Left Ventricle Diastolic Function Research Articles

Comparison of Current Echocardiographic Modalities Used to Assess Left Ventricle Diastolic Function in Pediatric Patients

Tissue Doppler imaging, left ventricular color M-mode velocity propagation, and deformation imaging techniques from the medical literature were critically reviewed. The review was undertaken to evaluate the accuracy, reproducibility, and clinical efficiency of echocardiographic technologies for image acquisition and data analysis in assessing pediatric diastolic function. Tissue Doppler imaging, velocity propagation, and deformation imaging all show low variability and high reproducibility and specificity. Age, growth, heart rate, morphology, and sonographic technique affect some pediatric echocardiographic indices more than others; therefore, each should not be solely relied on. Their complementary diagnostic information should be evaluated collectively as a complete echocardiographic examination by expertly trained medical professionals.

Diastolic function of the left ventricle in patients with cardiomyopathy and low ejection fraction: the role of torsion in left bundle branch block

Influence of left bundle branch block (LBBB) on left ventricle (LV) diastolic function and mechanisms of LV torsion remains underestimated. Aim. To study the relationship of LV diastolic function and LV torsion in patients with cardiomyopathy and LBBB in comparison with patients with cardiomyopathy and normal intraventricular conduction. Material and methods. Patients with cardiomyopathy (n=74) and LV ejection fraction <40% were included into the study and divided in two groups with narrow QRS complex and LBBB (the mean QRS duration = 153 ms). Echocardiography was performed in all patients with hemodynamic indices detection, and myocardium strain and torsion estimation. Results. The patients with LBBB showed less twisting, than patients without LBBB (3.24±3.35° and 5.87±3.83°, respectively, p=0.013914), but significant diastolic function differences between groups were absent. Despite the lack of difference in heart remodeling indices, subgroup of patients with LV rigid body rotation showed significantly less LV twisting and changes in pulmonary vein flow related to LV high end diastolic pressure. In the rigid body rotation group systolic left atrial filling fraction was 32.3±8.07%, whereas in the group with a physiological counter-rotation - 53.1±10.1% (p=0.000226). Potential reason of these findings was interventricular dyssynchrony. Deviation of time interval to peak myocardial systolic velocity between opposite basal segments in group with LBBB and anomalous LV rotation was more (63.3±35.1 ms) than this in group with LBBB and physiological LV rotation (8.0±17.9 mc, p=0.015922). This finding suggests that LV rigid body rotation in patients with LBBB may reflect a more pronounced mechanical dyssynchrony. Conclusion. LBBB has complex negative influence on process of LV electric activation and contraction which results in deterioration of LV twisting, mechanical dyssynchrony and deterioration of diastolic function. In disorders of intraventricular conduction and local contractility, assessment of pulmonary vein flow, possibly, more precisely reflects diastolic function status.

Strain rate and the coronary blood flow in patients with high normal blood pressure

Background. The population studies demonstrated the direct relationship between blood pressure (BP) level and risk of cardiovascular complications. The BP elevation (even within high normal values) in the young adults is associated with early involvement of target organs. Moreover, the initial myocardial structural and functional changes associated with BP increase are not studied completely. Modern ultrasound diagnostic opportunities (development of high frequency broadband transthoracic transducer, implementation of Tissue harmonic imaging and development of “speckle tracking” echocardiography method — STE) allow to assess the coronary blood flow status and to reveal the earliest signs of left ventricle (LV) myocardial dysfunction. The aim of our study is to assess the LV longitudinal deformation and coronary blood flow at the level of left anterior descending (LAD) artery and perforant arteries (PA) in young patients with high normal BP (HNBP). Design and methods . The study involved 43 men aged 18–27 years old, who were divided into 2 groups depending on office BP level. The first group consists of the subjects with HNBP, the second group included persons with optimal and normal BP values. The standard physical examination was performed in all patients. Heart condition was assessed by transthoracic EchoCG data. The registration of blood flow spectrum in LAD and in apical PAs was performed by impulse Doppler regimen. LV functional status was assessed by STE with global longitudinal strain analysis. Results. The traditional parameters of systolic and diastolic LV function were comparable in patients with HNBP and in healthy subjects. In patients with prehypertension a significant decrease of global strain rate was registered; they negatively correlate with systolic BP. In patients with HNBP the significant decrease of maximal diastolic blood flow rate in PA was registered. Conclusions. The earliest preclinical sign of myocardial contractile dysfunction in the subjects with HNBP is the decrease of global longitudinal strain. In patients with prehypertension the decrease of maximal diastolic blood flow rate in performant arteries is found.

