LV Diastolic Function In Patients Research Articles

VE/VCO2 slope in cardiopulmonary exercise testing was associated with left ventricular diastolic dysfunction in patients with reduced ejection fraction

Abstract Background Heart failure with reduced ejection fraction (EF) was well-known as a poor prognosis. VE/VCO2 slope and peak oxygen uptake (VO2) by cardiopulmonary exercise testing (CPET) is a useful parameter for predicting cardiovascular disease prognosis. Furthermore, though there are some reports that CPET parameters are associated with indicators of diastolic dysfunction, each of these indicators has some limitations. Recently, recommendations for the evaluation of left ventricular diastolic function by echocardiography were reported from the ASE/EACVI. However, there are no reports to examine the association between exercise tolerance indices and diastolic dysfunction based on these recommended variables. Purpose To examine the relationship between CPET parameters and diastolic dysfunction using the recommendation from ASE/EACVI in cardiovascular diseases patients with reduced EF Methods We recruited 214 patients who performed both CPET and echocardiography. EF<50% was 115 patients. All patients underwent 0W warm-up and 10W ramp on an upright electrical bicycle ergometer. We defined peak VO2<14 ml/min/kg as low peak VO2, and VE/VCO2>34 as high VE/VCO2 slope. Diastolic dysfunction was assessed using the recommendations for the evaluation of diastolic function by ASE/EACVI. We used this recommendation algorithm to estimate grading LV diastolic function in patients with depressed LVEF. Grading 3 shows the most severe diastolic dysfunction. Results Mean age was 55±15 years old, and the portion of women was 30%. The portion of Grading 3 diastolic dysfunction was 18%. In univariable logistic regression analysis for diastolic dysfunction, Log BNP, and high VE/VCO2 slope were significantly associated with diastolic dysfunction. In multivariable logistic regression analysis, each Model, LogBNP and high VE/VCO2 slope were independent factors for severe diastolic dysfunction [adjusted age and sex, Model 1: LogBNP (OR 2.42, CI 1.44-4.05, p<0.001), low PeakVO2. Model2: LogBNP (OR 2.23, CI 1.31-3.78, p=0.003), high VE/VCO2 slope (OR 3.30, CI 1.06-10.3, p=0.039)]. We performed receiver operating characteristics (ROC) curve analysis on the ability of BNP, and VE/VCO2 slope. The area under the ROC curve (AUC) for BNP was 0.77, with the discriminating sensitivity and specificity at 0.67 and 0.86, respectively (cut-off value 234 pg/mL). On the other hand, the AUC for the high VE/VCO2 slope was 0.75, with the discriminating sensitivity and specificity at 0.81 and 0.67, respectively (cut-off value 30). Conclusion In patients with depressed EF, high VE/VCO2 slope was significantly associated with diastolic dysfunction assessed by the recommendations from the ASE/EACVI.

Left ventricular diastolic function in patients with breast cancer treated with anthracycline-based chemotherapy

Abstract Background Despite major progress in novel breast cancer therapeutic regimens, anthracycline-based chemotherapy (ANT) remains among the most effective therapies. Cardiotoxicity, one of the most severe adverse events of ANT, has been defined as a reduction in left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS). However, the role of early diastolic dysfunction has been insufficiently researched. We aimed to determine if diastolic dysfunction could early diagnose and predict ANT cardiotoxicity. Methods Studies that reported on echocardiographic parameters of diastolic function before and at the end of ANT in breast cancer patients without cardiac disease were included. We evaluated parameter derived from pulsed wave Doppler interrogation of the mitral valve inflow (E/A ratio and mitral E-wave deceleration time (EDT)) and tissue Doppler (mean velocities of the mitral ring in the early diastole (E') and E/E' ratio). Results A total of 892 patients from 13 studies were included. E/A ratio was significantly reduced at the end of ANT (OR 2.34, 95% CI [1.49, 3.68], p<0.001), while EDT was not significantly influenced (OR 0.74, 95% CI [0.50, 1.08], p=0.121). Tissue Doppler velocity of the mitral ring E' and the LV filling pressure analysed through E/E' ratio did not show significant changes after ANT (OR 2.32, 95% CI [0.94, 5.72], p=0.068, and OR 0.79, 95% CI [0.56, 1.12], p=0.197, respectively). A modest reduction in LVEF and global longitudinal strain (GLS) was observed at the end of the ANT therapy with a difference in means of 3.77% and −1.08%, respectively. Patients receiving ANT doses over 400 mg/m2 doxorubicin or epirubicin therapeutic equivalent doses showed a significant change in E/A and E' after the therapy. Cardioprotective therapy like carvedilol, nebivolol and spironolactone did not have a significant impact on the parameter of diastolic function. Conclusion ANT has a modest early impact on LV diastolic function in patients with breast cancer without cardiac disease and cannot be validated as an early diagnostic or prognostic tool of ANT-induced cardiotoxicity. Randomized studies on larger population, using new parameter e.g. left atrial function parameter and multimodality imaging are required. Funding Acknowledgement Type of funding sources: None.

