Early Diastolic Mitral Inflow Velocity Research Articles

P1883Decrease of early diastolic mitral inflow velocity cause symptoms in patients with premature ventricular contraction

P1883Decrease of early diastolic mitral inflow velocity cause symptoms in patients with premature ventricular contraction

Cardiac Structural or Functional Changes Associated with CHA2DS2-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography.

BACKGROUNDCHA2DS2-VASc is the most widely accepted scoring system for atrial fibrillation (AF) to assess stroke risk, although little has been revealed regarding the accompanying cardiac functional/structural changes. This echocardiography study was undertaken to understand the changes related to CHA2DS2-VASc scores.METHODSA total of 4,795 nonvalvular AF patients were enrolled for the cohort, from which 591 were excluded as they did not meet the inclusion criteria. Based on the CHA2DS2-VASc scores, the remaining 4,204 patients included in the study were divided into 4 groups: 0 to 1 (n = 991); 2 to 3 (n = 1,642); 4 to 6 (n = 1,407); 7 to 9 (n = 164).RESULTSIncrease in the left ventricular mass index and prevalence of left ventricular hypertrophy (LVH) were observed with elevating CHA2DS2-VASc scores (p < 0.05 for all). Diastolic parameters such as left atrial volume index (LAVI) and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E′) also increased significantly in the higher CHA2DS2-VASc score groups (p < 0.001 for all), although two-way ANOVA analysis showed that such incremental diastolic impairment was independent of hypertension. LVH (hazard ratio [HR], 3.609; confidence interval [CI], 2.426–5.369; p < 0.001) and E/E′ (HR, 1.087; CI, 1.054–1.121; p < 0.001) were independent risk factors for CHA2DS2-VASc scores 2 or higher.CONCLUSIONSOur findings suggest that increasing CHA2DS2-VASc scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.

Early changes of left atrial structure and function in patients with obstructive sleep apnea syndrome

Objective To investigate the early changes of left atrial structure and function using echocardiography in obstructive sleep apnea syndrome(OSAS) patients with and without left ventricular hypertrophy(LVH). Methods Echocardiography was performed in 91 OSAS patients (64 without LVH, 27 with LVH), and the results were compared with those from age-matched and gender-matched controls (n=40). All subjects were examined with two-dimensional speckle tracking echocardiography (2D-STE) to obtain the apical four chamber and two chamber left atrium(LA) strain and strain rate curve image. Systolic strain and strain rate(Ss, SRs), early diastolic strain and strain rate(Se, SRe), late diastolic strain and strain rate(Sa, SRa) were measured. Phasic LA volumes and empty fractions were calculated. The ratio of peak early diastolic mitral inflow and annulus velocity(E/e′) was used to estimate left ventricular diastolic function. Results Compared with the control group, LA volume, LA stiffness index, SRa and active empyting fraction (AEF) increased, Ss, SRs, Se, SRe, total empyting fraction (TEF) and passive empyting fraction (PEF) decreased in none LVH group (P 0.05). Diastolic function decreased in LVH group, and the changes of left atrial structure and function like above mentioned were more significant.The apnea-hypopnea index (AHI) was found to be negatively correlated with Ss, SRs, Se, SRe, TEF and PEF. Conclusions OSAS is associated with LA remodeling and dysfunction that occurs before the development of LVH and left ventricular diastolic dysfunction, and it will be further aggravated along with the development of LVH. Key words: Two-dimensional speckle tracking imaging; Sleep apnea, obstructive; Atrial function, left

Arterial stiffness, sex, and age difference on hypertensive response to supine bicycle exercise.

Contributors to a hypertensive response to exercise (HTR) according to sex and age have not been fully evaluated. The authors analyzed a database of supine bicycle exercise stress echocardiography findings. HTR was defined as peak systolic blood pressure ≥210mmHg for men and ≥190mmHg for women during exercise. A total of 797 patients (306 [38%] women) were analyzed, with a mean age of 64±10years. Female sex, hypertension; higher left ventricular ejection fraction, effective arterial elastance, and pulse wave velocity; and lower total arterial compliance were significantly related to HTR. Patients with HTR had higher relative wall thickness, ratio of early diastolic mitral inflow and annular velocity, and diastolic elastance (all P≤.05). In multivariable analysis, indices of arterial stiffness such as pulse wave velocity, arterial elastance, total arterial compliance, and systemic vascular resistance were more strongly related in women, while in men, index of sympathetic activation was additionally related to HTR (all P≤.05). Female sex and lower total arterial compliance in older patients (≥65years) and higher systemic vascular resistance and left ventricular relative wall thickness in younger patients were more strongly related to HTR. In conclusion, HTR was related to arterial stiffness, sympathetic activation, and diastolic dysfunction; however, the associations were different according to sex and age, which might guide individualized therapy.

