Myocardial Diastolic Dysfunction Research Articles

ОЦЕНКА СОСТОЯНИЯ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У КРУПНОВЕСНЫХ И МАЛОВЕСНЫХ К СРОКУ ГЕСТАЦИИ НОВОРОЖДЕННЫХ ДЕТЕЙ

The aim of the study was to assess the cardiovascular status of large-forgestational-age (LGA) and small-for-gestational-age (SGA) full-term newborns. A survey of 192 newborns was carried out on the basis of the Republican Scientific and Practical Center “Mother and Child”. Group 1 (Gr1) consisted of 54 large-for-gestational-age newborns, group 2 (Gr2) – 43 small-for-gestational-age newborns, group 3 (Gr3) – 95 newborns with physical development corresponding to gestational age (appropriate for gestational age). Echocardiographic parameters were compared between study groups, as corrected to body surface area. Morphometric assessment of heart structures in the course of Echo-CG in Gr1 patients showed a statistically significant thickening of the heart walls with predominant localization in the posterior wall of the left ventricle (LV) and interventricular septum (IVS). Significant differences were found in all derivatives of echocardiographic indicators in the examined groups of newborns. In Gr2, signs of diastolic myocardial dysfunction were revealed reflecting an impairment of the age-related evolution of myocardial relaxation processes. The intragroup analyses of LGA and SGA neonates (subgrouped according to the birth weight percentile) revealed no statistically significant differences in the direct and derived echocardiographic parameters analyzed. The frequency of detection of open foramen ovale (PFO), IVS thickness of 5.0 mm and more in LGA newborns had greater as compared with the group of conditionally healthy infants (р = 0.038, р = 0.001). Fetal communications in SGA newborns occurred significantly more often (PFO – р = 0.031, patent ductus arteriosus – р = 0.026) than in newborns with normal weight. LGA and SGA newborns are characterized by the specific cardiovascular status. The revealed changes make it possible to assign infants with large and small birth weight to the risk group for the development of cardiovascular pathology, which requires dynamic observation as well as therapeutic and prophylactic measures.

ASSESSMENT OF TYPES OF MYOCARDIAL DIASTOLIC DYSFUNCTION DEPENDING ON THE DEGREE OF CORONARY ARTERY LESION IN PATIENTS WITH NSTEMI.

The aim: To evaluate the types of myocardial diastolic dysfunction depending on the degree of coronary artery lesion in patients with NSTEMI. Materials and methods: We examined 200 patients with NSTEMI aged 38 to 80 years, who were urgently hospitalized in the Vinnytsya Regional Clinical Center of Cardiovascular Pathology. All patients underwent echocardiography examination from 3 to 5 day of hospitalization after coronary angiography. Results: We established that there were no significant gender and age differences in the types of diastolic dysfunction. However, we found that with an increase in the degree of damage to the coronary arteries and an increase in the number of affected arteries, the degree of severity of myocardial diastolic dysfunction increases and the probability of occurrence of more unfavorable types of dysfunction increases. Conclusions: Determining the types of myocardial diastolic dysfunction in the early period of NSTEMI makes it possible to predict unfavorable variants of the course of the disease and prevent possible complications.

Associations between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large Single-Center Cohort Study

The clinical burden and prognostic role of diastolic dysfunction (DD), on the basis of the latest (2016) American Society of Echocardiography guidelines, remain unclear in patients with chronic kidney disease (CKD). Moreover, risk mapping of concomitant systolic dysfunction and DD to evaluate the hazard of cardiovascular (CV) mortality in patients with CKD remains unexplored. This retrospective cohort study identified 20,257 adult patients who underwent comprehensive echocardiography between 2008 and 2016 at a tertiary medical center in central Taiwan. The patients were stratified by CKD stage, and 3-year CV mortality risk in each CKD stratum was estimated through multivariable Cox proportional-hazards modeling using left ventricular ejection fraction (LVEF) and DD grades on the basis of the 2016 American Society of Echocardiography guidelines as the main risk factors. Compared with patients with stages 1 and 2 CKD, those with stages 4 and 5 CKD had significantly lower left ventricular ejection fractions and more severe DD. Both left ventricular ejection fraction (<40% vs ≥60%; adjusted hazard ratio, 3.17; 95% CI, 2.54-3.97) and DD grade (severe DD vs normal diastolic function; adjusted hazard ratio, 3.33; 95% CI, 2.33-4.76) were independently associated with 3-year CV mortality in the entire study population and had comparable effect sizes. The corresponding adjusted hazard ratios further increased to 4.20 (95% CI, 2.45-7.21) and 4.54 (95% CI, 2.20-9.38) in patients with stages 4 and 5 CKD. Systolic dysfunction and DD demonstrated mutually augmentative effects on CV mortality. These findings suggest that the current practice of cardioprotection for patients with CKD should be prioritized at an early stage along with conventional nephroprotection.

