Abnormal Left Ventricular Diastolic Function Research Articles

The clinical and echocardiography features of basal septal hypertrophy

Objective To explore the prevalence and clinical and echocardiography features of the basal septal hypertrophy(BSH). Methods Clinical and echocardiography data of 1 056 elderly population in an urban community of Beijing were analyzed. BSH was defined as the thickness of basal interventricular septum ≥1.4 cm and basal septal/mid septal ≥1.3. Data were compared between BSH and non-BSH, and the risk factors of BSH were evaluated. Results The prevalence of BSH in this population was 7.39%(95%CI: 5.8%-9.0%). BSH was not associated with current cardiovascular diseases (P>0.05). Its correlates in logistic analysis included male, diabetes mellitus, small end diastolic left ventricular dimension and abnormal left ventricular diastolic function (P<0.05), with OR 0.49(0.29, 0.83), 1.99(1.18, 3.37), 2.24(1.35, 3.72), 0.39(0.26, 0.59), and 1.96(1.01, 3.81), respectively. Conclusions BSH is common in elderly community population and not associated with cardiovascular diseases. Its risk factors included male, obesity, diabetes mellitus, small end diastolic left ventricular dimension and abnormal left ventricular diastolic function. Key words: Echocardiography; Ventricular septum; Cardiomyopathies; Epidemiologic studies

The effect of combined antihypertensive therapy on left ventricular diastolic function in resting and postexercise patients with arterial hypertension

The correction of left ventricular diastolic function abnormalities hasn’t been well investigated in arterial hypertension.The aim of the study was to determine the effects of two antihypertensive combinations (perindopril/amlodipine and losartan/amlodipine) on the state of diastolic function at rest and after exercise in patients with arterial hypertension.Results. The early diastolic transmitral flow velocity and mitral annular tissue doppler velocities increased under fixed-dose combination of perindopril and amlodipine. The combination shortened the transmitral E-wave deceleration time and isovolumetric left ventricular relaxation time. The prevalence of diastolic dysfunction decreased from 55.8% to 31% on therapy with perindopril and amlodipine (p&lt;0.05). The treatment reduced the frequency of pathologic results of diastolic exercise stress test. These changes were associated with improved exercise tolerance. Therapy with amlodipine and losartan shortened the deceleration time of early diastolic flow at rest and after exercise. The combination of amlodipine and losartan hasn’t reduced the prevalence of left ventricular diastolic dysfunction and hasn’t improved exercise tolerance.Conclusions. The six-month treatment with fixed-dose combination of perindopril and amlodipine has a pronounced effect on improving ofLV diastolic function compared with a combination of losartan and amlodipine.

Assessment of diastolic function in the management of patients with cirrhosis.

