Left Ventricular Diastolic Elastance Research Articles

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction.

Of the existing non-invasive diastolic indices, none consider arterial load. This article reveals points of caution for determining the diastolic prognostic index using a novel index of vascular resistance-integrated diastolic function in old, real-world patients with heart failure with preserved ejection fraction (HFpEF) in Japan. This index represents the ratio of left ventricular diastolic elastance (Ed) to arterial elastance (Ea), where Ed/Ea = (E/e')/(0.9 × systolic blood pressure), showing a relative ratio of left atrial filling pressure to left ventricular end-systolic pressure. The role of hemodynamic prognostic factors related to diastolic function, such as Ed/Ea, may differ according to the clinical endpoint, follow-up duration, and sex. In HFpEF patients with heterogenous cardiac structure and function, an assessment using a serial echocardiographic diastolic index in clinical care can provide an accurate prognosis.

Impact of aortic atheroma and distensibility on diastolic function and prognosis in patients with ischemic stroke.

Patients with ischemic stroke are vulnerable to heart failure with preserved ejection fraction (HFpEF) because these conditions share common risk factors. Although evaluation of the ascending aorta, aortic arch, and proximal descending thoracic aorta is an essential step to determine the source of the causative embolism, the relationship between the degree of aortic atheroma and left ventricular (LV) diastolic function has not been extensively investigated. We analyzed the transesophageal and transthoracic echocardiography in ischemic stroke patients. Patients with previous coronary artery disease, valvular heart disease of more than moderate degree, and an LV ejection fraction of less than 50% were excluded. The relationships between the grade of the aortic atheroma, aortic stiffness indexes, and diastolic functional indexes were evaluated. In 295 patients, the atheroma grade was significantly correlated with aortic stiffness index, ratio of mitral annular and inflow velocities (E/e'), left atrial volume index, and LV diastolic elastance. With further adjustment for age, hypertension, diabetes, estimated glomerular filtration rate, left atrial volume index, and LV mass index, the significance of the atheroma grade was attenuated. In the subgroup analysis, the atheroma grade was significantly and independently related to E/e' in women (β = 0.181, p = 0.032), but not in men. However, atheroma grade was not associated with poor clinical outcomes in either sex. Aortic atheroma grade was significantly and independently related to LV diastolic function, especially in women. This suggests that aortic atheroma is an index of arterial stiffness and a potential risk factor for HFpEF through ventricular-vascular interactions, especially in women.

IMPACT OF SINGLE-PILL COMBINATION OF VALSARTAN/AMLODIPINE ON LEFT VENTRICULAR HYPERTROPHY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS

Objective: to investigate effects of single-pill combination (SPC) of valsartan/amlodipine (V/A) on left ventricular (LV) and left atrial (LA) myocardial stiffness (MS) parameters and LV mass index (LVMI) in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases. Design and method: Retrospective, cohort, open-label study. According to the medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 38, mean age 49.7 ± 7.0 years) was retrospectively formed. All the patients were treated with V/A SPC and all of them had achieved target office blood pressure (BP) <140/90 mmHg. In all included patients clinical and echocardiographic data (acquired using Vivid 7 Dimension system, GE) were available at baseline and on 12th week after reaching the target BP. LVMI, diastolic interventricular septum thickness (IVS) and diastolic LV posterior wall thickness (PWT) were used as a measures of LV hypertrophy. LV end-diastolic stiffness, LV end-systolic elastance (ESE), LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived LA strain were calculated as MS parameters. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: at the end of follow-up LV ESE significantly (p < 0.001) decreased from 4.01 ± 1.12 to 3.46 ± 0.88 mmHg/ml. In the subgroup of patients with initially abnormal LV GLPS (less than 19.7%) this parameter significantly (p = 0.005) increased in absolute value from −16.14 ± 2.21 to −17.30 ± 2.13% (+8,45 ± 13.35%). All LV hypertrophy markers significantly decreased (p < 0.001 for all) – LVMI from 113.40 ± 22.24 to 103.52 ± 21.30 g/m2 (−8.58 ± 7.57%), IVS from 1.30 ± 0.20 to 1.23 ± 0.19 cm (−5.38 ± 5.29%) and PWT from 1.03 ± 0.11 to 0.95 ± 0.11 cm (−7.82 ± 9.29%). After the treatment with V/A SPC the number of patients with LV hypertrophy significantly (p = 0.039) reduced from 65.8% to 39.5%. Conclusions: in naïve 40–65 years old patients with stage II grade 1–2 EAH antihypertensive therapy with V/A SPC provides effective BP control, improves LV MS parameters and reduced LV hypertrophy.

