Left Ventricular Diastolic Dysfunction Research Articles

Effect of HbA1c on The Severity of Diastolic Dysfunction in Type Two Diabetic Patients Presenting to the Cardiology Department, Mardan Medical Complex: A Cross-Sectional Study

Objectives: This study aimed to delineate the graded impact of HbA1c levels on the severity of diastolic dysfunction among patients presenting to the cardiology department at Mardan Medical Complex. Methodology: A total of 151 consenting T2DM patients, aged 20 to 65, were enrolled in the study. Participants were categorized into three groups based on their HbA1c levels: <8, 8-10, and >10. Transthoracic echocardiography was utilized to assess left ventricular diastolic dysfunction. Results: Of the participants, 61 were male and 90 were female. Notably, 85 patients (56.30%) exhibited HbA1c levels >10, among whom 18 (21%) were diagnosed with LVDD grade III, 51 (60%) with LVDD grade II, and 16 (19%) with LVDD grade I (p<0.001). Females were predominantly affected, constituting 59.6% of the study cohort. A significantly positive correlation was observed between LVDD and HbA1c levels (r=0.841; p<0.001). Conclusion: This study underscores a significant relationship between the severity of diastolic dysfunction and HbA1c levels in T2DM patients. Poor glycemic control, as evidenced by elevated HbA1c levels, correlates with heightened diastolic dysfunction. The findings highlight the critical importance of optimizing glycemic control in individuals with T2DM to mitigate the risk of cardiovascular complications, particularly diastolic dysfunction.

PDE9A Inhibition Improves Coronary Microvascular Rarefaction and Left Ventricular Diastolic Dysfunction in the ZSF1 Rat Model of HFpEF.

Heart failure with preserved ejection fraction (HFpEF) commonly arises from comorbid diseases, such as hypertension, obesity, and diabetes mellitus. Selective inhibition of phosphodiesterase 9A (PDE9A) has emerged as a potential therapeutic approach for treating cardiometabolic diseases. Coronary microvascular disease (CMD) is one of the key mechanisms contributing to the development of left ventricular (LV) diastolic dysfunction in HFpEF. Our study aimed to investigate the mechanisms by which PDE9A inhibition could ameliorate CMD and improve LV diastolic function in HFpEF. The obese diabetic Zucker fatty/spontaneously hypertensive heart failure F1 hybrid (ZSF1) rat model of HFpEF was employed in which it was found that a progressively developing coronary microvascular rarefaction is associated with LV diastolic dysfunction when compared to lean, nondiabetic hypertensive controls. Obese ZSF1 rats had an increased cardiac expression of PDE9A. Treatment of obese ZSF1 rats with the selective PDE9A inhibitor, PF04447943 (3 mg/kg/day, oral gavage for 2 weeks), improved coronary microvascular rarefaction and LV diastolic dysfunction, which was accompanied by reduced levels of oxidative and nitrosative stress markers, hydrogen peroxide, and 3-nitrotyrosine. Liquid chromatography-mass spectrometry (LC-MS) proteomic analysis identified peroxiredoxins (PRDX) as downregulated antioxidants in the heart of obese ZSF1 rats, whereas Western immunoblots showed that the protein level of PRDX5 was significantly increased by the PF04447943 treatment. Thus, in the ZSF1 rat model of human HFpEF, PDE9A inhibition improves coronary vascular rarefaction and LV diastolic dysfunction, demonstrating the usefulness of PDE9A inhibitors in ameliorating CMD and LV diastolic dysfunction through augmenting PRDX-dependent antioxidant mechanisms.

Subclinical left ventricular structural and functional alterations in children with obesity: is body mass or insulin resistance the main issue?

