Peak Late Velocity Research Articles

Post-cardiac arrest temporal evolution of left ventricular function in a rat model: speckle-tracking echocardiography and cardiac circulating biomarkers.

There is little information from experimental studies regarding the evolution of post-resuscitation cardiac arrest [post-return of spontaneous circulation (post-ROSC)] myocardial dysfunction during mid-term follow-up. For this purpose, we assessed left ventricular (LV) function and circulating cardiac biomarkers at different time points in a rat model of cardiac arrest (CA). Rats were divided into two groups: control and post-ROSC rats. Eight minutes of untreated ventricular fibrillation were followed by 8 min of cardiopulmonary resuscitation. Conventional and speckle-tracking echocardiographic (STE) parameters and cardiac circulating biomarkers concentrations were assessed, at 3, 4, 72, and 96 h post-ROSC. At 3 and 4 h post-ROSC, LV systolic function was severely impaired, and high-sensitivity cardiac troponin T and N-terminal pro-atrial natriuretic peptide (NT-proANP) plasma concentrations were significantly increased, compared with control rats (P < 0.0001 for all). At 72 and 96 h post-ROSC, LV ejection fraction (LVEF) normalized. At 96 h, the following variables were significantly different from control rats: early trans-mitral peak velocity, 56.8 ± 3.1 vs. 87.8 ± 3.8 cm/s, P < 0.0001; late trans-mitral peak velocity, 50.6 ± 4.7 vs. 73.7 ± 4.2 cm/s, P < 0.0001; mean s' wave velocity, 4.6 ± 0.3 vs. 5.9 ± 0.3 cm/s, P < 0.0001, global longitudinal strain (GLS) -7.5 ± 0.5 and vs. -11 ± 1.2%, P < 0.01; GLS rate (GLSR) -0.9 ± 0.4 and -2.3 ± 0.2 1/s, P < 0.01; and NT-proANP concentration, 2.5 (0.2; 6.0) vs. 0.4 (0.01; 1.0) nmol/L, P < 0.01. s' velocity, GLS, and GLSR indicated that LV systolic function was still impaired 96 h post-ROSC. These findings agree with NT-proANP concentrations, which continue to be high. Normalization of LVEF supports the use of STE for its greater sensitivity for monitoring post-CA cardiac function. Further investigations are needed to provide evidence of the post-ROSC LV diastolic function pattern.

Cardiac function’s in patients with chronic kidney disease

Background: To assess the cardiac functions in patients with chronic kidney disease (CKD).Methods: 150 patients with CKD were randomly selected. 12 lead ECG were performed to detect CVD. All Patients were diagnosed with CKD. The left ventricular ejection fraction (LVEF) and fractional shortening (FS) were taken as measures of LV systolic function. Diastolic function was determined by measuring early to late peak velocities (E/A) ratio by spectral Doppler LV inflow velocity. Results: Male: female 95 and 55, hypertension 67% was leading cause of CKD. Diastolic dysfunction as denoted by E/A ratio of less than 0.75 or more than 1.8 was present in 64% of patients. Regional wall motion abnormality (RWMA) was present in 14%. LVH was present in 74%. Systolic dysfunction as measured by reduced fractional shortening (&lt;25%) and decreased LVEF (&lt;52%) was present in 8% and 12% respectively. PE was noted in 15% of patients. Valvular calcification in 8% of CKD patients. Mean LV internal diameter in diastole was 41±6 mm. Mean Interventricular septum diameters in systole was11.9±1.21 mm. Mean LA diameter was 29±4 mm. Statistically significant difference was noted in LVH and E/A ratio in hypertensive group as compared to normotensive group.Conclusions: LV diastolic dysfunction also happens in patients who having the early stage of CKD. Hypertensive patients along with CKD had found higher widespread presence of diastolic and systolic dysfunction as compared to normotensive.

EFEITO DE RESISTÊNCIA AO EXERCÍCIO NA TAXA DE REAÇÃO ADVERSA DA INSUFICIÊNCIA CARDÍACA

ABSTRACT Introduction: Heart Failure is a common disease in the elderly. In the end stage, patients usually accompany a reduction in fat content and lean body mass in addition to heart failure. Objective: Study the exercise resistance effects and adverse reaction rate in patients with heart failure. Methods: 52 patients with chronic heart failure (38 males, age 67 ± 2.2 years) were randomly divided into two groups. According to New York Heart Association Functional Classification, 27 patients with grade II and 25 with grade I was randomly divided. The experimental group was submitted to aerobic exercises under heart rate control for seven months and the control group with no exercise prescription. In the comparison, the 6-minute walk test and a cardiac function test were employed by Agilent 4500 EcoDoppler at a frequency of 2.5MHz. The indices of systolic and left ventricular function were recorded on ECG simultaneously using the improved Simpsons method, and the following indices were measured: left ventricular systolic and end-diastolic; left ventricular ejection fraction; left ventricular diastolic function; early, late peak velocity and its ratio; mitral valve diastole. Results: Compared to the control group, heart rate decreased to different degrees (P &lt; 0.05), exercise endurance increased significantly (P &lt; 0.01), and left ventricular function index improved significantly (P &lt; 0.01). Conclusion: We observed a positive impact of aerobic exercise directed at the rehabilitation of the cardiovascular system and mental health in elderly patients. Evidence Level II; Therapeutic Studies – Investigating the results.

