Pattern Of Diastolic Dysfunction Research Articles

P095 LEFT VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSIVE PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

The aim of this work was to study the prevalence of the left ventricular diastolic dysfunction and indeterminate diastolic function in sinus hypertension individuals with left ventricular hypertrophy and preserved ejection fraction, and its associated factors. Methods. We enrolled 56 patients (aged 62, 95% confidence intervals (CI) 58–65 years, 53.6% men) with uncontrolled in-treated arterial hypertension who underwent transthoracic echocardiography (TTE, Esaote, MyLabEight). Cardiac diastolic dysfunction was defined when more than half of the TTE criteria was met according to the existing algorithm (average E/e‘, septal / lateral e‘, tricuspid regurgitation velocity, left atrium volume) and indeterminate one, when half of the criteria was encountered. A binary logistic regression analysis (Stata 15, USA) was performed to evaluate parameters for indeterminate diastolic function state. Results. TTE detected the left ventricular diastolic dysfunction only in 5.4%, however, 80.0% subjects had indeterminate diastolic function. Associated with the indeterminate diastolic function pattern factors were age and mitral regurgitation (odds ratios (OR) 8.0, 95% CI 2.19-29.25, p=0.002 and OR 1.06, 95% CI 1.01-1.12, p=0.014, respectively), however, not sex, height, weight, body mass index, diabetes, overweight/obese, and E/e‘. After adjustment for age, sex (female vs male) mitral regurgitation was occurred significantly more often in patients with indeterminate diastolic function in multivariate logistic regression model (OR 5.97, 95% CI1.47-24.35, p=0.013). Conclusions. Prevalence of the left ventricular diastolic dysfunction pattern is low (5.4%) and the indeterminate diastolic function is considerable (80.0%) in cohort of hypertensions with preserved ejection fraction with sinus rhythm. Mitral regurgitation identifies as a factor that associated with the indeterminate diastolic function patterns in hypertension patients.

Impact of Hypertension on Left Ventricular Geometry and Diastolic Function in Africa: Results from the Population-Based TAnve Health (TAHES) Cohort Study

High blood pressure leads to morphologic changes and functional alterations of the myocardial structure. Transthoracic echocardiography is of great clinical interest to evaluate these alterations, using reference values proposed by the American Society of Echocardiography/European Association of Cardiovascular Imaging, largely based on studies in Caucasian Whites. We aimed to assess the impact of hypertension on echocardiographic parameters in a sub-Saharan African community, using ethnic-specific reference values. This study is part of the TAnve HEalth Study, a population-based prospective cohort study initiated in 2015 in the district of Tanve, Republic of Benin. Hypertension was defined as systolic blood pressure ≥140mm Hg and/or diastolic blood pressure ≥90mm Hg and/or currently taking antihypertensive medications. All participants had a transthoracic echocardiography. The patterns of diastolic dysfunction and left ventricular (LV) geometry were defined from 486 subjects in the cohort, free from cardiovascular disease, diabetes, and hypertension. Of all participants, 318 (65% women, median age 48years) had hypertension. Systolic blood pressure correlated significantly (p <0.0001) with LV mass (r = 0.28), wall thickness (r = 0.25), isovolumic relaxation time (r = 0.27), E/A ratio (r = -0.35), lateral e' velocity (r= -0.41), and E/E' ratio (r = 0.39). Ventricular geometry was normal in only 22% of participants with hypertension when using the American Society of Echocardiography/European Association of Cardiovascular Imaging reference values, versus 69% with ethnic-specific reference ranges. The severity of hypertension was associated with ventricular geometry abnormalities. The prevalence of diastolic dysfunction was 14.5% (confidence interval 10.6% to 18.4%), including relaxation impairment (9%) and pseudonormal pattern (6%). Thus, correct assessment of the repercussions of hypertension on LV geometry in Black Africans requires ethnic-specific reference values.

