Differences In Left Ventricular Systolic Function Research Articles

Phenotypic differences between peripartum cardiomyopathy and idiopathic or familial cardiomyopathy in young women

Abstract Introduction Peripartum cardiomyopathy (PPCM) is a form of heart failure (HF) characterised by left ventricular (LV) dysfunction, which develops in previously healthy women towards the end of pregnancy or in the months following delivery. PPCM should be distinguished from underlying familial or idiopathic dilated cardiomyopathy (DCM), as management and outcomes of these conditions differ. Purpose We sought to investigate the phenotypic differences in women with PPCM as compared to those with DCM, the aetiology of which was either familial or idiopathic. Methods Sub-analysis was conducted on data collected by the African Cardiomyopathy and Myocarditis Registry Program (IMHOTEP), including 226 women from 3 sites in South Africa. Patients with a diagnosis of PPCM were compared to DCM (idiopathic or familial cardiomyopathy), with regards to their clinical presentation, echocardiography, and electrocardiography. Results Women with PPCM (n=132) were significantly younger than those with DCM (n=94) (29 [23-34] vs 38 [28-45] years). Both cohorts consisted mostly of patients of Black African descent (PPCM 66.7%, DCM 60.6%). A family history of HF was more commonly reported with DCM (36.6% vs 15%, p<0.001). Comorbidities, including hypertension, were uncommon in both groups. Two thirds of patients (66.4%) with PPCM had NYHA functional class III/IV at time of presentation, as compared to half of those with DCM (52.4%, p=0.14). Median systolic BP (113mmHg), diastolic BP (72mmHg) and pulse rate (91 bpm) did not differ between groups. On the ECG, there were significant differences in the intervals between patients with PPCM and DCM (PR interval of 152ms vs 168ms, p<0.001; QRS duration of 87ms vs 106ms, p<0.001; QTc by Bazett 429ms vs 451ms, p<0.001). Atrial fibrillation/flutter (5.5% vs 0.8%, p=0.083), left axis deviation (20.2% vs 2.6%, p<0.001) and left bundle branch block (22.6% vs 3.9%, p<0.001) occurred more frequently DCM compared to PPCM. Patients with PPCM more often manifested T wave inversion in the precordial leads (62.1% vs 46.8%, p=0.022). While there was no difference in LV systolic function (LVEF 28% [22-37]) between the groups, women with DCM had larger ventricles (LVEDD 63mm [57-69] vs 61mm [57-65], p=0.023), and atria (left atrial area 26.8 cm2 [21.9-30.2] vs 20.9 cm2 [18.2-26.1], p=0.002). However, LV thrombus was more frequently reported in PPCM compared to DCM (9.1% vs 2.1%, 0.032). Conclusion In this study, we demonstrate that compared to women with idiopathic and familial DCM, patients with PPCM were younger and had a number of phenotypic differences. The 12-lead ECG may be useful in the differentiation of both conditions. Accurate phenotyping of patients presenting with cardiomyopathy in the peripartum period may help to determine which patients require further investigations for DCM and influence the immediate and long-term care of these women.Figure 1

Abstract 13211: Dysregulated Myocardial Calcium Handling is a Driver of Early Heart Failure in Type 1 and Type 2 Diabetes

