Myocardial Diastolic Function Research Articles

Effect of complex therapy on indicators of intracardiac hemodynamics in patients with arterial hypertension combined with chronic obstructive pulmonary disease

Aim. To study the effect of complex treatment of patients with arterial hypertension in combination with chronic obstructive pulmonary disease (COPD), including drug treatment and training programs, on the indicators of intracardiac hemodynamics. Materials and methods. 84 patients with stage II hypertension in combination with COPD were examined. Males made up 69.5% and females 30.5%. The average age of patients was 53.9±0.49 years. All patients underwent clinical and laboratory tests, transthoracic Doppler echocardiography, ambulatory blood pressure (BP) monitoring, and indicators of lung function were determined. The studied patients were prescribed a fixed combination of antihypertensive drugs: amlodipine 5 mg with perindopril 4 mg (Dalneva, KRKA) and COPD therapy according to GOLD (2017). Patients of the 1st group (n=45) on the background of drug treatment were trained in the school of health, patients of the 2nd group (n=39) did not attend the school of health. Results . By the 6th month of therapy, 97.8% of patients in group 1 the target blood pressure level was achieved, in the 2nd group - in 74.4%. By the end of examination in patients of group 1, left ventricular myocardial mass index (LVMI) decreased by 10.9% (p=0.01). In group 2, on the background of drug therapy, there was a 5.9% decrease in LVMI (p=0.1), but in comparison with group 1, it was less pronounced (p=0.02). Normalization of LVMI was observed in 20.2% of patients in group 1 and 5.1% of patients in group 2, which was accompanied by an improvement in left ventricular myocardial diastolic function. An increase in the mean values of left ventricular stroke volume and left ventricular ejection fraction in group 1 (p=0.01) was registered, indicating an improvement in the systolic function of the left ventricular myocardium. By the 6th month of treatment, there was an improvement in bronchial patency, but in the 2nd group of patients, changes in spirometry indicators were statistically insignificant. Conclusion. The use of combination therapy, including fixed combinations of antihypertensive drugs and group training programs in patients with arterial hypertension in combination with COPD, contributes to adequate blood pressure control, increases adherence to treatment, which is accompanied by an improvement in hemodynamic parameters and respiratory function. Regression of signs of left ventricular hypertrophy and improvement of its diastolic function in these patients, calls for a wide application of training programs in the treatment of comorbid patients at the early stages of the disease.

A New Framework for Performing Cardiac Strain Analysis from Cine MRI Imaging in Mice

Cardiac magnetic resonance (MR) imaging is one of the most rigorous form of imaging to assess cardiac function in vivo. Strain analysis allows comprehensive assessment of diastolic myocardial function, which is not indicated by measuring systolic functional parameters using with a normal cine imaging module. Due to the small heart size in mice, it is not possible to perform proper tagged imaging to assess strain. Here, we developed a novel deep learning approach for automated quantification of strain from cardiac cine MR images. Our framework starts by an accurate localization of the LV blood pool center-point using a fully convolutional neural network (FCN) architecture. Then, a region of interest (ROI) that contains the LV is extracted from all heart sections. The extracted ROIs are used for the segmentation of the LV cavity and myocardium via a novel FCN architecture. For strain analysis, we developed a Laplace-based approach to track the LV wall points by solving the Laplace equation between the LV contours of each two successive image frames over the cardiac cycle. Following tracking, the strain estimation is performed using the Lagrangian-based approach. This new automated system for strain analysis was validated by comparing the outcome of these analysis with the tagged MR images from the same mice. There were no significant differences between the strain data obtained from our algorithm using cine compared to tagged MR imaging. Furthermore, we demonstrated that our new algorithm can determine the strain differences between normal and diseased hearts.

Myocardial deformation and parameters of diastolic function of the left ventricle in workers of coal mining enterprises in the South of Kuzbass with arterial hypertension

