Indices Of Left Ventricular Diastolic Function Research Articles

Cardiac Systolic and Diastolic Function can be Improved and Epicardial Fat be can Decreased Over a Very Short Period of Time in Obese Patients without Heart Disease by the Very Low Calorie Diet

The objective of the study was to evaluate the effect of an eight week period of very low calorie diet (VLCD) on heart function and amount of epicardial adipose tissue in obese people without heart disease. Methods: Fifty-two obese patients (38 women, 14 men, mean age 47.6 ± 12.3 years, mean BMI 46.2±7.0 kg/m2) were assigned to a VLCD enriched with vegetables for eight weeks. Transthoracic echocardiography was performed before and after the diet period. Left ventricular size, ejection fraction, diastolic function, left and right ventricular myocardial performance index (MPI) and thickness of epicardial adipose tissue were measured. Heart rate, blood pressure and plasma glucose and triglyceride concentration were also analysed. Results: During the diet period the BMI decreased from 46.2±7.0 kg/m2 to 41.8± 6.1 kg/m2 (p<0.0001). The left ventricular MPI decreased from 0.42± 0.07 to 0.37± 0.07 (p<0.0001) and right ventricular MPI decreased from 0.30± 0.09 to 0.27± 0.09 (p=0.0256) showing significant systolic and diastolic improvement in the performance of both ventricles. The thickness of epicardial fat decreased from 4.4±1.5 mm to 3.4±1.4 mm (p<0.0001). The heart rate decreased from 75.8±9.7 beats/min to 67.0 ±10.3 beats/min (p<0.0001) and the systolic blood pressure decreased from 140±14.3 mmHg to 135.2±10.6 mmHg (p=0.0087). The plasma glucose concentration decreased from 6.71±1.96 mmol/l to 6.02±1.59 mmol/l (p<0.0001). The plasma triglyceride concentration decreased from 1.77±0.89 mmol/l to 1.36±0.68 mmol/l (p=0.0002). Conclusion: VLCD caused during only eight weeks period significant reduction in BMI as well as in the amount of epicardial fat and significant improvement in the systolic and diastolic function of both ventricles in obese persons.

Cardiac function associated with previous, current and repeated depression and anxiety symptoms in a healthy population: the HUNT study

ObjectiveSymptoms of anxiety and depression often co-exist with cardiovascular disease (CVD), yet little is known about the association with left ventricular (LV) subclinical dysfunction. We aimed to study the cross-sectional...

The Relationships Between the Arterial Stiffness Index Measured at the Radial Artery and Left Ventricular Diastolic Dysfunction in Asymptomatic High Risk Patients Without Atherosclerotic Cardiovascular Disease.

Arterial stiffness is associated with atherosclerosis and left ventricular (LV) diastolic function in general or hypertensive patients. However, the relationships between the arterial stiffness index measured at the radial artery and LV diastolic dysfunction in asymptomatic high-risk patients without atherosclerotic cardiovascular disease (ASCVD) have not been fully established.A total 532 statin-naïve patients (male:female ratio, 230:302, mean age, 56.0 ± 9.2 years) without ASCVD were enrolled from among subjects who simultaneously underwent transthoracic echocardiography and noninvasive semiautomated radial artery applanation tonometry from July 2011 to May 2014. Of these patients, 213 were categorized as the statin benefit group (Benefit) according to guidelines for blood cholesterol treatment, and the rest were placed in the nonbenefit control group (NoBenefit). Each group was subdivided into two groups (Y or N) according to antihypertensive medication administration. Thus, there were 4 groups: BenefitN (n = 80), BenefitY (n = 133), NoBenefitN (n = 251), and NoBenefitY (n = 68). There were significant differences in echocardiographic parameters of LV function and indices of arterial stiffness between the Benefit and NoBenefit groups. After adjusting for several risk factors, independent significant associations between echocardiographic parameters of LV diastolic function and arterial indices were identified with multivariate linear regression analysis in the Benefit patients.Parameters of arterial stiffness measured at the radial artery are associated with echocardiographic indices of LV diastolic function in asymptomatic high-risk patients without ASCVD. Therapies that prevent progression of arterial stiffness and reduce late-systolic pressure overload may help to reduce the prevalence of LV diastolic dysfunction in this population.