The Systolic and Diastolic Cardiac Function of Patients With Type 2 Diabetes Mellitus: An Evaluation of Left Ventricular Strain and Torsion Using Conventional and Speckle Tracking Echocardiography.

Objectives: This study aimed to quantify left ventricular (LV) myocardial strain and torsion in patients with type 2 diabetes mellitus (T2DM) and evaluate their systolic and diastolic function using conventional and speckle tracking echocardiography.Methods: Forty-seven patients with T2DM were divided into a group without microvascular complications (the DM A group) and a group with microvascular complications (the DM B group), while another 27 healthy participants acted as the control group. All the participants had had an echocardiography examination. All the original data were imported into EchoPAC workstation for the analysis and quantification of LV strain and torsion.Results: Compared with the control group, the LV end-diastolic volume, end-systolic volume, and ejection fraction of the DM A and DM B groups showed no significant differences, but the global longitudinal strain and the global circular strain were reduced in the DM B group. There were significant differences in the left ventricular relative wall thickness (RWT), left ventricular mass index (LVMI), the early mitral valvular blood flow velocity peak/left ventricular sidewall mitral annulus late peak velocity, left ventricular sidewall mitral annulus early peak velocity/left ventricular sidewall mitral annulus late peak velocity, isovolumic relaxation time, peak twisting, peak untwisting velocity (PUV), untwisting rate (UntwR), time peak twisting velocity (TPTV), and time peak untwisting velocity (TPUV) between the DM A, DM B, and control groups. While the peak twisting velocity (PTV) was slower in the DM B group compared with the control group, the RWT, PTV, PUV, UntwR, TPTV, and TPUV in the DM B group were significantly different from the DM A group.Conclusion: The cardiac function of patients with T2DM in its early stages, when there are no microvascular complications, could be monitored with the analysis of two-dimensional strain and torsion.

675 A rare case of tako-tsubo syndrome in a patient with hypertrophic cardiomyopathy

Abstract Aims We know that basal septal hypertrophy is a rare and unique anatomical finding associated with hypertrophic cardiomyopathy (HCM). Tako-Tsubo cardiomyopathy (TTC) is a transient left ventricular systolic dysfunction induced by high physical or emotional stress. Its occurrence with HCM is unusual. However, this presentation occurs more often with the classic asymmetrical septal hypertrophy compared with the apical variant. This case demonstrates that the coexistence of TTC with septal HCM in an elderly patient may lead to a severe haemodynamic instability picture. Methods and results A 81-year-old female presented to the emergency department (ED) complaining of dyspnoea and chest pain lasting for 1 day. She had hypertension and dyslipidemia associated with a familial history of sudden death. On physical exam, we found a severe hypotension (systolic blood pressure of 80 mmHg) associated with bilateral rales at chest auscultation. Cardiac auscultation revealed a harsh systolic murmur, best heard over the left sternal border. Heart rate was 60 b.p.m. in sinus rhythm. Labs were significant for HS-I troponin of 6.035 ng/L (NV: ≤ 12) and NT-proBNP of 7.640 pg/ml (NV: ≤1800). A 12-leads electrocardiogram (ECG) at admission revealed a STEMI-like ST segment elevation from V2 to V6 (Figure 1A). For this reason she was urgently taken to the cath-lab where she was found to have tortuous but normal coronary arteries. After coronary angiography, a trans-thoracic echocardiogram (TTE) revealed a pathological LV hypertrophy with a septal diastolic thickness of 19 mm, depressed LV ejection fraction (LVEF) due to a severe apical ballooning. At continuous wave (CW)-Doppler there was a dynamic obstruction across the LV outflow tract (LVOT), with a late peak velocity of 4.9 m/s and an estimated peak gradient of 98 mmHg. The gradient was increased by a systolic anterior motion (SAM) of anterior mitral leaflet causing a moderate mitral regurgitation (MR). All these findings were consistent with obstructive septal HCM associated with Takotsubo cardiomyopathy. After treatment with intravenous diuretics and metoprolol (5 + 5 mg i.v. bolus followed by oral dose of 100 mg daily), her clinical condition markedly improved. One week later, ECG demonstrated deeply inverted T waves on antero-lateral leads and QT prolongation (501 ms). Three weeks later, after a complete resolution of the LV apical dyskinesia, LVEF normalized. LVOT gradient decreased to 20 mmHg, with a dynamic increase to 70 mmHg during Valsalva manoeuvre. Conclusions It is well known that TTC may be complicated by a reversible LVOT obstruction by itself but the combination with obstructive HCM can lead to low cardiac output and acute heart failure. This combination has been found to be not common and the correct treatment of this unusual type of cardiogenic shock is still unclear. Careful initial evaluation and continuous monitoring must be warranted in such rare cases. Supportive care afterward with beta blockers, along with echocardiogram surveillance, are the mainstay of management. Cardiologists, intensivisits, and clinicians alike need to recognize and comprehend the pathophysiology behind this unique clinical manifestation so that they may adjust their management and treatment accordingly.

