Early Left Ventricular Diastolic Dysfunction Research Articles

Epicardial adipose tissue volume highly correlates with left ventricular diastolic dysfunction in endogenous Cushing’s syndrome

Background Cushing’s syndrome (CS) is associated with increased risk for heart failure, which often initially manifests as left ventricular diastolic dysfunction (LVDD). In this study, we aimed to explore the potential risk factors of LVDD in CS by incorporating body composition parameters. Methods A retrospective study was conducted on patients diagnosed with endogenous CS no less than 18 years old. The control group consisted of healthy individuals who were matched to CS patients in terms of gender, age, and BMI. LIFEx software (version 7.3) was applied to measure epicardial adipose tissue volume (EATV) on non-contrast chest CT, as well as abdominal adipose tissue and skeletal muscle mass at the first lumbar vertebral level. Echocardiography was used to evaluate left ventricular (LV) diastolic function. Body compositions and clinical data were examined in relation to early LVDD. Results A total of 86 CS patients and 86 healthy controls were enrolled. EATV was significantly higher in CS patients compared to control subjects (150.33 cm3 [125.67, 189.41] vs 90.55 cm3 [66.80, 119.84], p < 0.001). CS patients had noticeably increased visceral fat but decreased skeletal muscle in comparison to their healthy counterparts. Higher prevalence of LVDD was found in CS patients based on LV diastolic function evaluated by E/A ratio (p < 0.001). EATV was proved to be an independent risk factor for LVDD in CS patients (OR = 1.015, 95%CI 1.003–1.026, p = 0.011). If the cut-point of EATV was set as 139.252 cm3 in CS patients, the diagnostic sensitivity and specificity of LVDD were 84.00% and 55.60%, respectively. Conclusion CS was associated with marked accumulation of EAT and visceral fat, reduced skeletal muscle mass, and increased prevalence of LVDD. EATV was an independent risk factor for LVDD, suggesting the potential role of EAT in the development of LVDD in CS.

Early Left Ventricular Diastolic Dysfunction in Females with Chronic Hyperprolactinemia: a Doppler Echocardiographic Study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Early Left Ventricular Diastolic Dysfunction in Females with Chronic Hyperprolactinemia: A Doppler Echocardiographic Study.

Despite the myocardial prolactin (PRL) binding activity and the known effect of enhancing contractility in the isolated rat heart, little information is available concerning the cardiovascular consequences of hyperprolactinemia in humans. To elucidate the effects of chronic hyperprolactinemia on cardiac structure and function, twenty-four patients with isolated PRL-secreting adenoma and twenty-four controls underwent a complete mono- and two-dimensional Doppler-echocardiography. Blood pressure and heart rate were similar in the two groups, and no significant differences were observed as to left ventricular (LV) geometry between patients and controls. Resting LV systolic function was normal in patients with hyperprolactinemia, as shown by similar values of fractional shortening and cardiac output. Conversely, hyperprolactinemic patients exhibited a slight impairment of LV diastolic filling, as demonstrated by the prolongation of the isovolumetric relaxation time and the increase of the atrial filling wave of mitral Doppler velocimetry (58 ± 13 vs. 47 ± 8 cm/s, p < 0.05) with a subgroup of females (16%) having a clear diastolic dysfunction, and a worse exercise capacity (6 min walking test 452 ± 70 vs. 524 ± 56; p < 0.05). In conclusion, hyperprolactinemia in humans may be associated with a slight impairment of diastolic function, with an overt diastolic dysfunction in a subgroup of females which correlated with poorer exercise performance, in the absence of significant abnormalities of LV structure and systolic function.

Nonalcoholic fatty liver disease is associated with early left ventricular diastolic dysfunction in patients with type 2 diabeteS

ABSTRACT Background Left ventricular diastolic dysfunction (LVDD) is the first preclinical sign of diabetic cardiomyopathy. Nonalcoholic fatty liver disease (NAFLD) is linked to morbidity and mortality in Type 2 diabetes mellitus (T2DM) and increases the chance of developing cardiovascular disease, the primary cause of death. Aim This work aimed to identify the association of LVDD and NAFLD in T2DM. Methods We recruited 40 patients with T2DM (20 with NAFLD and 20 without NAFLD). Laboratory investigations and abdominal ultrasonography were carried out. The degree of hepatic steatosis was measured by the hepatorenal index (HRI). The LVDD was assessed by echocardiography and tissue doppler imaging. Results The Left atrial volume, left ventricular volume index, and left ventricle filling pressure index (E/é) were higher in the NAFLD group (P < 0.05). The E/é index was correlated with HRI and gamma-glutamyl transpeptidase (P < 0.05). Hepatic steatosis by HRI was the only independent variable associated with LVDD. Conclusion NAFLD is associated and correlated with an increased risk of left ventricular diastolic dysfunction in patients with T2DM regardless of ventricular systolic function.

