Indices Of Left Ventricular Diastolic Function Research Articles

Prevalence and determinants of right ventricular dysfunction in patients with severe symptomatic high gradient aortic stenosis

Abstract Background Right ventricular (RV) function in aortic stenosis (AS) has been largely neglected. Recently it was demonstrated that right ventricular impairment may be influenced by left ventricular (LV) function and afterload, well before overt pulmonary hypertension development. Aim To describe the prevalence of RV dysfunction in a group of patients with severe symptomatic aortic stenosis (AS) and its relation to LV function parameters and afterload. Methods We prospectively studied 93 consecutive patients (age: 73 years [IQR 68–77] years, 55% women) with pure severe symptomatic high gradient aortic stenosis: mean transaortic pressure gradient: 57.0mmHg [IQR 46.9–71.1]; aortic valve area: 0.72cm2 [IQR 0.61–0.88]; indexed stroke volume: 48.8±1.5 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance (CMR) for LV myocardium tissue characterization (late gadolinium enhancement and extracellular volume). Normal RV function was defined according to TAPSE ≥17mm, tricuspid annular systolic velocity ≥12cm/s, mean free wall longitudinal strain ≤−20%. Patients were divided into four groups: (0) – all three RV parameters below normal (1.1%), (1) – 1 normal parameter (12.9%), (2) – 2 normal parameters (44.1%), (3) – 3 normal parameters (41.9%). Indexes of LV systolic and diastolic function, CMR derived LV geometric remodeling, hypertrophy and tissue characterization, aortic valve disease severity and afterload were compared across the 4 groups of patients. We tried to identify predictors of RV dysfunction (group 0, 1, 2 vs. group 3) at multivariate regression analysis. Results Left ventricular performance parameters, diastolic and myocardial work indexes were significantly different across the groups (Figure). Neither AV severity indexes nor LV tissue characterization were distinct. At multivariate analysis only global constructive work was an independent predictor of RV dysfunction. Conclusion RV dysfunction is common in this group of patients with severe high gradient aortic stenosis and preserved ejection fraction. RV impairment is significantly related to several LV systolic and diastolic parameters and also to LV afterload, probably accounting for RV-LV interdependence. Funding Acknowledgement Type of funding sources: None.

Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction.

Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond.

Adaptation of left ventricular diastolic function to pregnancy: a systematic review and meta-analysis.

Objective:To meta-analytically determine the adaptation of left ventricular diastolic function (LVDF)-indices to singleton normotensive pregnancies.Methods:Literature was retrieved from PubMed and Embase. We included studies that reported a nonpregnant reference measurement and LVDF indices (mitral inflow signals, left atrial volume and tissue Doppler measurements). Mean differences between pregnant and reference measurements and weighted means of absolute values were calculated using a random-effects model.Results:We included 34 eligible studies. Normotensive pregnancies were characterized by an initially larger increase in the passive left ventricular filling (E-wave peak velocity, 13%) compared to active left ventricular filling during diastole (A-wave peak velocity, 6%) resulting in a 16% increase of the E/A ratio in the first trimester. The E/A ratio progressively decreased during advancing gestation to −18% at term, resulting from stabilizing E-wave peak velocity and increased A-wave peak velocity. The E/e′ ratio was increased between 22 and 35 weeks (a maximal increase of 13%) in normotensive pregnancy. Left atrial volume (LAV) progressively increased from 15 weeks onwards with a maximal increase of 30% between 36 and 41 weeks.Conclusion:LVDF in normotensive pregnancy was improved in the first trimester after which LVDF progressively worsened. Large-scale studies in normotensive and hypertensive complicated pregnancies are needed for a more precise insight into LVDF changes during pregnancy.

