction was classified based on echocardiographic criteria into SD (left ventricular ejection fraction < 52% in men or <54% in women) and DD (≥3 signs of DD in patients without SD). Clinically overt HF was classified into HF with reduced, mid‐range, or preserved ejection fraction. Between January 2014 and February 2017, 696 IS patients were enrolled. Of them, patients with sufficient echocardiographic data on SD were included in the analyses {n = 644 patients [median age 71 years (interquartile range 60–78), 61.5% male]}. In these patients, full assessment of DD was feasible in 549 patients without SD (94%). Prevalence of cardiac dysfunction and HF was as follows: SD 9.6% [95% confidence interval (CI) 7.6–12.2%]; DD in patients without SD 23.3% (95% CI 20.0–27.0%); and clinically overt HF 5.4% (95% CI 3.9–7.5%) with subcategories of HF with preserved ejection fraction 4.35%, HF with mid‐range ejection fraction 0.31%, and HF with reduced ejection fraction 0.78%. In multivariable analysis, SD and fulfilment of HF criteria were associated with history of coronary heart disease [SD: odds ratio (OR) 3.87, 95% CI 1.93–7.75, P = 0.0001; HF: OR 2.29, 95% CI 1.04–5.05, P = 0.0406] and high‐sensitive troponin T at baseline (SD: OR 1.78, 95% CI 1.31–2.42, P = 0.0003; HF: OR 1.66, 95% CI 1.17–2.33, P = 0.004); DD was associated with older age (OR 1.08, 95% CI 1.05–1.11, P < 0.0001) and treated hypertension vs. no hypertension (OR 2.84, 95% CI 1.23–6.54, P = 0.0405).ConclusionsA substantial proportion of the study population exhibited subclinical and clinical cardiac dysfunction. SICFAIL provides reliable data on prevalence and determinants of SD, DD, and clinically overt HF in patients with acute IS according to current guidelines, enabling further clarification of its aetiological and prognostic role.

New expectations for diastolic function assessment in TTE based on a semi-automated computing of strain-volume loops

Abstract Background Early diagnosis of heart failure with preserved ejection fraction (HFpEF) by determination of diastolic dysfunction is challenging. Strain-volume loop (SVL) is a new tool to analyze left ventricular function. Purpose We propose a new semi-automated method to calculate SVL area and explore the added value of this index for diastolic function assessment. Methods 50 patients (25 amyloidosis, 25 HFpEF) were included in the study and compared with 25 healthy control subjects. All patients underwent standard echocardiography. SVL area were also assessed. Results Left ventricular ejection fraction was preserved and similar between groups. Classical indices of diastolic function were pathological in HFpEF and amyloidosis groups with greater left atrial volume index, greater mitral average E/e' ratio, faster tricuspid regurgitation (p&amp;lt;0.0001 compared with controls). SVL analysis demonstrated a significant difference of the global area between groups, with the smaller area in amyloidosis group, the greater in controls and a mid-range value in HFpEF group (37 vs 120 vs 72 ml.%, respectively, p&amp;lt;0.0001) (Table 1). Applying a Linear Discriminant Analysis (LDA) classifier, results show a mean area under the curve (AUC) of 0.89 for the comparison between HFpEF and amyloidosis groups (Figure 1). Conclusion Strain-volume loops area is efficient to identify patients with a diastolic dysfunction. This new semi-automated tool is very promising for future development of automated diagnosis with machine-learning algorithms. Figure 1 Funding Acknowledgement Type of funding source: None

New expectations for diastolic function assessment in transthoracic echocardiography based on a semi-automated computing of strain-volume loops.

Early diagnosis of heart failure with preserved ejection fraction (HFpEF) by determination of diastolic dysfunction is challenging. Strain-volume loop (SVL) is a new tool to analyse left ventricular function. We propose a new semi-automated method to calculate SVL area and explore the added value of this index for diastolic function assessment. Fifty patients (25 amyloidosis, 25 HFpEF) were included in the study and compared with 25 healthy control subjects. Left ventricular ejection fraction was preserved and similar between groups. Classical indices of diastolic function were pathological in HFpEF and amyloidosis groups with greater left atrial volume index, greater mitral average E/e' ratio, faster tricuspid regurgitation (P < 0.0001 compared with controls). SVL analysis demonstrated a significant difference of the global area between groups, with the smaller area in amyloidosis group, the greater in controls and a mid-range value in HFpEF group (37 vs. 120 vs. 72 mL.%, respectively, P < 0.0001). Applying a linear discriminant analysis (LDA) classifier, results show a mean area under the curve of 0.91 for the comparison between HFpEF and amyloidosis groups. SVLs area is efficient to identify patients with a diastolic dysfunction. This new semi-automated tool is very promising for future development of automated diagnosis with machine-learning algorithms.

