Higher Prevalence Of Diastolic Dysfunction Research Articles

Coronary microvascular dysfunction and left heart filling pressures in patients with type 2 diabetes.

Patients with type 2 diabetes (T2D) have a high prevalence of diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF), which in turn leads to an increased risk of hospitalization and death. However, the factors of risk and their relative importance in leading to higher left ventricular filling pressures are still disputed. We sought to clarify the associations of a wide range of invasive and non-invasive risk factors with cardiac filling pressures in high-risk T2D patients. Patients with T2D at high risk of cardiovascular events were prospectively enrolled in this study. Participants were thoroughly phenotyped including right heart catheterization at rest and during exercise, echocardiography, urinary excretion of albumin (UACR), and quantification of their myocardial blood flow rate (MFR) using cardiac 82Rb-PET/CT. Of the 37 patients included in the study, 22 (59%) patients met invasive criteria for HFpEF. Only 2 out of 39 variables emerged as independent factors associated with left ventricular filling pressure as assessed by pulmonary capillary wedge pressure (PCWP) at rest; history of hypertension (coefficient: 2.6mmHg [0.3; 5.0], P=0.030) and MFR (P=0.026). We found a significant inverse association between MFR and PCWP with a coefficient of -2.3mmHg (-4.3; -0.3) in PCWP per integer change of MFR. The MFR ranged from 1.18 to 3.68 in our study, which corresponds to a difference in PCWP of approximately 6mmHg between patients with the lowest compared to the highest MFR. During exercise, only 2 variables emerged as borderline independent factors associated with PCWP: myocardial flow reserve (coefficient: -4.4 [-9.6; 0.8], P=0.091) and beta-blockers use (coefficient: 6.1 [-0.1; 12.4], P=0.053). In patients with type 2 diabetes without known HFpEF but risk factors for cardiovascular disease, myocardial blood flow rate was independently associated with PCWP at rest across the range from normal to abnormal left heart filling pressures. A clinically significant difference of 6mmHg in PWCP was attributable to differences in MFR in patients with the lowest compared with the highest MFR values. This suggests that strategies than attenuate microvascular dysfunction could slow progression of increased left ventricular left heart filling pressures in patients at increased risk.

Diastolic dysfunction and clinical outcomes after transcatheter or surgical aortic valve replacement in patients with atypical aortic valve stenosis.

Diastolic dysfunction is a predictor of poor outcomes in many cardiovascular conditions. At present, it is unclear whether diastolic dysfunction predicts adverse outcomes in patients with atypical aortic stenosis who undergo aortic valve replacement (AVR). Five hundred and twenty-three patients who underwent transcatheter AVR (TAVR) (n = 303) and surgical AVR (SAVR) (n = 220) at a single institution were included in our analysis. Baseline left and right heart invasive hemodynamics were assessed. Baseline transthoracic echocardiograms were reviewed to determine aortic stenosis subtype and parameters of diastolic dysfunction. Aortic stenosis subtype was categorized as typical (normal flow, high-gradient) aortic stenosis, classical, low-flow, low-gradient (cLFLG) aortic stenosis, and paradoxical, low-flow, low-gradient (pLFLG) aortic stenosis. Cox proportional hazard models were utilized to examine the relation between invasive hemodynamic or echocardiographic variables of diastolic dysfunction, aortic stenosis subtype, and all-cause mortality. Propensity-score analysis was performed to study the relation between aortic stenosis subtype and the composite outcome [death/cerebrovascular accident (CVA)]. The median STS risk was 5.3 and 2.5% for TAVR and SAVR patients, respectively. Relative to patients with typical aortic stenosis, patients with atypical (cLFLG and pLFLG) aortic stenosis displayed a significantly higher prevalence of diastolic dysfunction (LVEDP ≥ 20mmHg, PCWP ≥ 20mmHg, echo grade II or III diastolic dysfunction, and echo-PCWP ≥ 20mmHg) and, independently of AVR treatment modality, had a significantly increased risk of death. In propensity-score analysis, patients with atypical aortic stenosis had higher rates of death/CVA than typical aortic stenosis patients, independently of diastolic dysfunction and AVR treatment modality. We demonstrate the novel observation that compared with patients with typical aortic stenosis, patients with atypical aortic stenosis have a higher burden of diastolic dysfunction. We corroborate the worse outcomes previously reported in atypical versus typical aortic stenosis and demonstrate, for the first time, that this observation is independent of AVR treatment modality. Furthermore, the presence of diastolic dysfunction does not independently predict outcome in atypical aortic stenosis regardless of treatment type, suggesting that other factors are responsible for adverse clinical outcomes in this higher risk cohort.