EFFECT OF OBESITY ON VENTRICULAR MASS INDEX AND DIASTOLIC DYSFUNCTION IN YOUNG PATIENTS WITH HYPERTENSION

Objective: To investigate the effect of obesity on left ventricular mass index and diastolic dysfunction in young patients with hypertension. Design and method: A total of 166 young patients with hypertension (113 males and 53 females) diagnosed at the Lanzhou University Second Hospital from January 2018 to March 2019 were enrolled, aged 16–44 (34.25 ± 7.085) years old. According to the difference of body mass index (B M I), they were divided into 3 groups: the normal group (18.5 Kg/m2<=B M I < 24 Kg/m2; N = 58), the overweight group (24 Kg/m2<=B M I<28 Kg/m2; N = 62) and the obese group (B M I>=28 Kg/m2; N = 46). Detection of height, weight, 24 h ambulatory blood pressure, fasting blood glucose(F B G), blood lipid, uric acid (U A) and left ventricular structure and diastolic function index were performed. Variance analysis was used to compare the above data between groups, Pearson correlation analysis was used to analyze the influencing factors of ventricular remodeling and diastolic dysfunction. Results: (1) With the increase of B M I,U A (P < 0.05),L VD-s (P < 0.01), L VD-d (P < 0.01),L VS-D (P < 0.01),D (P < 0.01)and L V MI (P < 0.05) all increased in turn, the obese group was significantly higher than the overweight group, but the difference between the normal and the overweight group was not statistically significant (P > 0.05). (2) E/e’ in obese group was higher than that in normal group (P < 0.05) and there was no significant difference between the any other two groups (P > 0.05). (3) In young patients with hypertension: U A was significantly positively correlated with L V D-s, L V D-d, L VS-D, D and L V MI (both P < 0.01 or P < 0.05). (4) In the obese group, U A was positively correlated with E/e’ (P < 0.05), and the correlation was not observed in normal and overweight group (P > 0.05). Conclusions: Among young patients with hypertension, obese patients have higher U A, higher L V M I and more pronounced left ventricular diastolic dysfunction; moreover, U A is independently associated with ventricular remodeling in all subjects but correlates with ventricular diastolic dysfunction only in obese individuals.

Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study.

Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e' ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e' ratio: logβ = -0·03) and systolic function (GCS: β = -0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = -0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.

Echocardiography markers of myocardial deformation as independent predictors of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle Tracking Echocardiography (STE) provides a comprehensive and quantitative assessment of myocardial function. However, the accuracy of STE-derived indices to predict maintenance of sinus rhythm (SR) following radio-frequency catheter ablation (CA) is still under debate. Therefore, the aim of the present study is to define the accuracy of STE-derived parameters to predict long-term maintenance of SR in patients with paroxysmal AF undergoing CA. Methods We prospectively enrolled 218 consecutive patients (age: 62 ± 10 years, 30% females) with paroxysmal AF undergoing first-CA. All patients with preserved ejection fraction (EF ≥ 50%) underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional STE in apical views. Results At 12 months follow up, a total of 39 (18%) patients had a documented recurrence of AF. Among imaging parameters, LASr > 23% showed the largest area under the curve (0.80) to predict long-term maintenance of SR with sensitivity of 79% and specificity of 72%. Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve (Figure 1). Using multi-variable logistic regression, LASr (OR 1.19, 95% CI 1.10-1.23, p < 0.001) and LASct (OR 1.21, 95% CI 1.07-1.37, p = 0.002) were independently associated with long-term SR while maximum or minimum LA volume index was not. Conclusion In patients with paroxysmal AF undergoing radio-frequency CA, preserved LA reservoir and contractile strain is independently associated with long-term maintenance of SR, whereas LA diameter or volumes were not. LA strain may therefore be useful in management of patients with paroxysmal AF. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd), LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm. Abstract Figure.

Influence of birth weight on fetal cardiac indices at 35–37 weeks' gestation

Echocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation. This was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy-induced hypertension or pre-eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA-PI by UA-PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters. The study population included 146 (9.7%) small-for-gestational-age (SGA) fetuses with birth weight < 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non-SGA and non-FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth-weight Z-score. There were no significant associations between cardiac morphological and functional indices and UtA-PI Z-score or CPR Z-score. This screening study at 35-37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphology and function but UtA-PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Intravenous Infusion of the β3-Adrenergic Receptor Antagonist APD418 Improves Left Ventricular Systolic Function in Dogs With Systolic Heart Failure

