Independent Predictor Of Left Ventricular Diastolic Dysfunction Research Articles

Can glycated haemoglobin (HbA1c) be used as a predictor of left ventricular diastolic dysfunction in non-hypertensive patients with newly diagnosed type 2 diabetes mellitus: a cross-sectional study at a tertiary care centre in Eastern India

ObjectivesThis study was conducted to establish the association between glycated haemoglobin (HbA1c) and left ventricular diastolic dysfunction (LVDD) in non-hypertensive patients with newly diagnosed type 2 diabetes mellitus (DM) and...

MO744HIGH SENSIVITY CARDIAC TROPONIN I, A POSSIBLE BIOMARKER OF DIASTOLIC DYSFUNCTION IN ASYMPTOMATIC PATIENTS IN HEMODIALYSIS

Abstract Background and Aims Impairment in the diastolic function is strongly associated with heart failure and cardiovascular disease in patients with end-stage renal disease (ESRD), with a high prevalence of 50-65% and unobvious early symptoms. Hence, it is of great importance to explore serum biomarkers for early assessment of diastolic disfunction in patients with ESRD, providing evidence for performing an early intervention. When myocardial cell membrane integrity becomes damaged, cardiac troponin is released into the circulation, inducing an elevation of serum cardiac troponin in asymptomatic patients on dialysis. We analyzed the relationship between high-sensitivity cardiac troponin I biomarker (hs-cTnI) and left ventricular diastolic dysfunction (LVDD) in a cohort of asymptomatic patients on haemodialysis at our center. Method Cross-sectional study. We include patients on haemodialysis in our center. Demographic variables (age, sex), associated comorbidity, hs-cTnI levels, and echocardiographic parameters were collected. Statistical analysis was performed with SPSS 25.0. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation, and T-student, Anova or U-mann Whitney was used to compare them. Logistic regression analysis was performed to determine independent predictors of LVDD. Statistical significance for a value of p <0.05. Results 80 patients, with an average age of 67.44 ± 13 years. 57.5% were men. 86.3% had high blood pressure (HBP), 52.5% were diabetic, 75% dyslipidemic, and 51.2% had overweight/obese body mass index. 32.5% had previous history of ischemic heart disease, 41.3% had moderate/severe left ventricle hypertrophy (LVH), 8.8% left ventricular ejection fraction (LVEF) <55% and 37.5% LVDD. Mean hs-cTnI was 31.27 ± 59.37 ng/L. LVDD was related to age (71 ± 10 years vs 65 ± 14 years p = 0.049), HBP (96.7% vs 3.3% p = 0.036), moderate/severe LVH (63.3% vs 36.7% p = 0.002), heart rate (HR) (66.96 ± 8.6 vs 77.28 ± 43.63 p = 0.036) and hs-cTnI (47.48 ± 81.97 ng/L vs 21.54 ± 38.06 ng/L p = 0.005). We divide the hs-cTnI into quartiles, with mean hs-cTnI levels 4.83 ± 1.92 ng/L in Q1, 9.86 ± 1.68 ng/L in Q2, 20.67 ± 4.26 ng L in Q3 and 89.73 ± 98.49 ng/L in Q4. We observed statistical significance for age (Q3 71 ± 10 ng/L vs 60 ± 17 ng/L p = 0.040), HBP (Q4 141.60 ± 16.68 ng/L vs Q1 123.90 ± 25, 98 ng/L p = 0.025), overweight/obesity (p = 0.001) and LVEF <55% (p = 0.015). The logistic regression showed that HR (OR 0.94 95% CI 0.89-0.99 p = 0.025), LVH severity (OR 5.16 95% CI 1.74-15.25 p = 0.003), and hs-cTnI > 20 (OR 4.11 95% CI 1.38-12.18 p = 0.011) are independent risk factors for LVDD. Conclusion hs-cTnI levels could be a biomarker of LVDD in asymptomatic patients on haemodialysis. New studies with a greater number of patients would increase the evidence for this claim, in order to carry out early intervention and treatment.

Association between serum uric acid and left ventricular hypertrophy/left ventricular diastolic dysfunction in patients with chronic kidney disease.