For many years, it has been known that impaired liver function and portal hypertension are associated with a pronounced splanchnic vasodilatation. This leads to important circulatory changes with displacement of the circulating blood volume resulting in central hypovolemia [1]. The combination of effective hypovolemia, arterial hypotension, and baroreceptor-activation of potent vasoconstricting systems such as the sympathetic nervous system leads to a hyperdynamic circulation and a multi-organ failure including impaired function of the heart [2]. In a patient with a full-blown decompensated state of cirrhosis, the heart rate and cardiac output are typically increased [1]. Both experimental and clinical studies have shown that the dimensions of the cirrhotic heart are augmented and the contractility and electromechanical function are impaired [3, 4]. This condition has been termed cirrhotic cardiomyopathy, which designates a cardiac dysfunction that includes impaired cardiac contractility with systolic and diastolic dysfunction and electromechanical abnormalities in the absence of other known causes of cardiac disease [4]. Cirrhotic cardiomyopathy can be demasked by physical or pharmacological stress, which may reveal in particular a systolic dysfunction, which seems to contribute to several cirrhotic complications such as the formation of ascites [5, 6] and the development of hepatic nephropathy [7, 8]. Additionally, cirrhotic cardiomyopathy seems associated with the development of heart failure in relation to invasive procedures such as shunt insertion and liver transplantation [9, 10]. Abnormal left ventricular diastolic function, caused by decreased left ventricular compliance and relaxation, implies an abnormal filling pattern of the ventricles. The transmitral blood flow is changed, with an increased atrial contribution to the late ventricular filling [4]. The pathophysiological background of the diastolic dysfunction in cirrhosis is an increased stiffness of the myocardial wall, most likely because of a combination of mild myocardial hypertrophy, fibrosis, and subendothelial edema [2, 3]. The increase in myocardial stiffness is also reflected by other parameters of diastolic dysfunction, such as a prolonged time for the ventricles to relax after diastolic filling at a specific end-diastolic volume, which reflects an increased resistance to the ventricular inflow [4]. Natriuretic peptides are regarded as markers of volume overload and impaired contractility, and are released by stretch of the atrial fibers such as in patients with ascites where the right atrium has been reported increased partly because of volume overload with expanded blood volume [1, 4]. However, the interpretation of increased natriuretic peptides in patients who from a functional point of view suffer from effective hypovolemia is complex. Activation of the renin–angiotensin–aldosterone system (RAAS) is associated with cardiac disease such as hypertrophy and heart failure, and seems to be related to diastolic dysfunction in both cirrhotic and non-cirrhotic patients with portal hypertension [11]. Furthermore, RAAS may induce fibrosis, and there is evidence of relationships between plasma aldosterone and E/A ratio; thus, RAAS may be both directly and indirectly involved in diastolic dysfunction [4]. Echocardiography is the method more frequently utilised for the detection of left ventricular diastolic dysfunction. Diastolic dysfunction is expressed as a decreased S. Moller (&) Department of Clinical Physiology and Nuclear Medicine 239, Faculty of Health Sciences, Hvidovre Hospital, Centre of Functional Imaging and Research, University of Copenhagen, 2650 Hvidovre, Denmark e-mail: soeren.moeller@regionh.dk

Abnormal left ventricular diastolic function at late follow-up after repair of total anomalous pulmonary venous drainage: The impact of altered ventricular loading in utero

Assessment of diastolic function has not been described after repair of total anomalous pulmonary venous drainage (TAPVD), but studies of exercise capacity demonstrate impaired performance in this population despite normal systolic function. We postulated that diastolic impairment might contribute to this finding. We analyzed echocardiographic variables from 28 patients with repaired TAPVD and compared these with data from 32 healthy controls (normals) and 21 subjects with repaired transposition of the great arteries (TGA). Left ventricular (LV) end-diastolic volumes were smaller in the TAPVD group (median, 50 mL/m(2) compared with a median of 64 mL/m(2) in TGA and 67 mL/m(2) in normals; P<.001 in each case). LV diastolic function in the TAPVD group was impaired. Mitral early to late ratio was increased (median, 2.7 in TAPVD compared with a median of 1.9 in TGA [P=.047] and 2.1 in normals [P=.021]). LV isovolumic relaxation time was reduced (median, 50 milliseconds in TAPVD compared with a median of 70 milliseconds in both TGA and normals; P<.001 in each case). Late diastolic and systolic tissue Doppler velocities were lower and the E/e' ratio was higher in the TAPVD group. Patients with repaired TAPVD are usually regarded as having excellent outcomes, but the finding of LV diastolic dysfunction in this population warrants more careful follow-up. We postulate that the diastolic impairment in these patients is the result of relative unloading of the LV during early cardiac development. Thesefindings may also have implications in considering therapeutic approaches for hypoplastic ventricles in attempting to achieve biventricular repair.

Aortic Stiffness and Left Ventricular Diastolic Function in Children Following Early Repair of Aortic Coarctation

Aortic stiffness and diastolic function are abnormal in adults with repaired coarctation of the aorta (CoA). The goal of this study was to determine the relation between aortic stiffness and left ventricular (LV) diastolic impairment in children who had undergone CoA repair very early in life. This is a retrospective review of echocardiograms in children with isolated repaired CoA (group CoA; n= 24) and healthy matched controls (group Normal; n= 24). We analyzed systolic and LV diastolic functions, proximal and distal ascending aortic stiffness indices (SIs), distensibility, and strain. Age range was 0.3 to 21 (median 9) years. Age at time of CoA repair was 0 to 24 (median 0.5) months. Median time since CoA repair was 6 years. There was no significant difference in blood pressure, LV size, and systolic function between the groups. LV diastolic function was impaired in group CoA compared with group Normal (septal E': CoA 10.3 ± 1.6 cm/s and Normal 13.4 ± 1.9 cm/s, p <0.001). All parameters of proximal and distal ascending aortic elasticities were abnormal in group CoA versus Normal (SI of proximal ascending aorta: CoA 4.9 ± 1.6 and Normal 2.7 ± 0.6, p<0.001). Across all patients, there was a strong correlation between septal E' and proximal ascending aortic SI (r=-0.72, p <0.001). In conclusion, even children who underwent CoA repair at a very young age have abnormal LV diastolic function and aortic elasticity compared with controls and there is a linear relation between the 2. LV diastolic dysfunction in patients with repaired CoA may be due to chronically increased afterload.