Association of hepatic steatosis with subclinical cardiac dysfunction in asymptomatic people with type 2 diabetes

Abstract Introduction Non-alcoholic fatty liver disease is highly prevalent among people with type 2 diabetes (T2D) and is an emerging risk factor for heart failure with preserved ejection fraction (HFpEF). Whether excess liver adiposity is simply a marker of the coexisting adverse cardiometabolic risk profile or independently contributes to the development of HFpEF is unclear. Purpose To assess the association between liver fat fraction and subclinical cardiac dysfunction in adults with T2D. Methods Prospective cross-sectional study. Two-hundred and thirty-eight adults with T2D (mean age 63±7 years, 62% males, HbA1c 7.2±1.5%, diabetes duration 10±8 years) with no signs, symptoms, or evidence of cardiovascular disease and 40 age-, sex-, and ethnicity-matched non-diabetic controls (mean age 61±8 years, 63% males, HbA1c 5.2±1.2%) underwent comprehensive phenotyping with echocardiography and multiparametric cardiac MRI including adenosine stress and rest perfusion. Volumetric liver fat fraction (VLFF) was measured using a histologically validated, proprietary MRI technique blinded to all participant details. Inter-study reproducibility was assessed in participants (n=28) who underwent a repeat MRI within two weeks. Linear regression analysis was performed to assess any independent associations between VLFF and identified markers of subclinical cardiac dysfunction in subjects with T2D. Results People with T2D had evidence of concentric left ventricular (LV) remodelling (higher LV mass/volume), extracellular matrix expansion (higher ECV fraction), both systolic and diastolic dysfunction (lower global longitudinal systolic strain and E/A ratio, respectively), and coronary microvascular dysfunction (lower myocardial perfusion reserve) (Table 1). VLFF demonstrated excellent inter-study reproducibility with an intra-class correlation coefficient (ICC) of 0.988 (0.974–0.994). T2Ds had higher VLFF compared to controls [7.5 (3.8–13.7)% vs 2.9 (1.7–4.7)%, p&amp;lt;0.001]. In multivariable regression analysis adjusting for age, sex, ethnicity, body mass index, ambulatory systolic blood pressure, HbA1c, and low-density lipoprotein, VLFF (β=−0.161, p=0.027) was independently associated with E/A, but not other imaging measures of subclinical cardiac dysfunction. Conclusion Liver fat fraction is elevated in people with T2D and is independently associated with early LV diastolic dysfunction. These results add to the growing evidence that ectopic fat plays an important role in the pathogenesis of HFpEF and may be a potential target for intervention. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) United Kingdom through a Research Professorship award (RP-2017-08-ST2-007).British Heart Foundation through a Clinical Research Training Fellowship (FS/16/47/32190).

Effect of positive end-expiratory pressure on cardiac function in patients with early left ventricular diastolic dysfunction: a prospective cohort study