Determinants of Diastolic Dysfunction in Swine with HFpEF Arising From Transient Repetitive Left Ventricular Pressure Overload

ObjectiveWe recently demonstrated that swine subjected to 2‐weeks of repetitive pressure overload (RPO) exhibit adaptive myocardial remodeling in the absence of left ventricular (LV) hypertrophy. This remodeling is similar to that arising in many patients with heart failure and a preserved ejection fraction (HFpEF). While LV compliance is markedly reduced, the relative contribution of altered myocardial relaxation vs. passive myocardial properties to this is unclear. Accordingly, the objective of the present study was to determine how RPO affects passive myocardial stiffness and active myocardial relaxation, two key components of LV diastolic function.MethodsSwine (n=14) were subjected to 2‐weeks of RPO via daily infusions of phenylephrine (300 ug/min, 2 hours/day). Invasive measurements of LV performance were collected before and after RPO at rest and during alterations in loading conditions elicited by transient manipulation of venous return. To assess reversibility, a subset of animals (n=6) underwent repeat studies 2‐weeks after cessation of RPO. After the final study, myocardial tissue was collected from the LV free wall for post‐mortem assessment of calcium handling protein expression (western blot; n=8), passive myocardial stiffness (uniaxial tensile testing; n=3), and quantification of interstitial fibrosis (picrosirius red staining).ResultsCompared with baseline measurements, 2‐weeks of RPO did not significantly affect the LV relaxation time constant (Tau) or the rate of LV pressure change during isovolumic relaxation (dP/dtmin; Table ). Consistent with this observation, myocardial expression of calcium handling proteins SERCA (from 0.58±0.24 to 0.52±0.25, p=0.62), ryanodine receptor (from 0.37±0.17 to 0.36±0.14, p=0.99), and phospholamban (from 0.46±0.21 to 0.33±0.15, p=0.17) was not different following RPO vs. normal controls (n=8). However, assessment of LV performance under altered loading conditions revealed a significant increase in the LV stiffness coefficient (β) during IVC occlusion as well as the ΔEDP/ΔEDV ratio during rapid saline loading. These functional changes persisted for 2‐weeks following cessation of RPO and were accompanied by a significant increase in passive myocardial stiffness and interstitial fibrosis.ConclusionsThese results demonstrate that the reduction in LV compliance arising after RPO is not related to delayed active myocardial relaxation at rest or altered expression of sarcoplasmic reticulum calcium handling proteins. However, RPO elicits a persistent increase in passive myocardial stiffness that is likely mediated by interstitial collagen deposition. These passive diastolic properties may explain exercise intolerance in HFpEF patients despite normal resting hemodynamics and the absence of anatomic LV hypertrophy.Support or Funding InformationFunding Sources: The National Heart Lung and Blood Institute (HL‐061610), the American Heart Association (17SDG33660200), the National Center for Advancing Translational Sciences (UL1TR001412), the Department of Veterans Affairs (1IO1BX002659), the Community Foundation for Greater Buffalo, and the Albert and Elizabeth Rekate Fund in Cardiovascular Medicine. Baseline/Control RPO Cessation of RPO Tau (ms) 36.5 ± 1.6 35.9 ± 1.6 34.3 ± 1.7 dP/dtmin (mmHg/s) −2116 ± 369 −2301 ± 133 −2464 ± 272 Diastolic Stiffness Coefficient (β) 0.025 ± 0.003 0.054 ± 0.007 * 0.043 ± 0.009 * ΔEDP/ΔEDV During Saline Loading (mmHg/mL) 0.09 ± 0.02 0.21 ± 0.04 * 0.23 ± 0.03 * Ex Vivo Passive Stiffness (kPa) 77.8 ± 11.0 ‐‐‐ 131.0 ± 6.1 * Interstitial Fibrosis (%) 6.6 ± 0.7 12.9 ± 1.8 * 16.3 ± 1.1 * Values are mean ± SEM. *p&lt;0.05 vs. Baseline/Control

P6498What are the determinants of diastolic dysfunction after reperfused STEMI?