The level of serum uric acid (SUA) has been reported to be associated with left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD). However, this association remains unclear in patients with chronic kidney disease (CKD). A total of 1025 patients with pre-dialysis CKD with preserved left ventricular systolic function were enrolled in this cross-sectional study. The LVH and LVDD were assessed using two-dimensional echocardiography and tissue Doppler imaging. The associations of LVH/LVDD with clinical and laboratory variables were investigated using univariable and multivariable logistic regression analyses. In a multivariable analysis, the SUA level was an independent predictor of LVH (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.31-1.50, P < 0.001). In addition, patient age, systolic blood pressure, intact parathyroid hormone levels, and left atrial volume index levels were independent predictors of LVH. The SUA level was also an independent predictor of LVDD (OR: 1.93, 95% CI: 1.53-2.43, P < 0.001). Furthermore, systolic blood pressure and left atrial volume index levels were an independent predictor of LVDD. Receiver-operating characteristic curve analysis showed that the best cutoff values of SUA levels for identifying LVH and LVDD were ≥ 7.5 mg/dL and ≥ 6.3 mg/dL, respectively. The SUA level was an independent predictor of LVD and LVDD in patients with CKD, suggesting that SUA could be a biomarker for LVH and LVDD.

Factors Predicting Cardiac Dysfunction in Patients with Liver Cirrhosis.

BACKGROUND Left ventricular diastolic dysfunction (LVDD) is the earliest cardiac dysfunction noted in patients with liver cirrhosis, which increases the morbidity and mortality in such patients. There are sparse studies from India evaluating the predictive factors of LVDD in patients with cirrhosis. Hence we undertook this prospective study with an aim to evaluate the factors predicting the development of LVDD in liver cirrhosis. METHODS 104 patients with cirrhosis were enrolled in this prospective study. A detailed cardiac evaluation was done by 2 D echocardiography with tissue Doppler imaging by an experienced senior cardiologist. The severity of liver disease was defined by Model For End-Stage Liver Disease (MELD) and Child-Pugh score. RESULTS The prevalence of LVDD was 46% in our study. Multivariate logistic regression analysis revealed that serum albumin, MELD score, and presence of ascites (OR = 0.1, 95%CI 0.03-0.3, p < 0.001; Or = 1.12, 95%CI 1.03-1.22, p < 0.001; OR = 4.19, 95%CI 1.38-12.65, p < 0.01, respectively) were independent predictors of LVDD in patients with cirrhosis. Diastolic dysfunction was unrelated to age, sex, and etiology of cirrhosis. The patients with cirrhosis and LVDD had significantly higher child Pugh score, MELD score, and lower serum albumin than patients without LVDD. The echocardiographic parameters like E/e' ratio, Deceleration time (DT), and Left atrial volume index (LAVI) were significantly different in cirrhotic patients with higher MELD and child Pugh score than lower. CONCLUSION The present study showed a significant correlation of diastolic dysfunction with the severity of the liver disease. Low serum albumin, high MELD score, and presence of ascites significantly predict the development of LVDD in patients with cirrhosis.

Impact of left ventricular diastolic dysfunction on liver transplantation outcomes based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations.