Obesity is an independent risk factor for cardiovascular diseases. The study aims to assess the left ventricular structure and functions in children with obesity. This study included 29 patients with metabolic syndrome, 31 patients with obesity without metabolic syndrome, and 30 healthy children of similar age and gender. Demographic, anthropometric, and biochemical findings and left ventricular structure and functions evaluated by conventional pulsed wave Doppler and tissue Doppler echocardiography were compared. The left ventricular mass index and relative wall thickness were significantly higher in children with obesity compared to controls. The mean left ventricular mass index of children with metabolic syndrome was also higher than for those without it. Most children with obesity had normal left ventricular geometry; concentric hypertrophy (27.6%) was more common in children with metabolic syndrome, and eccentric hypertrophy (25.7%) was more common in those without. The early to late diastolic mitral annular velocity ratios obtained with conventional pulsed wave Doppler echocardiography and tissue Doppler echocardiography (E/A and Em/Am, respectively) were lower in children with obesity than controls. In addition, the ratio obtained by tissue Doppler echocardiography was lower in children with metabolic syndrome than without. The homeostatic model assessment of insulin resistance, systolic blood pressure, and body mass index has been identified as independent factors for left ventricular structures and functions. Obesity causes subclinical left ventricular hypertrophy and diastolic dysfunction. Additional metabolic syndrome-related risks lead to further deterioration of cardiac morphology and functions.

Interpreting Diastolic Dynamics and Evaluation through Echocardiography.

In patients with heart failure, evaluating left ventricular (LV) diastolic function is vital, offering crucial insights into hemodynamic impact and prognostic accuracy. Echocardiography remains the primary imaging modality for diastolic function assessment, and using it effectively requires a profound understanding of the underlying pathology. This review covers four main topics: first, the fundamental driving forces behind each phase of normal diastolic dynamics, along with the physiological basis of two widely used echocardiographic assessment parameters, E/e' and mitral annulus early diastolic velocity (e'); second, the intricate functional relationship between the left atrium and LV in patients with varying degrees of LV diastolic dysfunction (LVDD); third, the role of stress echocardiography in diagnosing LVDD and the significance of echocardiographic parameter changes; and fourth, the clinical utility of evaluating diastolic function from echocardiography images across diverse cardiovascular care areas.

Genetic insights and clinical implication of inherited hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is one of the most common inherited genetic diseases of myocardium. It is the leading cause of unexpected mortality among young people and athletes. H.C.M. has been regarded as a sarcomere illness for the past few decades, usually with incomplete penetrance and varied expressivity arising from autosomal dominance. For the purpose of risk and treatment stratification, all diagnostic techniques—such as tissue biopsy, genetic counselling, magnetic resonance imaging, transthoracic and transoesophageal echocardiography, heart catheterization, and genetic counselling—must be used. Additionally, each patient's results should be customized based on their genotype and phenotype. About one-third of people have left ventricular outflow tract blockage at rest, and another third may be prompted to develop it. Interstitial fibrosis and myocyte hypertrophy and disarray are among the histological characteristics of H.C.M. Another common complication of the hypertrophy is left ventricular diastolic dysfunction. The pathogenesis of H.C.M is complex, and its clinical profile is variable. Functional disability resulting from heart failure and stroke (induced by atrial fibrillation) is also attributed to H.C.M. The goal of the current treatments for H.C.M., which include medication, myectomy, alcohol septal ablation, and implanted cardiac defibrillators (I.C.Ds) to avoid SCD, is to slow down the disease's progression and relieve symptoms. Multidisciplinary approaches are best suited for the diagnosis and treatment of patients with H.C.M. More individualized care and better results for this patient population have been made possible by this, as well as the enhanced safety and effectiveness of medicinal, percutaneous, and surgical therapy for H.C.M. In this review the molecular pathophysiology of H.C.M will be reviewed in light of current knowledge. In addition, describing how genetic testing is used for diagnosis and outlining the range of clinical manifestations.

Left Ventricular Diastolic Dysfunction across Levels of Kidney Function: A Cross-Sectional Study Based on Routine Clinical Practice Data.