Introduction: Dysregulated myocardial calcium handling may be a precursor for heart failure in type 1 (T1D) and type 2 diabetes (T2D). Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing in vivo myocardial calcium handling. Hypothesis Myocardial calcium handling is impaired in patients with either T1D or T2D, despite normal left ventricular (LV) systolic function. Methods Prospective, multicentre, study in patients with T1D (n=19), T2D (n=30), and healthy volunteers (n=28), all of whom were free of known cardiovascular disease. Cardiac MRI was performed including MEMRI, during which T1 mapping was performed at baseline and every 2.5 min for 30 min after manganese infusion (Figure 1a). The rate of myocardial manganese uptake, determined by Patlak modelling [1]. Results No difference in LV systolic function was observed between groups, but those with T2D had more concentric LV remodelling compared to T1Ds and healthy volunteers (LV mass:volume 0.90±0.16 vs. 0.75±0.09 vs. 0.74±0.10 g/mL, respectively; p=0.001, Table 1). Mean myocardial manganese uptake was significantly lower in both T1Ds (6.47±0.99 mL/100g/min) and T2Ds (6.43±0.77 mL/100g/min) compared with healthy volunteers (8.33±0.77 mL/100g/min; p<0.001 for both, Figure 1b). Conclusion For the first time, we have demonstrated that myocardial calcium handling is impaired in patients with either T1D or T2D despite apparently normal LV systolic function. This may be a precursor to the development of diabetic cardiomyopathy and has implications for developing novel therapeutic targets for its prevention and treatment. [1] Skjold, A et al. J Magn Reson Imag 2006;24:1047-1055 graphic_{ECFA3EC4-96D0-4ADC-8599-3D854C84F04F}graphic_{F1770AC6-718C-4C39-B107-4A5DD60957A8}

Both beat-to-beat changes in RR-interval and left ventricular filling time determine ventricular function during atrial fibrillation.

AimsThe irregular atrial electrical activity during atrial fibrillation (AF) is associated with a variable left ventricular (LV) systolic function. The mechanisms determining LV function during AF remain incompletely understood. We aimed at elucidating how changes in RR-interval and LV preload affect LV function during AF.Methods and resultsBeat-to-beat speckle-tracking echocardiography was performed in 10 persistent AF patients. We evaluated the relation between longitudinal LV peak strain and preceding RR-interval during AF. We used the CircAdapt computational model to evaluate beat-to-beat preload and peak strain during AF for each patient by imposing the patient-specific RR-interval sequences and a non-contractile atrial myocardium. Generic simulations with artificial RR-interval sequences quantified the haemodynamic changes induced by sudden irregular beats. Clinical data and simulations both showed a larger sensitivity of peak strain to changes in preceding RR-interval at slow heart rate (HR) (cycle length, CL <750 ms) than at faster HR. Simulations explained this by a difference in preload of the current beat. Generic simulations confirmed a larger sensitivity of peak strain to preceding RR-interval at fast HR (CL = 600 ms: Δ peak strain = 3.7% vs. 900 ms: Δ peak strain = 0.3%) as in the patients. They suggested that longer LV activation with respect to preceding RR-interval is determinant for this sensitivity.ConclusionsDuring AF, longitudinal LV peak strain is highly variable, particularly at fast HR. Beat-to-beat changes in preload explain the differences in LV systolic function. Simulations revealed that a reduced diastolic LV filling time can explain the increased variability at fast HR.

Spectrum of Cardiac Manifestations in COVID-19: A Systematic Echocardiographic Study.

Information on the cardiac manifestations of coronavirus disease 2019 (COVID-19) is scarce. We performed a systematic and comprehensive echocardiographic evaluation of consecutive patients hospitalized with COVID-19 infection. One hundred consecutive patients diagnosed with COVID-19 infection underwent complete echocardiographic evaluation within 24 hours of admission and were compared with reference values. Echocardiographic studies included left ventricular (LV) systolic and diastolic function and valve hemodynamics and right ventricular (RV) assessment, as well as lung ultrasound. A second examination was performed in case of clinical deterioration. Thirty-two patients (32%) had a normal echocardiogram at baseline. The most common cardiac pathology was RV dilatation and dysfunction (observed in 39% of patients), followed by LV diastolic dysfunction (16%) and LV systolic dysfunction (10%). Patients with elevated troponin (20%) or worse clinical condition did not demonstrate any significant difference in LV systolic function compared with patients with normal troponin or better clinical condition, but they had worse RV function. Clinical deterioration occurred in 20% of patients. In these patients, the most common echocardiographic abnormality at follow-up was RV function deterioration (12 patients), followed by LV systolic and diastolic deterioration (in 5 patients). Femoral deep vein thrombosis was diagnosed in 5 of 12 patients with RV failure. In COVID-19 infection, LV systolic function is preserved in the majority of patients, but LV diastolic function and RV function are impaired. Elevated troponin and poorer clinical grade are associated with worse RV function. In patients presenting with clinical deterioration at follow-up, acute RV dysfunction, with or without deep vein thrombosis, is more common, but acute LV systolic dysfunction was noted in ≈20%.

