Improvement In Diastolic Function Research Articles

Association of aortic stiffness to brain natriuretic peptide in children before and after device closure of patent ductus arteriosus

ObjectivesWe evaluated the influence of device closure for patent ductus arteriosus (PDA) on the aortic stiffness index (ASI) and brain natriuretic peptide (BNP) and their association with cardiac function. Patients and methodsASI and echocardiography assessment before and after treatment (16±9months) in 48 children with PDA (mean age 10±4.5) and 52 control children (mean age 9.7±4.6). BNP level was measured pre-closure for all children, and was measured six months after closure only for children with PDA. ResultsASI was higher in PDA patients than in controls (P<0.001). ASI correlated with age (P<0.05), LVEF% (P<0.01), E/E′ (<0.03), pulmonary artery pressure (P<0.001), and BNP (P<0.001). ASI and BNP significantly decreased after closure (P<0.001). ASI and BNP were independent predictors for post-closure systolic dysfunction (P<0.001and <0.005, respectively). Receiver operating curve (ROC) analysis showed that ASI⩾13.5, BNP level ⩾75pg/ml and basal mean pulmonary artery pressure (PAP)⩾23 were powerful predictors for post-closure systolic function. ConclusionASI is significantly associated with BNP and basal PAP in children with PDA. After device closure, aortic distensibility improved significantly and was associated with significant improvement in both systolic and diastolic functions. ASI can be used for monitoring the course of patients with PDA, and may give opportunities for early intervention.

Dynamics of structural and functional changes of the heart and the levels of GDF 15 and NTproBNP on the candesartan and ramipril therapy in patients with heart failure with preserved ejection fraction after myocardial infarction on the background of arter

Chronic heart failure (CHF) is actual medical problem around the world and in Ukraine. Almost 50% of these patients have heart failure with preserved ejection fraction. CHF is the result of many complications and cardiovascular disease, such as coronary heart disease, including myocardial infarction and hypertension. Despite the prevalence of heart failure with preserved ejection fraction a common strategy for the treatment of this disease has not yet been developed. This is due to the limited number of controlled studies in these patients. One of the most effective drugs in the treatment of heart failure with preserved ejection fraction after myocardial infarction are candesartan and ramipril. Determining the dynamics of GDF 15 and NTproBNP along with those of echocardiography is promising for evaluating the effectiveness of treatment of patients with heart failure with preserved ejection fraction after myocardial infarction in the background of arterial hypertension.The aim of research. To determine the dynamics of structural and functional changes of the heart and the levels of GDF 15 and NTproBNP on the ramipril and candesartan therapy in patients with heart failure and preserved ejection fraction after myocardial infarction on the background of arterial hypertension.Materials and methods. 38 patients with heart failure with preserved left ventricular ejection fraction (EF&gt;45%) after myocardial infarction with comorbidity arterial hypertension were included into the study. Dynamics of structural and functional changes of the heart and the levels of GDF 15 and NTproBNP on the ramipril and candesartan therapy for 12 weeks (mean age 64,3 ± 1,3 years) were investigated. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 2 groups. The first group in addition to the basic treatment received candesartan (KASARK "Arterium", Ukraine) at a mean dose 18,5 ± 2,1 mg daily. Patients of the second group received ramipril (RAMIMED, «Medochemie Ltd.», Iceland/Cyprus) at a mean dose 5,8±0,6 mg daily.Results. In patients receiving candesartan was observed decreased hypertrophy with significant thinning left ventricular walls, decreased left ventricular mass index (5,4%, p&lt;0,05), MVA (11,0%, p&lt;0,05), increase E' (12,5%, p&lt;0,05), reduction ratio E/E' (10,9%, p&lt;0,05) and decreased left atrium volume index (12,0%, p&lt;0,05). Patients with ramipril therapy have significant thinning posterior left ventricular wall (6,7%, p&lt;0,05), decreased left ventricular mass index (5,9%, p&lt;0,05) and left atrium volume index (10,1%, p&lt;0,05). On the candesartan therapy for 12 weeks was observed a significant reduction the levels of GDF 15 (Δ (%)=-27±4,65) and NTproBNP (Δ(%)=-22±12,7) in serum. Patients with ramipril therapy also contributed to a significant decrease levels of GDF 15 (Δ (%)=-25±3,48) and NTproBNP (Δ(%)=-16±12,6). On the background of candesartan therapy was a significant increased the distance of the 6-minute walking test (26,1%; p&lt;0,05). Ramipril therapy also led to a significant increased the distance of the 6-minute walking test (13,1%; p&lt;0,05).Conclusion. Intaking of the candesartan and ramipril contributed to decreasing LV. On the background of candesartan therapy was observed more substantial improvement of LV diastolic function with decreasing E/E' compared with ramipril. Candesartan and ramipril therapy led to a lowering of GDF 15 and NTproBNP, while the dynamics of NTproBNP in patients receiving candesartan was more significant. Candesartan and ramipril therapy provided to improve the clinical condition of patients.

