Diastolic Dysfunction In Subjects Research Articles

Global molecular calcium score: is there a link between sodium fluoride uptake and cardiovascular risk burden?

Abstract Background Sodium fluoride (18F-NaF) uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification both in atherosclerotic plaques and the aortic valve. Purpose We aimed to evaluate global cardiac microcalcification activity with 18F-NaF, as a measure of the microcalcification burden, in high cardiovascular (CV) risk patients. Additionally, as an exploratory endpoint, we evaluated the association between global cardiac microcalcification and diastolic dysfunction. Methods High CV-risk individuals without previous CV events from a single centre were prospectively scanned with 18F-NaF PET-CT. Total cardiac 18F-NaF uptake was measured as global molecular calcium score (GMCS), which was calculated by summing the product of mean standardized uptake value and volume of the region of interest on every slice within the borders of the heart. The result was then divided by the number of slices to adjust for the volume. Results We included sixty-five patients with a mean age of 64.0 ± 9.0 years and 38.5% females. There was a high rate of CV risk factors, including hypertension (95.4%), diabetes (84.6%), dyslipidemia (78.5%), obesity (58.5%), smoking (26.2%) chronic kidney disease (18.5%), and family history of premature coronary disease (9.2%). The mean 10-year risk of fatal and nonfatal cardiovascular events predicted by ASCVD risk score was 30.54 ± 18.4. Median GMCS was 221.42 [IQR 144.55-317.58]. Individuals with > 5 CV risk factors (46.2%) had increased overall GMCS compared to those with a lower number of CV risk factors (295.29, IQR 159.37-356.87 vs 186.16, IQR 122.57-281.78; p=0.03). Thirty-three patients underwent diastolic dysfunction evaluation by echocardiography. All patients had normal left ventricle ejection fraction, mean of 62.86 ± 3.58%. Mean E/A was 0.88 ± 0.27, mean septal e’ velocity 0.07 ± 0.02 m/s, mean lateral e’ velocity 0.08 ± 0.02 m/s, and mean average E/e’ 10.7 ± 3.3. The mean peak tricuspid regurgitation velocity was 2.14 ± 0.59 m/s and the median indexed left atrium volume was 37, IQR 29-44mL/m2. After applying the algorithm for diagnosis of diastolic dysfunction in subjects with normal ejection fraction, 21.2% had diastolic dysfunction and 36.4% had a normal diastolic function, while 42.4% were indeterminate. There was no correlation between echocardiographic variables of diastolic function and GMCS, except for indexed left atrium volume (r = 0.83, p<0.01). There was no association between GMCS and diastolic function categories. Conclusions In a high CV risk cohort, the global cardiac microcalcification assessed by GMCS was associated with the burden of CV risk factors. Additionally, despite a strong positive correlation between GMCS and indexed left atrium volume, we found no association between GMCS and echocardiographic variables of diastolic function.

The Additional Diagnostic Value of Electrocardiogram and Strain Patterns in Transplanted Patients

Background: Transplanted patients are frail individuals who may be affected by diastolic dysfunction, leading to a decrease in exercise tolerance. Previous studies have reported that certain ECG and echocardiographic parameters (such as the P-wave interval, PQ interval, P-wave dispersion, Tend-P interval, QTc interval, and strain) can support the diagnosis of diastolic dysfunction when the ejection fraction is preserved. This study aimed to examine the potential diagnostic contribution of specific ECG and deformation parameters in transplanted recipients, who are at a high risk of heart failure. Materials and Methods: A group of 33 transplanted subjects (17 renal and 16 liver) were categorized using two scores for heart failure with preserved ejection fraction (HFpEF). Additionally, they underwent evaluation based on ECG parameters (P-wave interval, PQ interval, Pwave dispersion, and Tend-P QTc) and echocardiographic deformation parameters (strain and twist). The Student’s t-test was used for statistical analysis. Results: The two scores identified different numbers of excludable and not excludable subjects potentially affected by HFpEF. The not excludable group presented ECG parameters with significantly higher values (P-wave, PQ interval, posterior wall diastole, and Tend-P, all with p ≤ 0.05) and significantly lower 4D strain and twist values (p < 0.05) Conclusions: There is evidence for a significant diagnostic contribution of additional ECG and echo strain parameters in an early phase of diastolic dysfunction in subjects potentially affected by HFpEF.

