Diastolic Function In Women Research Articles

Arterial Health After Preeclampsia: Role of Chronic Hypertension in the Early Vascular Aging (EVA) Study.

Preeclampsia (PE) is associated with increased cardiovascular risk. Recent data have shown worse left ventricular remodeling and diastolic function in women with PE and persistent hypertension (HTN). We performed a comprehensive arterial hemodynamic assessment to evaluate the contribution of persistent HTN on arterial health after PE. We recruited 40 women with PE history and 40 age-matched controls (6 months to 6 years postpartum). We evaluated arterial hemodynamics with validated techniques combining applanation tonometry and transthoracic echocardiography, comparing three groups: previous PE with persistent HTN (PE-HTN), previous PE with normalized blood pressure (PE-noHTN) and controls, using multivariable linear regression adjusted for age, body surface area, heart rate, diabetes, smoking history, creatinine, and gravidity. Eight (20%) of the post-PE women had persistent HTN. Mean age was 35.8 ± 3.9 years, median number of pregnancies was 2 (range 1-7), and time since last pregnancy 2.1 (range 0.5-5.7) years (not different between groups, P > 0.05). Compared to controls and to PE-noHTN, PE-HTN had higher aortic stiffness, wave reflections, pulsatile, and steady arterial load (P < 0.05 for each). Among PE-noHTN, aortic stiffness, wave reflections and steady arterial load were worse than controls (P < 0.05 for each), with smaller effect sizes. This is the most comprehensive assessment of arterial hemodynamics and first to demonstrate the contribution of persistent HTN on worse arterial health following PE. Since measures of arterial health are associated with cardiovascular events in the population, the combination of previous PE and chronic HTN may represent a higher risk subgroup who could benefit from targeted prevention strategies.

Abnormal left ventricular subendocardial perfusion and diastolic function in women with obesity and heart failure and preserved ejection fraction

Purpose– Coronary microvascular dysfunction (CMD) is common in patients with heart failure with preserved ejection fraction (HFpEF) and obesity. Stress cardiovascular magnetic resonance (CMR) has been proposed as a non-invasive tool for detection of CMD. The aim of this study was to determine relationship between CMD and diastolic function in patients with HFpEF using a novel CMR technique.Methods– Patients with obesity and HFpEF without epicardial coronary artery disease (CAD) underwent Doppler echocardiography to measure diastolic function, followed by vasodilator stress CMR, using a single bolus, dual sequence, quantitative myocardial perfusion mapping to measure myocardial blood flow (MBF) at rest and at peak hyperemia. With this, myocardial perfusion reserve (MPR), global stress endocardial-to-epicardial (endo:epi) perfusion ratio, and total ischemic burden (IB, defined as myocardial segments with MBF < 1.94 mL/min/g) were calculated. Results are reported as median and interquartile range.Results– Nineteen subjects were enrolled (100% female, 42% Black). Median age was 64 [56–72] years. Global stress MBF was 2.43 ml/min/g [2.16–2.78] and global myocardial perfusion reserve (MPR) was 2.34 [2.07–2.88]. All had an abnormal subendocardial perfusion with an endo:epi of less than 1 (0.87 [0.81–0.90]). Regional myocardial hypoperfusion was detected in 14 (74%) patients with an IB of 6% [0-34.4]. Endo:epi ratio significantly correlated with IB (R=-0.510, p = 0.026) and measures of diastolic function (R = 0.531, p = 0.019 and R=-0.544, p = 0.014 for e’ and E/e’ respectively).Conclusion– Using a novel quantitative stress CMR myocardial perfusion mapping technique, women with obesity and HFpEF were found to have patterns of abnormal subendocardial perfusion which significantly correlated with measures of diastolic dysfunction.