Echocardiographic Predictors of Pulmonary Embolism: Return to Old Parameter

SESSION TITLE: Venous Thromboembolism SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Transthoracic echocardiography (TTE) offers diagnostic clue and hemodynamic status in patients with pulmonary embolism (PE). Many indices have been suggested to play a useful diagnostic role. This study aimed to certify peak early diastolic mitral inflow velocity (E velocity) as diagnostic predictors of PE in patients who underwent chest computed tomography (CT) scanning for rule out PE. METHODS: During the period of January 2013 to May 2014, we enrolled a total of 131 consecutive patients (44.3% men, mean age 71±13 years) as following inclusion criteria: 1) Underwent chest embolism CT for the stated indication of rule out PE, 2) Underwent contemporary TTE within 48 hours interval, 3) Pulmonary arterial systolic pressure (PASP) ≥ 30 mmHg, using peak tricuspid regurgitation (TR) velocity. The patients were divided into two groups; 1) PE group (n=43), who was diagnosed as submassive or massive PE by chest CT scanning, 2) Non-PE group (n=88), who didn’t have an evidence of PE in chest CT scanning; and the clinical and echocardiographic parameters were compared between two groups. RESULTS: Baseline clinical characteristics were not different between two groups. The PE group had significantly lower mitral E velocity (56.61±19.02 vs. 85.16±28.29 cm/s, P<0.001), E/A ratio (0.62±0.16 vs. 1.26±0.92, P<0.001), E/E’ ratio (11.0±4.0 vs. 17.1±9.2, P<0.001). PASP (48.8±13.7 vs. 43.3±13.7 mmHg, P=0.03) and peak TR velocity (3.09±0.52 vs. 2.89±0.50 mmHg, P=0.036) were higher in the PE group. In multivariate regression analysis, mitral E velocity was independent predictor in diagnosis of PE (HR 0.955, 95% CI 0.929-0.983, P=0.002). The cut-off value of mitral E velocity (AUC 0.808, 95% CI 0.731-0.885, P<0.001) for diagnosis of PE was < 68.2 cm/s (Sensitivity 69.3%, Specificity 81.4%). CONCLUSIONS: These results suggest that the peak transmitral E velocity would be important adjunctive predictor for diagnosis of PE, which maybe related with left ventricular underfilling. CLINICAL IMPLICATIONS: This study certified the peak early diastolic mitral inflow velocity (E velocity) as a simple diagnostic predictor of pulmonary embolism. DISCLOSURE: The following authors have nothing to disclose: Chan-Hee Lee, Hyun Jung Kim No Product/Research Disclosure Information

Left ventricular myocardial performance index in prehypertensive patients with normal coronary arteries.

Prehypertension, which may be the precursor of hypertension, is an important public health problem in the community. Myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. Thus, our aim was to evaluate left ventricule (LV) functions with the MPI in prehypertensive patients with normal coronary artery angiography. Forty prehypertensive patients (21 women and 19 men), with blood pressures between 120/80 and 139/89 mmHg, and 40 normotensive controls (18 women and 22 men), with blood pressures under 120/80 mmHg, were included in the study. Patient population comprised those who underwent coronary angiography because of typical angina and had normal coronary arteries. The MPI was calculated and compared between the two groups. No statistically significant differences were found between the two groups in terms of age, sex, or other demographic characteristics (P>0.05). Moreover, LV ejection fraction, late diastolic flow, deceleration time, isovolumetric contraction time, and ejection time values were not significantly different between the two groups (P>0.05). However, early diastolic mitral inflow velocity, E/A ratio, isovolumetric relaxation, and MPI were all significantly higher in the patient group than in the control group. The MPI was increased in prehypertensive patients. This result demonstrates that LV diastolic and systolic functions may be negatively affected in patients with prehypertension. The advantages of our method are as follows: it is simple, it does not demand special equipment, and it is not time consuming.

Left Atrial Strain at Different Stages of Myxomatous Mitral Valve Disease in Dogs.