A randomized controlled trial of the effects of pioglitazone treatment on sympathetic nervous system activity and cardiovascular function in obese subjects with metabolic syndrome.

Insulin resistance and sympathetic nervous system overactivity are closely associated and contribute to cardiovascular risk. The objective of the study was to test the hypotheses that pharmacological improvement in insulin sensitivity would (1) attenuate sympathetic neural drive and (2) enhance neuronal norepinephrine uptake. A randomized, double-blind trial was conducted in 42 obese, unmedicated individuals with metabolic syndrome (mean age 56 ± 1 y, body mass index 34 ± 0.6 kg/m(2)) who received 12 weeks of pioglitazone (PIO; 15 mg for 6 wk, then 30 mg daily) or matched placebo. Clinical measurements included whole-body norepinephrine kinetics [spillover rate, plasma clearance, and the steady state ratio of tritiated 3,4-dihydroxyphenylglycol to tritiated norepinephrine ([(3)H]-DHPG to [(3)H]-NE) as an index of neuronal uptake-1], muscle sympathetic nerve activity, spontaneous baroreflex sensitivity, euglycemic hyperinsulinemic clamp, oral glucose tolerance test, ambulatory blood pressure, and Doppler echocardiography. PIO treatment increased glucose uptake by 35% and was accompanied by significant reductions in diastolic blood pressure and improved left ventricular diastolic and endothelial function. Resting muscle sympathetic nerve activity burst frequency decreased by -6 ± 3 burst/min compared with baseline (P = .03), but the magnitude of change was not different from placebo (P = .89). Norepinephrine spillover and clearance rates and baroreflex sensitivity were unchanged. Post hoc subgroup analyses revealed an 83% increase in [(3)H]-DHPG to [(3)H]-NE ratio in hyperinsulinemic (P = .04) but not normoinsulinemic subjects (time × group interaction, P = .045). Change in [(3)H]-DHPG to [(3)H]-NE ratio correlated with improvements in diastolic blood pressure (r = -0.67, P = .002), the ratio of early (E) to late (A) peak transmitral diastolic inflow velocity (r = 0.62, P = .008), E wave deceleration time (r = -0.48, P = .05), and Δinsulin area under the curve0-120 during the oral glucose tolerance test (r = -0.42, P = .08). Compared with placebo, PIO does not affect resting sympathetic drive or norepinephrine disposition in obese subjects with metabolic syndrome. Treatment induced changes in the [(3)H]-DHPG to [(3)H]-NE ratio related to reduction in hyperinsulinemia and improvements in diastolic function.

Cardiovascular remodeling during long-term nocturnal home hemodialysis.

BackgroundCardiovascular disease is the leading cause of morbidity and mortality in patients with kidney failure. Nocturnal home hemodialysis (NHD) is a form of kidney replacement therapy whereby hemodialysis is performed for at least 6-h overnight, at least 4 days per week. Little is known about the effects of NHD on cardiovascular remodeling as assessed by transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR).ObjectivesThe primary objective of the study was to determine the long-term effects of NHD on cardiovascular remodeling using different imaging modalities over a one-year follow-up.Methods and resultsA total of 11 patients were included in the study (6 males, mean age 48 ± 16 years) between 2009 and 2011 inclusive at a single tertiary care center. All patients underwent TTE and CMR at baseline and after 1 year of NHD. Left ventricular mass index decreased significantly at 1 year by both TTE (152 ± 7–129 ± 8 g/m2, p < 0.05) and CMR (162 ± 4–124 ± 4 g/m2, p < 0.05). There was also a significant decrease in both left and right atrial volume as well as in right ventricular mass index over 1 year of follow-up. Diastolic dysfunction, graded from 0 to 4, improved from a baseline grade of 3.4 to 1.2 at 1-year follow-up.ConclusionsLong-term nocturnal hemodialysis leads to favorable cardiovascular remodeling with a reduction in cavity dimensions, regression of left ventricular hypertrophy, and an improvement in diastolic function, as assessed by both TTE and CMR.