268 IMPACT OF AORTIC REGURGITATION ON LONG TERM OUTCOME IN HEART FAILURE AND PRESERVED EJECTION FRACTION

Abstract Background Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling. Objective To assess AR's prevalence and long-term prognostic implications in patients with HFpEF. Methods The study population consisted of 458 consecutive patients (age 77.5 ± 9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected. Results Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p < 0.05). During a median follow-up of 33 ± 25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95%CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR. Conclusions In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.

Impact of aortic regurgitation on long-term outcomes in heart failure with preserved ejection fraction

Abstract Background Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling. Objective To assess AR's prevalence and long-term prognostic implications in patients with HFpEF. Methods The study population consisted of 458 consecutive patients (age 77.5±9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected. Results Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p<0.05). During a median follow-up of 33±25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95% CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR (Figure). Conclusions In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF. Funding Acknowledgement Type of funding sources: None.

The Dynamic Characteristics of Myocardial Contractility and Extracellular Volume in Type 2 Diabetes Mellitus Mice Investigated by 7.0T Cardiac Magnetic Resonance.

Type 2 diabetes mellitus (T2DM) is associated with a high prevalence of diastolic dysfunction and congestive heart failure. A potential contributing factor is the accelerated accumulation of diffuse myocardial fibrosis and stiffness. Novel cardiac magnetic resonance (CMR) imaging techniques can identify both myocardial fibrosis and contractility quantitatively. This study aimed to investigate the dynamic characteristics of the myocardial strain and altered extracellular volume (ECV) fraction as determined by 7.0 T CMR in T2DM mice. C57Bl/6J mice were randomly divided into T2DM (fed a high-fat diet) and control (fed a normal diet) groups. They were scanned on 7.0 T MRI every 4 weeks until the end of week 24. The CMR protocol included multi-slice cine imaging to assess left ventricle strain and strain rate, and pre- and post-contrast T1 mapping images to quantify ECV. The ECV in the T2DM mice was significantly higher (p < 0.05) than that in the control group since week 12 with significantly impaired myocardial strain (p < 0.05). A significant linear correlation was established between myocardial strain and ECV (p < 0.001) and left ventricular-ejection fraction and ECV (p = 0.003). The results suggested that CMR feature tracking-derived myocardial strain analysis can assess functional abnormalities that may be associated with ECM alterations in diabetic cardiomyopathy, contributing to the study of diabetic therapy effects.

MO327: Acute Kidney Injury in Post Liver Transplantation in a Hospital in BogotÁ, Colombia

Abstract BACKGROUND AND AIMS Liver transplantation is a mandatory treatment for many cirrhotic patients worldwide. Nonetheless, frequently there is high systemic morbidity and considerable mortality in post transplantation [1]. Our aim was to calculate acute kidney injury incidence (KDIGO), need of renal replacement therapy, early liver graft dysfunction (first week post transplantation: Bilirubin &amp;gt; 10 mg/dL, INR &amp;gt; 1.5, ALT or AST &amp;gt; 2000 UI) and calculate mortality between liver transplantation and end of evaluation. METHOD We reviewed clinical registries from our transplantation service in La Cardio Hospital in Bogotá, Colombia, and included adult patients with diagnosis of cirrhosis and liver transplantation (Ltx) between 1 January 2005 and 31 July 2021. We excluded patients with acute liver failure without indication of transplantation, previous transplant or multiorganic transplantation (e.g. liver–kidney), heart failure and GFR &amp;lt; 30 mL/min/1.73 (CKD EPI). RESULTS We had 550 Ltx patients, of whom 397 (54.4% male) were included according to our inclusion criteria. Mean age of population was 56 year old at the moment of Ltx. Medical history of comorbidity was hypertension (15.8%), diabetes (24.1%) and smoking (25.44%). Mean Charlson index was 4.4 (Ds ± 1.5). Main etiologies of cirrhosis were alcohol (17.8%), idiopathic (16%), hepatitis C virus (15.3%). In terms of cirrhosis severity, 52.3% had CHILD B, and 26% CHILD C. Average MELD-Na was 16 (Ds ± 6). Anhepatic time was 57 min (RIQ: 47–69). Mean time in ICU was 2 days. There was early graft dysfunction in 32 patients (8%). AKI was diagnosed in 21% of patients. Renal replacement therapy was initiated in 29 patients. Global mortality was 15.1% during the time of study. We performed a classification and regression tree (CART) analysis, using mortality, graft dysfunction and AKI as variables. In CART for mortality, patients with BMI &amp;lt; 19 had 56% of probability of death. The absence of RRT need was related to a 95% probability of being alive at the end of the follow-up. A BMI &amp;gt; 19 and &amp;lt; 24 in need of RRT was associated to a 55% of probability of death (Graphic 1). In terms of graft dysfunction, it was present in 8% of patients. Patients taken to RRT had 55% of probability to death. Acute kidney injury was diagnosed in 21% of patients, classified according to KDIGO: 1: 38%, 2: 32% and 3: 30%. Patients who needed RRT showed a higher prevalence of diastolic dysfunction (88%). The majority of KDIGO 3 patients did not need RRT (Graphic 2). CONCLUSION Acute kidney injury was present in almost one quarter of liver transplantation patients and was related to an increase in mortality. We consider that those results highlight the importance of kidney function evaluation from the early post-operative state in a nephrology rapid response team scheme aligned with transplantation surgery, ICU and anaesthesia to improve AKI prevalence.