Cardiomyocyte NOX4 regulates resident macrophage-mediated inflammation and diastolic dysfunction in stress cardiomyopathy

In acute sympathetic stress, catecholamine overload can lead to stress cardiomyopathy. We tested the hypothesis that cardiomyocyte NOX4 (NADPH oxidase 4)-dependent mitochondrial oxidative stress mediates inflammation and diastolic dysfunction in stress cardiomyopathy. Isoproterenol (ISO; 5 mg/kg) injection induced sympathetic stress in wild-type and cardiomyocyte (CM)-specific Nox4 knockout (Nox4CM−/−) mice. Wild-type mice treated with ISO showed higher CM NOX4 expression, H2O2 levels, inflammasome activation, and IL18, IL6, CCL2, and TNFα levels than Nox4CM−/− mice. Spectral flow cytometry and t-SNE analysis of cardiac cell suspensions showed significant increases in pro-inflammatory and pro-fibrotic embryonic-derived resident (CCR2−MHCIIhiCX3CR1hi) macrophages in wild-type mice 3 days after ISO treatment, whereas Nox4CM−/− mice had a higher proportion of embryonic-derived resident tissue-repair (CCR2−MHCIIloCX3CR1lo) macrophages. A significant increase in cardiac fibroblast activation and interstitial collagen deposition and a restrictive pattern of diastolic dysfunction with increased filling pressure was observed in wild-type hearts compared with Nox4CM−/− 7 days post-ISO. A selective NOX4 inhibitor, GKT137831, reduced myocardial mitochondrial ROS, macrophage infiltration, and fibrosis in ISO-injected wild-type mice, and preserved diastolic function. Our data suggest sympathetic overstimulation induces resident macrophage (CCR2−MHCII+) activation and myocardial inflammation, resulting in fibrosis and impaired diastolic function mediated by CM NOX4-dependent ROS.

Cardiac functional status of patients with Chronic Kidney Disease: A cross sectional study

Background: In the recent years, the prevalence of chronic kidney disease (CKD) has increased in the community. CKD has been associated with several cardiac diseases. The aim of the study was to assess the cardiac status of the CKD patients. Methods: This cross-sectional study was done in Rangpur Medical College Hospital, Rangpur from June 2013 to November 2013. A total of 50 CKD patients were selected by convenient type of sampling. An informed written consent was taken before enrolling the patients into the study. All the data were recorded in a pre-structured questionnaire. Analysis of the data was done by SPSS V.22. A P value of &lt;0.05 was considered as significant. Results: A total of 50 cases were studied; age ranging from 23 years to 75 years and the mean age ± SD was 45.8 ± 11.56. We study showed that 30% of patients had cardiac dysfunction, among them 18% had systolic dysfunction and 12% had diastolic dysfunction. In the study, among the diastolic dysfunction 10% had slow relaxation pattern and 02% had restrictive pattern of diastolic dysfunction. In our study, we have seen that 36% patients had left ventricular hypertrophy. ECG findings showed that 36% of patients had LVH, 6% showed anterolateral ischaemia, 6% showed inferior ischaemia, 4% showed sinus bradycardia, 2% sinus tachycardia, 2% anterior ischaemia and 2% septal ischaemia. In our study chest X-ray P/A view showed 30% had cardiomegaly, 4% had pulmonary oedema, 4% had pleural effusion and 62% had normal findings. When we staged the CKD with the GFR, it was shown that 90% patients had GFR &lt;15, 6% had GFR in between 30—59 and 4% had in between 15-29ml/min. Systolic dysfunction was more (8%) in patients having GFR &lt; 15, whereas it was only 1% in patients having GFR in between 30—59. Conclusion: This study an suggested association between chronic kidney disease (CKD) and cardiac dysfunction, both systolic and diastolic. It demonstrated a high prevalence left ventricular hypertrophy (LVH) as well. Early detection and treatment of causes of CKD should be pursued aggressively at the earliest possible time to prevent cardiovascular complications and thus reduce morbidity. Bangladesh Crit Care J September 2022; 10(2): 99-103

A study of left ventricular diastolic dysfunction in patients of sickle cell disease

Background: Left ventricular diastolic filling patterns are altered in patients with sickle cell anaemia and these diastolic abnormalities may be present in the absence of heart failure. These abnormal patterns suggest an intrinsic myocardial abnormality in patients with sickle cell anaemia and may prove to be early markers of cardiac disease. The ventricles do not properly relax and become stiff meaning they cannot fill with blood properly.Methods: This study was carried out in tertiary health care hospital in western India, where homozygous sickle cell disease patients and age and haemoglobin matched controls were taken into cross sectional observational study design.Results: The mean values of E, A, E/A, IVRT, DT, AT, were in normal range in controls. In cases although the mean values of E, A, E/A, IVRT, DT, AT were in normal range, there were 19 cases of sickle cell anaemia who had significant alteration in indices of diastolic LV function from normal range. Out of these 20 cases with diastolic dysfunction, 11 cases had significant increase in (E) velocity from normal range with E/A ratio more than 2 suggestive of restrictive filling pattern of diastolic dysfunction while in 8 cases E value was less than normal with increase in (A) velocity and E/A ratio was less than 1 suggestive of impaired relaxation pattern of diastolic dysfunction. When indices of diastolic LV function were compared in cases and controls, mean early peak filling velocity (E) was significantly higher in cases. Conclusions: In present study, out of 37 cases 19 (51%) cases had LV diastolic dysfunction. Of these 19 cases with diastolic dysfunction, 11 cases had restrictive filling pattern and 8 cases had impaired relaxation pattern of diastolic dysfunction.