Haemodynamic effects of hypertension and type 2 diabetes: Insights from a 4D flow MRI-based personalized cardiovascular mathematical model.

Type 2 diabetes (T2D) and hypertension increase the risk of cardiovascular diseases mediated by whole-body changes to metabolism, cardiovascular structure and haemodynamics. The haemodynamic changes related to hypertension and T2D are complex and subject-specific, however, and not fully understood. We aimed to investigate the haemodynamic mechanisms in T2D and hypertension by comparing the haemodynamics between healthy controls and subjects with T2D, hypertension, or both. For all subjects, we combined 4D flow magnetic resonance imaging data, brachial blood pressure and a cardiovascular mathematical model to create a comprehensive subject-specific analysis of central haemodynamics. When comparing the subject-specific haemodynamic parameters between the four groups, the predominant haemodynamic difference is impaired left ventricular relaxation in subjects with both T2D and hypertension compared to subjects with only T2D, only hypertension and controls. The impaired relaxation indicates that, in this cohort, the long-term changes in haemodynamic load of co-existing T2D and hypertension cause diastolic dysfunction demonstrable at rest, whereas either disease on its own does not. However, through subject-specific predictions of impaired relaxation, we show that altered relaxation alone is not enough to explain the subject-specific and group-related differences; instead, a combination of parameters is affected in T2D and hypertension. These results confirm previous studies that reported more adverse effects from the combination of T2D and hypertension compared to either disease on its own. Furthermore, this shows the potential of personalized cardiovascular models in providing haemodynamic mechanistic insights and subject-specific predictions that could aid in the understanding and treatment planning of patients with T2D and hypertension. KEY POINTS: The combination of 4D flow magnetic resonance imaging data and a cardiovascular mathematical model allows for a comprehensive analysis of subject-specific haemodynamic parameters that otherwise cannot be derived non-invasively. Using this combination, we show that diastolic dysfunction in subjects with both type 2 diabetes (T2D) and hypertension is the main group-level difference between controls, subjects with T2D, subjects with hypertension, and subjects with both T2D and hypertension. These results suggest that, in this relatively healthy population, the additional load of both hypertension and T2D affects the haemodynamic function of the left ventricle, whereas each disease on its own is not enough to cause significant effects under resting conditions. Finally, using the subject-specific model, we show that the haemodynamic effects of diastolic dysfunction alone are not sufficient to explain all the observed haemodynamic differences. Instead, additional subject-specific variations in cardiac and vascular function combine to explain the complex haemodynamics of subjects affected by hypertension and/or T2D.

Association of Glycosylated Haemoglobin (HbA1c) Level With Left Ventricular Diastolic Dysfunction in Patients With Type 2 Diabetes.

Background Some literature has shown a high prevalence of pre-clinical diastolic dysfunction in subjects with type 2 diabetes mellitus. The current study was carried out to determine the association of glycosylated hemoglobin (HbA1c) levels with left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes. Methods An observational cross-sectional study was conducted in a tertiary health care center in Jharkhand.A total of 100 subjects diagnosed with type 2 diabetes mellitus who gave informed consent and fulfilled the inclusion and exclusion criteria were studied in our center from April 2019 to September 2020. Logistic regression was carried out to determine the association of potential variables with outcomes. Multivariable logistic regression analysis was conducted to determine the independent effects of variables for LVDD prediction. Results The mean HbA1c of the population with LVDD was found to be higher (11.07 ± 3.66%) as compared to the population with normal LVDD (9.11 ± 2.95%), which was found statistically significant (probability value (P) =0.004). This signifies that a higher level of HbA1c in a patient with diabetes will have a higher incidence of LVDD. On applying multivariate analysis to determine the independent effect of variables for LVDD, HbA1C was found to be significant with an odds ratio (OR) of 1.26, 95% CI 1.08-1.48. The duration of diabetes was also found to be significant with OR 1.48 and CI 95 % (1.20-1.82) P <0.001. On plotting the receiver operating characteristic curve (ROC), the area under the ROC curve to predict the left ventricular function with the model was 0.8137. Conclusions Patients who have higher HbA1C are linked to a higher risk of left ventricular diastolic dysfunction in patients with type 2 diabetes. The combination of diabetes and left ventricular dysfunction can lead to increase morbidity and mortality in those patients in whom it is not identified timely and appropriate measures are not taken.Our work emphasizes the requirement of screening intermittently symptomless diabetic patients for diastolic dysfunction through a Doppler echocardiography so that timely action can be taken.

