Echocardiographic Indices Of Diastolic Function Research Articles

Echocardiography to predict left ventricular filling pressure for long-term paediatric heart transplant patients.

Left ventricular diastolic dysfunction is a recognised sequela following transplantation in paediatric heart transplant patients. Traditional echocardiographic indices do not correlate well with left ventricular filling pressure immediately after transplantation. This study aimed to assess whether these indices have any long-term correlation after transplantation in paediatric patients. A retrospective chart review of 41 patients who had a heart transplant before the age of 24 years was performed. The median time since the transplantation was 11 years. Data obtained from surveillance cardiac catheterisation and echocardiographic examination were reviewed. Traditional echocardiographic indices of diastolic function were compared with the pulmonary capillary wedge pressure and left ventricular end-diastolic pressure obtained from cardiac catheterisation. The median age at transplant was 12.1 years, and the median time since transplant was 11 years. Eighteen patients (43%) had a history of at least one rejection episode and 12 patients (29%) had a history of cardiac allograft vasculopathy. There was no correlation between mitral inflow E velocity, mitral E/A ratio, tissue Doppler velocities, mitral E/e' (mitral inflow E velocity to mitral annular velocity), and elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. There was no correlation between mitral valve deceleration time or isovolumetric relaxation time with elevated pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure. Our findings suggest that traditional echocardiographic indices of diastolic function do not correlate well with elevated invasive pulmonary capillary wedge pressure or elevated left ventricular end-diastolic pressure in paediatric heart transplant patients' long-term post-transplantation.

852 DAPAGLIFOZIN IN PATIENTS WITH CARDIAC HEART FAILURE

Abstract Dapaglifozin on diastolic function in patients with type 2 diabetic mellitus and chronic heart failure Heart failure (HF) with reduced ejection fraction (HFrEF) remains a challenging problem due to its high mortality rate. Another novelty in HF therapy is dapagliflozin, a sodium-glucose transporter-2 inhibitor (SGLT2i) which decreased the rates of cardiac death and worsening of HF in the DAPA-HF trial, when added in other guideline recommended therapy. Material and methods A prospective cohort study of 30 symptomatic HF patients with EF < 35% (aged 65 ±10 years) (20 males and 10 females) was conducted. Diabetic (2TDM) patients of NYHA status II–III, previously treated with ARNI, β-blocker, and mineralocorticoid receptor antagonists (MRA) were included. Dapagliflozin 10 mg was added as an adjunct therapy for 2TDM but also as a novel therapy of HF in diabetic patients. Clinical examination and complete echocardiographic evaluation were performed at baseline and 30 days after the addition of SGLT2i to their treatment. 2D echocardiography and Doppler measurements were used for the evaluation of left ventricular function, and more specifically, peak early (E-wave) and late (A-wave) transmitral filling velocities and their ratio E/A, deceleration time of E velocity (DTE). To classify diastolic dysfunction according to the ASE/EACVI guidelines published in 2016, transmitral E and A waves velocities, septal and lateral E’ tissue velocities, indexed left atrium volume and peak velocity of tricuspid regurgitation were collected. Results After 30 days of therapy with dapagliflozin, blood pressure was reduced significantly and the echocardiographic parameters of diastolic function were improved. More specifically, after 6.1±3.6 months of treatment E/A ratio decreased from 1.7 ±1.5 to 1.01±0.70 (P <0.05), the E/Ea ratio decreased from 13.5± 6.3 vs. 10.2± 5.2 (P <0.05), tricuspid regurgitation peak velocity decreased from 3.0±0.4 to 2.4± 0.5m/s (P =0.03) and left atrial volume decreased from 53 ±29.3 to 40.3±11.5ml/m2 (P <0.05). Subsequently, both left-ventricular diastolic function and filling pressure improved significantly (P <0.05,). Discussion Our data support the evidence that SGLT2i ameliorate both the conventional echocardiographic indexes of diastolic function and this effect is noted quite promptly. The ratio of early diastolic transmitral flow velocity seems to correlate well with LV filling pressures, and may be use das a prognostic tool in patients with HFrEF. We have to emphasize that the diastolic function improvement was observed 30 days after the initiation of dapagliflozin treatment, and thus it may be considered an early marker of improvement and adequacy of treatment apart from BNP. Conclusions in this study classical diastolic echocardiographic parameters were improved promptly after initiation of dapagliflozin therapy. The ratio of early diastolic transmitral flow velocity at the early filling phase of diastole (E/SRE) may be considered a reliable index of HF therapy responders.

