Mitral Inflow Velocity Research Articles

1194-P: NT-proBNP, Subclinical Diastolic Dysfunction in Patients with DM Type 1 Treated with iSGLT2

Aim: Subclinical diastolic dysfuntion in patients with preclinical heart failure with preserved ejection fraction (HFpEF) has been demonstrated in patients with DM type 1. We investigated the relationship between diastolic dysfunction and NT-proBNP levels in patients with diabetes treated with iSGLT2 (dapagliflozin). Methods: NT-proBNP and diastolic function were assessed in 35 patients with DM 1 (31 ± 1,6 y, duration of DM 12,0± 1,2 y) and 15 control subjects (mean age - 29,9± 1,8years) without clinical evidence of heart disease. Data presented as M±m. The results were compared using Student’s paired test. Results: All patients had a normal ejection fraction (53,9±2,3 vs. 56,1± 4,3, (p > 0,05) in those with and without DM, respectively. 34,2% of the diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (E/A ratio 0,9±0,05 vs. 1,2± 0,06, p< 0,05), the DT was 257,1±28,2 ms vs. 186±14,6 ms p<0,05, in those with and without DM, respectively. Also, the IRT was increased in diabetic patients compared with control subjects (130±14,0 ms vs. 79,3±6,1 ms, p< 0,05). Median NT-proBNP plasma levels were elevated [189.54 pg/mL (86.16-308.27) and increased with greater severity of the diastolic dysfunction. Median NT-proBNP plasma levels have been decreased - 51.89 pg/mL (29.94-69.71); P<0.001] after 1 month treatment period with dapagliflozin. Conclusions: DM type 1 patients presenting with normal ejection fraction show disturbed diastolic function and higher NT-proBNP levels. 2. iSGLT2 (dapagliflozin) decreased NT-proBNP levels in DM1 patients with subclinical diastolic dysfunction. Disclosure S. Cherviakova: None. L.K. Sokolova: None. I. Belchina: None. I. Korzun: None. M.D. Tronko: None.

Evaluation of exercise on left ventricular function in patients with slow coronary flow by excercise-stress echocardiography

Objective To evaluate the role of treadmill exercise-stress echocardiography in the assessment of left ventricular (LV) function in patients with slow coronary flow (SCF), and discuss the possible mechanism of SCF. Methods Forty-six patients with diagnosis of SCF were enrolled as SCF group. Forty age and sex matched adults were included as control group. All subjects had underwent clinical evaluation and exercise stress echocardiography. LV diastolic and systolic functions were assessed by conventional echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography at rest and during exercise. Results ①LV function in patients with SCF at rest: LV peak systolic longitudinal strain (LS) was lower in patients with SCF than that in controls (P 0.05). Early diastolic mitral annulus velocity (Mitral e′) and the ratio between the early mitral inflow velocity and Mitral e′(Mitral E/e′) were significantly decreased in SCF group(all P 0.05). Compared with control group, ΔLS and ΔMitral e′ were significantly higher in SCF group (all P<0.05). Conclusions LV systolic and diastolic function in patients with SCF are impaired at rest. LV systolic and diastolic function recover in patients with SCF during exercise. Key words: Echocardiography, stress; Slow coronary flow; Ventricular function, left

Cardiac Doppler in patients with primary varicose veins of lower extremities.

This study examines the characteristics of cardiac Doppler in patients with primary varicose veins of lower extremities. We performed retrospective descriptive statistical analysis of cardiac Doppler data of 85 patients with primary varicose veins and compared obtained parameters with normal values. Patients with primary varicose veins in comparison with normal controls have significantly lower early diastolic mitral and tricuspid inflow velocities (E wave), significantly higher late diastolic mitral and tricuspid inflow and annular velocities (A and a' waves), significantly higher systolic mitral and tricuspid annular velocities (s' wave), and they have normal early diastolic mitral and tricuspid annular velocities (e' wave). Cardiac Doppler in patients with primary varicose veins differs significantly from the actual normal values. Possible mechanism of this finding is compensatory increased atrial ejection fraction due to altered preload in patients with primary varicose veins.