0512: Utility of echocardiography for detecting of hypoxic myocardial injury in newborns

to evaluate the utility of echocardiographic exam (echo) for diagnosis and follow up of perinatal posthypoxic myocardial injury. Patients: 78 newborns aged 0 to 14 days, normal birth weight, with perinatal hypoxia, receveing resuscitation (Apgar score 3-7), but without major congenital heart defects. In all cases were performed: clinical exam, ECG, chest X-ray (Rx.CT), Doppler echocardiography exam (Echo). Most of our patients were evaluated clinically and echo and after 6 months. The patients had mainly signs of neurological post hypoxic suffering, without signs of severe cardiac involvement. The cardiac exam revealed: systolic murmur (64) and signs of persistent pulmonary hypertension of newborn (PPHN). Chest X-ray: cardiomegaly (35 cases). ECG: severe left ventricle (LV) repolarization disturbances and low voltage of QRS complexes (37), without ischemic changes. Echo performed at 2-7 days of life revealed: the absence of other severe congenital cardiac anomaly; permeability of foramen ovalae (100% cases); myocardial hypertrophy (42 cases) mainly interventricular septal (29), signs of PPHN (6) with mild to severe tricuspid insufficiency and right atrium dilation (28 cases); prolonged isovolumic relaxation period(35), increased myocardial performance index (44), the systolic function normal (all cases) and severe LV diastolic dysfunction (E/A<1) in 45 cases. All the cases received spironolactone 1-2mg/kg/day. Reevaluation at 6 months showed the reduction of the myocardial hypertrophy and of the tricuspid regurgitation, with a normal LV diastolic function. The perinatal hypoxia can induce the apparition of a true posthypoxic cardiomypathy at more than 69% of patients, the signs of cardiovascular suffering missing often. Echo exam and especially Tei Index is the main method for diagnosis and follow up of perinatal hypoxic cardiomyopathy and is necessary from the first week of life.

The prevalence of minor heart anomalies and characteristics of intracardiac hemodynamics in patients with connective tissue dysplasia according to tissue Doppler imaging

Introduction and aim. Minor heart anomalies (MHA) are the visceral form of connective tissue dysplasia (CTD) that lead to a deterioration in both systolic and diastolic function of the left ventricle (LV). Information about functional state of the myocardium of the right ventricle (RV) of patients with MHA is not available widely. The aim of the study is to evaluate the frequency of occurrence of different types of MHA and features of intracardiac hemodynamic using Tissue Doppler (TD) examination of patients with CTD. Materials and methods. Total were surveyed 1240 people, of which were selected 67 patients with SHD and control group of 27 healthy persons (average age 30.1±4.0 years). Evaluation of systolic and diastolic function of LV and RV was carried out based on results of pulse-wave tissue Doppler of lateral and medial parts of the mitral fibrous annulus (MFAlat, MFFm) and tricuspid fibrous annulus (TEA), including the calculation of the index Tei. Results and discussion. The incidence of SHD was 23 %. Patients of first and second groups both have significantly higher Tei index MFAlat, MFFm and TFA, and at the same time the maximum values of Tei index were observed of patients with multiple MHA (0.50±0.09; 0.56±0.08; 0.49±0.10 standard units respectively). Conclusions. Evaluation of central hemodynamics using TD is very useful to identify disorders of myocardial performance of both the left and right ventricle. Increased Tei index is an early marker of diastolic dysfunction of both ventricles.

Efficacy and safety of myocardial gene transfer of adenovirus, adeno-associated virus and lentivirus vectors in the mouse heart.