Preoperative Cardiac Variables of Diastolic Dysfunction and Clinical Outcomes in Lung Transplant Recipients

Background. Orthotopic lung transplantation is now widely performed in patients with advanced lung disease. Patients with moderate or severe ventricular systolic dysfunction are typically excluded from lung transplantation; however, there is a paucity of data regarding the prognostic significance of abnormal left ventricular diastolic function and elevated pretransplant pulmonary pressures. Methods. We reviewed the characteristics of 111 patients who underwent bilateral and unilateral lung transplants from 200 to 2009 in order to evaluate the prognostic significance of preoperative markers of diastolic function, including invasively measured pulmonary capillary wedge pressure (PCWP) and echocardiographic variables of diastolic dysfunction including mitral A > E and A′ > E′. Results. Out of 111 patients, 62 were male (56%) and average age was 54.0 ± 10.5 years. Traditional echocardiographic Doppler variables of abnormal diastolic function, including A′ > E′ and A > E, did not predict adverse events (P = 0.49). Mildly elevated pretransplant PCWP (16–20 mmHg) and moderately/severely elevated PCWP (>20 mmHg) were not associated with adverse clinical events after transplant (P = 0.30). Additionally, all clinical endpoints did not show any statistical significance between the two groups. Conclusions. Pre-lung transplant invasive and echocardiographic findings of elevated pulmonary pressures and abnormal left ventricular diastolic function are not predictive of adverse posttransplant clinical events.

Abstract 9398: Cornell Product Criteria for Left Ventricular Hypertrophy Strongly Predicts the Presence of Diastolic Dysfunction

Background: Abnormal left ventricular (LV) diastolic function is a known predictor of poor cardiovascular outcomes. Although ECG LV hypertrophy (LVH) has been related to LV systolic dysfunction and both prevalent and incident heart failure, whether ECG LVH is associated with LV diastolic dysfunction (DD) is unknown. Methods: From a cohort of patients who underwent both cardiac computed tomographic angiography and transthoracic echocardiography (TTE) with complete evaluation of diastolic function, 185 that underwent ECG within one year of TTE were identified as the study group. The presence of DD was determined according to standard guidelines via evaluation of mitral inflow velocities, tissue Doppler imaging, deceleration time, isovolumic relaxation time, pulmonary venous systolic: diastolic ratio, and left atrial enlargement. ECG LVH by Cornell product (CP) criteria was categorized into the highest quartile (≥1595 mm[[Unable to Display Character: ⋅]]ms) vs the lower three quartiles or evaluated as a continuous variable with odds ratios (OR) calculated for each SD of the mean (664 mm[[Unable to Display Character: ⋅]]ms) higher CP. Results: Among the 185 patients (56.2% female, mean age 54.6 ± 15.6), mean CP was 1240 ± 664 mm[[Unable to Display Character: ⋅]]ms and 105 (57%) had DD. In univariate logistic regression analysis, being in the upper quartile of CP was associated with over fivefold greater odds of DD (OR 5.1 95% CI 2.2-11.7, p&lt;0.001). In alternative analyses treating CP as a continuous variable, each 1 SD increase in CP was associated with an OR of 1.9 for DD (95% CI 1.3-2.7 p&lt;0.001). In multivariate logistic regression analyses adjusting for statistically significant univariate predictors of DD including age, history of hypertension, hypercholesterolemia, indexed LV mass, R wave axis, degree of coronary artery disease, PR interval and ST segment deviation as covariates, the highest quartile of CP remained associated with a significantly increased odds of having DD (OR 5.7 95% CI 2.2-14.7 p=0.001); alternatively, each 1 SD of CP was associated with a 1.8-fold increased odds of DD (95% CI 1.2-2.5 p=0.003). Conclusions: Cornell product ECG LVH is a powerful predictor of the presence of diastolic dysfunction, even after adjustment for potential confounding risk factors and ECG variables.