Elevated soluble-St2 concentrations in preeclampsia correlate with echocardiographic parameters of diastolic dysfunction and return to normal values one year after delivery

Objectives: To compare soluble-ST2 (sST2) concentrations in patients with severe features of preeclampsia and healthy pregnant controls before as well as 1 year after delivery. Another objective was to assess potential correlation between sST2 concentrations and myocardial function.Methods: Patients with singleton pregnancy complicated by severe features of preeclampsia and healthy controls were included in a prospective observational study. Plasma sST2 concentrations were measured within 24 h before delivery and 1 year after delivery. Standard two-dimensional and Doppler echocardiography was performed at the time of first sST2 measurement before delivery. Mann–Whitney U test was used to compare sST2 values in preeclamptic patients versus controls. Kendall’s tau was used to assess correlation between sST2 values and echocardiographic measures of left ventricular systolic and diastolic function (p < .05 significant).Results: We included 24 patients with severe preeclampsia and 29 controls. One year after delivery, sST2 concentrations were available for 24 (45%) participants (13 in preeclampsia group and 11 controls). Concentrations of sST2 were markedly elevated in patients with severe preeclampsia compared to healthy controls before delivery (p = .04), but not 1 year after delivery (p = .80). There was no significant correlation between sST2 and parameters of systolic function. In preeclamptic patients, we found a significant inverse correlation between sST2 and markers of diastolic function: peak early mitral inflow velocity E (Kendall’s tau = −0.40; p = .02), peak early diastolic myocardial velocities at septal and lateral mitral annulus (e’) (Kendall’s tau = −0.354, p = .04) and ratio between e’ and peak systolic myocardial velocities at the septal and lateral mitral annulus (e'/s') (Kendall’s tau = −0.362, p = .04).Conclusions: Preeclampsia with severe features is associated with increased maternal plasma concentrations of sST2, which return to normal values in the first year after delivery. Higher sST2 levels in preeclamptic patients correlate with impaired parameters of left ventricular diastolic function.

Value of natriuretic peptides and tissue Doppler imaging in the estimation of left ventricular filling pressure in patients with cardiac amyloidosis

BackgroundEstimation of left ventricular filling pressures (LVFP) is a determining factor in the follow-up of patients with cardiac amyloidosis (CA). Natriuretic peptides (NPs) and tissue Doppler imaging may be used...

Tissue Doppler imaging predicts outcomes in hemodialysis patients with preserved left ventricular function.

Cardiovascular disease is a major cause of mortality in patients with end-stage renal disease (ESRD). In addition to arteriosclerosis (arterial stiffness) and atherosclerosis, left ventricular (LV) hypertrophy and LV systolic dysfunction are the major cardiac determinants of cardiovascular mortality in hemodialysis patients. Although LV diastolic dysfunction is common in patients with ESRD, its prognostic value is yet to be established. A total of 103 ESRD patients (52 females, 51 males, age 51 ± 14 years) receiving regular hemodialysis and with preserved LV systolic function were prospectively enrolled in the current study. A comprehensive cardiovascular evaluation was performed at baseline. LV diastolic function was assessed using Doppler mitral inflow velocity and tissue Doppler imaging (TDI) of the mitral annulus velocity. Predictors for hospitalization and all-cause mortality were identified via Cox proportional hazards analysis. There were 20 deaths and 46 hospitalizations during a follow-up period of 67.9 ± 20.2 months. After adjusting for age, aortic pulse wave velocity (PWV), and carotid intima media thickness, Cox analysis demonstrated that ratio of early ventricular filling velocity (E) to early diastolic tissue velocity mitral annulus (E') (E/E') was a significant predictor for hospitalization (hazard ratio [HR] 1.235 and 95% CI 1.115-1.368 per-1SD). E' also independently predicted mortality (HR 0.682, 95% CI 0.472-0.985). The TDI parameters significantly correlated with the LV mass index and PWV. The findings of the current study suggest that diastolic function, as indexed by TDI, is an independent predictor of hospitalization and mortality in ESRD patients receiving regular hemodialysis and with preserved LV systolic function. The TDI parameters may reflect the impairment of arterial function and LV pressure overload.