Echocardiographic Assessment of Cardiac Changes during Normal Pregnancy among Nigerians

BACKGROUNDPregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women.MATERIALS AND METHODSEchocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant.RESULTSThe mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19–44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e′ velocity at the septal margin but a progressive increase in a′ velocity were also observed (P < 0.05).CONCLUSIONCardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Abstract P243: A Maternal High Salt Diet During Pregnancy and Lactation Affects Offspring Cardiac Function

The maternal environment during pregnancy and lactation has important effects on the offspring’s cardiovascular system. For example, changes in offspring blood pressure and vascular structure have been reported to occur in response to a maternal high salt intake during pregnancy and lactation. However, it remains unclear whether a maternal high salt intake may affect cardiac function in offspring. We previously demonstrated that high salt diet causes aggravation of hypertension in young spontaneously hypertensive rats (SHR). Therefore, in the present study we investigated the influence of exposure to a maternal high salt diet during gestation and lactation on offspring cardiac function in SHR. SHR dams were fed either a high salt diet (4% NaCl) or a control (0.3% NaCl) diet. After weaning, the offspring were fed the control diet for 8 weeks. Systolic blood pressure and heart rate of the offspring were measured without heating using a photoplethysmographic tail-cuff system at 11 weeks of age. Indices of both left ventricular (LV) systolic and diastolic function (LV developed pressure [LVDP], and maximum rate of LV decline [-dP/dt]) and coronary flow were determined in 12 week old offspring using a Langendorff isolated perfused working heart system. Offspring of the high-salt diet-fed dams (High salt) had lower blood pressure, heart rate, and indices of both LV systolic and diastolic function, compared with offspring of the control diet-fed dams (control) (Fig.). There were no significant differences in coronary flow or heart weight between the two groups. These results suggest that a maternal high salt intake is a predisposing factor for disturbance of cardiac function in offspring.

Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis. A prospective tissue Doppler echocardiography study.

Patients with rheumatoid arthritis (RA) have a high risk for cardiovascular disease due to a chronic inflammatory state, accelerated atherosclerosis, and changes in left ventricular (LV) geometry. These conditions predispose patients to LV systolic dysfunction (LVSD). In this study we assessed whether RA is a condition associated with LVSD, and analyzed the prevalence and factors associated with LVSD in patients with RA. Echocardiographic and clinical data from 198 patients with RA without presence or history of symptoms of cardiac disease were compared with 198 non-RA controls matched for cardiovascular risk factors. LVSD was identified with tissue Doppler echocardiography (TDE) when mitral annular peak systolic velocity (S') was < 9.0 cm/s. Patients with RA were 61 ± 12 years old and 71 % were female (disease duration 14 ± 10 years). LVSD was found in 89 patients with RA (45 %). By multiple regression analysis including both RA patients and controls, RA emerged as an independent condition associated with LVSD (exp β 3.89; CI: 1.87-8.08) together with higher E/E' ratio (index of LV diastolic function) and diabetes mellitus. For the 198 patients with RA, the variables associated with LVSD were higher E/E' ratio and systolic blood pressure. Almost half of asymptomatic RA patients without history of cardiac disease have subclinical LVSD easily detectable with TDE. RA is closely related to LVSD. A higher degree of LV diastolic dysfunction and systolic blood pressure are associated with LVSD in these patients, whose risk for cardiovascular events could be better defined using such information in the asymptomatic stage of cardiac disease.