P183 DAPAGLIFOZIN ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH TYPE 2 DIABETIC MELLITUS AND CHRONIC HEART FAILURE

Abstract Heart failure (HF) with reduced ejection fraction (HFrEF) remains a challenging problem due to its high mortality rate. Another novelty in HF therapy is dapagliflozin, a sodium–glucose transporter–2 inhibitor (SGLT2i) which decreased the rates of cardiac death and worsening of HF in the DAPA–HF trial, when added in other guideline recommended therapy. Material and Methods A prospective cohort study of 30 symptomatic HF patients with EF < 35% (aged 65 ±10 years) (20 males and 10 females) was conducted. Diabetic (2TDM) patients of NYHA status II–III, previously treated with ARNI, β–blocker, and mineralocorticoid receptor antagonists (MRA) were included. Dapagliflozin 10 mg was added as an adjunct therapy for 2TDM but also as a novel therapy of HF in diabetic patients. Clinical examination and complete echocardiographic evaluation were performed at baseline and 30 days after the addition of SGLT2i to their treatment. 2D echocardiography and Doppler measurements were used for the evaluation of left ventricular function, and more specifically, peak early (E–wave) and late (A–wave) transmitral filling velocities and their ratio E/A, deceleration time of E velocity (DTE) . To classify diastolic dysfunction according to the ASE/EACVI guidelines published in 2016, transmitral E and A waves velocities, septal and lateral E’ tissue velocities, indexed left atrium volume and peak velocity of tricuspid regurgitation were collected. Results After 30 days of therapy with dapagliflozin, blood pressure was reduced significantly and the echocardiographic parameters of diastolic function were improved. More specifically, after 6.1±3.6 months of treatment E/A ratio decreased from 1.7 ±1.5 to 1.01±0.70 (P < 0.05), the E/Ea ratio decreased from 13.5± 6.3 vs. 10.2± 5.2 (P < 0.05), tricuspid regurgitation peak velocity decreased from 3.0±0.4 to 2.4± 0.5m/s (P = 0.03) and left atrial volume decreased from 53 ±29.3 to 40.3±11.5ml/m2 (P < 0.05). Subsequently, both left–ventricular diastolic function and filling pressure improved significantly (P < 0.05, ). Discussion Our data support the evidence that SGLT2i ameliorate echocardiographic indexes of diastolic function. The ratio of early diastolic transmitral flow velocity seems to correlate well with LV filling pressures, and may be use das a prognostic tool in patients with HFrEF. We have to emphasize that the diastolic function improvement may be considered an early marker of improvement and adequacy .

Coenzyme Q10 in the Treatment of Heart Failure with Preserved Ejection Fraction: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

BackgroundHeart failure with preserved ejection fraction (HFpEF) is common in elderly people and is increasing in prevalence. No specific treatment for this condition exists. Coenzyme Q10 (CoQ10) is an essential cofactor for energy production, with reduced levels being noted in HF. Previous studies have suggested a possible role for CoQ10 in the treatment of HF. This study examined the effect of CoQ10 supplementation on diastolic function in HFpEF patients.MethodsWe conducted a prospective, randomized, double-blind, placebo-controlled trial including patients aged > 55 years presenting with New York Heart Association class II–IV heart failure symptoms and left ventricular ejection fraction > 50%, with impaired diastolic function. Echocardiography and levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) were performed at baseline and following 4 months of CoQ10 or placebo supplementation.ResultsA total of 39 patients were enrolled—19 in the CoQ10 group and 20 in the placebo group. Baseline clinical characteristics were similar between groups, while compliance was high and also similar between the CoQ10 and placebo groups. There was no significant effect of treatment on indices of diastolic function (difference in the lateral E/e' ratio: −0.86 ± 6.57 in the CoQ10 group, +0.18 ± 3.76 in the placebo group; p = 0.561) or on serum NT-proBNP levels (− 72 pg/mL vs. − 42 pg/mL; p = 0.195).ConclusionsIn this pilot trial in elderly patients with HFpEF, treatment with CoQ10 did not significantly affect echocardiographic indices of diastolic function and serum NT-proBNP levels.Trial RegistrationThis trial was registered in the US National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT02779634).