Abstract 13430: Arterial Health After Preeclampsia: Role of Chronic Hypertension

Introduction: Preeclampsia (PE) is associated with an increased cardiovascular (CV) risk. Recent data have shown worse left ventricular remodeling and diastolic function in women with PE and persistent hypertension (HTN). To improve our understanding of CV risk after PE, we evaluated the contribution of persistent HTN on arterial health. Methods: We recruited 40 women with PE history and 40 age-matched women with normotensive pregnancies (6 months - 6 years post-partum). We comprehensively evaluated measures of arterial health and hemodynamics with validated technique combining applanation tonometry and transthoracic echocardiography. We compared 3 groups: previous PE with persistent HTN (PE-HTN), previous PE with normalized blood pressure (PE-noHTN) and controls. Associations of PE-HTN with arterial health measures were assessed with multivariable linear regression adjusted for age, BSA, heart rate, diabetes, smoking history, serum creatinine and parity. Results: Eight (20%) of the post-PE women had persistent HTN. Mean age was 35.8 ± 3.9 years, number of pregnancies was 2.4 ± 1.4, and time since last pregnancy was 2.6 ± 1.2 years, and not different across the 3 groups (P&lt;0.05 for each). Results of the multivariable linear regression models are summarized in the Figure, demonstrating that women with PE-HTN had significantly higher aortic stiffness, wave reflections, pulsatile and steady arterial load than controls. Among women with previous PE whose blood pressure normalized postpartum, arterial stiffness, wave reflections and steady arterial load were also worse compared to controls, albeit with smaller effect size (p&lt;0.05). Conclusions: This is the first study to demonstrate the contribution of persistent HTN on worse arterial health following PE. Since measures of arterial health are associated with CV events in the population, women with PE-HTN may represent a higher risk subgroup who could benefit from targeted primary prevention strategies.

Phasic left atrial strain to predict diastolic dysfunction development in women: results from the prospective Berlin Female Risk Evaluation (BEFRI) follow up trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research) OnBehalf BEFRI Background/Introduction: During the past few years, left atrial strain (LAS) has been identified to be significantly associated with left ventricular diastolic dysfunction (DD). However, the predictive value of LAS reductions on the course of DD in patients without or mild DD has so far not been investigated. Purpose To assess the predictive impact of phasic left atrial strain (LAS) reductions on the development of left ventricular (LV) diastolic function in women with normal (DD0) or mildly impaired diastolic function in a longitudinal study design. Methods We reinvited 449 participants of the Berlin Female Risk Evaluation (BEFRI) study for follow-up examinations. A comprehensive clinical and echocardiographic assessment comprising the analysis of phasic LAS was performed in 256 participants. The diagnostic and predictive value of LAS analysis was assessed and compared with standard echocardiographic DD parameters using receiver operating characteristic (ROC) curve analyses and a multivariate logistic regression model. Results After a mean time interval of 6.8 years, subjects with DD0 at baseline investigation and a worsening of diastolic function of at least one stage according to recent ASE / EACVI recommendations (DD_progress) showed a significantly reduced baseline LA reservoir strain (LASr) and conduit strain (LAScd) [LASr 28.1% (6.9) in DD_progress vs. 41.9% (8.5) in DD0 at follow up; and LAScd -13.2% (5.0) in DD_progress vs. -25.4% (9.1) in DD0 at follow up; p &amp;lt; 0.001 respectively]. With an area under the curve (AUC) of 0.89 [95% confidence interval (CI) 0.83-0.94], and 0.85 (95% CI 0.80-0.90), LASr and LAScd showed the highest discriminative value to predict DD_progress while the echocardiographic standard DD parameter left atrial volume index (LAVI) featured a limited predictive diagnostic accuracy [AUC of 0.65 (95%CI 0.52-0.72)]. In a multivariate logistic regression model controlling for age, BMI, and other standard echocardiographic DD parameters including LAVI, only LASr and LAScd remained significantly associated with DD_progress over time. Conclusions In addition to improving the diagnostic accuracy of the current DD algorithm, the analysis of phasic LAS reductions may be useful to predict the development of DD in previously healthy women.

