Impaired Left Ventricular Relaxation Research Articles

Coincidence of Moderately Elevated N-Terminal Pro–B-Type Natriuretic Peptide, Endothelial Progenitor Cells Deficiency and Propensity to Exercise-Induced Myocardial Ischemia in Stable Angina

Aim:To assess endothelial progenitor cells (EPC) counts, a novel prognostic marker, in relation to classical adverse outcome predictors–N-terminal pro–B-type natriuretic peptide (NT-proBNP), impaired left ventricular (LV) relaxation and exercise-induced ischemia–in stable coronary artery disease (CAD) with preserved LV systolic function.Methods:We studied 30 non-diabetic men with one-vessel CAD, LV ejection fraction ≥ 60% and normal LV diastolic function (n= 16) or impaired LV relaxation (by ultrasound including tissue Doppler) (n= 14), and 14 non-CAD controls matched for risk profile and medication. CD34+/kinase-insert domain receptor (KDR)+ cells (CD34+/KDR+ cells), a leukocytes subpopulation enriched for EPC, were enumerated by flow cytometry.Results:CAD patients with abnormal LV relaxation exhibited significantly elevated NT-proBNP and decreased CD34+/KDR+ cells vs. CAD with regular diastolic function and non-CAD controls. An inverse NT-proBNP–CD34+/KDR+ cells relationship was precipitated by the clustering of high resting NT-proBNP and low CD34+/KDR+ cells in the subjects with a lower Duke treadmill score.Conclusions:Propensity to symptomatic exertional ischemia may underlie the coincidence of moderately elevated NT-proBNP and EPC deficiency in stable angina. Additionally, chronic subclinical ischemia can also be involved in these associations. These might result from BNP overexpression in the ischemic myocardium and a hypothetical exhaustion of the bone marrow capacity to mobilize EPC at multiple ischemic episodes, thus contributing to NT-proBNP prognostic effect irrespective of hemodynamic factors.

Coincidence of moderately elevated N-terminal pro-B-type natriuretic peptide, endothelial progenitor cells deficiency and propensity to exercise-induced myocardial ischemia in stable angina.

Aim: To assess endothelial progenitor cells (EPC) counts, a novel prognostic marker, in relation to classical adverse outcome predictors–N-terminal pro–B-type natriuretic peptide (NT-proBNP), impaired left ventricular (LV) relaxation and exercise-induced ischemia–in stable coronary artery disease (CAD) with preserved LV systolic function. Methods: We studied 30 non-diabetic men with one-vessel CAD, LV ejection fraction ≥ 60% and normal LV diastolic function (n = 16) or impaired LV relaxation (by ultrasound including tissue Doppler) (n = 14), and 14 non-CAD controls matched for risk profile and medication. CD34+/kinase-insert domain receptor (KDR)+ cells (CD34+/KDR+ cells), a leukocytes subpopulation enriched for EPC, were enumerated by flow cytometry. Results: CAD patients with abnormal LV relaxation exhibited significantly elevated NT-proBNP and decreased CD34+/KDR+ cells vs. CAD with regular diastolic function and non-CAD controls. An inverse NT-proBNP–CD34+/KDR+ cells relationship was precipitated by the clustering of high resting NT-proBNP and low CD34+/KDR+ cells in the subjects with a lower Duke treadmill score. Conclusions: Propensity to symptomatic exertional ischemia may underlie the coincidence of moderately elevated NT-proBNP and EPC deficiency in stable angina. Additionally, chronic subclinical ischemia can also be involved in these associations. These might result from BNP overexpression in the ischemic myocardium and a hypothetical exhaustion of the bone marrow capacity to mobilize EPC at multiple ischemic episodes, thus contributing to NT-proBNP prognostic effect irrespective of hemodynamic factors.