Aim of the studyCirrhotic cardiomyopathy encompasses systolic dysfunction, left ventricular diastolic dysfunction (LVDD), and conduction abnormalities. This study aims to investigate the impact of LVDD on mortality in patients undergoing liver transplantation (LT).Material and methodsA retrospective review of 400 consecutive patients who underwent LT at our institution was performed. Patient demographics, clinical data, and transthoracic echocardiogram (TTE) were reviewed to identify LVDD. The total cohort consisted of 266 patients after excluding patients with insufficient TTE data (n = 56), patients with indeterminate LVDD (n = 71), and patients with ejection fraction (EF) < 55% (n = 7). Statistical analysis was performed using descriptive statistics. Cox regressions with hazard ratios (HRs) and 95% confidence intervals (CI) were applied to predict 5-year all-cause mortality. Kaplan-Meier survival analysis was conducted to understand the impact of LVDD on 5-year all-cause mortality.ResultsPatients with LVDD have higher incidence of hyperlipidemia (36% vs. 17%, p = 0.003), hypertension (50% vs. 27%, p = 0.001) and diabetes (52% vs. 30%, p = 0.003). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 24%, p = 0.001). A multivariate logistic regression analysis was performed with age, body mass index (BMI), NASH, alcoholic cirrhosis, hepatitis C, history of diabetes, history of hyperlipidemia, and history of hypertension. In this multivariate logistic regression analysis, NASH (odds ratio [OR] = 4.43 [1.10-17.8], p = 0.04), and history of hypertension (OR = 2.33 [1.16-4.66], p = 0.01) were independent predictors of LVDD. The Kaplan-Meier survival analysis and multivariate Cox regression demonstrated that the presence of LVDD had no impact on 5-year all-cause mortality (log-rank test nonsignificant).ConclusionsThis study indicates that LVDD in end-stage liver disease (ESLD) patients does not affect immediate post-transplant outcomes or 5-year all-cause mortality.

Abstract P476: Consumption Of Animal And Plant Food And Likelihood Of Left Ventricular Diastolic Dysfunction: A Prospective Study Among Black And White Adults Of The Bogalusa Heart Study

Introduction: Left ventricular diastolic dysfunction (LVDD) is one key subclinical precursor of heart failure with preserved ejection fraction (HFpEF). Whether dietary correlates serve as independent predictors of LVDD in adults without HFpEF is unknown. Hypothesis: We hypothesized that dietary habits in young adulthood would prospectively influence the likelihood of LVDD in middle age. Methods: The analysis included 456 individuals of the Bogalusa Heart Study (26.5% black, 62.7% female, baseline age=36.1 + 4.4 years) with an ejection fraction &gt; 55%. Diet was measured at baseline via food frequency questionnaires. LVDD was defined at follow-up (median=12.9 years) through echocardiographic measurement of the E/A ratio, E/e’ ratio, isovolumic relaxation time, and deceleration time. Logistic regression estimated the odds of LVDD according to protein source, adjusting for cardiovascular disease risk factors and total energy intake. Results: There were 72 cases of LVDD. Using the lowest tertile as reference, persons in the middle tertile of total protein (OR=3.31, 95% CI: 1.47, 7.46; p=8.5x10 -3 ) and animal protein (OR=2.93, 95% CI: 1.35, 6.37; p=0.03) intake had the highest likelihoods of LVDD. We observed 54% and 57% lower odds of LVDD for persons in the highest vs. lowest tertile of vegetable (OR=0.46, 95% CI: 0.22, 0.95; p=8.0x10 -4 ) and legume consumption (OR=0.43, 95% CI: 0.20, 0.92; p=0.02), respectively. Total protein, animal protein, processed meat, and eggs indicated a significant quadratic trend towards increased odds of LVDD, while legumes and vegetables indicated a significant quadratic trend toward decreased odds of LVDD ( Table ). There were no significant relationships of LVDD with other animal or plant foods. Conclusions: Animal and plant food consumption result in an increased and decreased likelihood of LVDD, respectively. Adherence to plant-based diets in young adulthood may protect against the development of LVDD, and thus future HFpEF, later in life.

Plasma neutrophil gelatinase-associated lipocalin is independently associated with left ventricular hypertrophy and diastolic dysfunction in patients with chronic kidney disease.