Cardiac troponin-I phosphorylation underlies myocardial contractile dysfunction induced by hypothermia rewarming.

Rewarming the intact heart after a period of hypothermia is associated with reduced myocardial contractility, decreased Ca2+ sensitivity, and increased cardiac troponin-I (cTnI) phosphorylation. We hypothesized that hypothermia/rewarming (H/R) induces left ventricular (LV) contractile dysfunction due to phosphorylation of cTnI at Ser23/24. To test this hypothesis, the response of wild-type mice (n = 7) to H/R was compared with transgenic (TG) mice expressing slow skeletal TnI (TG-ssTnI; n = 7) that lacks the Ser23/24 phosphorylation sites. Hypothermia was induced by surface cooling and maintained at 23-25°C for 3 h. Subsequently, the animals were rewarmed to 37°C. LV systolic and diastolic function was assessed using a 1.4 F pressure-volume Millar catheter introduced via the right carotid artery. At baseline conditions, there were no significant differences in LV systolic function between wild-type and TG-ssTnI mice, whereas measurements of diastolic function [isovolumic relaxation constant (τ) and end-diastolic pressure-volume relationship (EDPVR)] were significantly (P < 0.05) reduced in TG-ssTnI animals. Immediately after rewarming, significant differences between groups were found in cardiac output (CO; wild-type 6.6 ± 0.7 vs. TG-ssTnI 8.8 ± 0.7 mL/min), stroke work (SW; wild-type 796 ± 112 vs. TG-ssTnI 1208 ± 67 mmHg/μL), and the preload recruited stroke work (PRSW; wild-type 38.3 ± 4.9 vs. TG-ssTnI 68.8 ± 8.2 mmHg). However, EDPVR and τ returned to control levels within 1 h in both groups. We conclude that H/R-induced LV systolic dysfunction results from phosphorylation of cTnI at Ser23/24.NEW & NOTEWORTHY Rewarming following a period of accidental hypothermia leads to a form of acute cardiac failure (rewarming shock), which is in part due to reduced sensitivity to Ca2+ activation of myocardial contraction. The results of the present study support the hypothesis that rewarming shock is due to phosphorylation of cardiac troponin I.

Autoimmune myocarditis is not associated with left ventricular systolic dysfunction

BackgroundExperimental autoimmune myocarditis (EAM) is a common animal model for the investigation of the pathophysiology of myocarditis. Because of diverging findings from previous studies, we performed serial echocardiographic examinations throughout the course of the disease and investigated the dimensions of the murine heart and left ventricular (LV) systolic function.Materials and MethodsExperimental autoimmune myocarditis was induced in male Balb/c mice by subcutaneous injection of a fragment of the α‐myosin heavy chain (MyHC‐α 614‐629: Ac‐SLKLMATLFSTYASAD). Transthoracic echocardiography was performed on days 0, 7 and 21 in healthy animals and mice with EAM.ResultsExperimental autoimmune myocarditis was associated with a reduction in LV systolic function and an increase in LV internal diameter in diastole (LVIDd) and systole (LVIDs) 7 days postimmunization. After 21 days, EAM led to a significant increase in LV‐thickness (1.3‐fold increase in LV anterior wall diameter in diastole [LVAWDd]), but there was no difference in LV systolic function between immunized animals and healthy controls. LV‐thickness correlated well with the severity of myocarditis in the histopathological examination (LVAWDd: rs = 0.603, P = 0.003, LV anterior wall diameter in systole (LVAWDs): rs = 0.718, P < 0.0001).ConclusionOur results indicate that EAM leads to an initial dilatation of the LV that is followed by ventricular “hypertrophy.” On day 21, there was no significant difference in LV systolic function between immunized animals and controls. Furthermore, the ageing of the animals had a major impact on the echocardiographic parameters; therefore, the use of healthy age‐matched controls seems warranted when echocardiography is performed in rodents.