Association of hemodynamic parameters and cardiovascular risk factors with cardiac remodeling in young patients with prehypertension and hypertension

Aim. To assess the prevalence of left ventricular (LV) remodeling and identify its association with hemodynamic parameters and cardiovascular risk factors in young patients with prehypertension (preHTN) and hypertension (HTN).Material and methods. Group 1 (n=47) included patients with preHTN, group 2 (n=65) — patients with untreated HTN (age — 25-44 years). We performed 24-hour ambulatory blood pressure (BP) monitoring using a BpLAB monitor (OOO Petr Telegin). Echocardiography was carried out using a EnVisorC ultrasound system (Philips, Netherlands). Statistical analysis was performed using the software package Microsoft Excel 2010.Results. We revealed that 2,4% and 17,0% (p=0,002) of patients with preHTN and HTN had LV concentric remodeling, respectively; LV hypertrophy was recorded in 9,5% and 12,0% of patients, respectively. In group 1, a moderate positive relationship was found between the ratio of early to late peak velocities (E/A) and the average 24-hour aortic BP (r=0,66, p&lt;0,05) was revealed. We also identified correlation of the augmentation index with the LV mass index (LVMI) (r=0,57, p&lt;0,05) and LV relative wall thickness (RWT) (r=-0,7, p&lt;0,05). In hypertensive patients, a correlation of LVMI and left atrial dimensions with a decrease in peripheral systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night was found. A correlation of average 24-hour aortic BP and E/A (r=0,58, p&lt;0,05), LV posterior wall thickness (r=0,53, p&lt;0,05) and LV end-diastolic volume (r=0,45, p&lt;0,05) was also revealed. A direct effect of BMI, waist circumference, uric acid values on echocardiographic data in patients with preHTN and HTN was detected.Conclusion. Despite the age, young patients with preHTN and HTN can have LV concentric remodeling and hypertrophy. LV geometry is correlated with obesity and uric acid values; in preHTN patients — with vascular stiffness and 24-hour aortic BP, in HTN patients — with 24-hour central and peripheral BP.

Augmented Velocity Index: A New Doppler Index Associated with Arterial Stiffness

Augmented Velocity Index (Avi) is a new Doppler index developed to quantify velocity changes at the late systolic peak. We examined its reliability, association with arterial stiffness and cardiovascular risk factors. The Avi is calculated as (late systolic peak velocity − early systolic peak velocity)/(highest peak systolic velocity − end-diastolic velocity). Fifty volunteers (mean age ± standard deviation: 43.5 ± 14.2 y, men: 52%) without known medical illnesses or drug use were recruited. Carotid Doppler waveforms with measurements of Avi were recorded. Carotid pressure waveforms were obtained by applanation tonometry for measurement of the Augmentation Index (AI). Clinical measurements including body mass index (BMI) and blood pressure (BP) were assessed, and fasting blood was taken for measurement of glycemia and lipid profile. Another 15 volunteers (age range: 22–60 y, men: 33.3%) were recruited to study the reliability of Avi measurement. The results revealed that carotid Avi closely correlated with the index of arterial stiffness, AI (r = 0.76, p < 0.001) on Pearson correlation. On multiple linear regression analysis, Avi remained a significant independent determinant of AI after adjustments for clinical variables. The Avi had significant associations with cardiovascular risk factors (age, BMI, total cholesterol, low-density lipoprotein cholesterol, systolic and diastolic BP). The intra-class correlation coefficients for inter-observer and intra-observer reliability of Avi measurements were 0.93 (95% confidence interval [CI]: 0.8–0.98) and 0.97 (95% CI: 0.92–0.99) respectively. In conclusion, the Avi is a reproducible new Doppler index, independently associated with arterial stiffness in terms of the AI, which initially correlated with cardiovascular risk factors.