Gene therapy is a promising new treatment option for cardiac diseases. For finding the most suitable and safe vector for cardiac gene transfer, we delivered adenovirus (AdV), adeno-associated virus (AAV) and lentivirus (LeV) vectors into the mouse heart with sophisticated closed-chest echocardiography-guided intramyocardial injection method for comparing them with regards to transduction efficiency, myocardial damage, effects on the left ventricular function and electrocardiography (ECG). AdV had the highest transduction efficiency in cardiomyocytes followed by AAV2 and AAV9, and the lowest efficiency was seen with LeV. The local myocardial inflammation and fibrosis in the left ventricle (LV) was proportional to transduction efficiency. AdV caused LV dilatation and systolic dysfunction. Neither of the locally injected AAV serotypes impaired the LV systolic function, but AAV9 caused diastolic dysfunction to some extent. LeV did not affect the cardiac function. We also studied systemic delivery of AAV9, which led to transduction of cardiomyocytes throughout the myocardium. However, also diffuse fibrosis was present leading to significantly impaired LV systolic and diastolic function and pathological ECG changes. Compared with widely used AdV vector, AAV2, AAV9 and LeV were less effective in transducing cardiomyocytes but also less harmful. Local administration of AAV9 was safer and more efficient compared with systemic administration.

Acceleration rate of mitral inflow E wave: a novel transmitral doppler index for assessing diastolic function

BackgroundWe performed comprehensive transmitral and pulmonary venous Doppler echocardiographic studies to devise a novel index of diastolic function. This is the first study to assess the utility of the acceleration rate (AR) of the E wave of mitral inflow as a primary diagnostic modality for assessing diastolic function.MethodsStudy group consisted of 84 patients (53 + 11 years) with left ventricle (LV) diastolic dysfunction and 34 healthy people (35 ± 9 years) as control group, who were referred for clinically indicated two-dimensional transthoracic echocardiogram (TTE) during 2012 and 2013 to Imam Hospital. Normal controls were defined as patients without clinical evidence of cardiac disease and had normal TTE. LV diastolic function was determined according to standardized protocol of American Society of Echocardiography (ASE). As our new parameter, AR of E wave of mitral inflow was also measured in all patients. It was represented by the slope of the line between onset of E wave and peak of it. Correlation between AR of E wave and LV diastolic function grade was measured using the Spearman correlation coefficient. Receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of AR of E wave in diagnosing LV diastolic dysfunction in randomly selected two-thirds of population then its derived cutoff was evaluated in rest of the population. The institutional review board of the hospital approved the study protocol. All participants gave written informed consent. This investigation was in accordance with the Declaration of Helsinki.ResultsThe mean value of AR was 1010 ± 420 cm/s2 in patients whereas the mean value for the normal controls was 701 ± 210 cm/s2. There was a strong and graded relation between AR of E wave of mitral inflow and LV diastolic function grade (Spearman P ≤0.0001, rs =0.69). ROC curve analysis revealed that AR of E wave of mitral inflow =750 cm/s2 predicted moderate or severe LV diastolic dysfunction with 89 % sensitivity and 89 % specificity (area under curve [AUC] = 0.903, P <0.0001). Application of this cutoff on test group showed 96 % sensitivity and 77 % specificity with AUC = 0.932 and P <0.0001.ConclusionAR of E wave of mitral inflow could be used for assessment of diastolic function, especially moderate or severe diastolic dysfunction. However, before its clinical application, external validation should be considered.

Left ventricle diastolic function and cognitive performance in adults with Down syndrome

Left ventricle diastolic function and cognitive performance in adults with Down syndrome

Sleep Disordered Breathing: Hypertension and Cardiac Structure and Function.

Obstructive sleep apnea (OSA) is a common form of sleep disordered breathing and has a relatively high prevalence in the general population. The frequency and severity of OSA is associated with age, male sex, and obesity, and OSA has been linked to cardiovascular complications and death. Importantly, OSA has a strong association with both prevalent and incidental hypertension and has a particularly high prevalence in patients with resistant hypertension. In these patients, CPAP and other OSA-directed treatments have been proposed as therapy to help control blood pressure (BP), especially in patients who have not attained optimal BP control despite maximum pharmacological therapy. OSA has also been associated with alterations in cardiac structure and function, although most studies are small and highly limited in study design. Existing data suggest an association between OSA greater left ventricle (LV) mass and hypertrophy that appears independent of confounders including hypertension and obesity. Although less clear and more controversial, OSA severity has been linked to LV systolic and diastolic function, pulmonary hypertension, and right ventricular hypertrophy. Further studies are needed to confirm the potential causal role of OSA in these observed associations with cardiac abnormalities.

Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography in patients with end-stage renal disease on dialysis therapy

BackgroundPulmonary hypertension (PH) is one of the most important comorbidities in patients undergoing hemodialysis (HD). The goal of the present work is to determine the possible etiologic factors for its occurrence. MethodsThe prevalence of PH was estimated by Doppler echocardiography in a cohort of 100 patients aged 49.3±13.9years on regular HD. Mean pulmonary artery pressure was estimated from pulmonary acceleration time by Mahan’s regression equation. Pulmonary vascular resistance and pulmonary capillary wedge pressure were calculated. We focused on the effect of HD on left and right ventricle diastolic and systolic function. Right ventricle systolic function was assessed by tricuspid annular systolic excursion and pulsed Doppler myocardial performance index. Since impaired endothelial function was postulated as an underlying cause of PH, we studied the effects of HD on brachial artery endothelial function. ResultsThe current study found that pulmonary hypertension was prevalent in 70% of patients on dialysis. Left atrium diameter, left ventricle mass indexed to body surface area, and mitral E/E′ were increased in the dialysis group (4.4±0.2cm, 126.5±24.6g/m2, and 16.9±4.4, respectively, p<0.001 for all). Pulmonary artery systolic pressure was positively correlated to duration of dialysis and negatively correlated to glomerular filtration rate (p<0.001 and r=−0.991). Pulmonary vascular resistance was significantly increased in dialysis patients (1.9±0.2 Wood units vs. 1.2 Wood units in controls, p<0.001). Endothelial dysfunction, defined as brachial artery flow mediated dilatation <6%, was found in 46% of dialysis group. ConclusionIncreased pulmonary artery systolic pressure in the HD population could be attributed to left atrium dilatation and left ventricle diastolic dysfunction. Pulmonary vascular resistance was significantly increased in dialysis group. This might be explained by impaired endothelial nitric oxide synthesis that not only caused systemic vasoconstriction but also affected the pulmonary vasculature.

Diastolic function of the left ventricular in athletes with small abnormalities of heart development.

The purpose of our research was studying of cardiovascular system overexertion symptoms by dynamic of diastolic function of left ventricle during exercises of different power in athletes with small abnormalities of heart development. Wesurveyed 70 athletesaged 12-27 years.Thediastolicfunctiondynamicsof leftventricularisshowedinthework. Themainindexesofmyocardiumrelaxationdisorders duringdiastolearedefined.Itisprovedthatinathleteswithsmall abnormalities of heart development (mitral valve prolapse, open oval window) during submaximal physical loadings, signs of left ventricular diastolic dysfunction developed.

Age-Related Left Ventricular Changes and Their Association with Leukocyte Telomere Length in Healthy People

IntroductionWith advancing age the left ventricle (LV) undergoes structural and functional changes, thereby creating the substrate for the development of diseases. One possible mechanism of the ageing heart is a cellular senescence. Leukocyte telomere length (LTL) is a marker of replicative ageing. The purpose of this study was to evaluate the structure and function of the LV in people of different ages free of cardiovascular diseases (CVD) and regular drug medication and to assess their relationship with LTL. We hypothesized that age-related changes in LV myocardium are associated with telomere length.MethodsThe study population consisted of 150 healthy, non-obese volunteers aged 28 to 78 years without history of CVD, significant deviations by 12-lead electrocardiogram and negative exercise test (treadmill stress test). All the participants underwent standardized transthoracic echocardiography using an available system (iE33; Philips). The LTL was measured by real-time quantitative polymerase chain reaction. We determined the relative ratio of telomere repeat copy number (T) to single-copy gene copy number (S).ResultsIn the older people there was a higher wall thickness than in the younger (1.03±0.09 vs. 0.88±0.10, p<0.01), whereas LV mass index was comparable between them (85.8±15.40 vs. 83.1±11.8, p = 0.20). There was a decrease in LV dimensions with advancing age (p<0.001). Older subjects had impairment in LV relaxation. LTL was associated with decreased E/A, Em/Am ratio (β = -0.323, p = 0.0001) after adjusting for age, sex and risk factors. There is no relation between the LTL and the structure of LV.ConclusionsOur data suggest that the ageing process leads to changes in LV structure and diastolic function and is linked with a phenotype of concentric LV remodeling. Telomere attrition is associated with age-related LV diastolic dysfunction. Telomere length appears to be a biomarker of myocardial ageing.