Coronary microvascular dysfunction and findings of heart failure with preserved ejection fraction in patients with microvascular angina.

Coronary microvascular dysfunction (CMD) may cause symptoms of myocardial ischemia (microvascular angina [MVA]), but recent studies suggested that it might also contribute to the syndrome of heart failure with preserved ejection fraction (HFpEF). In this study we assessed the relation of CMD with findings of HFpEF in MVA patients. We enrolled 36 consecutive patients with MVA, in whom we assessed: 1) coronary blood flow (CBF) response to adenosine and cold pressor test (CPT) by color-Doppler echocardiography of the left anterior descending coronary artery; 2) complete echocardiographic examination; 3) N-terminal-pro-B-natriuretic peptide (NT-proBNP); 4) grade of dyspnea by the modified Medical Research Scale. Among patients, 15 had definite HFpEF findings (group 1), 12 had equivocal HFpEF findings (group 2) and 9 had no evidence of HFpEF findings (group 3). Group 1 patients were older, had more cardiovascular risk factors and higher NT-proBNP levels (P=0.018), and showed a higher prevalence of diastolic dysfunction. Left ventricle dimensions and systolic function, however, did not differ among groups. Dyspnea was also not significantly different among groups (P=0.19). CBF to adenosine was 1.85±0.47, 1.78±0.40 1.49±0.32 in group 1, 2 and 3, respectively (P=0.13). Similarly, CBF response to CPT was 1.57±0.4, 1.49±0.2 and 1.45±0.3 in the 3 groups, respectively (P=0.74). Both CBF response to adenosine and CPT showed no relation with the severity of dyspnea symptoms. Our data suggest that in patients with MVA there is no relation between the grade of impairment of coronary microvascular dilatation and findings of HFpEF.

Abstract 12011: Left Ventricular Hypertrophy Detected by Echocardiogram in Women With HIV

Introduction: Left ventricular hypertrophy (LVH) is an independent predictor of major cardiovascular events. People with HIV have an increased risk of cardiovascular disease (CVD), and a higher prevalence of LVH has been reported in this population. Women with HIV (WWH) have a higher CVD risk than their male counterparts. We sought to evaluate the current prevalence and characteristics of LVH in WWH. Methods: We performed a retrospective chart review (n=1,202) of patients seen at the University of Miami/Jackson Memorial Hospital Special Immunology clinic between 2017-2019. Of the 547 charts of WWH, 148 had available transthoracic echocardiogram. Data regarding demographic, clinical, imaging, and laboratory results was obtained. Results: The estimated prevalence of LVH in WWH was 25%. The mean age was 56.2 years. WWH with LVH were significantly older (60.7 vs. 54.9 years old, p=0.002), had higher systolic blood pressure (144 mmHg vs. 132 mmHg, p= 0.031), and left ventricle mass (169.2g vs. 128.7g, p&lt;0.001). Those who had LVH had a higher prevalence of diastolic dysfunction (68.8% vs. 40.3%, p=0.007), diabetes (47.4% vs. 18.7%, p=0.001), hypertension (76.3% vs. 54.2%, p=0.017), heart failure (23.7% vs. 7.5% p=0.012), and CVD (47.4% vs. 24.3%, p=0.008). We found no significant difference in those with and without LVH regarding race, ethnicity, body mass index, ejection fraction, statin use, alcohol use, smoking, or HIV-related factors (CD4 count and an undetectable viral load). Conclusions: These findings suggest that WWH have a higher prevalence of LVH in the current era when compared to previous reports (15% in 2009). Furthermore, consistent with prior reports, WWH with LVH had a higher prevalence of CVD in this cohort. These findings emphasize the need to further assess risk and mechanisms for the development of LVH in WWH to help reduce CVD risk in this population.