Diastolic Function in Pregnant Patients with Cardiac Symptoms

Objective. Dyspnea on exertion and peripheral edema occur routinely during normal gestational stage, making early diagnosis of congestive heart failure (CHF) during pregnancy difficult. Abnormal left ventricular (LV) diastolic function may be associated with dyspnea on exertion and peripheral edema, and brain natriuretic peptide (BNP) correlates with volume overload in nonpregnant populations. We tested the hypothesis that abnormal echocardiographic diastolic parameters and elevated BNP correlate in symptomatic pregnant patients. Methods. Sixty-six gravidas presented to an Obstetric Cardiology Clinic were analyzed. Data including symptoms of CHF, BNP, and maternal and gestational ages were recorded. Echocardiograms were reviewed to measure the diastolic parameters E, A, e′, and a′ wave velocities and left atrial volume index (LAVI). Logistic regression was performed to characterize the relationship between diastolic parameters and BNP. Results. Among the 66 pregnant patients included in the analysis, only 6 were found to have significant LV systolic dysfunction. LAVI, E, and E/e′ ratio correlated positively with BNP in this symptomatic population (p = 0.008, 0.007, and 0.002, respectively). Conclusions. Abnormal diastolic parameters that represent increased LV filling pressures correlated with higher BNP levels in pregnant patients with symptoms of CHF. This suggests that symptoms may be due to diastolic dysfunction, and BNP levels may identify elevated LV filling pressures in symptomatic pregnant patients.

Left ventricular function in children and adults after renal transplantation in childhood

Renal transplantation improves left ventricular (LV) function, but cardiovascular mortality remains elevated. The aim of this cross-sectional study was to determine whether subclinical abnormalities of LV longitudinal function also persist in patients who underwent renal transplant in childhood. Conventional and speckle tracking echocardiography was performed in 68 renal transplant recipients (34 children and 34 adults, median 9.8 years (range 2.0-28.4 years) after first transplantation and 68 age- and sex-matched healthy controls. Mean age at first transplantation was 8.8 ± 4.8 years. Forty-three percent had a pre-emptive transplant. Of the remaining, 70% received haemodialysis and 30% peritoneal dialysis on average for 6.9 months. Thirty-one percent of paediatric and 35% of adult patients had hypertension. LV mass index was increased in adult patients (92 ± 24 vs 75 ± 11 g/m(2), P< 0.01). LV diastolic function and exercise capacity were impaired in both paediatric and adult patients. LV longitudinal peak systolic strain and strain rate were comparable in patients and controls. In multivariate analysis, systolic blood pressure and LV diastolic relaxation were the main covariates of LV peak systolic strain and strain rate (all P < 0.01). Patients who underwent renal transplantation in childhood have abnormal LV diastolic function and impaired exercise capacity, despite preserved LV longitudinal systolic deformation.

Obesity as an independent risk for left ventricular diastolic dysfunction in 692 Japanese patients

Both obesity and left ventricular (LV) diastolic dysfunction are associated with an increased risk of cardiovascular morbidity and mortality. There is a paucity of data as to whether obesity is independently associated with LV diastolic dysfunction. Adult patients with sinus rhythm referred for a transthoracic echocardiography between July, 2007, and December, 2007, were prospectively included. Exclusion criteria were patient who had a history of congenital or valvular heart disease, treatment with pacemaker implantation or implantable cardioverter defibrillator, myocardial infarction, or impaired LV systolic function. Diastolic function was classified by an algorithm incorporating data from mitral and pulmonary venous flow indices, and Doppler tissue imaging. Body mass index (BMI) was evaluated as a categorical variable (normal weight <25.0 kg/m(2); overweight 25.0 to <30.0 kg/m(2); and obese ≥30 kg/m(2)). Logistic models were used to assess the risk of abnormal LV diastolic function associated with BMI categories. Of a total number of 692 patients who met all study criteria (mean 59 ± 15 year-old; 50% women, 48% hypertension, 16% diabetes, 26% overweight, 8% obese), 538 (78%) had abnormal LV diastolic function. In multivariate analyses adjusting for age, sex, and cardiovascular risk factors, obesity was independently associated with LV diastolic dysfunction (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.12-7.88; P = 0.03) compared to normal weight. LV mass did not weaken this association (OR: 2.88, 95% CI: 1.08-7.68; P = 0.04). Overweight was not independently associated with LV diastolic dysfunction. Obesity was associated with LV diastolic dysfunction independent of cardiovascular risk factors and LV mass.