Association between ventricular repolarization variables and cardiac diastolic function: A cross-sectional study of a healthy Chinese population.

BACKGROUNDDiastolic electromechanical couple, a well-described phenomenon in symptomatic heart failure, has not been well studied in healthy people. We hypothesized that ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, are associated with cardiac diastolic function in the healthy Chinese population.AIMTo assess the relationship between ventricular repolarization variables and cardiac diastolic function in apparently healthy Chinese individuals.METHODSThis was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35-91 years were enrolled. All subjects underwent standard 12-lead electrocardiography (ECG) and comprehensive echocardiography. ECG enabled the measurement of QT and Tpe intervals and Tpe/QT ratio. echocardiographic parameters, such as the ratio of mitral early diastolic inflow velocity (E) and late diastolic inflow velocity (A), E-wave deceleration time, left atrial volume (LAV) and LAV index, were measured to assess diastolic function. E/A < 0.75 was considered to indicate reduced diastolic function. ECG and echocardiography results were analyzed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations.RESULTSVentricular repolarization variables, such as the QTc interval (393.59 ± 26.74 vs 403.86 ± 33.56; P < 0.001), Tpe interval (72.68 ± 12.41 vs 77.26 ± 17.86; P < 0.01), Tpec interval (76.36 ± 13.53 vs 83.32 ± 21.25; P < 0.001) and Tpe/QT ratio (0.19 ± 0.03 vs 0.20 ± 0.04; P < 0.01), were significantly different between the normal diastolic function group and the reduced diastolic function group. Significant associations were found between repolarization variables and diastolic function. After adjusting for all other possible confounders, the QTc and Tpec intervals were significantly associated with the E/A ratio (P = 0.008; P = 0.010). In men, the QTc interval was associated with abnormal diastolic function, and compared to the third QTc tertile, in the second QTc tertile, the odds ratio was 0.257 (95%CI: 0.102–0.649; P = 0.004).CONCLUSIONRepolarization variables are associated with cardiac diastolic function even in healthy people. Moderate levels of the QTc interval exert a protective effect on diastolic dysfunction in men.

Prognostic value of ratio of transmitral early filling velocity to early diastolic strain rate in patients with Type 2 diabetes.

The ratio of early mitral inflow velocity to global diastolic strain rate (E/e'sr) has recently emerged as a novel measure of left ventricular filling pressure. E/e'sr has in previous studies demonstrated to have good prognostic value in various patient populations. The aim of this study is to investigate the prognostic value of E/e'sr in a large cohort of patients with Type 2 diabetes in relation to cardiovascular morbidity and mortality. In this prospective study, 848 Type 2 diabetic patients (mean age 63.6 ± 10.3 years, 64.7% male) underwent comprehensive echocardiographic examination including 2D speckle tracking in which E/e'sr along with novel and conventional echocardiographic variables were obtained. During follow-up (median: 4.8 years, interquartile range: 4.0-5.3), 122 (14.1%) met the composite outcome of cardiovascular disease, hospitalization, and mortality. Both E/e'sr and E/e' were significantly associated with the outcome [E/e'sr: hazard ratio (HR) 1.07, 95% confidence interval (CI): 1.05-1.10; P < 0.001, per 0.10 m increase] and (E/e': HR 1.07, 95% CI: 1.05-1.10; P = 0.001, per 1 unit increase). E/e'sr remained an independent predictor after multivariable adjustment for demographical, clinical, and echocardiographic parameters (HR 1.06, 95% CI: 1.01-1.12; P = 0.032, per 10 cm increase). The same was true for E/e' (HR 1.09, 95% CI: 1.04-1.14; P < 0.001, per 1 unit increase). Additionally, E/e'sr provided incremental prognostic information beyond the UK 'Prospective Diabetes Study risk engine' 0.72 (0.68-0.77) vs. 0.74 (0.70-79), P = 0.040. In patients with Type 2 diabetes, E/e'sr provides independent and incremental prognostic information regarding cardiovascular morbidity and mortality.

