Myocardial Diastolic Function In Patients Research Articles

Effect of positive end-expiratory pressure on cardiac function in patients with early left ventricular diastolic dysfunction: a prospective cohort study

To evaluate the effect of positive end-expiratory pressure (PEEP) ventilation on cardiac function in patients with early left ventricular (LV) diastolic dysfunction undergoing laparoscopic radical gastrectomy. Patients who underwent laparoscopic radical gastrectomy under elective general anesthesia from July 2021 to February 2022 at the Subei People's Hospital were enrolled [age 60-75 years old, American Society of Anesthesiologists (ASA) grade I-II, and left ventricular ejection fraction (LVEF) > 0.50]. Transthoracic echocardiography (TTE) was performed before operation, and the peak early diastolic velocity (E peak) and peak late diastolic velocity (A peak) at the mitral ostium were recorded and the E/A and E peak deceleration time (DT) were calculated. Then isovolumic relaxation time (IVRT) and early peak mitral annular diastolic velocity (e') were recorded and left ventricular E/e' (LVE/e') was calculated. According to the E/A, mitral e', LVE/e', DT, and IVRT, the patients were divided into early LV diastolic dysfunction group (E/A < 1, mitral e' < 7 cm/s, LVE/e' > 14, DT > 200 ms, and IVRT > 100 ms) and normal cardiac function group (1 < E/A < 2, 160 ms < DT < 240 ms, and 70 ms < IVRT < 90 ms), with 35 patients in each group. Both groups were received fixed 5 cmH2O (1 cmH2O ≈ 0.098 kPa) PEEP 5 minutes after the beginning of the pneumoperitoneum until the end of the procedure. A volume controlled ventilation was used with a tidal volume (VT) of 7 mL/kg, an inspired oxygen concentration of 0.60, and an inspiratory to expiratory ratio of 1:2. Left and right myocardial systolic and diastolic function related parameters, including LVEF, LV global longitudinal strain (LVGLS), tricuspid annulus plane systolic migration (TAPSE), the peak early diastolic velocity (E peak) at the mitral and tricuspid valve ostia and the peak early diastolic velocity (e') at the corresponding annulus were measured by transesophageal echocardiography (TEE) before tracheal intubation (T0), 5 minutes after the pneumoperitoneum (T1), 5 minutes after PEEP ventilation (T2), 30 minutes after PEEP ventilation (T3), and 5 minutes after the end of pneumoperitoneum (T4), respectively. The left and right ventricular myocardial performance index (LVMPI/RVMPI) was calculated. Finally, 60 patients were included in the analysis, including 28 patients in the early LV diastolic dysfunction group and 32 patients in the normal cardiac function group. Compared with those at T0, mean arterial pressure (MAP), LVEF, mitral e', LVGLS, tricuspid e' and TAPSE were significantly lower in the normal cardiac function group at T1, and the early LV diastolic dysfunction group at T1, T2, and T3, and LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those at T0 (LVE/e': 16.52±1.26 vs. 14.32±1.09, and RVE/e': 18.71±1.74 vs. 16.51±1.93, respectively, both P < 0.05), Mitral e' and tricuspid e' were significantly lower than those at T0 [mitral e' (m/s): 0.07±0.01 vs. 0.09±0.01, tricuspid e' (m/s): 0.06±0.01 vs. 0.08±0.01, both P < 0.05]. Compared with the normal cardiac function group, MAP, LVEF, mitral e', LVGLS, tricuspid e', and TAPSE at T1, T2, and T3 were significantly lower in the early LV diastolic dysfunction group, while LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those in the normal cardiac function group (LVE/e': 16.52±1.26 vs. 9.87±1.25, RVE/e': 18.71±1.74 vs. 10.97±1.70, both P < 0.05). Mitral e' and tricuspid e' were significantly lower in the normal cardiac function group [mitral e' (m/s): 0.07±0.01 vs. 0.11±0.02, tricuspid e' (m/s): 0.06±0.01 vs. 0.10±0.02, both P < 0.05]. In early LV diastolic dysfunction patients, compared with patients with normal cardiac function, 5 cmH2O PEEP can further exacerbate left and right myocardial systolic and diastolic function in patients during pneumoperitoneum; when the pneumoperitoneum was ended, 5 cmH2O PEEP only worsen left and right myocardial diastolic function in patients, and did not affect left and right myocardial systolic function.