A0188 Epidemiologic observations informing clinical application of a urinary peptidomic marker of diastolic left ventricular dysfunction

Objectives: Hypertension, obesity and older age are major risk factors for left ventricular (LV) dysfunction (LVDD), but easily applicable screening tools in people at risk are lacking. We investigated whether HF1, a urinary biomarker consisting of 85 peptides, can predict over a 5 year time span mildly impaired diastolic LV function as assessed by echocardiography. Methods: In 645 White Flemish (50.5% women; 50.9 years [mean]), we measured HF1 by capillary electrophoresis coupled with mass spectrometry in 2002–2010. We measured early (E) and late (A) peak velocities of the transmitral blood flow and early (e’) and late (a¢) mitral annular peak velocities and their ratios in 2009–2013. Results: In multivariable-adjusted analyses, per 1-SD increment in HF1, e¢ was − 0.193 cm/s lower (95% confidence interval [CI]: −0.352 to −0.033; P = 0.018) and E/e¢ 0.174 units higher (0.005 to 0.342; P = 0.043). Of 645 participants, 179 (27.8%) had LVDD at follow-up, based on impaired relaxation in 69 patients (38.5%) or an elevated filling pressure in the presence of a normal (74 [43.8%]) or low (36 [20.1%]) age-specific E/A ratio. For a 1-SD increment in HF1, the adjusted odds ratio was 1.37 (CI, 1.07 to 1.76; P = 0.013). The integrated discrimination (+1.14%) and net reclassification (+31.7%) improvement of the optimized HF1 threshold (−0.350) in discriminating normal from abnormal diastolic LV function at follow-up over and beyond other risk factors was significant (P ≤ 0.024). Conclusion: In conclusion, HF1 allows screening for LVDD over a 5 year horizon in asymptomatic people.

Associations of left atrial volumes and Doppler filling indices with left atrial function in acute myocardial infarction.

SummaryRecent findings suggest that left atrial (LA) function is more strongly related to adverse prognosis than LA volumes. We aimed to evaluate the associations between LA volumes and Doppler filling indices with LA function. Echocardiographic LA volumes (LAVs), mitral valve early (MV‐E) and late (MV‐A) peak flow velocities, and mitral atrioventricular plane tissue‐Doppler early (TD‐e′) and late (TD‐a′) peak velocities were obtained in 320 patients with acute myocardial infarction (AMI) free from atrial fibrillation and more than moderate valvular disease. LA function was estimated as the LA emptying fraction (LAEF), that is 100× (LAVmax‐LAVmin)/LAVmax. LA reservoir volume was calculated as LAVmax‐LAVmin and LA transit volume as LV stroke volume‐reservoir volume. In restricted cubic spline regression analyses with multivariable adjustment, a reduced LAEF was strongly associated with smaller reservoir volume, larger transit volume, LAVmax, LAVpreA and especially LAVmin. MV‐E linearly increased with a lower LAEF, whereas MV‐A decreased but only below LAEF levels of approximately 45%. The resulting E/A ratio showed a sudden increase in LAEF levels below ~45%. Lower TD‐a′ was linearly associated with a lower LAEF. In conclusion, a reduced atrial function was associated with smaller LA reservoir volume, larger LA transit volume, lower TD‐a′, a non‐linear decrease in MV‐A and a non‐linear increase in E/A. Our findings are likely a reflection of the adaptation to sustain LV filling volume and counteracting a rise in pulmonary venous pressure in face of an enhanced LV end‐diastolic pressure.

Improved cardiorespiratory fitness following moderate exercise may encourage inactive people for doable and sustainable behavioral change.

Global physical inactivity pandemic is responsible for more than 5 million deaths annually through its effects on non-communicable diseases. This requires urgent intervention. The aim of this study was to investigate the associations of physical activity with cardiovascular fitness in a cross-sectional retrospective observational fashion. Data were collected for 21 years from 2530 healthy volunteers and athletes representing the entire spectrum of physical activity from the totally inactive sedentary persons to the highly trained national athletes. Cardiac fitness was investigated echocardiographically, which is characterized by reduced resting heart rate (RHR), increased relative left ventricular muscular mass (rLVMM), improved left ventricular diastolic function (characterized by the ratio of early to late ventricular peak velocities, E/A) and peak exercise oxygen consumption. We found that even moderate exercise is associated with improved cardiac characteristics. With increasing exercise level, the RHR decreased from 69 to 63.3, 61.4, 58.6, 56.1, and 55.8/min in non-athletes, leisure athletes, lower class athletes, 2nd class athletes, 1st class athletes, and national athletes, respectively. While the rLVMM was increased from 64.6 to 70.7, 76.3, 78.5, 86.7, and 88.9 in the same groups. The E/A ratio also increased from 1.71 to 1.72, 1.85, 2.04 in the non-athletes, leisure athletes, lower class athletes, and 2nd class athletes, respectively, but then decreased to 1.92 and 1.98 in the 1st class athletes and national athletes. The largest exercise-induced improvement of cardiac fitness was observed between the inactive and the least active group, which did not increase further in the highly trained national athletes enduring up to 20 training hours per week. Our findings indicate that cardiac fitness can be improved by moderate exercise in sedentary persons. This information would help physicians to encourage inactive patients, who find physical exercise intimidating, for doable and sustainable behavioral change.