Reduced left ventricular diastolic function in women with posttraumatic stress disorder.

Women are two to three times more likely to develop posttraumatic stress disorder (PTSD) compared with men after exposure to a major trauma, and PTSD is associated with increased risk for cardiovascular disease in later life. The underlying mechanisms are unclear, but alterations in cardiac function may be involved. We hypothesized that women with PTSD have reduced left ventricular (LV) diastolic function. We studied 14 women with PTSD (PTSD group) and 14 women without PTSD (controls) using echocardiography Doppler to evaluate LV diastolic function, including peak velocities (E and A waves) in transmitral flow; diastolic, atrial kick, and systolic waveform velocities (e', a', and s') in tissue Doppler; the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e'); and velocity of propagation (Vp) . Baseline characteristics including age, body size, blood pressure, and heart rate were not significantly different between the two groups. Compared with the control group, women with PTSD showed greater E/e' (controls vs. PTSD group: 7.0 ± 1.3 vs. 9.1 ± 1.3, P = 0.002) and smaller Vp (controls vs. PTSD group: 63.7 ± 11.3 vs. 47.5 ± 6.9 cm/s, P = 0.003). These results suggest that women with PTSD have reduced LV diastolic function, which may contribute, at least in part, to the increased risk of cardiovascular disease later in life.

Lack of Synergy between Major Risk Factors, Obesity and Hypertension, in Development of Heart Failure with Preserved Ejection Fraction

BackgroundObesity and hypertension are highly associated with diastolic dysfunction. The current consensus is that metabolic‐ and hypertensive disease, like other comorbidities, contribute synergistically to a systemic state of inflammation, leading to coronary microvascular dysfunction, oxidative stress, cardiomyocyte stiffness and myocardial fibrosis. As unambiguous evidence for such a synergistic relation is currently lacking, we aimed to clarify if and how obesity and hypertension interact in development of diastolic dysfunction.MethodsMale lean and obese ZSF1 rats, of which the latter were previously shown to develop heart failure with preserved ejection fraction, were studied from 13 till 26 weeks of age. To assess the impact of severe hypertension, both lean and obese rats were treated with Deoxycorticosterone acetate implants plus 6% dietary salt (DS) or vehicle, from 19 to 26 weeks of age. In addition to echocardiographic, metabolic, and hemodynamic analyses, RNAseq and histochemistry were done on left ventricle tissue.ResultsBody weight, cholesterol, and triglycerides were elevated in obese rats (table 1). Systolic blood pressure (SBP) was increased by DS treatment. Ejection fraction (EF) was slightly reduced in both vehicle‐ and DS‐treated obese rats, though all animals remained within the spectrum of preserved EF (&gt;50%). Illustrative for diastolic dysfunction, the ratio between peak velocity of early mitral inflow, and early diastolic mitral annulus velocity (E/e′), was increased in obese animals. Importantly, no synergistic effects were observed of obesity and hypertension (p=0.55). In the vehicle‐treated obese rats, diastolic dysfunction developed in absence of significant fibrosis. Computational pathway analysis of the RNAseq data using Ingenuity Pathway Analysis however, predicted a steep elevation in obesity‐induced mitochondrial fatty acid oxidation (p=1.99E‐09). Both DS‐treated lean and obese rats on the other hand, showed severe mitochondrial dysfunction, as evidenced by an overall downregulation of enzymes involved in oxidative phosphorylation, and elevated cardiac fibrosis, macrophage presence, and apoptosis.ConclusionIn this study, no synergistic effect was observed of obesity‐ and hypertension in development of diastolic dysfunction. Our findings indicate that the metabolic derangements had a more pronounced contribution to diastolic dysfunction, whereas DS‐induced hypertension mainly triggered loss of cardiomyocytes, macrophage influx, and fibrosis.Support or Funding InformationThis study was supported by a grant from the Netherlands CardioVascular Research Initiative: an initiative with support of the Dutch Heart Foundation [CVON2014‐11 (RECONNECT)This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Chronic Reductive Stress Impairs Endoplasmic Reticulum Function and Cause Proteotoxic Cardiac Disease