Diabetic hearts have lower basal urocortin levels that fail to increase after cardioplegic arrest: Association with increased apoptosis and postsurgical cardiac dysfunction

The present study investigated the cardioprotective role of urocortin (Ucn) and its relationship with protein kinase C (PKC)ε and PKCδ in patients with (DMPs) and without (NDMPs) diabetes mellitus after on-pump cardiac surgery (OPCS). The molecular mechanisms responsible for the reported worse outcomes of DMP after OPCS remain unknown. Two sequential biopsy specimens were obtained from the right atrium of 27 DMPs and 22 NDMPs before and after cardiopulmonary bypass. Postcardioplegic induction of Ucn in NDMPs (P<.01) was not observed in the DMPs, whose precardioplegic Ucn levels were 50% lower than those in the NDMPs (P<.05). In the NDMPs, cardioplegic arrest increased PKCε mRNA and protein (P<.05); overexpression of PKCδ was not seen. In contrast, DMPs showed increased PKCδ expression (P<.01), with no change in PKCε. Apoptosis was more than twofold greater in the postcardioplegic samples from the DMPs than in those from the NDMPs. The apoptotic myocytes were Ucn negative and exhibited nuclear relocation of PKCδ. Enhanced PKCε/mitochondrial co-localization was observed in viable, Ucn-positive, myocytes. The leakage of troponin I documented in the DMPs was greater than that in the NDMPs, although the difference was not statistically significant (P=.06). Furthermore, despite a similar incidence of perioperative acute myocardial infarction, the DMPs did not show postoperative improvement of systolic or diastolic function, although that was seen in the NDMPs (P<.05). Cardioplegic arrest failed to induce in DMPs myocyte overexpression of Ucn or PKCε but was associated with induction and mitochondrial relocation of PKCδ, resulting in apoptosis. Failure to overexpress Ucn in the DMPs was associated with apoptosis and cardiac dysfunction and, thus, might contribute to worse postoperative outcomes.

Echocardiographic effect of successful balloon mitral valvuloplasty on right ventricular function

Abstract Background Rheumatic cardiac disease is an immunologic phenomenon that may affect any of the heart valves and is by far the most common cause of mitral stenosis. Aim of the work To evaluate impact of successful percutaneous balloon mitral valvuloplasty on right ventricular function. Subjects and methods 30 consecutive patients who underwent balloon mitral valvuloplasty for rheumatic mitral stenosis between September 2010 and July 2011 at Ain Shams University hospital were included. All patients were subjected to transthoracic echo Doppler study, tissue Doppler imaging and TEE for: (A) Assessment of severity of mitral stenosis. (B) Peak myocardial velocities during systole, early and late diastole. (C) Assessment of RV function by measurement of TAPSE and Tie index. Results The study revealed a significant drop in TAPSE (before and 24 h after, P 0.008; before and 3 ms after, P 0.001) respectively. There was no significant change 24 h and 3 ms after the procedure ( P 0.220) .There was no significant change in IVC flow before and after 24 h ( P 0.221). There was no significant drop between before and after 3 ms ( P 0.062). There was no significant change between 24 h and 3 ms after the procedure ( P 0.264). There was a significant drop in Tie index (before and 24 h after, P 0.008; before and 3 ms after, P 0.009) respectively but no significant drop was found 24 h and 3 ms after the procedure ( P 0.373). Conclusion The current study showed a significant improvement in both systolic and diastolic functions of RV as observed by different echocardiographic parameters post BMV in patients without organic TV disease.