Sex-specific associations of obesity with exercise capacity and diastolic function in Koreans

Background and aimsWomen with obesity are highly predominant among patients with heart failure with preserved ejection fraction (HFpEF). We aimed to elucidate sex-specific associations of obesity with exercise capacity and diastolic function. Methods and resultsHealthy individuals without known cardiovascular diseases undergoing cardiopulmonary exercise test and echocardiography (n = 736) were included and categorized into 4 groups according to their sex and obesity. Exercise capacity was lower in women than men. Obesity was associated with a lower exercise capacity in women (23.5 ± 7.3 vs. 21.3 ± 5.4 ml/kg/min, p < 0.05) but not in men (28.2 ± 7.8 vs. 28.0 ± 6.6 ml/kg/min, p > 0.10). Overall, women had a higher E/e′ than men. Women without obesity had a similar E/e′ to men with obesity (8.2 ± 1.8 vs. 8.4 ± 2.1, p > 0.10), and women with obesity had the highest E/e′. Among 5 risk factors (aging, obesity, elevated blood pressure, elevated heart rate, and elevated fasting glucose), obesity was a significant determinant of exercise intolerance in women but not men. Furthermore, obesity was associated with a greater risk of diastolic dysfunction in women than men (women, adjusted odds ratio 4.35 [95% confidence interval 2.44–7.74]; men, adjusted odds ratio 2.91 [95% confidence interval 1.42–5.95]). ConclusionObesity had a more deleterious effect on exercise capacity and diastolic function in women than men, even in a healthy cohort. These subclinical changes might contribute to the development of a female predominance among HFpEF patients, particularly among individuals with obesity.

Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus

Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodelling, and diastolic dysfunction in patients with type 2 diabetes (T2DM). The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodelling, and diastolic dysfunction in patients with T2DM. Further, the prognostic value of diastolic function in women and men was also evaluated. A total of 350 patients with T2DM (mean age 61 ± 11 years; women, 48.3%) was recruited. Detailed echocardiography was performed at baseline and after 25 months. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization, or myocardial infarction. Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 21 patients developed MACE (5 cardiovascular death, 9 hospitalization for heart failure, and 7 myocardial infarction) during a median follow-up of 56 months. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women [hazard ratio = 6.30; 95% confidence interval (CI) = 1.06-37.54; P < 0.05] but not men (hazard ratio = 2.29, 95% CI = 0.67-7.89; P = 0.19). LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.

Effect of Eplerenone on Diastolic Function in Women Receiving Anthracycline-Based Chemotherapy for Breast Cancer

Anthracycline agents are commonly used in early breast cancer but are associated with dose-related cardiotoxicity. Diastolic dysfunction may be more common and occur earlier than systolic dysfunction ([1][1],[2][2]). Eplerenone is an oral mineralocorticoid antagonist (MRA); these agents prevent

P3461Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus

Abstract Background Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodeling and diastolic dysfunction in patients with type 2 diabetes (T2DM). Purpose The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodeling and diastolic dysfunction in patients with T2DM. Further the prognostic value of diastolic function in women and men was also evaluated. Methods A total of 386 patients with T2DM (mean age 61±11 years; women, 48.2%) was recruited. Detailed echocardiography was performed and LV geometry, systolic and diastolic function were measured at baseline and follow-up. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization or myocardial infarction. Multivariable cox-regression adjusted for age, hypertension, LVEF and HbA1c was used to assess the association between sex-specific diastolic function and the development of a MACE. Results Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 26 patients developed a MACE (4 cardiovascular death, 14 hospitalization for heart failure, 8 myocardial infarction) during follow-up. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women (hazard ratio 6.35, 95% confidence interval 1.18–34.19, P&lt;0.05) but not men (hazard ratio 1.85, 95% confidence interval 0.58–5.92, P=0.30). Conclusions LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.

