Moderate Diastolic Dysfunction Research Articles

Left Ventricular Diastolic Dysfunction Late After Aortic Valve Replacement in Patients With Aortic Stenosis

Patients with severe aortic stenosis (AS) are known to have increased left ventricular (LV) mass and diastolic dysfunction. It has been suggested that LV mass and diastolic function normalize after aortic valve replacement (AVR). In the present study, change in LV mass index and diastolic function 10 years after AVR for AS was evaluated. Patients who underwent AVR from 1991 to 1993 (n = 57; mean age 67 +/- 8.6 years at AVR, 58% men) were investigated with Doppler echocardiography preoperatively and 2 and 10 years postoperatively. Diastolic function was evaluated by integrating mitral and pulmonary venous flow data. Expected values for each patient, taking age into consideration, were defined using a control group (n = 71; age range 18 to 83 years). Patients were classified into 4 types: normal diastolic function (type A), mild diastolic dysfunction (type B), moderate diastolic dysfunction (type C), and severe diastolic dysfunction (type D). There was a reduction in LV mass index between the preoperative (161 +/- 39 g/m2) and 2-year follow-up (114 +/- 28 g/m2) examinations (p <0.0001), but no further reduction was seen at 10 years (119 +/- 49 g/m2). The percentage of patients with increased LV mass index decreased from 83% preoperatively to 29% at 2-year follow-up (p <0.001). The percentage of patients with moderate to severe LV diastolic dysfunction (types C and D) was unchanged between the preoperative (7%) and 2-year follow-up (13%) examinations (p = 0.27). The percentage of patients increased at 10-year follow-up to 61% (p <0.0001). In conclusion, this reveals the development of moderate to severe diastolic dysfunction 10 years after AVR, despite a reduction in the LV mass index.

Detection of early systolic dysfunction with strain rate imaging in a patient with light chain cardiomyopathy

Congestive heart failure (CHF) in cardiac amyloidosis has been attributed to the development of diastolic dysfunction, because severe CHF symptoms have been observed despite a normal or only mildly reduced LV ejection fraction (EF). An early impairment of longitudinal systolic function has been described by means of tissue Doppler-derived myocardial deformation imaging ('strain rate imaging', SRI). Our patient presented with signs of CHF and significantly increased brain-natriuretic peptide (BNP) levels. Conventional measures of systolic contractile function were within the normal range and mitral inflow Doppler showed only moderate diastolic dysfunction. Histopathological examination by endomyocardial biopsy revealed interstitial deposition of amyloid fibers. Quantitative assessment of myocardial velocities (TDI) and deformation properties (Strain) from the apical view demonstrated a significant impairement of systolic longitudinal myocardial function. In patients with isolated diastolic dysfunction detected by conventional Doppler echocardiography, the quantitative assessment of myocardial strain and strain rate can be helpful in the early detection of systolic dysfunction.

Diastolic dysfunction was predictive of all cause mortality

(2003) JAMA 289, 194. Redfield MM, Jacobsen SJ, Burnett JC Jr, et al. . Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart...

Remodelling and left ventricular diastolic function in relation to blood pressure variability in patients with arterial hypertension and coronary heart disease

Sixty five patients (mean age 55.7 ± 8,7 years), including 51 patients with arterial hypertension (AH) (mean age 54,9 ± 8,6 years) and 14 patients with a combination of AG and coronary heart disease (CHD) with postinfarction cardiosclerosis (mean age 54,9 ± 8,6 years) were examined. According to the values of average daily blood pressure variability (HPV), the patients were divided into subgroups with normal (11 patients with AH and 3 patients with AH and CHD) and increased (39 patients with AH and 12 patients with AH and CUD) BPV. Patients with isolated AH were found to have developed concentric hypertrophy of the left ventricle (LV), and moderate LV diastolic dysfunction mainly with impaired relaxation and the patients with a combination of AH and CHD with postinfarction cardiosclerosis had more significant LV structural and geometric derangements with a tendency for the development of eccentric hypertrophy of the LV, as well as more marked diastolic dysfunction with a larger proportion of the pseudo-normal and restrictive types of LV diastolic function. Patients with increased average daily BPV were found to have more significant LV structural, geometrical, and diastolic impairments.

Burden of systolic and diastolic ventricular dysfunction in the community appreciating the scope of the heart failure epidemic