Left ventricular diastolic dysfunction (LVDD) commonly coexists with kidney dysfunction. In this study, we investigated the presence of abnormalities in echocardiography parameters indicative of LVDD across stages of kidney function. Methods: We selected patients who visited a university hospital and had a serum creatinine and echocardiography reported in their medical records. Participants were categorized based on their kidney function: normal (estimated glomerular filtration rate [eGFR] ≥ 90 mL/min/1.73 m2), mildly decreased (eGFR: 60-90), moderately decreased (eGFR: 30-60), and severely decreased (eGFR < 30). The relationship between kidney function and echocardiography parameters was examined using logistic and linear regressions. Results: Among 4022 patients (age: 66.5 years [SD: 12.1], 41% women), 26%, 50%, 20%, and 4% had a normal, mildly, moderately, and severely decreased kidney function, respectively. Compared to patients with normal kidney function, patients with mildly decreased kidney function had higher odds for an abnormal E/e' ratio (OR: 1.51 [95% CI: 1.13, 2.02]). Patients with moderately decreased kidney function presented a higher risk of abnormal E/e' (OR: 2.90 [95% CI: 2.08, 4.04]), LAVI (OR: 1.62 [95% CI: 1.13, 2.33]), TR velocity (OR: 2.31 [95% CI: 1.49, 3.57]), and LVMI (OR: 1.70 [95% CI: 1.31, 2.20]), while patients with severely decreased kidney function had higher odds for abnormal E/e' (OR: 2.95 [95% CI: 1.68, 5.17]) and LVMI > 95 g/m2 in women or >115 g/m2 in men (OR: 2.07 [95% CI: 1.27, 3.38]). The linear regression showed a significant inverse association between eGFR and echocardiography parameters, meaning that with worse kidney function, the parameters for LVDD worsened as well. Conclusions: Abnormal echocardiography parameters of LVDD were present even in patients with mildly decreased kidney function. As the kidney function worsened, there was a gradual increase in the risk of abnormal parameters of LVDD.

The role of Cardiotrophin-1 and echocardiography in early detection of subclinical diabetic cardiomyopathy in children and adolescents with type 1 diabetes mellitus.

To assess the role of Cardiotrophin-1 (CT-1) and echocardiography in early detection of subclinical Diabetic Cardiomyopathy (DCM) in children with type 1 Diabetes Mellitus (T1D). This case-control study included two groups of children and adolescents aged between 7 and 18. Group (1) included forty patients with T1D (duration > 5 years) regularly followed at the children's hospital of Cairo University, and Group (2) included forty age and sex-matched healthy subjects as a control group. The serum level of CT-1 was measured, and conventional echocardiography, tissue Doppler imaging (TDI), and 2D speckle tracking echocardiography were performed. The level of CT-1 in the cases ranged from 11 to 1039.4 pg/ml with a median (IQR) of 19.4 (16.60-25.7) pg/ml, while its level in the control group ranged from 10.8 to 162.6 pg/ml with a median (IQR) of 20.2 (16.2-24.8) pg/ml. CT-1 levels showed no statistically significant difference between cases and controls. Patients had significantly higher mean left ventricle E/E' ratio (p<0.001), lower mean 2D global longitudinal strain (GLS) of the left ventricle (LV) (p<0.001), and lower mean GLS of the right ventricle (RV) (p<0.001) compared to controls. Ofpatients with diabetes, 75 % had LV diastolic dysfunction, 85 % had RV diastolic dysfunction, 97.5 % had LV systolic dysfunction, and 100 % had RV systolic dysfunction. Non-conventional echocardiography is important for early perception of subclinical DCM in patients with T1D. CT-1 was not specific for early detection of DCM.

The oxytocin-oxytocin receptors system — a new pathogenetic mechanism in the development of diabetic phenotype of heart failure with preserved ejection fraction in women

Aim. To determine the pathogenetic role of the oxytocinergic system in the development of myocardium structural and functional changes in women with heart failure with preserved ejection fraction (HFpEF) associated with type 2 diabetes mellitus (DM2T) (diabetic phenotype of HFpEF).Material and methods. The study included 60 women aged 67.0±4.9 years with HFpEF stage I-IIA, FC I-III, 30 of them had DM2T who were admitted for elective coronary artery bypass grafting. The development of HFpEF is caused by coronary artery disease (CAD) and arterial hypertension (AH). Prior to surgery, all patients underwent a standard examination, blood levels of NT-proBNP, oxytocin (Ox), echocardiography were determined to find the types of left ventricular (LV) myocardial remodeling and diastolic dysfunction (DD). Myocardium biopsies of the right atrium auricle obtained during coronary bypass surgery were studied by microscopy, morphometry and immunohistochemistry (the expression of oxytocin receptors (OxR), a marker of proliferation ki-67).Results. According to echocardiography, eccentric LV hypertrophy (46.7/36.7%) and DD type 2 (47/17%, p=0.003) prevailed in the group of women with the diabetic phenotype of HFpEF. A higher content of NT-proBNP (480.72±241.87/434.46±282.78 ng/ml, p=0.06) and a lower concentration of Ox (102.11±35.89/320.37±294.71 pg/ml, p=0.0016) in blood serum were established, as well as an increase in the number of cardiomyocytes (CMC) with a high expression level OxR (63.69±19.47/12.16±23.09%, p=0.000) in patients with the diabetic phenotype of HFpEF. Negative associations were determined between the blood level of Ox and the CMC diameter (r=-0.10, p=0.020), the area of their cytoplasm (r=-0.16, p=0.000) and the area of the nuclei (r=-0.11, p=0.015) in patients of both groups. A decrease in Ox concentration in the blood of patients with diabetic phenotype of HFpEF was accompanied by an increase in the number of CMCs with a high level of OxR expression (r=-0.63, p=0.000).Conclusion. The study has shown the important involvement of oxytocinergic signaling pathways in the HFpEF pathogenesis. HFpEF associated with DM2T in women was characterized by more unfavorable structural and functional changes in the myocardium, a significant increase in the number of hypertrophied CMCs with a high level of OxR expression and Ox decrease in blood serum. The mechanisms of the first-established significant increase in the content of Ox in the blood of patients with HFpEF without diabetes and its significant decrease in patients with diabetic phenotype of HFpEF leading to more pronounced structural and functional changes in the myocardium, require further study.