To evaluate the effect of positive end-expiratory pressure (PEEP) ventilation on cardiac function in patients with early left ventricular (LV) diastolic dysfunction undergoing laparoscopic radical gastrectomy. Patients who underwent laparoscopic radical gastrectomy under elective general anesthesia from July 2021 to February 2022 at the Subei People's Hospital were enrolled [age 60-75 years old, American Society of Anesthesiologists (ASA) grade I-II, and left ventricular ejection fraction (LVEF) > 0.50]. Transthoracic echocardiography (TTE) was performed before operation, and the peak early diastolic velocity (E peak) and peak late diastolic velocity (A peak) at the mitral ostium were recorded and the E/A and E peak deceleration time (DT) were calculated. Then isovolumic relaxation time (IVRT) and early peak mitral annular diastolic velocity (e') were recorded and left ventricular E/e' (LVE/e') was calculated. According to the E/A, mitral e', LVE/e', DT, and IVRT, the patients were divided into early LV diastolic dysfunction group (E/A < 1, mitral e' < 7 cm/s, LVE/e' > 14, DT > 200 ms, and IVRT > 100 ms) and normal cardiac function group (1 < E/A < 2, 160 ms < DT < 240 ms, and 70 ms < IVRT < 90 ms), with 35 patients in each group. Both groups were received fixed 5 cmH2O (1 cmH2O ≈ 0.098 kPa) PEEP 5 minutes after the beginning of the pneumoperitoneum until the end of the procedure. A volume controlled ventilation was used with a tidal volume (VT) of 7 mL/kg, an inspired oxygen concentration of 0.60, and an inspiratory to expiratory ratio of 1:2. Left and right myocardial systolic and diastolic function related parameters, including LVEF, LV global longitudinal strain (LVGLS), tricuspid annulus plane systolic migration (TAPSE), the peak early diastolic velocity (E peak) at the mitral and tricuspid valve ostia and the peak early diastolic velocity (e') at the corresponding annulus were measured by transesophageal echocardiography (TEE) before tracheal intubation (T0), 5 minutes after the pneumoperitoneum (T1), 5 minutes after PEEP ventilation (T2), 30 minutes after PEEP ventilation (T3), and 5 minutes after the end of pneumoperitoneum (T4), respectively. The left and right ventricular myocardial performance index (LVMPI/RVMPI) was calculated. Finally, 60 patients were included in the analysis, including 28 patients in the early LV diastolic dysfunction group and 32 patients in the normal cardiac function group. Compared with those at T0, mean arterial pressure (MAP), LVEF, mitral e', LVGLS, tricuspid e' and TAPSE were significantly lower in the normal cardiac function group at T1, and the early LV diastolic dysfunction group at T1, T2, and T3, and LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those at T0 (LVE/e': 16.52±1.26 vs. 14.32±1.09, and RVE/e': 18.71±1.74 vs. 16.51±1.93, respectively, both P < 0.05), Mitral e' and tricuspid e' were significantly lower than those at T0 [mitral e' (m/s): 0.07±0.01 vs. 0.09±0.01, tricuspid e' (m/s): 0.06±0.01 vs. 0.08±0.01, both P < 0.05]. Compared with the normal cardiac function group, MAP, LVEF, mitral e', LVGLS, tricuspid e', and TAPSE at T1, T2, and T3 were significantly lower in the early LV diastolic dysfunction group, while LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those in the normal cardiac function group (LVE/e': 16.52±1.26 vs. 9.87±1.25, RVE/e': 18.71±1.74 vs. 10.97±1.70, both P < 0.05). Mitral e' and tricuspid e' were significantly lower in the normal cardiac function group [mitral e' (m/s): 0.07±0.01 vs. 0.11±0.02, tricuspid e' (m/s): 0.06±0.01 vs. 0.10±0.02, both P < 0.05]. In early LV diastolic dysfunction patients, compared with patients with normal cardiac function, 5 cmH2O PEEP can further exacerbate left and right myocardial systolic and diastolic function in patients during pneumoperitoneum; when the pneumoperitoneum was ended, 5 cmH2O PEEP only worsen left and right myocardial diastolic function in patients, and did not affect left and right myocardial systolic function.

Early Left Ventricular Diastolic Dysfunction, Reduced Baroreflex Sensitivity, and Cardiac Autonomic Imbalance in Anabolic-Androgenic Steroid Users.

The effects of androgen anabolic steroids (AAS) use on athletes’ cardiac autonomic activity in terms of baroreflex sensitivity (BRS), and heart rate variability (HRV) have not yet been adequately studied. Furthermore, there is no information to describe the possible relationship between the structural and functional cardiac remodeling and the cardiac autonomic nervous system changes caused by AAS abuse. Thus, we aimed to study the effects of long-term AAS abuse on cardiac autonomic efficacy and cardiac adaptations in strength-trained athletes. In total, 80 strength-trained athletes (weightlifters and bodybuilders) participated in the study. Notably, 40 of them using AAS according to their state formed group A, 40 nonuser strength-trained athletes comprised group B, and 40 healthy nonathletes (group C) were used as controls. All subjects underwent a head-up tilt test using the 30 min protocol to evaluate the baroreflex sensitivity and short HRV modulation. Furthermore, all athletes undertook standard echocardiography, a cardiac tissue Doppler imaging (TDI) study, and a maximal spiroergometric test on a treadmill to estimate their maximum oxygen consumption (VO2max). The tilt test results showed that group A presented a significantly lower BRS and baroreflex effectiveness index than group B by 13.8% and 10.7%, respectively (p < 0.05). Regarding short-term HRV analysis, a significant increase was observed in sympathetic activity in AAS users. Moreover, athletes of group A showed increased left ventricular (LV) mass index (LVMI) by 8.9% (p < 0.05), compared to group B. However, no difference was found in LV ejection fraction between the groups. TDI measurements indicated that AAS users had decreased septal and lateral peak E’ by 38.0% (p < 0.05) and 32.1% (p < 0.05), respectively, and increased E/E’ by 32.0% (p < 0.05), compared to group B. This LV diastolic function alteration was correlated with the year of AAS abuse. A significant correlation was established between BRS depression and LV diastolic impairment in AAS users. Cardiopulmonary test results showed that AAS users had significantly higher time to exhaustion by 11.0 % (p < 0.05) and VO2max by 15.1% (p < 0.05), compared to controls. A significant correlation was found between VO2max and LVMI in AAS users. The results of the present study indicated that long-term AAS use in strength-trained athletes led to altered cardiovascular autonomic modulations, which were associated with indices of early LV diastolic dysfunction.