Context Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic dysfunction and CHF in the community remain undefined. Objectives To determine the prevalence of CHF and preclinical diastolic dysfunction and systolic dysfunction in the community and determine if diastolic dysfunction is predictive of all-cause mortality. Design, Setting, Participants Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. Main Outcome Measures Doppler echocardiographic assessment of systolic and diastolic function. Presence of CHF diagnosis by review of medical records with designation as validated CHF if Framingham criteria are satisfied. Subjects without a CHF diagnosis but with diastolic or systolic dysfunction were considered as having either preclinical diastolic or preclinical systolic dysfunction. Results The prevalence of validated CHF was 2.2% (95% confidence interval [CI], 1.6%-2.8%) with 44% having an EF higher than 50%. Overall, 20.8% (95% CI, 19.0%-22.7%) of the population had mild diastolic dysfunction, 6.6% (95% CI, 5.5%-7.8%) had moderate diastolic dysfunction, and 0.7% (95% CI, 0.3%-1.1%) had severe diastolic dysfunction with 5.6% (95% CI, 4.5%-6.7%) of the population having moderate or severe diastolic dysfunction with normal EF. The prevalence of any systolic dysfunction (EF ≤50%) was 6.0% (95% CI, 5.0%-7.1%) with moderate or severe systolic dysfunction (EF ≤40%) being present in 2.0% (95% CI, 1.4%-2.5%). CHF was much more common among those with systolic or diastolic dysfunction than in those with normal ventricular function. However, even among those with moderate or severe diastolic or systolic dysfunction, less than half had recognized CHF. In multivariate analysis, controlling for age, sex, and EF, mild diastolic dysfunction (hazard ratio, 8.31 [95% CI, 3.00-23.1],P Conclusions In the community, systolic dysfunction is frequently present in individuals without recognized CHF. Furthermore, diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognized CHF, and associated with marked increases in all-cause mortality.

Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.

Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic dysfunction and CHF in the community remain undefined. To determine the prevalence of CHF and preclinical diastolic dysfunction and systolic dysfunction in the community and determine if diastolic dysfunction is predictive of all-cause mortality. Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. Doppler echocardiographic assessment of systolic and diastolic function. Presence of CHF diagnosis by review of medical records with designation as validated CHF if Framingham criteria are satisfied. Subjects without a CHF diagnosis but with diastolic or systolic dysfunction were considered as having either preclinical diastolic or preclinical systolic dysfunction. The prevalence of validated CHF was 2.2% (95% confidence interval [CI], 1.6%-2.8%) with 44% having an EF higher than 50%. Overall, 20.8% (95% CI, 19.0%-22.7%) of the population had mild diastolic dysfunction, 6.6% (95% CI, 5.5%-7.8%) had moderate diastolic dysfunction, and 0.7% (95% CI, 0.3%-1.1%) had severe diastolic dysfunction with 5.6% (95% CI, 4.5%-6.7%) of the population having moderate or severe diastolic dysfunction with normal EF. The prevalence of any systolic dysfunction (EF < or =50%) was 6.0% (95% CI, 5.0%-7.1%) with moderate or severe systolic dysfunction (EF < or =40%) being present in 2.0% (95% CI, 1.4%-2.5%). CHF was much more common among those with systolic or diastolic dysfunction than in those with normal ventricular function. However, even among those with moderate or severe diastolic or systolic dysfunction, less than half had recognized CHF. In multivariate analysis, controlling for age, sex, and EF, mild diastolic dysfunction (hazard ratio, 8.31 [95% CI, 3.00-23.1], P<.001) and moderate or severe diastolic dysfunction (hazard ratio, 10.17 [95% CI, 3.28-31.0], P<.001) were predictive of all-cause mortality. In the community, systolic dysfunction is frequently present in individuals without recognized CHF. Furthermore, diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognized CHF, and associated with marked increases in all-cause mortality.

Insertion of the Transesophageal Echocardiography Probe via Endoscopy Mask

Insertion of the Transesophageal Echocardiography Probe via Endoscopy Mask

Dyspnea of Cardiac Origin in 67-Year-Old Men: Relation to Clinical and Noninvasive Measures of Cardiac Function

The relation of presumed cardiac dyspnea to regional (presence of akinesia), systolic (fractional shortening), and diastolic (left atrial dimension, atrial emptying index, and heart rate adjusted A2 to O-point interval) cardiac dysfunction, as well as to nonspecific heart function indices (mitral valve E-point to septal separation and exercise test) and clinical information, was investigated in a sample from the general population. We selected, from a screened cohort of 644 67-year-old men, 42 subjects with presumed cardiac dyspnea and chose at random 45 nondyspneic controls. In univariate analysis the degree of dyspnea was most closely related to the E-point to septal separation (r = 0.58, p < 0.0001) and to presence of akinetic segments (r = 0.53, p < 0.0001). Clinical and noninvasive findings were compared in multivariate stepwise regression analysis, and, in order of significance, the E-point to septal separation, presence of akinetic segments, exercise capacity, history of angina pectoris and left atrial dimension contributed independently to the explanation of the dyspnea grade variance. Together they explained 74%. Of the 37 men with mild to moderate dyspnea, 27% had systolic dysfunction as evidenced by a low fractional shortening. Diastolic abnormalities and/or akinetic segments with normal fractional shortening were found in 44%. Increased E-point to septal separation was the only abnormality in 11 %, while 18 % had no detectable abnormality. The 5 men with severe dyspnea had several abnormalities, low fractional shortening being present in 4 men. Thus, severe dyspnea was associated with combinations of abnormalities, while, in men with mild to moderate dyspnea, diastolic dysfunction and/or akinetic segments were more prevalent than low fractional shortening, a finding with potential therapeutic implications. The mitral E-point to septal separation was found to be the measure most likely of those studied to reveal cardiac dysfunction as causing dyspnea.