Independent Association of Fatty Liver Index With Left Ventricular Diastolic Dysfunction in Subjects Without Medication

Nonalcoholic fatty liver disease has been reported to be potentially linked to cardiovascular disease. Fatty liver index (FLI) is a noninvasive and simple predictor of nonalcoholic fatty liver disease. However, little is known about the relationship between FLI and cardiac function, especially in a general population. We investigated the relationships of FLI with echocardiographic parameters in 185 subjects (men/women: 79/106) of the Tanno-Sobetsu Study, a population-based cohort, who were not being treated with any medication and who underwent echocardiography. FLI was negatively correlated with high-density lipoprotein cholesterol and peak myocardial velocity during early diastole (e'; r= -0.342, p <0.001), an index of left ventricular (LV) diastolic function, and ratio of peak mitral velocities during early and late diastole (E/A) and was positively correlated with age, systolic and diastolic blood pressures, creatinine, uric acid, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, ratio of mitral to myocardial early diastolic peak velocity (E/e'), left atrial volume index and LV mass index. No significant correlation was found between FLI and LV ejection fraction. Stepwise multivariable regression analysis showed that FLI was independently and negatively associated with e' after adjustment of age, gender, high-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance, and high-sensitivity C-reactive protein. Conversely, e' was independently and negatively associated with FLI after adjustment of age, gender, systolic blood pressure, and LV ejection fraction. In conclusion, elevated FLI is independently associated with LV diastolic dysfunction in a general population without medication. FLI would be a novel marker of LV diastolic dysfunction as an early sign of myocardial injury.

Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction

AimLeft ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population.Methods and resultsFrom the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD.ConclusionThe prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

Right ventricular function among South East Nigeria children with sickle cell anaemia

BackgroundSickle cell anaemia (SCA) is characterized by attendant ischemia-reperfusion injury especially to the heart.MethodsThe aim of this work is to compare the right ventricular function of children with SCA in steady state (subjects) with those with haemoglobin AA genotype (controls), using echocardiography. It is a cross-sectional study, which echocardiographic measurements to assess right ventricular function among children with SCA and their controls.ResultsThe mean trans annular plane systolic excursion (TAPSE) in subjects, 28.24 ± 5.23 (Z score: 0.258 ± 1.10) was higher than that in control, 25.82 ± 3.59 (Z score: - 0.263 ± 0.80), and the difference in mean was statistically significant, (t = 2.703, p = 0.008).Significantly higher proportion of subjects with sickle cell anaemia had right ventricular dysfunction (Abnormal TAPSE), 25 (50.0%) when compared with those in control, 11 (22.0%), {χ2 = 8.5, p = 0.0035}.A higher proportion of subjects with sickle cell anaemia (25.5%) had Pulmonary hypertension (RVP) when compared with control (2.0%) and the difference in proportions was found to be statistically significant, (χ2 = 11.668, p = 0.001). The prevalence of right ventricular diastolic dysfunction in subjects was 9.8% while control was 0%.ConclusionChildren with sickle cell anaemia present with right ventricular dysfunction. Prevalence of right ventricular systolic and diastolic dysfunction were higher in subjects. More of the subjects in this study (25.5%) had pulmonary hypertension.