Linear and volumetric parameters of left atrium in patients with isolated aortic stenosis

Aim . To study volumetric and linear parameters of the left atrium (LA) in operated and non-operated patients with severe aortic stenosis (AS) in comparison with the control group of a similar age and gender. Material and methods . Eighty-one patients with AS were examined, 49 patients — in the long term after aortic valve replacement (AVR), and 30 patients of similar age and gender — without a heart defect. Echocardiography was performed using an Acuson Sequia 512 ultrasound scanner. Results . The volumetric parameters of LA (LA volume index (LAVI)) and the ratio of the minimum LA with LV volume at this time point (LAVmin/LV) were the most sensitive parameter when evaluating the LV diastolic function in patients with isolated AS when comparing non-operated and operated patients and the control group. The study of association of non-operated AS patients with LAVI (greater than or less than 32 ml/m 2 ) showed only a slight divergence between the Kaplan-Meyer curves with a log-rank test of 0,15. Only the values of the LV ejection fraction (LVEF) differed from parameters of died (n=21) and alive patients at the time of the study (n=60): 61,0 (56,4-69,3)% in alive versus 46,4 (39,1-55,4)% in dead ones (p<0,0001). The time elapsed from the diagnosis to the date of the examination also differed: 0,5 (0,4-11,0) years in alive versus 7,0 (3,0-19,0) years in dead ones (p=0,004). With multiple regression, the highest and statistically significant beta coefficient was found only in LVEF (beta — -0,52, p=0,002). Conclusion . Linear and volumetric parameters of LA slightly associate with the age and gender of operated and non-operated AS patients. These parameters statistically significantly differ in the groups of non-operated AS patients and patients after AVR compared with the control group, including patients without heart disease. The values of linear and volumetric LA parameters in patients with AS after AVR are close to those in the control group.

REPLACEMENT AND INTERSTITIAL FIBROSIS BY CARDIAC MR AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH DILATED CARDIOMYOPATHY

Cardiac MR can be used to determine the extent of both replacement and interstitial fibrosis in patients with cardiomyopathies. We hypothesized that myocardial extracellular volume fraction (ECV) and scar burden by CMR are related to LV diastolic function in patients with dilated cardiomyopathy (DCM

EFFECT OF IRON AND SELENIUM DRUGS ON DIASTOLIC MYOCARDIAL FUNCTION IN PATIENTS WITH ANEMIC CARDIOMYOPATHY

Aim. To study the changes of the left (LV) and right (RV) ventricles diastolic function, the segmental LV diastolic function in patients with anemic cardiomyopathy after the iron and selenium drugs therapy. Material and methods. Patients (n=54) with severe chronic post-hemorrhagic iron deficiency anemia, complicated by cardiomyopathy were treated with iron sulfate and sele- nium. Segmental LV diastolic function was evaluated with pulsed tissue Doppler, and global diastolic function of the LV and RV – with Doppler echocardiography, before and af- ter treatment. Control group contained 16 healthy individuals Results. Disorders of segmental LV diastolic function, and both ventricles global diastolic function were found in anemic patients with cardiomyopathy. Flow rate rapid filling re- duced by 27.1% compared with this in control (p<0.001), and flow rate of atrial filling increased by 27.0% (p<0.001), and E/A decreased by 42.2% (p<0.001). Iron and se- lenium therapy in patients with anemic cardiomyopathy led to an improvement in diastolic function. LV and RV flow rapid filling increased by 32.2% (p<0.001) and 8.3% (p<0.05), respectively, and LV and RV flow rate of atrial filling reduced by 19.6% and 15.7% (p<0.001), respectively, and LV and RV E/A ratio grew up by 61.5% and 28.2%, respective- ly (p<0.001). Conclusion. Echocardiography and myocardial tissue Doppler provide early finding of segmental LV diastolic function disorders in anemic cardiomyopathy. Iron and selenium ther- apy leads to improvement of myocardial diastolic function in these patients.