BackgroundDecreased function of the left atrium (LA) is a useful prognostic indicator in dogs with myxomatous mitral valve disease (MMVD). In humans, LA strain is a novel severity indicator of mitral regurgitation, but its clinical utility in dogs has not been confirmed.ObjectivesTo examine whether LA strain as evaluated with speckle‐tracking echocardiography is associated with MMVD stage in dogs.AnimalsFifty‐two client‐owned dogs with MMVD.MethodsCross‐sectional study. Dogs were classified as stage B1, B2, C, or D, according to the American College of Veterinary Internal Medicine consensus. Physical examination findings and echocardiographic variables were compared among the groups. To assess the comparative accuracy of echocardiographic variables in identifying dogs with the presence or history congestive heart failure (CHF), receiver operating characteristic curves and multivariate logistic analysis were used.ResultsThere were no significant differences in parameters of LA strain between B1 and B2 groups. However, LA longitudinal strain during atrial contraction (εA) (median, 19.1%; interquartile range, 15.3–24.3% in B1, 19.6%; 14.1–21.4% in B2, 6.2%; 3.18–11.2% in C/D) and during ventricular systole (εS) (32.7%; 28.9–39.2% in B1, 35.6%; 31.7–41.9% in B2, 23.6%; 16.9–26.1% in C/D) were significantly lower in stages C/D than in stages B1 and B2. In multivariate logistic regression analysis, εA and peak early diastolic mitral inflow velocity were identified as independent indicators of stage C/D.Conclusions and Clinical ImportanceεA was the best predictor of the presence or history of CHF. Further studies are needed to determine the clinical implications of these findings for treatment decisions and prognosis determination.

PS 17-60 CORRELATION BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND COGNITIVE IMPAIRMENT IN PATIENTS WITH HYPERTENSIVE HEART DISEASE

Objective: To elucidate the relationship between left ventricular diastolic dysfunction and cognitive impairment in patients with hypertensive heart disease. Design and method: The Montreal Cognitive Assesment (MOCA) and echocardiography with tissue Doppler analysis were performed in 30 patients with hypertensive heart disease and preserved LV ejection fraction (EF > 40%). For statistical analysis, t-test, normality test using Shapiro-Wilks or Kolmogorov Smirnov test, followed by descriptive statistics and analysis of correlation between MOCA with a degree of diastolic dysfunction using the Spearman Rank analysis were performed. Results: Among 30 patients, 19 (63.3%) were diagnosed as CI (MOCA score < 26) and 11 (36.6 %) were diagnosed as no CI (MOCA score > or = 26). The ratio of early diastolic mitral inflow velocity to early mitral annular myocardial velocity by tissue Doppler (E/e’ Septal, E/e’ Lateral and E/e’ average) are no significantly different between the two groups and there were no correlation detected between (E/e’ Septal, E/e’ Lateral and E/e’ average) and the MOCA score (r = −0.229, p 0.112; r = −0.050, p 0.396; r = −0.168, p 0.187). Conclusions: LV diastolic dysfunction measured by the ratio of early diastolic mitral inflow velocity to early mitral annular myocardial velocity by tissue Doppler (E/e’) was not associated with cognitive impairment (CI) measured by MOCA score in patients with hypertensive heart disease.

Relationship between exercise induced elevation of left ventricular filling pressure and exercise intolerance in patients with atrial fibrillation.

BackgroundElevated left ventricular filling pressure (LVFP) is an important cause of exercise intolerance in patients with atrial fibrillation (AF). Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF.MethodsThis study included 145 consecutive patients (81 men and 64 women; mean age 65.5 ± 8.0 years) with persistent non-valvular AF and normal left ventricular systolic function (left ventricular ejection fraction ≥ 50%). All patients underwent a symptom-limited cardiopulmonary exercise test (CPET). Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') were taken and averaged. E/e' ratio was calculated. Elevated LVFP was defined as E/e' > 9, and patients with elevated LVFP at rest were excluded.ResultsPatients were classified into two groups according to LVFP estimated by E/e' ratio after exercise: 39 (26.9%) with elevated LVFP after exercise and 106 (73.1%) with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake (VO2 peak) (21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P < 0.001), lower anaerobic threshold (19.9 ± 2.5 vs. 26.0 ± 4.0 mL/min per kilogram, P < 0.001), and shorter exercise time duration (6.2 ± 0.8 vs. 7.0 ± 1.3 min, P < 0.001). Multivariate analysis showed that age, gender and E/e' after exercise were significantly correlated with VO2 peak.ConclusionElevated LVFP estimated by E/e' ratio after exercise is independently associated with reduced exercise capacity in AF patients.