Introduction. Long-term persistent hypertension can lead to heart failure. The study of its early markers, which include diastolic dysfunction of the left ventricle and reduction of longitudinal myocardial deformation, is of importance for workers engaged in harmful and dangerous working conditions.The aim of the study is to evaluate the parameters of myocardial deformation and diastolic function of the left ventricle, as well as their interrelation with arterial hypertension in workers of the coal mining industry in the South of Kuzbass.Materials and methods. 384 people were examined (men), including 266 workers of coal mines in the South of Kuzbass (drifters, stope miners, operators of rock removing machines) and 118 persons who were not employed in the coal industry, aged from 40 to 55 years. Arterial hypertension was detected according to the clinical recommendations for the diagnosis and treatment of arterial hypertension in 2019. The structural and functional state of the heart was studied by echocardiography with evaluation of the longitudinal deformation of the left ventricle by 2D-strain method and its diastolic function using pulse-wave and tissue dopplerography.Results. The prevalence of persons with arterial hypertension in the group of workers employed in the coal industry was established: 43.2% against 26.3% in the comparison group (p=0.002). Longitudinal deformation of the left ventricular myocardium in all subjects was significantly less in the presence of high blood pressure: -21.0±0.18 vs. -19.2±0.22% (p<0.001) in the main group and -21.54±0.22 vs. -19.84±0.38% (p<0.001) in the comparison group. It should also be noted that there is a tendency to differ in subgroups of subjects without arterial hypertension towards a greater reduction in longitudinal myocardial deformation in coal miners (-21.54±0.22 and -21.0±0.18%, p=0.062). In miners, diastolic left ventricular dysfunction was significantly more common than in the group without occupational hazards: 52.5 and 39.3%, respectively, p=0.021. Its presence in the cohort of coal miners with arterial hypertension was detected significantly more often (58.9%) than in individuals with normal blood pressure (25.9%), p<0.0001. In turn, in the group of people not employed in the coal industry, diastolic dysfunction of the left ventricle was also more common in the presence of arterial hypertension: in 42.6 and 13.9% of cases, respectively (p<0.001).Conclusions. The incidence of arterial hypertension among coal miners was significantly higher than in people who do not work at coal mining enterprises. In all patients with arterial hypertension, the longitudinal deformation of the left ventricular myocardium with the preserved ejection fraction was lower than in those with normal blood pressure. Diastolic myocardial dysfunction of the left ventricle was significantly more common among those examined with underground working conditions, especially in the group of people with arterial hypertension.The authors declare no conflict of interests.

Effects of Adrenocorticotropic Hormone Treatment on Heart Muscle in Patients with Infantile Spasm.

Background and aimInfantile spasm (IS) is a common epileptic syndrome of childhood epilepsies. The most effective treatment for IS is adrenocorticotropic hormone (ACTH). We hypothesized that ACTH treatment might change myocardial systolic and diastolic performance and cause cardiovascular side effects. This study aims to evaluate the effects of ACTH treatment on the heart muscle in IS patients.Materials and methodsEighteen newly diagnosed patients with IS participated in the study. ACTH (Synacthen® Depot) administered for two months in a total of 18 doses. A twelve-channel-surface electrocardiogram (ECG) and echocardiography performed in all patients before ACTH treatment, the second month after ACTH treatment (end of treatment), and two months later (after treatment). The systolic and diastolic myocardial functions were assessed by conventional and tissue Doppler imaging (TDI).ResultsThe mean age of the patients was 8.1 months, and the patient group consisted of five female and 13 male subjects. None of the patients had clinically significant arrhythmia during treatment. After treatment, the mean heart rates of the patients significantly decreased (p=0.02), the systolic and diastolic blood pressures of patients did not change. We observed mild septal hypertrophy and an increase in the left ventricle mass index with ACTH treatment. Septal hypertrophy did not show progression until the fourth month after treatment. After ACTH treatment, patients had higher left ventricular myocardial performance index and lower E′ and A′ values at the mitral lateral annuli, however, these values didn't statistically significant from pretreatment values.ConclusionThe low dose and short duration ACTH treatment in IS patients may cause subclinical myocardial hypertrophy. ACTH treatment has no significant side effects on cardiac functions.

Melatonin fine-tunes intracellular calcium signals and eliminates myocardial damage through the IP3R/MCU pathways in cardiorenal syndrome type 3

Cardiorenal syndrome type-3 (CRS-3) is characterized by acute cardiac injury induced by acute kidney injury. Here, we investigated the causes of CRS-3 by analyzing cardiac function after renal ischemia–reperfusion injury (IRI) using echocardiography and evaluation of pro-inflammatory markers, calcium balance, mitochondrial function, and cardiomyocyte death. Our results show that renal IRI reduces cardiac diastolic function associated with cardiomyocyte death and inflammatory responses. Renal IRI also disrupts cardiomyocyte energy metabolism, induces calcium overload, and impairs mitochondrial function, as evidenced by reduced mitochondrial membrane potential and increased mitochondrial fission. Further, renal IRI induces phosphorylation of inositol 1,4,5-trisphosphate receptor (IP3R) and expression of mitochondrial calcium uniporter (MCU), resulting in cytoplasmic calcium overload and mitochondrial calcium accumulation. Pretreatment with melatonin attenuates renal IRI-mediated cardiac damage by maintaining myocardial diastolic function and reducing cardiomyocyte death. Melatonin also inhibits IP3R phosphorylation and MCU expression, thereby alleviating cytoplasmic and mitochondrial calcium overload. Blockade of IP3R has similar cardioprotective effects, whereas MCU activation abrogates the melatonin-mediated cardioprotection. These results show that the negative effects of renal IRI on myocardial viability and cardiac function are caused by induced IP3R phosphorylation, MCU upregulation, and calcium overload. Melatonin protects cardiac function against CRS-3 by suppressing IP3R-MCU signaling.

