Marker Of Diastolic Dysfunction Research Articles

Impact of Exercise Training on Cardiac Function Among Patients With Type 2 Diabetes: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Type 2 diabetes (T2D) is associated with subclinical abnormalities in left ventricular function and an increased downstream risk for heart failure. Exercise training has been associated with significant improvement in cardiorespiratory fitness among these patients. However, its impact on cardiac function is not well established. We conducted a meta-analysis including all randomized and nonrandomized trials that evaluated effects of exercise training on cardiac function among patients with T2D. Primary outcomes were measures of left ventricular systolic (global longitudinal strain) and diastolic (early diastolic velocity [é]) function. The effects of exercise training on peak oxygen uptake; other markers of diastolic dysfunction: mitral peak early-to-late diastolic filling velocity (E/A), mitral inflow to annular ratio (E/é), and deceleration time (DT); and systolic velocity were also assessed. Our study included 441 patients enrolled in 6 trials. Exercise training significantly improved early diastolic velocity (standardized mean difference [SMD], 0.58; 95% CI, 0.09-1.07), global longitudinal strain (SMD, 0.62; 95% CI, 0.04-1.21), and peak oxygen uptake (SMD, 1.43; 95% CI, 0.51-2.35) as compared with control group. However, no significant changes were observed in other markers of diastolic function (E/A, E/é and DT) and systolic velocity. Exercise training in patients with T2D is associated with a significant improvement in some echocardiographic indicators of systolic and diastolic function and cardiorespiratory fitness. These findings suggest that exercise training may improve subclinical systolic and diastolic dysfunction in patients at risk for clinical heart failure.

Left ventricular diastolic dysfunction: identifying presence by left atrial function

Objective:The left atrium (LA) is exposed to left ventricular pressure during diastole. Applying the 2016 American Society of Echocardiography left ventricular diastolic function (LVDF) guidelines, this study aims to investigate whether left atrial ejection fraction (LAEF) and left atrial active emptying fraction (LAAEF) are markers of diastolic dysfunction (LVDD).Methods: Retrospective cohort of consecutive patients (n = 124) who underwent transthoracic echocardiography were studied. Doppler peak velocities of passive (MV E) and active filling (MV A) were measured and ratio E/A calculated. Tissue Doppler imaging parameters of peak early (e′) of the septal and lateral mitral annulus were measured, and average E/e′ ratio (E/e′) was calculated. Tricuspid regurgitation velocity, left atrial maximum volume, left atrial minimum volume and LA volume pre-contraction were measured, allowing calculation of LAEF and LAAEF. Subjects were assigned LVDF categories.Results: Binomial logistic regression model (X2(2) = 48.924, P < 0.01) determined that LAEF and LAAEF predicted diastolic dysfunction with sensitivity 85.5% and specificity 78%. ROC curves determined good diagnostic accuracy for LAEF and LAAEF to predict LVDD, AUC 0.826 and 0.861 respectively. Logistic regression model (X2(2) = 39.525, P < 0.01) predicted those patients with E/e′ ≥14 using LAEF and LAAEF with sensitivity 51.6% and specificity 92.4%. Moderate correlations were found between E/e′ and log derivatives of LAEF and LAAEF.Conclusions: A decline in LAAEF and LAEF is associated with worsening LVDD.

P6515Galectin 3 as a marker of diastolic dysfunction in patients with atrial fibrillation and heart failure with preserved ejection fraction

P6515Galectin 3 as a marker of diastolic dysfunction in patients with atrial fibrillation and heart failure with preserved ejection fraction

Diastolic dysfunction is associated with exercise impairment in patients with sickle cell anemia.