Abstract 16710: Evidence of Ischemic Memory From Strain Rate Analysis of Diastolic Function During/After Percutaneous Coronary Intervention

Introduction The ability to detect ischemia occurring prior to the time of examination (ischemic memory) would be of great clinical value. Studies have shown that abnormal left ventricular (LV) diastolic function may be a sensitive marker of myocardial ischemia.HypothesisWe hypothesized that analysis of diastolic function by strain imaging (SI) could detect abnormalities due to myocardial ischemia for some time after percutaneous coronary intervention (PCI). Methods We performed echograms on 31 pts having angiography, 18 controls (CON) without obstructive CAD and 13 undergoing single vessel PCI (ISCH), at baseline, during balloon occlusion, and for 15, 30, and 60 minutes afterwards. SI analysis of the ischemic segment using speckle tracking was done in parasternal short axis views. The end systolic strain at the closure of the aortic valve (A) and at the time of one-third of diastole (B) were measured. A strain imaging diastolic index (SIDI) was calculated as A-B/Ax100% to examine diastolic performance. Results (see Table)Baseline characteristics for CON were similar to ISCH: mean age 61 ±14 years, HR 70 ±12, BP 135/70 ±27/13mmHg, male 69%, DM 38%, HTN 100%. SIDI values for ISCH decreased during balloon occlusion and remained low at 60 minutes after reperfusion. SIDI values in CON did not change significantly from baseline for 60 minutes after the procedure. (A) for ISCH decreased from 30.5 ±4% at baseline to 11.4 ±2% at 15 minutes after balloon occlusion and improved slightly to 15.8 ±2% at 60 minutes after reperfusion. (A) values in CON were unchanged from 22.6 ±8% at baseline to 20.8 ±9% at 60 minutes after procedure. Conclusions Abnormalities of systolic and diastolic strain (manifested by a decrease in SIDI values) occur in response to the induction of myocardial ischemia by PCI. As compared to the change in systolic strain, the change in SIDI values is of greater magnitude, is persistent at 60 minutes after reperfusion, and may be a useful marker of ischemic myocardial memory.

Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level

BackgroundAbnormal left ventricular (LV) structure and diastolic function are frequently detected in a variety of heart diseases, and insulin resistance has been suggested to be associated with LV diastolic dysfunction (LVDD). The aims of this study were to determine the association between LVDD or LV structure and metabolic syndrome (MetS) or insulin resistance, and whether or not the associations are independent of age, blood pressure, and plasma glucose level. MethodsA total of 1599 subjects (1161 men and 398 women), 25–83years of age, who underwent medical health check-ups at two institutions, were enrolled. LV diastolic function and structure were assessed by echocardiographic evaluation, including tissue Doppler imaging (TDI). ResultsThe subjects with MetS had significant differences in the level of parameters reflecting cardiac structure and LV diastolic function compared to those without MetS, even after adjustment for age, gender, blood pressure, and fasting plasma glucose level (P<0.001). MetS was independently associated with an increased risk for LVDD (OR, 1.67; 95% CI, 1.18–2.37; P=0.004). In addition, as the HOMA-IR value increased, the level of parameters reflecting cardiac structure and LVDD significantly increased and the E/A ratio significantly decreased (P<0.001). Furthermore, the LV mass, E/A ratio, and E/E′ ratio were significantly different across the HOMA-IR quartiles, even after adjustment for other confounders. ConclusionsMetS and insulin resistance are associated with abnormal LV diastolic function and structure independent of age, gender, blood pressure, and fasting plasma glucose level.