Abstract 10533: Greater Left Ventricular Mass And Abnormal Diastolic Myocardial Function In Neonates Of Pre-eclamptic Pregnancies

Introduction: Maternal pre-eclampsia (PEC) is a placental insufficiency syndrome with potential effects on neonatal cardiac function. Hypothesis: We tested the hypothesis that neonatal exposure to maternal PEC results in systolic and diastolic myocardial dysfunction on echocardiogram. Methods: Neonates exposed to maternal PEC (N=142) were matched 1:1 for gestational age and gender (N=142) with neonates concurrently enrolled in our center during the same study period (2009-2019). Echocardiograms performed in first 30 days of life were analyzed. Image analysis was done retrospectively and included LV and RV global peak longitudinal strain, mitral and tricuspid inflow and tissue Doppler, and LV mass indexed to body surface area. Analyses included two-sample t-test, Wilcoxon rank sum, chi-squared, and Bonferroni correction testing. Results: The average gestational age was 28 weeks, with slight male predominance of 54.9%. Birth weight was 885g in PEC group, compared to 1100g in the control (p=0.003). Median age at echocardiogram was 8 days for PEC and 6 days for control.In the PEC group, systolic function demonstrated decreased longitudinal 2-chamber average peak strain and higher mean LV mass. There was no difference in 4-chamber average peak strain, circumferential mid-LV average peak strain, or longitudinal RV 6-segment average strain. Mitral and tricuspid valve E-wave deceleration times were shorter in the PEC group. There were no differences in other markers of diastolic function, including E/A and E/e’ ratio. Conclusions: PEC neonates have increased RV and LV stiffness, indicated by reduced E-wave deceleration time of the mitral and tricuspid valves. This is suggestive of grade 2 diastolic dysfunction. LV mass was increased in the PEC group. We did not find compelling evidence of systolic dysfunction with strain analysis. In conclusion, maternal PEC exposure results in neonatal diastolic abnormalities that may have long term effects on cardiac function.

Abstract 10610: Schistosomiasis and Cardiovascular Disease in 1,000 HIV-Infected and Uninfected Tanzanian Adults: A Prospective Cohort Study

Background: Variations in immune phenotype are increasingly recognized as drivers of cardiovascular disease (CVD). For example, the inflammatory effect of HIV-infection is associated with a 2-fold higher risk of CVD. Conversely, schistosome infection induces an anti-inflammatory immune response, which may counter CVD pathways related to inflammation. Whether the immune regulatory effect of schistosome infection is sufficient to suppress the contrasting stimulatory effect of another disease such as HIV remains unknown and may provide critical insight into the immunologic basis of non-communicable diseases. Methods: In this prospective cohort study, we enrolled 1,000 HIV-infected and uninfected adults at a referral HIV clinic in a schistosome endemic area in Mwanza, Tanzania. Standardized history, echocardiography and serum were obtained. Blood pressure was monitored over two years. Regression models adjusted for age and sex were used to quantify associations. Results: We enrolled 503 schistosome infected and 497 uninfected adults with a median age of 36 [28- 43]. Schistosome infection was significantly associated with a lower prevalence of hypertension (39.6% vs 46.7%, p=0.016), myocardial diastolic dysfunction (8.1% vs 13.4%, p=0.015) and total-to-high density lipoprotein ratio (1.77 vs 1.82, p&lt;0.0001) as compared to uninfected participants. Additionally, schistosome-infection was associated with significantly improved change in blood pressure over time (0.67 vs 3.35 mmHg increase, p=0.005). When stratified by concurrent HIV-infection, schistosome infection was associated with lower prevalence of diastolic dysfunction and total-to-HDL ratio in HIV- infected adults but lower prevalence of hypertension in those without HIV-infection. Conclusions: We provide the first evidence that schistosome infection may directly impact cardiac function and slow the age-related increase in blood pressure over time. Further, associations between schistosome and CVD differ by HIV status, implying that immune mediated interactions may have important physiologic ramifications for CVD. The patterns of these interactions may provide insight into the immunologic mechanisms of cardiovascular diseases.