Echocardiographic evaluation and comparison of the effects of isoflurane, sevoflurane and desflurane on left ventricular relaxation indices in patients with diastolic dysfunction

This prospective randomized study aims to evaluate and compare the effects of isoflurane, sevoflurane and desflurane (study drugs) on left ventricular (LV) diastolic function in patients with impaired LV relaxation due to ischemic heart disease using transesophageal Doppler echocardiography. After approval of the local ethics committee and informed consent, 45 patients scheduled for coronary artery bypass grafting surgery were enrolled in the study. Patients were selected by a preoperative Transthoracic Echocardiographic diagnosis of impaired relaxation or Grade 1 Diastolic Dysfunction. They randomly received fentanyl and midazolam anesthesia with 1 MAC of isoflurane (n=16), sevoflurane (n=14) or desflurane (n=15). Hemodynamic parameters and TEE derived ventricular diastolic relaxation indices before and after the study drug administration were compared. LV filling pressures were kept constant throughout the study period to exclude the effect of the loading conditions on diastolic function. Four patients in the sevoflurane group and three in the desflurane group were excluded from the study, after baseline TEE examination revealed normal diastolic filling pattern. All the three study drugs significantly reduced the systemic vascular resistance index with a significant increase in cardiac index. Mean arterial pressure was reduced by all the drugs, although the decrease was not statistically significant. Hemodynamic changes were comparable between all the three groups. In terms of LV relaxation indices, all three agents led to a significant improvement in diastolic function. Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly accompanied by a significant decrease in deceleration time and isovolumetric relaxation time. The effect of all three agents on diastolic relaxation parameters was comparable. In conclusion , Isoflurane, sevoflurane and desflurane, do not appear to have a detrimental effect in patients with early diastolic dysfunction. On the contrary, these inhalational agents actually improve the LV relaxation. A significant reduction in afterload produced by these vapors can be a possible reason for these findings. The positive effect of these inhalational agents on LV relaxation can have a profound effect on the perioperative anesthetic management of patients with diastolic dysfunction.

Usefulness of Early Diastolic Mitral Annular Velocity to Predict Plasma Levels of Brain Natriuretic Peptide and Transient Heart Failure Development After Device Closure of Atrial Septal Defect

Device closure of atrial septal defect (ASD) is sometimes followed by elevation of plasma brain natriuretic peptide (BNP), a marker of heart failure, and progression to heart failure. This study tested the hypothesis that the underlying diastolic dysfunction, assessed on tissue Doppler images (TDI) before device closure, can predict BNP level after ASD closure. The study subjects were 39 consecutive patients (age 27.5 +/- 16.3 years, range 5 to 63) who underwent device closure for ASD. Echocardiographic evaluation using TDI and 2-dimensional and pulse wave Doppler were performed, together with plasma BNP measurement 1 day before and 2 days after ASD closure. Before ASD closure, an age-dependent decrease was noted in left ventricular relaxation, assessed by early diastolic mitral annular velocity. ASD closure resulted in a decrease in early diastolic mitral annular velocity (from 14.7 to 12.3 cm/s, p <0.05) despite an increase in the left ventricular dimension (84% to 92% vs normal, p <0.05). These changes were associated with a parallel increase in BNP (17.9 to 48.4 pg/ml, p <0.05). Stepwise multivariate linear regression identified early diastolic mitral annular velocity before ASD closure and age as independent predictors of BNP levels after ASD closure (p <0.05). Consistent with this result, 2 patients with the lowest early diastolic mitral annular velocity developed exertional dyspnea after the procedure. In conclusion, our results indicate that TDI measurements could be useful to detect underlying diastolic dysfunction that can potentially cause heart failure after ASD closure and emphasize the importance of ASD closure at a young age before impairment of left ventricular relaxation.