A Phenotyping of Diastolic Function by Machine Learning Improves Prediction of Clinical Outcomes in Heart Failure.

Background: Discriminating between different patterns of diastolic dysfunction in heart failure (HF) is still challenging. We tested the hypothesis that an unsupervised machine learning algorithm would detect heterogeneity in diastolic function and improve risk stratification compared with recommended consensus criteria.Methods: This study included 279 consecutive patients aged 24–97 years old with clinically stable HF referred for echocardiographic assessment, in whom diastolic variables were measured according to the current guidelines. Cluster analysis was undertaken to identify homogeneous groups of patients with similar profiles of the variables. Sequential Cox models were used to compare cluster-based classification with guidelines-based classification for predicting clinical outcomes. The primary endpoint was hospitalization for worsening HF.Results: The analysis identified three clusters with distinct properties of diastolic function that shared similarities with guidelines-based classification. The clusters were associated with brain natriuretic peptide level (p < 0.001), hemoglobin concentration (p = 0.017) and estimated glomerular filtration rate (p = 0.001). During a mean follow-up period of 2.6 ± 2.0 years, 62 patients (22%) experienced the primary endpoint. Cluster-based classification predicted events with a hazard ratio 1.68 (p = 0.019) that was independent from and incremental to the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for HF, and from left ventricular end-diastolic volume and global longitudinal strain, whereas guidelines-based classification did not retain its independent prognostic value (hazard ratio = 1.25, p = 0.202).Conclusion: Machine learning can identify patterns of diastolic function that better stratify the risk for decompensation than the current consensus recommendations in HF. Integrating this data-driven phenotyping may help in refining prognostication and optimizing treatment.

Cardiovascular disintegration: A conceptual, model-based approach to heart failure hemodynamics.

The current understanding of heart failure (HF) largely centers round left ventricular (LV) function; however, disorders in serial integration of cardiovascular system may cause a hemodynamic picture similar to left-sided HF. Therefore, focusing only on LV function may be a limited and misleading approach. We hypothesized that cardiovascular system has four major integration points, and disintegration in any of these points may produce the hemodynamic picture of HF. We used a computational model in which mechanical properties of each chamber were characterized using time-varying elastance, and vascular beds were modeled by series of capacitances and resistances. The required percent changes in stressed volume (Vstressed) was presented as a measure of congestion susceptibility. As mean systemic pressure is closely correlated with pulmonary capillary wedge pressure (PCWP), arteriovenous disintegration can create a diastolic dysfunction pattern, even without any change in diastolic function. For 10%, 20%, 30%, 40%, and 50% interventricular disintegration, required Vstressed for reaching a PCWP over 20 mmHg was decreased by 42.0%, 31.2%, 22.5%, 15%, and 8.3%, respectively. Systolodiastolic disintegration, namely combined changes in the end-diastolic and systolic pressure-volume curves and ventriculoarterial disintegration significantly decreases the required percent change in Vstressed for generating congestion. Four disintegration points can produce the hemodynamic picture of HF, which indicates that combination of even seemingly mild abnormalities is more important than an isolated abnormality in a single function of a single chamber. Our findings suggest that a "cardiovascular disintegration" perspective may provide a different approach for assessing the HF syndrome.