Correlation Between Epicardial Fat Thickness and Cardiovascular Risk in Hemodialysis Patients

Background: Cardiovascular diseases are common in hemodialysis (HD) patients and cardiovascular mortality is responsible for 50% of overall deaths in these patients. Epicardial fat thickness (EpFT) may be an effective marker for the prediction of cardiovascular diseases in hemodialysis patients. The thickness of EpF can be measured by echocardiography that can accurately estimate the actual amount of EpF. The aim of the current study is to assess the association between EpFT and carotid intima-media thickness (CIMT), left ventricular systolic and diastolic function and left ventricular mass index in patients with chronic kidney disease (CKD) undergoing hemodialysis to clarify the relationships between EpF and cardiovascular disease risk in these patients. Materials and Methods: Forty adult uremic patients from dialysis unit and twenty (age and sex matched) healthy control subjects were included in this study. Clinical evaluation, routine laboratory investigations, echocardiographic study including measurement of EpFT and carotid Duplex to estimate CIMT were done to all subjects. Results: we found highly significant increase in serum C-reactive protein and significant increase in serum phosphorus and triglyceride with significant decrease in serum calcium and high-density lipoprotein cholesterol in hemodialysis patients compared to the controls. Also, there were significant increases in left ventricular mass index, left atrium diameter, carotid intima-media thickness, epicardial fat thickness, peak velocity of the late filling wave due to atrial contraction (A wave) and deceleration time of E wave in hemodialysis patients compared to the controls. There were also highly significant decrease in E/A ratio in hemodialysis patients compared to healthy control subjects. EpFT measured by echocardiography in hemodialysis patients was positively correlated with body mass index, CRP, left atrium diameter, left ventricular mass index, deceleration time and CIMT and negatively correlated with high-density lipoprotein cholesterol and E/A ratio. Conclusion: Hemodialysis patients can be evaluated routinely by echocardiography for early detection of cardiovascular structural and functional changes which are common in these patients and epicardial fat thickness is an effective marker for the prediction of cardiovascular risk in hemodialysis patients.

Elevation of circulating fatty acid-binding protein 4 is independently associated with left ventricular diastolic dysfunction in a general population.

BackgroundFatty acid-binding protein 4 (FABP4) is expressed in both adipocytes and macrophages. Recent studies have shown secretion of FABP4 from adipocytes and association of elevated serum FABP4 level with obesity, insulin resistance, hypertension, and atherosclerosis. However, little is known about role of FABP4 in cardiac function.MethodsFrom the database of the Tanno-Sobetsu Study, data for 190 subjects (male/female: 82/108) who were not treated with any medication and underwent echocardiography in 2011 or 2012 were retrieved for analyses of relationships between serum FABP4 concentration, metabolic markers and parameters of echocardiography.ResultsSerum FABP4 level was positively correlated with age, body mass index (BMI), blood pressure (BP), LDL cholesterol, HOMA-R and mean left ventricular (LV) wall thickness (LVWT, males: r = 0.315, females: r = 0.401, p < 0.01) and was negatively correlated with HDL cholesterol, estimated glomerular filtration rate (eGFR) and peak myocardial velocity during early diastole (e’; males: r = −0.434, females: r = −0.353, p < 0.01), an index of LV diastolic function. However, no significant correlation was found between FABP4 level and LV end-diastolic dimension, LV ejection fraction or LV mass index. There were significant correlations of e’ with age, BMI, BP, eGFR, brain natriuretic peptide (BNP), FABP4, metabolic markers and LVWT. Multivariate regression analysis adjusted by HOMA-R, BMI, eGFR, BNP or LVWT in addition to age, gender and BP revealed that serum FABP4 concentration was independently correlated with e’.ConclusionsElevation of circulating FABP4 may contribute to LV diastolic dysfunction in a general population.

Relation of epicardial fat to central aortic pressure and left ventricular diastolic function in patients with known or suspected coronary artery disease.