Appearance of Electrocardiographic Initial U‐Wave Inversion Dependent on Pressure‐Induced Early Diastolic Impairment in Patients with Hypertension

ECG U-wave inversion can be classified as initial and terminal U inversion according to the phasic relationship to positive U-wave deflection. Initial U inversion is occasionally observed in hypertensive patients while terminal U inversion frequently appears during severe myocardial ischemia. The genesis of initial U inversion may be related to pressure-induced diastolic dysfunction. In order to clarify the genesis of initial U-wave inversion we studied 11 consecutive hypertensive patients with both initial U inversion and impaired left ventricular early relaxation who were evaluated using Doppler echocardiography. The U inversion disappeared during acute pressure lowering by sublingual administration of nitroglycerin. The U inversion also disappeared and relaxation improved significantly after chronic blood pressure lowering. Initial U inversion reappeared during a cold pressor test. The appearance of initial U inversion was dependent on the pressure-induced impaired left ventricular early relaxation in hypertensive patients.

Doppler‐Derived Myocardial Performance Index in Patients with Impaired Left Ventricular Relaxation and Preserved Systolic Function

The Doppler-derived myocardial performance index (MPI) has been used in the evaluation of left ventricular (LV) function in several diseases. In patients with isolated diastolic dysfunction, the diagnostic utility of this index remains unclear. The aim of this study was to determine the diagnostic utility of MPI in patients with systemic hypertension, impaired LV relaxation, and normal ejection fraction. Thirty hypertensive patients with impaired LV relaxation were compared to 30 control subjects. MPI and its components, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and the ejection time (ET), were measured from LV outflow and mitral inflow Doppler velocity profiles. MPI was higher in patients than in control subjects (0.45 +/- 0.13 vs 0.37 +/- 0.07 P < 0.0029). The increase in MPI was due to the prolongation of IRT without significant change of ICT and ET. MPI cutoff value of > or =0.40 identified impaired LV relaxation with a sensitivity of 63% and specificity of 70% while an IRT >94 ms had a sensitivity of 67% and specificity of 80%. Multivariate analysis identified relative wall thickness, mitral early filling wave velocity (E), and systolic myocardial velocity (Sm) as independent predictors of MPI in patients with hypertension. MPI was increase in patients with hypertension, diastolic dysfunction, and normal ejection fraction but was not superior to IRT to detect impaired LV relaxation.

Assessment of left ventricular diastolic events interrelations: An integrated approach

Left ventricular (LV) diastolic function represents a complex performance that involves long axis displacement, myocardial lengthening velocities as well as cavity filling. The aim of this study was to assess the various diastolic event interrelations in a group of patients with different degrees of diastolic dysfunction. 128 consecutive subjects with various degrees of diastolic impairment were studied by Doppler echocardiography. The amplitude of early diastolic (El) and late diastolic (Al) long axis lengthening was measured by M-mode and corresponding myocardial velocities (Ea and Aa) by Tissue Doppler. LV filling velocities were also acquired by spectral pulsed wave Doppler. Early diastolic long axis amplitudes and velocities correlated (r=0.73, P<0.0001) as did late diastolic ones (r=0.67, P<0.0001). El of ≤5.6 mm was 80.6% sensitive and 70.5% specific in predicting Ea of <8.0 cm/s, a feature of LV impaired relaxation. El/Al correlated with Ea/Aa (r=0.78, P<0.0001), as did E/El with E/Ea ratios (r=0.74, P<0.0001). An E/El ratio>17.3 cm/s/mm had 94.1% sensitivity and 87.4% specificity for predicting an E/Ea ratio>15, a marker for raised LV filling pressures. El≤6.8 mm, total amplitude of diastolic motion (El+Al)≤11.5 mm, and E/El>14.2 cm/s/mm were the best criteria to discriminate between normal diastolic function and pseudonormal/restrictive LV filling. Diastolic LV components of motion, amplitude and velocities are not independent, neither from each other nor from filling pressures. An integrated approach towards using them all in assessing diastolic function, particularly in patients with raised filling pressure should be of great clinical value.

Assessment of left ventricular diastolic function using color kinesis: differentiation between normal and pseudonormalized patterns.