Impact of Weight Loss with Laparoscopic Sleeve Gastrectomy on Left Ventricular Diastolic Function: a Prospective Study.

The present study purposed to investigate the effects of weight loss with LSG on echocardiographic parameters of diastolic dysfunction in subjects with morbid obesity. Sixty-one subjects undergoing LSG for standard indications were enrolled. All subjects underwent a physical examination, electrocardiography, and transthoracic echocardiography before and 6months after the LSG. Peak early diastolic velocity (E), deceleration time (DT), and peak late diastolic velocity (A) were measured from the transmitral flow signal. Peak early (e') diastolic mitral annular velocity was measured at the two acquisition sites (basal septal and basal lateral) using the tissue Doppler recordings. A significant improvement was observed in echocardiographic measures of the diastolic function including E/A ratio, E/e' ratio, DT, and isovolumic relaxation time (IVRT) from baseline to the postoperative 6months. Left atrial volume index (LAVI) reduced from 30.3 ± 3.9ml/m2 to 28.0 ± 3.3ml/m2 (p < 0.001). In addition, interventricular septum diameter (IVSD) significantly decreased from 11.3 ± 1.3mm to 10.2 ± 1.1mm (p < 0.001). The change in BMI was significantly correlated with the improvements in DT (r = 0.334, p = 0.012), E/e' (r = 0.440, p = 0.001), E/A (r = - 0.317, p = 0.017), and IVRT (r = 0.348, p = 0.008). LSG leads to a significant improvement in echocardiographic measures of the left ventricular diastolic function in subjects with obesity. Our findings also show that LSG leads to a reverse remodeling indicated by the decrease in interventricular septum thickness and left atrial volume index in this population.

P2595The role of epicardial fat thickness and other parameters of visceral adiposity in right ventricular diastolic function in patients with metabolic syndrome

Abstract Background Abdominal obesity is associated with an increased risk of cardiovascular disease and all-cause mortality especially in patients with metabolic syndrome (MetS). Despite the undeniable importance of right ventricle (RV) function, little is known about RV diastolic function implication in obesity and MetS. Purpose The objective of our study was to evaluate the role of epicardial fat thickness (EFT) and other parameters of visceral obesity in diastolic function of RV in patients with MetS. Methods The study included 70 subjects with MetS (mean age 52.6±9.4 years) and 70 controls without MetS (mean age 53.8±7.5 years). MetS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. We assessed RV diastolic function by pulsed wave and tissue Doppler echocardiography and determined the ratio of early (TV E) and late (TV A) trans-tricuspid valve inflow velocities (TV E/A), early tricuspid valve (TV) annular tissue Doppler velocity (TV e'), the TV E/e' ratio and TV deceleration time (DT). Anthropometric and sonographic parameters of visceral adiposity included: waist circumference (WC), waist-to-hip ratio (WHR), visceral adiposity index (VAI), intraabdominal fat thickness (IFT), abdominal wall fat index (AWFI) and epicardial fat thickness (EFT). Results Mean values of WC (p=0.030), WHR (p=0.008), VAI (p=0.001), IFT (p=0.035), AWFI (p=0.013) and EFT (p=0.012) were significantly higher in the group with MetS vs. controls. RV diastolic function parameters were also significantly changed in the group with MetS vs controls (tab.1). TV E/e' was positively correlated with WC (r=0.297, p&lt;0.01), WHR (r=0.238, p&lt;0.05), VAI (r=0.271, p&lt;0.05), IFT (r=0.556, p&lt;0.01), AWFI (r=0.604, p&lt;0.01) and EFT (r=0.795, p&lt;0.01). Using multivariate regression analysis EFT, WC and plasma glucose level were the most important predictors for RV diastolic dysfunction in subjects with MetS (p&lt;0.05 for all parameters). Table 1. RV diastolic function Variables MetS (n=70) Controls (n=70) p TV E, cm/s 48±11.1 52.1±14 0.025 TV A, cm/s 56.54±11 52.3±11.7 0.034 TV E/A 0.92±0.4 1.07±0.44 0.029 TV e', cm/s 10.6±2.7 10.7±3.5 0.001 TV E/e' 5.84±1.04 4.59±0.82 0.001 DT, ms 227.9±12.4 217±17.8 0.009 Conclusion Our findings support that EFT and WC play an important role in RV diastolic dysfunction in patients with MetS.