TCTAP A-214 Early Regression of Indexed Left Ventricular Mass Together with Diastolic Function Improvement After Successful Transcatheter Aortic Valve Implantation

Severe aortic stenosis is associated with left ventricular (LV) hypertrophy resulting in impaired diastolic function. We investigated the benefit of transcatheter aortic valve implantation (TAVI) in high-risk patients with severe aortic stenosis in LV mass regression and changes in LV diastolic

Effects of testosterone undecanoate replacement and withdrawal on cardio-metabolic, hormonal and body composition outcomes in severely obese hypogonadal men: a pilot study

Modifications of cardiovascular and metabolic parameters during testosterone (T) replacement and withdrawal have never been investigated in severely obese hypogonadal men. Twenty-four severely obese (mean BMI 42; mean age 54.5) hypogonadal men (mean T = 245 ± 52 ng/dL) were enrolled in an observational, parallel-arm, open-label, 54-week study of hypocaloric diet plus physical activity (DPE; n = 12) or DPE plus T injections (DPE + T; n = 12), followed by 24 weeks of DPE alone. Primary endpoints were variations from baseline of cardiovascular (cardiac performance, blood pressure, endothelial function, carotid intima-media thickness, CIMT; epicardial fat thickness, EF) and body composition (fat/lean mass) parameters. Secondary endpoints were variations from baseline of hormonal (T and GH) and metabolic (oral glucose tolerance test, lipids, fibrinogen) parameters. At 54 weeks, DPE + T showed improvements in EF, ejection fraction, diastolic function, CIMT and endothelial function (p < 0.01 vs. controls). Also, hormonal (T, p < 0.0001; GH, p < 0.01), metabolic (HOMA, p < 0.01; microalbuminuria, p < 0.01), lipid (total cholesterol, p < 0.05) and inflammatory (fibrinogen, p < 0.05) parameters improved. After 24 weeks from T withdrawal, all cardiac and hormonal parameters returned to baseline, while fat but not lean mass and blood pressure ameliorations were maintained. An inverse relationship either between EF vs. endothelial function and EF vs. T levels was found (r (2) = -0.46, p < 0.001 and r (2) = -0.56, p < 0.0005, respectively) while direct relationship between T vs. endothelial function occurred (r (2) = 0.43, p < 0.005) in DPE + T. A 33 % dropout rate was reported in DPE without serious adverse events. In middle-aged hypogonadal obese men, 1-year T treatment was safe and improved cardio-metabolic and hormonal parameters. We firstly demonstrated that T withdrawal determines a return back to hypogonadism within 6 months, with loss of cardiovascular and some body composition improvements attained.

Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular Mass

Antihypertensive treatment can improve tissue Doppler indices of left ventricular diastolic function in the short term, but little is known about the longer-term effect of different antihypertensive treatments on progression of left ventricular diastolic function and left ventricular hypertrophy. We hypothesized that long-term treatment of hypertension will lead to improvements in left ventricular hypertrophy and diastolic function. We collected detailed cardiovascular phenotypic data on 1006 participants from a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial. Patients randomized to either an amlodipine±perindopril-based or an atenolol±bendroflumethiazide-based regimen underwent conventional and tissue Doppler echocardiography at time of control of blood pressure after randomization (≈1.5 years; phase 1) and after a further 2 years of antihypertensive treatment (phase 2). There were no prerandomization data. Five hundred thirty-six patients had complete data collection at both phases. Left ventricular mass index regressed from phase 1 to 2 with no significant difference between treatment groups (amlodipine: 119.5–116.8; atenolol: 122.9–117.5; P &lt;0.001 for both). Conversely, tissue Doppler diastolic indices did not change in the amlodipine±perindopril-based regimen (E/e′, 7.5–7.6 cm/s; P =not significant), but deteriorated in the atenolol±bendroflumethiazide-based regimen (E/e′, 8.0–8.5 cm/s; P &lt;0.01). Despite regression of left ventricular hypertrophy, there was no associated improvement in diastolic function. In fact, long-term treatment with atenolol±bendroflumethiazide resulted in a progressive deterioration in E/e′. This may be a factor contributing to the previously described worse clinical outcome in patients treated with atenolol±bendroflumethiazide compared with amlodipine±perindopril.

Interval training does not modulate diastolic function in heart transplant recipients

Objectives. This study investigates the effect of aerobic interval training on diastolic function at rest and during exercise in stable heart transplant (HTx) recipients. Design. Twenty-three stable HTx recipients (74% males, mean age 50 ± 14.9 years) were recruited to a training programme. Intervention was 8 weeks intensive training or control in a randomized controlled design. Results. At baseline, participants had normal or mild diastolic dysfunction at rest. During exercise, mean E/e′ increased from 9.0 (± 2.8) to 12.8 (± 7.7) (p = 0.09), E/A increased from 2.1 (± 0.6) to 2.6 (± 0.7) (p = 0.02), and deceleration time decreased by over 50 ms, all markers of increased filling pressure. There were no correlations between diastolic function and VO2peak at baseline. After intervention VO2peak increased from 23.9 (± 4.5) to 28.3(± 6) ml/kg/min in the training group (difference between groups p = 0.0018). No consistent pattern of improvement in diastolic function at rest or during exercise was seen. Conclusion. The study does not support a role of diastolic dysfunction in the limited exercise capacity of HTx recipients and suggests that in these patients peripheral factors are of greater importance.