BackgroundUnlike β1- and β2-adrenergic receptors (ARs), β3-AR stimulation inhibits cardiac contractility and relaxation. In the failing left ventricular (LV) myocardium, β3-ARs are upregulated, and can be maladaptive in the setting of decompensation by contributing to LV dysfunction. This study examined the effects of intravenous infusions of the β3-AR antagonist APD418 on cardiovascular function and safety in dogs with systolic heart failure (HF). Methods and ResultsThree separate studies were performed in 21 dogs with coronary microembolization-induced HF (LV ejection fraction [LVEF] of approximately 35%). Studies 1 and 2 (n = 7 dogs each) were APD418 dose escalation studies (dosing range, 0.35–15.00 mg/kg/h) designed to identify an effective dose of APD418 to be used in study 3. Study 3, the sustained efficacy study, (n = 7 dogs) was a 6-hour constant intravenous infusion of APD418 at a dose of 4.224 mg/kg (0.70 mg/kg/h) measuring key hemodynamic endpoints (e.g., EF, cardiac output, the time velocity integral of the mitral inflow velocity waveform representing early filling to time-velocity integral representing left atrial contraction [Ei/Ai]). Studies 1 and 2 showed a dose-dependent increase of LVEF and Ei/Ai, the latter being an index of LV diastolic function. In study 3, infusion of APD418 over 6 hours increased LVEF from 31 ± 1% to 38 ± 1% (P < .05) and increased Ei/Ai from 3.4 ± 0.4 to 4.9 ± 0.5 (P < .05). Vehicle had no effect on the LVEF or Ei/Ai. In study 3, APD418 had no significant effects on the HR or the systemic blood pressure. ConclusionsIntravenous infusions of APD418 in dogs with systolic HF elicit significant positive inotropic and lusitropic effects. These findings support the development of APD418 for the in-hospital treatment of patients with an acute exacerbation of chronic HF.

Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults

BackgroundAdults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM.MethodsWe analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients.Results331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e′. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p < 0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e′. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.ConclusionsAbnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.

Coronary microcirculation and left ventricular diastolic function: comparison between patients on hemodialysis and peritoneal dialysis.

End-stage renal disease is considered to influence coronary microcirculation and left ventricular (LV) diastolic function. We investigated whether differences exist in LV diastolic function indices and coronary flow reserve (CFR) between patients on hemodialysis (HD) and peritoneal dialysis (PD). A complete transthoracic echocardiographic study was performed on 21 HD and 22 PD patients and LV diastolic function was evaluated. CFR was estimated using transthoracic Doppler echocardiography on the left anterior descending artery, during high-dose dypiridamole infusion. HD and PD groups did not differ regarding Doppler-derived diastolic indices, but they significantly differed in the frequency of severe LV hypertrophy (38.1% in HD vs 4.5% in PD group, p = 0.009) and grade II diastolic dysfunction (42.9% in HD vs 4.5% in PD group, p = 0.004). No patient had restrictive filling pattern. There was no difference in the prevalence of arterial hypertension and diabetes mellitus in patients with grade II vs less than grade II dysfunction. Mean CFR was similar in the HD and PD groups (2.25 ± 0.65 vs 2.36 ± 0.76, p = 0.635) and lower in patients with grade II diastolic dysfunction (1.87 ± 0.43 vs 2.44 ± 0.72, p = 0.023) and diabetes (1.70 ± 0.59 vs 2.39 ± 0.68, p = 0.04). LV mass index was negatively associated with CFR (r = -0.308, p = 0.045). Patients on HD had more advanced diastolic dysfunction compared to PD, independently of the presence of hypertension and diabetes. CFR did not differ between HD and PD patients, but it was significantly lower in diabetics and in patients with more advanced diastolic dysfunction.

Effects of coenzyme Q10 on endothelial and cardiac function in patients undergoing haemodialysis: study protocol for a pilot randomised controlled trial

IntroductionEndothelial and cardiac dysfunction are highly prevalent and are associated with cardiovascular morbidity and mortality among patients undergoing dialysis. For patients undergoing dialysis, no study has explored the effect of...

Abnormal myocardial performance index in M-mode color tissue Doppler-echocardiography