Right ventricular thickness as predictor of global myocardial performance in systemic sclerosis: A Doppler tissue imaging study

BackgroundCardiopulmonary involvement in systemic sclerosis (SSc) is a poor prognostic factor, due to pulmonary hypertension and right ventricular dysfunction. We assessed the echocardiographic parameters of right ventricular (RV) function in SSc and correlated echocardiographic findings to clinical features of the disease. MethodsThirty patients with SSc (cases) and 30 healthy, age-matched subjects (controls) were studied. Echocardiography, including tissue Doppler imaging, was used to evaluate cardiac function. ResultsPulmonary hypertension could be documented in only 5 cases by Doppler echo, using Bernoulli principle. RV diastolic function was significantly deranged in cases. RV systolic function and left ventricle (LV) diastolic function were also significantly deranged in the cases. RV thickness was increased in patients with SSc. There were no significant differences in the echocardiographic variables between diffuse and limited subtypes of SSc. Myocardial performance index (MPI) of both ventricles were increased in cases. We could demonstrate RV thickness as the single most important predictor of MPI of both ventricles with sensitivity of 82% and specificity of 72% for RV-MPI and 63% for LV-MPI. Diastolic function was not found to be affected by disease duration or Rodnan skin score. ConclusionPatients with SSc exhibit abnormal RV and LV diastolic functions as well as abnormal RV systolic function. RV wall thickness was found to be simple and the single best predictor of global myocardial performance. RV dysfunction may be a response to intermittent pulmonary arterial hypertension, lung parenchymal involvement, or secondary to LV diastolic dysfunction in SSc.

The impact of cisplatinum-based chemotherapy on ventricular function and cardiovascular risk factors in female survivors after malignant germ cell cancer.

AimsAmong male cancer survivors, cisplatinum‐based chemotherapy (CBCT) is associated with impaired left ventricle (LV) diastolic function, increased risk of metabolic syndrome, and increased cardiovascular morbidity and mortality. Comparable data in females are limited. The long‐term effects of cisplatin on right ventricle (RV) function are unknown in both genders. We aimed to investigate the impact of CBCT on cardiovascular risk factors and cardiac function in female survivors after malignant ovarian germ cell tumour (MOGCT).Methods and resultsThis national cross‐sectional follow‐up study recruited MOGCT survivors, diagnosed from 1980–09 (n = 153). Seventy‐four (48%) participated in out‐patient visit, of whom 41 had received CBCT (62% of all CBCT): median age, 35 years (range, 18–64 years); median time since CBCT, 14 years (range, 5–31 years). Participants were categorized into high‐CBCT (n = 19) and low‐CBCT (n = 22) groups and compared with age‐matched healthy females. All participants underwent laboratory tests and echocardiography to determine cardiac function. Compared with low‐CBCT participants, the high‐CBCT group showed significantly impaired RV function, as evaluated by tricuspid annular plane systolic excursion (22.6 ± 2.4 mm vs. 26.3 ± 3.6 mm; P < 0.001); RV S' (10.7 ± 1.9 cm/s vs. 12.4 ± 2.3 cm/s; P = 0.01); RV global longitudinal strain (−23.4 ± 2.4% vs. −25.7 ± 3.7%; P = 0.02), and tricuspid annular displacement (21 ± 2 mm vs. 24 ± 3 mm; P = 0.001). LV diastolic function was impaired in the high‐CBCT group compared with controls. Patients and controls exhibited similar metabolic syndrome prevalences.ConclusionsAmong long‐term survivors of MOGCT, CBCT was associated with impaired RV function and LV diastolic function. Unlike men, women do not appear to have an elevated risk of metabolic syndrome after CBCT.

A right ventricular diastolic impairment is common in systemic sclerosis and is associated with other target-organ damage

Heart involvement in systemic sclerosis (SSc) is a strong prognostic factor. Our aim was to examine left ventricle (LV) and right ventricle (RV) involvement. We examined LV and RV, systolic and diastolic functions, using echocardiography and Tissue-Doppler echocardiography (TDE) indexes, in a cohort of 212 consecutive SSc patients seen during a 9-month period at 2 institutions (Paris, France and Los Angeles, USA). They were compared to 50 healthy controls. When compared to controls, SSc patients had consistently impaired RV indices that include reduced RV contractility (p < 0.001), larger right atrial area (p = 0.027) and overall RV diastolic dysfunction (25% of SSc patients versus 0% of controls; p < 0.001). Patients also exhibited alterations in LV contractility and diastolic function (p < 0.001 each). In multivariate analysis, RV contractility as expressed by the TDE S(T) parameter was associated with TDE LV contractility S(M) (p = 0.030), DLCO (p = 0.013) whereas RV diastolic impairment was associated with systolic pulmonary artery pressure (p = 0.015). A subgroup of 27 patients had proven pulmonary arterial hypertension (PAH); comparison between SSc-PAH versus SSc free of PAH patients revealed reduced LV diastolic function (transmitral E/A ratio, p = 0.045 and E(A) < 10 cm/s, p = 0.029), reduced overall RV contractility (21.5% versus 4.5%; p = 0.03) and reduced RV diastolic function (transtricuspid E/A ratio; p = 0.014 and 68% versus 29% with impaired function; p = 0.001). Our data show that RV is commonly affected in SSc with predominant impaired diastolic function. Several factors, including primary heart, lung vascular disease and pulmonary hypertension, contribute to such impairment.