The present study tested the hypothesis that epicardial fat may be associated with augmented central aortic pressure and impaired left ventricular (LV) function. We studied 134 consecutive patients undergoing left-sided cardiac catheterization for coronary artery disease (CAD) and examined the relation of epicardial fat volume measured by multi-detector computed tomography to ascending aortic pressure and LV ejection fraction determined by cardiac catheterization as well as indices of LV diastolic function assessed by Doppler echocardiography [early diastolic mitral annular velocity (e') and a ratio of early diastolic mitral inflow to annular velocities (E/e')]. Epicardial fat volume indexed to body surface area correlated positively with age (r = 0.24, P < 0.01), body mass index (r = 0.38, P < 0.001), systolic aortic pressure (r = 0.21, P < 0.05), aortic pulse pressure (r = 0.23, P < 0.01), LV ejection fraction (r = 0.22, P < 0.05) and E/e' (r = 0.24, P < 0.05) and did negatively with e' (r = -0.31, P < 0.05). In multivariate linear regression including potential confounders, increased epicardial fat volume index correlated with aortic systolic and pulse pressure and LV diastolic function indices, but not LV ejection fraction. In conclusion, we found that epicardial fat was associated with augmented central aortic pressure and LV diastolic dysfunction in patients with known or suspected CAD.

Influence of hyperhomocysteinemia on left ventricular diastolic function in Chinese patients with hypertension.

The aim of this study was to assess the effect of plasma homocysteine (Hcy) on left ventricular (LV) diastolic function in Chinese patients with essential hypertension. A total of 74 patients with hypertension were enrolled in the present study and were divided into two groups according to the plasma levels of Hcy: high levels of Hcy (Hhcy) group (n = 37) and control group (n = 37) with normal levels of homocysteine. The study participants consisted of 37 hypertensive patients with Hhcy and 37 hypertensive patients without Hhcy. Transthoracic Doppler echocardiography was performed to assess the LV diastolic function of the patients. The plasma level of Hcy was directly related to LV diastolic echocardiographic parameters in patients with hypertension whereby the ratio E/e' was higher (12.7 ± 2.64 vs. 8.98 ± 1.55, p < 0.01), e'/a' was lower (0.59 ± 0.13 vs. 0.83 ± 0.20, p < 0.01), and the left atrial (LA) diameter was longer (43.4 ± 3.6mm vs. 37.6 ± 5.0mm, p < 0.01) in the Hhcy group than in the control group. The LV diastolic function was significantly deteriorated in Chinese hypertensive patients with Hhcy and there were significant correlations between LV diastolic function indices and Hcy levels.

Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

Fetal aortic balloon valvuloplasty (FAV) has shown promise in averting progression of midgestation aortic stenosis (AS) to hypoplastic left heart syndrome in a subset of patients. Patients who achieve biventricular circulation after FAV frequently have left ventricular (LV) diastolic dysfunction (DD). This study evaluates DD in fetuses with AS by comparing echocardiographic indices of LV diastolic function in fetuses underwent FAV (n= 20) with controls (n= 40) and evaluates for LV factors associated with DD in patients with FAV. We also compared pre-FAV and post-FAV DD variables (n= 16). Median gestational age (24weeks, range 18 to 29weeks) and fetal heart rate were similar between FAV and controls. Compared with controls, patients with FAV had universally abnormal LV diastolic parameters including fused mitral inflow E and A waves (p= 0.008), higher E velocity (p<0.001), shorter mitral inflow time (p= 0.001), lower LV lateral annulus E' (p <0.001), septal E' (p= 0.003), and higher E/E' (p <0.001) than controls. Patients with FAV had abnormal right ventricular mechanics with higher tricuspid inflow E velocity (p <0.001) and shorter tricuspid inflow time (p= 0.03). Worse LV diastolic function (lower LV E') was associated with higher endocardial fibroelastosis grade (r= 0.74, p <0.001), large LV volume (r= 0.55, p= 0.013), and sphericity (r= 0.58, p= 0.009) and with lower LV pressure by mitral regurgitation jet (r=-0.68, p <0.001). Post-FAV, fewer patients had fused mitral inflow E and A than pre-FAV (p= 0.05) and septal E' was higher (=0.04). In conclusion, fetuses with midgestation AS have evidence of marked DD. Worse DD is associated with larger, more spherical LV, with more extensive endocardial fibroelastosis and lower LV pressure.