BackgroundCardiovascular disease (CVD) is a leading cause of death in patients with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) are known as predictors of CVD in these patients. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury. Recently, elevated NGAL levels have been reported in patients with CVD. This study aimed to evaluate the association between plasma NGAL levels and LVH/LVDD in patients with CKD.MethodsThis study included 332 patients with pre-dialysis CKD (estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2). Two-dimensional echocardiography was performed to measure the left ventricular mass index (LVMI). Tissue Doppler imaging was used to measure early mitral inflow velocity (E) and the peak early mitral annular velocity (E'). Diastolic function was estimated using E' and the ratio of E to E' (E/E'). The associations of echocardiographic index with clinical and laboratory variables (age, sex, diabetes, hypertension, eGFR, albumin, uric acid, calcium, phosphate, total cholesterol, hemoglobin, C-reactive protein, intact parathyroid hormone (PTH), the inferior vena cava collapse index (IVCCI) < 50%, and plasma NGAL) were investigated using univariate and multivariate analyses.ResultsIn multivariate logistic regression analysis, plasma NGAL was an independent predictor of LVH (OR: 1.02, 95% CI: 1.01–1.02), P < 0.001). In addition, hypertension, intact PTH, and IVCCI < 50% were independent predictors of LVH. Plasma NGAL (OR: 1.02, 95% CI: 1.01–1.02, P < 0.001) was also an independent factor of LVDD. Furthermore, hypertension, intact PTH, and IVCCI < 50% were independent predictors of LVDD. Receiver operating characteristic curve analysis (area under the curve: 0.835, 95% CI: 0.792–0.879) showed the best cutoff value of plasma NGAL for identifying LVDD was ≥ 258 ng/ml with an associated sensitivity of 77.6% and a specificity of 87.6%.ConclusionPlasma NGAL levels were independent predictors of LVH and LVDD in patients with pre-dialysis CKD, suggesting that plasma NGAL could be a biomarker for LVH and LVDD in these patients.

Sex-specific predictors of left ventricular diastolic dysfunction in untreated hypertension.

BackgroundLittle is known about the sex-specific differences in left ventricular (LV) diastolic dysfunction (DD) predictors. We hypothesized that arterial stiffness (AS) may play a different role in the etiology of LV DD in hypertensive men and postmenopausal women, acting independently from other established predictors of this condition, such as age, obesity, diabetes mellitus, LV remodeling, and systolic function.ObjectivesThe aim of the study was to analyze the sex-specific differences in AS and other predictors of LV DD in men and postmenopausal women with untreated hypertension (HTN).Patients and methodsThe study included 144 patients (63 postmenopausal women and 81 men, mean age 62.7±6.7 years) with previously untreated HTN and no history of cardiovascular diseases. All patients were subjected to detailed echocardiography, vascular ultrasound, and high-resolution echotracking (eTracking) of carotid arteries.ResultsIn the multivariate analysis, concomitant diabetes mellitus turned out to be an independent predictor of LV DD in women (P=0.02). In turn, two independent predictors of LV DD have been identified in men: S′-tissue Doppler-derived peak LV longitudinal systolic shortening velocity (P=0.001) and β, beta stiffness index (P=0.004).ConclusionThere are sex differences in the predictors of LV DD in untreated HTN. In postmenopausal women, LV DD is mostly determined by diabetes, while in men, it is determined by S′, reflecting LV systolic longitudinal function, and β, a parameter of AS.

The association between plasma thiol levels and left ventricular diastolic dysfunction in patient with hypertension

The balance of oxidant and antioxidant status plays an important role in the left ventricular diastolic dysfunction (LVDD) in patients with hypertension (HT). Thiol is an important part of antioxidant system in the body. The aim of this study was to investigate the relationship between plasma thiol levels and LVDD in patients with HT. A total of 138 patients with newly diagnosed essential hypertensive and 20 age-gender matched subjects as control group enrolled in the study. After echocardiographic assessment, the hypertensive patients were divided into three groups: Group 1: without LVDD (n = 41); group 2: with LVDD grade 1 (n = 57); and group 3: with LVDD grade 2 (n = 40). Plasma thiol, lipid and glucose levels were measured in all subjects. Plasma thiol levels were significantly different between the groups (all of p < 0.05). While the lowest thiol level was in the group 3, the highest level was in the control group. The presence of LVDD was correlated with age, systolic and diastolic blood pressure, thiol levels, and history of coronary artery disease and hyperlipidemia (all of p < 0.05). Age and thiol were however independent predictors of LVDD in multivariate analyses (β = 0.318, p < 0.001, and β = − 0.314, p < 0.001, respectively). ROC-curve analysis revealed that thiol levels over 163 μmol/L predict LVDD in hypertensive patients with 75% sensitivity and 70% specificity (AUC = 0.783; 95% CI: 0.714–0.852). Plasma thiol is an independent predictor for the presence of LVDD. This suggests that thiol plays a role in the pathogenesis of diastolic function. Increased thiol levels may provide protection against the development of diastolic dysfunction.