Association of Echocardiographic Diastolic Dysfunction with Discordance of Invasive Intracoronary Pressure Indices.

Instantaneous wave-free ratio (iFR)-guided coronary revascularization has similar clinical outcomes compared to fractional flow reserve (FFR)-guided revascularization strategy. However, some studies have shown a discordance of around 20% between iFR and FFR. Although various factors have been reported in the literature to affect pressure indices and lead to such discordance, there is a paucity of data regarding the effect of diastolic dysfunction on functional assessment of coronary arteries. Our study aimed to investigate whether there was an association between echocardiographic left ventricular diastolic dysfunction and iFR/FFR discordance. This retrospective observational study evaluated 100 patients with angiographically intermediate coronary stenosis (50–70%) who underwent physiological testing with iFR and FFR. Transthoracic echocardiograms were reviewed to assess echocardiographic indices of diastolic function. The study population was divided into two groups based on diastolic function. iFR and FFR discordance was measured in each group and compared to evaluate the statistical difference. The mean age of the study population was 66.22 ± 10.02 years. Discordance between iFR and FFR was seen in 45.16% of patients with diastolic dysfunction compared to 24.64% of patients with normal diastolic function (p = 0.04). Multivariable logistic regression analysis indicated that echocardiographic E/e′ was independently associated with iFR/FFR discordance (p = 0.02). Left ventricular diastolic dysfunction is a significant factor that can lead to discordance between iFR and FFR and should be taken into account during coronary physiological testing.

Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type natriuretic peptide.

Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters. A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e', and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e' were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index. B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.

Prognostic value of NT pro BNP and echocardiographic indices of diastolic function in patients with heart failure and preserved left ventricular ejection fraction

Prognostic value of NT pro BNP and echocardiographic indices of diastolic function in patients with heart failure and preserved left ventricular ejection fraction

Relationship between coronary microvascular dysfunction and left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries.

Diastolic dysfunction (DD) is reported to affect up to 35% of the adult general population. The consequence of progressive DD is heart failure with preserved ejection fraction (HFpEF). Coronary microvascular dysfunction (CMD) has been suggested as one of the pathologic mechanisms leading to HFpEF. We investigated whether there was an association between coronary microvascular function and echocardiographic indices of left ventricular diastolic function at rest in patients with chest pain and unobstructed coronary arteries (CPUCA). This retrospective observational study recruited patients referred to cardiology clinics assessment of chest pain who subsequently underwent assessment via CT coronary angiogram (CTA). Coronary microvascular dysfunction was determined by myocardial blood flow reserve (MBFR; <2.0) using myocardial contrast echocardiography. Echocardiographic indices of diastolic function (septal mitral annular e'; septal mitral annular E/e', E/A ratio) were measured from baseline transthoracic echocardiogram. 149 patients (52% men) with a mean age 59.7(9.5) years were recruited. Mean (standard deviation) MBFR was 2.2 (0.51). 37% (55/149) had MBFR<2.0. Median [interquartile range] septal mitral annular e' velocity and septal mitral annular E/e' were 7.6cm/s [6.2, 8.9] and 9.5 [7.5, 10.8], respectively. Univariate regression analysis showed only age was a significant predictor of increasing septal mitral annular E/e' (β=+0.20 95% CI 0.13, +0.28, P<.001) but not MBFR. Multivariable analysis also showed no association between these septal mitral annular E/e' and MBFR after adjustment for cardiovascular risk factors. There was no relationship found between echocardiographic indices of left ventricular diastolic function and coronary microvascular function at rest.

Prognostic value of NT-proBNP, and echocardiographic indices of diastolic function, in hospitalized patients with acute heart failure and preserved left ventricular ejection fraction