BackgroundHeart failure (HF) is a growing cause of global human morbidity and mortality and elevated ROS are generalized as drivers of HF pathology. However, antioxidant treatments have failed to offer sufficient therapeutic benefits; the underlying mechanisms remain largely unknown. Here, we hypothesized that chronic reductive stress (cRS) induces endoplasmic reticulum (ER) dysfunction, which leads to proteotoxicity and pathological cardiac remodeling.MethodsTransgenic mice expressing cardiac specific, constitutively active Nrf2 (caNrf2‐TG) and their non‐transgenic (NTG) littermates at the age of 3 and ~6 months (n=6–8/group) were used to determine ER redox states and protein aggregation levels. Diastolic function was measured by echocardiography.ResultscRS substantially increased ER glutathione levels and suppressed protein oxidation (DMPO‐adducts) in TG vs. NTG mouse hearts. The co‐localization of KDEL (ER‐marker) with GSH or DMPO, showed by immunofluorescent imaging, indicates a hyper‐reductive redox milieu in the ER. Immunoblotting revealed a dose‐dependent induction of ER‐proteins (CHOP, GRP78, GRP94 and PDI) in TG hearts at 3‐months‐old. However, at 6‐months of age, this response was significantly repressed along with impaired protein folding response in TG mice, evidencing that progressive cRS is associated with a transition from adaptive ER stress‐response to ER dysfunction. Notably, electron micrograph and Proteostat® staining showed a dose‐ and age‐dependent augmentation of misfolded/aggregated proteins in TG hearts; these aggregates were highly ubiquitinated as demonstrated. Patterns of Mitral valve movement showed that ≥6 month‐old TG mice developed overt LV diastolic dysfunction as evidenced by increased mitral inflow velocity (MV E/A ratio).ConclusionER dysfunction and proteotoxic insults triggered pathological cardiac remodeling and diastolic dysfunction in the TG hearts experiencing cRS. The heterogeneity of redox profiles in HF subjects demands further investigation into the potential impact of RS in cardiovascular pathology. Research focusing on correlations between redox stress intensity, redox imbalance and disease progression may offer insights into redox‐based therapies.Support or Funding InformationThis study was supported by funding from NHLBI (HL118067), NIA (AG042860), the AHA (BGIA 0865015F), University of Utah Center for Aging Pilot grant (2009), the Division of Cardiovascular Medicine/Department of Medicine, University of Utah and the start‐up funds (for NSR) by Department of Pathology, the University of Alabama at Birmingham, AL and UABAMC21 grant by the University of Alabama at Birmingham, AL.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Left ventricular vortex formation time in elite athletes: novel predictor of myocardial performance

BackgroundEfficient transportation of blood through the left ventricle (LV) during diastole depends on vortex formation. Vortex formation time (VFT) can be measured by echocardiography as a dimensionless index. As elite...

Ratio of Transmitral Early Filling Velocity to Early Diastolic Strain Rate as a Predictor of Cardiovascular Morbidity and Mortality Following Acute Coronary Syndrome