Echocardiographic evaluation of diastolic dysfunction in rheumatoid arthritis – a case–control study

Objectives. To assess left ventricular diastolic dysfunction (LVDD) and its predictors in rheumatoid arthritis (RA).Methods. This cross-sectional case–control study assessed 100 RA patients and 100 healthy controls for LVDD by M-mode, two-dimensional, colour Doppler echocardiography.Results. RA patients had higher prevalence of LVDD than controls (43% vs. 14%; p < 0.001). LVDD had significant association with duration (p = 0.033), severity of disease activity (p < 0.0001), Steinbrocker stage and functional class (p < 0.0001 each) and non-adherence to treatment (p = 0.047). Peak of late diastolic (A) mitral flow velocity and isovolumic relaxation time (IVRT) were higher (p < 0.05 each), whereas left ventricular ejection fraction, peak of early diastolic (E) mitral flow velocity and E/A ratio were lower (p < 0.05 each) in RA patients than in controls. Deceleration time (DT) was not significantly different in the two groups (p = 0.623). E/A ratio had significant correlation with anti-cyclic citrullinated peptide antibody (ACPA) (r = 0.233, p = 0.019) and age (r = 0.203, p = 0.042). IVRT had significant negative correlation with ACPA (r = −0.196, p = 0.044), while DT had significant correlation with Disease Activity Score with 28-joint (DAS28) counts (r = 0.244, p = 0.014). ACPA was an independent predictor of E/A ratio (p = 0.031). DAS28 was the only independent predictor of LVDD (odds ratio [OR] = 6.01; p = 0.007).Conclusions. LVDD occurred commonly in RA patients and depended on severity of disease activity.

P 21: Clinical and metabolic correlates of diastolic dysfunction in patients with type 2 diabetes

It has been previously shown that hyperglycaemia and insulin resistance can affect cardiac structure and function, independently of arterial hypertension and ischemic heart disease. Left ventricular diastolic dysfunction (LVDD) is considered to be the earliest myocardial lesion in patients with type 2 diabetes (T2D). The aim of this study was to assess the prevalence of LVDD, and to determine its predictors, clinical and metabolic correlates. In order to detect LVDD, 78 patients with T2D, without arterial hypertension, ischemic heart disease or other cardiac disease underwent high-resolution transthoracic echocardiography including tissue Doppler and exercise stressechocardiography). LVDD was diagnosed when E/E’ ratio (early mitral valve flow velocity/early diastolic lengthening velocity) was ≥15. If E/E’ ranged from 8–15, higher values of one of the additional diagnostic criteria were required: left ventricular mass index, left ventricular volume, E/A ratio, atrial fibrillation, N-terminal fragment pro B-type natriuretic peptide (NT-proBNP). Laboratory evaluation included metabolic parameters, biomarkers of inflammation and fibrinolysis, NT-proBNP, homocystein, tumor necrosis factor-⊠, and adiponectin. Minimal model test was performed to assess insulin resistance (28 patients). LVDD was diagnosed in 8 patients (10.3%). These patients were older (60.6±8.4 vs. 53.1±9.1; p=0.029). HDL cholesterol (1.3±0.4 vs. 1.0±0.3 mmol/l; p=0.012), and apolipoprotein A1 (2.4±0.5 vs. 1.8±0.4 mmol/l; p<0.0001) were significantly elevated in patients with LVDD. Univariate analysis confirmed predictive value of age and apolipoprotein A1 for the development of LVDD, while multivariate analysis revealed apolipoprotein A1 as an independant predictor. E/E’ correlated significantly with age, HDL cholesterol, and apolipoprotein A1. LVDD was detected in 10.3% T2D patients without arterial hypertension, ischemic heart disease or other cardiac disease. Higher apolipoprotein A1 was recognized as independent predictor of LVDD. Early detection of LVDD in T2D may be useful to halt the progression of myocardial lesions to heart failure.