Parameters Of Diastolic Function Research Articles

Evaluating the impact of Sacubitril/valsartan on diastolic function in patients with heart failure: A systematic review and meta-analysis.

Heart failure is a common and severe condition, often complicated by diastolic dysfunction. Current standard therapies such as ACEIs and ARBs have limited efficacy in managing diastolic function. Sacubitril/Valsartan, an emerging therapy, warrants rigorous investigation to elucidate its impact on diastolic function in heart failure patients. This systematic review and meta-analysis were conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and utilized the PICO schema. Searches were performed on 4 databases-PubMed, Embase, Web of Science, and Cochrane Library-without temporal restrictions. Inclusion and exclusion criteria were strictly defined, and quality assessments were conducted using the Cochrane Collaboration Risk of Bias tool. Both fixed-effects and random-effects models were used for statistical analysis, depending on inter-study heterogeneity assessed by I2 statistics and Chi-square tests. Out of 1129 identified publications, 8 studies met the criteria and were included in the meta-analysis. These studies consisted of both randomized controlled trials and cohort studies and featured diverse global populations. Significant reductions were found in the echocardiographic parameter E/e' ratio and LAVi upon treatment with Sacubitril/Valsartan compared to standard therapies, with mean differences of -1.38 and -4.62, respectively, both with P values < .01. This meta-analysis demonstrates that Sacubitril/Valsartan significantly improves diastolic function parameters in heart failure patients compared to standard treatments. These findings underscore the potential benefits of Sacubitril/Valsartan in the management of heart failure, particularly for patients with diastolic dysfunction.

Risk assessment by acute bedside echocardiography prior to acute coronary angiography in patients with ST-elevation myocardial infarction: a feasibility study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation. Background Early risk assessment by hemodynamic measurements in patients with ST-elevation myocardial infarction (STEMI) could be useful for early detection of patients at risk of developing hemodynamic instability after primary percutaneous coronary intervention (pPCI). Anterior STEMI patients have larger infarct size and may be of particular interest. Transthoracic echocardiography (TTE) is a quick, non-invasive, and available tool, however, evidence regarding the use of acute TTE prior to acute coronary angiography (CAG) is limited. Purpose To assess the feasibility of acute bedside hemodynamic assessment in the cath. lab. by TTE in addition to clinical examination, and blood samples in STEMI patients without CS at arrival in the cath. lab. Methods STEMI patients without CS at hospital arrival and treated with pPCI were included in the study during a five week period. Clinical examination (Killip class), blood sampling (lactate, troponin T (TNT), proB-type natriuretic peptide (proBNP), and focused bedside 2D TTE with Doppler were performed prior to the acute CAG. The TTE protocol was focused (approx. 5 minutes) on hemodynamic measurements, infarction related complications, and differential diagnoses e.g. aortic dissection. The TTE was performed during preparation for the acute CAG. Patients were stratified in anterior- vs. non-anterior STEMI based on the culprit artery and prehospital ECG. Feasibility was estimated by all of the following echocardiographic parameters; left ventricular ejection fraction (LVEF), left ventricular outflow tract (LVOT) velocity time integral (VTI), and right ventricular function (tricuspid annular plane systolic excursion (TAPSE)). Results A total of 60 STEMI patients (aged mean 63 years, 18% female) were included, and 47% had an anterior STEMI. No differences in baseline characteristics between the two groups were found including comorbidities, clinical parameters, and time from cath. lab. arrival to first wire over the culprit lesion (median (IQR) 28 (23; 38) vs 32 (24; 40) minutes). Admission biomarkers of blood glucose, lactate, and proBNP plasma concentrations were similar between the two groups. Whereas admission TNT were higher for patients with anterior STEMI (median (IQR) 110 (37; 449) vs. 37 (20; 94) ng/L, p=0.01). The feasibility of TTE-study protocol was 93%. Patients with anterior STEMI had lower LVEF (mean: 36±11 vs. 48±9%, p=0.0003; missing: n=0), and a trend to lower LVOT VTI (19 (6.4) vs. 22 (5.0) cm, p=0.06; missing: n=4). No difference in parameters of diastolic function or TAPSE (missing: n=0) were found. None of the included patients had echocardiographic visible complications related to the infarction. Conclusion Acute TTE is to a high degree feasible and does not delay time to acute revascularization in STEMI patients. Patients with anterior STEMI have significantly higher admission TNT levels, lower LVEF, and a trend to lower LVOT VTI compared with non-anterior STEMI patients.