Evaluation of the effectiveness of combined treatment of coronary heart disease – coronary artery bypass grafting, transplantation of autologous bone marrow mononuclear cells: a randomized, double-blind, placebo-controlled study

Introduction . Despite resounding success in treatment of patients with coronary heart disease (CHD), researchers are yet unable to significantly reduce mortality in this disease. With this in mind, there are ongoing studies everywhere, which are aimed at investigating new techniques in order to boost the efficiency of existing standards. One of such promising techniques is cell/regenerative therapy with autologous bone marrow mononuclear cells (ABMMCs). However, even though ABMMCs have been studied for more than 10 years, there are no unambiguous data yet on several issues. Objective : to evaluate the outcome of ABMMC transplantation during coronary artery bypass grafting (CABG) surgery in combined treatment of CHD. Materials and methods . The data of 408 patients admitted to the clinic from 2013 to 2016 for planned surgical treatment of CHD were analyzed. The work included 117 people based on the design of the study. Patients were randomized in 3 groups: Group 0 (control group) – CABG surgery and intramyocardial injection of 0.9% NaCl solution, Group 1 – CABG surgery and intramyocardial injection of ABMMCs, Group 2 – CABG surgery, intramyocardial and intra-graft injection of ABMMCs. The dynamics was assessed 12 months later – functional class of angina pectoris and heart failure, echocardiography, speckle tracking (assessment of the degree of myocardial deformation), treadmill test, 6-minute walk test, daily ECG monitoring, quality of life questionnaires, coronary angiography. Qualitative indicators were calculated using the Pearson’s chi-squared test and Fisher criteria. Quantitative indicators were calculated using the Kruskal–Wallis and Wilcoxon tests. Factor analysis was used to identify certain severity factors and to study data homogeneity. Discriminant analysis was performed to investigate the leading characteristics that determine differentiation between the groups. For analysis of variance, taking into account various factors, the model of variance analysis for dependent samples – Repeated Measures ANOVA – was used. Results . In the observation groups, an improvement in both systolic and diastolic myocardial function was universally noted. A six-minute walk test showed statistically significant increase in Groups 1 and 2 compared with the control Group 0 – 315.06 ± 17.6 (433.54 ± 20.6), Group 1 – 319.8 ± 24.5 (524.4 ± 28.7), Group 2 – 329.9 ± 25.3 (452.7 ± 29.7) meters. A significant decrease in the functional class of exertional angina pectoris in Groups 1 and 2 was noted unlike in the control group. The percentage of functioning coronary shunts after a 12-month follow-up period was 87.6% in Group 0. In Groups 1 and 2, this ratio was 96.2% and 97.3%, respectively. Predictors of overall effectiveness were identified: smoking, initial diastolic myocardial dysfunction, left ventricular ejection fraction. Conclusion . In addition to surgical treatment of coronary heart disease, ABMMC transplantation can improve myocardial contractility, boost exercise tolerance, and increase the duration of the functioning of coronary shunts at the follow-up period of 12 months. The study showed the need for stage-by-stage analytical calculations with the aim of possible correction of further work.

Risk assessment of acute kidney injury in patients with acute cardiovascular disease without invasive intervention

To evaluate the prevalence, predictors, prognostic value of cardiorenal interrelations in patients with acute cardiovascular disease (CVD), and to develop an algorithm for stratification these patients at risk of acute kidney injury (AKI). 566 patients (pts) were examined: 278 with acute decompensated heart failure (ADHF) and 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS). The levels of electrolytes, glucose, urea, creatinine were evaluated, glomerular filtration rate (GFR) was determined according to the formula CKD-EPI. Chest x-ray, electrocardiography at admission and in dynamics, echocardiography at admission with assessment of systolic and diastolic myocardial functions were performed. Chronic kidney disease (CKD), AKI, ADHF, NSTE-ACS were diagnosed according to Russian and international Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if p<0.05. Different variants of cardiorenal interrelations were revealed in 366 (64.7%) pts. CKD was diagnosed in 259 (45.8%), with more than half of the cases (61%) diagnosed for the first time at this hospitalization, 62 (11%) pts had signs of kidney damage of unknown duration (which did not allow to diagnose CKD). AKI occurred in 228 (40,3%) pts, more frequently in patients with ADHF vs with NSTE-ACS (43.5 and 37.2%). In all groups stage 1 of AKI was prevalent. In-hospital mortality was significantly higher in pts with AKI vs without AKI (14.9 vs 3.6%, p<0.001). The risk of AKI was determined by kidney function and blood pressure levels at admission, and comorbidities. Prevalence of cardiorenal interactions in patients with acute CVD (ADHF and NSTE-ACS) was 64.7%. Development of AKI was associated with poor prognosis in both groups. Renal function and blood pressure levels on admission are the main predictors of AKI.

