Early Diastolic Flow Velocity Research Articles

Echocardiographic Detection of Subclinical Left Ventricular Dysfunction in Asymptomatic Type Two Diabetes Mellitus

Background: Before systolic dysfunction and symptomatic heart, diabetic cardiomyopathy begins with left ventricular diastolic dysfunction (LVDD). Echocardiographic modalities were used to detect subclinical LV impairment in asymptomatic type 2 diabetics. This study aimed to identify subclinical left ventricular impairment in asymptomatic patients with type two diabetes using several echocardiographic techniques. Methods: In the present prospective cohort study, 30 adults over 18 having type II diabetes mellitus (DM) (Group I) and 20 normal controls (Group II) were studied. Transthoracic echocardiography and 12-lead ECG were performed on all individuals. Results: Pulsed wave Doppler techniques revealed significant variation in transmitral flow velocities between groups, including septal e', lateral mitral annulus early velocity (e'), septal early diastolic peak flow velocity (E)\e', Lateral E\e', and average E\e'. EF was significantly decreased in group I (P < 0.001). With a p-value of 0.001, LVESD was significantly higher in group I. The septal, lateral, and average systolic mitral annulus (S') motions in group II were significantly larger than those in group I. When comparing groups, I and II, the first showed much longer myocardial performance index (MPI) and isovolumetric contraction time (IVCT). The ET for Group I was significantly lower than that of Group II. The study group exhibited significantly greater levels of fasting blood sugar, post-prandial blood sugar, and haemoglobin A1C (HBA1C) compared to the control group (P <0.001). Conclusions: Patients having diabetes mellitus exhibited considerably greater levels of DM history fasting glucose levels, postprandial glucose levels, haemoglobin A1C (HBA1C), E/e´ ratio, LVESD, IVCT, and MPI, while having significantly lower EF and ET relative to the healthy group.

Impact of left ventricular diastolic function and direct oral anticoagulant use for predicting embolic events in patients with heart failure and atrial fibrillation

AbstractBackgroundPatients with atrial fibrillation (AF) and heart failure (HF) have high stroke risk owing to left atrial dysfunction. However, anticoagulation is a concern in patients with high bleeding risk. We aimed to identify independent predictors of stroke in HF patients with AF.MethodsWe retrospectively examined 320 patients (mean age 79 ± 12 years, 163 women) hospitalized with acute HF complicated by AF between January 2014 and December 2018. Patients were followed from admission until ischemic stroke or systemic embolism (SSE) onset or death or were censored at the last contact date or September 2023.ResultsSSE occurred in 40 patients (median follow‐up of 528 days). Multivariate Cox regression analysis identified age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.00–1.07, p = .034), direct oral anticoagulant (DOAC) use (HR 0.26, 95% CI 0.11–0.60, p = .002), and early diastolic peak flow velocity to early diastolic peak annular velocity (E/e'; HR 1.05, 95% CI 1.02–1.08, p < .001) to be independent predictors of SSE, whereas left atrial reservoir strain was not. After determining an appropriate E/e' cutoff by receiver‐operating characteristic curve analysis and adjusting the multivariate Cox model, E/e' ≥17.5 (HR 3.30, 95% CI 1.56–6.83, p = .001) independently predicted SSE. The results were consistent with no interaction in the subanalysis except for gender.ConclusionElderly patients not on DOACs with elevated E/e' may be at higher risk of stroke, suggesting that DOACs should be the first choice for patients with elevated E/e' and aggressive additional prophylaxis and careful follow‐up are needed.

Evaluation of right ventricular diastolic function, systolic function, and circulating galectin-3 concentrations in dogs with pulmonary stenosis.

Cardiovascular diseases with increased right ventricular (RV) afterload induce RV diastolic and systolic dysfunction, and myocardial fibrosis in humans. Studies in dogs with pulmonary stenosis (PS) evaluating RV diastolic function and markers of myocardial fibrosis are lacking. Dogs with PS have echocardiographic evidence of RV diastolic and systolic dysfunction and increased serum concentrations of galectin-3 (Gal-3), a surrogate biomarker for myocardial fibrosis. Forty client-owned dogs (10 controls, 30 with PS). Prospective study. All dogs had systemic blood pressure measurement, serum biochemical analysis, echocardiography, and measurement of serum Gal-3 concentration performed. Variables of RV diastolic function were obtained in 39/40 dogs. Trans-tricuspid flow velocity in early diastole to trans-tricuspid flow velocity in late diastole ratios (RV E/A) were lower (P < .001) in dogs with PS (median, 0.94; range, 0.62-2.04) compared to controls (1.78; 1.17-2.35). Trans-tricuspid flow velocity in early diastole to tricuspid annular myocardial velocity in early diastole ratios (RV E/e') were higher (P < .001) in dogs with PS (11.55; 4.69-28) compared to control (6.21; 5.16-7.21). Variables of RV systolic function were lower in dogs with PS (P = <.001). Serum Gal-3 concentration was higher (P = .002) in dogs with PS (285.1 pg/mL; 94.71-406.97) compared to control dogs (162.83 pg/mL; 52.3-232.82). Dogs with PS have RV diastolic and systolic dysfunction, and increased Gal-3 concentrations. These findings suggest the presence of RV myocardial fibrosis in dogs with PS, which could impact clinical management.