Monitorización de las líneas B con ultrasonido pulmonar en pacientes mayores de 65 años durante cirugía de fractura de cadera

BackgroundAnaesthetic management in elderly patients scheduled for hip fracture surgery is a challenge for anaesthesiologist. Ultrasound performed at the bedside (point-of-care) has a great potential for the non-invasive evaluation of extravascular lung water and cardiac function.We assessed B-lines using lung ultrasound (LUS) and their correlation with cardiac disfunction by transthoracic echocardiography (TTE) in patients undergoing hip fracture surgery with spinal anesthesia. Materials and methodsA multicentre prospective observational study was conducted that included 42 patients, ASA III, older than 65 year-old, and scheduled for hip fracture surgery under spinal anaesthesia. LUS and transthoracic echocardiography were performed before and 24hours after surgery. B-lines were determined using two scores: Echo Comet Score and B pattern score. Diastolic/systolic cardiac function and inferior vena cava collapsibility index were evaluated by transthoracic echocardiography. Restrictive fluid therapy was applied. ResultsDiastolic dysfunction was found in 80% of patients. B-pattern was found in 24 (57%) and 26 (61%) patients during pre/postoperative periods respectively. We found a linear correlation between the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/e′) and Echo Comet Score (P<.0001). The Echo Comet Score and B-pattern did not increase during the postoperative period (P<.63, P<.77, respectively). A statistically significant reduction was observed in inferior vena cava collapsibility index before and after surgery (P<.0001). DiscussionLUS detected asymptomatic lung congestion at a pre-clinical stage in a substantial proportion of elderly patients. B-lines did not increase during the postoperative period in these patients in whom restrictive fluid therapy was applied. ConclusionLUS may be a useful bedside tool to assess extravascular lung water in elderly patients during the peri-operative period, and can therefore help anaesthesiologists to optimise fluid therapy.

E5. Lung ultrasound and echocardiography for peripartum haemodynamic monitoring of patients with severe preeclampsia

Introduction: The ability to judge intravascular volume is fundamental in the management of patients with severe preeclampsia. Insufficient intravascular volume can result in decreased oxygen delivery to tissues and exacerbates organ dysfunction. On the other hand, fluid excesses can lead to fluid extravasation and pulmonary edema. Outside of pregnancy, transthoracic echocardiography and lung ultrasonography have become important diagnostic and monitoring tools in critically ill patients. Only few studies to date, however, examined the utility of echocardiography in combination with lung ultrasonography for guiding fluid therapy in patients with severe preeclampsia. The objective of our study was to evaluate the correlation between myocardial function, assessed by echocardiography, and extravascular lung water (EVLW) sonographic measurements in patients with severe preeclampsia before delivery as well as in the first days postpartum.Methods: The study population consisted of patients consecutively admitted at a single level III referral institution with the diagnosis of preeclampsia with severe features between April, 2015 and February, 2016. Severe features of preeclampsia were defined using the American College of Obstetricians and Gynecologist Task Force on Hypertension in Pregnancy recommendations. All subjects were studied by standard two-dimensional and Doppler transthoracic echocardiography. Patients were studied at rest in the left lateral decubitus position and data were acquired at end expiration from standard parasternal/apical/subcostal views. Left ventricular systolic function was assessed by the left ventricular ejection fraction (LV EF) using the Teicholz method from the parasternal long axis view. E/E’ ratio was used as a marker of diastolic function (E wave representing the early diastolic mitral inflow velocity assessed by pulse wave Doppler and E’ representing the early diastolic mitral annulus displacement velocity assessed by tissue Doppler). Preload assessment involved measurement of inferior vena cava (IVC) diameter and its response to respiration (% of decrease in IVC diameter with spontaneous inspiration). Lung ultrasound was performed according to a systematic protocol in supine patients. The Echo Comet Score (ECS) was obtained by the 28-rib interspaces technique dividing the chest wall in 12 areas on the left (from the second to the fourth intercostal space) and 16 areas on the right (from the second to the fifth intercostal space) anterior and lateral hemithorax. Statistical comparison between ECS, LV EF, E/E0 ratio, expiratory IVC diameter, and IVC diameter decrease with inspiration before delivery versus within 24 h post-delivery versus 4 days postdelivery was performed using repeated measures ANOVA. Spearman’s correlation analysis was used to determine whether ECS correlated with measures of systolic function, diastolic function or preload. A p values of < 0.05 was considered significant.Results: Seventeen women with preeclampsia with severe features were included. Echo Comet Score was significantly higher measured before delivery versus 24 h postdelivery, versus 4 days postdelivery (p = 0.03). Left ventricular EF and E/E’ ratio did not differ significantly before delivery versus within 24 h post-delivery versus 4 days post-delivery (p = 0.11 and p = 0.66, respectively). Expiratory IVC diameter and IVC diameter decrease during inspiration were significantly lower before delivery versus post-partum (p = 0.01 and p = 0.04, respectively). No statistically significant correlation was found between ECS and the LV EF, E/E’ ratio, expiratory IVC diameter, decrease in IVC during inspiration (p40.05 regardless of timing of measurement, i.e. before delivery versus within 24 h post-delivery versus 4 days post-delivery).Conclusions: The increased EVLW in preeclamptic patients decreases rapidly following delivery and it seems to be associated primarily with increased vascular permeability or “capillary leak” syndrome, rather than systolic or diastolic myocardial dysfunction. Rapid increase in expiratory inferior vena cava diameter immediately after delivery suggests limited accuracy of this sonographic parameter to assess preload in pregnancy probably due to decreased venous return caused by to the gravid uterus.