Elevated resting heart rate is a marker of subclinical left ventricular dysfunction in hodgkin lymphoma survivors.

BackgroundThoracic irradiation is one of the cornerstones of Hodgkin lymphoma (HL) treatment, which contributes to high rates of long-term survivorship, but begets a life-long increased risk of heart disease including heart failure. At the cardio-oncology (CO) clinic, persistent sinus tachycardia or elevated resting heart rate (RHR) is frequently observed in these patients. The aim of this study was to evaluate the relation between RHR and left ventricular (LV) dysfunction.MethodsIn 75 HL survivors visiting our CO-clinic echocardiographic evaluation of LV systolic and diastolic function including global longitudinal strain (GLS) was performed to assess subclinical LV dysfunction.ResultsMedian age of HL diagnosis was 24 [25th-75th percentile: [19], [29]] years with a 17 [12], [25] year interval to CO-clinic visit and 31 patients (41%) were male. Average RHR was 78 ± 14 bpm and 40% of patients (N = 30) had an elevated RHR defined as ≥ 80 bpm. While there was no difference in LV ejection fraction (55.6 ± 4.3 vs. 54.8 ± 6.6; p = 0.543), patients with elevated RHR had abnormal GLS (-15.9% vs. −18.3%, p = 0.045) and higher prevalence of diastolic dysfunction (73.3% vs. 46.7%; p = 0.022). GLS, E/e’ ratio and presence of diastolic dysfunction were independently associated with RHR when correcting for age, sex and mantle field irradiation. A significant improvement was observed of the RHR-association model with solely extracardiac confounders when LV-function parameters were added to the model (F-statistic = 6.36, p = 0.003).ConclusionsThis study indicates RHR as a possible marker for subclinical LV-dysfunction in HL survivors.

MO907ASSOCIATION OF ADIPOSITY AND SARCOPENIA WITH CARDIAC VALVE CALCIFICATION IN PATIENTS ON MAINTENANCE HEMODIALYSIS. A CROSS-SECTIONAL STUDY