Echocardiographic evaluation of cardiac function among male adolescents at high risk of coronary heart disease

Background and aim Obesity, and family history (smoking, obesity, and hypertension) are the most important risk factors for the development of coronary heart disease (CHD) among adolescents. The study aims to evaluate the cardiac function among male adolescents at high risk for coronary heart disease. Patients and methods A total of 100 male adolescents were selected by written questionnaire in addition to 30 normal adolescents as control. Thorough history taking and physical examination. Echocardiographic examination, serum lipids, and routine laboratory investigations. Results Obesity, and a family history of (smoking, hypertension, and obesity) are among the most frequent risk factors for CHD among male adolescents. We found a statistically significant elevated concentration of serum cholesterol and triglyceride and a significant decrease in high-density lipoprotein levels among diabetic and hypertensive children in addition to a significantly elevated concentration of serum low-density lipoprotein among hypertensive children and children with a sedentary lifestyle. The echocardiography reflects a significant increase in early and decreases in late diastolic flow velocity (E and A) among hypertensive and obese adolescents versus controls. A statistically significant differences between diabetics and controls for left ventricular posterior wall diameter, inter-ventricular septal diameter, and early and late diastolic flow velocity. Conclusion Obesity and a family history of smoking, obesity, and hypertension are among the most frequent risk factors for CHD among male adolescents. Echocardiography and lipid profiles should be performed for any adolescent at high risk for development of CHD.

RETRACTED ARTICLE: Effects of Dapagliflozin on myocardial remodeling, inflammatory factors, and cardiac events in heart failure with preserved ejection fraction.

To investigate the effects of Dapagliflozin on myocardial remodeling, inflammatory factors, and cardiac events in the treatment of heart failure with preserved ejection fraction (HFpEF). Ninety-two patients with HFpEF treated in our hospital from August 2021 to March 2022 were retrospectively picked as study subjects. These subjects were randomized as the study group and control group following the random number table, with 46 cases in each group. Patients in the control group adopted standard anti-heart failure (HF) treatment, including diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists β receptor blockers, and digitalis. Patients in the study group received Dapagliflozin on the basis of the control group. Changes in myocardial remodeling-related parameters [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic blood flow velocity to late diastolic blood flow velocity (E/A), plasma N-terminal B-type brain natriuretic peptide precursor (NT-proBNP), and cardiac troponin I (CTnI)] were assessed by echocardiography before and 12months after the intervention. The content of inflammatory factors [interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)] in serum was measured by enzyme-linked immunosorbent assay. The factors affecting the clinical efficacy of Dapagliflozin were analyzed by the multivariate logistic regression. The incidence of cardiac events was compared between the two groups. The effective rate of 95.65% in the study group was much higher than 80.43% in the control group (P < 0.05). After the intervention, the study group had an especially higher content of LVEF and E/A and sharply lower content of LVEDD, NT-proBNP, and CTnI than the control group (P < 0.001). After the intervention, IL-1β, TNF-α, and IL-6 levels were markedly lower in the study group than in the control group (P < 0.001). The incidence of cardiac events, including arrhythmias, recurrent angina, heart failure rehospitalization, cardiogenic death, and all-cause mortality, was 8.70% in the study group and 26.09% in the control group, which was much lower in the study group (P < 0.05). The results of multivariate logistic regression analysis showed that LVEF and E/A were independent protective factors affecting the ineffectiveness of Dapagliflozin (P < 0.05), and LVEDD, NT-proBNP, CTnI, IL-1β, TNF-α, and IL-6 were independent risk factors affecting the ineffectiveness of Dapagliflozin (P < 0.05). In conclusion, Dapagliflozin could effectively improve myocardial remodeling, inhibit inflammatory reaction, and play a more active role in the treatment of patients with HFpEF, providing a certain clinical basis for the treatment of patients.

Ventricular dysfunction consequences of mechanical dyssynchrony in isolated complete right bundle branch block versus left bundle branch block.