Age and the effectiveness of anti-hypertensive therapy on improvement in diastolic function

Diastolic dysfunction is associated with adverse outcomes and is highly prevalent among older adults with hypertension. Lowering SBP with antihypertensive therapy has been shown to improve diastolic function, but whether or not age influences this effect is unknown. In the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction trial, 189 patients (age range 45-93 years) with hypertension and diastolic dysfunction underwent echocardiography before and after 24 weeks of intensive versus standard antihypertensive therapy titrated to a goal SBP below 135 versus below 140 mmHg. We performed linear regression analyses to examine the association between age and improvement in diastolic function achieved with SBP reduction. Antihypertensive therapy reduced SBP by 28 ± 19 mmHg overall, and this was not significantly different across age strata. However, percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) for every 10 mmHg reduction in SBP was lower in older compared to younger patients. In analyses adjusting for age stratum, sex, treatment arm, baseline relaxation velocity, and baseline blood pressure, older age was associated with reduced improvement in diastolic relaxation velocity per 10 mmHg of SBP reduction (β -1.64, P = 0.009). In contrast, the degree of change in left ventricular mass index per 10 mmHg reduction in SBP was not influenced by age (P = 0.89). In our sample of individuals with hypertension and diastolic dysfunction, older compared to younger adults experienced less improvement in diastolic function in response to similar reductions in SBP.

Echocardiographic evaluation and comparison of the effects of sevoflurane and desflurane on left ventricular relaxation indices in patients with diastolic dysfunction scheduled for coronary artery bypass grafting surgery

Background Effect of inhalational anesthetics on diastolic function in humans is still controversial, although inhalational anesthetics have been shown to have negative lusitropic action in experimental studies, which were explained by interference of inhalational anesthetics with calcium homeostasis. Aim This prospective randomized study aims to evaluate and compare the effects of sevoflurane and desflurane on left ventricular (LV) diastolic function in patients with impaired LV relaxation due to ischemic heart disease using transesophageal Doppler echocardiography. Patients and methods After approval from the local ethics committee and informed consent, 24 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. Anesthetic induction was standardized in both groups. Patients randomly received 1 MAC of sevoflurane ( n = 12) or desflurane ( n = 12) for maintenance of anesthesia. Hemodynamic parameters and transesophageal echocardiography (TEE) derived ventricular diastolic relaxation indices before and after the study drug administration were compared. LV filling pressures were kept within normal range throughout the study period to exclude the effect of the loading conditions on diastolic function. Results The two study drugs significantly reduced the systemic vascular resistance index with a significant increase in the cardiac index. Hemodynamic changes measured by invasive arterial line and pulmonary artery catheter were comparable between the two groups. In terms of LV relaxation indices, the two agents led to a significant improvement in diastolic function. 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 the two agents on diastolic relaxation parameters was comparable. Conclusion Sevoflurane and desflurane appear to improve LV relaxation. This can be explained by a significant reduction in afterload produced by these vapors. The positive effect of these inhalational agents on LV relaxation can have a beneficial effect on the anesthetic management of patients with diastolic dysfunction.

Mitochondrial targeted peptides attenuate residual myocardial damage after reversal of experimental renovascular hypertension