BackgroundSeveral parameters have proven useful in assessing prognosis in outpatients with heart failure with preserved ejection fraction (HFpEF). In contrast, prognostic determinants in HFpEF hospitalized for an acute event are poorly investìgated. AimTo determine the predictive value of NT-proBNP, and diastolic function (assessed by E/e’), in patients with HFpEF hospitalized for acute heart failure. Methods and resultsWe evaluated 205 consecutive HFpEF patients admitted for acute heart failure (median age: 76[53,81], 36% male, median EF: 61 [54,77]). We assessed clinical, echocardiographic, and NT-proBNP values, on admission and at discharge. Primary end-point was the composite of all-cause death and/or HF rehospitalization.After a mean follow up of 28±10 months, 82 patients met the primary end-point; there were 30 deaths (14.6%), and 72 patients (35%) were rehospitalized for HF. By multivariable analysis, predictors of the composite end-point were: discharge E/e´ ≥14 (HR: 4.63 CI 95%: 2.71-18.2, p<0.0001), discharge NT-proBNP ≥1500 pg/ml (HR: 5.23, CI 95%: 2.87–17.8, p < 0.0001), ≥50% NT-proBNP decrease between admission and discharge (HR: 0.62, CI 95%: 0.25-0.79, p = 0.019). Combining E/e´ and NT-proBNP values at discharge further and significantly improved discrimination power compared to each variable analyzed separately (AUC, NT-proBNP at discharge: 0.80; E/e´ at discharge: 0.77; E/e´ + NT-proBNP: 0.88; p < 0.01). ConclusionsIn HFpEF patients hospitalized with acute heart failure, assessment of E/e´ ratio and NT-proBNP at discharge provides prognostic information on top of other variables, and allows to easily identify a population at higher risk of subsequent death or rehospitalization for heart failure, during a medium-term follow up.

Iron Deficiency in Acute Decompensated Heart Failure.

The aim of this study was to characterize iron deficiency (ID) in acutely decompensated heart failure (ADHF) and identify whether ID is associated with dyspnea class, length of stay (LOS), biomarker levels, and echocardiographic indices of diastolic function in patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Consecutive patients admitted with ADHF at a single tertiary center were included. Demographic information, pathology investigations, and metrics regarding hospital stay and readmission were recorded. Patients were classified as having ‘absolute’ ID if they had a ferritin level <100 ng/mL; or ‘functional’ ID if they had a ferritin 100–200 ng/mL and a transferrin saturation <20%. Of 503 patients that were recruited, 270 (55%) had HFpEF, 160 (33%) had HFREF, and 57 (12%) had heart failure with mid-range ejection fraction. ID was present in 54% of patients with HFrEF and 56% of patients with HFpEF. In the HFpEF group, ID was associated with a LOS of 11 ± 7.7 vs. 9 ± 6 days in iron replete patients, p = 0.036, and remained an independent predictor of increased LOS in a multivariate linear regression incorporating comorbidities, age, and ID status. This study corroborates a high prevalence of ID in both HFrEF and HFpEF, and further shows that in patients with HFpEF there is a prolongation of LOS not seen in HFrEF which may indicate a more prominent role for ID in HFpEF.

Clinical Utility of Left Atrial Strain in Children in the Acute Phase of Kawasaki Disease

We aimed to evaluate the diagnostic utility of peak left atrial longitudinal strain (PALS) during left ventricular (LV) systole to differentiate children in the acute phase of Kawasaki disease (aKD) from controls. We also aimed to compare the diagnostic utility of PALS with those of conventional echocardiographic indices of diastolic function. Retrospectively measured PALS, LV longitudinal peak systolic strain, and strain rate obtained via velocity vector imaging were compared in a derivation cohort comprising 95 aKD and 67 controls. The utility of PALS in differentiating aKD from controls was compared with those of E/E', E/A, and maximum left atrial volume index (LAVImax). Derived cutoffs from receiver operating characteristic curves were validated in a separate validation cohort comprising 37 aKD and 19 controls. In the derivation cohort, PALS was significantly decreased in aKD as compared with in controls. For differentiating aKD from controls, PALS outperformed E/E', E/A, and LAVImax. However, cutoffs of PALS (≤40% and ≤39%, before and after adjusting for the presence of significant mitral regurgitation and LV systolic dysfunction, respectively), like those of E/E', E/A, and LAVImax, showed low sensitivity and poor discriminative ability for differentiating aKD from controls. In the validation cohort, for differentiating aKD from controls, both cutoffs of PALS showed low sensitivity, like those of E/E', E/A, and LAVImax. In aKD, impaired left atrial reservoir function could be detected as decreased PALS. For differentiating aKD from controls, PALS outperforms E/E', E/A, and LAVImax. However, like E/E', E/A, and LAVImax, PALS as a single parameter is limited in its clinical utility to differentiate aKD from controls because of its low sensitivity and poor discriminative ability.