Evaluation of left ventricular diastolic function with a dedicated cadmium-zinc-telluride cardiac camera: comparison with Doppler echocardiography

To evaluate the relationships between measures of left ventricular (LV) filling dynamics at cadmium-zinc-telluride (CZT) imaging and indexes of LV diastolic function at transthoracic echocardiography. Two hundred and forty-seven patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and a baseline transthoracic echocardiography study. All patients were submitted to invasive or computed coronary angiography. The peak filling rate (PFR) and the time to PFR (TPFR) were derived from gated CZT images as measures of LV filling dynamics. LV diastolic function was also evaluated at echocardiography and the presence of significantly increased LV filling pressures determined. Increased LV filling pressures at transthoracic echocardiography were evident in 103 (42%) patients. Interestingly, independently from the presence of coronary artery disease, there was a strict correlation between the presence and severity of LV diastolic dysfunction at echocardiography and CZT-derived measures of filling dynamics, i.e., PFR (P = 0.001) and TPFR (P = 0.001). At receiving operating characteristic analysis, a composite index of reduced PFR (≤2.11 end-diastolic volume s(-1)) and increased TPFR (>234 ms) showed a sensitivity of 84% and a specificity of 67% in unmasking the presence of elevated LV filling pressures at echocardiography. CZT-derived measures of LV filling dynamics correlate with echocardiographic parameters of diastolic function and may identify the presence of increased LV filling pressures.

Left ventricular twist and untwist rate provide reliable measures of ventricular function in myocardial ischemia and a wide range of hemodynamic states

Although rotational parameters by speckle tracking echocardiography (STE) have been previously compared to sonomicrometry and cardiac magnetic resonance imaging, few have examined the relationship between left ventricular (LV) rotational mechanics and intraventricular measures of load-independent contractility, LV stiffness, or ventriculoarterial coupling. The aim of this study was to compare the changes in LV rotational indices to intraventricular pressure–volume (PV) relationships under a range of inotropic states induced by pharmacological interventions, acute ischemia, and changes in preload. In nine pigs, simultaneous echocardiographic imaging and LVPV measurements were performed during pharmacologically induced high or low inotropy and during acute ischemia by ligation of the left anterior descending coronary artery (LAD). Maximal ventricular elastance (Emax), arterial elastance (Ea), ventricular–arterial coupling (Emax/Ea), dP/dt, tau, and other hemodynamic parameters were determined. Dobutamine and esmolol infusions led to inversely correlated changes in hemodynamic measurements of LV function. Apical but not basal rotation and diastolic rotation rate were decreased by esmolol and increased by dobutamine. The LV twist correlates well with Emax (r = 0.83) and Emax/Ea (r = 0.80). Apical diastolic rotation rate also correlates with dP/dtmin (r = −0.63), τ (r = −0.81), and LV stiffness (r = −0.52). LAD ligation decreased systolic and diastolic LV rotation in apical (P < 0.05), but not basal myocardium. Occlusion of the inferior vena cava, to reduce preload, increased apical rotation in systole and diastole. LV rotational parameters measured by STE provide quantitative and reproducible indices of global LV systolic and diastolic function during acute changes in hemodynamics.

Effects of short-term exercise training on tissue Doppler indices of left ventricular diastolic function in overweight and obese individuals

Although exercise training is unable to improve obesity-associated decreases in left ventricular (LV) diastolic function, as assessed using chamber function measurements, the effects on LV diastolic myocardial function, as assessed using tissue Doppler imaging (TDI), are uncertain. In 32 overweight (n = 11) or obese (n = 21), sedentary or recreationally active men and women (30–57 years), we assessed the effects of 6 weeks of exercise training either preceded (n = 16) or followed (n = 16) by a 6-week control period on TDI indices of LV diastolic function (e', e'/a' and E/e') (echocardiography). Diastolic function at baseline was comparable to that noted in overweight and obese participants from a community sample (n = 245), and 56% (n = 18) had e' values below the lower 95% CI of a lean and healthy cohort (n = 60) of the community sample. Exercise training increased peak oxygen consumption (27.4 ± 4.9 to 29.4 ± 5.8 mL · kg–1 · min–1, P = 0.0001), but had no effect on body mass index (P = 0.99). No changes in TDI indices of diastolic function were observed after exercise training in all the participants (e': P = 0.74, a': P = 0.98, e'/a': P = 0.85, E/e': P = 0.26), participants with abnormal e' values (n = 18)(e': P = 0.99, a': P = 0.96, e'/a': P = 0.91, E/e': P = 0.97) or obese participants (n = 21)(e': P = 0.67, a': P = 1.00, e'/a': P = 0.78, E/e': P = 0.11). In conclusion, exercise training, despite increasing cardiorespiratory fitness, is unable to improve obesity-associated decreases in LV diastolic myocardial function.

Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality

BackgroundPositive end-expiratory pressure (PEEP) has been known to adversely influence cardiac output. Even though left ventricular (LV) diastolic function significantly contributes to LV performance, the effects of PEEP on LV diastolic function remains controversial. We, therefore, aimed to examine the effects of PEEP on LV diastolic function by use of pulsed wave Doppler tissue imaging in patients with pre-existing LV relaxation abnormality. MethodsSeventeen patients with peak early diastolic velocity of lateral mitral annulus (E′) <8.5 cm s−1 among patients who underwent coronary artery bypass graft surgery were evaluated. Echocardiographic and haemodynamic variables were measured with 0, 5, and 10 cmH2O of PEEP. E′ and deceleration time (DT) of peak early transmitral filling velocity (E) were used as echocardiographic indicators of LV diastolic function. ResultsMean arterial blood pressure decreased during 10 cmH2O PEEP, compared with that during 0 cmH2O PEEP. E′ showed a gradual and significant decrease with an incremental increase in PEEP (6.9±0.9, 5.8±0.9, and 5.2±1.2 cm s−1 during 0, 5, and 10 cmH2O PEEP, respectively), and DT of E was prolonged during 10 cmH2O PEEP, compared with that during 0 cmH2O PEEP. ConclusionsIncreasing PEEP led to a progressive decline in LV relaxation in patients with pre-existing LV relaxation abnormality.

Acute Intravenous Infusion of an Adenosine Regulating Agent Improves Left Ventricular Function in Dogs with Advanced Heart Failure

GP531 is a second generation adenosine regulating agent (ARA) that increases concentrations of endogenous adenosine, a natural cardioprotective agent, in ischemic/hypoxic tissue. This study examined the effects of acute intravenous infusions of GP531 on left ventricular (LV) systolic and diastolic function in dogs with advanced chronic heart failure (HF) (LV ejection fraction, EF <30%). Six dogs with intracoronary microembolization-induced HF received a constant intravenous infusion of GP531 (10μg/kg/min) or vehicle (normal saline) for 6h in random order 1week apart. Hemodynamic measurements were made at baseline and at 1, 2, 3, 4, 5 and 6h after initiating drug infusion. Myocardial oxygen consumption (MVO2) was measured at baseline and 4 and 6h. LV pressure-volume relationship (PVR) was measured at baseline and 6h. Vehicle infusions had no effect on indexes of LV systolic and diastolic function. GP531 infusion had no effect on heart rate or mean aortic pressure but significantly decreased LV end-diastolic pressure, end-diastolic volume, end-systolic volume and end-diastolic wall stress. GP531 significantly increased LV EF (27 ± 1 at baseline to 34 ± 1 after 6h of drug infusion, p < 0.05), deceleration time of early mitral inflow velocity and the slope of end-systolic PVR without increasing MVO2. Results of the study indicate that approaches which increase the local release of adenosine in failing LV myocardium, such as ARAs, have a favorable impact on LV performance. These observations support the continued development of ARA's for the treatment of acute HF syndromes.

Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients

BackgroundAssessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome.MethodsIn a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality.ResultsMAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1–2, 4–6).ConclusionsMAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.