Left ventricular diastolic dysfunction (DD) is an independent risk factor for mortality in sickle cell anemia (SCA) and is associated with increased extracellular volume (ECV) on cardiac MRI (CMR). Exercise impairment is common in SCA, but its causes and prognostic value are not well understood. To study the effects of DD and ECV on cardiopulmonary exercise test (CPET) in patients with SCA. As part of a prospective study to characterize the cardiomyopathy of SCA (NCT02410811), 20 children and adults with SCA underwent CMR, echocardiography, and cycle ergometer CPET (age range 8-43years). Maximum exercise was reached in 18 patients and 17 (94%) had reduced exercise capacity (%predicted VO2 less than 80%). Six patients had DD and none had systolic dysfunction. Patients with DD had lower exercise capacity compared to patients with normal diastolic function (%predicted VO2 48.2±9.1%vs. 61.2±11.7%; P=0.01). The z-score of left ventricular lateral E/e' ratio, which is a marker of DD, was negatively associated with %predicted VO2 (r=-0.61, P=0.01). All patients with moderate-to-severe exercise impairment (%predicted VO2 <60%) had lateral E/e' z-score>2. In a multivariate analysis, lateral E/e' z-score was independently associated with %predicted VO2 (P=0.02). All participants had elevated ECV but the degree of elevation was not associated with exercise parameters. Left ventricular DD is associated with decreased exercise capacity in SCA. Interventions to prevent or delay DD could improve exercise capacity, quality of life, and long-term outcomes in SCA.

NT-proBNP and Cardiovascular Dysfunction in Chronic Liver Disease

Plasma NT-proBNP levels are elevated in heart disease, especially in the presence of ascites-edema syndrome and left ventricular overload. Previous studies have reported cardiovascular dysfunction correlated with the severity of liver damage. This prospective study enrolled 65 subjects with the diagnosis of liver cirrhosis, 82 with chronic hepatitis and 65 healthy subjects in the control group. In chronic hepatitis, NT-proBNP has been shown to be an early marker of diastolic dysfunction and left ventricular remodeling, while in liver cirrhosis it also correlated with portopulmonary hypertension.

Comparison of Prognostic Usefulness of Serum Insulin-Like Growth Factor-Binding Protein 7 in Patients With Heart Failure and Preserved Versus Reduced Left Ventricular Ejection Fraction

We aimed to characterize of the role of insulin-like growth factor-binding protein 7 (IGFBP-7) in heart failure (HF) pathophysiology. IGFBP-7 has been associated with cardiac hypertrophy and diastolic dysfunction in HF. In 86 patients with HF with a preserved ejection fraction (HFpEF) (ejection fraction [EF] ≥45%) and 79 with HF with a reduced ejection fraction (HFrEF), we assessed concentrations of serum IGFBP-7, correlations between serum IGFBP-7 and clinical data, diastolic function, and associations with outcome. IGFBP-7 was lower in HFpEF than HFrEF (102 vs 152 µg/L, p <0.001) and correlated with New York Heart Association class (HFpEF: r = 0.25, p = 0.020; HFrEF: r=0.26, p = 0.022), N-terminal pro-brain natriuretic peptide (NT-proBNP) (HFpEF: r = 0.53, p <0.001; HFrEF: r = 0.50, p <0.001), and estimated glomerular filtration rate (eGFR) (HFpEF: r = -0.47, p <0.001; HFrEF: r = -0.45, p <0.001). In HFpEF, IGFBP-7 correlated with E/e' (r = 0.31, p = 0.012) and E/A ratio (r = 0.31, p = 0.011). In HFrEF, but not HFpEF, IGFBP-7 correlated with age (r = 0.29, p = 0.009) and atrial fibrillation (r = 0.34, p = 0.002). IGFBP-7 predicted the outcome in HFpEF (hazard ratio 4.19 [1.01 to 17.35], p = 0.048]) but not in HFrEF (0.72 [0.24 to 2.14], p = 0.554). In conclusion in HFrEF, IGFBP-7 was elevated and associated with HF severity but not prognostic, suggesting a marker of risk. In HFpEF, IGFBP-7 was less elevated but associated with markers of diastolic dysfunction, HF severity, and prognosis. IGFBP-7 may contribute to the progression of HFpEF possibly through inflammation and oxidative stress.