P1767 Abnormal longitudinal peak systolic strain in asymptomatic patients with psoriatic arthritis

Abstract Background/Introduction: Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting 15-30% of patients with psoriasis. Patients with PsA present 43% higher risk of cardiovascular disease compared to non-psoriatic patients. However, the probable existence of subclinical myocardial dysfunction in these patients has not been fully elucidated. Purpose Purpose of this study is to evaluate systolic and diastolic myocardial function in asymptomatic patients with PsA and no cardiac comorbidities and to reveal the value of speckle tracking echocardiography in this object. Methods Sixty patients (29 males, mean age 52.55) and 34 healthy controls (18 males, mean age 50.79) participated the study. They were subjected to TTE to evaluate left ventricular systolic function with conventional indexes such as ejection fraction (EF) and with novel indexes such as global longitudinal strain (GLS); diastolic dysfunction was also assessed in both groups. Blood exams were conducted including crp, esr. Severity scales of the disease such as PASI and DAS 28 scores, and the duration of the disease were also recorded. Results Linear regression analysis showed significantly impaired global longitudinal peak systolic strain (GLS) in PsA patients (mean =-19.79, s.d. =4.54) compared to the controls (mean =-23.67, s.d. =3.27). Ejection fraction, on the contrary, did not show any significant difference between the two groups. Left ventricular diastolic function did not present significant difference between the two groups. Comparison of GLS with PASI and DAS 28 scores, disease duration, esr and crp showed no association. Conclusions PsA patients present a higher risk of left ventricular systolic dysfunction. GLS is a useful tool in revealing myocardial impairment. Moreover, this high risk for systolic dysfunction did not appear to correlate with disease severity markers. Systolic and diastolic function indexes GroupStatistics group N Mean Std. Deviation Std. ErrorMean p-value E/A Cases 60 1,1510 ,49319 ,06367 0,971 Controls 34 1,1471 ,53555 ,09185 E/E" (average) Cases 60 8,21 3,016 ,389 0,703 Controls 32 7,95 3,096 ,547 GLS (%) Cases 52 -19,795 4,5495 ,6309 <0,001 Controls 34 -23,671 3,2668 ,5602 EF(%) Cases 59 59,24 3,919 ,510 0,986 Controls 34 59,26 10,880 1,866 Differences between PsA patients and control group Abstract P1767 Figure. GLS in PsA patients and control group

Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity

The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.

The Impact of Distinct Exercise Training Modalities on Echocardiographic Measurements in Patients with Heart Failure with Reduced Ejection Fraction

Exercise training is an important component of multidisciplinary heart failure management. However, the effects of aerobic training (AT) versus resistance training (RT) on cardiac function in patients with heart failure with reduced ejection fraction are not well defined. The aim of this study was to evaluate the impact of these exercise modalities on echocardiographic parameters. Participants with stable heart failure with reduced ejection fraction (ejection fraction<50%) were randomized to 12weeks of AT, RT, or untrained control. Exercise was performed at matched relative intensities of each training modality (50%-70% of maximum). Echocardiography and cardiopulmonary exercise testing were performed at baseline and after 12weeks of training. Thirty-eight participants were randomized, and 12 in each group completed the intervention (meanage, 61.5±1.7years; 89% men). Peak oxygen consumption increased from 14.5±1.3 to 17.2±1.6ml · min-1 · kg-1 after AT and from 13.7±1.2 to 16.4±1.1ml · min-1 · kg-1 after RT (P<.001 for both). In the AT group, there was a decrease in septal e' (from 0.052±0.004 to 0.041±0.004m/sec) and increases in E/e' ratio (from 18.2±3.1 to 23.8±3.5), left atrial volume (from 86±9 to 99±10mL), and right ventricular end-diastolic area (from 18±1 to 20±1cm2; P<.05 for all), but these were unchanged in the control and RT groups. There were no significant changes in left ventricular diameters or volumes or right ventricular fractional area change after exercise. There is a differential effect of AT versus RT on some echocardiographic parameters in patients with heart failure with reduced ejection fraction. AT was associated with evidence of worsening myocardial diastolic function, whereas this was not apparent after RT. Further studies are indicated to investigate the long-term clinical significance of these adaptations.