Left ventricular remodeling in patients with sickle cell disease: determinants factors and impact on outcome.

Cardiovascular complications have been increasingly detected as a result of prolonged longevity of patients with sickle cell disease (SCD). Previous studies have focused especially on pulmonary hypertension and its consequences on the right-side heart chambers, whereas factors associated with morphological changes in left ventricle (LV) remain poorly understood. This study was designed to identify clinical, laboratorial, and echocardiographic parameters associated with LV remodeling and its impact on outcome in SCD. Ninety patients aged 28 ± 7 years and 20 age- and gender-balanced healthy subjects were enrolled. Laboratory tests, electrocardiogram, and an echocardiogram with tissue Doppler imaging were performed in all patients. Patients with SCD had larger left and right heart chambers dimensions, LV mass, and tricuspid regurgitation (TR) velocity compared to health controls with similar demographic features. Despite chambers enlargement, systolic function of both ventricles was preserved. The mitral inflow velocities were higher in the patients than in controls, whereas septal and lateral annular motion velocities were normal, suggesting normal ventricular relaxation. SCD patients who were on hydroxyurea therapy and/or hypertransfusion had higher hemoglobin concentrations, but similar echocardiographic findings in comparison to those without treatment. Systolic blood pressure, ferritin concentration, TR velocity, and parameters of diastolic function were independently associated with increased LV mass. In addition, the predictors of adverse events were ferritin concentration, lactate dehydrogenase levels, and TR velocity. LV remodeling in SCD patients seems to be influenced by a combination of factors including blood pressure, ferritin concentration, TR velocity, and parameters of LV diastolic function, and was not associated with adverse outcomes.

Cardiac response to early conversion from calcineurin inhibitor to everolimus in renal transplant recipients--a three-yr serial echocardiographic substudy of the randomized controlled CENTRAL trial.

In transplant recipients, calcineurin inhibitors (CNIs) are associated with adverse cardiac effects while mTOR inhibitors have been reported to be beneficial. We performed a randomized controlled trial (RCT) in de novo renal transplant recipients examining cardiac responses of everolimus vs. CNI. This was a substudy of the three-yr CENTRAL study, an RCT on safety and efficacy of early (week 7 post-engraftment) conversion from cyclosporine A (CsA) to everolimus vs. continued CsA. Thirty-nine recipients [median age 64 yr, (range 31-81)] completed echocardiographic evaluations at baseline, one, and three yr. After three yr, there was no difference between groups in left ventricle (LV) diastolic function, LV systolic function, LV morphology, and blood pressure response. We observed a relevant decrease in LV mass (CsA; 9.6%, p = 0.008, vs. everolimus; 7.0% reduction, p = 0.15), stabilized LV diastolic function, and a trend toward lower systolic blood pressure with 6 mmHg decrease in both arms (CsA, p = 0.08; everolimus, p = 0.14). Diastolic blood pressure was significantly reduced (8 mmHg decrease, p = 0.002) only in everolimus patients. After three-yr follow-up, no clinically relevant effect on cardiac function of an early conversion from CsA to an everolimus-based immunosuppressive regimen was detected in de novo renal transplant recipients.