Abstract Background and Aims Cardiac valve calcification (CVC) is a common disorder in patients with end stage kidney disease (ESKD) and is a predictor of cardiovascular disease and all-cause mortality. Several risk factors are related to CVC in patients with ESKD which include higher age, dyslipidemia, hypertension and diabetes as well as inflammation, bone mineral disease and malnutrition. Moreover, visceral adiposity is associated with disturbed lipid metabolism and proinflammatory activity which could predispose for CVC. Furthermore, sarcopenia and dynapenia is a state common in patients with ESKD. Thus, the aim of this cross-sectional study is to investigate the relationship of adiposity, components of sarcopenia and malnutrition with cardiac valves calcification in patients on chronic hemodialysis. Method Adult patients that were on maintenance hemodialysis were eligible for entering the study. Recruitment took place from March 2019 to September 2020. Exclusion criteria included, patients with less than 6 months on hemodialysis, patients with cancer, inflammatory bowel disease, severe infection, cardiac valve disease prior to dialysis initiation, history of parathyroidectomy and intravenous albumin administration 3 months prior to nutritional assessment. Calcification of heart valves and systolic and diastolic function was assessed by using two-dimensional echocardiography. Nutritional assessment was made using the Geriatric Nutritional Risk Index. Conicity Index, Waist to Height Ratio, the Visceral Adiposity Index, the Lipid Accumulation Product, the Height to Waist Phenotype were also calculated. Waist, calf and mid arm circumference measurement was performed in the end of a midweek dialysis session. Muscle strength was based on a measurement of hand grip strength using a hydraulic hand dynamometer in the non-fistula hand prior to dialysis session. Dynapenia was considered for values &amp;lt; 16 kg in females and &amp;lt; 27kg in males. Serum biochemistry parameters such as total protein, albumin, calcium, phosphate, total cholesterol, triglycerides, HDL, LDL, CRP and iPTH were also measured. Results Overall, 130 patients were included in the study with a mean age of 66±12.47 years (68.5% males) and an average dialysis duration of 4.37±4.95 years. No cardiac valve calcification was found in 34.6%, while both aortic and mitral valve calcification was found in 41.5% of patients. Calcification only of the aortic (AVC) or mitral (MVC) valve was found in 14.6% and 9.2% respectively. Compared to non AVC group, AVC group had significantly higher age, higher prevalence of diastolic dysfunction, CRP values and CRP/albumin ratio and lower albumin to total proteins ratio. Patients with MVC showed significantly higher prevalence of diastolic dysfunction, higher levels of iPTH, CRP/albumin ratio and lower albumin to total proteins ratio. Adiposity, nutritional, anthropometric indices and sarcopenia parameters such as creatinine index, muscle power and physical performance status did not show any difference between all CVC groups. Increased age [OR (95%CI):1.06 (1.00-1.12) p=0.05], diastolic dysfunction [OR (95%CI): 3.07 (1.05-8.92); p=0.04], CRP/albumin ratio were associated with increased risk of AVC, whereas the CRP/albumin ratio appeared as the most powerful risk factor for mitral and for any CVC [OR (95%CI): 3.41 (1.40-8.28); p=0.007, OR (95%CI): 7.98 (2.62-24.98) p&amp;lt;0.001, respectively]. ROC analysis indicated that increased values of CRP/albumin ratio are strong positive predictors of AVC [AUC, 95%CI 0.66 (0.56-0.75) p=0.002], MVC [AUC, 95%CI 0.642 (0.545-0.74) p=0.005] and calcification of any valve [AUC, 95%CI 0.71 (0.615-0.806) p&amp;lt;0.001]. Conclusion Adiposity, nutritional, anthropometric indices and sarcopenia did not show to correlate with CVC in patients with ESKD on hemodialysis. Factors, such as diastolic dysfunction and notably increased CRP/albumin ratio were strong predictors of CVC.

Associations Between HIV Serostatus and Cardiac Structure and Function Evaluated by 2-Dimensional Echocardiography in the Multicenter AIDS Cohort Study.

BackgroundWe aimed to investigate whether there are differences in cardiac structure and systolic and diastolic function evaluated by 2‐dimensional echocardiography among men living with versus without HIV in the era of combination antiretroviral therapy.Methods and ResultsWe performed a cross‐sectional analysis of 1195 men from MACS (Multicenter AIDS Cohort Study) who completed a transthoracic echocardiogram examination between 2017 and 2019. Associations between HIV serostatus and echocardiographic indices were assessed by multivariable regression analyses, adjusting for demographics and cardiovascular risk factors. Among men who are HIV+, associations between HIV disease severity markers and echocardiographic parameters were also investigated. Average age was 57.1±11.9 years; 29% of the participants were Black, and 55% were HIV+. Most men who were HIV+ (77%) were virally suppressed; 92% received combination antiretroviral therapy. Prevalent left ventricular (LV) systolic dysfunction (ejection fraction <50%) was low and HIV serostatus was not associated with left ventricular ejection fraction. Multivariable adjustment models showed that men who were HIV+ versus those who were HIV− had greater LV mass index and larger left atrial diameter and right ventricular (RV) end‐diastolic area; lower RV function; and higher prevalence of diastolic dysfunction. Higher current CD4+ T cell count ≥400 cell/mm3 versus <400 was associated with smaller LV diastolic volume and RV area. Virally suppressed men who were HIV+ versus those who were HIV− had higher indexed LV mass and left atrial areas and greater diastolic dysfunction.ConclusionsHIV seropositivity was independently associated with greater LV mass index, left atrial and RV sizes, lower RV function and diastolic abnormalities, but not left ventricular ejection fraction, which may herald a future predisposition to heart failure with preserved ejection fraction among men living with HIV.

Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter

Background and aimsUric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation. Methods and results231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function. ConclusionsIn conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.