INTERDEPENDENCE BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND ARTERIAL ELASTICITY ALTERATION

Objective: In HT, both arterial elasticity of the central arteries (C1) and of the distal circulation (C2) has been reported to be reduced and this condition favours the development of other cardiovascular diseases. Diastolic dysfunction (DD) identifies hypertensives with high cardiovascular risk independent of LV mass and BP level. Several studies have shown that the extent of diastolic function's impairment could be interdependent on the level of arterial elasticities’ alteration. PURPOSE: To evaluate the correlation between the elasticity of large and small arteries and DD Design and method: Arterial elasticity indices (C1, C2) were derived from pulse wave analysis based on a modified Windkessel model in 101 hypertensive subjects, (mean age 51.08 ± 0.79 yrs; 48.51% of men, SBP/DBP: 202.49 ± 7.41/106.7 ± 5.54 mmHg, BMI- 29.38 ± 0.22 kg/m2), without other co-morbidities. Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE)were performed at baseline and after 6, 12- months period of treatment. DD patterns were appreciated according to ASE/EACVI 2016 guidelines. Altered arterial elasticity was considered for C1 &lt; 10 ml/mm Hg × 10, C2 &lt; 6 ml/mm Hg × 1. Correlation analysis was performed using Pearson's test. The correlation coefficient was considered weak at &lt; 0.3, medium-0.3–0.7 and strong &gt; 0.7–1.0. Statistical significance was appreciated at a P-value &lt; 0.05 and highly significant at a P-value &lt; 0.001 Results: Diastolic dysfunction and C1 and C2 indices demonstrated a statistically significant correlation (p &lt; 0.001). More advanced patterns of diastolic dysfunction were associated with higher C1 and C2 abnormalities (Tab. 1,). Conclusions: Diastolic dysfunction is associated with arterial elasticity's alteration, and this association appears to have a particularly strong relationship with the extent of diastolic function's impairment. The more advanced patterns of diastolic dysfunction occurred, the stronger is the interdependence with arterial elasticity abnormalities.

Abstract 16855: NOX4 NADPH Oxidase Mediates Diastolic Dysfunction in Stress Cardiomyopathy via Regulation of Inflammation and Fibrosis

Acute sympathetic stress in adults results in catecholamine overload and often leads to development of stress cardiomyopathy complicated by long-lasting diastolic dysfunction. We previously reported that activation of β-adrenergic signaling in the heart increases reactive oxygen species-mediated inflammasome activation and IL-18 release, inducing myocardial inflammation, fibrosis, and dysfunction. Here we tested the hypothesis that NOX4 NADPH oxidase is a primary mediator of myocardial inflammation and diastolic dysfunction in the setting of acute stress. Acute stress in wild-type and mice with cardiomyocyte (CM)-specific Nox4 deletion ( Nox4 CM-/- ) was induced with a single dose of β-adrenergic receptor agonist isoproterenol (ISO; 5 mg/kg) injection. After 3 days, ISO-treated wild-type mice had higher myocardial H 2 O 2 , inflammasome activation and IL-1β, IL-18, IL-6, CCL2, and TNF-α levels and enhanced myocardial interstitial macrophage infiltration compared with vehicle-treated or Nox4 CM-/- mice (p&lt;0.001). Wild-type mice left ventricles had increased presence of activated fibroblasts (periostin + ) and myofibroblasts (α-actin-2 + ) and significantly higher interstitial collagen deposition compared with Nox4 CM-/- mice 7 days post-ISO. Assessment of left ventricular function showed significantly increased mitral valve E, decreased deceleration time, decreased tissue Doppler E’ and increased E/E’ without changes in ejection fraction and end systolic or diastolic volumes, suggesting restrictive pattern of diastolic dysfunction with increased filling pressure in wild-type compared with control or Nox4 CM-/- mice. ISO treatment of ventricular CMs isolated from wild-type mice significantly increased levels of H 2 O 2 and expression of NLRP3 and cleaved caspase-1 and IL-18 as compared with Nox4 -deficient or wild-type CMs pretreated with NOX4/NOX1 inhibitor GKT137831. These data suggest that NOX4 NADPH oxidase is a critical mediator of CM sympathetic overstimulation inducing inflammasome activation and cytokine release, myocardial inflammation, and fibrosis, resulting in impaired diastolic function. Inhibiting myocardial NOX4 during acute sympathetic stress may be beneficial to preserve cardiac function.

Diastolic function of the left and right ventricles of the heart in outpatients with arterial hypertension.