The myocardial performance index (MPI) is used for global systolic-diastolic left ventricular function and prognosis assessment in patients with heart disease, allowing assessment of the patient‘s current condition and disease development follow-up. The classic method of calculation is pulsed Doppler echocardiography. The aim of the study was to evaluate the correlation of myocardial performance index with established left ventricular systolic and diastolic function indices and to determine cut-off values of the myocardial performance index in M-mode color tissue Doppler echocardiography through the aortic and mitral valves predicting abnormal myocardial performance index by pulsed Doppler echocardiography. One hundred and fi ve subjects were studied, including 30 healthy controls, 45 hypertensive patients, and 30 patients with CHD. MPI was calculated using pulsed Doppler (MPIPW) and M-mode color tissue Doppler echocardiography through the aortic (MPIAO1 and MPIAO2) and mitral (MPIMV) valves. In all patients, the myocardial performance index showed a low to moderatenegative correlation with the left ventricular ejection fraction, and the correlation with the diastolic function indices was moderate to high. In healthy persons, the correlations were not signifi cant in almost all comparisons. The MPIAO1, MPIAO2,and MPIMV values predicting abnormal MPI by pulsed Doppler (MPIPW ≥ 0.50) are MPIAO1 ≥ 0.578, MPIAO2 ≥ 0.446, and MPIMV ≥ 0.552. The cut-off values of MPI by M-mode color tissue Doppler echocardiography through the aortic and mitral valve obtained can be used for global left ventricular function assessment in patients with heart disease. Further studies, on a larger number of patients, are necessary to estimate the predictive value of the parameters established.

Dynamics of Parameters of Transmitral Blood Flow and Markers of Myocardial Fibrosis in Patients with Myocardial Infarction

Aim To study possible correlations between echocardiography (EchoCG) indexes and markers of myocardial fibrosis, procollagen I C-terminal propeptide (PICP) and procollagen III N-terminal propeptide (PIIINP) during one year following ST-segment elevation myocardial infarction (STEMI).Material and methods 120 patients with STEMI were evaluated. EchoCG was used to assess dimensions and volumes of heart chambers, left ventricular (LV) systolic function, mean pulmonary arterial pressure (mPAP), and indexes of LV diastolic function (Em, early diastolic lateral mitral annular velocity; e', peak early diastolic septal mitral annular velocity; E / e', ratio of peak early diastolic transmitral inflow velocity and mitral annular velocity -, Е / А, ratio of peak early and late transmitral inflow velocities; DT, deceleration time of LV early diastolic filling). EchoCG indexes and serum concentrations of PICP and PIIINP were determined at 1 (point 1) and 12 (point 2) days of disease and one year after STEMI (point 3). The sample was divided into two groups: group 1 (n=86; 71.7 %) included patients with a LV ejection fraction (EF) ≥50 % and group 2 (n=34; 28.3 %) consisted of patients with LV EF ≤49 %.Results At one year, the number of patients with signs of diastolic dysfunction increased by 10% in group 1 whereas myocardial systolic dysfunction worsened in both groups. LV EF decreased in 15 (17.4%) patients of group 1 and in 4 (11.8%) patients of group 2. Concentrations of PIIINP were correlated with Em, E / e', mPAP, PICP, e', and LV EF.Conclusion Direct correlations between PIIINP concentrations and Em, E / e', and mPAP were found in the group with LV EF ≥50 %. In the group with LV EF &lt;50 %, correlations were observed between PICP concentrations, LV EF, and e'. Also, in this group, the increase in PIIINP was statistically more significant. These results indicate continuing formation of myocardial fibrosis in a year following MI, which may underlie progression of chronic heart failure.

Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35–36 weeks’ gestation

Gestational diabetes mellitus is associated with early-onset cardiovascular disease and increased incidence of adverse cardiovascular outcomes in mothers and their offspring. Few studies with a limited number of patients have reported subclinical cardiac changes in association with gestational diabetes mellitus; however, it remains unclear whether the mother and the fetus respond in a similar fashion to gestational diabetes mellitus; thus, by assessing the heart of one, we can estimate or predict changes in the other. This study aimed to compare maternal and fetal cardiovascular functions in the third trimester between women with gestational diabetes mellitus and women with uncomplicated pregnancy and to explore whether gestational diabetes mellitus affects to the same extent the maternal and fetal heart. This was a cross-sectional study of maternal and fetal echocardiography for assessment of cardiovascular function in the third trimester in women with singleton pregnancies who received a diagnosis of gestational diabetes mellitus and the control group with uncomplicated pregnancies. In this study, we included 161 women with gestational diabetes mellitus and 483 women with uncomplicated pregnancies. Compared with women in the control group, women with gestational diabetes mellitus were older (34.5, standard deviation, 5.3 years] vs 32.5, standard deviation, 4.8 years]; P<.001), had higher body mass index (31.3 kg/m2 [standard deviation, 5.8] vs 28.6 kg/m2 [standard deviation, 4.4]; P<.001), had lower weight gain during pregnancy (8.3 [interquartile range, 4.8-11 kg] vs 10.8 [interquartile range, 8.2-13.5 kg]; P<.001), and delivered babies with lower birthweight (P<.001). After multivariable analysis, accounting for differences in maternal characteristics and fetal weight, mothers with gestational diabetes mellitus had lower left ventricular diastolic and systolic (tissue Doppler systolic [s'] wave) functional indices (P<.01 for both) compared with those of mothers in the control group. The noted cardiac changes did not fulfill the adult criteria for clinical cardiac dysfunction. No differences in hemodynamic indices (cardiac output and peripheral vascular resistance) and left ventricular mass were noted between the groups. Fetuses of mothers with gestational diabetes mellitus had more globular-shaped hearts with increased right and left ventricular sphericity indices (P<.001 for both) and reduced global longitudinal right and left ventricular systolic functional indices (P<.001 for both). The effect of gestational diabetes mellitus on maternal and fetal hearts was different, and there was no clear association between the two. In the third trimester, in pregnancies with gestational diabetes mellitus, there were subclinical cardiac changes in both the mother and the fetus, but there was no significant difference in any of the fetal cardiac parameters between women with and women without unfavorable cardiac profile. This suggests that the stimulus for cardiovascular responses in the mother and fetus may not be the same in pregnancies with gestational diabetes mellitus.

Determinants of Left Ventricular Diastolic Function and Exertional Symptoms in Adults With Coarctation of Aorta.

Coarctation of aorta (COA) results in chronic left ventricular (LV) pressure overload and subsequently leads to LV diastolic dysfunction and heart failure over time. The goal of COA intervention is to prevent these complications. The timing of COA interventions is based on the presence of these COA severity indices: doppler mean COA gradient, systolic blood pressure, upper-to-lower-extremity SBP gradient, aortic isthmus ratio, presence of collaterals, and exercise-induced hypertension. Although these indices are physiologically intuitive, the relationship between these indices and LV diastolic dysfunction and exertional symptoms has not been studied. The purpose of this study was to evaluate the association between the indices of COA severity and LV diastolic function and symptoms. In this cross-sectional study, multivariate linear and logistic regression analyses were used to assess the correlation between indices of COA severity, LV diastolic function (average e' and E/e'), and exertional symptoms (NYHA II-IV and peak oxygen consumption). Of all the COA indices analyzed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with e' (β [95% CI]: 3.11 [2.02-4.31]; P=0.014) per 1 cm/second; E/e' (-13.4 [-22.3 to -4.81]; P=0.009) per 1 unit; peak oxygen consumption (4.05 [1.97-6.59] per 1% change, P=0.019), and NYHA II to IV symptoms (odds ratio, 2.16 [1.65-3.18]; P=0.006). Of all the COA severity indices stipulated in the guidelines, aortic isthmus ratio had the strongest correlation with LV diastolic function and exertional symptoms. As LV diastolic dysfunction typically precede heart failure symptoms, we anticipate that the results of this study will improve and simplify patient selection for COA intervention and potentially improve long-term outcomes.

Association of serum calcium and phosphorus with measures of left ventricular structure and function: The ARIC study

Elevated serum calcium and phosphorus have been associated with increased risk of cardiovascular disorders. We evaluated whether abnormal calcium and high serum phosphorus are associated cross-sectionally with echocardiographic measures of left ventricular (LV) structure and function, as doing so may provide insight into the etiology of cardiac disorders. Included in the analysis were 5213 Atherosclerosis Risk in Communities Study (ARIC) participants who in 2011-2013 had echocardiography and serum calcium and phosphorus measurements. We evaluated the association of serum calcium (corrected for albumin) and phosphorus quintiles with measures of LV structure and function, after adjusting for other cardiovascular risk factors. Participants were on average 75.3 years old; 59.1% were female and 19.8% were African American. Mean (±SD) concentrations of calcium and phosphorus were 9.33±0.38 and 3.46±0.45mg/dL, respectively. Higher calcium was associated with lower LV end-diastolic diameter (LVEDD) but greater prevalence of concentric remodeling (p-trend: 0.005 and 0.004 respectively). We observed association between high phosphorus and high septal E/e' (p-trend: 0.02). Likewise, higher serum phosphorus was associated with higher left atrial volume index (p-trend: 0.001) and LV hypertrophy prevalence (p-trend: 0.04). In conclusion, higher calcium was associated with more concentric remodeling but lower LVEDD, suggesting complex associations between calcium and cardiac function. Serum phosphorus was related to worse indices of LV diastolic function and LV hypertrophy, but not to LV systolic function. However, the magnitudes of association were modest, so clinical implications of these findings may be limited.