Dynamics of clinical and echocardiographic parameters of patients with cardiovascular diseases 3, 12 and 26 months after COVID-19 pneumonia

Aim: to study the dynamics of clinical and echocardiographic parameters in patients with cardiovascular diseases (CVD) at 3, 12, and 26 months after COVID-19 pneumonia. Material and methods. The dynamics of clinical and echocardiographic parameters were studied in 130 patients with CVD at 3, 12, and 26 months after COVID-19 pneumonia (57 ± 8 years old, 46.9 % males). Results. Between the 1st and 2nd visits, body mass index (BMI) increased (30.6 ± 5.1 kg/m2 vs. 31.4 ± 5.4 kg/m2, p &lt; 0.001), the number of patients with obesity of grades 2 –3 increased (14.6 % vs. 23.1 %, p &lt; 0.001). Early diastolic septal mitral annular velocity decreased from the 2nd to the 3rd visit (7.0 [6.0; 8.0] cm/s vs. 6.0 [5.0; 8.0] cm/s, p = 0.023), as did the maximum diastolic lateral tricuspid annular velocity (12.0 [11.0; 14.0] cm/s vs. 8.0 [6.0; 9.0] cm/s, p &lt; 0.001). Between the 2nd and 3rd visits, the average global longitudinal strain of the left ventricle increased ( –19.3 ± 2.6 % vs. –19.8 ± 2.2 %, p = 0.034), the frequency of detecting its reduced values decreased (34.9 % vs. 17.4 %, p = 0.003). Conclusion. In the long term after COVID-19 pneumonia, patients with CVD show an increase in BMI accompanied by worsening of diastolic ventricular function parameters without signifi cant progression in the frequency and severity of CVD.

Changes in the cardiovascular profile in patients 3 and 12 months after COVID-19 pneumonia: parameters of arterial stiffness, global longitudinal strain, and diastolic function of the left ventricle

Aim. To study changes in the brachial – ankle pulse wave velocity (baPWV), ankle – brachial index (ABI), diastolic function, and global longitudinal strain of the left ventricle (LV) 3 and 12 months after COVID-19 pneumonia.Materials and methods. The dynamics of vascular age and LV global longitudinal strain was studied in 154 patients 3 and 12 months after COVID-19 pneumonia (51 ± 12 years, 48% were women). The control group consisted of 55 sexand age-matched individuals.Results. During the follow-up, the average baPWV decreased (13.2 [11.8; 15.1] cm / sec vs. 13.0 [11.8; 14.1] cm/ s; p &lt; 0.001), and the frequency of its elevated values declined (45.4 vs. 35.1%; p = 0.008). The average ABI increased (1.09 [1.04; 1.14] vs. 1.11 [1.06; 1.17]; p = 0.012), but remained within the normal range. LV global longitudinal strain (LV GLS) (–19.6 ± 2.2 and –19.7 ± 2.5%; p = 0.854) and the frequency of reduced LV GLS (21.4 and 26.6%; p = 0.268) did not change significantly and did not differ from values in the control group. Global longitudinal strain in the LV basal inferoseptal segment improved (–19.2 ± 3.6% vs. –20.1 ± 4.0%; p = 0.032). The early diastolic mitral annular velocity decreased (8.4 ± 3.0 cm / s vs. 8.0 ± 2.5 cm / s; p = 0.023). The LV isovolumic relaxation time was greater than in the control group (101.8 ± 22.3 ms at the 1st visit vs. 92.9 ± 21.5 ms; p = 0.012; 105.9 ± 21.9 ms vs. 92.9 ± 21.5 ms at the 2nd visit; p &lt; 0.001). A positive correlation was found between baPWV (r = 0.209; p = 0.009) and ABI (r = 0.190; p = 0.021) and strain parameters of the LV basal segments 12 months after discharge.Conclusion. Patients with optimal visualization on echocardiography at 12 months after COVID-19 pneumonia, compared to the results of the examination 3 months after the disease, had deteriorated parameters of LV diastolic function. LV GLS was within the grey zone and did not change significantly. An improvement in arterial stiffness was noted, associated with an improvement in the strain of basal LV segments.

Glucose control during pregnancy in patients with type 1 diabetes correlates with fetal hemodynamics: a prospective longitudinal study

BackgroundMaternal diabetes adversely affects fetal cardiovascular system development. Previous studies have reported that the fetuses of mothers with diabetes exhibit both structural and functional changes; nevertheless, prior studies have not examined the association between glucose control and fetal cardiac morphology and performance. Thus, the objective was to determine the association between fetal cardiac morphology and function and maternal glucose control in type 1 diabetes and to compare the differences in measured cardiac parameters between the fetuses of mothers with diabetes and healthy controls.MethodsIn this prospective, longitudinal case-control study — including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women — fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors — including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) — were analyzed across three time periods: the last menstrual period to 13 (V1), 14–22 (V2), and 23–32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed.ResultsAt 28–32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18–22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28–32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester.ConclusionIn women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.