The aim of the study is to investigate the impairment of diastolic function of the left ventricle (LV) and the right ventricle (RV) in arterial hypertension outpatients. Arterial hypertension patients (n=299) and practically healthy people (n=62) were examined on an outpatient basis. Echocardiographically, diastolic dysfunctions of both ventricles were evaluated. All the arterial hypertension patients had a pattern of diastolic dysfunction (DD) of the RV of different grades (grade I RVDD and grade II RVDD), regardless of the presence or absence of pulmonary arterial hypertension. Patterns of grade I LVDD and grade I RVDD were detected in 84 patients. Patterns of grade I LVDD and grade II RVDD were detected in 77 patients. Patterns of grade II LVDD and grade II RVDD were detected in 41 patients. A pattern of grade II RVDD with normal left ventricular diastolic function was detected in 97 patients with a short duration of disease (3.92±0.48years) vs the other groups with more than 15years of hypertension. One hundred and seventy-five arterial hypertension patients had grade I or II LVDD only in 18.3% of cases according to the recommendations of the American and European societies of echocardiographers (2016). The patients with a short period of hypertensive disease have only the pseudonormal pattern of RVDD, which can be an early diagnostic marker of heart failure. Echocardiographic diagnosis of diastolic function made according to various criteria can both increase the number of chronic heart failure patients and significantly decrease it.

Relationship between ECG QRS voltage and left ventricular functions in patients with heart failure attending federal Medical Centre Nguru, Northeastern Nigeria

Introduction: Heart failure (HF) is a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral edema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Electrocardiogram (ECG) is a widely available tool; it is relatively inexpensive and simple to perform; and it yields an instant result. A normal ECG makes systolic dysfunction unlikely and is rare in patients with suspected heart failure. Low ECG voltage has been reported as a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year. However, the relationship between ECG QRS voltage and left ventricular function in patients with heart failure has not been evaluated. Therefore, the objective of this study is to determine the relationship between electrocardiographic QRS voltage and left ventricular function. Methodology: This was a prospective cross-sectional study conducted among inpatients with HF in the medical ward of the hospital. Results: Three hundred and sixty patients were recruited for the study, of which 19 had incomplete data and were excluded in the analysis. The remaining 341 subjects were analyzed comprising 215 female and 126 male with a mean age of 47.54 ± 18.85 years. Majority of patients with normal or high QRS voltage had HF with preserved ejection fraction (HFpEF), while those with low QRS voltage had HF with reduced ejection fraction (HFrEF). On the other hand, patients with high QRS voltage had impaired relaxation pattern of diastolic dysfunction, while those with low QRS voltage had a restrictive pattern of diastolic dysfunction. There was a positive and significant correlation between the QRS voltage and ejection fraction, fractional shortening, isovolumic left ventricular relaxation time, and left ventricular deceleration time, while a negative but not significant correlation was observed between electrocardiographic QRS voltage and transmitral E/A ratio. Majority of patients with normal QRS voltage had normal left ventricular geometry, while those with high QRS voltage predominantly had concentric left ventricular hypertrophy and those with low QRS voltage had eccentric left ventricular hypertrophy. Patients with concentric left ventricular hypertrophy had predominantly HFpEF and impaired relaxation pattern of diastolic dysfunction, while those with eccentric left ventricular hypertrophy had HFrEF and restrictive pattern of diastolic dysfunction. Conclusion: HF patients with high QRS voltage had preserved left ventricular systolic function, impaired relaxation pattern of left ventricular diastolic dysfunction, and concentric left ventricular hypertrophy. While those with low QRS voltage predominantly had reduced left ventricular systolic function, restrictive pattern of left ventricular diastolic dysfunction, and eccentric left ventricular hypertrophy.

P659 Patterns of diastolic dysfunction and correlation with lung ultrasound B-lines among patients with end-stage renal disease