Combination of B-type brain natriuretic peptide with left ventricular diastolic dysfunction for prediction of mortality in the patients with septic shock

To evaluate the prognostic value of combination of plasma brain natriuretic peptide(BNP) with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity(E/E') in the patients with septic shock. From June 2012 to December 2013 , 127 patients with septic shock were consecutively recruited and underwent trans-thoracic echocardiography examination within 6 h after admission to Intensive Care Unit(ICU), Zhejiang Provincial People's Hospital. Plasma BNP concentration was measured using ELISA method. All Clinical, laboratory, and survival data were prospectively collected. Of 127 patients enrolled, mean values for age were(59.9±17.3) years and APACHE Ⅱ score(16.8±5.8), respectively. 95 patients(74.8%) took mechanical ventilation. 28- , 60-day mortality rate was 36.3% and 42.3%, respectively. Univariate Cox regression analysis showed that age, coronary artery disease, serum creatinine and lactate, plasma BNP, left ventricular ejection fraction(LVEF), E/E' and APACHE Ⅱ score were significantly(P≤0.05) associated with 60-day mortality. Multivariate analysis revealed that serum lactate, plasma BNP(χ(2)=9.4, P=0.002) , E/E'(χ(2)=4.89, P=0.02) and APACHE Ⅱ score(χ(2)=10.6, P=0.001) remained independent predictors for 60-day mortality. ROC curve analysis showed that the optimal plasma BNP and E/E' cutoff values identified were 338.8 pg/ml and 10.8, and the areas under ROC curve were 0.89(sensitivity: 83.7%; specificity: 81.4%)and 0.83(sensitivity: 76.7%; specificity: 72.9%)for 60-day mortality, respectively. In addition to plasma BNP and clinical predictors, the E/E' could provide in independent and incremental prognostic value of 60-day mortality(χ(2)=59.3 vs 47.8, P<0.001). Plasma BNP and E/E' are independent predictors for 60-day mortality, and combination of plasma BNP and E/E' could improve risk stratification in patients with septic shock.

Home-Based Exercise Training Improves Left Ventricle Diastolic Function in Survivors of Childhood ALL: A Tissue Doppler and Velocity Vector Imaging Study.

Advanced echocardiographic methods may reveal signs of late anthracycline cardiac toxicity (ACT) even in asymptomatic patients. We studied echocardiographic tissue Doppler imaging (TDI) and velocity vector imaging (VVI) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) before and after an exercise intervention. Twenty-one asymptomatic, anthracycline-treated, long-term childhood ALL survivors with matched controls were studied at baseline. Seventeen of the survivors participated in a 3-month home-based exercise program. Echocardiography with TDI and VVI was performed. At baseline, ejection fraction (60.7±4.7% vs. 62.3±3.7%, P=0.22) and fractional shortening (32.6±3.1% vs. 34.0±2.8%, P=0.13) were similar in survivors and controls. Lateral early diastolic mitral annulus velocity E' (32.81±5.71cm/sec vs. 38.03±6.21cm/sec, P=0.01), E'/A' (1.60±0.48 vs. 2.07±0.63, P=0.01), and E/E' (2.78±0.35 vs. 2.42±0.62, P=0.04) were impaired compared to controls. Peak circumferential strain and strain rate were attenuated at apex (-24.50±3.46% vs. -28.06±4.39%, P=0.01 and -1.47±0.22sec(-1) vs. -1.68±0.33sec(-1) , P=0.02) compared to controls. After the intervention, early diastolic mitral inflow velocity E (87.76±12.54cm/s vs. 95.28±10.48cm/s, P=0.04) and E' increased (31.78±5.50cm/s vs. 34.96±5.41cm/s, P<0.01). Peak circumferential systolic and diastolic strain rates at mid-level (-1.22±0.21sec(-1) vs. -1.35±0.24sec(-1) , P=0.04 and 1.25±0.25sec(-1) vs. 1.48±0.35sec(-1) , P<0.01) improved after the exercise program. A simple home-based exercise program improved cardiac function in asymptomatic childhood ALL survivors. Adding TDI in routine echocardiographic examination may improve the recognition of early signs of ACT, and VVI may bring additional information. The improvements in cardiac function after the exercise program emphasize the importance of physical activity in this population.