Abstract 10168: Association Between the Grade of Cytokine Release Syndrome and Cardiac Dysfunction After Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma Patients

Introduction: As Chimeric Antigen Receptor T cell (CAR-T) therapy gains its clinical advantage in the management of diffuse large B cell lymphoma (DLBCL), accumulating evidence shows that it often accompanies cardiac dysfunction. Previous retrospective studies indicated the involvement of cytokine release syndrome (CRS) in cardiac dysfunction after CAR-T therapy, but their association is not fully investigated. Therefore, we designed a prospective study to clarify the association between the grade of CRS and cardiac dysfunction in the DLBCL patients after CAR-T therapy. Methods: In this prospective study, 14 DLBCL patients who underwent CAR-T therapy from July 2020 to May 2021 were enrolled. Before and after CAR-T therapy, we collected the levels of troponin T (TnT) as a marker for myocardial damage, left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) as markers for systolic function, and E/e’ and left atrial volume index (LAVI) as markers for diastolic function. We classified all patients into two groups according to the severity of CRS after CAR-T therapy, namely the low-CRS Group (CRS&lt;3) and the high-CRS Group (CRS≧3). The markers for cardiac injury and dysfunction were further analyzed in both groups. Results: Average age was 56.4 years and 7 patients (50%) were female. The number of patients in the low-CRS and high-CRS Group were 11 and 3, respectively. Before CAR-T therapy, there were no differences in cardiac function between the two groups. From the hyper-early phase of CAR-T therapy, the increase of TnT, E/e’ and LAVI from the baseline were significantly larger in the high-CRS Group compared to the low-CRS Group (P=0.023, 0.039, and 0.024, respectively). Subsequently, the decrease of GLS from the baseline became significantly larger in the high-CRS Group compared to the low-CRS Group (P=0.049). These results indicated that cardiac dysfunction after CAR-T therapy occurred in the order of myocardial damage, diastolic dysfunction, and systolic dysfunction. Conclusion: We for the first time demonstrated the association between high-grade CRS and cardiac dysfunction after CAR-T therapy through a prospective study.

Abstract 12205: A New Mouse Model of Myocardial Lipids, Fibrosis, Arrhythmia and Diastolic Dysfunction Induced by Hyperlipidemia and Cardiac LDLR

Background: Hyperlipidemia is a major risk factor for CVD. Patients with HF with preserved ejection fraction (HFpEF) have more myocardial lipid accumulation than patients with reduced EF (HFrEF). RNASeq data from cardiac biopsies showed downregulation of the gene for lipoprotein lipase (LPL) that degrades triglycerides, in HFpEF patients compared to healthy and HFrEF controls. Poloxamer-407 (p407) induces hyperlipidemia by blocking LPL and subsequent increase in plasma triglycerides and low-density lipoprotein (LDL) cholesterol. We hypothesized that mice treated with p407 and cardiac LDL-Receptor (LDLR) over-expression (OE) develop hyperlipidemia, myocardial lipid accumulation, and diastolic dysfunction resulting in HFpEF and arrhythmias. Methods: Baseline cardiac function was assessed by echo for male and female C57Bl6 mice (n=9) for 2 groups: 4wk biweekly i.p. p407-injections with (n=4) or without (n=3) single i.v. injection with AAV9-cTnT-LDLR. Cardiac function was assessed by echocardiography at 3 and 4 wks. Blood Pressure (BP) and Whole Body Plethysmography (WBP) were assessed during wk4. Ttest was used for statistics. PR and ORO staining and telemetry were performed at wk4. Results: At wk3, P407 and LDLR OE led to alterations in diastolic function (increased IVCT, IVRT, MV E/E’, MPI, and NFT) and increased LV wall thickness, p&lt;0.05. At wk4, there was pulmonary hypertension (increased mean pulmonary arterial pressure, decreased pulmonary acceleration time p &lt;.05).Histology showed excessive myocardial lipids and fibrosis, and telemetry showed incidents of second-degree and higher-degree AV block. The group injected solely with p407 show e d alterations in diastolic function (increased IVCT, IVRT, NFT, LVMPI, LVMPI NFT p&lt;.05 ) and decreased EDV, ESV, EDLVM, ESLVM, p&lt;.05 at wk4. All groups had preserved %EF and no abnormalities in BP or WBP. Conclusions: P407 and cardiac LDLR OE induce a drastic decline in cardiac diastolic function over a shorter period of time compared to p407 alone. Diastolic dysfunction was observed in wk3 followed by pulmonary hypertension, arrhythmia, myocardial lipid accumulation and fibrosis in wk4. This new model may allow for more rapid investigations of cardiac abnormalities seen in HFpEF patients.