Incidence and predictors of heart failure with reduced and preserved ejection fraction after ST-elevation myocardial infarction in the contemporary era of early percutaneous coronary intervention.

The development and incidence of de-novo heart failure after ST-elevation myocardial infarction (STEMI) in the contemporary era of rapid reperfusion are largely unknown. We aimed to establish the incidence of post-STEMI heart failure, stratified by left ventricular ejection fraction (LVEF) and to find predictors for its occurrence. Furthermore, we investigated the course of left ventricular systolic and diastolic function after STEMI. A total of 1172 all-comer STEMI patients from the CardioLines Biobank were included. Patients were predominantly male (74.5%) and 64 ± 12 years of age. During a median follow-up of 3.7 years (2.0, 5.5) we found a total incidence of post-STEMI heart failure of 10.9%, of which 52.1% heart failure with reduced ejection fraction (HFrEF), 29.4% heart failure with mildly reduced ejection fraction and 18.5% heart failure with preserved ejection fraction (HFpEF). Independent predictors for the development of HFrEF were male sex (β = 0.97, p = 0.009), lung crepitations (β = 1.09, p = 0.001), potassium level (mmol/L, β = 0.43, p = 0.012), neutrophil count (109/L, β = 0.09, p = 0.001) and a reduced LVEF (β = 1.91, p < 0.001) at baseline. Independent predictors for the development of HFpEF were female sex (β = 0.99, p = 0.029), pre-existing kidney failure (β = 1.95, p = 0.003) and greater left atrial volume index (β = 0.04, p = 0.033) at baseline. Follow-up echocardiography (median follow-up 20 months) showed an improvement in LVEF (p < 0.001), whereas changes in diastolic function parameters showed both improvement and deterioration. In the current era of early STEMI reperfusion, still one in 10 patients develops heart failure, with approximately half of the patients with a reduced and half with a mildly reduced or normal LVEF. Predictors for the development of HFrEF were different from HFpEF.

Association Between Family History in Patients with Primary Gout and Left Ventricular Diastolic Function: A Cross-Sectional Study.

This study aimed to employ echocardiography for measuring the markers of left ventricular (LV) diastolic function to investigate the effects of family history of gout on the LV diastolic function in patients with primary gout. Two hundred and eighty-four patients with primary gout who visited the Department of Rheumatology and Immunology of the First Affiliated Hospital of Chengdu Medical College from September 2020 to July 2022 were selected and their family history of gout, general information, and laboratory markers were recorded. Parameters of LV diastolic function were measured via echocardiography. The correlation between family history and LV diastolic function markers was analyzed using univariate and multivariate regression and the receiver operating characteristic (ROC) curve analyses. LV diastolic function parameters, peak early mitral diastolic velocity (E)/peak late mitral diastolic velocity (A), and early septal mitral annulus diastolic motion velocity (Sepe'), early lateral mitral annulus diastolic motion velocity (Late') and their mean (e'), were significantly lower in patients with familial primary gout, while left atrial volume index (LAVI) and E/e' were markedly elevated in patients with sporadic primary gout. In patients with family history, the proportion of grade ≥2 LV diastolic insufficiency was distinctly higher than that in patients without family history (41.6% vs 12.3%). Even after adjusting for confounding variables, LAVI, E/A, Sepe', Late', e', E/e' were obviously associated with family history of gout. The area under ROC of family history combined with SUA level for identifying grade ≥2 LV diastolic insufficiency in patients with primary gout was 0.872 (P<0.05). Family history of gout was closely related to echocardiographic LV diastolic function parameters in patients with gout, what is more, family history of gout combined with SUA level was found to be a valuable indicator for discriminating grade ≥2 LV diastolic insufficiency in patients with primary gout.

Evaluation of cardiac function in paediatric Wilson's disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography).

In Wilson's disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography). Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children's Hospital were included in the study between 2022 and 2023. The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e', mitral septal e' and tricuspid lateral e' velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002). Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.

Echocardiographic evaluation of myocardial structural and functional changes in patients with stage 5 chronic kidney disease before and after kidney transplantation