Abstract 285: Osteopontin Deficiency Ameliorates Heart Failure with Preserved Ejection Fraction &lt;HFpEF&gt; Pathology by Upregulating Mitochondrial 2-Oxoglutarate Dehydrogenase Like &lt;OGDHL&gt; Enzyme

HFpEF is an increasingly prevalent syndrome associated with impaired myocardial energetics, for which no etiologic therapy is available. Osteopontin (OPN) is a matricellular protein that is upregulated in the circulation of HFpEF patients, and reported to induce mitochondrial stress in rodent cardiomyocytes. Here we evaluate the role of circulating OPN in regulating myocardial function in the nephrotic Col4a3 -/- mouse model of HFpEF. We performed extensive cardiac, biochemical and mitochondrial analyses of the Col4a3 -/- mouse and found a striking HFpEF phenotype. We showed OPN levels were elevated in Col4a3 -/- mice (FC=2.1, n=6; p&lt;.01). Col4a3 -/- mice were hypertensive, had diastolic dysfunction, myocyte hypertrophy and interstitial fibrosis - all of which were ameliorated in Col4a3 -/- OPN -/- mice (n=5-20; p&lt;.05). Col4a3 -/- hearts had dysmorphic mitochondria (EM), lowered antioxidant capacity as a 50% reduction in GSH/GSSG ratio (n=6; p&lt;.05) and lower protein levels of mitochondrial respiratory complexes I, II and IV (p&lt;.05). Flux assay in adult cardiomyocytes showed that maximal respiration was reduced in Col4a3 -/- hearts (575.84±37.6 vs 322.34±25.48 pmol/min in WT, n=9; p&lt;.0001). Microarray data (validated by mitochondrial blot) implicated OGDHL as decreased in Col4a3 -/- hearts but increased in double knockout Col4a3 -/- OPN -/- hearts compared to WT (n=3; p&lt;.05). OGDH activity was also lower in Col4a3 -/- hearts (17.1±7.3 vs 2.5±1.1 mU/mg in WT; n=6; p&lt;.05). In Col4a3 -/- mice, heart-specific AAV9-mediated overexpression of OGDHL, similar to global OPN KO, improved survival by ~50-100% (p&lt;.0001). Isovolumetric relaxation time, a marker of diastolic dysfunction, which is prolonged in Col4a3 -/- mice (26.17 vs 15.30±1 ms, n=26; p&lt;.001) was decreased in Col4a3 -/- OPN -/- mice (18.1±1 ms, n=37; p&lt;.01) as well as in AAV9-cTnT-OGDHL-treated Col4a3 -/- mice (16.7±2.5 ms, n=8; p&lt;.05). In conclusion, we present a new mouse model for HFpEF in which diastolic function and lifespan can be improved by genetic deletion of OPN or cardiac OGDHL gene therapy. Our results elucidate for the first time the pivotal roles of circulating OPN and cardiac OGDHL in HFpEF pathophysiology and present two related potential therapeutic targets for HFpEF.

Left ventricular end-diastole hemodynamics is strongly associated with spontaneous cardiac baroreflex in humans

ABSTRACTBackground: In animals, hemodynamic conditions during left ventricular (LV) end-diastole are crucial for the excitation of autonomic afferents distributed throughout cardiac chambers and large thoracic vessels. The objective of the study was to select the echocardiographic indices of LV diastolic function that are the most potent predictors of the heart’s spontaneous baroreflex in humans. Methods: In 47 untreated hypertensive patients (26 with normal and 21 with increased left atrium diameter) and 24 healthy controls, baroreflex sensitivity (BRS) was assessed in the low (αLF; 0.04–0.15 Hz) and high frequency (αHF; 0.15–0.4 Hz) components in the supine and during tilting. The normalized to LV end-diastolic diameter (the index) is a marker of the septum late diastolic distension rate ( denotes peak late diastolic velocity at the septal mitral annulus) under the corresponding transmitral pressure gradient that determines the peak velocity of blood flow (A) into the LV chamber. Results: The markedly stronger than ratio correlated with the BRS. In the best-fit models of multivariable linear regression, the index was the independent predictor of the αLF BRS at tilting (β = −0.3; p = 0.01). Independent of clinical and echocardiographic parameters, the index predicted also both the αHF BRS in the supine position (β = −0.23; p = 0.01) and the αHF BRS reinforcement due to increased preload (β = −0.28; p = 0.001). Conclusions: The index is a reliable marker of diastolic dysfunction that evokes significant heart’s baroreflex impairment and is markedly stronger than ratio associated with these systemic consequences of altered LV diastole hemodynamics.

Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction.