Cardiovascular Comorbidity Associated With Albuminuria in Youth-Onset Type 2 Diabetes: Analyses From the iCARE Study

ObjectivesLittle is known about the relationship between albuminuria in youth with type 2 diabetes (T2D) and cardiovascular risk. We aimed to determine whether youth with T2D and albuminuria have evidence of increased cardiovascular risk and/or early cardiovascular dysfunction compared with youth with T2D without albuminuria. MethodsYouth with T2D were stratified by albuminuria status. Cardiovascular risk factors, including body mass index (BMI), 24-hour blood pressure, lipid profile, smoking and smoking exposure, habitual physical activity and screen time, were compared between groups. Left ventricular structure and function and carotid intima-media thickness (cIMT) were evaluated in participants who underwent cardiac imaging. ResultsTwo hundred sixty-five youth participated, 83 (31.3%) of whom had albuminuria. Ethnicity, sex, BMI z score, age at diagnosis, duration of diabetes and hepatocyte nuclear factor-1alpha status did not differ between youth stratified by albuminuria. Smoking, exposure to second-hand smoke and low physical activity levels did not differ between groups. Youth with albuminuria were more likely to have hypertension, dyslipidemia and poor glycemic control. Left ventricular structure and carotid cIMT did not differ between groups, but youth with albuminuria had evidence of early left ventricular diastolic dysfunction. ConclusionsWe found evidence of increased cardiovascular disease risk factors and left ventricular diastolic dysfunction in youth with T2D and albuminuria compared with those without albuminuria, despite a relatively short duration of disease. Thus, albuminuria may serve as a marker of early cardiovascular disease risk in youth with T2D.

Early Left Ventricular Diastolic Dysfunction and Abnormal Left Ventricular-left Atrial Coupling in Asymptomatic Patients With Hypertension: A Cardiovascular Magnetic Resonance Feature Tracking Study.

Hypertension (HTN) patients suffer from increased risk of left ventricular (LV) diastolic dysfunction and LV hypertrophy (LVH). Evaluation of early LV diastolic function requires accurate noninvasive diagnostic tools. The aim of this study was to evaluate whether cardiovascular magnetic resonance feature-tracking (CMR-FT) could detect early LV dysfunction and evaluate LV-left atrium (LA) correlation in HTN patients. In all, 89 HTN patients and 38 age-matched and sex-matched controls were retrospectively enrolled and underwent CMR examination. HTN patients were divided into LVH (n=38) and non-LVH (n=51) groups. All LV deformation parameters were analyzed in radial, circumferential, and longitudinal directions, including peak strain, peak systolic strain rate and peak diastolic strain rate (PDSR), LA strain and strain rate (SR), including LA reservoir function (εs, SRs), conduit function (εe, SRe), and booster pump function (εa, SRa). Compared with controls, the LV PDSR in radial, circumferential, and longitudinal directions and the LA reservoir and conduit function were significantly impaired in HTN patients regardless of LVH (all P<0.05). LV longitudinal and radial PDSR were correlated with LA reservoir and conduit function (all P<0.01). Among all LV and LA impaired deformation parameters, the longitudinal PDSR (in LV) and εe (in LA) were the most sensitive parameter for the discrimination between non-LVH and healthy volunteers, with an area under the curve of 0.70 (specificity 79%, sensitivity 55%) and 0.76 (specificity 95%, sensitivity 49%), respectively. The area under the curve reached 0.81 (specificity 82%, sensitivity 75%) combined with the longitudinal PDSR and εe. CMR-FT could detect early LV diastolic dysfunction in HTN patients, which might be associated with LA reservoir and conduit dysfunction.

Abstract 13566: Clinical Utility of Noninvasive Assessment of Flow-pressure Relationship in Scleroderma