Abstract Background Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). The degree of diastolic dysfunction (DD) as assessed by the E/e’ ratio correlates with worsening eGFR and the presence of diastolic dysfunction is an independent predictor of mortality for these patients. Purpose This study aimed to evaluate the patterns of DD in patients with end-stage renal disease not on renal replacement therapy (RRT) and investigate the correlation with lung ultrasound B-lines as an indicator of the hydration status. Methods Population: CKD patients with eGFR &amp;lt;15 ml/min/1.73 m2 referred for echocardiography. According to the ESC recommendations for DD assessment, the following parameters derived from conventional 2D echocardiography, tissue and conventional doppler imaging were used: average E/e’, septal and lateral e’ velocities, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVi), E/A, E wave velocity, EF. Lung B-lines were assessed at the same time by scanning 28 intercostal spaces (IS) on the antero-lateral chest, 2nd-5thIS along with the midaxillary, anterior axillary, midclavicular and parasternal lines. In each IS, the B-lines were counted from 0 = black lung to 10 = white lung. Results 60 patients (41 males) with an eGFR &amp;lt; 15 ml/min/1.73 m2(CKD-EPI) were included (mean eGFR = 8.3 ml/min/1.73 m2). The mean age was 61 (range 19-83) years old and 28.9% were diabetic. The number of B-lines varied between 0 and 80, with a median of 21. Of the 60 patients enrolled, 19 patients (31.6%) had an EF of &amp;lt;50%. All of them had at least grade I DD and an increased LAVi. 41 patients (68.3%) had a preserved EF (pEF) and among these, 33 had diastolic dysfunction (80.4%). Overall, 52 of the 60 patients enrolled (86.6%) had DD (54.5 % grade I, 42.4 % grade II, 3 % grade III). Mean E/e’, lateral and septal e’, LAVi, TR velocity and the grade of DD were independently correlated with the number of B-lines - as assessed by lung ultrasound (p = 0.03, r = 0.34; p = 0.005, r = 0.43; p = 0.01, r = 0.40; p = 0.04, r = 0.32; p = 0.04; r = 0.32 and p = 0.02; r = 0.37 respectively). Additionally, the number of B-lines correlated with eGFR (p = 0.0008; r = 0.51), hemoglobin (Hb) levels (p = 0.03: r = 0.33) and EF (p = 0.0002; r = 0.56). In multiple regression analysis of a model consisting of E/e’, eGFR, Hb and B-lines, the number of B-lines counted for 18% of the variance of E/e’ (R2= .118, p = 0.03, F = 4.833). Conclusions Our study confirms that DD is extremely common among patients with ESRD even in the presence of a pEF. Additionally, we proved for the first time the independent correlation between the number of B-lines as assessed by lung ultrasound and the grade of DD in ESRD patients not yet on RRT. As it correlates with worse prognosis and mortality, further studies are needed to determine whether improving DD in patients with ESRD translates into better outcomes.

P1648Prevalence of increased filling pressure assessed by echocardiography in acute dyspnoea cohort

Abstract Introduction Acute heart failure (AHF) is frequently associated with congestion leading to elevation of cardiac filling pressure. The present study investigates echocardiographic parameters of diastolic function in patients with AHF or non-AHF aetiology of acute dyspnoea. Purpose To determine the patterns of diastolic dysfunction in different profiles of acute dyspnoea. Methods Prospective multicentre observational study included 1455 acutely dyspnoeic patients in emergency departments from 2015 to 2017. Echocardiography was performed during the first 48 hours in 452 (31%) patients assessing left ventricular (LV) parameters. They were compared in four patient profiles based on dyspnoea cause and history of chronic HF (CHF): 1) AHF; 2) acute coronary syndrome without adjudicated AHF (Non-AHF+ACS); 3) non-AHF with CHF (Non-AHF+CHF); 4) other non-AHF patients (Non-AHF+other). Data were analysed using R statistical package. Results Significant differences in LV morphology and function were observed in the groups (Table 1). Increased LV filling pressure (E/E' &gt;13) was found in most of AHF and Non-AHF+ACS patients, and in around 1/4 of Non-AHF+CHF group. Furthermore, more pronounced left-sided remodelling was observed in the first two groups. 1/3 of AHF patients had restrictive pattern of LV filling. Normal filling pressure dominated in Non-AHF+CHF and Non-AHF+other subgroups. LV parameters in acute dyspnoea profiles Parameter AHF (n=291) Non-AHF + ACS (n=43) Non-AHF + CHF (n=44) Non-AHF + other (n=74) p value Age, years 71 [62–78] 72 [64–78] 71 [65–80] 68 [56–74] 0.045 LVEF, % 38 [25–55] 47 [32–55] 55 [45–55] 55 [50–55] &lt;0.001 LV MMI, g/m2 126 [104.6–150.4] 99.1 [82.9–124] 94.4 [78.3–108.6] 79.6 [70.7–99.4] &lt;0.001 LAVi, cm3 61.7 [50.9–81.1] 40.4 [35.5–46.8] 43.2 [39.8–58.9] 37.2 [32.6–43.8] &lt;0.001 E/E' &gt;13, % 57.7% 57.1% 23.1% 2.9% &lt;0.001 E/E' &lt;10, % 23.4% 38.1% 76.9% 70.6% &lt;0.001 E/A &gt;2, % 34.4% 14.8% 12.5% 3.9% &lt;0.001 E/A &lt;1, % 30.3% 59.3% 66.7% 74.5% &lt;0.001 LVEF, left ventricular ejection fraction; LVdd, left ventricular diastolic diameter; LV MMI, left ventricular myocardial mass index; LAVi, left atrial volume index; AHF, acute heart failure; ACS, acute coronary syndrome; CHF, chronic heart failure. Conclusions Our data confirm the predominance of an increased cardiac filling pressure in acute heart failure patients, differently from chronic heart failure patients admitted due to other causes of dyspnoea. Patients with dyspnoea due to acute coronary syndrome frequently demonstrate elevated left-sided filling pressure. Acknowledgement/Funding The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.