Objectives: This descriptive study was performed to evaluate the capability of a non-invasive transabdominal electrocardiographic system to extract clear fetal electrocardiographic (FECG) measurements from intrauterine growth restricted (IUGR) fetuses and to assess whether abdominal FECG parameters can be developed as markers for evaluating the fetal cardiac status in IUGR.Methods: Transabdominal FECG was attempted in 20 controls and 15 IUGR singleton pregnancies at 20+0−33+6 weeks gestation. Standard ECG parameters were compared between the study groups and evaluated for their correlation. Accuracy for the prediction of IUGR by cut off values of the different FECG parameters was also determined.Results: Clear P-QRST complexes were recognized in all cases. In the IUGR fetuses, the QT and QTc intervals were significantly prolonged (p = 0.017 and p = 0.002, respectively). There was no correlation between ECG parameters and Doppler or other indices to predict IUGR. The generation of cut off values for detecting IUGR showed increasing sensitivities but decreasing specificities with the prolongation of ECG parameters.Conclusion: The study of fetal electrocardiophysiology is now feasible through a non-invasive transabdominal route. This study confirms the potential of FECG as a clinical screening tool to aid diagnosis and management of fetuses after key limitations are addressed. In the case of IUGR, both QT and QTc intervals were significantly prolonged and thus validate earlier study findings where both these parameters were found to be markers of diastolic dysfunction. This research is a useful prelude to a test of accuracy and Receiver Operating Characteristics (ROC) study.

Echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction.

To determine if markers of diastolic dysfunction are associated with atrial fibrillation (AF) development among patients with heart failure with preserved ejection fraction (HFpEF). We examined the association of several echocardiographic measures of diastolic dysfunction with incident AF in 573 patients (mean age = 68 ± 9.5 years; 48% men; 79% white) with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT) who were free of baseline AF. Echocardiograms were analysed at a core laboratory. Incident AF cases were identified by follow-up study electrocardiograms and review of relevant medical records through May of 2013. Over a median follow-up of 3 years, 40 patients developed AF (incidence rate = 2.2 per 100 person years). Increasing values of the E/A ratio [per 0.1 increase: hazard ratio (HR) = 1.11, 95% confidence interval (CI) = 1.06-1.17], left atrial volume (per 5 mL increase: HR = 1.13, 95% CI = 1.03-1.23), and left atrial area (per 5 cm2 increase: HR = 1.51, 95% CI = 1.03-2.22) were associated with greater risk of AF. The risk of AF decreased with increasing peak A wave velocities (per 10 cm/s increase: HR = 0.83, 95% CI = 0.72-0.96). The risk of AF was not materially altered when peak A wave velocity was further adjusted for left atrial volume (HR = 0.83, 95% CI = 0.71-0.96) and area (HR = 0.83, 95% CI = 0.71-0.96). However, the associations of left atrial volume (HR = 1.10, 95% CI = 0.99-1.22) and area (HR = 1.48, 95% CI = 0.96-2.28) were no longer significant when accounting for peak A wave velocity. Diastolic parameters of left atrial function possibly are more important markers of AF risk than left atrial dilation in HFpEF.

Arterial stiffness and elevated left ventricular filling pressure in patients at risk for the development or a previous diagnosis of HF—A subgroup analysis from the DIAST-CHF study