Introduction: Cardiac involvement in Systemic sclerosis (SSc), especially left ventricular diastolic dysfunction (DD), is high prevalence and associated with high mortality. Thus, the early detection of left ventricular DD might be important to manage SSc. Recent study has shown that exercise stress test may evaluate an early stage of heart failure in patients with normal resting echocardiogram. Hypothesis: We hypothesized that SSc patients with normal resting hemodynamics may present early phase of left ventricular DD by exercise echocardiogram, leading to the model of predicting long-term outcomes. Methods: Between January 2014 and December 2018, we prospectively enrolled 140 SSc patients who underwent 6-minute walk (6MW) stress echocardiographic studies with normal range of estimated mean pulmonary arterial pressure (mPAP) (&lt;25mmHg) and mean pulmonary artery wedge pressure (mPAWP) (&lt;15mmHg) at rest. We used ΔmPAP/Δcardiac output (CO) to assess pulmonary vascular reserve and ΔmPAWP/ΔCO to assess left ventricular (LV) reserve between resting and post-6MW point. Results: During a median period of 3.6 years, 25 patients (18%) reached the composite outcome. Both ΔmPAP/ΔCO and ΔmPAWP/ΔCO in patients with events were significantly higher than in ones without events (8.9±3.8mmHg/l/min vs. 3.0±1.7mmHg/l/min; p=0.002, and 2.2±0.9mmHg/l/min vs. 0.9±0.5mmHg/l/min; p&lt;0.001, respectively). In addition, ΔmPAWP/ΔCO is strongly associated with events (p=0.04) in patients with normal ΔmPAP/ΔCO (≤median value), although ΔmPAWP/ΔCO had weak impact in patients with abnormal ΔmPAP/ΔCO (&gt;median value) (p=0.23). Conclusions: Exercise echocardiography revealed impaired LV functional reserve in SSc patients with normal resting hemodynamics. Furthermore, in the group of normal pulmonary vascular function, the patients with impaired LV functional reserve had significantly shorter event-free survival than the ones with non-impaired LV function. Thus, the evaluation of early left ventricular DD with 6MW may detect high-risk group in SSc patients.

Cellular, mitochondrial and molecular alterations associate with early left ventricular diastolic dysfunction in a porcine model of diabetic metabolic derangement

The prevalence of diabetic metabolic derangement (DMetD) has increased dramatically over the last decades. Although there is increasing evidence that DMetD is associated with cardiac dysfunction, the early DMetD-induced myocardial alterations remain incompletely understood. Here, we studied early DMetD-related cardiac changes in a clinically relevant large animal model. DMetD was established in adult male Göttingen miniswine by streptozotocin injections and a high-fat, high-sugar diet, while control animals remained on normal pig chow. Five months later left ventricular (LV) function was assessed by echocardiography and hemodynamic measurements, followed by comprehensive biochemical, molecular and histological analyses. Robust DMetD developed, evidenced by hyperglycemia, hypercholesterolemia and hypertriglyceridemia. DMetD resulted in altered LV nitroso-redox balance, increased superoxide production—principally due to endothelial nitric oxide synthase (eNOS) uncoupling—reduced nitric oxide (NO) production, alterations in myocardial gene-expression—particularly genes related to glucose and fatty acid metabolism—and mitochondrial dysfunction. These abnormalities were accompanied by increased passive force of isolated cardiomyocytes, and impaired LV diastolic function, evidenced by reduced LV peak untwist velocity and increased E/e′. However, LV weight, volume, collagen content, and cardiomyocyte cross-sectional area were unchanged at this stage of DMetD. In conclusion, DMetD, in a clinically relevant large-animal model results in myocardial oxidative stress, eNOS uncoupling and reduced NO production, together with an altered metabolic gene expression profile and mitochondrial dysfunction. These molecular alterations are associated with stiffening of the cardiomyocytes and early diastolic dysfunction before any structural cardiac remodeling occurs. Therapies should be directed to ameliorate these early DMetD-induced myocardial changes to prevent the development of overt cardiac failure.