P6498What are the determinants of diastolic dysfunction after reperfused STEMI?

Left ventricular diastolic function in patients with obstructive sleep apnoea syndrome and obesity

Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of complete or partial obstruction of the upper airways during sleep and results in sleep fragmentation, night hypoxemia, and daytime sleepiness. The aim of this study was to investigate the state of left ventricular diastolic function in patients with first diagnosed COAS and obesity and to define the determinants of diastolic dysfunction in this category of patients. There were 46 patients (33 men and 13 women) with OSAS and obesity and 52 patients with obesity without OSAS enrolled in the study. The control group included 22 practically healthy individuals. Each patient underwent assessment of body mass index (BMI), 24-hour ambulatory blood pressure monitoring, cardiorespiratory monitoring, transthoracic echocardiography. We found that patients with OSAS and obesity had significant impairment of diastolic function in comparison with patients with obesity without OSAS, which manifested itself in decreasing of E/A ratio, increasing deceleration time and increasing isovolumic relaxation time. Increasing body mass index and increasing level of hypoxia lead to impairment of diastolic dysfunction. Diastolic dysfunction was diagnosed in 4 obese patients without OSAS and in 17 patients with OSAS and obesity. All patients with diastolic dysfunction had second or third stage obesity and severe OSAS. Left ventricular hypertrophy was diagnosed in 9 patients with OSAS and obesity. Patients with concentric hypertrophy had significantly lower E/A in comparison with patients without hypertrophy or with concentric remodeling. We found that the deceleration time has positive correlation with body mass index and desaturation index and negative correlation with min SaO2. Isovolumic relaxation time correlated only with desaturation index. According to the results of univariable regression analysis, five variables were allocated: body mass index, age, desaturation index, index apnea-hypopnea and left ventricular mass index. The multivariate analyses, after adjustment for age and sex and stepwise regression, showed that only the desaturation index was an independent predictor of left ventricular diastolic dysfunction in patients with OSAS and obesity. Obstructive sleep apnea syndrome combined with obesity leads to a deterioration of the diastolic function of the left ventricle even in patients without cardio-vascular diseases. The state of the diastolic function of the left ventricule worsens with an increase in the severity of hypoxic disorders in the syndrome of obstructive sleep apnea and with the degree of obesity. In multivariate regression analysis, the desaturation index was a predictor of left ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome and obesity.

Abstract 18996: Impact of Infarct Size on Left Ventricular Diastolic Function Following Acute Myocardial Infarction

Introduction: Severe left ventricular diastolic dysfunction is associated with worse prognosis after acute myocardial infarction (MI). Twenty percent of patients have a restrictive filling pattern (RFP) following MI, and this is associated with a fourfold increase in mortality. The determinants of diastolic function in this setting are not well defined. Aim: We sought to determine the correlation between enzymatic infarct size and RFP in patients with a first ever MI. We hypothesized that a larger infarct size would result in greater impairment of left ventricular diastolic function. Methods: Data analysis was performed on consecutive patients admitted with first ever non-ST elevation MI (NSTEMI) or ST-elevation MI (STEMI) to a single large tertiary referral hospital from January 2013 to December 2014. All patients underwent coronary angiography during the index admission. Infarct size was determined by peak troponin I. Doppler transmitral flow pattern was obtained from the initial transthoracic echocardiogram performed within 48 hours of admission. RFP was defined as: E/A ratio &gt;2.0 and/or E-wave deceleration time &lt;160ms (American Society of Echocardiography Guidelines 2009). Results: Data were available on 645 consecutive patients who underwent coronary angiography for MI. We excluded 160 patients with a previous MI. Of the remaining 485 patients (mean age 62±13 years; mean left ventricular ejection fraction (LVEF) 53±12%), there were 338 NSTEMIs (70%) and 147 STEMIs (30%). PCI was performed in 360 (74%) patients (single vessel (82%), ≥2 vessels (18%)); coronary artery bypass surgery in 58 (13%); and medical management in 67 (13%). Sixty-nine patients (14.4%) had RFP; 52% of these had a LVEF ≥45%. Peak troponin I levels were higher in the RFP group (31.8±30.9μg/L vs 16.8±25.2μg/L, p=&lt;0.001). On multivariate analysis, infarct size by peak troponin I (OR 1.02, 95%CI 1.00-1.03, p=0.026) and low LVEF (OR 0.95, 95%CI 0.91-0.99, p=0.015) were the only independent predictors of RFP. Conclusion: Infarct size was a major determinant of diastolic dysfunction following first ever MI. Whilst LV systolic dysfunction was strongly associated with impaired diastolic function, 52% of patients with severe diastolic dysfunction had relatively preserved LVEF.