Complete bundle branch block in individuals without structural heart disease is known as isolated complete bundle branch block. Isolated complete left bundle branch block (CLBBB) is correlated with ventricular dysfunction secondary to dyssynchrony; however, few studies have investigated isolated complete right bundle branch block (CRBBB), which was previously considered benign but was recently found to be associated with adverse cardiovascular outcomes. This study aimed to evaluate cardiac mechanical synchrony, and systolic and diastolic function in patients with isolated CRBBB and compare cardiac synchrony and function to patients with isolated CLBBB. This cross-sectional study was conducted at The First Hospital of China Medical University in Shenyang, China, from 2020 to 2021. A total of 44 isolated CRBBB patients, 44 isolated CLBBB patients, and 42 healthy subjects were enrolled in the study. Transthoracic echocardiography was performed in all subjects. Synchrony parameters, including the mechanical dispersion of the right ventricle [the standard deviation of time to the peak longitudinal strain of six right ventricular (RV) segments] and atrioventricular dyssynchrony parameter [the ratio of left ventricular (LV) diastolic filling time to the time interval between two adjacent R waves (RR interval) measured by tissue Doppler imaging]. RV and LV function were assessed by the global longitudinal strain (GLS) of six RV segments and 18 LV segments, and the ratio of the peak early diastolic flow velocity to annular velocity (E/e') of the tricuspid valve and mitral valve. Statistical analyses were performed, including an analysis of variance, Pearson correlation analysis, and linear regression analysis. Compared with the healthy subjects, the mechanical dispersion of the right ventricle was significantly increased, and ventricular function was impaired as evidenced by the decreased RV GLS and LV GLS, and the increased E/e' of the tricuspid valve and mitral valve in the isolated CRBBB patients (all P<0.001). Moreover, compared with the isolated CLBBB patients, the mechanical dispersion of the right ventricle and E/e' of the tricuspid valve were increased, and RV GLS was significantly reduced in the isolated CRBBB patients (all P<0.001). Mechanical dispersion of the right ventricle was independently associated with RV GLS [coefficient, 0.13; 95% confidence interval (CI): 0.004-0.26; P=0.04] in the isolated CRBBB patients. RV GLS (coefficient, 0.10; 95% CI: 0.01-0.20; P=0.03) and the ratio of the LV diastolic filling time to the RR interval measured (coefficient, -0.30; 95% CI: -0.53 to -0.07; P=0.01) were independent factors of LV GLS. The isolated CRBBB patients had impaired cardiac mechanical synchrony and ventricular function, and more decreased RV synchrony and function than the isolated CLBBB patients. Right intraventricular synchrony was independently associated with RV systolic dysfunction in patients with isolated CRBBB. Atrioventricular synchrony and RV systolic function were independently associated with the LV systolic function. Therefore, comprehensive evaluations of echocardiography results and close monitoring is required for isolated CRBBB patients.

The exercise tolerance dependence on epicardial fat thickness, right ventricular hypertrophy and right ventricular global function in patients with metabolic syndrome

Abstract Background The importance of the evaluation of right compartments of the heart is beyond doubts. Right ventricle (RV) plays one of the leading roles in assessing the prognosis of the patients, especially in the context of metabolic syndrome (MS), insulin resistance and visceral obesity. Several trials highlight the epicardial fat thickness (EFT) as a novel marker of visceral obesity and the proximity to the RV does not exclude its direct effect on ventricular function. More of that, EFT represents a metabolically active organ with a wide range of bioeffects that could potentiate cardiometabolic risk profile in patients with MS and visceral obesity. Purpose The objective of the present study was to evaluate the impact of visceral obesity, RV hypertrophy and RV diastolic and global function on exercise capacity (i.e., exercise duration (ED), metabolic equivalents (METs)) in patients with MS and persevered left ventricular function. Methods We included 97 subjects with MS (mean age 54±8.7 years) and 97 controls without MS (mean age 53±9.6 years, P=0.13). MS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. Using 2D echocardiography we assessed RV diastolic function: the ratio of early and late diastolic tricuspid flow velocities (Et/At), the ratio of early diastolic tricuspid flow velocity and early diastolic tricuspid annular velocity (Et/e't), Et deceleration time (DT); Tei index of RV by pulsed tissue Doppler; RV free wall thickness; epicardial fat thickness (EFT). All the participants underwent exercise ECG stress test (cycle ergometry) and the exercise capacity was determined by ED and METs. Results Et/At, Et/e't, EtDT and Tei index were significantly deteriorated in MS group (all P&amp;lt;0.05). Also, RV free wall thickness and EFT showed significant correlations with parameters of RV diastolic function in patients with MS, respectively: Et/At (r=−0.432, P&amp;lt;0.05; r=−0.523, P&amp;lt;0.01), Et/e't (r=0.334, P&amp;lt;0.01; r=0.291, P&amp;lt;0.01), EtDT (r=0.411, P&amp;lt;0.05; r=0.593, P&amp;lt;0.001). RV Tei index positively correlated with RV free wall thickness (r=0.628, P&amp;lt;0.001) and EFT (r=0.623, P&amp;lt;0.001). In bivariate analysis we found that METs were negatively associated to Et/e't (r=−0.208, P=0.033), EtDT (r=−0.295, P&amp;lt;0.01), RV Tei index (r=−0.515, P&amp;lt;0.001), RV free wall thickness (r=−0.504, P&amp;lt;0.001), EFT (r=−0.646, P&amp;lt;0.05) in MS group. Also, ED showed important negative correlation with the same parameters (all P&amp;lt;0.05). Systolic function of RV did not show statistically significant correlations with METs or ED. Multivariate regression analysis showed that RV free wall thickness, RV Tei index and EFT were independently associated with METs in patients with MS (P&amp;lt;0.05). Conclusions Our findings support that epicardial fat thickness, right ventricular Tei index and right ventricular hypertrophy impact exercise tolerance in patients with metabolic syndrome. Funding Acknowledgement Type of funding sources: None.