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

P4529Atrioventricular optimization in cardiac resynchronization therapy with quadripolarleads, improves energy handling and quality of life in heart failure patients: HUMVEE Trial

Abstract Background Cardiac resynchronization therapy (CRT) is a well-established technique for symptomatic heart failure (HF) patients, producing significant clinical benefits. Recent studies have revealed the potential role of multipoint pacing (MPP) in improving response and clinical outcomes. The aim of Heart failUre study of Multisite pacing effects on VEntriculoartErial coupling (HUMVEE) trial was to evaluate the association between MPP of the left ventricle vs those of standard biventricular pacing (BVP) on: a) ventriculoarterial coupling (VAC) and energy efficiency of the failing heart, b) diastolic function, c) quality of life, and d) NT-proBNP levels. Methods HUMVEE is a single-center, prospective (13 months) trial (clinicaltrials.gov identifier NCT03189368), of 54 NYHA III patients (69±9 years; 79% men; 50% dilated cardiomyopathy), under optimal tolerated medical therapy, with standard BVP indication, having being implanted with a CRT system able to deliver both modes of pacing. Creatinine and NT-proBNP levels and echocardiographic measurements (VAC calculation, strain rate, diastolic function assessment), as well as 6-min-walking-test and quality of life (MLHF questionnaire) were measured at baseline, 6 months post BVP optimization (right before MPP activation) and at the end of follow-up (6 months post MPP optimization). Cardiac power (CP) was calculated according the equation: CP=Cardiac Output x Mean Aortic Pressure/451. Results Both CRT and MPP improved 6-min-walk (differences at baseline/6 mo/end of FU: 277±27 vs. 345±27 vs 363±27 m, p=0.07); left ventricular ejection fraction (24,2% vs 30,6%vs, 32%, p=0.05); end -diastolic diameters of left ventricle (65±1,4 vs. 63±1.7 vs. 61±1.1, p=0.03); end-systolic volume (150±15 vs. 140±10 vs. 131±13, p=0.08); stroke volume (41.6±9 vs. 53.6±14 vs. 62±9, p=0.0001 for MPP); left atrial volume (76±5 vs. 74±10 vs 61±6, p=0.001 for MPP), E/Emv (14±5 vs. 12±4 vs. 11±3, p=0.05 for MPP); NtproBNP (2782±1000 vs. 2080±2500 vs. 2000±1000, p=0.05 for MPP). VAC was reduced from 1.14±0.27 to 1.1±0.17 (p=0.1) while CP increased from 564.2±142 to 768±103 (p=0.009). Quality of life score (the lower the better) improved from 23.75±17 at baseline to 17.25±10 at end of FU (p=0.05). Conclusions MPP is a new, promising pacing modality with the potential to improve HF patients' outcome, offering additive effects on myocardial energy balance, cardiac power, systolic and diastolic ventricular function and aortoventricular coupling, especially in ischemic patients. HUMVEE trial illustrates those clinical, imaging and biochemical divergences of MPP from standard BVP that reflect significant improvement in quality of life in patients with advanced HF and cardiac dysychronization.

P5266Renal denervation improves diastolic dysfunction in patients with HFpEF - initial results of a multicenter CMR study

Abstract Introduction Renal denervation (RDN) significantly reduces blood pressure (BP) and improves myocardial function in patients with resistant hypertension. Purpose This multicenter study aimed to investigate the intermediate term effect of RDN on left ventricular global longitudinal strain (GLS), a surrogate for diastolic myocardial function in RDN patients with proven heart failure with preserved ejection fraction (HFpEF), assessed by cardiac magnetic resonance imaging (CMR). Methods We analyzed data from 22 patients with resistant hypertension (mean age 68±6 years). 16 patients underwent renal denervation (RDN) and 6 matched control patients received optimal medical therapy (OMT). Both groups had diastolic dysfunction defined by preserved ejection fraction (EF ≥50%) and pathologically elevated GLS at baseline (GLS &gt;−18%) quantified by cardiac magnetic resonance (CMR). A standardized CMR protocol was performed at baseline (BL) and 6 months follow-up (FU). Left ventricular mass index (LVMI) was quantified in end-diastolic and end-systolic endo- and epicardial contouring in short axis cine-MRI images. GLS was measured by end-diastolic and end-systolic endocardial contouring in 2-, 3- and 4-chamber view cine-MRI images. MRI-Images have been analyzed with Medis, Netherlands. Results GLS following RDN patients significantly improved after 6 months by 21% (−14.21% ±3.19 vs. −17.17%± 3.1; p=0.007). In control patients with OMT, no significant change in GLS was detected (−14.77% ±3.05 vs. −17.39% ± 4.49; p=0.327). LVMI was numerically reduced in the RDN group at follow-up but did not reach statistical significance (58.55 g/m2±11.37 vs. 55.46 g/m2±12.76; p=0.085). There was no such effect in control patients with OMT (49.25 g/m2±8.2 vs. 50.18 g/m2±7.27; p=0.665). (See also: Figure A and B). Conclusions We found significantly improved diastolic function (GLS) in patients with HFpEF and resistant hypertension undergoing RDN. Future studies are needed to determine whether RDN represents a treatment option in patients with HFpEF.