362 LA Strain is Reduced in Patients With Heart Failure Compared to Controls

Tabled 1HF(n=36)Control(n=36)Age70.363.8Gender Male%/Female%56/4483/17LVEF%50.159.1 (p<0.01)NYHA status2.330Reservoir Strain%18.230.8 (p<0.01)Contractile strain%7.916.5 (p<0.01)Conduit strain%10.414.3 (p<0.01)LA compliance% (Reservoir strain/E’e’)1.43.9 (p<0.01)LA volume (index) (ml/m2)53.727.5 (<0.01) Open table in a new tab Heart failure (HF) is an important cause of morbidity; HF with preserved ejection fraction (HFpEF) comprises ∼50% of all HF, with similar adverse outcomes compared to reduced ejection fraction (HFrEF). Current echocardiographic criteria lack sensitivity in diagnosing left ventricular diastolic dysfunction (LVDD); left atrial (LA) strain, a measure of myocardial deformation, improves sensitivity for LVDD. LA strain quantifies phasic (reservoir, conduit and contractile) LA function; reservoir strain can determine early LVDD with prognostic value in HFpEF. We retrospectively performed strain analysis on 36 HF patients (HFpEF n=18, HFrEF n=18) who presented to Westmead Hospital HF Clinic and compared these to age-matched healthy controls. Patients with AF, severe valvular disease, devices and inadequate image quality were excluded. Biplane measurements were performed using offline TomTec software as an average of 3 cycles. Group differences were evaluated by ANOVA with post-hoc Bonferroni comparisons (SPSS). HF patients had larger LA volumes and reduction in all three phasic LA strain. Subgroup analyses between HFpEF (n=18) and HFrEF (n=18) yielded lower reservoir (21.4% vs 15.1% p<0.01) and contractile strain (9.6% vs 6.2% p=0.04) in the HFrEF group. LA reservoir and contractile strain could be a more sensitive discriminator in evaluating groups of HF patients, and may be utilised as therapeutic and prognostic targets.Tabled 1DescriptivesNMeanStd. DeviationStd. Error95% Confidence Interval for MeanMinimumMaximumLower BoundUpper BoundER_biplaneHFpEF1821.377787.6060691.79276817.5953725.160198.40033.433HFrEF1815.084265.1567791.21546412.5198517.648675.98325.817Control1830.973155.5547651.30927128.2108333.7354725.06845.730Total5422.478408.9705171.22073320.0299224.926875.98345.730TTPbiplaneHFpEF18360.4814855.97186213.192694332.64733388.31563280.000468.000HFrEF18355.1175975.25824117.738537317.69255392.54264255.667484.500Control18413.9074137.5309818.846137395.24369432.57113348.167496.833Total54376.5021663.1746478.596981359.25880393.74552255.667496.833ECD_biplaneHFpEF1811.825095.3463841.2601559.1664014.483795.52022.858HFrEF188.929263.322160.7830417.2771910.581334.61314.850Control1813.895744.7034651.10861711.5567616.234726.96728.573Total5411.550034.902194.66710410.2119912.888074.61328.573ECT_biplaneHFpEF189.552694.9249631.1608257.1035612.001812.88018.495HFrEF186.155003.606893.8501534.361337.948671.01215.340Control1817.078523.380362.79675915.3975018.7595311.23023.917Total5410.928736.070023.8260259.2719412.585531.01223.917ANOVASum of SquaresdfMean SquareFSig.ER_biplaneBetween Groups2304.81821152.40929.985.000Within Groups1960.1015138.433Total4264.91953TTPbiplaneBetween Groups38036.059219018.0305.591.006Within Groups173488.853513401.742Total211524.91253ECD_biplaneBetween Groups224.0362112.0185.443.007Within Groups1049.6345120.581Total1273.67053ECT_biplaneBetween Groups1125.0342562.51734.658.000Within Groups827.7605116.231Total1952.79453 Open table in a new tab

Assessment of Early Left Ventricular Diastolic Dysfunction in Patients with Metabolic Syndrome by 2D Speckle Tracking Echocardiography

Background: Metabolic syndrome predisposes to left ventricular dysfunction and heart failure, early detection of associated subclinical cardiac changes has important diagnostic and prognostic values. 2D strain and strain rate allow detection of subtle abnormalities of global and regional left ventricular systolic and diastolic functions. Objectives: To detect early diastolic dysfunction in the left ventricle in patients with metabolic syndrome by 2D speckle tracking echocardiography based on global longitudinal isovolumic relaxation strain rate. Subjects and Methods: This prospective study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of diastolic dysfunction by speckle tracking. Results: There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of GLS and SR IVR. Conclusion: Impairment of diastolic function detected by speckle tracking based on global longitudinal isovolumic relaxation strain rate in metabolic syndrome patients.

Anemia and Its Effect on Cardiovascular Findings in Obese Adolescents

Objective:We assessed the effect of anemia on cardiovascular findings in obese adolescents.Materials and Methods:We studied 29 anemic and 33 nonanemic obese adolescents, and 33 nonobese healthy adolescents. These three groups were investigated for clinical and laboratory features of anemia and obesity. Echocardiography was used to examine cardiac functions.Results:The anemia was mild (mean hemoglobin: 11.67±0.79 g/dL), ferritin level was significantly low, and C-reactive protein and fibrinogen levels were significantly high in anemic obese patients. Increased cardiac pulse and echocardiographic findings, which may be indicative of early left ventricular diastolic dysfunction, were present in these patients.Conclusion:Anemia may develop due to iron deficiency and chronic inflammation in obese adolescents. Even mild anemia may cause increased heart rate and affect left ventricular diastolic functions. Diet programs for obese children should be carefully planned to avoid iron deficiency anemia, which may worsen the cardiac events in long-term follow-up.