Impact of arterial stiffness on diastolic function and outcomes of heart failure in patients presenting with acute myocardial infarction

Abstract Background Relation of arterial stiffness and cardiovascular disease is well-known. However, there is no data on association between diastolic function and brachial-ankle pulse wave velocity (baPWV) and influence on heart failure outcomes in patients with acute myocardial infarction (AMI). Methods Among patients presenting with AMI, all subjects underwent baPWV and echocardiography were recruited. Diastolic function was categorized by 2016 guideline of ASE/EACVI left ventricular diastolic function. Heart failure outcomes were defined 1) hospitalization for heart failure, 2) cardiac death and 3) sudden cardiac arrest. Results Totally 1,016 subjects were enrolled (FU duration; 3.5±2.0 years, mean age 65±13, predominant male 71.3% and STEMI 40.8%) from 2012 to 2015 in the our University Hospital. Elderly, female, low BMI, higher PWV, HTN, DM and stroke were associated with higher baPWV. Increased arterial stiffness (defined as baPWV ≥1700) had higher prevalence of diastolic dysfunction compared with baPWV &amp;lt;1700 (98.3% vs 86.2%). HF outcomes of 69 events were identified (HF; n=48, cardiac death; n=16, sudden cardiac arrest; n=2, death d/t HF; n=3). In the multivariate analysis, baPWV ≥1700, HTN and low BMI (23 kg/m2) were independent predictors for HF outcomes after adjustment with age, LVEF, DM and stroke (Table 1). Furthermore, KM curve showed that increased arterial stiffness was associated with higher prevalence of diastolic dysfunction and poor outcomes of heart failure (Figure 1). Conclusions In patients with AMI, arterial stiffness was associated with higher prevalence of diastolic dysfunction an independent predictor for heart failure hospitalization and cardiac death. Figure 1. Diastolic dysfunction and HF in AMI Funding Acknowledgement Type of funding source: None

Aortic wall elasticity and left ventricular function in hypertensive patients with nonsignificant coronary artery disease.

Hypertension is an important cause of nonischemic heart failure. It is important to identify subclinical left ventricular dysfunction in patients with hypertension in an early stage to lower the risk of progression to more severe illness. The aim of our study was to assess the correlation between indices of left ventricular function and aortic stiffness in patients with hypertension. Our study was a case control study of 42 hypertensive and 40 normotensive patients with nonsignificant coronary artery disease. All the patients underwent echocardiography and left ventricular ejection fraction, global longitudinal strain, post systolic index, pulsed Doppler early transmitral peak flow velocity, early diastolic mitral annular velocity (e'), and aortic elasticity measurements were calculated. The hypertensive patients were older (58.47 ± 9.57 vs. 52.94 ± 10.38 years, p = 0.018) and had a higher body mass index (30.09 ± 5.08 vs. 27.48 ± 4.17 kg/m2, p = 0.013) and E/e' ratio (8.16 ± 1.81 vs. 6.56 ± 1.71, p < 0.001) and a lower e' velocity (8.25 ± 2.28 vs. 9.52 ± 2.34 cm/s, p = 0.015) than normotensives. They also had a lower aortic distensibility (p = 0.008) and a higher aortic stiffness index (p = 0.039) compared with the normotensive group. The hypertensive patients did not show any association between aortic elasticity and stiffness with age or e' velocity despite significant association in normotensives. Hypertension is associated with a high prevalence of diastolic dysfunction, elevated left ventricular filling pressure, and increased arterial stiffness, all of which have significant association with adverse outcomes. The measurements found in the hypertensive patients compared with the normotensive group may be due to several age-independent mechanisms.

Human Immunodeficiency Virus-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study.

The aims of this study were (1) to compare the prevalence of myocardial diastolic dysfunction (DD) in antiretroviral therapy (ART)-naive people living with human immunodeficiency virus (PLWH) to human immunodeficiency virus (HIV)-uninfected adults in East Africa and (2) to determine the association between serum concentration of the cardiac biomarkers ST2 and DD. In this cross-sectional study, we enrolled PLWH and uninfected adults at a referral HIV clinic in Mwanza, Tanzania. Standardized history, echocardiography, and serum were obtained. Regression models were used to quantify associations. We enrolled 388 ART-naive PLWH and 461 HIV-uninfected adults with an average age of 36.0 ± 10.2 years. Of PLWH in the third, fourth, and fifth decades of life, 5.0%, 12.5%, and 32.7%, respectively, had DD. PLWH had a higher prevalence of DD (adjusted odds ratio, 2.71 [95% confidence interval, 1.62-4.55]; P < .0001). PLWH also had a higher probability of dysfunction with one or fewer traditional risk factors present. Serum ST2 concentration was associated with dysfunction in PLWH but not uninfected participants (P = .04 and P = .90, respectively). In a large population of young adults in sub-Saharan Africa, DD prevalence increased starting in the third decade of life. HIV was independently associated with dysfunction. Serum ST2 concentration was associated with DD in PLWH but not HIV-uninfected participants. This pathway may provide insight into the mechanisms of HIV-associated dysfunction.