Cognitive impairment in patients with coronary arteries disease and diastolic dysfunction

Aim of the study – to assess the prevalence of cognitive impairment in patients with coronary heart disease and determine the relationship between the presence of cognitive impairment and left ventricular diastolic dysfunction.Materials and methods. 110 patients with a history of acute myocardial infarction, unstable angina, or revascularization of the coronary arteries were included. Depending on the diastolic function, the patients were divided into three groups: Group I – normal diastolic function; Group II – diastolic dysfunction, impaired relaxation; Group III – pseudonormalization or restriction patterns of diastolic dysfunction. The level of cognitive functions was determined according to the MMSE, MoCA scales, and the frontal assessment battery (FAB) scale.Results. The were no significant differences in age, duration of cardiovascular diseases, the levels of systolic and diastolic blood pressure in office measurement, lipidogram indices between groups. A significant difference between in the left ventricular mass index, diameter and left atrium volume index, end-diastolic and end-systolic volume indexes between groups was noted. The left ventricular ejection fraction was significantly higher in group I compared with groups II and III. Assessment of cognitive function by the MMSE scale showed, that 17.6 % of patients have no cognitive impairment. Mild cognitive impairment was detected in 51.9 % of patients, mild dementia was detected in 25 %, and moderate dementia - in 5.5 % of the examined. On the MoCA scale, cognitive impairment was observed in 74 % of patients. In the first group, the average score on the MMSE scale was 25.45±2.62, in the second - 24.95±2.69, in the III - 22.30±3.17 (p1.3 &lt;0.0001, p2.3 &lt;0.0005). On the MoCA scale, the corresponding values were 15.66±1.95, 15.47±2.30, 14.35±3.45 (p1.3=0.01, p2.3 &lt;0.05). Average scores on the FAB scale did not differ significantly between groups. A significant negative correlation of the average degree between the indicator E/e’ and scores on the MMSE, MoCA and FAB scales was found (r=-0.51, r=-0.42, r=-0.41, respectively).Conclusions. Cognitive impairment occurs in 92.4 % of patients with coronary artery disease. The presence of diastolic dysfunction of pseudonormalization or restriction patterns is associated with significantly worse indicators of cognitive function, while the indicator E/e’, that reflects left ventricle filling pressure, significantly correlates with scores on the scales of cognitive impairment.

KINEMATIC MODELING OF DIASTOLIC FILLING IDENTIFIES DISTINCT DIASTOLIC FUNCTION PATTERNS IN HEART FAILURE WITH PRESERVED AND REDUCED EJECTION FRACTION

Standard Doppler parameters do not characterize specific patterns of diastolic dysfunction in HFpEF vs. HFrEF. Parametrized kinematic modeling of diastolic filling (diastolic filling formalism, PDFF) may provide a more specific characterization of diastolic abnormalities. We studied 241 subjects

1025P - Independent predictors of one year mortality in patients with primary systemic immunoglobulin light chain cardiac amyloidosis