P.268 - Cardiac diastolic dysfunction correlates with the CTG trinucleotide repeat length in ambulatory myotonic dystrophy 1

Myotonic dystrophy type 1 (DM1) is a multisystemic neuromuscular disease and cardiac involvement occurs in 80% of DM1 and it is the most common cause of sudden death. Few studies have illustrated cardiac involvements constituting of left ventricular tachycardia, ventricular fibrillation, conduction defects and arrhythmia. The aim of our study was to find an additional echocardiographic abnormality in the early stage of DM1 that correlate with the CTG repeat length. 21 genetically confirmed ambulatory DM1 patients were enrolled in this retrospective study. The clinical parameters included age of onset, disease duration, modified medical research council sum score (MRCSS), 6 minute walk test (6MWT). serum creatine kinase level and pulmonary function test. We examined the echocardiography at the first visit. The echocardiographic parameters such as left ventricular (LV) dimension, LV volume, LV wall thickness, LV mass index, left atrial dimension, mitral inflow velocity (E, A, E/A ratio), mitral flow deceleration time (DT), mitral annulus velocity (E', A'), E/E' ratio were measured and analyzed statistically in correlation to CTG repeat length. The asymptomatic arrhythmia was observed in 2 out of 21 patients. Among the echocardiography parameters, LV end-diastolic dimension (LVEDD), LV end-systolic dimension and mitral A velocity had significant negative correlation with CTG repeat length. Interestingly, E/A ratio showed a significant positive correlation with the CTG repeat length. The septal wall thickness also showed a significant correlation with the 6 MWT in the multiple linear regression model. The early LV diastolic dysfunction in DM1 can be partly explained by myocardial myotonia. This is the first study that showed diastolic dysfunction in early stages of DM1 and further longitudinal studies are warranted to understand the degenerative mechanism of the cardiac muscles in DM1.

4D-flow cardiac magnetic resonance-derived vorticity is sensitive marker of left ventricular diastolic dysfunction in patients with mild-to-moderate chronic obstructive pulmonary disease.

To investigate the possibility that vorticity assessed by four-dimensional flow cardiac magnetic resonance (4D-Flow CMR) in the left ventricle of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is a potential marker of early LV diastolic dysfunction (LVDD) and more sensitive than standard echocardiography, and whether changes in vorticity are associated with quantitative computed tomography (CT) and clinical markers of COPD, and right ventricular (RV) echocardiographic markers indicative of ventricular interdependency. Sixteen COPD patients with presumptive LVDD and 10 controls underwent same-day 4D-Flow CMR and Doppler echocardiography to quantify early and late diastolic vorticity as well as standard evaluation for LVDD. Furthermore, all patients underwent detailed CT analysis for COPD markers including percent emphysema and air trapping. The 4D-Flow CMR derived diastolic vorticity measures were correlated with CT measures, standard clinical and CMR markers, and echocardiographic diastolic RV metrics. Early diastolic vorticity was significantly reduced in COPD patients (P < 0.0001) with normal left ventricular (LV) mass, geometry, systolic function, and no or mild signs of Doppler LVDD when compared with controls. Vorticity significantly differentiated COPD patients without echocardiographic signs of LVDD (n = 11) from controls (P < 0.0001), and from COPD patients with stage I LVDD (n = 5) (P < 0.0180). Vorticity markers significantly correlated with CT computed measures, CMR-derived RV ejection fraction, echocardiographic RV diastolic metrics, and 6-minute walk test. 4D-Flow CMR derived diastolic vorticity is reduced in patients with mild-to-moderate COPD and no or mild signs of LVDD, implying early perturbations in the LV flow domain preceding more obvious mechanical changes (i.e. stiffening and dilation). Furthermore, reduced LV vorticity appears to be driven by COPD induced changes in lung tissue and parallel RV dysfunction.

Comparative study of left ventricular function in a group of asymptomatic patients with systemic sclerosis and a controls group

Introduction. Cardiac involvement in systemic sclerosis (SSc) represents a major cause of morbidity and mortality and constitutes a turning point in this disease. The aim of this study was to describe echocardiographic data in asymptomatic patients with SSc and compare them to results obtained in a control population in order to unmask subclinical cardiac involvement during systemic sclerosis. Material and methods. A prospective study was conducted between 2012 and 2017 including two groups: group A included 25 asymptomatic scleroderma patients without other comorbidities, while group B consisted of 25 control and healthy subjects. The two groups were examined by echocardiography coupled with tissue Doppler and 2D strain. Results. The mean age of our patients was 45 ± 7 years. The sex ratio was 0.8. The control population was epidemiologically similar to the group of patients. The anatomical data of the left ventricle and the ejection fraction were normal and comparable between the two groups, but the Tei index was significantly higher in group A (0.8 ± 0.04 vs. 0.28 ± 0.07, p < 0.01). Tissue Doppler velocity S peak measurement was reduced in group A compared to group B (5.6 ± 0.5 vs. 9.30 ± 0.5, p < 0.01), and global longitudinal strain was also altered in scleroderma patients (–11 ± 0.4 vs. –18 ± 0.3, p < 0.01). There was no significant difference in E/A ratio, however early left ventricular diastolic dysfunction was revealed by a higher E/Ea and E/Vp ratio in group A compared to group B with respectively (13 ± 1.8 vs. 6 ± 1.6, p < 0.01) and (2.2 ± 0.6 vs. 1.5 ± 0.6, p < 0.01), a longer Ap–Am duration (≥ 20 ms), and a higher volume of the left atrium was noted in group A. The mean value of the pulmonary pressions was 37.9 ± 9 mm Hg in patients with scleroderma versus 25 ± 3 mm Hg for the control group (p < 0.01). There was no right ventricular dysfunction. Conclusions. Cardiac involvement during systemic sclerosis precedes clinical expression. Echocardiography coupled with tissue Doppler and 2D strain are useful to detect these abnormalities at a subclinical stage of the disease.

Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes

Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes

Nonalcoholic Fatty Liver Disease Is Independently Associated with Early Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes.

Accumulating evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with left ventricular diastolic dysfunction (LVDD) in nondiabetic individuals. To date, there are very limited data on this topic in patients with type 2 diabetes and it remains uncertain whether NAFLD is independently associated with the presence of LVDD in this patient population. We performed a liver ultrasonography and trans-thoracic echocardiography (with speckle-tracking strain analysis) in 222 (156 men and 66 women) consecutive type 2 diabetic outpatients with no previous history of ischemic heart disease, chronic heart failure, valvular diseases and known hepatic diseases. Binary logistic regression analysis was used to examine the association between NAFLD and the presence/severity of LVDD graded according to the current criteria of the American Society of Echocardiography, and to identify the variables that were independently associated with LVDD, which was included as the dependent variable. Patients with ultrasound-diagnosed NAFLD (n = 158; 71.2% of total) were more likely to be female, overweight/obese, and had longer diabetes duration, higher hemoglobin A1c and lower estimated glomerular filtration rate (eGFR) than those without NAFLD. Notably, they also had a remarkably greater prevalence of mild and/or moderate LVDD compared with those without NAFLD (71% vs. 33%; P<0.001). Age, hypertension, smoking, medication use, E/A ratio, LV volumes and mass were comparable between the two groups of patients. NAFLD was associated with a three-fold increased odds of mild and/or moderate LVDD after adjusting for age, sex, body mass index, hypertension, diabetes duration, hemoglobin A1c, eGFR, LV mass index and ejection fraction (adjusted-odds ratio 3.08, 95%CI 1.5–6.4, P = 0.003). In conclusion, NAFLD is independently associated with early LVDD in type 2 diabetic patients with preserved systolic function.

Diastolic Dysfunction Occurs Early in HER2-Positive Breast Cancer Patients Treated Concurrently With Radiation Therapy and Trastuzumab.

Left ventricular ejection fraction (LVEF) is used routinely to monitor cardiac dysfunction associated with breast cancer treatment. In this study the prevalence of early left ventricular diastolic dysfunction (LVDD) and its relationship to the dose-volume of the heart irradiated were evaluated in HER2-positive breast cancer patients undergoing concurrent trastuzumab and adjuvant radiotherapy (RT). Data from 40 breast cancer patients treated with concurrent trastuzumab and left-sided adjuvant RT between September 2011 and October 2012 were collected prospectively. For comparison, 32 patients treated with concurrent trastuzumab and right-sided adjuvant RT and 71 patients treated with left-sided RT alone were collected retrospectively. Echocardiography was obtained before RT, immediately following RT, and 3 and 6 months after RT. Doses to the heart and left ventricle (LV) were quantified. Prior to RT with concurrent trastuzumab, 11 of 29 (left) and 8 of 25 (right) patients with normal baseline left ventricular diastolic function (LVDF) developed LVDD. In patients receiving left-sided RT alone, 12 of 61 patients with normal baseline LVDF developed LVDD. Dmean, D15-D40, D60-D70, and V3-V10 of the LV were significantly higher in patients who developed LVDD after concurrent trastuzumab and left-sided RT. In contrast, only two patients developed grade 1 LVEF decrease after both concurrent treatment and left-sided RT alone. Changes in LVDF compared with LVEF are more sensitive for early detection of cardiotoxicity. The dose-volume of the heart contributes significantly to the risk of LVDD in patients with left-sided breast cancer treated concurrently with trastuzumab. Abnormalities in diastolic function are more sensitive than changes in the left ventricular ejection fraction for detecting acute cardiotoxicity and are related to the dose-volume of the heart irradiated in patients with left-sided breast cancer receiving radiotherapy concurrently with trastuzumab. This result highlights the importance of decreasing the dose-volume of heart irradiated as a protective strategy in the treatment setting of concurrent trastuzumab and radiotherapy. Diastolic dysfunction may serve as a more sensitive tool for the early detection of cardiac damage and should be incorporated as a routine parameter in the functional monitoring of cardiotoxicity.