Early Diagnosis of Cardiac Toxicity Related to Antineoplastic Treatment

Background: breast cancer because of radiotherapy and/or chemotherapy causes cardiac disease, often it occurs on women just affected by hypertension and/or diabetes. All these conditions may affect left ventricular (LV) geometry, mass and diastolic function. The purpose of this study is to early detect these affections to improve heart failure prevention. Patients and methods: 134 women, affected by breast cancer, underwent to conventional transthoracic echocar-diography (TTE) and pulse wave tissue Doppler imaging (PW-TDI). A control group (CG) of 80 women unaffected by breast cancer, hypertension and diabetes was enrolled. Results: 54 of 134 women (40.2%), were affected by hypertension or diabetes too (Prone Group = PG), 8 by both, 80 (59.8%) were free (FG). Mean age of all patients was 45.4 years. The rates of LV eccentric hypertrophy and LV distolic dysfunction were statistically significant higher on FG group than controls, and on PG group than FG group. Conclusions: an abnormal LV diastolic function is more common among women affected by breast cancer after treatment than in general population, the same for LV eccentric hypertrophy but at a lower rate. 40% of women were affected by hypertension, diabetes or both, and as expected they have a higher rate of LV eccentric hypertrophy and diastolic dysfunction. This high prevalence of LV eccentric hypertrophy and diastolic dysfunction, on asymptomatic women, affected by breast cancer, is a predictor of heart failure; Doppler-echo techniques may be helpful in early diagnosis.

Adenosine Stress Perfusion CMR Safely Guides Revascularisation Decisions in Patients with Intermediate Coronary Stenosis

Background: A number of patients undergoing assessment for ischaemic heart disease proceed straight to coronary angiography without prior non-invasive functional tests. When an intermediate coronary lesion is then encountered, the functional significance of that lesion is often unclear. Non-invasive tests are then requested. We sought to determine the ability of stress perfusion cardiac magnetic resonance (CMR) to guidemanagement in these patients. Methods: Consecutive patients with an intermediate coronary stenosis on coronary angiography referred for subsequent adenosine stress CMR were evaluated. All lesions were angiographically intermediate (30–70% stenosis). Perfusion imaging was obtained at stress (adenosine 140 g/kg/min) and rest on a 1.5 T scanner. tored bymeasuring change in left ventricular (LV) systolic function. However, recent evidence suggests, that abnormalities of LV diastolic function can precede systolic abnormalities. Method: Thirty consecutive breast cancer patients (age 48± 10 years) with no background cardiac history were prospectively studied with an echocardiogram before and directly after chemotherapy; 25were treatedwithDoxorubicin (≤310mgm−2), five with Epirubicin (≤360mgm−2). LV systolic function was evaluated with biplane LVEF; diastolic function evaluated with transmitral, tissue Doppler (TDI) and strain rate (SR−1) measurements. Results: LVEF was significantly lower after chemotherapy (56± 3% vs. 59± 3%, p< 0.01). Significant changes in measures of diastolic function were also observed (see table).

Plasma amino-terminal propeptide of procollagen type III is associated with subclinical left ventricular systolic dysfunction in aortic stenosis

ObjectiveThe aim of the study was to investigate the association of plasma amino-terminal propeptide of procollagen type III (PIIINP) with subclinical left ventricular (LV) systolic dysfunction in patients with aortic stenosis (AS) and normal LV ejection fraction. MethodsThe study was performed in 57 AS patients with normal LV ejection fraction and in 30 control subjects with normal aortic valve and normal LV ejection fraction. Tissue Doppler and speckle tracking image were performed to assess LV diastolic and systolic function. Plasma PIIINP level was measured by specific radioimmunoassay. ResultsIn AS patients, LV systolic longitudinal strain was significantly reduced (−17.1±2.1 vs. −18.8±1.4%, P<0.001) and plasma PIIINP was increased compared with controls (2.5±0.6 vs. 2.1±0.4μg/l, P<0.001). A significant correlation was found between LV systolic longitudinal strain and PIIINP (r=−0.67, P<0.001). In patients with abnormal LV diastolic function, LV systolic longitudinal strain was reduced compared with patients with normal LV diastolic function (−16.3±1.5 vs. −18.8±2.1%, P<0.001) and plasma PIIINP was increased (2.8±0.5 vs. 2.0±0.3μg/l, P<0.001). A stepwise multivariate regression analysis revealed that LV systolic longitudinal strain and diastolic blood pressure were independent predictors of plasma PIIINP (multiple r=0.71, P<0.001). ConclusionsPlasma PIIINP is associated with subclinical LV systolic dysfunction (the impaired LV systolic long axis function) in patients with AS and normal LV ejection fraction. In addition, the impaired LV systolic long axis function and increased plasma PIIINP concentration are most marked in patients with abnormal LV diastolic function.