Left ventricular filling pressure (LVFP) is a marker for diastolic dysfunction and heart failure (HF) with preserved ejection fraction (pEF). The interaction between arterial stiffness (AS) and elevated LVFP has not been sufficiently investigated. In 257 patients with preserved left ventricular ejection fraction (mean age: 66 years, 53% female, mean left ventricular ejection fraction: 61%) and at least one cardiovascular risk factor (eg, hypertension and diabetes) for the development of HF or a previous diagnosis of HF, LVFP was estimated in accordance with the recommendations of the American Society of Echocardiography (elevated when E/e' ≥ 13, left atrial volume index ≥ 34 mL/m2). LVFP was correlated with radial pulse wave analysis (augmentation index normalized by 75 b/min [AIx@75]) and carotid-femoral pulse wave velocity (cfPWV). Thirty-eight percent of patients demonstrated an elevated LVFP. These patients were significantly older (68.3 ± 7.4 vs. 63.5 ± 7.6 years, P < .001), demonstrated a higher body mass index (29.8 ± 4.6 vs. 28.0 ± 5.0; P < .01), presented more often with hypertension (89.7% vs. 73.1%, P < .01), hypercholesterolemia (32.0% vs. 21.3%, P < .05), dyspnea on exertion (28.4% vs. 16.6%, P < .05), and peripheral edema (25.3% vs. 10.2%, P < .01). cfPWV and AIx@75 and were significantly elevated in patients with elevated LVFP (12.2 ± 2.7 m/s vs. 10.5 ± 2.6 m/s, P < .001, an 29.2 ± 6.7% vs. 27.4 ± 6.7%, P < .05 respectively). cfPWV and AIx@75 were correlated with echocardiographic parameters, that is, posterior wall thickness (r = 0.292, P < .001; r = 0.167, P < .01), left ventricular mass index (r = 0.255, P < .001; r = −0.192, P < .01), e' (r = −0.508, P < .001; r = −0.159, P < .05), and E/e' (r = 0.380, P < .001; r = 0.200, P < .01). cfPWV correlated with left atrial volume index (r = 0.189, P < .05) and increasing E/A ratio (r = −0.334, P < .001). Multivariate linear regression analysis demonstrated age and PWV as most important and independent predictors of LVFP elevation in the cohort. Increased AS measured by cfPWV was associated with an elevated LVFP in patients with preserved systolic function. Whether targeting AS as a major component of diastolic dysfunction and HF with preserved ejection fraction needs to be further investigated.

Low adiponectin is associated with diastolic dysfunction in women: a cross-sectional study from the Troms\xf8 Study

BackgroundHeart failure with preserved ejection fraction is closely associated with diastolic dysfunction and related to obesity and female sex. We investigated whether adiponectin, an adipocyte-secreted protein hormone with cardioprotective effects, was associated with indices of diastolic dysfunction, and whether the association was sex dependent.MethodsWe conducted a cross-sectional study on 1165 women and 896 men without diabetes. We stratified the multivariable adjusted logistic regression analyses and the fractional polynomial regression analyses according to sex, with echocardiographic markers of diastolic dysfunction as dependent variables, and adiponectin as the independent variable of interest.ResultsDecreased adiponectin was associated with higher odds of average tissue Doppler e’ < 9 in women (odds ratio [OR] 1.17 per 1 μg/mL adiponectin decrease, 95% confidence interval [CI] 1.04–1.30), but not in men (p for interaction with sex 0.04). Women, but not men, had higher odds of E/e’ ratio ≥ 8 with lower adiponectin (OR 1.12 per 1 μg/mL adiponectin decrease, 95% CI 1.02–1.24, p for interaction with sex 0.04). Adiponectin in the lower sex-specific tertile was associated with increased odds of concentric left ventricular hypertrophy in women (OR 2.44, 95% CI 1.03–5.77), but with decreased odds in men (OR 0.32, 95% CI 0.11–0.88, p for interaction with sex 0.002), and decreased odds of eccentric hypertrophy in men only (OR 0.53, 95% CI 0.33–0.88, p for interaction with sex 0.02). Adiponectin in the lower sex-specific tertile was associated with moderately enlarged left atria in women only (OR 1.43, 95% CI 1.01–2.03, p for interaction with sex 0.04). Finally, adiponectin had a non-linear relationship with left ventricular mass in women only, with exponentially increasing left ventricular mass with lower adiponectin levels (p for interaction with sex 0.01).ConclusionsLow adiponectin was associated with higher odds of indices of diastolic dysfunction in women, but lower odds of indices of diastolic dysfunction in men. Lower adiponectin was associated with increased left ventricular mass in women only.