Renovascular hypertension (RVHT) increases cardiovascular morbidity and mortality. Renal revascularization with percutaneous transluminal renal angioplasty and stenting (PTRS) may reverse RVHT but may not fully regress cardiac remodeling and damage, possibly due to persistent myocardial insults. Bendavia is a mitochondrial targeted peptide that reduces ischemic cardiomyopathy by improving mitochondrial function. However, its potential for attenuating residual myocardial damage after reversal of RVHT has not been explored. We hypothesized that treatment with Bendavia as an adjunct to PTRS would improve cardiac function and oxygenation, and decrease myocardial injury in swine RVHT. After 6 weeks of RVHT (unilateral renal artery stenosis) or control, pigs underwent PTRS (or sham), with adjunct continuous infusion of Bendavia (0.05 mg/kg intravenously, 30 min before to 3.5 h after PTRS) or vehicle (n = 7 each). Four weeks later, systolic and diastolic function were assessed by multidetector computed tomography, myocardial oxygenation by blood oxygen level-dependent MRI, and myocardial morphology, apoptosis, mitochondrial biogenesis, and fibrosis evaluated ex vivo. PTRS restored blood pressure in both groups, yet E/A ratio remained decreased. Myocardial oxygenation and mitochondrial biogenesis improved, and myocardial inflammation, oxidative stress, and fibrosis normalized in association with improvement in diastolic function in RVHT + PTRS + Bendavia animals. Adjunct Bendavia during PTRS in swine RVHT improved diastolic function and oxygenation and reversed myocardial tissue damage. This approach may allow a novel strategy for preservation of cardiac function and structure in RVHT.

Comment on “Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction”

We read with great interest the manuscript entitled “Analisis de la function diastolica mediante gated-SPECT de perfusion miocardica tras revascularizacion coronaria en el infarto agudo de miocardio” [Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction] by Romero-Farina et al. in the first issue of 2013 of Rev Esp Med Nucl Imagen.1 They should be congratulated for the article which is drawing attention to the important field of nuclear cardiology. With the present communication, we would like to contribute a technical detail regarding this issue. Authors analyzed the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction. Significant improvement in diastolic function has been reported mainly associated to the amount of salvage myocardium afterpercutaneous coronary revascularization inpatientwith acute myocardial infarction. They acquired the gated SPECT images by dividing the R–R interval to 8 frames and the results of the time to peak filling rate (TTPF) and peak filling rate (PFR) was obtained by the software using this data. It has been recommended that

Effects of Bariatric Surgery on Cardiac Structure and Function: A Systematic Review and Meta-Analysis

Morbid obesity, a condition increasingly treated with bariatric procedures, is strongly associated with left ventricular (LV) hypertrophy and impaired LV function. We analyzed the literature to provide comprehensive information on cardiac structural and functional changes, as assessed by imaging techniques, after bariatric surgery. The studies were identified by the following search terms: "bariatric surgery," "obesity," "left ventricle," "left ventricular hypertrophy," "cardiac hypertrophy," "ventricular dysfunction," "left ventricular hypertrophy regression," "echocardiography," "magnetic resonance imaging," and "cardiac imaging techniques." In a pooled population of 1,022 obese subjects with preserved systolic function included in 23 studies, bariatric procedures induced (i) a decrease in LV mass (standardized mean difference (SMD) = -0.46; P < 0.001) and relative wall thickness (SMD = -0.20; P < 0.001); (ii) an improvement of LV diastolic function, as reflected by the increase in mitral flow E/A ratio (SMD = +0.39; P < 0.001); (iii) a decrease in left atrium diameter (SMD = -0.26; P < 0.001); or (iv) no changes in LV ejection fraction (SMD = +0.03; P = 0.46). The present meta-analysis, the largest to date focusing on cardiac structural and functional changes in morbidly obese subjects after bariatric surgery, documents that this therapeutic approach exerts important cardioprotective effects in terms of regression of LV hypertrophy, improvement of LV geometry and diastolic function, and reduction of left atrial size.

Improvements in Left Ventricular Hypertrophy and Diastolic Function Following Renal Denervation: Effects Beyond Blood Pressure and Heart Rate Reduction