The ratio of early mitral inflow velocity (E) to early diastolic strain rate (E/e'sr) is a significant predictor of cardiac outcomes in various patient populations. This study aims to evaluate the predictive value of E/e'sr for heart failure, acute myocardial infarction, and death due to cardiovascular disease following acute coronary syndrome (ACS). In total, 432 ACS patients underwent echocardiography following percutaneous coronary intervention. The end point was the composite of heart failure, acute myocardial infarction, and death due to cardiovascular disease. Median follow-up was 4.4 (interquartile range 0.2 to 6.3) years. During the follow-up period, 199 (46.1%) met the composite outcome. Mean value of E/e'sr in patients was 0.70 ± 0.37 m. In univariable Cox regression, E/e'sr was a predictor of the composite outcome (hazard ratio [HR] 1.05 95% confidence interval [CI] 1.03 to 1.07, p <0.001, per 0.10 m increase). After multivariable adjustment for demographic and clinical parameters, E/e'sr remained an independent predictor (HR 1.03; 95% CI 1.01 to 1.06; p = 0.013, per 0.10 m increase). Global longitudinal strain (GLS) modified the relation between E/e'sr and outcome (p value for interaction = 0.011). In ACS patients with a relatively preserved systolic function assessed by GLS (GLS ≥ 13.2%), E/e'sr showed to be a significant predictor (HR 1.20; 95% CI 1.06 to 1.36; p = 0.005, per 0.10 m increase). In contrast, E/e'sr was not a significant predictor in ACS patients with impaired systolic function (GLS < 13.2%; HR 1.02; 95% CI 0.99 to 1.04; p = 0.28). In conclusion, E/e'sr provides important prognostic information regarding cardiovascular morbidity and mortality in ACS patients. However, E/e'sr was not an independent predictor over that of echocardiographic parameters. Furthermore, E/e'sr is a stronger prognosticator in patients with relatively preserved systolic function as opposed to patients with impaired systolic function.

The effect of luseogliflozin and alpha-glucosidase inhibitor on heart failure with preserved ejection fraction in diabetic patients: rationale and design of the MUSCAT-HF randomised controlled trial

IntroductionType 2 diabetes mellitus (T2DM) is a strong risk factor for coronary artery disease and heart failure, particularly heart failure with preserved ejection fraction (HFpEF). The aim of the ongoing...

Sex Differences in Heart Failure With Preserved Ejection Fraction Pathophysiology: A Detailed Invasive Hemodynamic and Echocardiographic Analysis

ObjectivesThis study sought to identify sex differences in central and peripheral factors that contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF) by using complementary invasive hemodynamic and echocardiographic approaches. BackgroundWomen are overrepresented among patients with HFpEF, and there are established sex differences in myocardial structure and function. Exercise intolerance is a fundamental feature of HFpEF; however, sex differences in the physiological determinants of exercise capacity in HFpEF are yet to be established. MethodsPatients with exertional intolerance with confirmed HFpEF were included in this study. Evaluation of the subjects included resting and exercise hemodynamics, echocardiography, and mixed venous blood gas sampling. ResultsA total of 161 subjects included 114 females (71%). Compared to males, females had a higher pulmonary capillary wedge pressure (PCWP) indexed to peak exercise workload (0.8 [0.5 to 1.2] mm Hg/W vs. 0.6 [0.4 to 1] mm Hg/W, respectively; p = 0.001) and lower systemic (1.1 [0.9 to 1.5] ml/mm Hg vs. 1 [0.7 to 1.2] ml/mm Hg, respectively; p = 0.019) and pulmonary (2.9 [2.2 to 4.2] ml/mm Hg vs. 2.4 [1.9 to 3] ml/mm Hg, respectively; p = 0.032) arterial compliance at exercise. Mixed venous blood gas analysis demonstrated a greater rise in lactate indexed to peak workload (0.05 [0.04 to 0.09] mmol/l/W vs. 0.04 [0.03 to 0.06] mmol/l/W, respectively; p = 0.007) in women compared to men. Women had higher mitral inflow velocity to diastolic mitral annular velocity at early filling (E/e′) ratios at rest and peak exercise, along with a higher ejection fraction and smaller ventricular dimensions. ConclusionsWomen with HFpEF demonstrate poorer diastolic reserve with higher echocardiographic and invasive measurements of left ventricular filling pressures at exercise, accompanied by lower systemic and pulmonary arterial compliance and poorer peripheral oxygen kinetics.

Diastolic dysfunction and acute kidney injury in elderly patients with femoral neck fracture.