Abstract 023: Angiotensin-(1-7) Reduces Doxorubicin-Induced Cardiac Fibrosis

Doxorubicin (Dox) is a commonly used and effective chemotherapeutic agent for childhood leukemias and sarcomas. However, Dox administration often results in cumulative dose-dependent cardiotoxicity that manifests as cardiomyopathy with marked fibrosis that leads to reduced cardiovascular function and heart failure. Consequently, there is a need for adjunct therapies to reduce Dox-induced cardiotoxicity and enhance long-term quality-of-life in cancer patients, especially in pediatric patients. Angiotensin-(1-7) [Ang-(1-7)] is an endogenous peptide hormone of the renin-angiotensin system with cardioprotective properties; studies by us and others showed that Ang-(1-7) reduces cardiac fibrosis and improves cardiac function in various animal models. In this study, we investigated whether adjunct Ang-(1-7) attenuates cardiotoxicity resulting from an acute (6 week) exposure of juvenile Sprague-Dawley rats (male, n = 8-10) to Dox (22 mg/kg). Dox treatment reduced body mass, cardiac weight and cardiomyocyte size, while Ang-(1-7) co-administration had no effect on these changes. However, co-administration of Ang-(1-7) prevented Dox-mediated increases in cardiac fibrosis (interstitial fibrosis: 1.4 ± 0.1% to 2.5 ± 0.3%; perivascular fibrosis: 15.8 ± 1.4% to 23.2 ± 1.6%; p &lt; 0.01) and coronary vessel hypertrophy (media-to-lumen ratio: 2.4 ± 0.2 to 3.3 ± 0.3; p &lt; 0.05). Administration of Dox significantly increased E/E’ by 47%, a marker of diastolic dysfunction, and pulse wave velocity by 74%, as a measure of arterial stiffness, quantified using a Vevo 2100 small animal ultrasound system; co-administration of Ang-(1-7) prevented the Dox-induced increases in diastolic dysfunction and arterial stiffness. In contrast, Ang-(1-7) had no effect on the Dox-mediated reductions in ventricular diameter, parasternal wall thickness, stroke volume and cardiac output. The anti-fibrotic and anti-hypertrophic effects of Ang-(1-7) may account for the improvement in diastolic and arterial function. Collectively, these results suggest that adjuvant Ang-(1-7) may attenuate cardiac fibrosis and toxicity induced by Dox administration.

0172: The relationship between hyperleptinemia and diastolic dysfunction in patients with diabetes mellitus type 2

The risk of myocardial pathology increases several times when type 2 diabetes mellitus (T2DM) is combined with other metabolic disorders. But the role of adipokine leptin into the development of diastolic dys-function, typical for DCMP, is not well studied. The Purpose of our research was to evaluate the interconnection between the leptin level and markers of diastolic dysfunction in patients with T2DM. 102 patients (average age of 49.73±1.85 years) with T2DM of moderate severity without signs of coronary artery disease, hypertension and heart failure were examined. Duration of T2DM was 4.55±1.02 years. The level of leptin was determined by immune-enzyme assay. The maximal velocity of early diastolic stream E; stream velocity, caused by atrial systoles A; deceleration time of early diastolic filling (DT); and an E/A ratio were measured by heart sonography. The control group included 20 healthy individuals of corresponding age. The mean level of leptin composed 18.94±0.63 ng/ml in the group of patients with T2DM and 7.59±0.35 ng/ml ( p <0.05) in the control group. The mean level of E/A ratio was 0.83±0.02 ( p <0.05) in the group of patients and 1.4±0.075 in the control group. The mean level of DT composed 238.95±1.58ms in the group of patients and 182.2±3.7ms in the control group. A significant reliable correlation was revealed between leptin and E/A ( R =-0.274 ( p <0.05)), between leptin and DT ( R =0.205( p <0.05)) in the group of patients with T2DM. The received data prove that hyperleptinemia is probably one of the pathogenetic mechanisms of DCMP. We consider that hyperleptinemia participates in the development of structural pathology of the myocardium, which leads to the formation of chronic heart failure in patients with T2DM.

Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study

IntroductionUnderlying mechanisms of heart failure (HF) with preserved ejection fraction (HFPEF) remain unknown. We explored copeptin, a biomarker of the arginine vasopressin system, hypothesising that copeptin in HFPEF is elevated,...