Pulse Waveform Analysis in Ocular Microcirculation by Laser Speckle Flowgraphy in Patients with Left Ventricular Systolic and Diastolic Dysfunction

Purpose: To determine: (1) whether variables of a pulse wave form analysis of ocular microcirculation shown by laser speckle flowgraphy (LSFG) correlate with left ventricular (LV) systolic dysfunction and (2) whether these variables correlate with LV diastolic dysfunction in subjects without LV systolic dysfunction as assessed by echocardiography. Methods: We studied 200 consecutive subjects. LV systolic dysfunction has been determined to be present when the LV ejection fraction was < 50%. LV diastolic dysfunction was diagnosed when subjects had an E/e’ ratio ≥15 and an e’ velocity < 10 cm/s. We evaluated the pulse waveform analysis variables “rising rate” and the blowout score (BOS) using LSFG in the optic nerve head (ONH) and choroid. Results: The brain natriuretic peptide (BNP) level, the rising rate in the choroid area (rising rate-choroid), and heart rate were revealed as independent factors for LV systolic dysfunction, and BOS-choroid was identified as an independent factor for LV diastolic dysfunction. The areas under the curve (AUC) of BNP and rising rate-choroid for LV systolic dysfunction were 0.83 and 0.81, respectively. The AUC of BOS-choroid for LV diastolic dysfunction was 0.73. Conclusion: Pulse waveform analysis in the choroid has a significant correlation with LV systolic and LV diastolic function.

Predictors of diastolic dysfunction in ethnic groups: observations from the Hypertensive Cohort of The Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES).

The study aimed to establish a relationship of ethnicity to diastolic dysfunction in subjects of African-Caribbean and South Asian origins and the impact of diastolic dysfunction and ethnicity on all-cause and cardiovascular mortality.Hypertensive subjects with ejection fraction ≥55% and no history of ischemic heart disease/valve pathology (n=1546, 830 South Asians and 716 African-Caribbeans) were identified from the Ethnic - Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography.African-Caribbean ethnicity was associated with lower prevalence of having diastolic dysfunction (odds ratio 0.67, 95% confidence interval 0.51-0.87, p=0.003) and increased left ventricular filling pressure (odds ratio 0.48, 95% confidence interval 0.34-0.69, p<0.001) as well as lower left atrial index (p<0.001). This was the case despite the fact that African-Caribbean ethnicity was independently associated with higher left ventricular mass index (p<0.001). Ninety-two deaths (6%) occurred during 68±21 months follow up. On Cox regression analysis, South Asian ethnicity (p=0.024) was predictive of all-cause death before adjustment for parameters of diastolic dysfunction, but it was no longer predictive of death after accounting for these variables.South Asian ethnicity is independently associated with worse parameters of diastolic function in hypertension, despite African-Caribbeans having more prominent hypertrophy.

The renal-cardiac connection in subjects with preserved ejection fraction: a population based study.