Quantification of diastolic dysfunction via the age dependence of diastolic function — Impact of insulin resistance with and without type 2 diabetes

BackgroundThe alarming prevalence of heart failure with preserved ejection fraction requires quantification of diastolic dysfunction (DDF). Myocardial diastolic velocity E′ implies that age is the most important determinant. We tested the hypothesis that age allows for quantification of DDF and assessment of the structural and metabolic determinants in patients with and without type 2 diabetes (D). MethodsThis prospective, cross-sectional study assessed cardiovascular, metabolic and ultrasound data in 409 consecutive patients (Diabetes Center, Bogenhausen-Munich) between 20 and 90years without known cardiac disease and either with (n=204) or without D but with common prevalence of cardiovascular risk factors, including a subgroup of healthy individuals (H, n=94). ResultsIn H, E′ related to age as: E′norm=−0.163∗years+19.69 (R2=0.77, p<0.0001). According to this 1% reduction by annual physiologic aging, DDF was quantitated as E′−E′ norm. Compared to nondiabetics, D patients were older, had greater BMI, lower E′, more cardiovascular risk and greater DDF. In nondiabetics, grading of DDF by E−E′norm correlated with grading by filling pressure E/E′. Determinants of DDF by multivariate analysis included pulse wave velocity, diastolic blood pressure and the triglyceride/HDL ratio (a marker of insulin resistance) in nondiabetics and in D the same risk factors in reverse sequence and heart rate. Neither left atrial size nor left ventricular mass had significant impact. ConclusionsThe physiological impact of age on myocardial function consists of a 1% annual reduction in E′ and enables precise quantification of diastolic dysfunction thereby unmasking the importance of metabolic risk for DDF.

Clinical and echocardiographic determinants of diastolic dysfunction among Nigerian hypertensive subjects

Background: Diastolic dysfunction can occur either as an early marker or in late stages of hypertensive heart disease. Knowledge about its determinants is crucial to its management. Reports about clinical and echocardiographic determinants of diastolic dysfunction among Nigerian hypertensive subjects are few. This study aimed at describing the main clinical and echocardiographic determinants of diastolic dysfunction among Nigerian hypertensive subjects. Methods: Two hundred and forty-five hypertensive subjects and 68 age and sex-matched normotensives that had echocardiography were used for this study. Diastolic function was assessed by a combination using the ratio of early and late mitral flow velocity E/A ratio, isovolumic relaxation time (IVRT) and deceleration time (DT). Statistical analysis was carried out with the SPSS 16.0. Correlation and stepwise regression analysis were used for univariate and multivariate analysis respectively. Results: Mean age of the hypertensive subjects was similar with that of the controls (56.8±12.2 vs. 55.0±7.9 respectively, P>0.05). Diastolic dysfunction was commoner among hypertensive subjects than controls. Age, systolic and diastolic blood pressure (BP), and left ventricular chamber dimensions generally showed the greatest correlation with indices of diastolic function among the study population. Using the multivariate analysis, age was the strongest determinant of DT and IVRT followed by left ventricular chamber dimension for DT and systolic BP for IVRT. Left ventricular internal chamber dimension was the strongest determinant of mitral E/A ratio followed by diastolic BP. Conclusion: Age, systolic BP, and left ventricular volume and dimension are the major determinants of the diastolic dysfunction among hypertensive Nigerians. They affect different aspect of the diastolic parameters.