Red cell distribution width (RDW) correlates with markers of diastolic dysfunction in patients with impaired left ventricular systolic function

ObjectiveRed-cell distribution width (RDW) has been identified as a novel prognostic marker in a heterogeneous group of heart failure patients. In this group, diastolic dysfunction is associated with worse outcome. As the evidence is limited, the aim of the present study was to assess the relationship of RDW to diastolic markers in patients with left ventricular dysfunction (LVD) diagnosed during cardiac catheterization. MethodsClinical and angiographic data were collected retrospectively on a total of 291 stable patients (mean age 62years, 199 males) with systolic dysfunction documented during cardiac catheterization in a regional medical center between January 2006 and December 2010. ResultsPositive association was seen between RDW and Left ventricular end diastolic pressure (LVEDP), estimated systolic pulmonary arterial pressure(sPAP), and left atrial dimension (LAD) (r: 0.18, 0.24, 0.28, respectively; p:<0.05).Three year retrospective survival analysis for 108 patients admitted in the first 2years showed a statistically significant decrease in survival patients with high RDW(>14.5) vs. normal RDW (73%vs.88%;log rank p:0.03). This was seen even in the asymptomatic subgroup (71% vs. 94%; log rank p: 0.01). ConclusionRDW correlates with markers of diastolic dysfunction in patients with LVD. Additionally, in patients asymptomatic LVD, high RDW is still associated with lower survival.

The usefulness of left atrial volume index and left ventricular mass index in determining subclinical cardiac involvement in patients with early-stage sarcoidosis.

Sarcoidosis is a multi-systemic granulomatous disease of unknown etiology. The present study has been designed to evaluate the importance of diastolic dysfunction with left atrial volume index (LAVi) and left ventricular mass index (LVMi) in determining subclinical cardiac involvement in subjects with stage I-II pulmonary sarcoidosis. A total of 54 patients under follow-up for sarcoidosis without cardiac involvement and 56 healthy subjects were included in the study. The echocardiographic assessment of the patients revealed no significant difference between the two groups regarding left ventricular end-systolic and end-diastolic diameters, ejection fraction (LVEF) and annular velocity determined by tissue Doppler evaluation. The LVEF calculated was 61.8±7.8% in the sarcoidosis group versus 64.1±2.7% in the control group (p=0.04). Left ventricular interventricular septum thickness, posterior wall thickness, and relative wall thickness were significantly higher in the sarcoidosis group compared to the control group (p<0.001). The sarcoidosis group had higher LVM and LVMi values compared to the control group (145±18.1 and 79±14g/m(2), 135±27.7 and 74±14.2g/m(2); p=0.020 and p=0.021, respectively). Left atrial end-systolic volume and LAVi were higher in the sarcoidosis group (28.7±18.5; 15.6±10.2) compared to the control group (16.6±10.9; 8.9±5.5) with a statistically significant difference (p<0.001). The present study indicates diastolic dysfunction and increased LVMi despite normal systolic function in patients with early-stage sarcoidosis without cardiac involvement. Also, the diastolic parameters were normal without showing any significant difference compared to the control group while there was a statistically significant increase in LAVi. This finding suggests that LAVi may be the earliest marker of diastolic dysfunction in patients with early-stage sarcoidosis without cardiac involvement.

0098 : Uric acid predict clinical outcomes in heart failure

Heart failure (HF) has become a major epidemic and a significant public health problem, with considerable morbidity and mortality. Uric acid (UA) levels are frequently increased in patients with heart failure (HF), and may be an indicator of a poor prognosis and an innovative target for treatment. We evaluated the prognostic effect of UA on clinical outcome in patients with HF. In addition, we looked at the relation of UA to echocardiographic parameters in a subset of these patients. Totally 309 consecutive patients with chronic heart failure symptomatic class II, III, or IV were retrospectively studied. Clinical, electrocardiographic, echocardiographic and biological data were investigated. 84% of the patients had elevated UA (>70mg/L in men and >60mg/l in women). We divided patients on 2 groups: group 1 with hyperuricemia and group 2 without hyperuricemia. Mean UA levels were 71,4mg/l in group 1 and 42,2mg/l in group 2. Male sex, diabetes mellitus, hyperlipidemia, and ischemic heart disease were associated with higher UA levels. Increased urea and creatinine were also associated with higher UA levels, whereas reduced estimated glomerular filtration rate, hyponatremia treatment with furosemide were seen with higher UA levels. An increase in UA levels was a predictor of increased cardiac hospitalizations (p= 0.0001) and mortality (p<0.00039). Echocardiographic data demonstrated a significant correlation between UA levels and E/A ratio, a marker of diastolic dysfunction (p<0.0001). Increased UA level was independent predictor of increased morbidity and mortality in a cohort of ambulatory patients with chronic heart failure.