Epicardial adipose tissie-derived leptin induce MMPs/TIMPs imbalance and promotes myocardial remodeling in high fat diet-induced obese rats

Abstract Background and aims Epicardial adipose tissue (EAT)-derived leptin contributes to myocardial remodeling in metabolic syndrome. However, the precise mechanisms remain to be determined. The present study was designed to elucidate the adverse effects of EAT-derived leptin on obesity-related myocardial remodeling. Methods and results Eight-week-old male Wistar rats were divided into two groups that received either a normal diet (control, n=10) or a high-fat diet (obese, n=10) for 12 weeks. Obese rats exhibited abnormal myocardial structure, diastolic dysfunction and abundant collagen deposition. Local leptin expression in obese rats EAT upregulated along with adipocyte hypertrophy, accompanied by renin-angiotensin-aldosterone system (RAAS) activation and increased oxidative stress level. Leptin receptor (ObR) and angiotensin II type 1 receptor (AT1R) expression in obese EAT were significantly higher than that in control. In vitro, mature adipocytes treated with angiotensin II (Ang II) exhibited pronounced leptin synthesis and secretion by promoting AP-1 nuclear translocation via the AT1R-ROS-ERK1/2 pathway. Moreover, cardiac fibroblasts were incubated with obese rat EAT-conditioned medium (EAT-CM), plus various inhibitors. EAT-derived leptin promoted proliferation of cardiac fibroblasts associated with increased ERK1/2 phosphorylation and induced MMPs/TIMPs imbalance, stimulating upregulation of type I collagen via the JAK2/STAT3-TGF-β1/Smad3 pathway in cardiac fibroblasts of obese rats. Conclusions The paracrine effect of EAT-derived leptin on myocardial remodeling, inducing MMPs/TIMPs imbalance and promoting the proliferation of cardiac fibroblasts via activating ERK1/2 and JAK2/STAT3-TGF-β1/Smad3 pathway in obesity. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): the Nature Science Foundation of China (grant no. 81873513, 81600574, and 30871042)

Эректильная дисфункция: взаимосвязь показателей гемодинамики полового члена и диастолической функции левого желудочка

Introduction. Erectile dysfunction (ED) is one of the most common male urological complaints. At the same time, ED is pathogenetically closely associated with many life-threatening diseases (coronary heart disease, cerebrovascular diseases). Purpose. Based on Doppler data, determine the relationship between the blood flow in the cavernous arteries and intracardiac hemodynamics. Materials and methods. There are 246 men aged 40-65 years with complaints of erectile dysfunction was evaluated. The examination included anthropometry, questionnaires (IIEF-5, AMS), biochemical, hormonal blood tests and a comprehensive instrumental study: (Penile Doppler ultrasound, Holter ECG monitoring, Treadmill test, EchoCG). Results. Patients with arteriogenic ED have a significantly different risk factor profile. These patients have worse indicators of intracardiac hemodynamics compared to ED of other etiology - a higher ratio of the maximum rate of early and late left ventricular filling (E / A), lower rates of slowing down of early diastolic left ventricular filling and the time of isovolumic relaxation of the left ventricle. A significant correlation was found between the peak systolic blood flow velocity in the cavernous bodies of the penis, the resistance index in the cavernous arteries, and the E/A ratio. Discussion. Arteriogenic ED may be a sign of left ventricular diastolic myocardial dysfunction in men without symptoms of cardiovascular disease and may be a criterion for the formation of a group of high cardiovascular risk. Conclusions. Penile hemodynamics can be used as a predictive marker for early forms of cardiovascular disease.

Possibilities of cardio- and nephroprotective eff ects of drugs of the SGLT2 inhibitor group

This work is an attempt to analyze the data on the mechanisms of cardio- and nephroprotection of drugs of the SGLT2 inhibitor group (Sodium / glucose cotransporter 2). The data of recent studies are shown to indicate the eff ect of drugs of this group on the indices of central hemodynamics, on the volume of circulating plasma in particular, which can reduce the risk of progression and decompensation of chronic heart failure (CHF). The ability of empaglifl ozin to reduce pulsatility, a marker of increased vascular wall stiff ness, has been demonstrated. Also, SGLT2 inhibitors improve the energy supply of the myocardium and kidney tissue by increasing the concentration of ketone bodies in the blood, which are a more effi cient energy substrate than glucose and fatty acids. A direct pleiotropic eff ect on the myocardium, improvement of diastolic myocardial dysfunction is also not excluded. It is known that SGLT2 inhibitors also reduce cortical hypoxia, decrease intraglomerular hypertension and increase glomerular fi ltration rate, lessen incidence of nephropathy, its severity and rate of progression. Some studies have revealed antioxidant, anti-infl ammatory, antifi brotic eff ect of type 2 sodium glucose cotransporter inhibitors. The use of this group of drugs also leads to a decrease in body weight. This eff ect is more pronounced in combination with other drugs intended for the treatment of obesity. All this makes SGLT2 inhibitors a promising group of drugs that have a large number of pathogenetic points of application in relation to cardiorenal syndrome.