BackgroundFemoral neck fracture is common in the elderly population. Acute kidney injury (AKI) is an important risk factor for mortality in patients who have had such fracture. We evaluated the incidence of AKI in patients who had femoral neck fracture and identified risk factors for AKI and mortality.MethodsThis was an observational cohort study including 285 patients who were ≥ 65 years of age and who underwent femoral neck fracture surgery between 2013 and 2017.ResultsThe mean age was 78.63 ± 6.75 years. A total of 67 (23.5%) patients developed AKI during the hospital stay: 57 (85.1%), 5 (7.5%), and 5 (7.5%) patients were classified as having stage 1, 2, and 3 AKI, respectively. Patients with AKI had a lower baseline estimated glomerular filtration rate and higher left atrial dimension, left ventricular mass index, pulmonary artery pressure, and the ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) and were more likely to have diabetes or hypertension (HTN) (P < 0.05). The presence of HTN (odds ratio [OR], 4.570; 95% confidence interval [CI], 1.632–12.797) higher E/e’ (OR, 1.105; 95% CI, 1.019–1.198), and lower hemoglobin (OR, 0.704; 95% CI, 0.528–0.938) were independently associated with a higher risk for developing AKI. Severe AKI (OR, 24.743; 95% CI, 2.822–212.401) was associated with a higher risk of mortality.ConclusionElderly patients with femoral neck fracture had a high incidence of AKI. Diastolic dysfunction was associated with AKI. Severe AKI was associated with in-hospital mortality.

Early mitral inflow velocity to left ventricular global strain ratio predicts limited exercise capacity.

Estimation of left ventricular filling pressure (LVFP) is the essential part of the echocardiographic workup for exercise intolerance. The ratio of the mitral early filling velocity to the left ventricular global longitudinal strain (E/LVGLS) has emerged as a novel index of LVFP. This study aimed to investigate the relationship between E/LVGLS and exercise capacity. We retrospectively reviewed 90 patients with exertional dyspnea who underwent echocardiography and cardiopulmonary exercise test. Patients were classified into three groups according to their percent-predicted maximal oxygen consumption (ppVo2 ) (G≧75, ppVo2 >75%, n=20; G 50-75, ppVo2 75-50%, n=57; G<50, ppVo2 <50%, n=13). Measurements were (a) the relationship between ppVo2 and E/LVGLS and (b) the efficiency of integrated diastolic assessment using E/LVGLS, left ventricular volume, mitral annular early diastolic velocity (E'), and tricuspid regurgitation to identify the patient with impaired exercise capacity. Univariate linear regression analysis demonstrated that E/LVGLS had significant correlation with ppVo2 (ρ=0.52, P<0.001). The area under the ROC of E/LVGLS for ppVo2 <50% was 0.86 (95%CI 0.75-0.97). The DeLong test showed that E/LVGLS was efficient to detect ppVo2 <50% than E/E' (P=0.007). When used in the integrated assessment of LVFP as the alternative for E/E', E/LVGLS improved risk classification for impaired exercise capacity. E/LVGLS may be a more efficient index than E/E' to identify exercise impairment as a single index and as a part of the integrated diastolic assessment.

Diastolic Function and Peripheral Venous Pressure as Indices for Fluid Responsiveness in Cardiac Surgical Patients

Identifying fluid responsiveness is critical to optimizing perfusion while preventing fluid overload. An experimental study of hypovolemic shock resuscitation showed the importance of ventricular compliance and peripheral venous pressure (PVP) on fluid responsiveness. The authors tested the hypothesis that reduced ventricular compliance measured using transesophageal echocardiography results in decreased fluid responsiveness after a fluid bolus. Prospective observational study. Two-center, university hospital study. The study comprised 29 patients undergoing elective coronary revascularization. Albumin 5%, 7 mL/kg, was infused over 10 minutes to characterize fluid responders (>15% increase in stroke volume) from nonresponders. Invasive hemodynamics and the ratio of mitral inflow velocity (E-wave)/annular relaxation (e'), or E/e' ratio, were measured using transesophageal echocardiography to assess left ventricular (LV) compliance at baseline and after albumin infusion. Fifteen patients were classified as responders and 14 as nonresponders. The E/e' ratio in responders was 7.4 ± 1.9 at baseline and 7.1 ± 1.8 after bolus. In contrast, E/e' was significantly higher in nonresponders at baseline (10.7 ± 4.6; p = 0.04) and further increased after bolus (12.6 ± 5.5; p = 0.002). PVP was significantly greater in the nonresponders at baseline (14 ± 4 mmHg v 11 ± 3 mmHg; p = 0.02) and increased in both groups after albumin infusion. Fluid responsiveness was tested using the area under the receiver operating characteristic curve and was 0.74 for the E/e' ratio (95% confidence interval 0.55-0.93; p = 0.029) and 0.72 for the PVP (95% confidence interval 0.52-0.92; p = 0.058). Fluid responders had normal LV compliance and lower PVP at baseline. In contrast, nonresponders had reduced LV compliance, which worsened after fluid bolus. E/e,' more than PVP, may be a useful clinical index to predict fluid responsiveness.