Improved diastolic function in type 2 diabetes after a six month liraglutide treatment

AimsTo investigate whether liraglutide improves diastolic function in type 2 diabetes. MethodsThirty-seven patients with type 2 diabetes who began liraglutide therapy between June 2013 and May 2014 were enrolled in this observational, prospective study. 26 patients received liraglutide therapy for at least 6months. The remaining 11 patients withdrew from liraglutide therapy during the first month, were started on other hypoglycaemic therapies and formed the control group. Anthropometric, metabolic and echocardiographic parameters including pulsed wave tissue Doppler imaging were evaluated at baseline and at 6months. ResultsIn the liraglutide group the early diastolic mitral annulus velocity on the lateral (e-lat) and medial (e-med) sides of the mitral annulus increased from 9.2±3.4 to 11.6±4.7cm/s (p<0.001) and from 6.9±1.7 to 8.4±2.6cm/s (p<0.003), respectively. The ratio of early-to-late velocities on the lateral and medial sides of the mitral annulus increased from 0.7±0.3 to 0.9±0.4 (p<0.001) and from 0.5±0.1 to 0.6±0.1 (p<0.02), respectively. The ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity decreased from 10.7±4.3 to 8.5±2.5 (p<0.005). No improvements in diastolic function was detected in the control group. Glucose control improved similarly in both groups: HA1bc −1.5% (−17mmol/mol) vs −1.3% (−14mmol/mol), p=0.67. ConclusionsIn patients with type 2 diabetes, 6months liraglutide treatment was associated with a significant improvement in diastolic function.

Prognostic Value of Right Ventricular Tei Index in Dogs with Myxomatous Mitral Valvular Heart Disease.

BackgroundThe right ventricular (RV) Tei index (TX) has a significant correlation with the severity of pulmonary hypertension. However, the role of RV dysfunction in dogs with myxomatous mitral valvular heart disease (MMVD) has not been addressed.ObjectivesTo investigate the correlation between right ventricular Tei‐index (RVTX) and the prognosis for dogs with MMVD.AnimalsThirty client‐owned dogs with MMVD.MethodsClinical cohort study. Dogs were divided into two groups on the basis of the onset of cardiac‐related death within 1 year of the first echocardiographic examination. Physical examination and echocardiographic variables were compared between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic analysis were used to assess the comparative accuracy when identifying dogs with cardiac‐related death.ResultsThe highest accuracy was obtained for RVTX with an area under the ROC curve (AUC) of 0.95 (95% confidence interval [CI] 0.81–0.99) followed by the left atrial to aortic root ratio with an AUC of 0.91 (95% CI 0.74–0.98), peak early diastolic mitral inflow velocity with an AUC of 0.84 (95% CI 0.64–0.94), and Doppler estimates of systolic pulmonary artery pressure with an AUC of 0.84 (95% CI 0.61–0.95). According to the multivariate logistic regression analysis, RVTX was the only independent correlate of cardiac‐related death within 1 year.Conclusions and Clinical ImportanceRight ventricular Tei‐index has a strong correlation with the prognosis for dogs with MMVD. The most significant independent predictor of death was RVTX in this study.

The proposed new classification of coronary microcirculation as the predictor of the heart failure progression in idiopathic dilated cardiomyopathy.