AimsChronic kidney disease (CKD) is prevalent and is associated with increased cardiovascular morbidity and mortality. The interaction between diastolic dysfunction (DD) and CKD in subjects with preserved systolic function is not well defined. This study sought to determine the association between renal function and DD in subjects with preserved ejection fraction.Methods and resultsThrough the Rochester Epidemiology Project, subjects who underwent echocardiography over 2 years with EF ≥50% were identified and the clinical data were obtained. Glomerular filtration rate (GFR) was estimated using the modification of diet in renal disease equation. Linear regression was used to test for association of GFR and DD. DD was defined as follows: Grade 2 or pseudonormal pattern (0.75 < E/A ≤ 1.5, E/e′ ≥ 10, DT > 140 ms, ΔE/A ≥ 0.5, and PV S < D) or Grade 3+ or restrictive pattern (E/A > 1.5, E/e′ ≥ 10, DT < 140 ms, and PV S < D). Cox regression was used to assess correlation of GFR and DD with time‐to‐event outcomes. A total of 2056 patients were identified. There was significant correlation between worsening GFR and degree of DD assessed by echo Doppler E/e′ ratio (P = 0.005), left ventricular mass index (P = 0.004), and right ventricular systolic pressure (P = 0.01). Worsening GFR was associated with increased mortality, development of heart failure, and hospitalization (P < 0.001). Within each GFR group, abnormal DD was associated with a higher risk of the clinical outcomes. No interaction between GFR and DD was noted, suggesting an increased risk of events associated with abnormal DD across ranges of GFR.ConclusionsWorsening GFR was associated with a greater degree of diastolic dysfunction and adverse clinical outcomes. Within each GFR group, the presence of DD was associated with increased morbidity and mortality. Further studies are warranted to determine if improving DD in patients with CKD will benefit clinical outcomes.

Skin autofluorescence is associated with inappropriate left ventricular mass and diastolic dysfunction in subjects at risk for cardiovascular disease

BackgroundEnhanced advanced glycation end products deposition within myocardial tissue may cause diastolic dysfunction. However, whether this is related to left ventricular hypertrophy or inappropriate left ventricular mass remains unclear.MethodsWe prospectively enrolled 139 subjects at risk for cardiovascular diseases. We used echocardiography for measurements of left ventricular mass and cardiac systolic and diastolic functional parameters. An advanced glycation end product reader was applied for measurements of skin autofluorescence values. Comparisons of left ventricular mass and echocardiographic parameters between the higher and lower skin autofluorescence groups were analyzed.ResultsCompared with the lower skin autofluorescence group, left ventricular mass index and the ratio of observed left ventricular mass/predicted left ventricular mass (oLVM/pLVM) was significantly higher in the higher skin autofluorescence group (61.22 ± 17.76 vs. 47.72 ± 11.62, P < 0.01, 1.62 ± 0.38 vs. 1.21 ± 0.21, P < 0.01). After adjustment for potential confounding factors, skin autofluorescence was an independent factor for left ventricular mass index (β = 0.32, P < 0.01) and the ratio of oLVM/pLVM (β = 0.41, P < 0.01). Skin autofluorescence ≥2.35 arbitrary unit predicted left ventricular hypertrophy at a sensitivity of 58.8%, and a specificity of 73.0% (P < 0.01). Skin autofluorescence ≥2.25 arbitrary unit predicted inappropriate left ventricular mass at a sensitivity of 71.1%, and a specificity of 83.9% (P < 0.01). Skin autofluorescence was positively correlated with E/E′, an indicator for diastolic dysfunction (r = 0.21, P = 0.01).ConclusionsSkin autofluorescence is a useful tool for detecting left ventricular hypertrophy, inappropriate left ventricular mass and diastolic dysfunction.

Improvement of impaired diastolic left ventricular function after diet-induced weight reduction in severe obesity.

Background/objectivesObesity is independently associated with left ventricular (LV) diastolic dysfunction and altered cardiac morphology. Morbidity and mortality in patients with diastolic dysfunction are similar to values observed in patients with systolic heart failure. We hypothesized that dysfunctional cardiac responses in people with obesity are reversible after weight loss. Thus, we studied the effect of dietary weight reduction on LV diastolic function as well as on cardiac structure using transthoracic echocardiography and tissue Doppler imaging (TDI).Subjects/methodsThirty-two subjects with obesity underwent a 12-week low-calorie fasting phase of a formula diet. Echocardiographic tissue Doppler indices of diastolic function and measurements of cardiac size were obtained prior to and after the fasting phase.ResultsA 12-week diet significantly reduced body mass index from 40.3 ± 6.6 kg/m2 to 33.2 ± 6.1 kg/m2 (p < 0.01). Weight loss was associated with a significant reduction in blood pressure and heart rate. Echocardiography revealed diastolic dysfunction in subjects with obesity, which was improved by dieting. After weight loss, trans-mitral Doppler echocardiography showed a significant reduction in A-wave velocity, from 65.8 ± 19.2 cm/s to 57.0 ± 16.8 cm/s, and an increase in E/A ratio from 1.2 ± 0.4 to 1.4 ± 0.5 (p < 0.01). TDI displayed a significantly lower a′-wave velocity (10.3 ± 2.3 cm/s and 8.9 ± 1.7 cm/s; p < 0.01). Left atrial and LV dimensions were normal and remained unchanged after weight loss.ConclusionObesity is associated with diastolic dysfunction. A 12-week low-calorie diet with successful weight loss can reduce blood pressure and heart rate and partially normalize diastolic dysfunction.