Doppler examination of transmitral flow has been widely used to noninvasively assess left ventricular (LV) diastolic function. However, it has been demonstrated that transmitral flow velocity is dependent on LV relaxation and left atrial pressure. Increases in left atrial pressure compensate for the effects of impaired LV relaxation, frequently resulting in a "pseudonormalization" of the transmitral flow pattern. The purpose of this study was to assess whether analysis of diastolic color kinesis (CK) can be applied to differentiation between normal and pseudonormalized (PN) patterns of LV inflow. We studied 60 subjects with a ratio of early to late transmitral peak velocities (E/A) greater than 1.0 according to conventional Doppler echocardiography. All subjects simultaneously underwent measurement of the early diastolic mitral annular velocity (e'), which was measured by tissue Doppler imaging, and LV ejection fraction (EF), which was calculated by the modified Simpson method. Study subjects were classified into the following three groups according to the value of e' and EF: (1) the normal group (e' > 10 cm/s, EF > 60%), including 20 subjects (mean age 35 ± 10 years); (2) the PN1 group (e' < 7 cm/s, EF > 50%), consisting of 20 patients [mean age 63 ± 11 years, 15 patients with hypertensive heart disease (HHD), 5 patients with aortic valve stenosis]; and (3) the PN2 group (e' < 7 cm/s, EF < 50%), consisting of 20 patients (mean age 61 ± 17 years, 18 patients with dilated cardiomyopathy, 2 patients with HHD). Diastolic CK images were obtained for each subject from the LV midpapillary short-axis view. Analysis of CK diastolic images was performed using ICK software. The CK-diastolic index (CK-DI) was defined as the calculated LV segmental filling fraction during the first 30% of diastole, expressed as a percentage. The mean CK-DI was determined from the average CK-DI of six LV segments. The mean CK-DI was 70.9% ± 6.5% in the normal group, 46.3% ± 10.4% in the PN1 group, and 36.3% ± 5.1% in the PN2 group. The mean CK-DI was significantly reduced in the PN1 and PN2 groups compared with the normal group (P < 0.0001). Although there was no difference in e' (PN1 group: 4.6 ± 1.8 cm/s, PN2 group: 4.4 ± 1.7 cm/s) between the two pseudonormalized patient groups, the mean CK-DI was significantly reduced in the PN2 group compared with the PN1 group (P < 0.005). The reduction in mean CK-DI was seen not only in pseudonormalized patients with LV systolic dysfunction but also in those with preserved LV systolic function. The analysis of diastolic CK with ICK software is a useful method for detecting delayed early diastolic relaxation. We concluded that diastolic CK images may be applied to differentiating between normal and pseudonormalized patterns of LV inflow.

Association between troponin T and impaired left ventricular relaxation in patients with acute decompensated heart failure with preserved systolic function

To examine relationships between cardiac troponin T (cTnT) and parameters of left ventricular (LV) structure and function in patients with acute destabilized heart failure (HF) with preserved LV ejection fraction. In 44 patients with acute heart failure (HF) with preserved left ventricular (LV) ejection fraction, parameters of LV structure and function were assessed via comprehensive two-dimensional Doppler echocardiography. There was no correlation between cTnT and LV wall thickness, left atrial volume index, or transmitral E wave velocity or deceleration time. There were associations between cTnT and LV end-diastolic dimension (r = -0.34, P = 0.02) and LV mass index (r = 0.32; P = .04). A lower tissue Doppler Ea wave peak velocity was associated with higher cTnT concentrations (r = -0.90, P < 0.001). In multivariate analyses, only LV end-diastolic dimension (t = 2.2; P = 0.04), LV mass index (t = 2.3; P = .03), and tissue Doppler Ea wave peak velocity (t = -4.7; P < .001) emerged as significant predictors of cTnT. In patients with HF with preserved LV ejection fraction, cTnT is strongly associated with the extent of LV relaxation abnormalities and LV mass.