The appropriate condition of the coronary microcirculation is essential for proper cardiac muscle activity. The understanding of the pathological microcirculation changes in different stages of idiopathic dilated cardiomyopathy (IDCM) could provide a reliable background for proper therapeutic decisions and prognosis. The study population consisted of 116 patients (86.2% males, mean age 50.4±13.2 years) with IDCM and heart failure. In samples from left ventricular endomyocardial biopsy, the coronary microcirculation was evaluated by staining with hematoxylin and eosin, Masson's trichrome, and anti-CD34 antibody. The microvessel density (MVD) was calculated. Also, the electron microscopic evaluation of the extracellular matrix capillaries was performed. Samples were assigned to one of four types according to the microcirculation condition: 1, normal microvessels (MVs) (18 patients); 2, mostly normal, some MVs with slightly decreased lumen diameter and thickened wall, absent/mild intravascular fibrosis, and MVD decrease (37 patients); 3, MVs with moderately decreased lumen diameter and thickened wall, moderate intravascular fibrosis, and MVD decrease (45 patients); and 4, MVs with significantly decreased lumen diameter and thickened wall, significant intravascular fibrosis, and MVD decrease (16 patients). Taking all types of the proposed classification into consideration, in type 4, clinical (incidence of New York Heart Association 3 and 4, dyspnea on exertion, pulmonary congestion) and echocardiographic (left atrial and right ventricular diameter, left ventricular mass and ejection fraction, tricuspid annular plane systolic excursion, early diastolic mitral annular velocity measured at the interventricular-septal annulus [E'med], ratio of early diastolic mitral inflow velocity to E'med) parameters were worst. Only atrial fibrillation, diabetes, tricuspid annular plane systolic excursion, and the type of the microcirculation significantly correlated with the incidence of cardiovascular hospitalizations in the linear regression models. The condition of the coronary microcirculation corresponds with the heart failure progression in patients with IDCM.

Association of Exercise Intolerance in Type 2 Diabetes With Skeletal Muscle Blood Flow Reserve

ObjectivesThis study sought to investigate the association of exercise intolerance in type 2 diabetes (T2DM) with skeletal muscle capillary blood flow (CBF) reserve. BackgroundExercise intolerance in T2DM strongly predicts adverse prognosis, but associations with muscle blood flow independent of cardiac dysfunction are undefined. MethodsIn 134 T2DM patients without cardiovascular disease, left ventricular function and contrast-enhanced ultrasound of the quadriceps (for CBF; i.e., product of capillary blood volume and velocity) were assessed at rest and immediately following treadmill exercise for peak oxygen uptake (Vo2peak). Left ventricular systolic and diastolic functional reserve indexes were derived from changes in systolic and early diastolic color tissue Doppler velocities. Cardiac index reserve and its constituents (stroke volume and chronotropic indexes) and left ventricular filling pressure (ratio of early diastolic mitral inflow and annular velocities) were also measured. ResultsVo2peak correlated with muscle CBF reserve (β = 0.16, p = 0.005) independent of cardiac index reserve and clinical covariates. This was explained by higher muscle capillary blood velocity reserve (β = 0.18, p = 0.002), rather than blood volume reserve (p > 0.10) in patients with higher Vo2peak. A concurrent association of Vo2peak with cardiac index reserve (β = 0.20, p < 0.001) appeared to reflect chronotropic index (β = 0.15, p = 0.012) rather than stroke volume index reserve (p > 0.10), although the systolic functional reserve index was also identified as an independent correlate (β = 0.16, p = 0.028). No associations of Vo2peak with diastolic functional reserve were identified (p > 0.10). ConclusionsVo2peak is associated with muscle CBF reserve in T2DM, independent of parallel associations with cardiac functional reserve. This is consistent with a multifactorial basis for exercise intolerance in T2DM.

Assessment of subclinical left ventricular dysfunction in patients with psoriasis by speckle tracking echocardiography: A Speckle Tracking Study.

Psoriasis is a systemic inflammatory disease and is reportedly associated with adverse cardiovascular risks. Left ventricular (LV) function has not been studied comprehensively in psoriasis. This study was conducted to study LV mechanics in patients with psoriasis by speckle tracking echocardiography. The study population consisted of 40 patients with psoriasis and 35 age- and sex-matched control subjects. Two-dimensional echocardiography images were obtained from LV apical four-chamber (4C), long axis (LAX), and two-chamber (2C) views. Peak longitudinal strain and strain rate were obtained from 4C, LAX, and 2C views. Global strain and strain rate were calculated by averaging data for the three apical views. Patients with psoriasis had significantly lower mean±standard deviation (SD) 4C (17.1±1.7 vs. 19.2±2.3; P<0.01), LAX (16.6±1.5 vs. 19.5±2.3; P<0.01), and 2C (16.5±1.5 vs. 19.4±2.2; P<0.01) peak longitudinal strain values compared with the control group. Moreover, mean±SD LV global strain (16.6±1.5 vs. 19.9±2.1; P<0.01) and strain rate (1.39±0.30 vs. 1.51±0.20; P<0.01) values were found to be significantly lower in the psoriasis group. In a multiple regression model, global strain was independently associated with high-sensitivity C-reactive protein (β=0.29, P=0.04), duration of disease (β=0.35, P<0.01), ejection fraction (EF) (β=0.38, P=0.01), and the ratio of early diastolic mitral inflow velocity to early diastolic annular velocity (E/E' ratio) (β=0.34, P=0.02). Also, in a multiple regression model, global strain rate was independently associated with duration of disease (β=0.36, P<0.01), EF (β=0.32, P=0.01), and E/E' ratio (β=0.35, P<0.01). Using 2-D strain imaging, we have demonstrated that patients with psoriasis have lower LV functions.