Epidemiologic observations guiding clinical application of a urinary peptidomic marker of diastolic left ventricular dysfunction

Hypertension, obesity, and old age are major risk factors for left ventricular (LV) diastolic dysfunction (LVDD), but easily applicable screening tools for people at risk are lacking. We investigated whether HF1, a urinary biomarker consisting of 85 peptides, can predict over a 5-year time span mildly impaired diastolic LV function as assessed by echocardiography. In 645 white Flemish (50.5% women; 50.9 years [mean]), we measured HF1 by capillary electrophoresis coupled with mass spectrometry in 2005–2010. We measured early (E) and late (A) peak velocities of the transmitral blood flow and early (e') and late (a') mitral annular peak velocities and their ratios in 2009–2013. In multivariable-adjusted analyses, per 1-standard deviation increment in HF1, e' was −0.193 cm/s lower (95% confidence interval: −0.352 to −0.033; P = .018) and E/e' 0.174 units higher (0.005–0.342; P = .043). Of 645 participants, 179 (27.8%) had LVDD at follow-up, based on impaired relaxation in 69 patients (38.5%) or an elevated filling pressure in the presence of a normal (74 [43.8%]) or low (36 [20.1%]) age-specific E/A ratio. For a 1-standard deviation increment in HF1, the adjusted odds ratio was 1.37 (confidence interval, 1.07–1.76; P = .013). The integrated discrimination (+1.14%) and net reclassification (+31.7%) improvement of the optimized HF1 threshold (−0.350) in discriminating normal from abnormal diastolic LV function at follow-up over and beyond other risk factors was significant (P ≤ .024). In conclusion, HF1 may allow screening for LVDD over a 5-year horizon in asymptomatic people.

Left ventricular function in relation to chronic residential air pollution in a general population.

BackgroundIn view of the increasing heart failure epidemic and awareness of the adverse impact of environmental pollution on human health, we investigated the association of left ventricular structure and function with air pollutants in a general population.MethodsIn 671 randomly recruited Flemish (51.7% women; mean age, 50.4 years) we echocardiographically assessed left ventricular systolic strain and strain rate and the early and late peak velocities of transmitral blood flow and mitral annular movement (2005−2009). Using subject-level data, left ventricular function was cross-sectionally correlated with residential long-term exposure to air pollutants, including black carbon, PM2.5, PM10 (particulate matter) and nitrogen dioxide (NO2), while accounting for clustering by residential address and confounders.ResultsAnnual exposures to black carbon, PM2.5, PM10 and NO2 averaged 1.19, 13.0, 17.7, and 16.8 µg/m3. Systolic left ventricular function was worse (p ≤ 0.027) with higher black carbon, PM2.5, PM10 and NO2 with association sizes per interquartile interval increment ranging from −0.339 to −0.458% for longitudinal strain and from −0.033 to −0.049 s−1 for longitudinal strain rate. Mitral E and a′ peak velocities were lower (p ≤ 0.021) with higher black carbon, PM2.5 and PM10 with association sizes ranging from −1.727 to −1.947 cm/s and from −0.175 to −0.235 cm/s, respectively. In the geographic analysis, the systolic longitudinal strain sided with gradients in air pollution. The path analysis identified systemic inflammation as a possible mediator of associations with black carbon.ConclusionsLong-term low-level air pollution is associated with subclinical impairment of left ventricular performance and might be a risk factor for heart failure.