Overlap between angina without obstructive coronary artery disease and left ventricular diastolic dysfunction with preserved ejection fraction

BackgroundA link between angina with no obstructive coronary artery disease (CAD) and heart failure with preserved left ventricular ejection fraction has been proposed, but evidence in support of this is lacking. In a cross-sectional study, we investigated whether left ventricular diastolic function in women with angina pectoris and no obstructive CAD differed from a reference population.MethodsWe included 956 women with angina and <50% coronary artery stenosis at invasive coronary angiography. Women with cardiovascular risk factors, but no history of chest pain or cardiac disease served as controls (n = 214). Left ventricular diastolic function was assessed by transthoracic echocardiography.ResultsThe women with angina were slightly older, had higher body mass index, higher heart rate, and more had diabetes compared with controls while systolic blood pressure was lower. In age-adjusted analyses, angina patients had significantly lower E/A (Estimated difference -0.13, 95% CI: -0.17; -0.08), higher left ventricular mass index (5.73 g/m2, 95% CI: 3.71; 7.75), left atrial volume index (2.34 ml/m2, 95% CI: 1.23; 3.45) and E/e’ (0.68, 95% CI: 0.30; 1.05) and a larger proportion had higher estimated left ventricular filling pressure (17% versus 6%, p = 0.001). No between group differences were seen for e’ or deceleration time. After adjustment for known cardiovascular risk factors, between group differences for echocardiographic parameters remained statistically significant.ConclusionsPatients with angina and no obstructive CAD had a more impaired left ventricular diastolic function compared with an asymptomatic reference population. This suggests some common pathophysiological pathway between the two syndromes.

Reduced left ventricular diastolic function in women with posttraumatic stress disorder.

Women are two to three times more likely to develop posttraumatic stress disorder (PTSD) compared with men after exposure to a major trauma, and PTSD is associated with increased risk for cardiovascular disease in later life. The underlying mechanisms are unclear, but alterations in cardiac function may be involved. We hypothesized that women with PTSD have reduced left ventricular (LV) diastolic function. We studied 14 women with PTSD (PTSD group) and 14 women without PTSD (controls) using echocardiography Doppler to evaluate LV diastolic function, including peak velocities (E and A waves) in transmitral flow; diastolic, atrial kick, and systolic waveform velocities (e', a', and s') in tissue Doppler; the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e'); and velocity of propagation (Vp) . Baseline characteristics including age, body size, blood pressure, and heart rate were not significantly different between the two groups. Compared with the control group, women with PTSD showed greater E/e' (controls vs. PTSD group: 7.0 ± 1.3 vs. 9.1 ± 1.3, P = 0.002) and smaller Vp (controls vs. PTSD group: 63.7 ± 11.3 vs. 47.5 ± 6.9 cm/s, P = 0.003). These results suggest that women with PTSD have reduced LV diastolic function, which may contribute, at least in part, to the increased risk of cardiovascular disease later in life.

Left Ventricular Function Before and After Aerobic Exercise Training in Women With Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a chronic debilitating illness. The effects of vigorous aerobic exercise training (AET) on heart function in PAH are poorly understood. Eighteen women with PAH (aged 56.2 ± 8.8 yr, body mass index: 28.8 ± 7.3 kg/m) underwent 10 wk of vigorous AET. Cardiac function was observed at rest and peak exercise using bioelectrical impedance cardiography before and after the AET. Cardiac function was observed in a small PAH subset (n = 7) for 10 wk before beginning the AET. A cohort of sedentary women (n = 19) served as healthy controls. Left ventricular ejection fraction (48 ± 9.2 vs 61.5 ± 13.3%, P = .034) and the systemic vascular resistance index (2258 ± 419.1 vs 2939 ± 962.4 dyn·sec/cm·m, P = .008) were lower at supine rest in the baseline PAH group versus the healthy group, as were peak exercise heart rate (140 ± 13.3 vs 170 ± 13.8 beats/min, P < .001) and systemic vascular resistance index (828 ± 141.1 vs 824 ± 300.9 dyn·sec/cm·m, P = .050) after controlling for age and heart rate. Systemic vascular resistance index measured at peak exercise decreased in the PAH group after AET (828 ± 141.1 vs 766 ± 139.6 dyn·sec/cm·m, P = .020). Left ventricular early diastolic filling ratio worsened in the PAH subset prior to AET (95.9 ± 19.4 vs 76.2 ± 18.9%, P = .043) and remained unchanged after AET. Vigorous AET was not associated with significant declines in left ventricular systolic or diastolic function in women with PAH. Aerobic exercise training may be beneficial for reducing afterload and may preserve left ventricular diastolic function.