THE IMPACT OF QUERCETIN ON THE FUNCTIONAL STATE OF CARDIOVASCULAR SYSTEM AND HEMOSTASE IN RATS WITH TYPE 2 DIABETES MELLITUS

Introduction. Type 2 diabetes mellitus (T2DM) increases the risk for atherosclerotic cardiovascular disease and other cardiovascular complications such as cardiac arrhythmias, heart failure, and thrombotic events. Quercetin (Q) possesses a wide range of multiple activities: anti-diabetic, anti-proliferative, anti-atherosclerotic, antioxidant, anti-inflammatory, anti-thrombotic, anti-apoptotic effects and is regarded as a candidate for the role of cardiovascular complications protecting agent.&#x0D; The aim of this study was to assess the effects of Q on the functional state of cardiovascular system and haemostasis in diabetic rats.&#x0D; Materials and Methods. T2DM was induced in Wistar rats by a high-caloric diet during 14 weeks combined with intraperitoneal injections of 25 mg/kg streptozotocin twice per week. All diabetic animals were divided into three groups: treated with solvent and with Q (in dose 10 and 50 mg/kg/day per os) for 8 weeks after diabetes induction. Fibrinogen concentration and induced euglobulin fibrinolysis time were measured in plasma using reagent kits. Electrocardiograms were recorded in leads II.&#x0D; Results. It was established that Q in dose 50 mg/kg b.w. prevents in the formation of sinus tachycardia in experimental animals. In addition, Q in both doses inhibits the development of myocardial diastolic dysfunction, which was confirmed by prolongation of T-P interval and a decrease of duration of the T wave in comparison with diabetic rats. Q in both doses restorated the processes of coagulations and fibrinolysis, as indicated by a decrease of fibrinogen levels and the time of thrombolysis compared to diabetic rats.&#x0D; Conclusions. Q, independently of dose, inhibits the development of myocardial diastolic dysfunction and reduces prothrombotic potential in rats with type 2 diabetes, which may ameliorate diabetic cardiovascular risk. This data justify the perspective of Q for the prevention and management of cardiovascular complications in patients with type 2 diabetes.

Myocardial ischemia and left ventricular diastolic dysfunction in HIV infected patients and asymptomatic for coronary artery disease

Highly active antiretroviral therapy (HAART) allows chronicity of AIDS evolution, leading to association of other pathologies such as coronary artery disease (CAD). Myocardial ischemia (MI) and left ventricular diastolic dysfunction (LVDD) evaluation in HIV-infected patients may favor primary prevention of CAD. The study aimed to evaluate frequencies of MI and LVDD in the population living with the human immunodeficiency virus (PLHIV) and asymptomatic for CAD. We analyzed data from 110 HIV-infected patients who underwent clinical and laboratory evaluation, treadmill exercise stress test, and transthoracic echocardiogram, and compared it with 2,619 healthy individuals from the control group (non-HIV and non-CAD), selected from the database. HIV-infected patients presented lower average age (51.5 ± 7.7), systemic arterial hypertension (28.0%) and dyslipidemia frequencies (32.0%). On the other hand, their MI frequency was twice as high (14.7%); and diastolic dysfunction (DD) percentage was higher in ischemic patients (45.5%). In the HIV-infected group, MI frequency was 10.0%, while that of DD was 18.2%. MI was twice as frequent among HIV infected patients compared to uninfected, despite lower frequency of risk factors for CAD. Non-ischemic patients living with HIV had a frequency of DD more than twice compared to the control individuals.

Диабетическая кардиомиопатия: эпидемиология, этиология и патогенез

В обзоре детально проанализированы современные взгляды на эпидемиологию, этиологию и патогенез диабетической кардиомиопатии. Сахарный диабет вызывает различные структурные и функциональные модификации ткани миокарда. Эти патофизиологические изменения возникают в результате метаболических нарушений, вызванных гипергликемией, инсулинорезистентностью и дислипидемией. Свободные жирные кислоты могут стимулировать окисление и накапливаться в цитозоле, что приводит к липотоксическим эффектам путем образования церамидов, диацилглицерола и реактивных форм кислорода. Гипергликемия также вызывает увеличение содержания реактивных форм кислорода и образования конечных продуктов гликирования, что сопровождается развитием сердечной глюкотоксичности. Сочетание этих патофизиологических процессов, дефицит АТФ и липо-/глюкотоксичность являются промоторами дисбаланса Ca2+, стресса митохондриального/эндоплазматического ретикулума и развития апоптоза, активации сигнальных путей протеинкиназы С, митоген-активируемой протеинкиназы, убиквитин-протеасомной системы, протеотоксического стресса, активации циклического модулятора аденозиновых 5’-монофосфатов, ренин-ангиотензиновой системы, вызывают хроническое воспаление низкой интенсивности, диастолическую, а в дальнейшем систолическую дисфункцию, фиброз миокарда. Хроническая гипергликемия, инсулиновая резистентность и гиперинсулинемия вызывают резистентность кардиомиоцитов к инсулину и метаболические расстройства, которые усиливают дисфункцию митохондрий, оксидативный стресс, выработку конечных продуктов гликирования, нарушение обмена Ca2+ в митохондриях, хроническое воспаление низкой интенсивности, активацию системы «ренин — ангиотензин — альдостерон», стресс эндоплазматического ретикулума, гибель кардиомиоцитов, а также микрососудистую дисфункцию. Эти патофизиологические нарушения способствуют жесткости сердца, гипертрофии и фиброзу, развитию диастолической и систолической дисфункции миокарда и сердечной недостаточности.

Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters.

TO STUDY RIGHT VENTRICLE (RV) AND LEFT VENTRICLE ( LV) DYSFUNCTION IN TRANSFUSION DEPENDENT BETA THALASSEMIA CHILDREN AT TERTIARY CARE HOSPITAL IN NORTH WEST RAJASTHAN

Background- Regular blood transfusions used for long term survival in ß-thalassemia major patients cause a secondary state of tissue iron overload. Myocardial iron deposition can result in cardiomyopathy, and heart failure remains the leading cause of death. This study was planned to see the Right Ventricle (RV) and Left Ventricle(LV)dysfunction in beta thalassemia transfused patients.&#x0D; Method- Patients of ß thalassemia major above 2 years of age received regular blood transfusions at least for 1 year duration, attending OPD in the Department of Pediatrics, S P Medical College, Bikaner were included.Echo was correlated with serum ferritin Level(SFL).&#x0D; Results- Tissue Doppler imaging(TDI) parameters of 50 patients at mitral annulus e.g. Em septal, Em Lateral, Am septal, Am lateral, Sm Septal and Sm Lateral were abnormal(&lt;2SD and &gt;2SD)in 70% &amp; 0%, 50% &amp; 4%, 10% &amp; 46%, 34% &amp; 24%, 40% &amp; 22% and 60% &amp; 10% patients respectively.TDI parameters at tricuspid valvee.g. Et, At and St were abnormal(&lt;2SD)in 98%, 96% and 98% patients respectively. The differences in mean values of Et, At and St, when compared in the SFL groups &lt;2500,2500-5000 and&gt;5000, was non significant(p&gt;0.05).&#x0D; Conclusion- TDI is superior to conventional echocardiography in giving an early evidence of diastolic myocardial dysfunction in asymtopmatic and normal LV function patients.TDI can be applied as an integrated part of assessment of children &amp; adolescents with ß-thalassemia. Septal Sm, Em &amp; lateral Em, Sm, Am and RV Et, At, St were reduced early in majority of patients. Our study showed early involvement of septum and RV in thalassemic patients.&#x0D; Key Words: ß-thalassemia major ;Right Ventricle (RV) and Left Ventricle ( LV) dysfunction; Echocardiogram ;Tissue Doppler Imaging

Association of microalbuminuria with left ventricular dysfunction in type 2 diabetes mellitus

BackgroundThe prevalence of diabetes mellitus is on rising trend in developing countries like India. In type 2 diabetes patients, albuminuria has been shown to predict development of dysfunction in other organ systems such as kidneys, nervous system, and retina and increase risk of cardiovascular (CV) morbidity and mortality. In this study, we plan to assess association of microalbuminuria with left ventricular dysfunction in type 2 diabetes mellitus.ResultsThis cross-sectional study was conducted among 100 type 2 diabetes mellitus patients attending a tertiary care hospital in Gujarat, Western India. Based on urine albumin excretion status, they were divided in two groups of 50 each—normoalbuminuric and microalbuminuric patients. The mean FBS, PPBS, and HbA1c level was significantly lower in normoalbuminuric group compared to microalbuminuric group. There was an increase in cholesterol, triglyceride, VLDL, and LDL levels and decrease in HDL levels in microalbuminuric group as compared to normoalbuminuric group. Multivariate logistic regression analysis revealed that increase in age and a decrease in E/A ratio in patients with microalbuminuria was significantly associated with left ventricular diastolic dysfunction (LVDD).ConclusionThe presence of microalbuminuria is associated with increased likelihood of LVDD in type 2 diabetes patients. Increase in age and decrease in E/A ratio show direct and independent association with LVDD in normotensive diabetic patients with microalbuminuria. Therefore, diabetes patients who have microalbuminuria should be regularly (or more frequently) evaluated for development of LVDD using Echocardiography. This can allow early identification of myocardial diastolic dysfunction.