Hyperdynamic left ventricle on radionuclide myocardial perfusion imaging (RNMPI): A marker of diastolic dysfunction in patients presenting with dyspnea on exertion

BackgroundWe hypothesized that among patients presenting with dyspnea on exertion (DOE), those who were found to have hyperdynamic left ventricle (i.e. LVEF≥70%) on stress radionuclide myocardial perfusion imaging (RNMPI), are more likely to have features of diastolic dysfunction on transthoracic echocardiography. MethodsMedical records of 1892 consecutive patients who presented between February 2011 and September 2012 with the chief complaint of DOE and were referred to stress RNMPI were reviewed. Among these, patients who had no evidence of reversible ischemia and had hyperdynamic left ventricle on perfusion imaging, were selected and their recent echocardiograms were reviewed for evidence of diastolic dysfunction. Logistic regression analysis was used to develop an equation to predict diastolic dysfunction with the ejection fraction as the predictor. A two-way analysis of variance model was used to detect differential patterns of ejection fraction across diastolic dysfunction and gender. ResultsA hyperdynamic left ventricle identified on stress RNMPI was found to be a significant predictor of diastolic dysfunction on echocardiography in logistic regression analysis (odds ratio=1.24, 95% CI=1.13–1.35, p<0.0001). A hyperdynamic left ventricle on stress RNMPI has a specificity of 96.77% (CI 83.24–99.46%) and a positive predictor value of 97.83% (CI 88.43–99.64%) in identifying diastolic dysfunction. ConclusionIn patients presenting with DOE who have no evidence of reversible ischemia on radionuclide stress testing but have hyperdynamic left ventricle, a search should be made for alternate cardiac etiology for this complaint such as diastolic dysfunction and heart failure with preserved ejection fraction.

Abstract 15545: Incremental Prognostic Value of Echocardiographic Markers of Left Ventricular Remodeling and Diastolic Function in the Surgical Treatment for Ischemic Heart Failure Trial

Introduction: Whether echocardiographic (echo) markers of left ventricular (LV) remodeling and diastolic dysfunction contribute incremental and independent prognostic information to clinical risk markers in patients (Pts) with coronary artery disease and severe LV systolic dysfunction is unclear. We sought to determine which echo variables provide the greatest prognostic value in the Surgical Treatment for Ischemic Heart Failure (STICH) population. Methods: Pts enrolled in STICH for whom transmitral Doppler (E/A ratio) was available on a baseline echo interpreted by an echo core laboratory blinded to treatment and outcomes formed the analysis cohort. Comprehensive datasets to account for missing echo data were created by multiple imputation and the impact on all-cause mortality was determined with the Cox’s regression model. Results: E/A ratio could be measured in 1511 of the 2136 Pts enrolled in STICH. Amongst markers of diastolic dysfunction, E/A ratio was the most significant predictor of mortality (χ 2 41.05, p &lt;0.001) with a non-linear, u-shaped, relationship. Mortality was lowest with E/A ratio = 1.0, and increased for E/A ratio &lt;0.6 and &gt;1.0 up to 2.3, beyond which there was no further increase in risk. The combination of larger LV end-systolic volume index (LVESVI), low or high E/A ratio, and mitral regurgitation severity grade, had highly significant incremental negative effects on mortality (χ 2 69.65, p&lt;0.001) when added to a multivariable model with clinical risk markers. Overall, creatinine (χ 2 30.00, p &lt;0.001), followed by LVESVI (χ 2 27.26, p&lt;0.001), age, and E/A ratio (χ 2 12.46, p&lt;0.001) were among the most significant predictors of mortality and accounted for 74% of the total prognostic information. LVESVI and E/A ratio were stronger predictors of poor prognosis than New York Heart Association (NYHA) functional class, hemoglobin, diabetes, stroke, or atrial fibrillation. Conclusions: Echo markers of advanced LV remodeling and diastolic dysfunction add incremental prognostic value to clinical risk markers and are more predictive of poor prognosis than advanced NYHA functional class or anemia. LVESVI and E/A ratio outperformed other echo markers and should be considered standard in assessing risk in Pts with ischemic LV dysfunction.