Real-Time Three-Dimensional Echocardiography in the Evaluation of Left Atrial Structure and Function in Normal, Aging, Hypertensive and Heart Failure Patients: New Insights into Left Atrial Adaptation and Remodeling

Precise left atrial (LA) volume quantification, representative of LA function, is of extraordinary clinical prognostic value. However, a detailed description of pathophysiology in different disease populations and interactions with aging by real-time three-dimensional echocardiography (RT-3DE) is lacking. This study consisted of three protocols: (1) to test the impact of different LA cutting planes on LA volume quantification in different disease populations ( n = 61) by RT-3DE; (2) to examine the impact of aging, hypertension ( n = 145), the interaction on LA remodeling; and (3) to further depict the LA regional and global remodeling process in different disease entities ( n = 68), including heart failure (HF). Bias and percentage error in LA volume quantification tended to decrease significantly when compared with the automatic border detection method at eight cutting planes. A linear relationship was apparent between maximal LA volume and age in the hypertensive group ( r = 0.26, p = 0.03), but not in the normal aging group ( r = 0.16, p = 0.19). A significantly reduced pumping fraction and enlarged LA volume was observed in HF patients ( p < 0.01), with a trend toward less LA pumping volume ( p = 0.1). Eight cut planes provided sufficient accuracy in LA volume quantification using the RT-3DE method. Compared with normal aging, LA volume tends to increase with higher pumping volume to compensate for impaired left ventricular relaxation in hypertension. Relatively preserved total LA pumping volume may exist in heart failure patients at the expense of further adaptive volume expansion with a subsequently reduced total emptying fraction.

Acute left ventricular dilatation and shock-induced myocardial dysfunction*

Whether cardiac ventricles can acutely dilate during septic myocardial dysfunction. A prospective echocardiographic study was performed to assess changes of left ventricular dimensions over time in patients with septic shock. A 20-bed surgical intensive care unit of Pitié-Salpêtrière university hospital in Paris. Forty-five patients were studied over the first 10 days of septic shock. None. Left ventricular end-diastolic area (LVEDA), fractional area change (FAC), velocity time integral of the aortic flow, echocardiographic indices of left ventricular relaxation, and cardiac troponin I (cTnI) were measured at day 1, 2, 3, 4, 7, and 10. Three groups were defined: 29 patients without increased cTnI and cardiac impairment (group 1), eight patients with increased cTnI and left systolic ventricular dysfunction (group 2), and eight patients with increased cTnI and isolated impairment of left ventricular relaxation (group 3). At day 1, LVEDA was significantly higher in group 2 (13 +/- 3 cm/m, p < 0.05) compared with groups 1 (10 +/- 2 cm/m) and 3 (11 +/- 2 cm/m). LVEDA did not change in groups 1 and 3. In group 2, LVEDA and FAC returned within 10 days to values observed in groups 1 and 2. A significant correlation was found between aortic velocity time integral and LVDEA (r =.78, p = 0.022) and FAC (r =.89, p = 0.003) only in group 2. Acute and reversible left ventricular dilation accompanies septic shock-induced systolic left ventricular dysfunction. When septic myocardial abnormalities are limited to reversible impairment of left ventricular relaxation, left ventricular dimensions remain unchanged.

Abstract 707: Nonuniformity of Left Ventricular Apical-to-Basal Diastolic Lengthening in Patients with Hypertrophic Nonobstructive Cardiomyopathy

Quantification of left ventricular (LV) apex-to-base dispersion has been feasible with two-dimensional echocardiographic tissue tracking system (2DTT, Hitachi EUB7500), which based on pattern matching algorithm. Although impairment of LV relaxation was characterized in patients with hypertrophic cardiomyopathy (HCM), the behavior of LV apical and basal diastolic lengthening and its relation to LV filling are unknown. We obtained basal and apical LV short-axis views in 22 patients with non-obstructive HCM and 25 healthy volunteers (N). Eight equiangular points on endo-myocardium at end-diastole were placed in each view, and the shortening ratios of four directions were calculated and averaged by 2DTT. Then, the time-LV shortening and lengthening curves were obtained. The time intervals from the aortic valve closure to the point of the first 40% of peak lengthening (T 40 ) were measured in each view. Isovolumic relaxation time (IRT) was measured by pulsed Doppler LV in- and out-flow recordings. Although both apical and basal T 40 were similar in N (145.8±38.4 vs. 134.3±34.2msec 0.5 , ns.), the apical T 40 in HCM was longer compared to base (118.7±51.1 vs. 168.8±52.5msec 0.5 , p&lt;0.0001). The time difference of T 40 between apex and base was related to LV IRT (r=0.59, p&lt;0.0001). Nonuniformity of apical-to-basal left ventricular lengthening during early diastole was present in HCM. This apex-to-base dispersion, especially apical delay in timing of LV lengthening may have a physiologic importance for impairment of LV relaxation in HCM.