PP.13.19] MONOTHERAPY WITH RILMENIDINE PRODUCES AN EFFECTIVE BLOOD PRESSURE CONTROL AND IMPROVES ECHOCARDIOGRAPHIC VARIABLES IN YOUNG MILD TO MODERATE HYPERTENSIVES

Objective: Rilmenidine is a new centrally acting antihypertensive agent with selective agonist activity at imidazoline I1 receptors from the brain with less adverse effects than other centrally acting sympatholytic drugs. In previous studies, Rilmenidine proved effective antihypertensive efficacy regardless of the age of patients. It is especially effective in patients with sympathetic overstimulation. The aim of this study was to evaluate the antihypertensive efficacy of rilmenidine and its effects on left ventricular hypertrophy and diastolic function in young patients with mild to moderate hypertension. Design and method: We performed a prospective study, lasting 3 months, in which 42 patients younger than 55 years old, (medium age 47.9 ± 5.6years), received once a day 1 mg rilmenidine. Diastolic left ventricular function was assessed by the following Doppler parameters: early (E) and late (A) peak velocities, E/A ratio, isovolumic relaxation time (IVRT), and deceleration time of E velocity (DT). Left ventricular mass index (LVMI) and diastolic function were determined at baseline and after 3 months. Blood pressure and heart rate were monitored at baseline and every month. Patients were requested to subjectively estimate their state as excellent, good, satisfactory and unsatisfactory. Results: After 3 months of therapy, systolic BP was reduced from 157.9 ± 13.6 mmHg to 130.1 ± 11.4 mmHg (p < 0.005) and diastolic BP from 97.6 ± 6.8 mmHg to 82.6 ± 6.7 mmHg (p < 0.005). Heart rate was reduced from 86.4 ± 6.6 bpm to 71.2 ± 4.4 bpm. LVMI decreased from 131.5 ± 3.5 g/m2 to 113.4 ± 3.6 g/m2 (p < 0.001). E/A ratio increased from 0.86 ± 0.24 to 1.02 ± 0.14 (p < 0.002). IVRT decreased from 118 ± 11 ms to 98 ± 10 ms (p < 0.001) and DT decreased from 216 ± 21 ms to 187 ± 17 ms (p < 0.002). 83.3% from the patients were controlled after 3 months of therapy. Treatment was well tolerated. None of the hypertensives estimated his state as unsatisfactory. Conclusions: Rilmenidine can be regarded as an effective and safe therapeutic possibility in mild/moderate young hypertensives. Therapy with Rilmenidine proved a good control of blood pressure, rich the therapeutic target, and was accompanied by the regression of cardiac hypertrophy and improvement in left ventricular diastolic function.

Correlation between 2D Echocardiography and Multidetector Row CT for Early Detection of Diastolic Dysfunction in Normotensive Diabetic Patients

Abnormalities in diastolic function are considered early signs of diabetic cardiomyopathy. Two dimensional echocardiography with Tissue Doppler Imaging (TDI) has been used most commonly to evaluate diastolic left ventricular function. The study was conducted to study the prevalence of diastolic dysfunction with the help of echocardiography and MDCT and their correlation in asymptomatic diabetic people. A total of 15 diabetic, normotensive patients who had undergone 64-multidetector row CT and 2D echocardiography with TDI were included. The parameters used for assessment of diastolic dysfunction were early (E) and late (A) transmitral peak velocity (cm/s) and peak mitral septal tissue velocity (Ea; cm/s). Subsequently, LV filling pressures (E/Ea) were estimated. Of the total 73.3% patients showed presence of diastolic dysfunction by both CT and echocardiography. Good correlations were observed between cardiac CT and 2D echocardiography for assessment of E (r = 0.992; p < 0.001), A (r=0.974, p <0.001), E/A (r = 0.979; p < 0.01), Ea (r = 0.977; p < 0.001), and E/Ea (r = 0.994; p < 0.001). Doppler echocardiography is considered one of the best methods for assessment of LV diastolic dysfunction. In this study of cardiac-asymptomatic diabetic patients, MDCT and echocardiography showed good correlation for assessment of early diastolic dysfunction. Hence, cardiac CT can be an additional tool for assessing LV diastolic function.

Effect of ultra-endurance exercise on left ventricular performance and plasma cytokines in healthy trained men.

The purpose of this study was to investigate the effect of ultra-endurance exercise on left ventricular (LV) performance and plasma concentration of interleukin (IL)-6, IL-10, IL-18 and tumour necrosis factor alpha (TNF-α) as well as to examine the relationships between exercise-induced changes in plasma cytokines and those in echocardiographic indices of LV function in ultra-marathon runners. Nine healthy trained men (mean age 30±1.0 years) participated in a 100-km ultra-marathon. Heart rate, blood pressure, ejection fraction (EF), fractional shortening (FS), ratio of early (E) to late (A) mitral inflow peak velocities (E/A), ratio of early (E’) to late (A’) diastolic mitral annulus peak velocities (E’/A’) and E-wave deceleration time (DT) were obtained by echocardiography before, immediately after and in the 90th minute of the recovery period. Blood samples were taken before each echocardiographic evaluation. The ultra-endurance exercise caused significant increases in plasma IL-6, IL-10, IL-18 and TNF-α. Echocardiography revealed significant decreases in both E and the E/A ratio immediately after exercise, without any significant changes in EF, FS, DT or the E/E’ ratio. At the 90th minute of the recovery period, plasma TNF-α and the E/A ratio did not differ significantly from the pre-exercise values, whereas FS was significantly lower than before and immediately after exercise. The increases in plasma TNF-α correlated with changes in FS (r=0.73) and DT (r=-0.73). It is concluded that ultra-endurance exercise causes alterations in LV diastolic function. The present data suggest that TNF-α might be involved in this effect.