Incremental Value of the Tissue Motion of Annular Displacement Derived From Speckle-Tracking Echocardiography for Differentiating Chronic Constrictive Pericarditis From Restrictive Cardiomyopathy.

The tissue motion of annular displacement provides an accurate and rapid assessment of left ventricular (LV) systolic function. However, it has rarely been used in patients with chronic constrictive pericarditis and restrictive cardiomyopathy. This study aimed to assess the differences in LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy using tissue motion of annular displacement derived from speckle-tracking echocardiography. Twenty-four patients with constrictive pericarditis, 24 with restrictive cardiomyopathy, and 25 healthy volunteers (controls) were enrolled. The septal and lateral mitral annular longitudinal displacements, displacement at the midpoint, and normalized midpoint displacement of the mitral ring were calculated. Mitral annular tracking and quantification of the tissue motion of annular displacement were achieved within 10 seconds. In patients with constrictive pericarditis, the lateral mitral annular longitudinal displacement, displacement at the midpoint, and midpoint displacement of the mitral ring were decreased, whereas the septal mitral annular longitudinal displacement was preserved compared to controls, indicating that the reduction of systolic function in constrictive pericarditis was caused by pericardial adhesion and calcium. In patients with restrictive cardiomyopathy, tissue motion of annular displacement was more reduced compared to patients with constrictive pericarditis and controls. The correlation between the septal mitral annular longitudinal displacement and left ventricular ejection fraction was 0.67 (P < .001). A cutoff value of 8.45 mm for the septal mitral annular longitudinal displacement could effectively differentiate constrictive pericarditis from restrictive cardiomyopathy with 95.2% sensitivity and 91.7% specificity. The tissue motion of annular displacement was decreased in patients with constrictive pericarditis, which indicated early impairment of longitudinal function in constrictive pericarditis; adhesion and calcium in the pericardium might account for the reduction. The septal mitral annular longitudinal displacement provides a fast and effective method for the assessment of LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy.

Long-Term Effects of In Utero Antiretroviral Exposure: Systolic and Diastolic Function in HIV-Exposed Uninfected Youth.

The aim of this study was to evaluate the association of in utero exposure to highly active antiretroviral therapy (HAART) with left ventricular (LV) function and structure in HIV-exposed uninfected (HEU) children. A prospective, multisite cohort study in HEU children was conducted by the Pediatric HIV/AIDS Cohort Study (PHACS). Echocardiographic measures of LV systolic and diastolic function and cardiac structure were obtained from HEU subjects aged ≥6 years enrolled in the PHACS Surveillance Monitoring of ART Toxicities study. Echocardiographic Z-scores were calculated using normative data from an established reference cohort. We used adjusted linear regression models to compare Z-scores for echocardiographic measures from HEU children exposed in utero to HAART with those exposed to non-HAART, adjusting for demographic and maternal health characteristics. One hundred seventy-four HEU subjects with echocardiograms and maternal ARV information were included (mean age 10.9 years; 48% male, 56% black non-Hispanic). Among 156 HEU youth with any ARV exposure, we observed no differences in Z-scores for LV systolic function measures between youth exposed in utero to HAART (39%) and HAART-unexposed youth in either unadjusted or adjusted models. In adjusted models, those exposed to HAART had significantly lower mitral late diastolic inflow velocities (adjusted mean Z-score = 0.00 vs. 0.52, p = .04) and significantly higher adjusted mean LV mass-to-volume ratio Z-scores (adjusted mean Z-score = 0.47 vs. 0.11, p = .03) than HAART-unexposed youth. Uninfected children with perinatal exposure to HAART had no difference in LV systolic function. However, small but significant differences in LV diastolic function and cardiac structure were observed, suggesting that continued monitoring for cardiac outcomes is warranted in this population.