Clinical value of left ventricular diastolic function in predicting the short-term prognosis of sepsis-associated acute lung injury/acute respiratory distress syndrome in the elderly

Objective To investigate the clinical and prognosis value of left ventricular diastolic function(LVDF)in predicting the short-term prognosis of sepsis-associated acute lung injury/acute respiratory distress syndrome(ALI/ARDS)in the elderly. Methods This was a prospective case-control study.A total of 93 elderly patients with sepsis-associated ALI/ARDS, who admitted to our hospital between February 2015 and February 2018, were selected as the study subjects.And they were divided into ALI group(n=52)and ARDS group(n=41). Meanwhile 50 elderly sepsis patients without ALI/ARDS were selected as the control group.Based on the prognosis at the 28th days of admission, patients with ALI/ARDS were divided into a death group and a survival group.General clinical data and left ventricular diastolic function index at different time points after admission were compared between groups. Results There were statistically significant differences among the ALI group, ARDS group and control group(P<0.05)on admission and at 3 and 7 days after admission in the parameters as the following: heart rate, mean arterial pressure(MAP), acute physiology and chronic health evaluation system Ⅱ(APACHEⅡ)score, acute lung injury score(LIS), oxygenation index(PaO2/FiO2), arterial blood lactic acid, blood glucose, serum creatinine, troponin I, B-type brain natriuretic peptide(BNP), procalcitonin(PCT), C-reactive protein(CRP)and early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio(E/Em). APACHEⅡscore, LIS score, blood glucose, troponin I, BNP, PCT, CRP and E/Em were higher in the death group than in the survival group on admission and at 3 and 7 days after admission(all P<0.05). Multivariate logistic regression analysis showed that E/Em on admission and at 3 and 7 days after admission were the independent predictors for mortality in patients with sepsis-associated ALI/ARDS(OR=1.346, 2.150 and 1.954, respectively, P<0.05). ROC curve analysis showed that the area under curve(AUC)of E/Em for predicting death on admission and at 3 and 7 days after admission were 0.687, 0.840 and 0.771, respectively, with the optimal threshold value of 13.26, 14.90 and 14.62, respectively, and the sensitivity and specificity were 74.2% and 67.1%, 81.5% and 84.2%, 79.1% and 87.8%, respectively, .The mortality rate was higher in patients with E/Em above the optimal threshold value than below the optimal threshold value at each time point(all P<0.05). Conclusions The impairment of LVDF is serious in elderly patients with sepsis-associated ALI/ARDS, may be an independent predictor for recent death in such patients, and has a good predictive value for the prognosis of elderly patients with sepsis-associated ALI/ARDS. Key words: Ventricular function, left; Sepsis; Acute lung injury; Respiratory distress syndrome, adult; Prognosis

SERUM URIC ACID AND LONGITUDINAL CHANGES IN LEFT VENTRICULAR STRUCTURE AND FUNCTION IN THE GENERAL POPULATION

Objective: Previous studies showed that serum uric acid as a marker of increased xanthine oxidase activity may be a useful prognosticator for incident heart failure particularly in patients with hypertension. However, population data on the longitudinal changes in left ventricular (LV) structure and function in relation to serum uric acid are sparse. We, therefore, assessed in the general population whether hyperuricemia predicts longitudinal changes in echocardiographic indexes reflecting LV structure and function. Design and method: In 641 randomly recruited Flemish participants (mean age 50.6 years, 50.9% women), we assessed echocardiographic indexes of LV structure and diastolic function at baseline and after 4.7 years. We regressed longitudinal changes in these indexes on baseline uric acid, and reported standardized effect sizes as a percentage of the SD of LV changes associated with a 1-SD of serum uric acid. Results: In multivariable-adjusted cross-sectional analyses, higher serum uric level correlated (P < 0.0018) with greater LV mass index (LVMI) and E/e′ ratio measured at follow-up. From examination 1 to 2, LVMI and E/e′ ratio increased by +3.6 ± 13.2 g/m2 and +0.37 ± 1.46, respectively (P < 0.0001). In longitudinal analyses, after full adjustment, higher baseline serum uric acid independently predicted a greater increase in LVMI (effect size: +14.8%; P = 0.0021) and E/e′ ratio (+21.6%; P < 0.0001) during follow-up. Compared to participants who had normal level of serum uric acid over time (n = 497), subjects with hyperuricemia at both visits (n = 65) experienced worse temporal changes in LVMI (+7.2 g/m2 vs +2.4 g/m2; P = 0.011) and E/e′ ratio (+0.97 vs +0.27; P = 0.0008). Conclusions: Hyperuricemia at baseline predicted worsening of LV diastolic function and LV remodeling over time. These findings suggest the importance of management of hyperuricemia in order to delay or prevent progression of adverse LV remodeling and dysfunction.