Professional chronic obstructive pulmonary disease in combination with heart failure — clinical and functional features

Introduction. Heart failure increases the severity of symptoms and worsens the prognosis of chronic obstructive pulmonary disease (COPD) in smokers. Professional COPD is a separate phenotype, which suggests dif erences in the pat ern of comorbidity. Professional COPD in combination with heart failure has not been studied enough. T e aim of the study was to determine the relationship of heart failure c clinical, functional and hygienic characteristics of professional COPD. Materials and methods. T e one-center observational study included 115 patients with occupational chronic obstructive pulmonary disease (OCOPD). T e comparison group of 103 patients with COPD, smokers of tobacco. T e diagnosis of COPD met the criterion of GOLD 2011–2019. OCOPD patients were exposed to aromatic hydrocarbons with an excess of MPC in the air of working zone is 1.5 to 6 times, or of inorganic dust in the range of 2 to 9.5 MPC. Heart failure was diagnosed on the basis of any signs of myocardial dysfunction in echocardiography and/or elevation of the N-terminal precursor of cerebral natriuretic peptide (NT-pro-BNP) serum more than 125 PG/ml. the Groups were comparable in sex, age, durationof COPD, duration of action of exogenous etiological factor, causes of heart failure. Clinical and functional characteristics of COPD and heart failure were evaluated. For comparisons between groups for quantitative parameters used covariance analysis or test Kruskall-Wallis for comparison, the share of χ2 criterion. Relationships were determined by logistic regression. Results. In patients with OCOPD, the heart failure rate was higher — 63 (54.8%) cases compared to 38 (36.9%) in the group of COPD Smoking (p=0.009). Biventricular failure prevailed (44 (38.3%) patients) with preserved ejection fraction(47 (40.9%) cases). Right ventricular failure was detected in 15 (13.0%) of the subjects, lef ventricular failure — in 4 (3.5%), p=0.002. Echocardiography revealed severe pulmonary hypertension and diastolic myocardial dysfunction in the OCOPD group. OCOPD in combination with heart failure was characterized by CAT index values of more than 10 points, low exercise tolerance, a signif cant rate of decline in FEV1, a decrease in the partial tension of arterial blood oxygen, severe exacerbations of COPD. In multivariate analysis of the development of heart failure in patients with OCOPD predicted: length of service, systolic pressure in the pulmonary artery, partial oxygen tension of arterial blood, the test distance of six-minute walk. Conclusions. 1. OCOPD is characterized by a probability of heart failure — 54.8%. Biventricular failure with preserved ejection f action and predominant violation of diastolic myocardial function prevails. 2. T e subphenotype of OCOPD in combination with heart failure is characterized by severe symptoms, hypoxemia of rest, severe exacerbations of COPD.

The Relationship Between Rhythm Variability and the Structural and Functional State of the Heart in Patients with Cerebral Atherosclerosis

The objective: to identify the presence of relationships between indicators of HRV and the structural and functional state of the heart in patients with cerebral atherosclerosis (CA) stage 1–3, depending on the hemispheric localization of the ischemic focus.Materials and methods. In a comprehensive study, 229 patients with CA 1–3 rd degree took part. The patients were divided into 4 groups: І - those who had ischemic stroke (IS) in the right hemisphere (RH); II – transferred IS in the left hemisphere (LH); ІІІ – with CA of 1st – 2nd degree (without IS – comparison group); IV – a general group of patients who have undergone ischemic atherothrombotic stroke. The age of patients of the examined groups ranged from 55 to 75 years. All patients underwent transthoracic echocardiography and an ECG with an assessment of heart rate variability (HRV). Statistical analysis was performed using non-parametric methods (Mann – Whitney test, Spearman’s rank correlation coefficient). Results are presented as medians and 25%, 75% quartiles. To identify the relationship between the indicators of the structural and functional state of the heart and HRV, a correlation analysis was carried out with the calculation of the Spearman’s rank correlation coefficient.Results. In the general group of patients undergoing IS, one inverse correlation was established between the indices of the left ventricular myocardial mass index (MMI) and LF/HF% (r=–0,298), and in the group of patients without IS with CA 1–2 stages were established to relate the index of the relative wall thickness of the LV with the HRV and LF/HF indices (r=–0,196 and r=0,183 respectively) and 2 links of the LV diastolic myocardial function index with HRV and the triangular index (r=0,202 and r=0,217 respectively). When comparing groups of patients with different localization of IS, it was found that for patients with IS in the L, there is a characteristic of 3 MMLV connections with PNN50% and LF/HF% (0,322, –0,304 and –0,373 respectively), whereas for patients with the localization of IS in RH links no links were established.Conclusions. In patients with cerebral atherosclerosis without ischemic stroke, a decrease in HRV with activation of the sympathetic nervous system is associated with concentric LV remodeling and more severe left ventricular diastolic dysfunction. The presence of an ischemic focus in the left hemisphere of the brain, in contrast to the right hemisphere, determines more pronounced changes in HRV in patients as the degree of LV hypertrophy increases, which determines the high risk of repeated vascular events.