Correlation analysis of the triglyceride glucose index and heart failure with preserved ejection fraction in essential hypertensive patients.

BackgroundTriglyceride glucose index (TyG index) is a novel marker of insulin resistance. Studies have shown that TyG index is closely associated with the occurrence of hypertension and cardiovascular disease. However, little is known about the correlation between TyG index and the occurrence of heart failure with preserved ejection fraction (HFpEF) in hypertensive patients.HypothesisOur study assumes that TyG index strongly correlates with occurence of HFpEF in hypertensive patients.MethodsThis research enrolled 559 hypertensive patients (273 patients with HFpEF and 286 without HFpEF) admitted to the Department of Cardiology of Jiading Branch of Shanghai General Hospital from 2020 to 2021 as the study subjects. Gender, age, diastolic blood pressure, systolic blood pressure (SBP), and heart rate (HR) were recorded at admission. Medication history and fasting blood samples were harvested after admission to detect laboratory index. Cardiac function and ventricular structure index were measured by echocardiography. Pearson correlation analysis was conducted to identify the correlation of TyG index with cardiac function and ventricular structure. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of TyG index in HFpEF with hypertension.ResultsHFpEF patients had higher diuretic use frequencies, fasting plasma glucose, NT‐proBNP, triglycerides, TyG index, left atrial diameter (LAD), left ventricular mass index (LVMI), the ratio of peak E‐velocity of mitral orifice to peak velocity of early diastolic mitral annulus (E/e′), and SBP but lower ratio of peak E of early diastolic maximum blood flow velocity to peak A of late diastolic maximum blood flow velocity of mitral orifice (E/A) and average e′ than non‐HFpEF patients. Moreover, TyG index was correlated with LAD, left ventricular ejection fraction (LVEF), LVMI, average e′, E/e′, and NT‐proBNP. The multivariate regression analysis suggested that TyG index, E/e′, and NT‐proBNP were independent risk factors for HFpEF in hypertensive patients. Compared with E/e′ and NT‐proBNP, the area under the ROC curve (0.778 [95% confidence interval: 0.707–0.849]) was the largest for TyG index.ConclusionTyG index is higher in HFpEF patients than in non‐HFpEF patients and related to cardiac diastolic function, which strongly correlates with occurrence of HFpEF in hypertensive patients.

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis.

Several studies have shown that patients with cystic fibrosis (CF), even at a young age, have pulmonary and cardiac abnormalities. The main complications are cardiac right ventricular (RV) systolic and/or diastolic dysfunction and pulmonary hypertension, which affects their prognosis. Exercise training (ET) is recommended in patients with CF as a therapeutic modality to improve physical fitness and health-related quality of life. However, questions remain regarding its optimal effective and safe dose and its effects on the patients’ cardiac function. The study aimed to provide a wearable activity tracker (WAT)-based ET to promote physical activity in CF patients and assess its effects on cardiac morphology and function. Forty-two stable CF individuals (aged 16.8 ± 3.6 years) were randomly assigned to either the intervention (Group A) or the control group (Group B). Group A participated in a 1-year WAT-based ET program three times per week. All patients underwent a 6-min walking test (6-MWT) and an echocardiographic assessment focused mainly on RV anatomy and function at the baseline and the end of the study. RV systolic function was evaluated by measuring the tricuspid annular plane systolic excursion (TAPSE), the systolic tricuspid annular velocity (TVS’), the RV free-wall longitudinal strain (RVFWSL), and the right ventricular four-chamber longitudinal strain (RV4CSL). RV diastolic function was assessed using early (TVE) and late (TVA) diastolic transtricuspid flow velocity and their ratio TVE/A. Pulmonary artery systolic pressure (PASP) was also estimated. In Group A after ET, the 6MWT distance improved by 20.6% (p < 0.05), TVA decreased by 17% (p < 0.05), and TVE/A increased by 13.2% (p < 0.05). Moreover, TAPSE, TVS’, RVFWSL, and RV4CSL increased by 8.3% (p < 0.05), 9.0% (p < 0.05), 13.7% (p < 0.05), and 26.7% (p < 0.05), respectively, while PASP decreased by 7.6% (p < 0.05). At the end of the study, there was a significant linear correlation between the number of steps and the PASP (r = −0.727, p < 0.01) as well as the indices of RV systolic function in Group A. In conclusion, WAT is a valuable tool for implementing an effective ET program in CF. Furthermore, ET has a positive effect on RV systolic and diastolic function.

Two-Dimensional Ultrasound and Triplane Tissue Doppler Ultrasound of Patients with Severe Preeclampsia.