Diagnostic accuracy of plasma NT-proBNP levels for excluding cardiac abnormalities in the very elderly

BackgroundIn the elderly the diagnosis of chronic heart failure is often challenging and the availability of echocardiography can be limited. Plasma levels of NT-proBNP are valuable tools to diagnose patients with heart failure. However, the performance of this biomarker to detect cardiac abnormalities in the very elderly remains unclear. The aims of this study were to investigate the relation between NT-proBNP and cardiac abnormalities and to evaluate the use of NT-proBNP to exclude structural and functional cardiac abnormalities in a community-based sample of "well-functioning" nonagenarians.MethodsA diagnostic cross-sectional study embedded within the Leiden 85-plus Study in the municipality of Leiden, the Netherlands. Plasma NT-proBNP levels were measured and 2-dimensional echocardiography was performed in a subgroup of 80 well-functioning nonagenarians. Linear regression analysis was used to explore the relation between NT-proBNP and cardiac abnormalities and ROC curve analysis was used to assess the performance of NT-proBNP to exclude cardiac abnormalities. The upper limit of the lowest tertile of NT-proBNP was used as a cut-off value.ResultsNT-proBNP levels were associated with abnormal left ventricular (LV) dimensions, LV systolic and diastolic function, left atrial enlargement and valvular heart disease. LV mass, E/A ratio and degree of aortic regurgitation were identified as independent predictors of NT-proBNP. NT-proBNP levels were higher with greater number of echocardiographic abnormalities (P < 0.001). A cut-off level of 269.5 pg/mL identified patients with abnormal LV dimensions or depressed LV systolic function (sensitivity 85%, negative predictive value (NPV) 77%, area under the curve 0.75 (95% CI 0.64-0.85)). In addition, high NPV were found for LV systolic dysfunction, left atrial enlargement, severe valvular heart disease and pulmonary hypertension. The test performance of NT-proBNP to exclude any echocardiographic abnormality showed a sensitivity of 82% and a NPV of 65%.ConclusionsIn this convenience sample of well-functioning nonagenarians NT-proBNP was related to a wide variety of functional and structural echocardiographic abnormalities. Moreover, NT-proBNP could be used to exclude echocardiographic abnormalities in well-functioning nonagenarians and might be used to indicate who needs to be referred for further cardiovascular examination.

Impact of long-term caloric restriction on cardiac senescence: Caloric restriction ameliorates cardiac diastolic dysfunction associated with aging

Approximately half of older patients with congestive heart failure have normal left ventricular (LV) systolic but abnormal LV diastolic function. In mammalian hearts, aging is associated with LV diastolic dysfunction. Caloric restriction (CR) is expected to retard cellular senescence and to attenuate the physiological decline in organ function. Therefore, the aim of the present study was to investigate the impact of long-term CR on cardiac senescence, in particular the effect of CR on LV diastolic dysfunction associated with aging. Male 8-month-old Fischer344 rats were divided into ad libitum fed and CR (40% energy reduction) groups. LV function was evaluated by echocardiography and cardiac senescence was compared between the two groups at the age of 30-month-old. (1) Echocardiography showed similar LV systolic function, but better LV diastolic function in the CR group. (2) Histological analysis revealed that CR attenuated the accumulation of senescence-associated β-galactosidase and lipofuscin and reduced myocyte apoptosis. (3) In measurements of [Ca2+]i transients, the time to 50% relaxation was significantly smaller in the CR group, whereas F/F0 was similar. (4) CR attenuated the decrease in sarcoplasmic reticulum calcium ATPase 2 protein with aging. (5) CR suppressed the mammalian target of rapamycin (mTOR) pathway and increased the ratio of conjugated to cytosolic light chain 3, suggesting that autophagy is enhanced in the CR hearts. In conclusion, CR improves diastolic function in the senescent myocardium by amelioration of the age-associated deterioration in intracellular Ca2+ handling. Enhanced autophagy via the suppression of mTOR during CR may retard cardiac senescence.