Introduction. Chronic kidney disease, stage 5, leads to structural remodeling of the myocardium, and heart failure. Kidney transplantation promotes normalization of structural and functional parameters of the myocardium through reverse remodeling with an improvement of its systolic function.Aim. To evaluate structural and functional changes of the myocardium in patients before and after kidney transplantation, using echocardiography.Material and methods. A retrospective cross-sectional study included 111 individuals of whom 36 patients underwent evaluation for kidney transplant waiting list placement program (Group I), and 51 patients received kidney transplants from deceased donors (Group II). Group III consisted of 24 individuals without kidney pathology. All patients underwent transthoracic two-dimensional echocardiography using the Phillips Epiq 7 device to determine the structural and functional parameters of the heart, including the use of speckle-tracking technique to assess longitudinal and circumferential myocardial deformation of the left ventricle.Results. There were no statistically significant differences in transthoracic echocardiography results between patients in Group I and Group II. When compared to the parameters of patients in Group III, statistically significant differences were found in the following parameters: volume and volume index of the left atrium, end-diastolic volume index, left ventricular mass index, interventricular septum thickness and posterior wall thickness of the left ventricle, as well as diastolic function parameters (E/A). Patients in Group I and Group II had significantly higher values of left atrium diameter: 32 (26.0;38.0) mmHg and 31.0 (27.3;40.0) mmHg, respectively, (p1-2=0.949), while in Group III this parameter value was 22.5 (20.8;25.3) mmHg (p1-3&lt;0.001, p2-3&lt;0.001). Correlation analysis revealed statistically significant correlations between left ventricular mass index and global circumferential strain (r=0.41, p=0.0027), as well as between E/e' ratio and left ventricular mass index (r=0.323, p=0.00197). It was found that after 3 months post kidney transplantation, there was a decrease in the left atrium diameter, volume, and volume index. The values of left atrium diameter immediately after kidney transplantation and after 3 months were 40 (32.5;45) mmHg and 35 (25.5;41.0) mmHg (p=0.049); those of the left atrium volume were 62.5 (50.0;77.3) and 51.5 (47.5;64.5) ml (p=0.03); and those of the left atrium volume index were 33.4 (29.3;40.2) and 28.3 (25.5;33.6) ml/m2 (p=0.01) respectively.Conclusions. Patients with chronic kidney disease stage 5 have a high incidence of functional and structural abnormalities of the left heart chambers; left ventricular mass index positively correlates with E/e' and global circumferential strain. At 3 months after kidney transplantation, there was a slight positive trend manifested in the form of a decrease in left atrium diameter and a decrease in left ventricle volume. Further dynamic study of this group of patients in the long term after kidney transplantation is planned.

Assessment of the Relationship between Periodontitis and Cardiac Parameters in Patients with Early Chronic Heart Failure: A Cross-Sectional Study.

Periodontal disease (PD) is considered a risk factor for cardiovascular events. However, its relationship to chronic heart failure (CHF) is unclear. The aim was to compare cardiac and inflammatory parameters in CHF patients with (PG) versus without periodontitis (NPG). The following parameters were recorded in 58 patients: periodontal screening and recording (PSR), troponin T, NT-proBNP, C-reactive protein (CRP), interleukin-6 (IL-6), blood pressure, heart rate, ejection fraction (EF), ventricular systolic and diastolic function parameters, incremental test, and three questionnaires (Mediterranean Diet Adherence Screener, MEDAS; Oral Health Impact Profile, OHIP-14; Patient Health Questionnaire, PHQ). The serum levels of NT-proBNP and troponin T were significantly higher in the PG, and the left ventricular systolic and diastolic function parameters were significantly lower. The correlation analysis showed age as the only independent risk factor for periodontitis and cardiac biomarkers. No significant group differences were found in the MEDAS, OHIP-14, and PHQ scores, or in CRP, IL-6, and cardiocirculatory parameters. Overall, the BMI correlated significantly with the mean PSR and total cholesterol. The occurrence of increased PSR together with increased age and cardiac risk parameters does not exclude an association between periodontitis and CHF, though no positive correlation was calculated. Periodontitis may be a modifiable risk factor for CHF. Its treatment may help to control the inflammatory burden.

Assessment of fetal cardiac functions in pregnant women with anemia: prospective, case-control study.

To compare the fetal cardiac functions between pregnant women with iron deficiency anemia (IDA) and healthy controls. This single-center, prospective, case-control study was conducted at a tertiary hospital. A total of 150 patients, including 50 patients with IDA and 100 healthy pregnant women at 30-34 weeks of gestation, were included in the study. Of the patients with anemia, 20 had mild anemia, 18 had moderate anemia, and 12 had severe anemia. Pulsed-wave Doppler, M-mode, and tissue Doppler imaging (TDI) were performed to evaluate fetal cardiac functions. The fetal cardiac score was calculated using the systolic, diastolic, and global hemodynamic function parameters. The myocardial performance index and isovolumetric relaxation time were significantly higher in the IDA group than the control group, while isovolumetric contraction time was similar. Among the tricuspid and mitral valve diastolic parameters, the E, A, and E/A values were significantly lower in the IDA group (p<0.001). Mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) were significantly lower in the IDA group (p<0.001). The IDA group also had significantly lower values for the TDI parameters, mitral and tricuspid E', A', S', E'/A' and a significantly higher E/E' ratio (p<0.001). Upon examination of anemia subgroups, a significant decrease was observed in the tricuspid and mitral A, E, and E/A in those with severe anemia (p<0.001). M-mode Doppler analysis revealed significantly lower TAPSE and MAPSE in the patient group with severe anemia. According to the subgroup comparison of TDI findings, the patients with severe anemia had significantly lower tricuspid and mitral E', A', S' and E'/A' (p<0.001) values and a significantly higher E/E' ratio (p<0.001). The fetal cardiac score was significantly higher in the maternal IDA group compared to the control group. A significant negative correlation was found between maternal hemoglobin level and fetal cardiac score (p<0.001). There may be changes in the systolic and diastolic cardiac functions of the fetuses of pregnant women with IDA. This study showed an increased E/E' ratio in the fetuses of pregnant women with IDA, suggesting a decrease in fetal heart maturation. Within the IDA group, fetal cardiac functions were more affected in those with severe anemia. This article is protected by copyright. All rights reserved.