Echocardiographic evaluation of left ventricular function in normotansive obese children: A comparative analysis according to body mass index

The purpose of our study was to determine structural and functional changes on left ventricular function (LV) according to body mass index (BMI) in normotansive overweight and obese children. Thirty normotansive overweight children (group 2; mean age: 13.2 ± 2.1 years, BMI: 25-30 kg/m²), 30 obese children (group 3; mean age: 13.3 ± 2.0 years, BMI ≥ 30 kg/m²), and 50 healthy controls (mean age: 13.2 ± 1.8 years, BMI: 18-24.9 kg/m²) were included in this study. Continuous ambulatory pressure was monitored in the obese group, while standard and pulsed wave (PW) Doppler echocardiographic examinations were evaluated in all three study groups. In overweight and obese children, left atrial volume, left atrial/aortic root diameter ratio, LV interventricular septum, LV posterior wall thickness, LV end-diastolic diameter and volume, and LV mass were significantly higher than those children in the control group (p<0.01). Blood pressure was within the normal range but was increased in the obese groups. Transmitral E/A and pulmonary vein (PV) systolic/diastolic velocity (S/D) ratios were decreased, but E-wave deceleration time, PVA velocities, and the end-diastolic distance from the mitral annulus to the LV apex were increased in both obese groups (p<0.05). BMI was significantly correlated with duration of obesity and LV mass (r=0.527, r=0.506, p<0.01, respectively). Significantly negative correlations were found between BMI, Mitral E/A, and PV S/D ratio (r=-0.230, r=-0.577, p<0.01, respectively). Subclinical LV myocardial dysfunction was noted in obese subgroups. Determination of diastolic dysfunction by PV PW Doppler can be useful a pre-obese period.

Left Ventricular Diastolic Dysfunction in Dialysis Patients Assessed by Novel Speckle Tracking Strain Rate Analysis: Prevalence and Determinants

Background. Diastolic dysfunction is common among dialysis patients and is associated with increased morbidity and mortality. Novel echocardiographic speckle tracking strain analysis permits accurate assessment of left ventricular diastolic function, independent of loading conditions and taking all myocardial segments into account. The aim of the study was to evaluate the prevalence of diastolic dysfunction in chronic dialysis patients using this novel technique, and to identify its determinants among clinical and echocardiographic variables. Methods. Patients currently enrolled in the ICD2 study protocol were included for this analysis. Next to conventional echo measurements diastolic function was also assessed by global diastolic strain rate during isovolumic relaxation (SRIVR). Results. A total of 77 patients were included (age 67 ± 8 years, 74% male). When defined as E/SRIVR ≥236, the prevalence of diastolic dysfunction was higher compared to more conventional measurements (48% versus 39%). Left ventricular mass (OR 1.02, 95% CI 1.00–1.04, P = 0.014) and pulse wave velocity (OR 1.34, 95% CI 1.07–1.68, P = 0.01) were independent determinants of diastolic dysfunction. Conclusion. Diastolic dysfunction is highly prevalent among dialysis patients and might be underestimated using conventional measurements. Left ventricular mass and pulse wave velocity were the only determinants of diastolic dysfunction in these patients.

Abstract 18131: Increased Cardiomyocyte Stiffness in Cardio-Renal Disease

Cardio-renal disease has been associated with diastolic rather than systolic cardiac dysfunction. As diastolic dysfunction cannot be attributed to adverse remodelling, the present study investigated if intrinsic cardiomyocyte stiffness is a determinant of diastolic dysfunction in cardio-renal disease. Thereto, cardiomyocyte function was studied in rats with cardio-renal disease, which was induced by myocardial infarction in rats with chronic renal dysfunction (Munich Wistar Fromter; RD+CD). This group was compared to rats with solely cardiac disease (CD; age-matched Wistar rats), solely renal disease (RD) and healthy rats (Ctrl). Twelve weeks after surgery force was measured in left ventricular Triton-permeabilized cardiomyocytes at different calcium concentrations to assess myofilament function. Maximal force did not differ among groups. In contrast, myocardial infarction significantly increased passive force (CD vs Ctrl; figure), which was even more pronounced in rats with renal dysfunction (RD+CD vs RD; figure). No change in myofilament Ca 2+ -sensitivity was observed in the CD group, whereas Ca 2+ -sensitivity of force was significantly reduced in RD+CD compared to Ctrl. The changes in passive force and Ca 2+ -sensitivity could not be corrected by protein kinase A, which mimics beta-adrenergic stimulation. In contrast, a 2-times increase in expression and activity of protein kinase C (PKC) alpha was found in RD+CD myocardium (Figure). In conclusion, diastolic dysfunction in cardio-renal disease may be partly attributed to increased intrinsic cardiomyocyte stiffness, rather than to adverse remodelling. The increase in cardiomyocyte stiffness may result from increase PKCalpha-mediated phosphorylation of titin, and could represent a target for treatment of diastolic dysfunction in cardio-renal disease.