Abstract 48: Differentiation of Moderate and Severe Ischemic Heart Failure by Invasive and Non-invasive Assessments of Diastolic Function in a Rat Model of Chronic Heart Failure

Background: This work is designed to determine if specific left ventricle (LV) pressure-volume relations, hemodynamic, and echo derived parameters of diastolic function are able to separate severe from moderate CHF in rats with left coronary artery occlusion. Hypothesis: Echocardiographic indices of diastolic function, end-diastolic pressure (EDP), dead volume, stiffness constants (k), and pressure volume relations predict the severity of CHF in infarcted rats. Methods: Male Sprague Dawley rats (N=14) were randomized to undergo left coronary artery ligation or sham operation. Echocardiography was performed at 3 and 6 weeks post coronary ligation. The rats were categorized into moderate or severe CHF according to their LVEDP at 6 weeks post ligation. Invasive hemodynamic measurements with solid state micro manometer pressure catheters as well as diastolic pressure-volume relation values were obtained at the 6 week end point. Results: Moderate and severe CHF rats had significantly (P&lt;0.05) elevated left ventricular (LV) end-diastolic pressure (LV EDPs), prolonged time constants of LV relaxation (tau), and decreased peak development pressures. When moderate versus severe CHF rats were separated based on LV EDP, early diastolic anterior wall radial relaxation velocity as well as e’, and E/e’ had strong correlations with invasive hemodynamic measurements of diastolic functions. There was a trend towards decreased compliance as measured by stiffness constants in severe heart failure group. Differences (P&lt;0.05) in dead volume, mean arterial pressure (MAP), tau, and ejection fraction (EF) were also displayed. End diastolic pressure-volume analyses illustrated significant differences in plot positioning and curvature. Conclusion: While it is possible to separate rats with moderate and severe CHF in the rat coronary artery ligation model, the separation is not simply based on a specific EF value. This work may be useful in deciding whether there is a differential effect of new treatments for severe versus moderate CHF.

Relationship of ischemic times and left atrial volume and function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Little is known about the impact of duration of ischemia on left atrial (LA) volumes and function during acute phase of myocardial infarction. We investigated the relationship of ischemic times, echocardiographic indices of diastolic function and LA volumes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). A total of 433 consecutive STEMI patients underwent echocardiographic examination within 48 h of primary PCI, including the measurement of LA volumes and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e'). Time intervals from onset of chest pain to hospital admission and reperfusion were collected and magnitude of Troponin I release was used to assess infarct size. Patients with LA volume index (LAVI) ≥28 ml/m(2) had longer total ischemic time (410 ± 347 vs. 303 ± 314 min, p = 0.007) and higher E/e' ratio (15 ± 5 vs. 10 ± 3, p < 0.001) than those with LAVI <28 ml/m(2), while the indices of LA function were similar between the study groups (p > 0.05, for all). Significant correlation was found between E/e' and LA volumes at all stages of LA filling and contraction (r = 0.363-0.434; p < 0.001, for all) while total ischemic time along with E/e' and restrictive filling pattern remained independent predictor of LA enlargement. Increased LA volume is associated with longer ischemic times and may be a sensitive marker of increased left ventricular filling pressures in STEMI patients treated with primary PCI.

127 Early Manifestations of Diabetic Cardiomyopathy Assessed by Cardiac Magnetic Resonance Imaging and Spectroscopy

BackgroundLarge, population based studies have shown that diabetes mellitus (DM) of long durationis associated with increased incidence of heart failure, independent of underlying hypertension and coronary artery disease. Cardiovascular magnetic...

943Native T1 mapping correlates with echocardiographic indices of diastolic function in hypertrophic cardiomyopathy

943Native T1 mapping correlates with echocardiographic indices of diastolic function in hypertrophic cardiomyopathy

Abstract 606: DPP-4 Inhibition Improves Diastolic dysfunction in obese mice fed a Western Diet