Metabolic effectiveness of gliflozins and gliptins in the routine clinical practice of patients with type 2 diabetes: preliminary results from GIOIA, a prospective multicentre study

AimsGIOIA is an ongoing prospective multicentre study aiming to assess the vascular and metabolic effects of SGLT-2 inhibitors (gliflozins) and DPP-4 inhibitors (gliptins) in the routine clinical practice of patients with type 2 diabetes (T2D). Herein we describe the preliminary effectiveness data at 6 months. MethodsSGLT-2i and DPP-4i-naïve adult patients with T2D (N = 301 and 260, respectively), with glycated haemoglobin A1c (A1C) >7%, an estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, on background therapy with metformin, insulin or both, are being followed to evaluate markers of vascular (carotid intima-media thickness), myocardial (myocardial diastolic function) and renal (urinary albumin/creatinine ratio) damage during treatment with SGLT-2i or DPP-4i for a period of 24 months. ResultAt baseline, patients initiated on SGLT-2i are younger (about 6 years) and more heavy (about 7.5 kg), have higher A1C level (0.5% more), a longer diabetes duration and more CV events (20% more) than patients initiated on DPP‐4i. At 6 months, patients on SGLT-2i (N = 298) and DPP-4i (N = 258) exhibit significant ameliorations in A1C (−1.% and −0.7%, respectively), which were greater (−1.2% and −0.81%) in those on a background metformin treatment only. The composite endpoint (A1C ≤ 7.0% + weight loss ≥ 3 kg) was achieved by 24% and 16% of patients receiving SGLT-2i or DPP-4i, respectively. No unexpected adverse events were reported. ConclusionsBoth SGLT-2i and DPP-4i provide substantial improvements in metabolic parameters in the usual clinical practice of T2D, especially when used as second-line treatment.

NT-proBNP as an Early Marker of Diastolic Ventricular Dysfunction in Very-Low-Birth-Weight Infants.

The objective is to examine the correlation between plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) echocardiographic parameters in the first 28days of life in very-low-birth-weight infants (VLBWI). VLBWI admitted to the Neonatal Intensive Care Unit (NICU) at Hospital Puerta del Mar, Spain, from January 2015 to January 2017 were prospectively enrolled. Weekly determination of plasma NT-proBNP (pg/mL), and echocardiograms were done during the first 28days of life. 101 preterm infants with a mean GA of 28.85weeks (± 1.85 SD) and mean birth weight of 1152g (± 247.4 SD) were included. A total of 483 echocardiograms and 139 NT-proBNP determinations were performed.We found a negative correlation between plasma NT-proBNP levels and diastolic velocities: mitral A' (ρ = - 0.15, p = 0.04), mitral E' (ρ = - 0.17, p = 0.02), tricuspid A' (ρ = - 0.20, p = 0.006), tricuspid E' (ρ = - 0.24, p = 0.0009). In the first 24h of life, NT-proBNP levels were strongly correlated with mitral A' and E' velocities in patients with no patent ductus arteriosus (PDA) (ρ = - 0.75, p = 0.04). In preterm patients, elevated NT-proBNP levels are related to worse diastolic myocardial function. In the first 24h, this correlation is much stronger in the absence of PDA.