Genetic Predisposition to Left Ventricular Hypertrophy and the Potential Involvement of Cystatin-C in Untreated Hypertension

The angiotensinogen M235T and aldosterone synthase C-344T gene polymorphisms have been associated with cardiac and structure function. However, these associations in untreated hypertension remain unknown. We examined whether these variants determined both echocardiography indices and the potential associated underlying mechanisms, including cystatin-C and vascular inflammation. The study population consisted of 319 untreated patients and 191 healthy individuals. Polymorphisms were determined by polymerase chain reaction technique. Left cardiac indices of geometry and function were assessed by echocardiography. Cystatin-C, intracellular cell adhesion molecule 1, and vascular cell adhesion molecule 1 levels were measured by enzyme-linked immunosorbent assay, whereas high sensitivity C-reactive protein levels were measured by immunonephelometry. There was no significant interaction between the angiotensinogen genotypes on left ventricular mass index (LVMI) and diastolic function indices in all study groups. Regarding C-344T polymorphism, TT homozygous hypertensive subjects exhibited higher values of LVMI compared with C allele carriers (P = 0.02) and higher prevalence of concentric hypertrophy (P < 0.001). However, this polymorphism was not associated with variations in left atrial volume and diastolic dysfunction. Cystatin-C levels were correlated with LVMI values (r = 0.22; P = 0.002) and mean E/A ratio (r = -0.24; P < 0.001). Interestingly, a linear increase of LVMI with cyctatin-C quartiles has been revealed (F = 5.01; P < 0.001). Moreover, post hoc tests showed that increased levels of cystatin-C (above 75th percentile) were significantly different between both the first (P = 0.009) and the second quartile (P = 0.02). We have shown that C-344T potentially predicts higher values of LVMI and concentric hypertrophy in untreated hypertension, independently of renal function and subclinical inflammation. Increased levels of cystatin-C were correlated with higher LVMI values.

Left ventricular diastolic dysfunction is associated with impaired baroreflex at rest and during orthostatic stress in hypertensive patients with left ventricular hypertrophy

The study aimed to determine the relationship between left ventricular (LV) diastolic function and the heart's spontaneous baroreflex at rest and in response to orthostatic stress during a prospective follow-up of hypertensive patients with LV hypertrophy (LVH+). LV structure and function and baroreflex sensitivity (BRS) during tilt testing were evaluated in 24 LVH+ patients and compared with 25 age-matched healthy controls and 25 hypertensive patients without LVH (LVH-). Clinical status, diastolic function and BRS were then assessed in LVH+ patients during treatment with telmisartan (monotherapy or combined with hydrochlorothiazide and/or amlodipine) at 6- and 18-month follow-ups. LVH+ patients had significantly altered diastolic function indices and decreased BRS as compared with healthy controls and LVH- patients. During the 18-month follow-up, favorable changes in diastolic function were associated with improvement in BRS at rest and during tilting. In multivariate regression models, an index reflecting rate of LV myocardial relaxation (E'sept) where E'sept denotes peak early diastolic velocity at the septal mitral annulus and a surrogate for LV filling pressure (E/E'sept), independently from other clinical and echocardiographic variables related to the low-frequency component of BRS during tilting. In conclusion, the LV diastolic function indices have independent associations with BRS parameters obtained at rest and during orthostatic stress in LVH+ patients receiving long-term pharmacological intervention.

Measurement of left ventricular torsion using block-matching-based speckle tracking for two-dimensional echocardiography

Left ventricular (LV) torsion is a sensitive and global index of LV systolic and diastolic function, but how to noninvasively measure it is challenging. Two-dimensional echocardiography and the block-matching based speckle tracking method were used to measure LV torsion. Main advantages of the proposed method over the previous ones are summarized as follows: (1) The method is automatic, except for manually selecting some endocardium points on the end-diastolic frame in initialization step. (2) The diamond search strategy is applied, with a spatial smoothness constraint introduced into the sum of absolute differences matching criterion; and the reference frame during the search is determined adaptively. (3) The method is capable of removing abnormal measurement data automatically. The proposed method was validated against that using Doppler tissue imaging and some preliminary clinical experimental studies were presented to illustrate clinical values of the proposed method.