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Types of remodeling and assessment of myocardial diastolic function in patients with ACS and CCS

Abstract Funding Acknowledgements Type of funding sources: None. Objective to study the features of the structural and functional condition of the myocardium in patients with various forms of coronary artery disease. Methods. 165 patients with various forms of coronary artery disease were examined. On average, patients NSTEMI - 90, NSTE-ACS - 25, STEMI - 25, chronic coronary syndrome (CCS) - 25. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes. All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association. Results. Evaluation of the nature of structural-geometric remodeling of the left ventricle (Fig. 1) revealed the predominance of normal geometry in patients with NSTEMI in comparison with STEMI (8 (8.9%) vs. 2 (8.0%), p= 0.06), and in the group with NSTE-ACS in comparison with STEMI (0 (0) vs. 2 (8.0%), p = 0.02). Concentric remodeling was significantly more common in the group of patients with NSTEMI compared with STEMI (23 (25.6%) vs. 2 (8.0%), p = 0.06), and in the group with NSTE-ACS compared with STEMI (9 ( 36.0%) vs. 2 (8.0%), p = 0.02). Analysis of the nature of diastolic transmitral blood flow revealed the following changes normal type - 5 vs. 0 in the groups of NSTE-ACS and STEMI, respectively (p = 0.02), the type of relaxation disorder - 58 against 19 in the groups NSTEMI and NSTE-ACS, respectively (p = 0.02), 58 vs. 13 in the NSTEMI and STEMI groups, respectively (p = 0.03), 19 vs. 13 in the NSTE-ACS and STEMI groups, respectively (p &amp;lt;0.0001), 19 vs. 16 in the NSTE-ACS and CCS groups, respectively (p= 0.04), by type of pseudonormalization - 23 against 1 in the groups NSTEMI and NSTE-ACS, respectively (p =0.02), 23 against 12 in the groups NSTEMI and STEMI, respectively (p = 0.03), 1 against 12 in the groups NSTE-ACS and STEMI, respectively (p &amp;lt;0.0001), 1 vs. 6 in the groups NSTE-ACS and CCS, respectively (p = 0.04). Conclusions. The highest degree of concentric remodeling was found in patients with NSTE-ACS, concentric hypertrophy in the CCS group, excentric hypertrophy in the STEMI group. Changes in transmitral blood flow by type of relaxation disorder prevailed in the NSTE-ACS group, by type of pseudonormalization in STEMI patients. In patients with NSTEMI, transmitral blood flow prevailed as a type of relaxation disorder. Abstract Figure. Fig. 1

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Two-dimentional speckle tracking strain imaging in the assessment of myocardial diastolic function in patients with stable angina pectoris

Article type Systematic review article Introduction: Ischemic heart disease is caused mainly by obstruction of coronary arteries. The ischemic assessment through echocardiography is dependent on wall motion abnormality detection during systole. In patients with ischemic heart disease the diastolic function is impaired before systolic function and measurement of regional diastolic dysfunction if possible will be most sensitive for assessment of obstructed coronary artery region. This study was designed to determine whether regional left ventricular delayed relaxation diagnosis could be detected with strain imaging derived from two-dimensional speckle tracking echocardiography in patients with coronary artery disease. Methods: All the articles reviewed were obtained using MEDLINE & ScienceDirect (up to October 2014). All data extracted by speckle tracking echocardiography. The index which is used is strain imaging diastolic index which is calculated as: (A-B) A×100. A is the amount of strain at the time Aortic value closure and B is the amount of strain in first one-third point of diastolic duration. Result: Four articles were reviewed. Three articles assessed patients with echocardiography at rest and one with stress echocardiography. All articles showed the coronary artery tracking with significant stenosis is possible by regional deformation analysis through two-dimensional strain. Discussion: The usage of strain images obtained through two-dimensional speckle tracking has been validated for the quantitation assessment of regional dysfunction in ischemic heart disease. Regional LV delayed relaxation diagnosis with strain imaging is a reliable method after treadmill stress test. Conclusion: Strain imaging is reasonable for evaluation of ischemia as a low cost noninvasive test with high accuracy.

Peculiarities of myocardial diastolic function in patients with autoimmune thyroiditis divided according to the mild hypothyroidism range