Left Ventricular Diastolic Dysfunction in Patients With Heart Failure With a Higher Left Ventricular Ejection Fraction and Its Relation to Prognosis

Left Ventricular Diastolic Dysfunction in Patients With Heart Failure With a Higher Left Ventricular Ejection Fraction and Its Relation to Prognosis

P095 LEFT VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSIVE PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

The aim of this work was to study the prevalence of the left ventricular diastolic dysfunction and indeterminate diastolic function in sinus hypertension individuals with left ventricular hypertrophy and preserved ejection fraction, and its associated factors. Methods. We enrolled 56 patients (aged 62, 95% confidence intervals (CI) 58–65 years, 53.6% men) with uncontrolled in-treated arterial hypertension who underwent transthoracic echocardiography (TTE, Esaote, MyLabEight). Cardiac diastolic dysfunction was defined when more than half of the TTE criteria was met according to the existing algorithm (average E/e‘, septal / lateral e‘, tricuspid regurgitation velocity, left atrium volume) and indeterminate one, when half of the criteria was encountered. A binary logistic regression analysis (Stata 15, USA) was performed to evaluate parameters for indeterminate diastolic function state. Results. TTE detected the left ventricular diastolic dysfunction only in 5.4%, however, 80.0% subjects had indeterminate diastolic function. Associated with the indeterminate diastolic function pattern factors were age and mitral regurgitation (odds ratios (OR) 8.0, 95% CI 2.19-29.25, p=0.002 and OR 1.06, 95% CI 1.01-1.12, p=0.014, respectively), however, not sex, height, weight, body mass index, diabetes, overweight/obese, and E/e‘. After adjustment for age, sex (female vs male) mitral regurgitation was occurred significantly more often in patients with indeterminate diastolic function in multivariate logistic regression model (OR 5.97, 95% CI1.47-24.35, p=0.013). Conclusions. Prevalence of the left ventricular diastolic dysfunction pattern is low (5.4%) and the indeterminate diastolic function is considerable (80.0%) in cohort of hypertensions with preserved ejection fraction with sinus rhythm. Mitral regurgitation identifies as a factor that associated with the indeterminate diastolic function patterns in hypertension patients.

P223 BENEFICIAL EFFECT OF ACEI/ARB, BETABLOCKER AND MINERALOCORTICOID RECEPTOR ANTAGONIST IN PATIENTS WITH RECURRENT FLASH PULMONARY EDEMA INITIATED ON HEMODIALYSIS FOR END STAGE RENAL FAILURE