This study sought to investigate the interaction between blood pressure (BP) and heart rate (HR) reduction and changes in left ventricular (LV) structure and function following renal sympathetic denervation (RDN). Hypertension results in structural and functional cardiac changes. RDN reduces BP, HR, and LV mass and improves diastolic dysfunction. We evaluated LV size, mass, and function before and 6 months after RDN in 66 patients with resistant hypertension and analyzed results in relation to systolic BP (SBP) and HR. SBP decreased by 11 ± 3 mm Hg in the first, 18 ± 5 mm Hg in the second, and 36 ± 7 mm Hg in the third tertile of SBP at baseline (p < 0.001). HR decreased by 13 ± 4 beats/min, 8 ± 3 beats/min, and 11 ± 6 beats/min in tertiles of SBP (p for interaction between tertiles = 0.314). In all SBP tertiles, LV mass index (LVMI) decreased similarly (LVMI −6.3 ± 2.2 g/m 2.7 , −8.3 ± 2.1 g/m 2.7 , and −9.6 ± 1.9 g/m 2.7 ; p for interaction = 0.639). LVMI decreased unrelated to HR at baseline (p for interaction = 0.471). The diastolic parameters E-wave deceleration time, isovolumetric relaxation time, and E′-wave velocity improved similarly in all tertiles of SBP and HR. Changes in LV mass and function were also unrelated to reduction in SBP or HR. Vascular compliance improved dependently on BP but independently of HR reduction. In patients with resistant hypertension, LV hypertrophy and diastolic function improved 6 months after RDN, without significant relation to SBP and HR. These findings suggest a direct effect of altered sympathetic activity in addition to unloading on cardiac hypertrophy and function.

Pilot Study of Pioglitazone and Exercise Training Effects on Basal Myocardial Substrate Metabolism and Left Ventricular Function in HIV-Positive Individuals with Metabolic Complications

Background: Individuals with HIV infection and peripheral metabolic complications have impaired basal myocardial insulin sensitivity that is related to left ventricular (LV) diastolic dysfunction. It is unknown whether interventions shown to be effective in improving peripheral insulin sensitivity can improve basal myocardial insulin sensitivity and diastolic function in people with HIV and peripheral metabolic complications. Objective: In a pilot study, we evaluated whether the peroxisome proliferator-activated receptor-gamma (PPAR-γ) agonist pioglitazone or combined endurance and resistance exercise training improves basal myocardial insulin sensitivity and diastolic function in HIV+ adults with peripheral metabolic complications. Design: Twenty-four HIV+ adults with metabolic complications including peripheral insulin resistance were randomly assigned to 4 months of pioglitazone (PIO; 30 mg/d) or supervised, progressive endurance and resistance exercise training (EXS; 90-120 min/d, 3 d/wk). Basal myocardial substrate metabolism was quantified by radioisotope tracer methodology and positron emission tomography (PET) imaging, and LV function was measured by echocardiography. Results: Twenty participants completed the study. Neither PIO nor EXS resulted in a detectable improvement in basal myocardial insulin sensitivity or diastolic function. Post hoc analyses revealed sample sizes of more than 100 participants are needed to detect significant effects of these interventions on basal myocardial insulin sensitivity and function. Conclusions: PIO or EXS alone did not significantly increase basal myocardial insulin sensitivity or LV diastolic function in HIV+ individuals with peripheral metabolic complications.

Abstract 19245: Heart of Stone: A Mysterious Case of Diastolic Dysfunction

A 27 year old Somali female initially presented with renal failure and a creatinine of 10mg/dl. A kidney biopsy showed crystalline nephropathy and she was initiated on hemodialysis. A year later while she was pregnant she had multiple heart failure admissions. Echocardiograms (echo) showed normal ejection fraction (EF). A month after delivery she was admitted again with heart failure. Vital signs were stable with elevated JVP and a pansystolic murmur at the apex. Chest x ray showed pulmonary edema. Echo showed moderately concentric left ventricular hypertrophy (LVH) with an EF of 40% and severe mitral regurgitation (MR). Doppler echo showed restrictive filling pattern. Pulmonary artery pressure (PA) was 99 mm of Hg + right atrial pressure (RA) with dilated vena cava. Repeat echocardiogram post ultrafiltration of just 1 liter of volume reduced PA pressures from 99 mm+RA to about 35 mm Hg+ RA with a simultaneous reduction in MR, demonstrating marked preload dependency of left sided filing pressures. Her myocardium demonstrated an echodense speckled reflection and infiltrative cardiomyopathy was suspected. EKG showed LVH making amyloidosis unlikely diagnosis. Right ventricular endomyocardial biopsy showed extensive deposition of calcium oxalate crystals in myocardium. Further tests showed increased serum oxalate level: 140 μmoles/L (ref. upto 27), increased urinary oxalic acid excretion:171 μgm (ref. &lt; 57) and increased urine glycolate: 101 μg/mg Cr (ref. &lt; 79) . Liver biopsy showed very low AGT (Alanine glyoxylate aminotransferase) activity of 3.0 μmol/h/mg protein (Ref. 19.1-47.9) along with negative AGT immunoreactivity . These results confirmed diagnosis of primary hyperoxaluria type 1 (PH1) . She was started on intense hemodialysis regimen and underwent a deceased donor combined liver-kidney transplantation (CLKT). Repeat echo 6 months later shows normal EF, normal PA pressures, regression of infiltrative process with improvement in diastolic function. This is a rare case of PH1 with cardiac involvement leading to progressive infiltrative restrictive cardiomyopathy and recurrent heart failure. Early recognition of the disease is important because CLKT may achieve long-term survival and regression of cardiomyopathy.