Age and gender differences in phenotype of heart failure with preserved left ventricular ejection fraction in patients with arterial hypertension

The aim — to determine differences in the structure and function of the heart, arterial stiffness, resistive and pulsative loads and ventricular‑arterial connection in patients with arterial hypertension, confirmed heart failure (HF) and preserved ejection fraction, depending on age and gender.Materials and methods. The study included 115 patients (62 (53.9 %) men and 53 (46.1 %) women, average age — 67.3 ± 9.7 years) with a diagnosis of HF with preserved EF of IIA or IIB stage, II — III functional class according to NYHA, left ventricular (LV) ejection fraction (EF) ≥ 50 % and signs of LV diastolic dysfunction according to transthoracic echocardiography, who were divided into two groups by gender and two groups by age (≥ 65 years and 0.05). The glomerular filtration rate was lower in the elderly, and the frequency of anemia in these groups of patients was higher. In women of both age groups it was lower than in men (p 0.05) for both sexes. When assessing the pulse load, an increase in the augmentation index was detected, standardized to a heart rate of 75 per 1 min and a pulse wave velocity in older women, compared with older men (24.9 ± 4.3 and 22.4 ± 5.7; 13.04 ± 1.4 and 12.4 ± 1.9, respectively (p < 0.05).Conclusions. Among patients with hypertension and verified HF with preserved EF, in younger women compared with men there was a greater degree of diastolic dysfunction in terms of diastolic elastance, left atrial volume index, DT, an increase in systolic pressure in the pulmonary artery and NT‑proBNP level at the same frequency atrial fibrillation and body mass index. With a greater resistive load on the LV in terms of systemic vascular resistance and Ea, women patients with hypertension and heart failure with preserved EF had a higher pulse load (according to ascending augmentation index standardized to heart rate of 75 per 1 min and pulse wave velocity) than men with comparable central systolic blood pressure, regardless of age.

Sex Differences in Coronary Microvascular Function in Individuals With Type 2 Diabetes.

Cardiovascular (CV) disease fatality rates are higher for women compared with men with diabetes despite lower rates of obstructive coronary artery disease (CAD). Impaired coronary flow reserve (CFR), the ratio of adenosine-stimulated to rest myocardial blood flow (MBF), is an indicator of coronary microvascular dysfunction and predicts major adverse CV events. We performed a post hoc analysis to determine whether there was a sex disparity in coronary microvascular dysfunction among 46 men and 27 women with well-controlled type 2 diabetes and without clinical evidence of obstructive CAD. We found that women had a higher rest MBF, lower CFR, and worse diastolic function compared with men. In addition, rest MBF was positively correlated with worse diastolic function in women. We previously showed that mineralocorticoid blockade improved CFR in men and women with type 2 diabetes, implicating aldosterone in the pathophysiology of coronary microvascular dysfunction. We therefore examined aldosterone levels and found that women had larger increases in aldosterone in response to an angiotensin-II infusion than did men. In conclusion, among individuals with type 2 diabetes and good cardiometabolic control, women had worse myocardial perfusion and diastolic function compared with men. The greater aldosterone responsivity in women may be a mechanism for this sex effect.

Phosphodiesterase type 5 inhibition may reduce diastolic function in women with ischemia but no obstructive coronary artery disease