The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries.

The aim of this study is to evaluate the effect of epicardial adipose tissue (EAT) thickness on left ventricular diastolic functions in patients with normal coronary arteries (NCA) proven by angiography. We selected study patients who were referred to coronary angiography due to typical chest pain or atypical chest pain with a positive pre-test result for coronary artery disease (CAD). After coronary angiography, 85 patients with significant coronary lesion (≥ 50% stenosis) served as the CAD group, 82 patients with non-significant coronary lesion (< 50% stenosis) and/or a coronary plaque served as the non-significant CAD group, and 83 patients with NCA served as the NCA group. All patients underwent transthoracic echocardiographic examination to measure EAT thickness and left ventricular diastolic properties. Gensini score, total cholesterol, and C-reactive protein were significantly higher in the CAD group compared to the non-significant CAD group and the NCA group. The average of EAT thickness was 7.3 ± 2.4 mm in all groups. It was 5.8 ± 2.3 mm in the NCA group, 6.4 ± 2.4 mm in the non-significant CAD group, and 7.8 ± 2.2 mm in the CAD group (p < 0.001). In correlation analyses, average EAT thickness was significantly correlated with E/e' ratio in the NCA group. In multivariate analysis, average of EAT thickness was significantly associated with left ventricular diastolic dysfunction in subjects with NCA (OR 1.019, 95% CI 1.012-1.027, p < 0.001). Based on our findings, EAT thickness may have an effect on left ventricular diastolic functions. This independent relationship showed us the clinical importance of measuring of EAT thickness.

Associations between native myocardial T1 and diastolic function evaluated by PC-CMR in patients with severe aortic valve stenosis

Background To assess the relationship between the presence of myocardial interstitial fibrosis as reflected by the increase in native T1 values and alterations in left ventricular (LV) diastolic function evaluated by phase contrast cardiac magnetic resonance (PC-CMR), in subjects with severe aortic valve stenosis (AVS). Methods We studied 20 subjects (71±10 years) with severe AVS including 19 with a preserved ejection fraction. All patients underwent transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) exams. CMR included conventional LV systolic function and delayed enhancement evaluations as well as a native T1 mapping acquisition using the modified Look-Locker inversion recovery sequence and velocity encoding data of the transmitral inflow for the evaluation of LV diastolic function. These latter CMR data were analyzed using custom software resulting in segmental T1 values and diastolic parameters such as transmitral peak velocities (E, A), peak flow rates (Ef, Af), filling volume (FV), and myocardial peak velocities. Results For all patients, TTE revealed the presence of severe AVS according to ESC criteria (aortic valve area indexed to BSA= 0.43±0.09 cm2/m2 and mean gradient 54 ±14mmHg). When compared to CMR data of 34 elderly controls (60±8 years) despite the preserved ejection fraction (patients=66±10%; controls=66±4%), diastolic parameters indicated an impaired LV relaxation in patients with severe AVS. Importantly, while dense fibrosis volume quantified from delayed enhancement images was not related to diastolic function parameters, a significant relation was found between native myocardial T1 values and parameters of LV filling such as: the ratio between the peak filling rate and the peak atrial rate EfMR/AfMR (r=0.51; p<0.05); the ratio between the peak atrial rate and the filling volume Af/FVMR (r=0.67; p<0.05); and the peak atrial rate Af (r=0.63; p<0.05). Conclusions Interstitial myocardial fibrosis assessed non-invasively by native T1 is related to the severity of diastolic dysfunction in subjects with severe AVS.