Cardiovascular Characteristics in Subjects With Increasing Levels of Abnormal Glucose Regulation

OBJECTIVETo evaluate whether impaired fasting glucose (IFG) or the combination of IFG and impaired glucose tolerance (IGT) is associated with progressive abnormalities of cardiac geometry and function.RESEARCH DESIGN AND METHODSWe studied 562 nondiabetic (311 women), nonhypertensive participants of the second Strong Heart Study exam, without prevalent cardiovascular (CV) disease and with estimated glomerular filtration rate ≥60 mL/min/1.73 m2 (age 46–65 years, 198 with isolated IFG [35%], and 132 with combined IFG and IGT [23%]). Anthropometric parameters, insulin resistance, fibrinogen, C-reactive protein (CRP), lipid profile, blood pressure (BP), and echocardiographic parameters were compared with 232 participants with normal glucose tolerance (NGT).RESULTSBMI, prevalence of central obesity, homeostatic model assessment index of insulin resistance, plasma triglycerides, fibrinogen, and CRP increased progressively across categories of glucose intolerance (P < 0.0001), with the IFG+IGT group having higher values than those with isolated IFG (0.05 < P < 0.0001). Compared with NGT, both IFG and IFG+IGT exhibited greater left ventricular (LV) mass (P < 0.0001) and lower Doppler early peak rapid filling velocity to peak atrial filling velocity ratio (P < 0.005), without differences in LV systolic function. The odds of LV hypertrophy (LV mass index >46.7 in women or >49.2 g/m2.7 in men) was 3.5 in IFG participants (95% CI 0.68–17.76; P = NS) and 9.76 (2.03–46.79; P = 0.004) in IFG+IGT, compared with NGT, after adjustment for age, sex, heart rate, systolic BP, and waist circumference (WC). In the overall sample, LV mass index was associated with WC (P = 0.033), CRP (P = 0.027), and 2-h oral glucose tolerance test (P = 0.001) independently of confounders.CONCLUSIONSCardiometabolic profile and markers of inflammation are more severely altered in men and women with both IFG and IGT compared with those with IFG alone. These individuals, in the absence of hypertension, have a 10-fold greater probability of preclinical CV disease (LV hypertrophy).

Left Ventricular Diastolic Function in Patients on Hemodialysis

BackgroundPrevious studies have shown that the assessment of Doppler mitral flow velocity (DMFV) curves can be used to predict prognosis owing to left ventricular (LV) diastolic dysfunction in certain specific...

Left ventricular function by ‘conventional’ and ‘tissue Doppler’ echocardiography in paediatric dialysis patients

Cardiovascular abnormalities are common in children with chronic kidney disease (CKD). Left ventricular (LV) structure and functions have been extensively studied by conventional pulse-wave Doppler echocardiography (cPWD), however, tissue Doppler imaging (TDI) is a relatively new echocardiography method. The aims of this study were to evaluate LV diastolic function in paediatric dialysis patients using cPWD and TDI methods, and to compare the findings obtained with two modalities. This study included 38 children and adolescents on dialysis (14 haemodialysis and 24 peritoneal dialysis, duration of dialysis 58.0 +/- 32.8 months) and 16 age- and sex-matched healthy subjects. The mean left ventricular mass index (LVMI) was significantly higher in the patient group (P < 0.001) and the most common cardiac geometry was concentric LV hypertrophy (55%). There was no significant difference in LV systolic function between patient and control groups. However, dialysis patients had worse LV diastolic function both according to cPWD (lower E/A ratio) and TDI (lower Em/Am ratio) than the healthy subjects (P < 0.001 and P = 0.001, respectively). Also, the index of LV filling pressure (E/Em ratio) obtained by the combination of cPWD and TDI was significantly higher in the patients (P < 0.001). Cumulative dose of calcium-based phosphate binder (CBPB), diastolic blood pressure and LVMI were the independent predictors of E/Em ratio. Our study shows that LV diastolic dysfunction is common in paediatric dialysis patients and TDI findings correlate well with cPWD findings. Similarly, higher dose intake of CBPB, hypertension and LV hypertrophy have a negative effect on LV filling pressure suggesting diastolic function.