Background and rationale: Obesity and diabetes are associated with insulin resistance, salt sensitive hypertension and cardiovascular dysfunction. Pharmacological inhibition of dipeptidylpeptidase-4 (DPP-4) to increase the bioavailability of glucagon like peptide-1 (GLP-1) is a contemporary therapy for control of glycemia in Type2 diabetes patients. Whether DPP-4 inhibition lowers blood pressures and improves pre-diabetic cardiomyopathy in a diet induced obesity (DIO) mouse model has not been examined in detail. Methods: C57Bl/6 mice were fed high fat/high sucrose (Western diet, WD) for 16wks starting at ∼4 wks of age and treated with MK-0626 (10mg/kg/day, Merck). Results: When compared to normal chow-fed mice, Western diet-fed (DIO) mice manifested increased MAP (15-20mmHg), heart (50%) and body weight (33%), increased blood sugars (FBS) and sodium retention (urine sodium 6.9μmol/day/gBW vs. 2.3μmol/day/gBW, respectively). In addition to correcting FBS, MK-0626 lowered MAP and increased sodium excretion and corrected cardiac diastolic dysfunction ( Table ). Indeed, echocardiographic indices of diastolic function, including tissue doppler E’/A’ ratio, estimates of LV filling pressure (E/E’), isovolemic relaxation time and the Tei index, all abnormal in mice fed a WD, were improved by MK-0626. Contemporaneous with these cardiac functional abnormalities, the mTOR/S6K and ERK1/2 growth signaling pathways were activated in DIO mice and improved by 16 wks of MK-0626 treatment. Conclusion: These studies suggest that MK-0626 increases cardiac and renal bioavailability of GLP-1 and improves myocardial GLP-1R signaling, myocardial remodeling resulting in increased renal sodium excretion and improvements in cardiac diastolic function in pre-diabetic insulin resistant DIO mice. Table: Summary of 2D M-Mode, pulse wave and tissue doppler Echo measurements on 20 wk old mice on control diet (CD), Western diet (WD), or Western Diet with MK-0626 (WD-MK). Values are mean ± SE. Numbers in parentheses are sample sizes. Paired t-tests: *p&lt;0.05 CD vs WDC; † P&lt;0.05 WDC vs WD-MKE, velocity of early mitral flow; E’, peak velocity of septal annulus; E/E’ index of LA filling pressure; Vp, flow propogation velocity; E/Vp, index of LV filling pressure; IVRT, isovolumic relaxation time; MPI, myocardial performance index.

Abstract 16804: Long-Term Differential Effects of Amlodipine and Atenolol based Antihypertensive Therapy on Left Ventricular Structure and Function: An ASCOT Sub-Study

Background: Both left ventricular hypertrophy (LVH) and impairment of LV diastolic function have been shown to be important predictors of morbidity and mortality in hypertension. Anti-hypertensive treatment can cause regression of LVH and improve LV diastolic function. However little is known about whether these changes are sustained with long term treatment. Methods: Six-hundred and sixty-nine patients (mean age 62 years, 78.9% male) in the ASCOT study who were randomised to either an amlodipine-based regimen (Amlod), or an atenolol-based antihypertensive regimen (Aten) had LV structure and diastolic function assessed by tissue Doppler echocardiography. Measurements were made a median time of 1.48 (Phase 1) and 3.49 (Phase 2) years after randomisation. Results: Blood pressure was lower in Amlod both at phase 1 (141/80 vs 146/83) and phase 2 (138/79 vs 143/82).Left ventricular mass index had significantly improved between Phase 1 and Phase 2 assessment in both treatment groups (Amlod: 119.6 to 116.6 g/m 2 , p=0.007, Aten: 121.8 to 117.2 g/m 2 , p&lt;0.001).At the initial Phase 1 assessment LV diastolic function was better in Amlod compared with Aten (e' 8.5cm/s versus 7.7cm/s, p&gt;0.001; E/e' 7.6 versus 8.1, p=0.008). With a further 2 years of antihypertensive therapy with good BP control there was a small, significant drop in e' but no change in E:e'with Amlod (e' Phase 2 8.1cm/s, versus phase 1 p&lt;0.001; E/e' Phase 2 7.8, versus phase 1 p=0.29); in contrast in Aten there was no change in e' but a small, significant rise in E:e' (e' Phase 2 7.7cm/s, versus phase 1 p=0.59; E/e' Phase 2 8.4, versus phase 1 p=0.02).By the end of the phase 2, after correction for age, gender and systolic blood pressure, e' in Amlod remained significantly higher than aten (p&lt;0.01). Conclusions: Patients with hypertension and good BP control had further regression of LV mass between 1.5 and 3.5 years of antihypertensive therapy with both Amlod and Aten. Those receiving Amlod had better echocardiographic indices of diastolic function at both time points when compared with Aten. Appropriate antihypertensive therapy may lead to early improvement of diastolic function and allow maintenance of a more normal pattern at longer follow-up with improvement in left ventricular mass. Character Count: 1926