Predictors of improvement in diastolic function after transcatheter aortic valve implantation.

Aortic stenosis is associated with concentric left ventricle (LV) hypertrophy or remodeling resulting in impaired diastolic function and elevated left-sided filling pressure. We investigated the changes in LV geometry and LV filling hemodynamics, giving emphasis to parameters associated with changes in diastolic function after transcatheter aortic valve implantation (TAVI). Comprehensive diastolic assessment was performed before and six months after TAVI in 70 patients with severe aortic stenosis. Patients with any degree of mitral stenosis or >mild left-sided valvular regurgitation were excluded. In the entire cohort six months after TAVI, LV end-diastolic diameter increased (44.1±6 versus 45±6mm, P=0.02), whereas LV mass and relative wall thickness (RWT) decreased (270.1±76 versus 245.1±75g and 0.53±0.15 versus 0.46±0.1, respectively; P<0.0001 for both). Lateral e' increased (5.8±2 versus 6.6±3cm/s, P=0.03) and left atrium (LA) volume, E/e' ratio, and systolic pulmonary pressure decreased (88.1±30 versus 80±28cc, 18±7.8 versus 16.3±5.5, and 42.7±14.9 versus 38.7±12mmHg, respectively; P<0.05 for all), suggesting reduction in LA pressure. The improvement in LA volume and E/e' was almost exclusively seen in patients with LV hypertrophy before TAVI (P<0.05 both), as opposed to patients with concentric remodeling. In our preliminary study, TAVI resulted in LV and LA reverse remodeling, and improved LV relaxation and LA filling pressure in patients with severe aortic stenosis and concentric hypertrophy. Patients with concentric remodeling at baseline seem to have limited improvement in LV diastolic function and filling pressure following TAVI, but larger clinical trials would be required to conclude if they have no improvement at all.

Improvement of left ventricular diastolic function and left atrial reverse remodeling after catheter ablation of premature ventricular complexes

Catheter ablation of premature ventricular complexes (PVC) improves left ventricular (LV) systolic performance in certain patients; however, the effect on diastolic function and left atrial (LA) remodeling is unclear. We assessed the effects of catheter ablation of PVCs on parameters of LV diastolic function and LA remodeling. Forty-seven patients (age 65 ± 10 years, 46 men) who underwent catheter ablation for symptomatic PVCs were evaluated using two-dimensional echocardiography before and 6 ± 2 months after ablation. The measured diastolic indices included mitral inflow parameters (E wave, A wave, E/A ratio, and deceleration time (DT)), mitral lateral annulus early diastolic velocity (Ea), and E/Ea ratio. The LA volume was measured using modified biplane Simpson's method. We also compared the changes in the left atrial volumes and left atrial volume index (LAVI) after PVC ablation. After catheter ablation of PVCs, the mean LV ejection fraction (EF) increased significantly (49.9 ± 10.3 vs. 42.8 ± 11.8, p < 0.01). Significant improvement was also seen in A wave velocity (71.3 ± 17.1 vs. 59.5 ± 15.1 cm/s, p = 0.039), E/A ratio (1.42 ± 0.6 vs. 1.07 ± 0.5 ml, p = 0.034), Ea (8.9 ± 3.9 vs. 6.8 ± 2.9 cm/s, p = 0.04), and E/Ea ratio (15.4 ± 5.8 vs. 10.6 ± 3.4, p = 0.027), whereas mitral E and DT did not show significant change. LAVI decreased significantly after ablation (44.4 ± 14.8 vs. 36.7 ± 12.5, p < 0.001). Significant improvement in LAVI was also seen in patients with normal baseline LVEF (p = 0.04). Catheter ablation of PVCs improved LV diastolic function and resulted in left atrial reverse remodeling.