This study was to investigate the cardiac function characteristics under two-dimensional ultrasound and triplane tissue Doppler imaging (TDI) of patients with severe preeclampsia (SPE). 28 SPE patients with singleton pregnancy from January 2018 to December 2020 were included in the SPE group. 25 healthy nonpregnant women of reproductive age were taken as the control group (Ctrl group), and 26 normal pregnant women with singleton pregnancy were selected as the normal group (Norm group); all the research objects underwent ultrasonography. The morphological and functional indexes of left and right ventricles were compared among the cases in different groups. The results showed that the left ventricular end-diastolic period diameter (LVEDd), left ventricular relative wall thickness (LV-RWT), left ventricular mass index (LVMi), left anterior descending (LAd), left ventricular E/e and e/a values, right ventricular diameter (RV-D), right ventricular anterior wall thickness (RVAW), a value, right atrial septum (RA-S), pulmonary artery systolic pressure (PASP), left ventricular end-systolic period diameter (LVEds), interventricular septal thickness (IVSd), posterior wall thickness (PWd), end-diastolic period volume (EVD), end-systolic period volume (ESV), relative wall thickness (RWT), sphericity index (SpI), left atrium volume index (LAVi), and E/e value of patients in the SPE group were higher than those in the Ctrl group and the Norm group (P < 0.05). The mitral annular plane systolic excursion (MAPSE), s value, tricuspid annual plane systolic excursion (TAPSE), ratio of early diastolic blood flow velocity to late diastolic blood flow velocity (E/A), ratio of peak early diastolic velocity to peak late diastolic velocity (e/a), peak early diastolic velocity (e), and ejection fraction (EF) of the SPE group were lower than those of the Ctrl group and the Norm group (P < 0.05). The ratio of mitral valve early diastolic blood flow velocity to peak early diastolic velocity (E/e) of the Norm group was higher than that of the Ctrl group (P < 0.05). In two-dimensional ultrasound of the SPE group, the maximum difference in time from the start to the peak of systole (Ts) of the right ventricle between the basal and middle segments of the lateral wall and that of interventricular septum (RV-Ts-max) was 31.56 ± 0.39%. The maximum difference in time to peak of early diastole (Te) under the same condition (RV-Te-max) was 47.16 ± 0.19%. Left ventricular LV-Ts-max and LV-Te-max were 9.83 ± 0.80% and 8.37 ± 0.68%, respectively, in triplane TDI, which were considerably higher than those in the Ctrl and Norm groups (P < 0.05). It suggested that two-dimensional ultrasound and triplane TDI could reflect the ventricular morphology as well as diastolic and systolic function injury in patients, which offered a reference basis for the diagnosis of SPE.

Right ventricular dysfunction during chemotherapy in patients with breast cancer

Aim. To assess the right ventricle (RV) during chemotherapy (CT) in patients with breast cancer (BC).Material and methods. The study included 40 women aged 35-72 years with BC who underwent anthracycline chemotherapy. The main group (n=40) included women with BC, examined at the first contact, 37 of whom were reexamined after 6 months. Control group (n=25) included women without BC.Results. In the main group, the median transverse dimension and anterior wall thickness of the RV were significantly greater than in the control group (p&lt;0,001). Early diastolic transtricuspid flow velocity (Et) after 6 months was lower than in the control group (p=0,003). The ratio of Et to late (At) diastolic transtricuspid flow (Et/At) in BC patients significantly decreased during the follow-up period (p&lt;0,05) when compared with the control group and baseline values. Higher values of Tei index were noted in the main group compared to the control one (p&lt;0,05). Using logistic regression for the Tei index, the model included radiation therapy, the total anthracycline dose, and negative affectivity score as follows: F(3,17)=12,548, p&lt;0,001, R2=0,729. For the Et/At ratio, additional radiation therapy and heart rate were significant factors as follows: F(2,16)=12,548, p=0,005, R2=0,526.Conclusion. Against the background of CT, deterioration of RV systolic (increase in Tei index and RV volume) and diastolic (decrease in Et and Et/At ratio) function was noted.

Effect of food intake on echocardiographic measurements in healthy elderly

This study evaluates whether food intake affects systolic and diastolic echocardiographic measurements in healthy seniors. Thirty healthy subjects 65-70 years of age were investigated with echocardiography, at fasting and then 30, 90, and 180 min after a meal. After 30 min the biggest changes were seen in left ventricular wall stress and myocardial performance index with a decrease of 45% and 33%, respectively, compared to fasting values. Significant (p<.05) increases also were seen in left ventricular stroke volume, left ventricular cardiac output, left ventricular cardiac index, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, the E/A ratio, pulsed tissue Doppler peak systolic (s') and early (e') and late (a') diastolic velocities, pulmonary vein peak velocities in systole (S) and diastole (D), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and global longitudinal strain (GLS) (increases ranging 6%-19%). After 90 min there remained a decrease in wall stress and myocardial performance index of 31% and 17%, respectively, and smaller, but still significant, changes could be seen in left ventricular stroke volume, left ventricular outflow velocity-time integral, MAPSE (lateral), TAPSE, GLS, and a few pulsed tissue Doppler peak systolic velocities and late diastolic velocities. An increase also could be seen in deceleration time of E-wave (DT). After 180 min, all variables except DT were back at baseline or below. No significant changes were seen in S/D ratio, lateral early diastolic velocity (e' lateral) and E/e'ratio. This study shows that food intake affects commonly used echocardiographic parameters, both systolic and diastolic, in healthy seniors. With a few exceptions, the changes seen in the older population were less pronounced than previous studies in younger subjects.