Polistemi Vera ve Esansiyel Trombositemi Tanısı Alan Hastalarda Elektrokardiyografik ve Ekokardiyografik Bulgularının Değerlendirilmesi

Background/Aims: Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative diseases. Along with the increase in myeloproliferative cell lines, they can cause various clinical outcomes such as arterial and venous thrombosis, pulmonary hypertension, and myocardial infarction. This study was designed to evaluate the cardiac effects of these diseases via electrocardiography and echocardiography. Methods: A total of 50 patients with a diagnosis of PV, 50 patients with a diagnosis of ET, and 50 healthy individuals as a control group were included in this study. Data on patient demographics were recorded in all subjects. All patients and control subjects had electrocardiography (ECG) recordings and routine transthoracic echocardiographic examination. Pulse wave velocity (PWV) was assessed with a Holter blood pressure device. Results: In total, 50 PV patients, 50 ET patients, and 50 control group were included in the study. The demographic characteristics of the PV, ET and control groups were similar. The PR interval was significantly shorter in control subjects than in PV and ET patients (p:0.007, p:0.024). Although the measured values were within normal limits, diastolic posterior wall thickness was significantly lower in the control group compared to PV and ET patients (p:0.019, p:0.009). PWV was significantly higher in ET patients compared to the control group (p:0.012). Conclusion: In this study, evaluating the effects of PV and ET on electrocardiography and transthoracic echocardiography; ECG parameters used to predict ventricular arrhythmias (QT, QTc, Tp-Te, Tp-Te/QT) and Pulmonary Artery Pressure showed no significant change, in opposition to existing literature. Nonetheless, similar to previous publications, PV and ET were found to negatively affect the diastolic function parameters on transthoracic echocardiography. While the aortic stiffness was significantly higher in ET patients compared to the control group, no significant difference was noted between PV patients and control subjects in terms of aortic stiffness.

Реєстр PULSE-COR: взаємозв’язок між еластичністю лівого шлуночка та жорсткістю артерій у пацієнтів з есенціальною артеріальною гіпертензією

For a long time, the problem of the formation of diastolic dysfunction (DD) of the left ventricle (LV) in patients with arterial hypertension (AH) remained insufficiently studied. It was demonstrated that the formation of LV DD is largely related to the increase in stiffness of this heart chamber. We decided to evaluate the extent to which increased LV stiffness, determined noninvasively by echocardiography, is associated with LV diastolic dysfunction and determine the relationship of this method with arterial stiffness indicators for which validated methods have been developed.Materials and methods. A one-center registry called PULSE-COR was established in 2011 and is still in operation. There were 779 AH participants in our sample. A distinct cohort of patients (n=283) with essential AH and no substantial comorbidities were found from the final analysis, which comprised 320 patients who had undergone all requisite diagnostic procedures. Our tool of choice for measuring carotid-femoral pulse wave velocity (cfPWV) was the SphygmoCor device (AtCor, Australia). We also used the VaSera 1500 device (Fukuda Denshi, Japan) to measure cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI). Vascular ultrasound and intima-media thickness measurement (IMT) were included in the ultrasound diagnosis. The ASE 2016 recommendations were followed for the evaluation of diastolic LV function, and the standardized ASE protocol was followed for echocardiography. A standardized formula was used to assess the ventriculo-arterial coupling (VAC) which also included LV end-systolic elastance (Ees) and arterial elastance (Ea) evaluation. We conducted Spearman correlation analysis to identify relationships.Results and discussion. Our cohort were patients with AH, 51 % males; the mean age was 53.6±2.0 years. Mean office blood pressure (BP) was 159.8±4.5 mm Hg for systolic (SBP), 97.9±2.6 mm Hg for diastolic (DBP), 62.0±3.5 mm Hg for pulse blood (PBP) BP, and 76.6±2.2 bits per minute was the mean heart rate (HR). Both the left and right CAVI (R=0.698; p=0.012 and R=0.683; p=0.014) showed a strong correlation with VAC. Both E/A and E/e showed a substantial correlation with ABI (R=0.716; p=0.006 and R=0.764; p=0.002, respectively). cfPWV was linked with nearly the same parameters (R=0.248; p=0.001 for correlation with IMT, R=0.382; p=0.01 for correlation with low-density lipoproteins). Ea was substantially associated with IMT (R=0.491; p=0.24), total cholesterol (R=0.499; p=0.07), and low-density lipoproteins (R=0.687; p=0.001). Ees was substantially correlated with end diastolic volume (R=0.644; p=0.001), blood lymphocytes (R=–0.678; p=0.001), E/A (R=0.159; p=0.007), and E/e’ (R=–0.130; p=0.029).Conclusions. We have found a substantial correlation between validated arterial stiffness measurements and non-invasive LV stiffness evaluation parameters (VAC). VAC also was associated with LV diastolic function parameters