The aim of the present study was to evaluate myocardial diastolic function in patients with autoimmune thyroiditis (AT) against the TSH level within the reference range and subclinical interval as well as to determine whether it is related to the thyroid function or other metabolic and functional indices. METHODS. We studied diastolic function of left and right ventricles by the ratio of mitral and tricuspid annular early and late diastolic velocities (em/am and et/at respectively) using tissue Doppler imaging; structural heart characteristics by echocardiography; lipid profile and peroxidation parameters; serum ferritin and iron concentrations in 132 middle-aged women. 36 of them were euthyroid controls, 96 had AT and were ranged according to their TSH value into 4 groups: women with “low- normal” (0.4–2.5 mU/L) and “upper-normal” (2.5–4.0 mU/L) TSH range; patients with subclinical hypothyroidism and TSH below and above 6 mU/L. RESULTS. The increase of TSH value within reference range and subclinical interval was associated with the parallel tendency to the em/am and et/at ratio decrease suggesting detrimental effect of the mildest thyroid failure on the left and right ventricles diastolic function. Thus, patients with TSH values >6 mU/L had significantly lower em/am and et/at ratio compared to the “low-normal” TSH group ( p < 0.05) and controls ( p < 0.01). Among them, the highest LDL cholesterol, myocardial mass index and oxidative stress rate were detected as well as lower iron and ferritin serum concentrations ( p < 0.05 compared to controls with regard to all the parameters listed above). Abnormalities in heart structure, lipid and iron metabolism correlated with alterations in ventricular relaxation suggesting that they can contribute, at least partly, to the diastolic dysfunction devel- opment CONCLUSION. The increase of TSH value within reference range and subclinical interval can affect diastolic function of the heart. Its detrimental effect may be mediated, at least partly, by ventricular mass changes, lipid profile and iron metabolism alterations.

Beneficial effects of ramipril on myocardial diastolic function in patients with type 2 diabetes mellitus, normal LV systolic function and without coronary artery disease: a prospective study using tissue Doppler

Angiotensin-converting enzyme (ACE) inhibitors can improve cardiovascular outcome in patients with type 2 diabetes mellitus (T2DM). Myocardial diastolic function (Ve) is a known marker of cardiovascular prognosis. It could potentially indicate the effects of preventive therapy if evaluated by tissue Doppler. We tested the hypothesis that treatment with the ACE inhibitor ramipril has beneficial effects on Ve. In this study, 16 subjects on insulin therapy (eight receiving 10 mg ramipril/day compared to eight matched controls who were not treated with an ACE inhibitor) were followed up for a period of nine months. Myocardial and vascular function were assessed by tissue Doppler and ultrasound. In the ramipril group, Ve improved significantly after nine months of treatment (7.8+/-0.9 cm/s to 8.6+/-0.9 cm/s, p<0.04). Systolic blood pressure and intima media thickness (IMT) demonstrated a trend towards improvement. In controls, Ve remained unchanged and there was a trend towards deterioration in stiffness index beta (p<0.07). In conclusion, the observed improvement of myocardial diastolic function with ramipril in patients with T2DM is an encouraging result. It might contribute to the overall improvement that has been observed with hard cardiovascular end points.

Beneficial effects of ramipril on myocardial diastolic function in patients with type 2 diabetes mellitus – a prospective pilot study in comparison to matched control individuals

Background/aims: Treatment with ACE-inhibitors is an important factor within multi-modal strategies to improve cardiovascular outcome for patients with type 2 diabetes mellitus (T2DM). Myocardial function may have the potential to serve as an immediate indicator in the assessment of preventive therapy if evaluated by a sensitive technology such as tissue Doppler which quantifies diastolic myocardial function, known to have important prognostic relevance. Consequently, the hypothesis was tested, that treatment with ramipril (R) has beneficial effects on myocardial diastolic function in T2DM.

Diastolic Function in Young Patients with Beta‐Thalassemia Major: An Echocardiographic Study

We aimed to evaluate myocardial diastolic function in patients with beta-thalassemia major (beta-TM) using pulsed-tissue Doppler imaging (TDI) and flow propagation (VP), in relation to BNP levels. We enrolled 192 consecutive patients with beta-TM (88 men (25 +/- 6 years) and 104 women (26 +/- 6 years), with normal left ventricular (LV) systolic function. By TDI, diastolic myocardial velocities were sampled at the lateral section of the mitral annulus (Smv, Emv, Amv). From the apical four-chamber view diastolic transmitral flow velocities, including measures of E- and A-waves were performed. The propagation velocity of early flow into the LV cavity was measured by color M-mode Doppler. Plasma BNP levels were measured in all patients. A nonlinear relationship was found between BNP levels and E/A ratio (beta coefficient for the second-order term = 1.4 +/- 0.4, P = 0.001). We also found a positive association of BNP levels with Amv (r = 0.28, P = 0.023), and a reverse with Smv (r =-0.59, P = 0.01) and Emv/Amv (r =-0.36, P = 0.019). Moreover, an inverse relationship was observed between BNP and Vp (r =-0.43, P = 0.012) levels. Finally, a strong positive linear relationship was found between E/Vp ratio and BNP levels (r = 0.76, P < 0.001). A U-curved association of E/A ratio of transmitral Doppler velocity was revealed with BNP levels, while the tissue Doppler of the Emv/Amv of the mitral annulus movement showed a negative linear association with BNP levels.