BLOOD PRESSURE VARIABILITY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED NAÏVE HYPERTENSIVE PATIENTS

Objective: to assess left ventricular (LV) and left atrial (LA) echocardiographic myocardial stiffness parameters in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases in relation to short-term blood pressure variability (BPV). Design and method: Retrospective, controlled study. According to medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 100, 47.0% men, mean age 51.9 ± 6.5 years) and a group of healthy controls (n = 86, 32.6% men, mean age 48.8 ± 5.8 years) was retrospectively formed. In all included participants clinical, echocardiographic data (acquired using Vivid 7 Dimension system, GE) and ambulatory blood pressure monitoring [ABPM] (BPLab, BP2005–01.04.00.2540, Petr Telegin, Russia) parameters were available. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index (LASI), LA expansion index and tissue Doppler-derived LA strain were calculated as myocardial stiffness parameters. 2-D speckle tracking echocardiography data were used for determination of LV myocardial global longitudinal peak strain (LV GLPS). BPV was estimated as standard deviation based on ABPM reports. Hypertensive patients were divided into 2 subgroups according to median value of day-time systolic BPV (dtSBPV) – 15 mmHg and into 2 subgroups according to median value of night-time systolic BPV (ntSBPV) – 14 mmHg (subgroups of «high» and «normal» dtSBPV and ntSBPV), and study parameters analyzed separately in these subgroups compared to the control group. Results: in hypertensive patients with «high» dtSBPV (n = 59) LV GLPS (−17.5 ± 3.0%) was significantly (p = 0.002) lower in absolute value and LASI (0.17 ± 0.09) was significantly (p = 0.015) higher compared to the controls (respectively, −19.5 ± 2.6% and 0.12 ± 0.06). No significant differences in myocardial stiffness parameters were obtained compared to the controls in hypertensive patients with «normal» dtSBPV and both «normal» and «high» ntSBPV. Conclusions: the present study reveals that higher dtSPBV predispose to increased LV myocardial stiffness in untreated middle-aged patients with stage II grade 1–2 EAH without concomitant cardiovascular diseases in comparison with sex- and age-matched healthy individuals with normal blood pressure.

Sex-related differences in left ventricular diastolic function and arterial elastance during admission in patients with heart failure with preserved ejection fraction: The PURSUIT HFpEF study.

We previously reported that an index of afterload-related left ventricular diastolic function, operant diastolic elastance (Ed)/effective arterial elastance (Ea) = E/e'/(0.9 × systolic blood pressure), was significantly higher in elderly hypertensive women. We aimed to determine sex-related differences in the E/e'-related indices for left ventricular diastolic function and their related factors during admission in patients with heart failure with preserved ejection fraction (HFpEF). Elderly HFpEF women exhibit severe left ventricular diastolic dysfunction associated with different left atrioventricular volume ratio. We divided 267 patients with HFpEF (men/women, 116/151) into two groups by age (≥75 years, n = 212; <75 years, n = 55). We examined the alterations of E/e', E/e'/stroke volume index = Ed, and Ed/Ea, and cardiac structure during admission. Ed and Ea were significantly higher in women than in men, at admission, especially in patients ≥75 years. Before discharge, not only Ed and Ea but also Ed/Ea was significantly higher in women than in men, especially in patients ≥75 years. Elderly female patients had larger left atrial than left ventricular volume. Higher afterload-related left ventricular diastolic elastance, Ed/Ea, in association with higher arterial elastance, Ea, accompanied by left atrioventricular volume mismatch was observed in elderly HFpEF women.

Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction.