PP.36.09

Objective: The purpose of this study was to evaluate the relationship between insulin resistance (IR) and the state of the global contractility and relaxation in patients with ischemic chronic heart failure (CHF). Design and method: The study involved 112 patients with documented coronary artery disease and heart failure at the age of 48 to 62 years. IR was verified by the homeostasis model assessment (HOMA-IR). Evaluation of hemodynamics was performed using transthoracic B-mode echocardiography with tissue Doppler imaging and Speckle Tracking imaging. Biomarker measurements were performed at baseline. Results: Univariable and multivariable Cox regression adjusted on NT-proBNP level has shown that IR (OR = 2.15; 95% CI = 1.05–3.22; p = 0.001), age (OR = 1.07; 95% CI = 1.03–1.10; p = 0.001) and NYHA class (OR = 1.03; 95% CI = 1.02–1.08; p = 0.001) predicted decrease in contractility function of LV in CHF patients. The independent predictors of declining of global longitudinal strain rate were IR (OR = 1.25; 95% CI = 1.11–1.89; p = 0.002), LVEF (OR = 1.05; 95% CI = 1.03–1.08; p = 0.002), NYHA class (OR = 1.07; 95% CI = 1.03–1.12; p = 0.001), and obesity (OR = 1.06; 95% CI = 1.02–1.10; p = 0.001). Therefore, IR (OR = 1.58; 95% CI = 1.13–2.64; p = 0.001), NYHA class (OR = 1.09; 95% CI = 1.03–1.17; p = 0.001), multi coronary vessel diseases (OR = 1.04; 95% CI = 1.00–1.09; p = 0.001) predicted decreasing of global circumferential strain rate. Conclusions: Insulin resistance in none-diabetes patients with CHF associates with sufficient disorders of integrated systolic and diastolic function of left ventricle.

Left Ventricular T-Cell Recruitment Contributes to the Pathogenesis of Heart Failure.

Despite the emerging association between heart failure (HF) and inflammation, the role of T cells, major players in chronic inflammation, has only recently begun to be explored. Whether T-cell recruitment to the left ventricle (LV) participates in the development of HF requires further investigation to identify novel mechanisms that may serve for the design of alternative therapeutic interventions. Real-time videomicroscopy of T cells from nonischemic HF patients or from mice with HF induced by transverse aortic constriction revealed enhanced adhesion to activated vascular endothelial cells under flow conditions in vitro compared with T cells from healthy subjects or sham mice. T cells in the mediastinal lymph nodes and the intramyocardial endothelium were both activated in response to transverse aortic constriction and the kinetics of LV T-cell infiltration was directly associated with the development of systolic dysfunction. In response to transverse aortic constriction, T cell-deficient mice (T-cell receptor, TCRα(-/-)) had preserved LV systolic and diastolic function, reduced LV fibrosis, hypertrophy and inflammation, and improved survival compared with wild-type mice. Furthermore, T-cell depletion in wild-type mice after transverse aortic constriction prevented HF. T cells are major contributors to nonischemic HF. Their activation combined with the activation of the LV endothelium results in LV T-cell infiltration negatively contributing to HF progression through mechanisms involving cytokine release and induction of cardiac fibrosis and hypertrophy. Reduction of T-cell infiltration is thus identified as a novel translational target in HF.

Возрастные изменения диастолической функции миокарда левого желудочка, уровня NT-proBNP и изучение их связи с длиной теломер лейкоцитов

With advancing age the left ventricle (LV) undergoes structural and functional changes, thereby creating the substrate for the development of diseases. One possible mechanism of the ageing of the heart is cellular senescence. Leukocyte telomere length (LTL) is a marker of replicative ageing. The purpose of this study was to evaluate the diastolic function of LV and level of NT-proBNP in people of different ages free of cardiovascular diseases and to assess their relationship with LTL. Our data showed that old age is associated with diastolic dysfunction and increase in the levels of NT-proBNP. The group of older subjects had lower values of E/A (0.96 ± 0.036 vs 1.27 ± 0.03, p < 0.001), Em/Am (0.9 ± 0.035 vs 1.5 ± 0.066) and higher values of IVRT (81 ± 1.56 vs 70 ± 1.23 MS, p < 0.001), DT (198 ± 3.98 vs 175 ± 2.82 MS, p < 0.001), that reflected impairment of LV relaxation. NT-proBNP level was higher in the elderly (100.82 ± 7.1 vs 48.47 ± 6.7 ωg/ml, p < 0.01), but it did not correlate with LTL. The most sensitive to the age parameters of LV diastolic function (E/A and Em/Am ratio) were positively and independently of age associated with LTL (p < 0.001). Older individuals with shorter LTL had significantly lower values of E/A ratio.Telomere length appears to be a biomarker of myocardium ageing.