Carvedilol may alleviate late cardiac remodelling following surgical ventricular restoration

Surgical ventricular restoration (SVR) can be effective to treat ischaemic cardiomyopathy or left ventricular (LV) aneurysm. However, the initial improvement in LV function does not always last long because of LV remodelling. Beta-blockers prevent LV remodelling of failing hearts; however, their effects following SVR have not been elucidated. Thus, we sought to investigate the effects of a potent beta-blocker, carvedilol, on LV remodelling and function following SVR in rats with myocardial infarction. Rats, which developed LV aneurysm 4 weeks after coronary artery ligation, underwent SVR. They were orally administered a vehicle (vehicle group), and low or high dose of carvedilol (20 or 50 mg kg(-1)day(-1) for C20 or C50 group) for 4 weeks following SVR (n=7 in each group). Four weeks following SVR, late cardiac remodelling was alleviated only in the C50 group (LV end-diastolic area: 65+/-4 mm(2) vs 74+/-11 mm(2) and 76+/-11 mm(2) for C50, C20 and vehicle groups; p=0.039 and p=0.013, respectively). There was no difference in LV systolic function (end-systolic elastance) among the three groups; however, LV diastolic functions (LV end-diastolic pressure and the time constant of isovolumic relaxation) were significantly better in the C20 and C50 groups. Histologically, the percentage of myocardial fibrosis in the C50 group (4.1+/-0.2%) was lower than those in the C20 (6.7+/-0.4%, p<0.0001) and vehicle (7.5+/-0.6%, p<0.0001) groups. The mRNA expression of transforming growth factor-beta1 and brain natriuretic peptide in the C50 group were lower than those in the C20 and the vehicle groups. High-dose carvedilol alleviated LV remodelling and diastolic dysfunction following SVR accompanying with reduction in myocardial fibrosis. Blockade of beta-adrenergic receptor may be a promising adjuvant therapy in patients following SVR.

Left ventricular diastolic dysfunction in the early stage of chronic kidney disease

The disadvantageous effect of kidney dysfunction on left ventricular (LV) diastolic function is still unknown. Forty non-chronic kidney disease (CKD) patients and 202 CKD patients, aged 40-89, were examined by standard echocardiography and the new modality of tissue Doppler imaging. All subjects were divided into 5 groups depending on their estimated glomerular filtration rate (GFR: ml/min/BSA). Classifications by GFR were defined as follows: group 1 (more than 90: normal subjects), group 2 (60-89), group 3 (30-59), group 4 (15-29) and group 5 (less than 15). There were no significant differences in LV systolic function among the groups. Mitral E velocity was significantly lower in groups 1-4 (p<0.01-0.02) compared with group 5. Mitral A velocity was higher in groups 2-5 (p<0.01-0.04) compared with group 1. The ratio of mitral E and A velocities (E/A) was significantly higher in group 1 (p<0.02-0.05) compared with groups 2-5. Deceleration time was significantly shorter in groups 1 and 2 (p<0.01-0.02) compared with groups 4 and 5. Furthermore, it was significantly lower in group 5 (p<0.01) compared with group 4. Early diastole velocity of mitral annulus (Ea) by tissue Doppler was also higher in group 1 (9.1+/-2.5; p<0.01-0.04) compared with group 2 (7.9+/-1.7), group 3 (7.9+/-1.6), group 4 (7.5+/-2.1), and group 5 (7.6+/-2.0). Severity of the kidney dysfunction appears to parallel with the rise of E/Ea significantly (p<0.02). A, E/A and Ea could differentiate between groups 1 and 2 with early stage of CKD. These data suggest that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction. Doppler indices combined with conventional and tissue Doppler methods could detect the subtle changes of diastolic function due to kidney dysfunction.