Previous studies found that global longitudinal strain is a superior predictor of mortality in male patients with heart failure with reduced ejection fraction (EF). This does not apply to women. Our aim was to investigate sex-specific differences in cardiac function and identify echocardiographic predictors of mortality in women with heart failure with reduced EF. Echocardiographic examinations were retrieved from 968 patients with heart failure with reduced EF (26.7% women). Images were analyzed offline, and the end point was all-cause mortality. During follow-up (median: 41 months) 163 patients (16.8 %) died. Women had significantly higher left ventricular (LV) EF (27.1% versus 25.4%, P=0.004), global longitudinal strain (-9.9% versus -8.9%, P<0.001), and global circumferential strain (-10.9% versus -9.7%, P<0.001). Moreover, women displayed higher E/e' (14.4 versus 13.0, P=0.004), LV diastolic elastance (1.16 versus 0.75, P<0.001), and lower e' (6.2 cm/s versus 6.9 cm/s, P<0.001). In women, tricuspid annular plane systolic excursion and LV isovolumetric relaxation time were significant predictors of outcome after multivariable adjustment (tricuspid annular plane systolic excursion: hazard ratio, 1.11; 95% CI, 1.04-1.18; P=0.003 per 1 mm decrease; isovolumetric relaxation time: hazard ratio, 1.07; 95% CI, 1.03-1.10; P=0.001 per 5 ms decrease). LVEF and global longitudinal strain were significant predictors in men (LVEF: hazard ratio, 0.94; 95% CI, 0.90-0.99; P=0.014 per 1% increase; global longitudinal strain: hazard ratio, 1.20; 95% CI, 1.04-1.38; P=0.013 per 1% decrease). Tricuspid annular plane systolic excursion and LV isovolumetric relaxation time provide prognostic information in women but not in men. Hence, in women with heart failure with reduced EF, right ventricular function, and LV diastolic function seem paramount in predicting mortality, whereas LV systolic function is more important in men.

A13994 Blood pressure variability and hypertensive target organ damage

Objectives: to investigate an impact of blood pressure variability (BPV) on heart and brain hypertensive damage in the middle-aged untreated patients with grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases. Methods: we examined 60 naive hypertensive patients (HP) with EAH and 44 sex- and age-matched healthy individuals. Comprehensive transthoracic echocardiography (Vivid 7 Dimension, GE) with 2D speckle tracking analysis and ambulatory blood pressure monitoring were performed in all participants. BPV was estimated as standard deviation. 41 HP underwent brain magnetic resonance imaging (MAGNETOM Skyra 3.0T, Siemens AG). Fazekas scale was used to quantify the amount of white matter hyperintensities (WMH). Results: nighttime systolic BPV (sBPV) and nighttime diastolic BPV (dBPV) were significantly (p < 0,001 for all) higher in HP (12,1 ± 0,1 vs. 9,3 ± 0,4 mmHg in controls and 9,8 ± 0,4 vs. 6,9 ± 0,3 mmHg in controls, respectively). Correlation analyses in HP revealed significant association of nighttime sBPV with left ventricular (LV) end-systolic elastance (r = −0,375; p < 0,01) and LV end-diastolic stiffness (r = −0,429; p < 0,01). Daytime dBPV significantly correlated with LV diastolic elastance (r = 0,265; p < 0,05), nighttime dBPV - with left atrial expansion index (r = −0,282; p < 0,05). WMH (Fazekas 1 and 2) were found in 53,7% HP patients. In HP with WMH 24 hours sBPV (19,7 ± 3,9 mmHg) and daytime sBPV (18,0 ± 4,5 mmHg) were significantly (p < 0,05 for all) higher compared to same parameters in HP without WMH (17,2 ± 3,3 and 15,7 ± 3,1 mmHg, respectively). Conclusion: middle-aged untreated patients with grade 1–2 uncomplicated EAH are different from the sex- and age-matched healthy individuals by higher nighttime BPV. BPV associated with heart and brain hypertensive organ damage.