Effect of Sevoflurane Anesthesia on Diastolic Function: A Prospective Observational Study.

The effect of sevoflurane on left ventricular diastolic function is not well understood. We hypothesized that parameters of diastolic function may improve under sevoflurane anesthesia in patients with preexisting diastolic dysfunction compared to patients with normal diastolic function. This observational study included 60 patients undergoing breast surgery or laparoscopic cholecystectomy. Patients were assigned to diastolic dysfunction (n = 34) or normal (n = 26) groups of septal e' < 8 or ≥ 8.0 cm/s on the first thoracic echocardiography (TTE) performed before anesthesia. During anesthesia, sevoflurane was maintained at 1 to 2 minimum alveolar concentration (MAC) to maintain the bispectral index at 40 to 50. At the end of surgery, the second TTE was performed under 0.8 to 1 MAC of sevoflurane with the patient breathing spontaneously without ventilator support. Primary end point was the percentage change (Δ) of e' on 2 TTEs (Δe'). Secondary end points were ΔE/e', Δleft atrial volume index (ΔLAVI), and Δtricuspid regurgitation maximum velocity (ΔTR Vmax). These percentage changes (Δ) were compared between diastolic dysfunction and normal groups. e' (Δe': 30 [6, 64] vs 0 [-18, 11]%; P < .001), mitral inflow E wave velocity (E), mitral inflow E/A ratio (E/A), and mitral E velocity deceleration time (DT) improved significantly in diastolic dysfunction group compared to normal group. LAVI decreased in diastolic dysfunction group but did not reach statistical significance between the 2 groups (ΔLAVI:-15 [-31, -3] vs -4 [-20, 10]%, P = .091). ΔE/e' was not different between the 2 groups (11 [-16, 26] vs 12 [-9, 22]%, P = .853) (all: median [interquartile range, IQR]). TR was minimal in both groups. In this study, echocardiographic parameters of diastolic function, including septal e', E, E/A, and DT, improved with sevoflurane anesthesia in patients with preexisting diastolic dysfunction, but remained unchanged in patients with normal diastolic function.

Pulmonary congestion and systemic congestion in hemodialysis: dynamics and correlations.