Treatment of Hypertension in Heart Failure with Preserved Ejection Fraction: Role of the Kidney

Heart failure can present clinically as primarily diastolic or systolic dysfunction or both. There is an increasing awareness that heart failure can occur in the presence of a normal left ventricular ejection fraction. Heart failure with normal left ventricular ejection fraction is frequently referred to as diastolic heart failure because of the presence of diastolic left ventricular dysfunction evident from impaired left ventricular relaxation. This article focuses on the treatment of hypertension and the role the kidney plays in selecting appropriate agents.

Left Ventricular Systolic and Diastolic Function in Asymptomatic Patients With Moderate Aortic Stenosis

Tissue Doppler imaging (TDI) has improved the ability to detect subclinical changes in left ventricular (LV) function. The aim of this study was to investigate if asymptomatic patients with moderate aortic stenosis (AS) had impaired LV systolic and diastolic function. Fifty patients (mean age 65 +/- 12 years) recruited into the multicenter Simvastatin + Ezetimibe in Aortic Stenosis (SEAS) study with aortic peak velocities of 2.5 and 4.0 m/s were compared with 26 healthy subjects (mean age 64 +/- 12 years) (p = NS). Peak systolic tissue velocities and strain were measured at 8 LV locations and averaged. Early diastolic tissue velocity from the septal mitral annulus (E'sep) was measured as an index of LV relaxation. The ratio of early diastolic transmitral pulsed Doppler (E) to E'sep (E/E'sep) was calculated as an index of LV filling pressure. Peak systolic tissue velocity (4.1 +/- 1.0 vs 4.8 +/- 1.1 cm/s, p <0.01) and strain (-16.6 +/- 2.7% vs -17.9 +/- 2.0%, p <0.05) were decreased in patients with AS compared with controls. E'sep was decreased (4.9 +/- 1.0 vs 5.8 +/- 1.3 cm/s, p <0.01) and E/E'sep was increased (17.4 +/- 9.7 vs 11.7 +/- 3.8, p <0.01) in the AS group compared with the control group. In conclusion, asymptomatic patients with moderate AS have impaired LV systolic function as measured by reduced peak systolic tissue velocity and strain. Augmented LV filling pressure measured by E/E'sep and impaired LV relaxation measured by reduced E'sep also indicate diastolic dysfunction in these patients.

Differential effects of nebivolol and atenolol on transmitral diastolic filling parameters in patients with essential hypertension

Impaired left ventricular (LV) diastolic relaxation, detected by pulsed Doppler echocardiography, is predictive of a higher incidence of major cardiovascular events in hypertensive patients. An improvement in LV diastolic function is an important goal of treatment. However, treatment of LV diastolic dysfunction remains empirical. The objective of our study was to compare the short-term effects of nebivolol and atenolol on Doppler diastolic filling parameters in hypertensive patients. A total of 32 patients with mild-to-moderate hypertension were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg/day) or atenolol (50 mg/day) for 1 month. Diastolic filling parameters, with pulsed-wave Doppler transmitral flow velocities, were measured 1 day before and 1 month after treatment. Compared with baseline, both agents significantly decreased heart rate and blood pressure. However, there was no significant difference in pre-and post-treatment values between the nebivolol and atenolol groups. Both drugs significantly improved LV transmitral flow measured by early diastolic flow/atrial contraction signal (E/A) ratio, decreased deceleration time (DT) and isovolumetric contraction time (IVRT), but post-treatment improvement in E/A, DT and IVRT values was more significant with nebivolol compared with atenolol (P=0.05, P=0.05 and P=0.003, respectively). Although treatment with nebivolol or atenolol results in improved LV transmitral diastolic function filling parameters (E/A ratio, IVRT and DT), nebivolol has a greater effect compared with atenolol in patients with mild-to-moderate hypertension.