Clinical Effect of Nicorandil Combined with Aspirin in the Treatment of Myocardial Ischemia.

Objective To investigate the clinical effect of nicorandil combined with aspirin in the treatment of myocardial ischemia. Methods A total of 104 patients with myocardial ischemia were admitted to our hospital from June 2019 to August 2020. These patients were selected as the research objects and randomly divided into two groups: the control group and the observation group. The control group was given asilin, and the observation group was given nicorandil tablets based on the control group. Both groups were given continuous treatment for 3 months. The curative effect, cardiac function indexes, dynamic electrocardiogram, and the occurrence of adverse reactions were observed in the two groups. Results The total effective rate of the observation group was 96.15% (50/52), which was higher than that of the control group (61.54%, 32/52), and the difference was statistically significant (P < 0.05). After treatment, left ventricular ejection fraction (LVEF) and peak early/late diastolic flow velocity (E/A) were increased (P < 0.05), while peak early diastolic flow velocity to peak mitral annular root movement velocity (E/Ea) was decreased (P < 0.05). After treatment, LVEF and E/A in the observation group were higher than those in the control group, while E/Ea was lower than that in the control group (P < 0.05). The frequency, duration of ST segment, and a total load of myocardial ischemia in the ST segment within 24 h after treatment were decreased compared with those before treatment (P < 0.05). The frequency and duration of ST segment decreased, and the total load of myocardial ischemia in the observation group was lower than those in the control group within 24 h after treatment (P < 0.05). After treatment, the total occurrence of adverse reactions in the observation group was lower than that in the control group (P < 0.05). Conclusion Nicorandil combined with aspirin in the treatment of patients with myocardial ischemia has a significant effect, which can effectively improve the electrocardiogram and cardiac function indicators of patients and reduce the incidence of adverse reactions and is worthy of clinical application.

Retrospective Echocardiographic Analysis of West Syndrome During Adrenocorticotropic Hormone Therapy.

BackgroundVentricular hypertrophy is a well-known side effect of adrenocorticotropic hormone (ACTH) therapy in patients with West syndrome (WS), but there are only a few reports of echocardiographic evaluation of these patients’ diastolic function.MethodsThe present, retrospective study analyzed echocardiographic findings in 24 patients with WS treated with ACTH therapy between April 2010 and December 2014. The therapy protocol involved administering tetracosactide acetate 0.01–0.0125 mg/kg via intramuscular injection once a day for weeks 1–2, then gradually tapering off. Echocardiographic evaluation was done before treatment initiation and at weeks 1, 2, and 4 after the initiation of treatment.ResultsThe systolic and diastolic blood pressure values were elevated at week 1 after commencement of the therapy and remained elevated throughout its duration. Both the interventricular septal end-diastolic thickness and left ventricular posterior wall end-diastolic diameter increased in thickness at week 1 and remained thickened. None of the patients experienced heart failure or systolic dysfunction. Early diastolic mitral flow velocity (E)/early diastolic mitral annular velocity (E′) increased at week 1 and remained high at weeks 2 and 4. The E wave deceleration time (DcT) was prolonged at week 2 and returned to the baseline at week 4.ConclusionIncreased ventricular wall thickness, decreased diastolic capacity, and elevated BP were noted in children with WS during ACTH therapy. Cardiac function, including ventricular wall thickness and diastolic function, should be monitored during ACTH therapy. E/E′ and DcT are useful in evaluating diastolic function.

Diagnostic Value and Clinical Performance of Cardiac Ultrasound in Patients with Chronic Heart Failure with Hypertension.

Objective To assess the diagnostic value and clinical performance of cardiac ultrasound in patients with chronic heart failure and hypertension. Methods In this prospective study, between August 2017 and January 2020, 50 patients with chronic heart failure and hypertension were recruited and assigned to the study group and 50 healthy individuals during the same period after physical examinations were included in the control group. Cardiac ultrasound examinations were performed on the participants, and the results were compared and analyzed. Results The study group had a higher left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), and late diastolic peak flow velocity (A wave) and showed lower early diastolic peak flow velocity (E wave) and late diastolic peak flow velocity/lower early diastolic peak flow velocity (E/A) ratio levels than in the control group. The study group had 15 patients with grade I cardiac function (ultrasound detection rate of 100%), 18 patients with grade II cardiac function (ultrasound detection rate of 100%), and 17 patients with grade III cardiac function (ultrasound detection rate of 100%). Grade I cardiac function patients showed the lowest LVEDD, LVESD, and E/A and the highest LVEF than grade II patients, followed by grade III patients. The study group showed higher LVEF and echocardiographic estimation of the pulmonary arterial systolic pressure (PASP) and lower right ventricular lateral wall systolic excursion velocity and tricuspid annular plane systolic excursion (TAPSE) than the control group. Chronic heart failure with hypertension was associated with high levels of right atrial total emptying volume (RAVIt), right atrial passive emptying volume (RAVIp), right atrial active emptying volume (RAVIa), and right atrial active emptying fraction (RAVIaEF) and low levels of right atrial total emptying fraction (RAVItEF) and right atrial passive emptying fraction (RAVIpEF) versus the healthy status (all P < 0.05). Conclusion Cardiac ultrasound is a noninvasive operation with low cost, high repeatability, and accurate detection, which can identify right heart function impairment at an early stage, assist clinical treatment, and improve patient prognosis, so it is worthy of promotion and application.