Pulse Pressure Widening is a Determinant of Diastolic Dysfunction

Background: Widened pulse pressure, a marker for increased vascular stiffness, is associated with adverse cardiovascular outcomes. Since diastolic dysfunction may also relate to vascular stiffness and may portend a poor prognosis, our aim was to determine the association between pulse pressure and diastolic dysfunction in patients with preserved LVEF. Methods: 150 consecutive patients with and 300 consecutive controls without diastolic dysfunction and LVEF $50% were studied. We excluded patients with severe valve abnormalities and incomplete documentation. Severity of diastolic dysfunction was graded 1-3 (abnormal relaxation, pseudonormal, restrictive). We compared pulse pressure (at time of echo) in patients with and without diastolic dysfunction and adjusted for baseline covariates before and after propensity score matching. We analyzed the data before and after excluding patients with mild diastolic dysfunction to determine the association in the absence of borderline dysfunction. Results: Data from 269 controls were compared to 130 patients with diastolic dysfunction. Of those, 74 (57%) had abnormal relaxation, 45 (35%) had pseudonormal and 11 (8%) had restrictive patterns. Pulse pressure was wider in patients with diastolic dysfunction compared to controls (74 6 24 vs. 65 6 18, p!.0001). After adjustment for baseline covariates this association was not statistically significant. In 63 propensity-matched patient pairs, diastolic dysfunction was associated with a numerically greater but statistically non-significant difference in pulse pressure (74 6 24 vs. 70 6 18 mmHg, p50.26). After excluding patients with mild (grade 1) diastolic dysfunction, pulse pressure was wider in those with diastolic dysfunction (79 6 23 vs. 65 6 19 mmHg, p!.0001), and remained statistically significant after multivariate adjustment. The odds ratio comparing 25 vs. 75 percentile of pulse pressure for presence of diastolic dysfunction was 1.57 (95% CI 1.01-2.43). Other predictors of diastolic dysfunction that remained significant after multivariable adjustment were older age, LVH, hypertension, and low GFR. Conclusion: Patients with more severe diastolic dysfunction have a wider pulse pressure compared to controls. These results are consistent with the hypothesis that increased vascular stiffness contributes to both a widened pulse pressure and diastolic dysfunction, and may help to explain the increased risk in these patients. We speculate that pulse pressure may be a modifiable risk factor to improve diastolic dysfunction and long term outcomes.

Determination of diastolic dysfunction by conventional and Doppler tissue echocardiography in dogs

The aim of this study was to explore the feasibility and the diagnostic value of conventional Doppler parameters of transmitral inflows and Doppler tissue echocardiography parameters of septal annulus motion for the assessment of diastolic dysfunction in dogs with cardiac failure. The LV diastolic mitral flow patterns were divided into normal diastolic flow pattern (group 1), delayed relaxation pattern (group 2), pseudonormal flow pattern (group 3), and restrictive pattern (group 4). In our study population, 17 patients had normal mitral inflow variables (E/A ratio > 1 and Dt < 109 m). The other 7 patients were classified as having abnormal mitral inflow pattern (E' > 8 cm/s, E'/A' > 1). In conclusion, the combination of Doppler tissue echocardiography of the mitral septal annulus and mitral inflow patterns by conventional Doppler indices provides better estimates of diastolic dysfunction in dogs.

Determinants of Diastolic Dysfunction: A Geometric Matter?

Determinants of Diastolic Dysfunction: A Geometric Matter?

152 A prevalence and determinants of diastolic dysfunction in a general population

152 A prevalence and determinants of diastolic dysfunction in a general population