Diastolic Dysfunction Is Associated with Impaired Cardiopulmonary Exercise Performance in Sickle Cell Disease

▪Background:Left ventricular diastolic dysfunction is associated with increased mortality in sickle cell disease (SCD). Diffuse myocardial fibrosis is common in patients with SCD and is associated with diastolic dysfunction. Measurement of functional capacity by cardiopulmonary exercise test (CPET) has prognostic value in several cardiac diseases. Exercise impairment is common in SCD, but the causes and correlates are not well understood. Diastolic dysfunction is associated with a shorter 6-minute walk distance in SCD, but the effect of diastolic dysfunction and myocardial fibrosis on CPET has not been studied before.Methods:As part of a prospective study to characterize the cardiomyopathy of SCD (NCT02410811), children and adults with SCD underwent cardiac MRI (CMR), echocardiography and cycle ergometer CPET. Diffuse myocardial fibrosis was assessed by CMR-based measurement of extracellular volume fraction (ECV) from pre- and post-gadolinium T1 maps. Cardiac chamber sizes and cardiac performance were evaluated using CMR, and diastolic parameters were measured by echocardiography. Patients were classified to have diastolic dysfunction if they had left atrial enlargement and abnormalities in two diastolic parameters (E/e' ratio and e'). The following measures were recorded during CPET: percent predicted VO2 at maximum exercise (VO2 max) and ventilation efficiency (VE/VCO2 slope at maximum exercise (VE/VCO2 max). Reduced exercise capacity was defined by VO2 max <80% and classified as mild (VO2max 60-80%) or moderate to severe (VO2 max <60%).Results:Fifteen patients with SCD have completed the study (age range 8-38 years). No adverse events were reported within one month of CPET. Only one patient did not reach maximum exercise due to muscular fatigue. Fourteen patients (93%) had reduced exercise capacity; four of them (28%) had mild impairment and 10 (71%) had moderate to severe impairment. Four patients had diastolic dysfunction and none had systolic dysfunction. Patients with diastolic dysfunction had lower exercise capacity compared to patients with normal diastolic function as measured by lower VO2 max (46.6 ± 5.9% vs 59.2 ± 11.5%; p=0.02). The z-score of the left ventricular lateral E/e' ratio, a diastolic measure that reflects left ventricular filling pressure, negatively correlated with the maximal exercise capacity VO2 max (r=-0.57, p=0.02) and positively with worse ventilation efficiency measured by VE/VCO2 max (r=0.61, p=0.01), indicating an association between diastolic dysfunction and worse exercise performance. We did not find an association between ECV and exercise capacity. Hemoglobin concentration was moderately associated with VO2 max (r=0.37) but this association was not statistically significance (p=0.09).Conclusion:Diastolic dysfunction is associated with poor exercise capacity assessed by CPET in patients with SCD. Myocardial diastolic dysfunction may be one of the causes of impaired exercise capacity in SCD. Strategies to prevent or delay the acquisition of diastolic dysfunction to improve exercise capacity and long-term outcomes in SCD should be explored. DisclosuresQuinn:Global Blood Therapeutics: Research Funding.