BackgroundIschemia, in the absence of obstructive coronary artery disease, is prevalent in women, and associated with increased risk for major cardiovascular events. Coronary microvascular dysfunction is prevalent in these patients, and associated with impaired diastolic function. Despite our general understanding, however, optimal treatment of this cohort remains elusive.MethodsTo address this knowledge gap, we performed an open-label treatment trial to assess whether phosphodiesterase type 5 inhibition improves coronary microvascular perfusion and diastolic function in women with signs and symptoms of ischemia but no evidence of obstructive coronary artery disease. Left ventricular morphology and function, along with myocardial perfusion reserve index, were assessed by contrast-enhanced cardiac magnetic resonance imaging.ResultsA total of five women enrolled of which four completed the trial, while one was withdrawn by the investigators after developing dyspnea 1 week after treatment. Her symptoms resolved after cessation of the study medication. In contrast to our hypothesis, phosphodiesterase type 5 inhibition reduced the rate of circumferential strain in diastole in all four women who completed the trial (that is, diastolic dysfunction). This impairment could not be explained by changes in heart rate, contractility, blood pressure, or preload, and was not associated with a change in myocardial perfusion reserve index. Frequency of angina also tended to increase with treatment, with the greatest increase occurring in the patient with the greatest impairment in diastolic strain.ConclusionsTaken together, these data question the efficacy of phosphodiesterase type 5 inhibition to treat women with ischemic heart disease, and highlight the need for further investigation.

CORONARY MICROVASCULAR DYSFUNCTION IS RELATED TO LEFT VENTRICULAR CONCENTRIC REMODELING AND DIASTOLIC DYSFUNCTION: FROM THE WISE-CVD STUDY

Background: Women with signs and symptoms of ischemia but no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD). However, mechanistic contributors of CMD remain poorly understood. We investigated relations between CMD, LV geometry and diastolic function in women

Bone mineral density is associated with left ventricular diastolic function in women.

Low bone mineral density (BMD) and left ventricular (LV) diastolic function are associated with heart failure. However, little is known about the association between BMD and LV diastolic function. BMD is independently related to LV diastolic function in women. We conducted a cross-sectional study of 432 women. Brachial-ankle pulse wave velocity (baPWV) and BMD measurements were performed. LV diastolic function and structure were assessed by echocardiographic examination. BaPWV and the percentage of LV diastolic dysfunction increased with progressive bone loss. Moreover, partial correlation analysis demonstrated that BMD at spine L2-4 and at femoral neck were correlated with baPWV and LV diastolic function parameters after adjusting covariates. Multivariate logistic regression analysis revealed that osteoporosis was independently associated with LV diastolic dysfunction in women. Osteoporosis is independently associated with LV diastolic dysfunction in women. A prospective study is needed to elucidate the effects of BMD on cardiac function in women.

Changes in Ventricular Function After Vigorous Aerobic Exercise Training in Women with Pulmonary Arterial Hypertension

PURPOSE: To determine if 10 weeks of vigorous aerobic exercise training (AET) worsens left ventricular diastolic and systolic function in a group of women with pulmonary arterial hypertension (PAH). METHODS: 18 women with PAH (age 56.2 ± 8.8 years, BMI 28.8 ± 7.3 kg/m2) underwent 10 weeks of vigorous AET at 70-80% heart rate reserve. Indices of cardiac function were measured during a graded exercise test (GXT) to peak exhaustion using bioelectrical impedance cardiography (ZCG) before and after the AET. A small subset (N=7) participated in a 10-week waiting period prior to beginning the AET and performed an additional GXT with ZCG before that period. A cohort of sedentary women serving as healthy controls (N=19) also performed a GXT with ZCG and were used for comparison. RESULTS: Left ventricular ejection fraction (EF; 48 ± 9.2 vs. 61.5 ± 13.3 %, p=0.034) and the systemic vascular resistance index (SVRI; 2,258 ± 419.1 vs. 2,939 ± 962.4 dyn·s/cm5·m2, p=0.008) were significantly lower in the baseline PAH group vs. healthy groups respectively at supine rest. At peak exercise, heart rate (HR) was lower in the PAH group vs. healthy control group (140 ± 13.3 vs. 170 ± 13.8 bpm, p<0.001) and SVRI higher in the PAH group (828 ± 141.1 vs. 824 ± 300.9 dyn·s/cm5·m2, p=0.050) when controlling for age and HR. After AET, the PAH group did not have a significant decline in left ventricular function, but rather a decrease in SVRI (828 ± 141.1 vs. 766 ± 139.6 dyn·s/cm5·m2, p=0.020) at peak exercise. The subset of subjects with PAH who participated in the 10-week waiting period had a significant decline in the early diastolic left ventricular filling ratio (EDFR; 95.9±19.4 vs. 76.2±18.9%, p=0.043) prior to AET. The EDFR remained unchanged after the AET training period in all subjects. CONCLUSIONS: Vigorous AET does not appear to be associated with significant declines in either left ventricular systolic or diastolic function in women with PAH. AET may be beneficial for reducing afterload and may be protective against decline in left ventricular diastolic function occurring over time. Funding Source: NIH/IRP 1 Z01 CL060068-02 CC.