Diagnostic utility of brain‐natriuretic peptide for left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients

Left ventricular (LV) diastolic dysfunction has been reported to be prevalent in diabetic subjects, but this recognition could often be missed. We evaluated prevalence of LV diastolic dysfunction and diagnostic utility of brain-natriuretic peptide (BNP) in asymptomatic patients with type 2 diabetes mellitus. Plasma BNP levels and LV geometry and diastolic filling indices, including the ratio of peak early transmitral Doppler flow (E) over flow propagation velocity (Vp) measured by colour M-mode Doppler echocardiography, were analysed in 98 consecutive asymptomatic patients with type 2 diabetes mellitus and 51 age-matched controls. The LV mass index and relative wall thickness were higher in diabetic groups than controls without any differences in LV systolic function. The frequency of diastolic dysfunction defined as E/Vp > or = 1.5 were 31% in diabetic groups and 15% in controls (chi(2) = 4.364, p = 0.037). By receiver-operating characteristic (ROC) curve analysis, a BNP cutoff value of 19.2 pg/ml in controls had a 53.1% positive predictive value (53.1%) and a high negative predictive value (94.4%) for E/Vp >/= 1.5, whereas a BNP cutoff value of 18.1 pg/ml in diabetic groups had a 61.8% positive and 97.3% negative predictive values. The frequency of E/Vp > or = 1.5 was higher in asymptomatic diabetic patients, suggesting that LV diastolic dysfunction was prevalent. The plasma concentration of BNP could be used to depict LV diastolic dysfunction in such population.

Do women have impaired regional systolic function in hypertensive heart disease? A 3-dimensional echocardiography study

In pressure overload left ventricular (LV) hypertrophy, gender-related differences in global LV systolic function have been previously reported. The goal of this study was to determine regional systolic function of the left ventricle in male and female patients with hypertensive heart disease. Regional LV function was analyzed from multiplane transesophageal echocardiography with three-dimensional (3D) reconstruction of the left ventricle. In 24 patients (13 males and 11 females), four parallel (2 basal and 2 apical) equidistant short axis cross-sections from base to apex were obtained from the reconstructed LV. In each short axis 24 wall-thickness measurements were carried out at 15 degrees intervals at end-diastole and end-systole. Thus, a total of 192 measurements were obtained in each patient. Wall thickening was calculated as difference of end-diastolic and end-systolic wall thickness, and fractional thickening as thickening divided by end-diastolic thickness. Fractional thickening and wall stress were inversely related to end-diastolic wall thickness in both, males and females. Females showed less LV systolic function when compared to males (p<0.001). However, when corrected for wall stress, which was higher in females, there was no gender difference in systolic function. There are regional differences in LV systolic function in females and males which are directly related to differences in wall stress. Thus, gender-related differences in LV regional function are load-dependent and not due to structural differences.

Are there sex differences in regional systolic function and wall stress in hypertrophic obstructive cardiomyopathy? A three-dimensional echocardiography study