Assessment of left ventricular filling pressure and its correlation with severity of chronic kidney disease

Aims: This study was aimed to assess the left ventricular filling pressure (LVFP) and its relationship with severity of chronic kidney disease (CKD). Methods: One hundred CKD patients were subjected to standard echocardiography and the new modality of tissue Doppler imaging. The LVFP is calculated with E/e' ratio (early diastolic mitral inflow velocity – E to early diastolic mitral annulus velocity – e'). All these patients were divided into five subgroups depending on their estimated glomerular filtration rate (eGFR: ml/min/body surface area). Results: The analysis of echocardiographic parameters (E and e') showed that in CKD patients, the stage of renal failure was associated with the significant increase in LVFP with P

Feeding Induces Left Atrial Compression and Impedes Cardiac Filling in Patients With Large Hiatal Hernia

Patients with large hiatal hernias (HH) frequently experience postprandial dyspnea. The aim of this study was to evaluate whether feeding induced cardiac compression in these patients using echocardiography. Transthoracic echocardiography was performed during fasting and 30min after feeding (300g rice pudding) in patients with HHs (n=32; mean age, 72±9years). A subset of patients (n=15; mean age, 76±6years) were evaluated postoperatively. Preoperatively, feeding decreased left atrial (LA) volumes (maximal 27.4±11.3 vs 19.2±9.7mL/m2, P<.001; minimal 13.1±7.0 vs 6.9±5.1mL/m2, P<.001), and increased LA inflow velocities (systolic wave 0.62±0.14 vs 0.77±0.17m/sec, P<.01; diastolic wave 0.46±0.13 vs 0.59±0.13m/sec, P<.01), mitral inflow velocities (E wave 0.79±0.17 vs 0.94±0.19m/sec, P<.01; A wave 0.93±0.20 vs 1.05±0.22m/sec, P<.01), and E/E' ratio (12.1±2.7 vs 13.7±3.9, P<.01). Cardiac output (6.3±1.6 vs 7.24±2.0L, P<.01) increased postprandially by marked heart rate augmentation (68.8±7.0 vs 84.2±8.4 beats/min, P<.01), with modest stroke volume increase (88.5±16.7 vs 94.3±19.5mL, P=.03). After HH surgery, feeding did not change LA volumes (maximal 52.9±13.6 vs 53.4±12.5mL, P=.89; minimal 28.6±12.2 vs 27.4±8.7mL, P=.59) or E/E' ratio (10.9±2.1 vs 11.3±2.3) and induced more modest alterations in LA inflow (systolic wave 0.58±0.17 vs 0.68±0.16m/sec, P=.01; diastolic wave 0.41±0.12 vs 0.47±0.13m/sec, P=.01) and mitral inflow (E wave 0.69±0.15 vs 0.80±0.13m/sec, P<.01; A wave 0.92±0.13 vs 1.01±0.18m/sec, P=.02). Postoperatively, feeding increased cardiac output by substantial stroke volume augmentation (81.9±16.5 vs 90.8±16.0mL, P=.01), with only modest increase in heart rate (69.8±9.1 vs 75.9±10.5 beats/min, P<.01). Feeding produces marked LA compression in patients with HHs, inducing compensatory exaggerated responses in cardiac inflow and hemodynamic status. These compensatory mechanisms improve postoperatively following resolution of LA compression, likely explaining the debility noted preoperatively.