Characterization of Static and Dynamic Left Ventricular Diastolic Function in Patients With Heart Failure With a Preserved Ejection Fraction

Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.

ASSOCIATION BETWEEN CAROTID ARTERY STIFFNESS ESTIMATED WITH E-TRACKING AND DIASTOLIC DYSFUNCTION ASSESSED WITH TDI IN 105 PATIENTS WITH MASKED HYPERTENSION: PP.31.237

A normal blood pressure in the clinic or office but an elevated blood pressure out of the clinic is defined as masked hypertension. It may occurs in as many 10% of the general population. Increased arterial stiffness directly increase end-diastolic left ventricular pressure and compromise myocardial relaxation properties. Thanks to our study we can evaluate the role of carotid artery stiffness parameters on diastolic function in patients with masked hypertension. Methods: Observing 105 consecutive patients with masked hypertension (proved by 24 H- ambulatory blood pressure monitoring), we have noticed that diastolic early (E’) and late (A’) velocities were recorded by pulse wave tissue. Doppler imaging of the lateral mitral anulus in the apical 4- chamber view and carotid artery stiffness parameters were valued by e-tracking on the left carotid with ALOKA a 10 ultrasound system. Pulse wawe velocity (PWV), elastic pressure (Ep) and stiffness parameter (ß) were measured. Results: Pwv (m/s) 8+/-2, Ep (Kpa) 134+/-23, ß 12+/-2, normalized for age, were increased when compared with healthy subjects. Stiffness parameters correlate significantly with Tissue Doppler imaging diastolic parameters in particularly with E’ pwv (r = 0.68, p < 0.05), Ep (r = 0.60, p < 0.05) and ß (r = 0.68, p < 0.01). Conclusion: patients with masked hypertension increased arterial stiffness and abnormal left ventricular diastolic function (particularly with E’), was associated with arterial stiffness, expression of a greater contribution of atrial contraction to left ventricular filling for increased left ventricular end-diastolic pressure due to an high afterload.

Transmitral E/A ratio decreases in association with abdominal fat accumulation in patients with impaired glucose tolerance or mild diabetes without left ventricular hypertrophy

An abnormal left ventricular (LV) diastolic function is an early sign of diabetic cardiomyopathy, which is characterized by an impaired diastolic and/or systolic function of the left ventricle in the absence of ischemic, valvular, or hypertensive heart disease, and serves as a marker of cardiovascular risk. However, it is unclear whether LV diastolic abnormalities can be detected in patients with impaired glucose tolerance (IGT) or mild diabetes without LV hypertrophy (LVH). We examined echocardiographic data from 92 consecutive Japanese patients aged 45-79 years with or without IGT or mild diabetes in the absence of LVH. Impaired glucose tolerance or mild diabetes was defined as the presence of one or more of the following criteria: fasting plasma glucose >110 mg/dl, hemoglobin A1c >5.6%, homeostasis model assessment ratio >1.73, or the taking of oral antihyperglycemic drugs. Left ventricular hypertrophy was defined as an LV mass index (LVMI) >116 g/m(2) in men and >104 g/m(2) in women. Patients with ischemic, valvular, or hypertensive heart disease were excluded. The age, blood pressure, heart rate, and LVMI were similar between patients with (IGT/DM group, n = 43) and without IGT or mild diabetes (non-IGT/DM group, n = 49), whereas the body mass index and waist circumference (WC) were greater in the IGT/DM compared to the non-IGT/DM group (P < 0.05 and P < 0.001, respectively). The transmitral E/A ratio was lower and the deceleration time longer in the IGT/DM than in the non-IGT/DM group (both P < 0.05). Stepwise regression analysis revealed that age and WC were independent determinants of the E/A ratio. In conclusion, diastolic abnormalities without LVH can be detected in Japanese patients with IGT or mild diabetes. The E/A ratio decreases in association with abdominal fat accumulation.