Methodical, Diagnostic and Prognostic Aspects Using Transmitral Blood Flow Indicators as Markers of Diastolic Dysfunction During the Progression of Chronic Heart Failure

The objective: to evaluate changes in transmitral blood flow indices asmarkers of myocardial diastolic function using Doppler echocardiography with an increase in the severity of chronic heart failure (CHF).Materials and methods. 84 patients with CHF II-III FC were examined. Evaluation of left ventricular (LV) diastolic function was carried out by the Doppler-echocardiography method in pulsed mode on a Toshiba SSH-160A apparatus (Japan) using a 3.5 MHz transducer based on transmitral diastolic blood flow.Results. The analysis showed that if in patients with CHF II FC,LV myocardial hypertrophy dominates in the pathogenesis, then in patients with CHF III FC there is systolic dysfunction. The main pathogenetic factor in the increase in the severity of CHF from II to III FC is diastolic dysfunction.Conclusion. In patients with CHF II FC in an intact left atrium, impaired transmitral diastolic blood flow occurs in the «slow relaxation» mode. Patients with CHF II FC against the background of an increased size of the left atrium, especially in the presence of post-infarction cardiosclerosis and arrhythmias, are diagnosed with a «pseudonormal» type of transmitral blood flow. The majority of patients with CHF III FC are diagnosed with a «restrictive» type of transmitral blood flow.

MYOCARDIAL FUNCTIONS IN OBESE CHILDREN WITH SUBCLINICAL HYPOTHYROIDISM

Ponte Academic JournalFeb 2019, Volume 75, Issue 2 MYOCARDIAL FUNCTIONS IN OBESE CHILDREN WITH SUBCLINICAL HYPOTHYROIDISMAuthor(s): Atilla Cifci ,Mehmet BoyrazJ. Ponte - Feb 2019 - Volume 75 - Issue 2 doi: 10.21506/j.ponte.2019.2.11 Abstract:Childhood obesity is an important health problem representing a major public health concern worldwide. An isolated elevation of Thyroid Stimulating Hormone (TSH) with normal levels of thyroid hormones is frequently found in obese children. It has been named Isolated Hyperthyreotropinemia or Subclinical Hypothyroidism (SCH) and may be considered a consequence of obesity. SCH is related to impairment of both systolic and diastolic myocardial function in the adult population. Objective: Aim of this study is to evaluate whether SCH affects myocardial function in childhood obesity. Material and Methods: We examined 48 obese children and adolescents with SCH and 70 obese children and adolescents with normal TSH. Doppler echocardiography was performed in order to evaluate myocardial function to all cases in both groups. Results: Global systolic function was evaluated with, ejection fraction (EF) and compared between groups. Right ventricular global systolic function and pressure were significantly decreased in SCH group. LV mass index was significantly higher in SCH group (p=0.041). Global systolic function was evaluated as EF and no difference was found among the groups. RV global longitudinal function was evaluated with TAPSE measurement and a significant decrease was observed for this value in SCH group compared to the other group (p=0.0015). MAPSE lateral and MAPSE septum which are important for showing LV longitudinal function in SCH group decreased significantly (p=0.004 and p=0.002). Similarly, tissue Doppler imaging (TDI) and peak systolic movement were decreased in SCH group (9,6±1,8 cm/s vs 11.5±1.7 cm/sn; p=0.03). In addition, significant changes were observed in both systolic and diastolic functions in the left ventricle in SCH group. Conclusions: These results suggest the possible involvement of cardiac functions in obese children with SCH. Download full text:Check if you have access through your login credentials or your institution Username Password

Effect of PCI on Cardiac Function in Chronic Stable Angina Patients with âNormalâ Ejection Fraction: A Tissue Doppler Study

Background: Patients with stable coronary artery disease may have subtle derangements in their cardiac function before evident changes occur in conventional echocardiography-derived ejection fraction (EF). These derangements manifest firstly in the longitudinal before circumferential LV function. The effect of percutaneous coronary intervention (PCI) on ventricular function in patients with chronic stable angina has shown controversial results. In the current study, we tried to assess the impact of PCI on myocardial systolic and diastolic function using different noninvasive indices in patients with stable coronary artery disease. \ Methods: A total of 50 patients scheduled for elective PCI were enrolled in this study. All had chronic stable angina and a left ventricular ejection fraction>55%. All underwent echocardiographic evaluation of left ventricular function using EF and Myocardial Performance Index (MPI), in addition to pulsed-wave tissue Doppler imaging (TDI) at the mitral and lateral tricuspid annulus. All indices were measured one day before and 5 days after PCI. Results: 44% of the patients were males and 56% were females. The mean age was 55.5 ± 9.1 years. There was a significant improvement of the mean systolic myocardial velocity S′ wave in the LV as a whole and the lateral RV annulus 5 days after intervention irrespective of the lesion site. There was also a highly significant improvement in anterior S′ wave velocities 5 days after intervention. Conclusion: Pulsed wave tissue Doppler is more sensitive in postPCI monitoring and follow up of systolic function in patients with chronic stable angina and seemingly normal baseline cardiac function