MYOCARDIAL STIFFNESS AND LEFT VENTRICULAR HYPERTROPHY IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS

Objective: to investigate left ventricular (LV) and left atrial (LA) stiffness parameters in middle-aged patients with grade 1–2 essentiial arterial hypertension (EAH) without concomitant cardiovascular diseases according to the presence of LV hypertrophy (LVH). Design and method: Case-control study. We examined 127 naive patients with uncomplicated grade 1–2 EAH and divided them into two groups according to the LV mass index (LVMI). The first one is included 96 hypertensive patients (HP) with LVH (mean LVMI 125,8 ± 2,1 g/m2, mean age 52,6 ± 0,7 years; mean office blood pressure (BP) 151,9 ± 1,5/93,8 ± 1,1 mm Hg). The second group consisted of 31 patients without LVH (mean LVMI 89,7 ± 2,1 g/m2, mean age 51,3 ± 1,0 years; mean office BP 138,7 ± 2,1/83,5 ± 1,9 mm Hg). 44 healthy individuals (mean age 51,5 ± 1,0 years; mean office BP 120,1 ± 2,0/80,5 ± 1,0 mm Hg) represented the control group. All the patients underwent 24-hours ambulatory BP monitoring. Comprehensive transthoracic echocardiography using Vivid 7 Dimension system (GE) was also performed. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived (TDD) LA strain were calculated. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: TDD LA strain was significantly higher in HP without LVH (60,01 ± 4,77%) compared to HP with LVH (49,77 ± 1,49%; p < 0,05). LV GLPS was significantly lower in absolute value in HP with LVH (−16,9 ± 0,3%) and HP without LVH (−17,5 ± 0,6%) compared to controls (−19,9 ± 0,4%; p < 0,001 and p < 0,01, respectively). No significant differences between studied groups were obtained in other myocardial stiffness parameters. LV GLPS showed a weak but significant associations with office diastolic BP (r = 0,354; p < 0,01), 24 h systolic BP (r = 0,291; p < 0,05), 24 h pulse pressure (r = 0,296; p < 0,05), and average night-time systolic and diastolic BP (r = 0,343; p < 0,01 and r = 0,262; p < 0,05, respectively). Conclusions: the present study reveals that disturbances in myocardial stiffness parameters occur early, before the development of echocardiographic signs of LHV. They are earlier markers of target organ damage even in middle-aged untreated patients with grade 1–2 uncomplicated EAH.

MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS IN THE PRESENCE OF OVERWEIGHT OR OBESITY

Objective: to evaluate left ventricular (LV) and left atrial (LA) stiffness parameters in middle-aged patients with arterial hypertension grade 1–2 without concomitant cardiovascular diseases in terms of the presence of overweight or obesity. Design and method: Case-control study. We examined 127 naive patients with uncomplicated essential arterial hypertension grade 1–2 and divided them into three groups in accordance with body mass index (BMI) values. The first one is included 19 patients with normal weight - mean BMI 23,2 ± 0,2 kg/m2, mean age 50,6 ± 1,0 years; 7 men; mean office blood pressure 142,1 ± 3,6/ 83,2 ± 2,5 mm Hg). The second group consisted of 52 patients with overweight - mean BMI 28,0 ± 0,2 kg/m2, mean age 53,1 ± 1,0 years; 26 men; mean office blood pressure 147,9 ± 2,0/ 90,9 ± 1,5 mm Hg). And the third group is included 56 patients with obesity - mean BMI 34,2 ± 0,4 kg/m2, mean age 52,0 ± 0,8 years; 33 men; mean office blood pressure 151,7 ± 2,0/ 94,4 ± 1,5 mm Hg). Comprehensive transthoracic echocardiography using Vivid 7 Dimension system (GE) were performed. LV end-diastolic stiffness, LV end-systolic elastance (ESE), LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived LA strain were calculated. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: LV GLPS was significantly (p < 0,001) lower in absolute value in patients with obesity (−15,6 ± 0,4%) compared with overweight group (−18,0 ± 0,4%) and the patients with normal weight (−18,5 ± 0,5%). LV ESE was significantly lower in patients with obesity (3,75 ± 0,13 mm Hg/ml) compared with overweight persons (4,34 ± 0,16 mm Hg/ml; p < 0,05) and the patients with normal weight (4,81 ± 0,26 mm Hg/ml; p < 0,001). No significant differences between studied groups were obtained in other myocardial stiffness parameters. Conclusions: The present study reveals that obesity leads to increased LV myocardial stiffness in untreated middle-aged patients with uncomplicated arterial hypertension grade 1–2 in comparison with sex-, age- and hypertension history-matched patients with overweight or normal BMI.