Cardiovascular dysfunction in offspring of ovarian-hyperstimulated women and effects of estradiol and progesterone: a retrospective cohort study and proteomics analysis.

The cardiovascular dysfunction in children born with assisted reproductive technologies has been of great concern. However, the association of ovarian hyperstimulation syndrome (OHSS), a complication of assisted reproductive technologies, with worse cardiovascular functions and underlying mechanism remains unknown. The objective of the study was to assess the cardiovascular functions of children born to mothers with OHSS and investigate the underlying regulator(s). This was a retrospective cohort recruited in a university hospital. We assessed the cardiovascular functions by Doppler echography in 42 children born to OHSS women, 34 children of mothers with non-OHSS in vitro fertilization, and 48 spontaneously conceived (SC) children (mean age ∼ 4.5 y). Groups were matched for gestational age at delivery and birth weight. An isobaric tag for relative and absolute quantitation-labeled proteomics analysis was performed with another set of umbilical arteries from OHSS and SC pregnancies (n = 3 for both groups). Children of OHSS mothers showed a significantly decreased mitral ratio of early to late mitral peak velocities, reduced systolic and diastolic diameters of common carotid arteries, and impaired flow-mediated dilation compared with non-OHSS in vitro fertilization and SC children. Intima-media thickness and arterial stiffness indices were similar in the three groups. In the proteomics study, 1640 proteins were identified from OHSS and SC umbilical arteries, and 40 differentially expressed proteins were selected for further analysis. Estradiol and progesterone were identified as activated upstream regulators. Children born to ovarian-hyperstimulated women displayed cardiovascular dysfunctions. The underlying mechanisms may involve the effects of supraphysiological estradiol and progesterone levels.

Hemodynamic Changes in Preterm Neonates With Septic Shock

We evaluated hemodynamic changes in preterm neonates with septic shock using functional echocardiography and studied the effects of vasoactive drugs on hemodynamic variables. Prospective observational study. Level III neonatal ICU. We enrolled 52 preterm neonates with septic shock (shock group) and an equal number of gestation and postnatal age-matched healthy neonates (control group). We measured functional hemodynamic variables (left and right ventricular output, ejection fraction, isovolumetric relaxation time, and early passive to late active peak velocity ratio) by echocardiography in the shock group during initial fluid resuscitation, before initiation of vasoactive drugs, and again 30-40 minutes after initiation of vasoactive drug infusion. Control group underwent a single assessment after enrollment. We compared various hemodynamic variables between shock group and control group using paired t test or Wilcoxon signed-rank test. The baseline left ventricular output was significantly higher in neonates with septic shock as compared with controls (median [interquartile range], 305 mL/kg/min [204, 393] vs 233 mL/kg/min [204, 302]; p < 0.001), but ejection fraction was similar between the two groups (55% ± 12% vs 55% ± 5%, p = 0.54). Other hemodynamic variables were comparable between the two groups. After vasoactive drug infusion, there was a significant increase in heart rate (152 ± 18 to 161 ± 18 beats/min, p ≤ 0.001) and right ventricular output (median [interquartile range], 376 [286, 468] to 407 [323, 538] mL/kg/min; p = 0.018) compared with the baseline, but left ventricular output and ejection fraction did not change significantly. We found an elevated left ventricular output but normal ejection fraction in preterm neonates with septic shock. This suggests that septic shock in preterm neonates is predominantly due to vasoregulatory failure. Vasoactive drugs significantly increased right ventricular output, which was predominantly due to increase in heart rate.

The predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction on short- and long-term outcomes of catheter ablation of atrial fibrillation