Postnatal Left Ventricular Diastolic Function After Fetal Aortic Valvuloplasty

Fetal aortic balloon valvuloplasty (FAV) has shown promise in altering in utero progression of aortic stenosis to hypoplastic left heart syndrome. In patients who achieve a biventricular circulation after FAV, left ventricular (LV) compliance may be impaired. Echocardiographic indexes of diastolic function were compared between patients with biventricular circulation after FAV, congenital aortic stenosis (AS), and age-matched controls. In the neonatal period, patients with FAV had similar LV, aortic, and mitral valve dimensions but more evidence of endocardial fibroelastosis than patients with AS. Patients with FAV underwent more postnatal cardiac interventions than patients with AS (p = 0.007). Mitral annular early diastolic tissue velocity (E') was lower in patients with FAV and those with AS and controls in the neonatal period and over follow-up (p <0.001). Septal E' was similar among all 3 groups in the neonatal period. In follow-up patients, with FAV had lower septal E' than patients with AS or controls (p <0.001). Early mitral inflow velocity/E' was higher in patients with FAV as neonates and at follow-up (p <0.001). Mitral inflow pulse-wave Doppler-derived indexes of diastolic function were similar between groups. In conclusion, echocardiographic evidence of LV diastolic dysfunction is common in patients with biventricular circulation after FAV and persists in short-term follow-up. LV diastolic dysfunction in this unique population may have important implications on long-term risk of left atrial and subsequent pulmonary hypertension.

Echocardiographic Indices of Diastolic Function Relate to Functional Capacity and Quality of Life in Ambulatory Men with Atrial Fibrillation

We sought to explore the reliability of echocardiographic parameters of diastolic function and determine their relationship with functional capacity (New York Heart Association [NYHA] class and 6-minute walk test [6MWT]) and the domains of a health-related quality of life (HR-QOL) questionnaire (Veterans RAND 36-Item Health Survey) in a cohort of ambulatory patients with atrial fibrillation (AF). Forty-eight male veterans with persistent or permanent AF underwent clinical examination, echocardiography, and 6MWT, and filled out a Veterans RAND 36-Item Health Survey questionnaire at two visits 1 week apart. Pairwise correlation was performed to evaluate the reliability of echocardiographic parameters and multiple regression analyses to assess the association of these parameters with functional capacity and HR-QOL. E/e' average had the highest correlation between the two visits (coefficient: 0.87) and had a significant relationship with NYHA, 6MWT, and physical functioning domain of HR-QOL even after adjusting for confounding variables (odds of NYHA >1: OR 1.5, 95% CI, 1.2-1.9; 6MWT coefficient: -31 ± 9 ft; physical functioning score coefficient: -1.7 ± 0.7). Average E/e' is a reliable diastolic function parameter that also independently relates with functional capacity and HR-QOL in ambulatory patients with atrial fibrillation.

Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis?

We assessed the hypothesis that diastolic function represented by left atrial size determines the rate of development of symptoms and the risk of all-cause mortality in asymptomatic patients with severe aortic stenosis (AS). From a database of 622 asymptomatic patients with isolated severe AS (velocity by Doppler >or= 4 m/sec) followed for 5.4 +/- 4 years, we reviewed the echocardiograms and evaluated Doppler echocardiographic indices of diastolic function. Prediction of symptom development and mortality by left atrial diameter with and without adjusting for clinical and echocardiographic parameters was performed using Cox proportional-hazards regression analysis. The age was 71 +/- 11 years and 317 (62%) patients were males. The aortic valve mean gradient was 46 +/- 11 mmHg, and the Doppler-derived aortic valve area was 0.9 +/- 0.2 cm(2). During follow-up, symptoms developed in 233 (45%), valve surgery was performed in 290 (57%) and 138 (27%) died. Left atrial enlargement was significantly correlated with symptom development (P < 0.05) but the association diminished after adjusting for aortic valve area and peak velocity (P = 0.2). However, atrial diameter predicted death independent of age and gender (P = 0.007), comorbid conditions (P = 0.03), and AS severity and Doppler parameters of diastolic function (P = 0.002). Diastolic function, represented as left atrial diameter, is related to mortality in asymptomatic patients with severe AS.