New perspective on fatigue in hemodialysis patients with preserved ejection fraction: diastolic dysfunction : Fatigue and diastolic dysfunction.

The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 ± 13.5years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r -0.257, p 0.012) and e' (r -0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e' ratio, PAP and TAPSE.

Network Meta-analysis of oral blood-activating and stasis-removing Chinese patent medicines in treatment of hypertensive left ventricular hypertrophy

This study was designed to assess the clinical efficacy of oral blood-activating and stasis-removing Chinese patent medicines in treating hypertensive left ventricular hypertrophy(LVH) based on network Meta-analysis. The clinical randomized controlled trials(RCTs) concerning the treatment of hypertensive LVH with oral blood-activating and stasis-removing Chinese patent medicines were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library from their inception to September 2021. Two researchers independently completed the literature screening, data extraction, and quality evaluation. The data were then analyzed by RevMan 5.3, Stata 15.1, and ADDIS 1.16.8. Finally, a total of 31 RCTs were included, involving 3 001 patients and four oral blood-activating and stasis-removing Chinese patent medicines. In terms of the alleviation of heart damage, the Chinese patent medicines combined with conventional western medicine groups were superior to the conventional western medicine groups in lo-wering the left ventricular mass index(LVMI). There was no significant difference in LVMI, left ventricular ejection fraction(LVEF), or the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity(E/A) between different Chinese patent medicines combined with conventional western medicine groups. Xinnao Shutong Capsules/Tablets combined with conventional western medicine had the best efficacy in reducing LVMI and elevating LVEF, while Xinkeshu Capsules/Tablets combined with conventional western medicine had the best effect in improving E/A. In the control of blood pressure, when all Chinese patent medicines except for Xinnao Shutong Capsules/Tablets were combined with conventional western medicine, the resulting systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower than those in the conventional western medicine group. Xinkeshu Capsules/Tablets combined with conventional western medicine produced the best effect in reducing SBP and DBP, followed by Xinnao Shutong Capsules/Tablets. In terms of safety, no serious adverse reactions occurred in all trials. The four oral blood-activating and stasis-removing Chinese patent medicines included in this study exhibited obvious advantages in the treatment of hypertensive LVH when they were combined with conventional western medicine, with the best effects observed in the Xinnao Shutong Capsules/Tablets combined with conventional western medicine group. However, due to the limitation of the quantity and quality of the included articles, the conclusion of this study still needs to be verified by more high-quality, multi-center, and large-sample RCTs.

Abstract 10130: Immediate Changes of Transesophageal Echocardiographic Findings in Percutaneous Closure of Atrial Septal Defects

Introduction: Atrial septal defects (ASD) are treated with percutaneous closures that subsequently increase the left ventricular volume load. This retrospective study aimed to assess the change in transesophageal ultrasound indices and to determine the search associated post-closure left diastolic index. Subjects: We enrolled 62 patients who underwent percutaneous closure of ASD in our hospital between January 2018 and November 2020. Method: Percutaneous ASD closure was performed under general anesthesia. We measured left ventricular inflow (early diastolic flow velocity, E; atrial contraction flow velocity, A; E-wave deceleration time, DT), mitral annulus velocity by tissue doppler imaging at lateral annulus (early diastolic myocardial velocity, E'; atrial contraction velocity, A'), and pulmonary venous blood flow velocity (peak systolic velocity, S; diastolic velocity, D; atrial systolic regurgitation velocity, AR; atrial systolic regurgitation time, AD) using transesophageal echocardiography (TEE). The ratio of E and E' (E/E') was calculated for and compared between before (pre) and after (post) ASD closure. Statistical analysis was performed using the EZR software. Wilcoxon's code order test was used for comparison, and multivariate correlation analysis was performed with post-occlusion E/E' as the objective variable. Statistical significance was set at p&lt;0.05. Results: Significant changes were seen in A', E', E, S, D, AD, and E/E'. Multivariate correlation analyses revealed a significant association of post E/E’ with the pre E/E’ and pre AR. Conclusion: In this study, the pulmonary venous flow velocity was found to decrease during systole and diastole following ASD closure. The DT did not change; thus, there was no change in the stiffness of the left ventricle. We concluded that the increased left ventricular volume load caused the increase in the left end-diastolic pressure.