The impact of overweight and obesity on the development of systolic and diastolic myocardial dysfunction in patients with type 2 diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf I.M. Sechenov First Moscow State Medical University Background Obesity and type 2 diabetes mellitus (DM) promote the development of systolic and diastolic myocardial dysfunction. The method of equilibrium radionuclide ventriculography (ERVG) can be used to estimate these dysfunctions. Purpose We conducted a comparative ERVG evidence-based analysis in patients with type 2 diabetes mellitus and varying degree of overweight. We analyzed the correlation between body mass index (BMI) and ERVG data. Methods The study included 42 patients (8 male and 34 female): group 1 – 12 patients with BMI 25.0-29.9 kg / m2, group 2 – 16 patients with BMI 30.0-34.9 kg / m2, group 3 – 14 patients with BMI 35.0-39.9 kg / m2. The average duration of type 2 diabetes mellitus was 11 ± 3.8 years. The average age of patients in each group was 65.8 ± 5 y.o., 57.7 ± 6 y.o., 64.6 ± 8 y.o. respectively. The groups were comparable in duration of type 2 diabetes mellitus, level of glycated hemoglobin, presence and severity of combined pathology. The patients with postinfarction cardiosclerosis and decompensated heart failure were excluded. The following ERVG indices of left ventricle (LV) and right ventricle (RV) were examined: systolic function – ejection fraction (EF), peak (PER) and average (AER) ejection rates, ejection within 1/3 of systole (ejec.1/3 s.), end-systolic volume (ESV), stroke volume (SV), diastolic function – peak filling rate (PFR), filling within 1/3 diastole (fil. 1/3 d.), end-diastolic volume (EDV). Results the EF of the LV in all examined patients was more than 40%. In group 2 we discovered an increase in the EDV and ESV indices of the LV, ESV of the RV compared to group 1 (123.8 ± 23.6 ml, 52.4 ± 14.5 ml, 66.3 ± 21.6 ml - in group 2 and 96.5 ± 22.7 ml, 37.9 ± 10.7 ml, 50.2 ± 16.7 ml - in group 1, respectively, p &amp;lt;0.05). SV of the LV in group 3 was considerably larger compared to group 1 (76.4 ± 17.8 ml vs 59.1 ± 15.6 ml, p &amp;lt;0.05). In all groups fil. 1/3 d. for LV and RV was below normal equal to 50% of EF. The correlation analysis revealed a negative association between fil. 1/3 d. of the RV and BMI (r = -0.46, p &amp;lt;0.05) in group 1. Conclusions As long as BMI increases in patients with type 2 diabetes mellitus, there is a significant increase in the ESV of both ventricles and EDV of the LV. The most sensitive ERVG indices during the obesity progression are ESV, EDV, and filling within 1/3 diastole. The revealed diastolic dysfunctions in absence of a significant decrease in EF are a manifestation of a myocardial stiffness. Early diagnosis of these disorders and correction of treatment can improve the prognosis of patients with type 2 diabetes mellitus and varying degree of overweight.

Cardiorespiratory disorders in abdominal obesity in workers of coal mining enterprises in the south of Kuzbass

Introduction. The wide prevalence of cardiovascular diseases and their close connection with obesity, especially abdominal, makes the question of the relationship of these disorders with the respiratory system highly relevant to the coal industry. Their working conditions are closely related to the harmful effects on production factors. The study aimed to study the main cardiorespiratory parameters in coal industry workers with abdominal obesity. Materials and methods. We explored 369 men, including 225 employees of coal mines and 114 workers of open-pit coal mining enterprises in the South of Kuzbass, aged from 40 to 55 years (the average age of miners - 46.2±0.36 years, workers of open-pit mines - 46.7±0.36 years, p=0.344). Scientists conducted a study of external respiration function on an analyzer of the pneumotachometric type "Spiro-Spectrum." We used the ultrasound system "Vivid E9", manufactured by General Electric, to define echocardiographic parameters. Results. The percentage of abdominal obesity among the coal mining industry employees in the south of Kuzbass was relatively high (more than 50%). At the same time, we detected arterial hypertension much more often. Scientists have found that the average values of the lungs' vital capacity and the volume of forced exhalation for the first second have decreased in both groups in the presence of abdominal obesity. Moreover, we found a pronounced deviation among the miners. Researchers associate the values of the leading echocardiographic indicators with the presence of visceral obesity. We identified high values of systolic pressure in the pulmonary artery and characteristic signs of diastolic myocardial dysfunction in the examined patients. The researchers also identified the most pronounced indices of right and left atrial volumes in miners. In underground workers, the data of correlation analysis indirectly indicate that an increase in waist circumference is not the main factor affecting the reduction in their left ventricular longitudinal deformation. But we can't say this for onshore coal mining workers, who have a moderate connection. Conclusions. Abdominal obesity harms the respiratory system of coal industry workers, more pronounced in miners. Visceral obesity is significantly associated with dysfunction of the right and left parts of the heart, both in miners and in coal mine workers.

New biomarkers of injury, inflammation and remodeling in the differential diagnosis of heart failure types

Heart failure (HF) is a global pandemic that is steadily increasing in prevalence. Currently, based on the left ventricular ejection fraction, three types of HF are distinguished. A theory was created that the HF pathophysiology is based on two processes: systolic and diastolic myocardial dysfunction. Due to the heterogeneity of HF, it is necessary to develop methods for differential diagnosis of its types to ensure adequate risk assessment and patientcentered therapy. Taking into account the objectivity, reproducibility, and high sensitivity of biomarkers of injury, inflammation, and myocardial remodeling, these parameters can be used for these purposes. To date, many biological molecules have been identified, such as sST2, Gal-3, GDF-15, FABP, IGFBP, micro-ribonucleic acid, sensitivity and specificity of which are superior to natriuretic peptides and high sensitivity troponins used today, and are already being introduced into clinical practice. At the same time, it is advisable to conduct additional prospective studies for a more objective assessment of diagnostic significance and the potential of its use in routine diagnosis and prognosis of heart failure.