The Natural History of Subjects with Isolated Metabolic Syndrome- A Population Based Study

The Natural History of Subjects with Isolated Metabolic Syndrome- A Population Based Study

The clinical usefulness of central hemodynamics to evaluate diastolic dysfunction in subjects without hypertension.

ObjectiveDiastolic dysfunction is associated with increased arterial stiffness in patients with hypertension. However, the role of arterial stiffness in diastolic dysfunction in subjects without hypertension has not been fully established.Materials and methodsA total of 287 subjects (male:female ratio 121:166, mean age 53.0±14.4 years) without hypertension or any heart disease who simultaneously received transthoracic echocardiography and noninvasively semiautomated radial artery applanation tonometry (with an Omron HEM-9000AI) in the Department of Internal Medicine, St Vincent’s Hospital, from July 2011 to September 2012, were enrolled in this study.ResultsA total of 147 subjects (male:female ratio 59:88, mean age 61.7±9.9 years), representing 51.2% of the 287 subjects, had diastolic dysfunction (defined as abnormal relaxation pattern of mitral inflow). There were significant differences in systolic blood pressure (BP), pulse pressure, late systolic peak pressure (SBP2), and radial augmentation index (RaAIx) between normal diastolic function and diastolic dysfunction. ΔBP was defined as systolic BP minus SBP2, because of the difference in systolic BP between the two groups. ΔBP (odds ratio [OR] 1.059, 95% confidence interval [CI] 1.005–1.115; P=0.032) and RaAIx (odds ratio 1.027, 95% CI 1.009–1.044, P=0.003) were associated with diastolic dysfunction. A receiver operating-characteristic curve showed that ΔBP (area under the curve 0.875, 95% CI 0.832–0.911) and RaAIx (area under the curve 0.878, 95% CI 0.835–0.914) were associated with diastolic dysfunction.ConclusionWe found that ΔBP and increased RaAIx were associated with diastolic dysfunction in subjects without hypertension after adjustment for age and sex. Therefore, it is suggested that noninvasive estimation of central BP may be useful to reflect diastolic dysfunction in subjects with normal peripheral BP.

Treatment of Diabetes in People with Heart Failure

Treatment of Diabetes in People with Heart Failure

Serum High-Sensitivity Cardiac Troponin T Is a Significant Biomarker of Left-Ventricular Diastolic Dysfunction in Subjects with Non-Diabetic Chronic Kidney Disease

Background: Chronic kidney disease (CKD) is associated with left-ventricular (LV) diastolic dysfunction (LVDD) which progresses to diastolic heart failure. However, biomarkers predicting LVDD in patients with CKD are largely unknown. Methods: In 93 patients with non-diabetic CKD, the relationships among echocardiography, high-sensitivity cardiac troponin T (hs-cTnT), B-type natriuretic peptide (BNP), and renal function were evaluated. LV mass index, peak early diastolic mitral filling velocity (E), peak early diastolic mitral annular velocity (E′), and E/E′ were recorded. Results: The E′ values were significantly decreased and E/E′, BNP, and hs-cTnT increased with increasing CKD stage. The CKD patients with LVDD with E′ <5 cm/s had a significantly higher hs-cTnT level as well as a significantly higher BNP level compared to those with E′ ≧5 cm/s. The area under the receiver-operating characteristic curve for hs-cTnT and BNP to detect E′ <5 cm/s was 0.880 (p = 0.0101) and 0.741 (p = 0.0570), respectively. In multivariate analysis, hs-cTnT and albuminuria were significantly associated with E′, and estimated glomerular filtration rate with the hs-cTnT level, after adjusting for age, cause of CKD, and other parameters. Conclusions: These data suggest that hs-cTnT may be a useful biomarker of LVDD in non- diabetic CKD patients.