Effects of Amlodipine/Lisinopril Fixed-Dose Combination on Severity of Left Ventricular Hypertrophy and Parameters of Myocardial Stiffness in Patients With Hypertension

To assess effects of 12 weeks treatment with the amlodipine/lisinopril fixed-dose combination (ALFDC) on the left ventricular (LV) mass index (LVMI), parameters of LV and left atrial stiffness. At phase 1 of the study we examined 44 healthy subjects (21 men, 23 women, mean age 51.5+/-1.0 years) and 60 untreated patients (31 men, 29 women, mean age 53.6+/-0.8 years) with stage II grade 1-2hypertension. Myocardial stiffness parameters, LVMI were calculated using data of transthoracic echocardiography. 2-D speckle tracking echocardiography was used for determination of LV myocardial global longitudinal peak strain (GLPS). All participants underwent ambulatory blood pressure (BP) monitoring, and office BP measurement. At phase 2 a subgroup of 30 untreated patients (16 men, 14 women; mean age 52.7+/-1.11years) received ALFDC in a start dose of 5 mg/10 mg titrated every 14 days to achieve BP<140/90 mm Hg. Therapy in selected doses was continued for 12 weeks thereafter. In hypertensive patients LV GLPS was significantly lower while LA stiffness index higher compared with controls (17.08+/-0.38 vs. 19.91+/-0.41%, p<0.001, and 0.20+/-0.01 vs. 0.16+/-0.01, p<0.01, respectively). There were no significant differences in the LA tissue Doppler derived strain, LV end-systolic elastance, LA expansion index between hypertensive and control groups. After ALFDC therapy BP was significantly (p<0.001) reduced: systolic (S)BP from 154.4+/-2.7 to 130.6+/-1.2, diastolic (D)BP from 96.5+/-1.3 to 83.0+/-0.5 mm Hg. After therapy LV GLPS, LA expansion index, LV diastolic elastance significantly increased (from 17.10+/-0.57 to 18.29+/-0.35%, p<0.01; from 1.47+/-0.08 to 1.68+/-0.08, p<0.001; from 9.25+/-0.99 [10-2] to 10.88+/-1.0 8 [10-2], p<0.05, respectively) while LVMI, LV end-diastolic stiffness, and LA stiffness index significantly (p<0.001) decreased (from 129.4+/-4.5 to 111.8+/-3.3 g/m2, from 0.16+/-0.01 to 0.12+/-0.01 mm Hg/ml, from 0.21+/-0.02 to 0.15+/-0.01, respectively). Change in the LA tissue Doppler derived strain correlated with the change in dynamics of nighttime SBP (r=-0.410, p<0.05). There was direct relationship between change in LV diastolic elastance and nighttime DBP (r=0.424; p<0.05); and an inverse correlation between changes in LV end-diastolic stiffness and dynamics of the daytime SBP and DBP (r=-0.404; p<0.05 and r=-0.364; p<0.05, respectively). Change of LVMI after ALFDC treatment correlated with dynamics of 24-hour, daytime SBP, and daytime pulse pressure (r=0.382, p<0.05, r=0.478, p<0.01, and r=0.364, p<0.05, respectively). In untreated patients with stage II, 1-2 degree hypertension 12-week therapy with ALFDC allowed to achieve target BP levels, reduced severity of LV hypertrophy and improved stiffness parameters of the myocardium.

Echo-Doppler-derived indexes of ventricular stiffness and ventriculo-arterial interaction as predictors of new-onset atrial fibrillation in patients with heart failure.

BackgroundAtrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis. Vulnerability to changes in loading is an important factor in the development of AF and is strongly influenced by ventricular stiffness and ventriculo-arterial interaction. The aim of this study was to investigate predictors of AF development in patients with HF.MethodsWe studied 349 patients with stable HF. The following parameters of ventricular stiffness and ventriculo-arterial interaction were derived from echo-Doppler measurements: left ventricular (LV) diastolic elastance (Ed), effective arterial elastance (Ea), LV end-systolic elastance (Ees) and ventricular–vascular coupling index (VVI).ResultsAF occurred in 57 (16.3 %) patients over a median follow up of 30.3 months. Echo-Doppler–derived parameters of ventricular stiffness and ventriculo-arterial interaction were closely associated with HF severity. Ed was independently associated with AF after adjustment for age, hypertension, diabetes mellitus, and left atrial volume index (hazard ratio [HR] 5.49, p = 0.018). Ea and VVI were also associated with new-onset AF (HR 1.66, p = 0.027, and HR 1.06, p = 0.001, respectively).ConclusionsEcho-Doppler indexes of ventricular stiffness are closely associated with HF severity. LV diastolic elastance (Ed) is the strongest predictor of new-onset AF in HF patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-016-0050-y) contains supplementary material, which is available to authorized users.

Gender Differences in Ventricular-vascular Coupling Following Exercise.

To study the differences of cardiovascular system between men and women in response to exercise stress. Forty healthy youth were tested according to Bruce protocol of exercise stress. They were detected by ultrasonography during the rest, peak exercise, and recovery stages, respectively. The left ventricular diastolic elastance (Ed), effective arterial elastance (Ea), left ventricular end-systolic elatance (Ees), ventricular-vascular coupling index (VVI), and total stiffness index (TSI) were measured and calculated according to the formulas. The results of all stages were compared according to genders. All stages, the Ed, TSI, and VVI of women were higher than those of men, but the Ees was lower than that of men (all P<0.05); there was no significant difference in Ea between men and women. The Ed, Ees, Ea, and TSI were closely related with left ventricular oxygen consumption and heart function, and women showed more closely. Before and after exercise, the changes were different in Ed, Ees, Ea, TSI, and VVI (all P<0.05), and VVI changed least. Before and after exercise, the ventricular stiffness matched well with arterial stiffness and maintained within a narrow range. For women, the tolerance of exercise was lower than that of men.

Left Ventricular Diastolic Elastance is Higher in Women Compared to Men, and Elevated with Beta‐blockade

Left Ventricular Diastolic Elastance is Higher in Women Compared to Men, and Elevated with Beta‐blockade

Increase in ventricular-arterial stiffness in patients with psoriatic arthritis

Ventricular and arterial stiffness is an accepted cause of myocardial diastolic dysfunction. The aim of this study is to determine whether there is increased ventricular and arterial stiffness in patients with PsA and any relationship with disease-related risk factors. Seventy-three patients with PsA were divided into two subgroups based on the absence or presence of hypertension and/or left ventricular (LV) hypertrophy. Fifty healthy controls were enrolled for comparison. All participants underwent non-invasive assessments including conventional echocardiography with tissue Doppler imaging and pulse wave analysis. Ventricular stiffness was measured by ventricular end-systolic and diastolic elastance, whereas arterial stiffness was measured by total arterial compliance and aortic augmentation index. There was significantly increased ventricular and arterial stiffness in patients with PsA (P < 0.001), even in those without hypertension and/or LV hypertrophy. Based on the cut-off points derived from the controls, 38.4% of PsA patients had increased LV stiffness including 31.5% in diastole and 17.8% in systole, and 15.1% had increased arterial stiffness. Multivariable logistic regression analysis showed that long PsA disease duration (>10 years) (odds ratio = 6.55, P = 0.001) was an independent risk factor for increased LV diastolic elastance after adjusting for age, gender and hypertension. Patients with PsA may have increased ventricular and arterial stiffness even without evidence of LV remodelling, and those with long disease duration may be at a higher risk. Therefore, prolonged inflammatory burden may be an important cause of early cardiovascular disease in patients with PsA.

Preliminary study on ventricular arterial coupling of patients with hypertension by ultrasonography

BackgroundAgeing and chronic diseases, such as hypertension and diabetes, modify the structure and function of both the arteries and ventricles. The ventricular performance is influenced by arterial load and affects...