Assessment of risk factors and left ventricular function in patients with slow coronary flow

Slow coronary flow (SCF) is characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Life-threatening arrhythmias and sudden cardiac death can occur; however, the pathological mechanism and influence on left ventricular function remain undetermined. We aimed to assess the risk factors and left ventricular (LV) function in SCF and evaluate the relationships between thrombolysis in myocardial infarction frame count (TFC) and the number of involved coronary arteries with LV function in patients with SCF. We included 124 patients who underwent coronary angiography because of symptoms of angina; 71 patients with angiographically proven SCF and 53 cases with normal coronary flow pattern. SCF was diagnosed as TFC >27 in at least one coronary artery. Complete blood count and biochemical parameters were compared between the two groups. Conventional echocardiography and tissue Doppler imaging were used to assess LV systolic and diastolic function. Platelet aggregation rate induced by ADP was an independent predictor of SCF and positively correlated with coronary artery mean TFC (mTFC) (r = 0.514, P < 0.001) and the number of coronary arteries with SCF (r = 0.628, P < 0.001). Early diastolic mitral inflow velocity (E) (0.66 ± 0.15 vs. 0.74 ± 0.17, P = 0.008), ratio of early to late diastolic mitral inflow velocity (E/A) (0.95 ± 0.29 vs. 1.15 ± 0.35, P = 0.002), global myocardial peak early diastolic velocity (gVe) (4.41 ± 1.25 vs. 4.96 ± 1.45, P = 0.037), and ratio of global myocardial peak early to late diastolic velocity (gVe/gVa: 1.09 ± 0.45 vs. 1.36 ± 0.58, P = 0.006) were decreased in patients with SCF compared with controls. gVe (3 vs. 0 branches, 4.08 ± 1.14 vs. 4.97 ± 1.45, respectively, P = 0.008) deteriorated significantly in patients with SCF involving three coronary arteries. mTFC negatively correlated with E and E/A (r = -0.22, P = 0.02; r = -0.20, P = 0.04, respectively). The number of coronary arteries with SCF negatively correlated with E, E/A, gVe and gVe/gVa (r = -0.23, P = 0.02; r = -0.25, P = 0.009; r = -0.25, P = 0.008; r = -0.21, P = 0.03, respectively). Platelet aggregation rate induced by ADP was an independent predictor of SCF and positively correlated with coronary artery TFC and the number of affected coronary arteries. Left ventricular global and regional diastolic function was impaired in SCF patients. Furthermore, the number of coronary arteries involved rather than coronary artery TFC determined the severity of left ventricular dysfunction in patients with SCF.

Prognostic value of left atrial function in dogs with chronic mitral valvular heart disease.

BackgroundA strong correlation between left atrial (LA) dysfunction and the severity of cardiac disease has been described in human patients with various cardiac diseases. The role of LA dysfunction in dogs with chronic mitral valvular heart disease (CMVHD) has not been addressed.ObjectivesTo investigate the correlation between LA function and the prognosis of dogs with CMVHD.AnimalsThirty‐eight client‐owned dogs with CMVHD.MethodsProspective clinical cohort study. Dogs were divided into 2 groups (survivors and nonsurvivors) based on the onset of cardiac‐related death within 1 year. Physical examination and echocardiographic variables were compared between the groups. For the assessment of the comparative accuracy in identifying patients with cardiac‐related death, receiver operating characteristic (ROC) curves and multivariate logistic analysis were used.ResultsThe highest accuracy was obtained for the LA active fractional area change (LA‐FAC act), with an area under the ROC curve (AUC) of 0.95, followed by the left atrial to aortic root ratio (LA/Ao), with an AUC of 0.94; peak early diastolic mitral inflow velocity (E), with an AUC of 0.85; and LA total fractional area change (LA‐FAC total), with an AUC of 0.85. In the multivariate logistic regression analysis, LA‐FAC act emerged as the only independent correlate of cardiac‐related death within 1 year (odds ratio = 1.401, P = .002).Conclusions and Clinical ImportanceRegarding both the size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was LA‐FAC act.