Tissue Doppler assessment of left ventricular diastolic function in rheumatic mitral stenosis

Left ventricular systolic and diastolic functions are reported to be altered in mitral stenosis. Although conventional Doppler ultrasound recording of transmitral flow is used in the assessment of left ventricular diastolic function, yet, in patients with mitral stenosis, it is altered by mitral stenosis itself and thus precludes the proper assessment of LV diastolic function. The aim of this work is to assess LV diastolic function using pulsed tissue Doppler interrogation of mitral annulus motion in patients with rheumatic mitral stenosis. Twelve patients with established diagnosis of rheumatic mitral stenosis in normal sinus rhythm were obtained from outpatient clinic of Cardiology Department in Mansura specialized hospital. Thirteen age and sex matched controls with completely normal echo-Doppler study were taken for comparison. All patients were subjected to thorough history taking including dyspnea grading according to NYHA score, clinical examination, 12 lead surface electrocardiogram and most importantly echo-Doppler study. We found statistically significant higher peak mitral annular E a velocity from septal, anterior, inferior and lateral portions of the mitral annulus in controls compared with mitral stenosis patients as well as their averaged values. There is no statistically significant difference regarding peak mitral annular A a velocity from septal, anterior, inferior and lateral portions of the mitral annulus between both groups as well as their averaged values. The ratio of early to late mitral annular velocities from all recorded sites was statistically significantly higher in the controls compared with mitral stenosis patients. TDI of mitral annulus may provide potential diagnostic role for assessment of LV diastolic function in patients with mitral stenosis.

Temporal changes in diastolic function in heart failure patients with restrictive filling

In patients with heart failure (HF) with impaired left ventricular ejection fraction (LVEF; systolic HF), a restrictive filling pattern (RFP) is associated with a worse outcome than less severe forms of LV diastolic dysfunction [ [1] Xie G.Y. Berk M.R. Smith M.D. Gurley J.C. DeMaria A.N. Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. J Am Coll Cardiol. 1994; 24: 132-139 Abstract Full Text PDF PubMed Scopus (407) Google Scholar ]. However, data on the temporal changes in LV diastolic function in patients with systolic HF and RFP are minimal. The aim of the present study was to assess serial changes in LV diastolic function and its determinants in a contemporary population of patients with systolic HF and RFP.

Assessment of LV Diastolic Function in Patients With β-Thalassemia Major With Special Reference to E/Eann Ratio

The present study was undertaken to evaluate left ventricular function in patients with beta-thalassemia major with special reference to pulsed wave tissue Doppler imaging. The present study compared 30 diagnosed cases of beta-thalassemia major (mean age: 9.43+/-2.78 y) with 30 age-sex-matched healthy controls (mean age: 8.3+/-2.83 y) for left ventricular function assessment using following parameters: ejection fraction, mitral valve E/A ratio and E deceleration time (Edec), isovolumic relaxation time, and E/Eann ratio. Serum ferritin levels were also measured. There was significant increase in E/Eann (9.46+/-1.5 vs. 6.16+/-2.4, P<0.0001) and significant prolongation of Edec (177.66+/-40.73 vs. 138.5, P<0.001) and isovolumic relaxation time (40.2+/-14.89 vs. 36.67+/-5.12, P<0.05) in cases as compared with controls. However, there was no significant difference in ejection fraction value (65.55+/-8.98 vs. 63.87+/-16.35) and E/A ratio (2.0386+/-0.73 vs. 2.119+/-0.92). Serum ferritin levels although increased significantly in cases (8370.85+/-2660.35), no correlation could be established between increased serum ferritin and progressive diastolic dysfunction (r=0.148, P=0.258). Diastolic dysfunction precedes systolic dysfunction in patients with beta-thalassemia major as assessed by Edec and E/Eann ratio.

Effects of CABG on LV diastolic function in patients with acute coronary syndrome

Effects of CABG on LV diastolic function in patients with acute coronary syndrome

Is Left Ventricular Diastolic Function Affected by Previous Acute Clinical Events in Heart Transplant Recipients?

Introduction: Although acute deterioration of LV diastolic dysfunction occurs frequently concomitant with symptom development such as during acute rejection in patients with heart transplant (TP), it is unknown whether prior acute clinical events persistently affects LV diastolic function in patients with TP who are receiving standard post TP care. Thus, we evaluated the relationship between LV diastolic function and previous acute clinical events. Methods: Seventy-nine consecutive patients who underwent TP in our institute (age 59±1, mean±SEM, 17 females) were evaluated for LV diastolic function with standard transthoracic Doppler and tissue Doppler echocardiography.

531 Plasma levels of proinflammatory cytokines and LV diastolic function in patients with stable angina pectoris undergoing percutaneeous or surgical revascularization

531 Plasma levels of proinflammatory cytokines and LV diastolic function in patients with stable angina pectoris undergoing percutaneeous or surgical revascularization

LV diastolic function in patients with heart failure: Assessment by multigated radionuclide angiography and effect of inotropic therapy

LV diastolic function in patients with heart failure: Assessment by multigated radionuclide angiography and effect of inotropic therapy