Background and Objectives: Recurrent flash pulmonary edema is a rare manifestation of ESRF commencing hemodialysis, necessitating more frequent dialysis. Recurrent flash pulmonary edema is seen in renal artery stenosis and rarely in chronic kidney disease. Objective of the study is look for any possible contributory factors for recurrent flash pulmonary edema in patients with ESRF initiated on hemodialysis; and the potential role of ACEI/ARB, β blockers and MRA in controlling episodes of flash pulmonary edema. Methods: All patients initiated on hemodialysis from January 2020 to December 2023 were studied in detail; including ECHO cardiography and renal ultrasound doppler. Patient were divided in to 2 groups based on absence or presence of recurrent flash pulmonary edema (Group A and Group B).Group B further divided in to Group C and D. Group C were treated with ACEI/ARB, β blocker and MRA in addition to nitroglycerine infusion and hemodialysis. Group D were given usual anti hypertensives nitroglycerine infusion and hemodialysis as per requirement. Group C and D were followed up for 2 months and evaluated for the final out come. Results: 238 patients were initiated on hemodialysis during the period of 3 years. 18 patients (7.56%) presented with recurrent flash pulmonary edema (Group B) and 220 patients (92.44%) comprised Group A. Patients in Group B had more severe LVH, left ventricular diastolic dysfunction (LVDD) PAH and accelerated hypertension. None of the patients had renal artery stenosis. At the end of 2 months patients in Group C (9 patients) were free from recurrent flash pulmonary edema compared to Group D (9 patients) Conclusions: Recurrent flash pulmonary edema is a rare manifestation of ESRF. Renal artery stenosis was not seen in our patients. LVH, LVDD due to uremic cardiomyopathy and accelerated hypertension due to RAAS activation may be the contributory factors. Treatment with ACEI/ARB, β blockers and MRA may help in controlling episodes of flash pulmonary edema.

Association of QRS Duration with Echocardiographic Left Ventricular Dimensions

Background: QRS duration (QRSd) is used to diagnose left bundle branch block (LBBB) and is important for determining cardiac resynchronization therapy eligibility. Others have reported associations of left bundle branch block (LBBB) and interventricular conduction delay with left ventricular (LV) systolic and diastolic dysfunction in patients without clinical HF. Individualized QRSd thresholds may improve diagnosis and intervention strategies. The goal of this study was to assess the relations of QRS duration to echocardiographic left ventricular (LV) dimensions in individuals. Methods: This was a hospital-based cross-sectional analytical study. A total of 134 purposively selected respondents were included in the study from the patients attending the outpatient or inpatient department of cardiology, Dhaka Medical College Hospital, advised for an echocardiogram. They were divided into two groups depending on their QRS complex duration (Group I≤100 ms and Group II&gt;100 ms). After taking informed written consent, a case record form was filled and Echo measurements were taken following standard procedure with confidentiality. Results: Among the respondents, the mean age was found 52.68 ± 14.24 years. The majority were male (68%), and around 1/3rd of the respondents were overweight or obese. Males were found to have less QRS duration than females (p&lt;0.001) but there was no difference in age (p=0.814) between the groups. All the risk factors considering obesity, diabetes mellitus, hypertension, family history, smoking status, and dyslipidemia were found in similar proportions in both groups (p&gt;0.05). The study found that the interventricular septum thickness and inferolateral wall thickness were higher among those having a QRS duration of more than 100 ms (Group II), but this difference was not significant (p &gt; 0.05). On the other hand, left ventricular diastolic dimension, systolic dimension, and left ventricular mass were found to be increased significantly (p&lt;0.05) with a reduction in ejection fraction in Group II (p&lt;0.05). Conclusion: Left ventricular diastolic and systolic dimensions along with left ventricular mass significantly increase according to QRS duration among the patients. Meanwhile, a reduction in ejection fraction was also evident. (Bangladesh Heart Journal 2024; 39(2): 144-150

Diffuse Interstitial Fibrosis of the Myocardium Predicts Outcome in Moderate and Asymptomatic SevereAortic Stenosis.

Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events. The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS. A prospective, international, multicenter cohort (n=457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5cm2) or asymptomatic severe AS (AVA≤1.0cm2 and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission. Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P< 0.05). Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.

Abstract P419: Left Ventricular Diastolic Dysfunction in Preeclamptic Patients: A Systematic Review and Meta-Analysis