Relationship Between Arterial Stiffness And Cardiac Function In Athletes

Arterial function and left ventricular (LV) function are inter-related. In fact, increased arterial stiffness increases afterload and causes decrease in LV diastolic function in elderly hypertensive patients. The high arterial stiffness causes increased myocardial workload for compensation. However, the relationship between arterial stiffness and cardiac function in athletes remain unknown. PURPOSE: The present study aimed to determine the relationship between aortic stiffness and LV function in athletes. METHODS: The participants in this study were 16 male college athletes (age 21.5±0.9 yrs). Carotid-femoral pulse wave velocity (cfPWV), which reflects aortic stiffness, was measured using an automatic oscillometric device. In addition, cardiac function was measured using a ultrasoundechography. Color Doppler, Pulsed Doppler, and Tissue Doppler images were recorded and used to assess LV diastolic function, evaluated as the early and late mitral inflow velocity ratio (E/A ratio) and early septal mitral anulus movement velocity (e’). The “E/A ratio” is a classical method of assessing LV diastolic function and is influenced by afterload. On the other hand, “e’” is an index of myocardial stiffness, but is not influenced by afterload. We examined the correlation between cfPWV and each indicator of LV diastolic function. Data analysis was performed using Spearman’s rank correlation coefficient. RESULTS: A negative correlation between cfPWV and E/A ratio (r=0.557, p=0.02) was observed. However, there was no correlation between cfPWV and e’ (r=-0.076, p=0.772). CONCLUSION: These results suggested that higher aortic stiffness causes decreased LV diastolic function in athletes, regardless of LV myocardial stiffness.

Left Atrial Function and Volume an Independent Markers of Cardiovascular Involvement in Early Chronic Kidney Disease

Aim: value of left atrium (LA) volume and function evaluated by strain analysis in the detection of myocardial involvement in early chronic kidney disease (CKD) patients with coexistent of hypertension. Methods: 33 patients with CKD stage 2 or stage 3, with mild hypertension compared with 32 age matched hypertensive patients with normal kidney function and 30 healthy control subjects, all participants underwent trans thoracic echocardiography to assess left ventricular (LV) systolic and diastolic function, LV mass and LA volume index (LAVI) by 2D and pulsed wave Doppler imaging, and LA segmental strain measured by tissue Doppler imaging (TDI). Results: Stage 3 CKD had the most reduced diastolic function compared with other groups. (LAVI) was higher significantly in both CKD group (36.2+8.4 ml/m2) and HT group (34.31+4.75 ml/m2) compared to control group (22.18+3 ml/m2) (p=0.001), LAVI was significantly higher in stage 3 compared with stage 2 CKD (p=0.001), Global systolic strain (GS)was significantly reduced in CKD group (17.48+4.3%) compared to both HT group (27.92+5.17%) and controls (31.75+6.8%) (p=0.001), GS was significantly lower in HT group compared with controls (p=0.014), systolic strain of four left atrial walls were different significantly between CKD group and both HT and control groups. there was high significant difference between stage 2 and stage 3 CKD as regard left atrial lateral and anterior walls systolic strain (p=0.001), inferior and septal wall systolic strain were significantly lower in stage 3 compared to stage 2 CKD. Conclusion: LA dysfunction and enlargement are evident in patients with early CKD, LA systolic strain was reduced in CKD earlier than LA enlargement which occur later, hence LA systolic strain and volume index could be used to detect myocardial involvement in early CKD.