4086 HIV-Associated Myocardial Diastolic Dysfunction and Soluble ST2 Concentration in Tanzanian Adults: A Cross-Sectional Study

OBJECTIVES/GOALS: To determine the prevalence of myocardial diastolic dysfunction (DD) and association of serum concentration of the cardiac biomarker serum soluble ST2 in HIV-infected as compared to uninfected Tanzanian adults at the time of HIV diagnosis. METHODS/STUDY POPULATION: In this cross-sectional study we consecutively enrolled HIV-infected participants and uninfected controls at a large, referral HIV clinic in Mwanza, Tanzania. Standardized history, physical examination, echocardiography and serum samples were obtained. The primary outcome was prevalence of myocardial diastolic dysfunction in HIV-infected as compared to uninfected adults. The secondary outcome was the association of baseline serum sST2 concentration with diastolic dysfunction prevalence. Regression models were used to quantify the associations. RESULTS/ANTICIPATED RESULTS: We enrolled 388 HIV-infected, ART naïve and 461 HIV-uninfected controls. Participants with HIV had a higher prevalence of DD (OR = 2.44, p = 0.001, controlled for age, sex, hypertension and BMI) and more severe dysfunction (66.7% vs 42.5%, p = 0.056) at an earlier age. Baseline serum sST2 concentration was significantly associated with DD in HIV-infected but not uninfected participants (p = 0.04 and 0.90, respectively). More HIV-infected adults with concurrent DD exceeded the threshold of 35ng/mL as compared to controls (15.7% vs 5.3%, p&lt;0.0001). Additionally, a significant population level shift to higher sST2 concentration was observed in HIV-infected adults with dysfunction as compared to both HIV-infected without and HIV-uninfected adults with dysfunction (Kolmogrov-Smirnov test: p = 0.02 and 0.04). DISCUSSION/SIGNIFICANCE OF IMPACT: In a large population of HIV-infected adults in sub-Saharan Africa, HIV infection is associated with myocardial diastolic dysfunction. This dysfunction is associated with higher sST2 concentrations. Therefore, we conclude that the sST2 pathway may provide insight into the pathophysiologic mechanisms of dysfunction in HIV-infected adults.

Association Between Sleep Disordered Breathing and Left Ventricular Function: A Cross-Sectional Analysis of the ECHO-SOL Ancillary Study.

Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1-0.3) lower E', 0.3 (0.1-0.5) greater E/E' ratio, and 1.07-fold (1.03-1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3-2.4) g/m2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.

Association of Diastolic Dysfunction with Reduced Cardiorespiratory Fitness in Adults Living with HIV.

Despite the high prevalence of diastolic dysfunction in adults living with HIV, the impact on cardiorespiratory fitness (CRF) is understudied. The objective of this cross-sectional study was to investigate the relationship between cardiac function and CRF in adults with HIV. Adults receiving antiretroviral therapy with no history of coronary artery disease (CAD) or heart failure were eligible to participate. Cardiac function was assessed by resting Doppler echocardiography. CRF was measured by oxygen utilization at peak exercise (VO2peak). The majority of participants were African American (86%) and male (97%) with a mean [standard deviation (SD)] age of 56.6 (7.1) years and median CD4 lymphocyte count of 492 cells/mL. The mean (SD) VO2peak was 26.1 (5.5) mL/(kg·min). Age, diabetes, hypertension, and hemoglobin were associated with VO2peak. Overall, diastolic dysfunction was present in 38% and was associated with lower VO2peak (p < 0.05). VO2peak was lower among those with impaired myocardial relaxation (e' <8 cm/s) compared with normal relaxation [mean ± SE mL/(kg·min), 25.2 ± 0.6 vs. 27.7 ± 0.9, p < 0.05]. Adjusted for age and clinical factors, each unit increase in left ventricular relaxation (E/A) was associated with an average 4.4 mL/(kg·min) higher VO2peak, representing more than one metabolic equivalent. We conclude that diastolic dysfunction is independently associated with clinically significant low CRF in adults with HIV and no history of CAD or heart failure. These results highlight the importance of recognizing diastolic dysfunction in individuals living with HIV regardless of their cardiovascular disease history.

PREVALENCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PREOPERATIVE VISIT CLINIC

Objective: To evaluate the prevalence of left ventricular dysfunction and somerelated factors in patients referred to the preoperative visit clinic. Methodology: In this cross-sectional study, patients aged above 20 years whounderwent echocardiography after physical examination at Poorsina Hospitalaffiliated to Guilan University of Medical Sciences Iran from January to July 2016.Patients were evaluated in two groups with left ventricular diastolic dysfunctionand without left ventricular diastolic dysfunction. The research inclusion criteriaincluded a lack of history of systolic heart failure and proven heart valvedysfunction, lack of deformity, infection and ulcers in the echo site. Lack ofpatient's willingness to continue the study and poor echocardiography windowwere our exclusion criteria. Then, the data was analyis in SPSS version 16. Results: Among 399 patients, 175 had no diastolic dysfunction and 224 (56.1%)had diastolic dysfunction, 200 patients (89.3%)had grade 1 diastolic dysfunctionand 24 patients (10.7%) had grade 2 dysfunction. There was a significantdifference in the frequency distribution of sex between the two groups (p=0.001), so that the odd ratio of this dysfunction was two times more in femalecompared to male. There was a significant difference between the two groups inthe mean age and age ranges (p= 0.0001), with increased prevalence ofdiastolic dysfunctions in elderly. The mean BMI in the affected group was higherthan that in non-affected group. (p = 0.034). There was a statistically significantdifference between two groups with and without left ventricular diastolicdysfunction in terms of the history of diabetes (p= 0.0001). Conclusion: Given the high prevalence of diastolic dysfunction in the communityof patients, who were candidate for surgery especially at higher ages as well aspatients with high risk factors (female sex, diabetes, hypertension and medicineusers), echocardiography was recommended to investigate the preoperativeheart diastolic dysfunction.

Abstract 182: Left Ventricular Diastolic Dysfunction in HIV-infected ART-naive and HIV-negative Tanzanian Adults: A Cross-sectional Study

Objective: To compare the prevalence and associated factors of left ventricular diastolic dysfunction in HIV-infected, ART naïve and HIV-negative Tanzanian adults. Methods: A cross-sectional analysis of a longitudinal study including: 257 HIV-infected, ART naïve adults and 265 HIV-negative controls. Echocardiography and traditional risk factors were performed and determined by standard investigations. The primary outcome was prevalence of left ventricular diastolic dysfunction. Secondary outcomes were factors associated with and grade of dysfunction. Results: Compared to HIV-negative controls, HIV-infected, ART naïve adults had a 2-fold higher prevalence of diastolic dysfunction (OR=2.06 [1.16-3.66], p=0.01). Additionally, age, female sex, obesity and hypertension were significantly associated with dysfunction in HIV-negative adults; whereas, only age and hypertension were associated with dysfunction in HIV-infected adults. As compared to HIV-negative controls, significantly more HIV-infected, ART naïve adults had higher grade dysfunction (p=0.02) and more ventricular hypertrophy. HIV-infected adults with diastolic dysfunction also expressed higher levels of inflammatory cytokines including TNFa, IL6, IL8, IL33 and sST2 as compared to both HIV-negative and HIV-infected adults without dysfunction. Conclusions: HIV-infected Tanzanian adults have a 2-fold higher prevalence of left ventricular diastolic dysfunction in the period immediately following diagnosis and before ART initiation as compared to HIV-negative adults, and this dysfunction is of higher grade and is associated with myocardial hypertrophy. These data identify diastolic dysfunction in an international cohort in the immediate post-diagnosis, pre-ART period similar to that previously reported in the post-ART period in high-income countries. Additionally, traditional cardiovascular risk factors are not significantly associated with dysfunction in HIV-infected adults; however, cytokine patterns are present and may be important for risk stratification in this group. Therefore, studies delineating appropriate screening for this population are needed.