Recurrence of atrial fibrillation (AF) is frequently observed after AF catheter ablation. However, the predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction (LVDD) has not been well studied. In 124 consecutive patients (mean age 61 ± 10 years, 60% male) with paroxysmal (n = 70) or persistent AF (n = 54) undergoing AF catheter ablation, mitral early diastolic peak (E-wave) and late peak (A-wave) velocities, E/A ratio, deceleration time (DT) of mitral early velocity, early diastolic mitral annulus peak velocity (e'), and E/e' ratio were determined by transthoracic echocardiography. Early (ERAF) and late AF recurrence (LRAF) were monitored with 7-day Holter electrocardiograms directly after catheter ablation and after 6 and 12 months. Early AF recurrence occurred in 34% of the patients, while LRAF was observed in 27% of the patients. Patients with ERAF had higher E-wave (0.9 ± 0.2 vs. 0.8 ± 0.2 m/s, P = 0.035) and lower A-wave velocity (0.5 ± 0.2 vs. 0.6 ± 0.2 m/s, P = 0.038), higher E/A ratio (1.8 ± 0.9 vs. 1.5 ± 0.9, P = 0.089), and slower DT (214 ± 67 vs. 243 ± 68 ms, P = 0.073), while E/e', left atrial diameter, and left ventricular ejection fraction were similar. In multivariable regression analysis, the E/A ratio was the only independent predictor of ERAF (odds ratio 2.905, 95% confidence interval 1.072-7.870, P = 0.036). None of the echocardiographic parameters influenced the late therapy outcome. Early results of the catheter ablation, but not the late rhythm outcome, are influenced by an impaired mitral inflow pattern, which is associated with LVDD.

The effect of myocardial fibrosis on left ventricular diastolic function assessed by non-invasive cardiac magnetic resonance and echocardiography

Methods Ninety one eligible subjects undergoing cardiac structural and functional assessment with LGE-CMR and Doppler echocardiography were investigated. Left ventricular function, volumes, myocardial thickness, left atrial volume, wall motion score index (WMSI) and the extent of LGE were assessed using CMR. Mitral early diastolic peak (Ewave) and late peak (A-wave) velocities, E/A ratio, deceleration time (DT) of mitral early velocity, early diastolic mitral annulus peak velocity was measured by echocardiography, and ratio of transmitral diastolic peak velocity to the mitral annular diastolic peak velocity (E/E’) was calculated. Classification of diastolic function as normal, mild dysfunction (impaired relaxation), moderate dysfunction (pseudonormal), and severe dysfunction (restrictive filling pattern) was performed according to standard criteria. The E/E ratio was used to estimate LV filling pressures. Results The majority (90%) of subjects with normal diastolic function exhibited no or minimal fibrosis (median LGE score, 0; interquartile range, 0 to 0). The prevalence of LGE positivity by diastolic filling pattern was 11.8% in impaired relaxation, 100% in pseudonormal, and 75% in restrictive filling (P<0.001). LGE score significantly and progressively increased with increasing severity of filling impairment, reaching 5 (interquartile range, 0.59.75) in patients with restrictive filling pattern (P<0.001). LGE was observed in 80% of patients with ischemic cardiomyopathy and 26.3% of patients with nonischemic cardiomyopathy, but only in 3.6% of patients with repaired tetralogy of Fallot and none of patients with simple congenital heart disease (P<0.001). LGE score progressively increased with increasing left ventricular filling pressure estimated by tissue Doppler imaging-derived E/E (P<0.001, r=0.455). However it did not have any significant correlation with other echocardiographic diastolic function indices, such as E velocity, A velocity, and DT. Multiple linear regression showed LGE score (P=0.026, B =0.251) and WMSI (P<0.001, B=0.422) to be positively predictive for E/E value.

Assessment of Left Ventricular Diastolic Dysfunction in Sub-clinical Hypothyroidism

Background:Adverse cardiovascular effect of hypothyroidism has been identified in many studies. Early identification of patients with sub-clinical hypothyroidism may lead to early treatment and thereby favourable effect on cardiovascular morbidity and mortality.Objectives:To find out the association of sub clinical hypothyroidism and left ventricular dysfunction and also to find out relationship between systolic and diastolic dysfunction in these patients.Material and Methods:A total 30 cases of sub clinical hypothyroidism along with 15 age sex matched healthy control subjects were included in study. Serum TSH, T4, T3 hormone level was measured and those who were found to have sub-clinical hypothyroidism underwent for 2DEcho.Results:Significant reduction in peak early filling velocity (PE) (p<0.001) and early filling time velocity integral (Ei) (p<0.001). Ratio of early and late peak velocities (PE/PA) (p<0.001), ratio of time velocity integral of early and atrial filling (Ei/Ai) (p<0.001) and ratio of the early peak to average velocity (PE/M) (p<0.001) were also reduced. Mean EF was 54.9± 5.55 as compared to 55.7 ± 3.46 of control subjects with a T.value of 0.48 ,however there was significant diastolic dysfunction in case of hypothyroid patients (mean Ei/Ai = 1.35 ± 0.53) as compared to control group subjects (mean Ei/AI = 2.11 ± 0.26) with a T value of 5.22.Conclusion:Sub-clinical hypothyroidism showed significant diastolic dysfunction in the absence of significant impairment of systolic function.