Low hematocrite seems to correlate with impaired left ventricular relaxation estimated by color M-mode flow propagation in patients with heart failure

Low hematocrite seems to correlate with impaired left ventricular relaxation estimated by color M-mode flow propagation in patients with heart failure

Thyroid Hormone Treatment to Mend a Broken Heart

Thyroid Hormone Treatment to Mend a Broken Heart

Isolated and reversible impairment of ventricular relaxation in patients with septic shock*

Many patients with septic shock and increased cardiac troponin I (cTnI) do not exhibit significant left ventricular systolic dysfunction. We hypothesized that an isolated and reversible impairment of ventricular relaxation may be associated with the increase in cTnI. Prospective, observational study. Surgical intensive care unit in a university hospital. Total of 54 patients with septic shock. Fractional area change, early diastolic velocity of mitral annulus, flow propagation velocity of early diastolic mitral inflow, cTnI, tumor necrosis factor-alpha, interleukin (IL)-6, -1beta, -8, and -10 were measured at days 1, 2, 3, 4, 7, and 10 after onset of septic shock. Patients were classified into three groups: normal cTnI (group 1), increased cTnI and fractional area change <50% (group 2), and increased cTnI and fractional area change >50% (group 3). A total of 22 patients had an increase in cTnI, 11 with both systolic and diastolic dysfunctions and 11 with isolated impairment of left ventricular relaxation. At day 1, early diastolic velocity of mitral annulus and flow propagation velocity of early diastolic mitral inflow were significantly lower and tumor necrosis factor-alpha, IL-8, and IL-10 significantly higher in groups 2 and 3 compared with group 1. With resolution of septic shock, early diastolic velocity of mitral annulus and flow propagation velocity of early diastolic mitral inflow measured in patients of groups 2 and 3 returned progressively to values observed in group 1, with a parallel normalization of tumor necrosis factor-alpha, IL-8, and IL-10. Isolated and reversible impairment of left ventricular relaxation, associated with transient increases in cTnI, tumor necrosis factor-alpha, IL-8, and IL-10, was observed in 20% of patients with septic shock.

Heterogeneity of regional systolic function detected by tissue Doppler imaging is linked to impaired global left ventricular relaxation in hypertrophic cardiomyopathy

Objective:To evaluate regional and global left ventricular (LV) function and LV wall thickness (LVWT) in patients with hypertrophic cardiomyopathy (HCM).Design and setting:Observational study at the National Cardiovascular Centre and Nagoya...

Echocardiographic Features of Patients With Congestive Heart Failure and Preserved Left Ventricular Pump Function: A Retrospective Study in a Selected Common Disease Cohort

Background. Little is known of the pathophysiologic characteristics of a common disease cohort with congestive heart failure (CHF) and preserved left ventricular (LV) systolic function. The objective of this retrospective study was to determine the differences in the echocardiographic features in patients with or without previous evidence of new-onset CHF in the outpatient setting using a selected common disease cohort.Methods and Results. We selected 72 consecutive outpatients, including 37 patients with hypertension, 16 with diabetes, 30 with hyperlipidemia, and/or 10 with coronary artery disease with no significant stenosis, having an early diastolic to atrial systolic transmitral flow velocity ratio (E/A) =50%. The patients were divided into 2 groups according to the presence or absence of previous evidence of new-onset CHF: CHF group (n=7) and control group (n=65). Of the 72 patients, previous CHF was certified in 7 patients (9.7%). The LV mass index and maximal left atrial dimension were significantly greater (P Conclusions. Left atrial enlargement, LV hypertrophy, and LV systolic myocardial dysfunction are important in the development of CHF in patients with impaired LV relaxation and preserved LV pump function.