Systemic congestion and pulmonary congestion (PC) are common in hemodialysis (HD) patients. However, the relationship between these two entities is not quite clear. We study this relationship and attempt to uncover the factors that may affect it considering different inter-dialytic intervals. A prospective pilot observational and interventional study including 18 HD patients was conducted. The following were obtained: i) B-line score (BLS) by lung ultrasound (LUS) (reflecting significant pulmonary congestion if BLS > 5), ii) echocardiography, iii) bioelectrical impedance analysis (BIA) (reflecting global volume status), and iv) inferior vena cava (IVC) dynamics (reflecting systemic congestion) before and after the first two consecutive HD sessions of the week, with different inter-dialytic intervals (68 hours and 44 hours). Serum N-terminal pro-brain natriuretic peptide type B (NT-proBNP) levels were obtained before each session. Then, patients were randomized into two groups: the active group, where dry weight was reduced according to BLS + standard of care, and the control group, where dry weight was modified according to standard of care. All the measures were repeated on day 30. We found no correlation between pulmonary congestion represented by BLS and IVC dimensions and dynamics reflecting systemic congestion, independent of different inter-dialytic intervals. Pulmonary congestion was quite prevalent, as mean pre- and post-dialysis BLSs were quite elevated (16 ± 5.53 and 15.3 ± 6.63, respectively) in the first session compared with the second session (16.3 ± 5.26 and 13.6 ± 5.83, respectively). Systolic (left ventricular ejection fraction) and diastolic cardiac function (e/è ratio) parameters from one side and pulmonary congestion (BLS) from the other were not always correlated. BLS was correlated to e/è ratio before HD (session 1) (R 2 = 0.476, p = 0.002) and after HD (session 2) (R 2 = 0.193, p = 0.034). Pulmonary congestion reflected by BLS was correlated to the global volume state reflected by BIA only in the second HD session (HD2) (R 2 = 0.374, p = 0.007). NT-proBNP levels and BLS were correlated before both sessions (R 2 = 0.421, p = 0.004, and R 2 = 0.505, p = 0.001, respectively). Systemic congestion was quite prevalent, as mean pre- and post-dialysis IVC dimensions and dynamics were quite elevated in both sessions, with a higher level of systemic congestion in the first HD session (diameter and collapsibility of 2.1 cm and 23%, and 2.01 cm and 19%, respectively) compared with the second session (1.98 cm and 17.5%, and 1.9 cm and 22%, respectively) without reaching statistical significance. IVC dimensions and global volume status measured by BIA were correlated in the second dialysis session (R 2 = 0.260, p = 0.031). No correlation was found between IVC dimensions and diastolic cardiac function (e/è ratio) parameters or with NT-proBNP levels. On day 30, BLS was significantly reduced in the active group, whereas no difference was found in the control group. However, no real impact was observed on IVC dimensions and dynamics or in total volume status by BIA. Pulmonary congestion is common in HD patients even after reaching their dry weight at the end of two consecutive sessions, and it is not correlated to systemic congestion, suggesting a complex multifactorial pathophysiology origin. Global volume status reflected by BIA and cardiac function are not always related to either systemic congestion represented by IVC dimensions or pulmonary congestion represented by BLS. Fluid redistribution anomalies may allow pulmonary congestion accumulation independently from systemic congestion and global volume status (non-cardiogenic pulmonary congestion). We recommend a personalised approach when managing HD patients by integrating systemic and pulmonary congestion parameters. Dry weight modification guided by repeat LUS may safely reduce pulmonary congestion. However, no impact was observed on systemic congestion or global volume status.

Evaluation of cardiac electrophysiological features in patients with premature adrenarche.

This study aimed to analyze the cardiac effects of hyperandrogenism in premature adrenarche (PA) and evaluate the risk of arrhythmia development. Fifty patients with PA and 50 healthy children from a pediatric endocrinology outpatient clinic were included in the study. The patients underwent echocardiography and electrocardiographic evaluations. Conventional echocardiography, tissue Doppler echocardiography, repolarization time, and repolarization dispersion time were evaluated. The median age in the PA and control groups was 7.91 years (5.83-9.25), 8.08 years (5.75-9.33), respectively. Thirty percent of patients in the PA group were male. While mitral early diastolic velocity deceleration time (DT), isovolumetric relaxation time (IRT), and E/e' ratio were significantly higher in the PA group than in the control group, mitral lateral annulus tissue Doppler early diastolic velocity was significantly lower (p=0.0001, 0.0001, 0.003, 0.0001). While P wave dispersion (PWD), Tpe, and QT-dispersion (QT-d) values were significantly higher in the PA group than in the control group, the P minimum value was significantly lower in the PA group (p=0.0001, 0.02, 0.004, and 0.0001, respectively). Early subclinical diastolic dysfunction was observed in the PA group. There was an increased risk of atrial arrhythmia with PWD and an increased risk of ventricular arrhythmia with increased Tpe and QT-d. There was a correlation between testosterone levels and diastolic function parameters. The increased risk of atrial arrhythmia is closely related to diastolic function.

Angiotensin Receptor-Neprilysin Inhibition (Sacubitril/Valsartan) Reduces Structural Arterial Stiffness in Middle-Aged Mice.

Increasing arterial stiffness is a prominent feature of the aging cardiovascular system. Arterial stiffening leads to fundamental alterations in central hemodynamics with widespread detrimental implications for organ function resulting in significant morbidity and death, and specific therapies to address the underlying age-related structural arterial remodeling remain elusive. The present study investigates the potential of the recently clinically available dual angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (LCZ696) to counteract age-related arterial fibrotic remodeling and stiffening in 1-year-old mice. Treatment of in 1-year-old mice with ARNI (sacubitril/valsartan), in contrast to angiotensin receptor blocker monotherapy (valsartan) and vehicle treatment (controls), significantly decreases structural aortic stiffness (as measured by invivo pulse-wave velocity and exvivo aortic pressure myography). This phenomenon appears, at least partly, independent of (indirect) blood pressure effects and may be related to a direct antifibrotic interference with aortic smooth muscle cell collagen production. Furthermore, we find aortic remodeling and destiffening due to ARNI treatment to be associated with improved parameters of cardiac diastolic function in aged mice. This study provides preclinical mechanistic evidence indicating that ARNI-based interventions may counteract age-related arterial stiffening and may therefore be further investigated as a promising strategy to improve cardiovascular outcomes in the elderly.