Introduction: Preeclamptic (PE) patients are at a 4-fold higher risk for developing heart failure later in life. Pathological cardiac remodeling, and the ensuing left ventricular (LV) dysfunction during hypertensive pregnancy are thought to precede heart failure in these patients. Specifically, several observational studies employing echocardiography demonstrate exaggerated LV diastolic function alterations in PE patients suggestive of diastolic dysfunction. Objective: Thus, to consolidate the evidence supporting diastolic dysfunction in preeclampsia, we sought to systematically review the clinical literature, and conduct a meta-analysis on the pooled data pertaining to LV diastolic function. Methods: Three databases, MEDLINE (Ovid), Embase (Elsevier), and Scopus (Elsevier) were searched from inception to January 26, 2024 and the search results were uploaded to Covidence for screening. The diastolic function data—early diastole mitral flow to annulus velocity ratio (E/e’), isovolumic relaxation time (IVRT), early to late diastole mitral flow velocity ratio (E/A), and E wave deceleration time (DT)—were extracted, and subsequently used to perform meta-analysis using Cochrane’s RevMan Web (Mean Difference, MD; random effects models with inverse variance weighting). Results: A total of 63 from 5013 screened studies were eligible for inclusion and of these, only the studies reporting E/e’ (34/63), IVRT (18/63), E/A (38/63), and DT (16/63) were included in the meta-analysis. Our analysis showed that E/e’ is increased (MD of 2.33 [95% CI, 1.77 to 2.89], p&lt;0.00001) in PE patients when compared to healthy pregnant women indicating elevated LV filling pressures. Further, PE patients exhibited significantly higher IVRT (MD of 8.88 msec [95% CI, 6.07 to 11.68], p&lt;0.00001) and lower E/A (MD of -0.16 [95% CI, -0.25 to -0.06], p=0.001), collectively suggesting that the myocardial relaxation is impaired in preeclampsia. Interestingly, DT (MD of 3.10 msec [95% CI, -5.43 to 11.62], p=0.48) was not found to be different between the groups. Conclusions: Our findings demonstrate that PE patients develop LV diastolic dysfunction during pregnancy which may be mediated by hypertension caused pressure overload. Given that diastolic dysfunction is a hallmark characteristic of heart failure with preserved ejection fraction (HFpEF), future longitudinal studies examining cardiac function during pregnancy and postpartum will help determine if PE patients are destined to develop HFpEF.

Relationship between left atrial/left ventricular diameter ratio and outcomes in patients with hypertrophic cardiomyopathy

BackgroundAlthough diastolic dysfunction is the main pathophysiological feature of hypertrophic cardiomyopathy (HCM), it remains to be clarified whether parameters of diastolic function can reliably determine HCM prognosis. In patients with reduced left ventricular (LV) distensibility, chronic elevation of LV diastolic pressure is seen with a smaller than expected LV size. Accordingly, patients with HCM with severe LV diastolic dysfunction typically demonstrate left atrial (LA) dilation and a disproportionately smaller left ventricle. Therefore, we investigated the relationship between LA/LV diameter ratio, as a potential indicator of disease progression, and outcomes in patients with HCM. MethodsWe included 468 patients in whom LA and LV end-diastolic diameter were successfully evaluated by echocardiography at the initial assessment. We divided the patients into two groups: those with an LA/LV diameter ratio > 1 and those with an LA/LV diameter ratio ≤ 1. We compared the HCM-related death rates between the two groups. ResultsOf the 468 patients, 96 patients (20.5 %) with HCM showed an LA/LV diameter ratio > 1. In the univariate analysis, patients with an LA/LV diameter ratio > 1 had a significantly greater likelihood of HCM-related death than patients with an LA/LV diameter ratio ≤ 1 (log-rank p = 0.002). In the multivariate Cox proportional hazards analysis, when including LA/LV diameter ratio > 1 and imbalanced baseline variables, an LA/LV diameter ratio > 1 was an independent determinant of HCM-related death (adjusted hazard ratio: 1.87, 95 % confidence interval: 1.08–3.24; p = 0.024). ConclusionLA/LV diameter ratio can be easily evaluated and may be useful for risk stratification of HCM-related death in patients with HCM.