Gender-Related Difference in Left Ventricular Diastolic Elastance During Exercise in Patients With Diabetes Mellitus

Because the ratio of mitral inflow and annular velocity to stroke volume has been reported as an index of diastolic elastance (Ed), the hypothesis tested in the present study was that Ed during exercise would be more abnormal in female than in male patients with type 2 diabetes. Ed was measured at rest and during graded supine bicycle exercise (25W, 3-min increments) in 53 patients (27 males, mean age 53+/-14 years) with type 2 diabetes and 53 age- and gender-matched controls. The patients with diabetes were divided into 2 groups by gender. Ed was not significantly different at rest between men and women, but was significantly higher during exercise in women than in men (25 W, 0.15+/-0.04 vs 0.20+/-0.07, p=0.009; 50 W, 0.16+/-0.05 vs 0.21+/-0.08, p=0.0175). Left ventricular (LV) diastolic elastance is abnormal during exercise, but not at rest, in patients with diabetes without overt heart disease. Female gender was associated with increased LV stiffness during exercise among patients with type 2 diabetes.

161 Improvement in left ventricular diastolic elastance induced by physical training in patients with heart failure

161 Improvement in left ventricular diastolic elastance induced by physical training in patients with heart failure

Cardiac Structure and Ventricular–Vascular Function in Persons With Heart Failure and Preserved Ejection Fraction From Olmsted County, Minnesota

Mechanisms purported to contribute to the pathophysiology of heart failure with normal ejection fraction (HFnlEF) include diastolic dysfunction, vascular and left ventricular systolic stiffening, and volume expansion. We characterized left ventricular volume, effective arterial elastance, left ventricular end-systolic elastance, and left ventricular diastolic elastance and relaxation noninvasively in consecutive HFnlEF patients and appropriate controls in the community. Olmsted County (Minn) residents without cardiovascular disease (n=617), with hypertension but no heart failure (n=719), or with HFnlEF (n=244) were prospectively enrolled. End-diastolic volume index was determined by echo Doppler. End-systolic elastance was determined using blood pressure, stroke volume, ejection fraction, timing intervals, and estimated normalized ventricular elastance at end diastole. Tissue Doppler e' velocity was used to estimate the time constant of relaxation. End-diastolic volume (EDV) and Doppler-derived end-diastolic pressure (EDP) were used to derive the diastolic curve fitting (alpha) and stiffness (beta) constants (EDP=alphaEDVbeta). Comparisons were adjusted for age, sex, and body size. HFnlEF patients had more severe renal dysfunction, yet smaller end-diastolic volume index and cardiac output and increased EDP compared with both hypertensive and healthy controls. Arterial elastance and ventricular end-systolic elastance were similarly increased in hypertensive controls and HFnlEF patients compared with healthy controls. In contrast, HFnlEF patients had more impaired relaxation and increased diastolic stiffness compared with either control group. From these cross-sectional observations, we speculate that the progression of diastolic dysfunction plays a key role in the development of heart failure symptoms in persons with hypertensive heart disease.

Extracellular matrix proteins are a determinant of left ventricular diastolic elastance at low filling pressures

Extracellular matrix proteins are a determinant of left ventricular diastolic elastance at low filling pressures

Ventricular interdependence and the transient response of the left ventricle to inspiration: a model study.

A mathematical model of the circulation was developed and used to study the transient variations in ventricular volumes with inspiration. The contributions of increased left ventricular afterload, ventricular interdependence, and reduced pulmonary venous flow to the initial decrease in left ventricular stroke volume were examined. Heart rate was kept constant. Right ventricular end diastolic volume increased rapidly, but transiently, with inspiration. Ventricular interdependence affected left ventricular function; it increased the magnitude of the decrease in left ventricular stroke volume, reduced the corresponding increase in end systolic volume, and appeared to be responsible for an initial decrease in end diastolic volume. Despite a 10% pooling of blood in the pulmonary circulation the decrease in pulmonary venous flow was small. It is suggested that the decrease in left ventricular stroke volume is caused both by the reduced intrathoracic pressure, which increases the afterload on the left ventricle, and by the increase in the diastolic elastance of the left ventricle caused by the increase in right ventricular volume (ventricular interdependence). The increased afterload reduces the effective ejection pressure, decreases the stroke volume, and increases the end systolic volume. The increase in left ventricular diastolic elastance, secondary to the increase in right ventricular volume, further reduces the stroke volume by increasing the left ventricular diastolic pressure at a given volume and thus decreases the end diastolic volume.