Abstract 13846: Prognostic Value of Echocardiographic Markers of Diastolic Dysfunction for Heart Failure in Overweight and Obese Patients in CAMELLIA-TIMI 61

Background: Recent guidelines have outlined echo markers of diastolic dysfunction (DD); evidence is limited for their prognostic value for hospitalization for heart failure (HHF) in overweight and obese pts. Methods: CAMELLIA-TIMI 61 was a randomized placebo-controlled trial of the weight loss agent lorcaserin in 12,000 pts with BMI ≥27 with or at risk for CV disease (median follow-up, 3.3 yrs). Echo with core lab interpretation was performed on a subset of pts. Established DD parameters were measured, including the ratio of the peak early transmitral diastolic flow velocity over the early diastolic mitral annulus velocity (average E/e’), left atrium volume index (LAVi), and tricuspid regurgitation jet velocity (TRV). These were analyzed continuously, using the standard cutpoints of &gt;14, &gt;34 mL/m 2 , and &gt;2.8 m/s, respectively, and separately to determine the optimal cutpoints. The primary outcome for this analysis was HHF. Results: In 3,972 pts with baseline ejection fraction ≥50%, all 3 variables on a continuous scale predicted increased risk of HHF; using standard cutpoints, only E/e’&gt;14 remained independently associated with HHF after adjustment for the other 2 echo parameters and clinical variables ( Panel A ). In an analysis of optimal cutpoints in these overweight and obese pts, &gt;13 was optimal for E/e’, &gt;2.5 m/s for TRV, and &gt;58 mL/m 2 for LAVi. In a model with all 3 echo parameters, all remained significant predictors of HHF. After incorporation of clinical variables, E/e’ (HR 2.15, 95%CI 1.24-3.72) and LAVi (HR 2.41, 1.33-4.36) remained independent predictors of HHF ( Panel A ). Rates of HHF were 0.6, 3.3, and 10.1% (p-trend&lt;0.0001) in pts with none, one, or both measures of DD ( Panel B ). Conclusions: Several echocardiographic markers of diastolic dysfunction used in current guidelines predict increased risk of HHF events in the understudied obese and overweight population. A higher LAVi (&gt; 58 ml/m 2 ) cutpoint should be considered in these pts to prognosticate risk of HHF.

The role of visceral obesity and insulin resistance in right ventricular function in patients with metabolic syndrome

Abstract Background Evidence shows a strong relationship between visceral obesity, insulin resistance, metabolic syndrome (MetS) and cardiovascular disease risk. The role of right ventricular (RV) function is indisputably important in estimating of patient's prognosis. Multiple studies demonstrate that visceral fat represents a metabolically active organ, secreting a plethora of vasoactive substances that may have impact on cardiometabolic risk profile of the patient, especially under the circumstances of MetS. Purpose The objective of our study was to evaluate the role of visceral obesity and insulin resistance in RV function in patients with MetS. Methods The study included 100 subjects with MetS (mean age 53±8.9 years) and 100 controls without MetS (mean age 51±9.3 years, P=0.08). MetS was defined by ≥3 criteria of IDF, AHA/NHLBI. The participants of the study underwent complete 2D echocardiography and abdominal sonography with the assessment of diastolic function of RV: the ratio of early and late diastolic tricuspid flow velocities (Et/At), the ratio of early diastolic tricuspid flow velocity and early diastolic tricuspid annular velocity (Et/e't), Et deceleration time (DT); systolic RV function: TAPSE, ejection fraction of RV (EF); global RV function: Tei index of RV (by pulsed and pulsed tissue Doppler); visceral obesity sonographic parameters: epicardial fat thickness (EFT), intra-abdominal fat thickness (IFT), abdominal wall fat index (AWFI). The status of insulin resistance was determined by HOMA-IR≥2.5. Results All the parameters of RV diastolic function, as well as Tei index, were significantly changed in MetS group (P&amp;lt;0.05 for all parameters). Systolic function of RV showed no statically important differences among the groups (TAPSE 20,4±1,7 mm vs. 21.4±2.3 mm, P=0.087; EF RV 53±3% vs. 54±4%, P=0.092). In patients with MetS we found important correlations of diastolic parameters of RV (Et/At, Et/e'T, EtDT) with EFT (respectively: r=−0.524, P&amp;lt;0.001; r=0.291, P&amp;lt;0.001; r=0.692, P&amp;lt;0.001), IFT (respectively: r=−0.342, P&amp;lt;0.001; r=0.335, P&amp;lt;0.001; r=0.592, P&amp;lt;0.001), and AWFI (respectively: r=−0.426, P&amp;lt;0.001; r=0.212, P=0.002; r=0.538, P&amp;lt;0.001). In MetS group Tei index of RV (determined by pulsed and pulsed tissue Doppler) showed important correlations with EFT (r=0.623, P&amp;lt;0.001; r=0.618, P&amp;lt;0.001), IFT (r=0.498, P&amp;lt;0.001; r=0.530, P&amp;lt;0.001) and AWFI (r=0.313, P=0.001; r=0.307, P=0.001). In patients with HOMA-IR ≥2.5 risk for diastolic dysfunction of RV was 5 times higher. Systolic RV function did not show important correlations with selected parameters of visceral obesity. Multivariate regression analysis showed that EFT and HOMA-IR were independently associated with RV global and diastolic dysfunction in patients with MetS (P&amp;lt;0.05). Conclusions Our findings support that visceral obesity (especially determined by EFT) and insulin resistance are associated with diastolic and global dysfunction of RV in patients with MetS. Funding Acknowledgement Type of funding sources: None.