P098 CARDIAC REMODELING IN MICE TREATED WITH SODIUM OXALATE AND AORTIC STENOSIS

Background: Cardiovascular Diseases are one of the main global public health problems, with increasing mortality due to population aging and Hypertension (HTN). HTN is a risk factor for other diseases, such as aortic stenosis, renal dysfunction, and cardiac hypertrophy (CH). The hemodynamic overload caused by HTN affects the heart and kidneys, but the exact mechanisms of these alterations are not fully understood. Experimental models help study these mechanisms; however, a well-established model of CH with cardiorenal dysfunction does not yet exist. Objective: to evaluate whether the combination of cardiac hypertrophy, induced by transverse aortic constriction (TAC), and renal injury, induced by soluble sodium oxalate (OXA), can be a new model of CH with cardiorenal dysfunction. Methods: Male C57BL mice were randomized as follows: SHAM, receiving saline or OXA solution, and TAC, receiving saline or OXA solution. Echocardiography, direct blood pressure (BP) recording, metabolic cage, histology were performed to evaluate cardiac and renal function, hemodynamics, autonomic modulation, and baroreflex. Results: The TAC+OXA group showed the highest systolic BP(SBP) (SBP: SHAM: 122±5.24 vs. TAC+OXA: 160±5.24 mmHg, p&lt;0.01), increased double product (DP) (DP: SHAM: 64.65±4.76 mmHg/bpm vs. TAC: 89.53±5.85 mmHg/bpm, p=0.02), significant reduction in autonomic modulation (RMSSD: OXA: 12.5±1.8 vs. TAC+OXA: 2.8±0.2 ms, p&lt;0.01) and reflex tachycardia, eccentric hypertrophy, and worse renal function. The TAC group showed eccentric hypertrophy, increased BP variability (SD-SBP: SHAM: 2.97±0.07 mmHg vs. TAC: 5.63±0.57 mmHg, p≤0.01), diastolic dysfunction, and dilated left ventricle in diastole. The OXA group showed increased autonomic modulation and heart rate variability, renal damage characterized by inflammation, proximal tubule damage, and interstitial fibrosis when associated with TAC. All treated groups showed a significant reduction in reflex tachycardia. Conclusion: Transverse aortic constriction combined with OXA gavage is a model of CH with renal dysfunction, as the combination caused more significant renal damage, systemic hypertension, decreased autonomic modulation and baroreflex sensitivity, and eccentric hypertrophy with subsequent LV diastolic dysfunction.

Effect of obesity and hypertension on left ventricular geometry and function among asymptomatic Indian adults.

Hypertension & obesity are important independent predictors of cardiovascular morbidity & mortality specifically left ventricular (LV) functions. With the Objectives to examine the effect of obesity & hypertension on echocardiographic parameters of geometry, systolic, and diastolic functions of left ventricle in asymptomatic adults the cross-sectional study was conducted with 100 individuals (60 male & 40 female). Their Blood Pressure & Body Mass Index was recorded following which they were divided into obese normotensives & non-obese hypertensive. Echocardiographic parameters indicating LV geometry and function were recorded. Data was statistically analysed with Unpaired t test considering p value <0.05 as significant. LV geometry and LV systolic function parameters were significantly altered in non-obese hypertensive. Parameters of LV diastolic functions were affected in obese normotensives. 54% of obese normotensives had LV diastolic dysfunction & 58% of non-obese hypertensive had LV diastolic dysfunction. 2% of obese non-hypertensive individuals had LV systolic dysfunction & 6% of non-obese hypertensive had LV diastolic dysfunction. Hypertension significantly affects LV geometry, LV systolic and diastolic function. Obesity affects LV geometry & diastolic functions of LV even in individuals with preserved systolic function.

Left Ventricular Diastolic Dysfunction in the Critically Ill: The Rubik\'s Cube of Echocardiography

Left Ventricular Diastolic Dysfunction in the Critically Ill: The Rubik\'s Cube of Echocardiography

Diabetic Cardiomyopathy: Role of Cell Death, Exosomes, Fibrosis and Epicardial Adipose Tissue.

Diabetic cardiomyopathy (DCM) represents one of the typical complications associated with diabetes. It has been described as anomalies in heart function and structure, with consequent high morbidity and mortality. DCM development can be described by two stages; the first is characterized by left ventricular hypertrophy and diastolic dysfunction, and the second by heart failure (HF) with systolic dysfunction. The proposed mechanisms involve cardiac inflammation, advanced glycation end products (AGEs) and angiotensin II. Furthermore, different studies have focused their attention on cardiomyocyte death through the different mechanisms of programmed cell death, such as apoptosis, autophagy, necrosis, pyroptosis and ferroptosis. Exosome release, adipose epicardial tissue and aquaporins affect DCM development. This review will focus on the description of the mechanisms involved in DCM progression and development.

Depressive Symptoms and Left Ventricular Diastolic Dysfunction Among Men and Women with HIV

Depressive Symptoms and Left Ventricular Diastolic Dysfunction Among Men and Women with HIV