Assessment of structural cardiac abnormalities and diastolic function in women with gestational diabetes mellitus

The main manifestation of hyperglycaemia during pregnancy is gestational diabetes mellitus. It can herald diabetes mellitus type 2 and its deleterious long-term effects, such as hypertension and cardiovascular disease. The aim of this study was to assess diastolic function in women with gestational diabetes mellitus, one of the first signs of future cardiovascular disease. A total of 21 women with gestational diabetes mellitus and 23 healthy pregnant women (control group) between 34 and 37 weeks of gestation underwent echocardiographic assessment. The diagnosis of gestational diabetes mellitus was made in agreement with the American Diabetes Association criteria. Echocardiographic images obtained were analysed according to the criteria of the American Society of Echocardiography. Data were analysed using Pearson correlation coefficient, analysis of variance and Student's t-test. Women with gestational diabetes mellitus had higher posterior wall and interventricular septum thickness, increased left ventricular mass and left ventricular mass index, lower early diastolic annular velocity and early diastolic annular velocity/late diastolic annular velocity ratio. There was a positive correlation between left ventricular mass index and fasting glucose and pregnancy body mass index. Patients with gestational diabetes mellitus seem to have a different diastolic profile as well as a mildly dysfunctional pattern on echocardiogram, which may show a need for greater glycaemic control.

Endothelial function is associated with myocardial diastolic function in women with systemic lupus erythematosus

Endothelial dysfunction is associated with traditional and systemic lupus erythematosus (SLE)-specific risk factors, and early data suggest reversibility of endothelial dysfunction with therapy. The clinical relevance of endothelial function assessment has been limited by the lack of studies, demonstrating its prognostic significance and impact on early myocardial function. Therefore, we aimed to determine the association between endothelial and myocardial diastolic function in SLE women. Women with SLE and no coronary artery disease were prospectively recruited and underwent radionuclide myocardial perfusion imaging (MPI) (Jetstream, Philips, the Netherlands) to exclude subclinical myocardial ischemia. Cardiac and vascular functions were assessed in all patients (Alpha 10, Aloka, Tokyo). Diastolic function was assessed using pulse wave early (E) and late mitral blood inflow and myocardial tissue Doppler (mean of medial and lateral annulus e') velocities. Endothelial function was measured using brachial artery flow-mediated vasodilatation (FMD%). Univariate and multivariate linear regressions were used to assess the association between FMD% and myocardial diastolic function, adjusting for potential confounders. Thirty-eight patients without detectable myocardial ischemia on MPI were studied (mean age 44 ± 10 years; mean disease duration 14 ± 6 years). About 61 % of patients had normal diastolic function (E/e' ≤ 8), and 5 % of patients had definite diastolic dysfunction with E/e' > 13 (mean 7.1 ± 2.9). FMD% was associated with E/e' (regression coefficient β = -0.35; 95 % CI -0.62 to -0.08; p = 0.01) independent of systolic blood pressure, age, and SLICC/ACR Damage Index.

Early-pregnancy Changes in Cardiac Diastolic Function in Women With Recurrent Preeclampsia and in Previously Preeclamptic Women Without Recurrent Disease

Early-pregnancy Changes in Cardiac Diastolic Function in Women With Recurrent Preeclampsia and in Previously Preeclamptic Women Without Recurrent Disease