Objectives Sex-related differences in left ventricular (LV) systolic function have been previously reported in patients with aortic stenosis and hypertensive heart disease. The goal of this study was to determine systolic function of the LV in male and female patients with hypertrophic obstructive cardiomyopathy and to relate it to wall thickness and wall stress, respectively. Background Wall thickening, a parameter of regional systolic function, is determined by wall thickness and wall stress. A comprehensive analysis of regional LV function was performed from multiplane transesophageal echocardiography with 3-dimensional reconstruction of the LV. Methods In 21 patients (11 men and 10 women) 4 parallel (2 basal and 2 apical) equidistant short-axis cross sections from base to apex were obtained from the reconstructed LV. In each short axis, 24 wall-thickness measurements were carried out in 15-degree intervals at end-diastole (ED) and end-systole. Thus, a total of 192 measurements were obtained in each patient. Wall thickening, a parameter of regional systolic function, was calculated as the difference of ED and end-systolic wall thickness, and fractional thickening as thickening divided by ED thickness. Results Fractional thickening and wall stress were inversely related to ED wall thickness in both men and women. Women showed better LV systolic function when compared with men ( P < .001). However, when corrected for wall stress, which was lower in women, there was no sex difference in systolic function. Conclusions There are regional differences in LV systolic function in men and women that depend on regional wall thickness and wall stress.

Racial differences in left ventricular structure in healthy young adults

Racial differences in cardiac structure and function were evaluated in 62 black and 71 white healthy young adults. Left ventricular (LV) mass index, relative wall thickness, fractional shortening, resting cardiac index and resting systemic vascular resistance index were estimated using M-mode echocardiography. Pulsed Doppler interrogation of transmitral flow was used to characterize LV filling. Average daytime blood pressure (BP) was determined by ambulatory monitoring during a typical work or school day. Ambulatory daytime BP averaged 127 ± 12 80 ± 7 mm Hg in black subjects, and 127 ± 9 80 ± 6 mm Hg in white subjects (p = not significant). The 2 groups were also similar in resting BP, age and gender composition. Relative wall thickness was significantly greater in black than in white subjects (0.37 ± 0.06 vs 0.34 ± 0.05; p < 0.01). This difference was found in both men and women. Black subjects also had a higher resting systemic vascular resistance index (2,110 ± 570 vs 1,920 ± 500 dynes · s · cm −5 · m 2; p < 0.05) and lower resting cardiac index (3.14 ± 0.84 vs 3.46 ± 0.85 L/min/m 2; p < 0.05). There were no significant differences between black and white subjects in LV mass index, fractional shortening and normalized peak filling velocity. These results suggest that racial differences in LV structure and systemic hemodynamics exist even in patients without sustained hypertension. In our study population, the greater relative wall thickness in black subjects was not accompanied by significant differences in LV systolic function or diastolic filling.

Effect of Increasing Intraabdominal Pressure and Volume on Left Ventricular Function in Continuous Ambulatory Peritoneal Dialysis (CAPD)

To determine the effect of increasing intraabdominal pressure on left ventricular (LV) systolic function in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we studied 15 patients who had been on CAPD for at least 2 months. The study protocol included measurement of echocardiographic LV internal dimensions in diastole and systole, LV wall thickness and mass, LV ejection time, the mean velocity of circumferential fiber shortening (mean Vcf), heart rate, BP, and intraabdominal pressure. Measurements were obtained at baseline (OL) and following intraperitoneal infusion of 1-L increments of dialysate solution (up to 4 L) in both the recumbent and standing positions. Significant differences in LV systolic function resulting from intraperitoneal infusion of dialysate were confined to the subgroup with increased LV wall thickness (n = 8). In this subgroup, mean Vcf decreased progressively from 0.99 +/- 0.18 circumferences/second at baseline to 0.88 +/- 0.16 circumferences/second at 1 L (P = NS), to 0.86 +/- 0.16 circumferences/second at 2 L (P = NS), to 0.66 +/- 0.18 circumferences/second at 3 L (P less than 0.005), and to 0.60 +/- 0.14 circumferences/second at 4 L (P less than 0.005) in recumbent position. Measurements obtained in the standing position paralleled those observed during recumbency. These changes were accompanied by a significant decrease in the mean LV internal dimension in diastole and a significant increase in intraabdominal pressure, but no significant change in the mean LV internal dimensions in systole, mean heart rate, or mean systolic or diastolic BP.(ABSTRACT TRUNCATED AT 250 WORDS)