Effects of ipragliflozin on left ventricular diastolic function in patients with type 2 diabetes: A sub-analysis of the PROTECT trial

BackgroundWe hypothesized that the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on diastolic function might depend on baseline left ventricular (LV) systolic function. MethodsTo investigate the effects of SGLT2 inhibitors on LV diastolic function in patients with type 2 diabetes mellitus (T2DM), we conducted a post-hoc sub-study of the PROTECT trial, stratifying the data according to LV ejection fraction (LVEF) at baseline. After excluding patients without echocardiographic data at baseline or 24 months into the PROTECT trial, 31 and 38 patients with T2DM from the full analysis dataset of the PROTECT trial who received ipragliflozin or no SGLT2 inhibitor (control), respectively, were included. The primary endpoint was a comparison of the changes in echocardiographic parameters and N-terminal pro-brain natriuretic peptide levels from baseline to 24 months between the two groups stratified according to baseline LVEF. ResultsDifferences in diastolic functional parameters (e' and E/e') were noted between the two groups. Among the subgroups defined according to median LVEF values, those with higher LVEF (≥60 %) who received ipragliflozin appeared to have a higher e' and lower E/e' than did those who received the standard of care with no SGLT2 inhibitor, indicating longitudinal improvements between baseline and follow up (p = 0.001 and 0.016, respectively). ConclusionsIpragliflozin generally improved LV diastolic function in patients with type 2 diabetes, the extent of this improvement might appear to vary with LV systolic function.

Modeling the Relationship Between Diastolic Phenotype and Outcomes in Pediatric Hypertrophic Cardiomyopathy

Pediatric hypertrophic cardiomyopathy (HCM) is associated with adverse events. The contribution of diastolic dysfunction to adverse events is poorly understood. The aim of this study was to explore the association between diastolic phenotype and outcomes in pediatric patients with HCM. Children <18years of age with diagnosed with HCM were included. Diastolic function parameters were measured from the first echocardiogram at the time of diagnosis, including Doppler flow velocities, tissue Doppler velocities, and left atrial volume and function. Using principal-component analysis, key features in echocardiographic parameters were identified. The principal components were regressed to freedom from major adverse cardiac events (MACE), defined as implantable cardioverter-defibrillator insertion, myectomy, aborted sudden cardiac death, transplantation, need for mechanical circulatory support, and death. Variables that estimate left ventricular filling pressures were highly collinear and associated with MACE (hazard ratio, 0.86; 95% CI, 0.75-1.00), though this was no longer significant after controlling for left ventricular thickness and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with outcomes in the covariate-adjusted model (hazard ratio, 0.69; 95% CI, 0.5-0.94). The covariate-adjusted model had an Akaike information criterion of 213, an adjusted R2 value of 0.78, and a concordance index of 0.82 for association with MACE. Echocardiographic parameters of diastolic dysfunction were associated with MACE in this population study, in combination with the severity of left ventricular hypertrophy and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with adverse events. Additional study of diastolic function parameters adjusted for patient size could facilitate the prediction of adverse events in pediatric patients with HCM.

Assessment of atrial electromechanical delay and echocardiographic parameters in patients with multiple sclerosis

Objective: Data on cardiovascular dysfunction is limited in the previous literature on patients with multiple sclerosis. In this study, we aimed to elucidate the cardiovascular parameters in multiple sclerosis patients by comparing the systolic-diastolic functions and atrial electro-mechanical delay compared to the control group. Method: A total of 37 patients with a diagnosis of relapsing-remitting multiple sclerosis and had Expanded Disability Status Scale (EDSS) scores between 0 – 3, and 20 individuals in the control group were included in the study. Seventeen of the MS patients (n=17) were taking immunomodulatory drugs and the other 20 did not receive any immunomodulatory agents. Patients with a diagnosis or clinical suspicion of cardiac dysfunction and using cardiotoxic medications were excluded. The measurement of systolic and diastolic function parameters was performed via M – Mode 2D transthoracic echocardiography, and Atrial electro-mechanical delay (AEMD) measurements were performed with tissue Doppler. Results: E’ MV lateral and MV E/A values were determined to be higher in MS patients, who did not use immunomodulatory drugs, compared to the control group (p&lt;0.001, p=0.010 respectively). E/E’ MV lateral and MV AVmax values were determined to be significantly higher in the patient group using immunomodulators compared to the other two groups (p=0.009, p=0.012 respectively). PAs, PAI, left and right intraatrial EMG values were determined to be prolonged in MS patients using and not using drugs compared to the control group, but these values were not determined to be statistically significant. Conclusion: We found that left ventricular diastolic function was impaired in MS patients compared to the control group, and right-left intra- and interatrial AEMD were similar. Based on these results, we recommend echocardiographic assessment for early detection of left ventricular diastolic dysfunction in MS patients.