Background: Immunoglobulin light chain amyloidosis (AL amyloidosis) is a monoclonal plasma cell proliferative disorder that is characterized by tissue deposits of misfolded insoluble κ and λ light chain derived amyloid fibrils, leading to organ dysfunction. The prognosis of patients depends on the number and severity of organ involvement, especially cardiac involvement. Nearly half of the patients with amyloidosis die within a year of diagnosis. We analysed factors predicting early mortality (within one year) in patients with systemic immunoglobulin light chain cardiac amyloidosis. Methods: Retrospective analysis of patients between January 2007 and January 2016 from our hospital database. In patients with AL cardiac amyloidosis, cardiac involvement was defined as per American society of echocardiography (ASE) criteria. We evaluated the clinical, ECG and ECHO parameters of early relapse (ER) within one year in these cardiac AL amyloidosis patients. Log rank test was done to identify independent predictors of one year all cause mortality. Results: Among the 72 patients (mean age 58.2 + 8.2 years, 59.7% males) of AL amyloidosis with cardiac involvement, 32 (44.4%) died within one year. Sixty five patients (90%) received melphalan/thalidomide/bortezomib/cyclophosphamide/dexamethasone based chemotherapy as a monotherapy or in combinations. Logistic regression analysis revealed NYHA Class III/IV (p = 0.024), BNP (p = 0.031), Troponin I (p = 0.042), Free light chain difference (p = 0.011) and restrictive pattern of diastolic dysfunction (E/E1 > 20) to be independent predictors of all cause mortality (p = 0.021). Kaplan Meir survival analysis showed a worse prognosis in patients with E/E1 > 20 (Log rank, p < 0.001). In addition, in patients who completed atleast 6 months of chemotherapy, a decrease in E/E 1 (survivors delta E/E1 5.2+ 0.8, nonsurvivors 0.8+ 0.3, p = 0.001) is associated with better one year survival. Conclusions: AL Cardiac amyloidosis carries a poor outcome. Baseline Troponin I, NYHA class III/IV, difference in free light chain, restrictive pattern of diastolic dysfunction and BNP were the independent predictors of early mortality within 1 year in patients with AL cardiac amyloidosis. In patients who completed atleast 6 months of chemotherapy, a decrease in the ECHO parameter E/E1 is associated with better one year survival. This will help us in better prognostication of patients with AL cardiac amyloidosis. Legal entity responsible for the study: Amrita institute of medical sciences Funding: None Disclosure: All authors have declared no conflicts of interest.

Assessment of diastolic dysfunction in hypertensive patients and its association with left ventricular mass index

Objective: Early detection of diastolic dysfunction in hypertensive patients to reduce complications and improve outcome. Place of Study: East Medical and Cardiology wards of Mayo Hospital Lahore. Study Design: A descriptive cross-sectional study. Patients and Methods: 51 hypertensive patients between 50 - 80 years of either sex enrolled through out patient department of Mayo Hospital Lahore underwent Doppler Echocardigraphy and data was analyzed by using Chi-square and Students `t` tests. Results: The percentage of left ventricular hypertrophy (LVH) was 66.66%. On comparing hypertensive patients with and without LVH, E and A wave velocities, E:A ratio, deceleration time and isovolumic relaxation time were similar. Conclusion: 33.33% of patients had no LVH in the presence of diastolic dysfunction so LVH was not an independent factor associated with abnormal flow patterns in hypertensive patients with normal systolic contractility. Impaired relaxation was the predominant pattern of diastolic dysfunction an d increased further with age.

Association and pattern of diastolic dysfunction in metabolic syndrome: Potential for diagnosis and prognosis

BackgroundThere is need to assess left ventricular diastolic dysfunction (LVDD) in metabolic syndrome to effectively implicate and strengthen population-based prevention strategies. ObjectivesTo assess the prevalence of LVDD in metabolic syndrome. MethodsThis study was conducted in the Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot on 100 cases (with metabolic syndrome diagnosed on International Diabetic Federation criteria) and 100 age- and sex-matched controls (without metabolic syndrome) between 30 and 60 years of age by echocardiography to assess LVDD. ResultsOverall prevalence of diastolic dysfunction was 73% in the cases and 14% in controls with an increasing trend with increasing age in both groups showing age an important determinant of diastolic dysfunction; gender-wise difference was not significant in any group. However, increasing trend with increasing body mass index, elevated blood pressure, elevated fasting blood sugar, elevated serum triglyceride, and deceased serum high density lipoprotein was noted showing their risk correlation in the outcome of diastolic dysfunction; participants without metabolic syndrome had lesser diastolic dysfunction (14%). ConclusionsThe diastolic dysfunction in metabolic syndrome was found to be higher that supports the assumption that metabolic syndrome could be correlated to risk of development of LVDD. Holistic prevention of metabolic syndrome has an important role to prevent development of diastolic dysfunction.

Continuous infusion or bolus injection of loop diuretics for patients admitted for severe acute heart failure: Is one strategy better than the other?

Introduction and ObjectivesIntravenous loop diuretics are an essential part of acute heart failure management; however, data to guide their use is sparse. Our aim was to compare continuous intravenous infusion of loop diuretics with intravenous bolus administration in terms of efficacy and adverse events in patients admitted with severe acute heart failure. MethodsOver a period of three years, 110 patients were admitted to our cardiac intensive care unit with acute heart failure. Clinical, laboratory and prognostic parameters were compared according to the diuretic strategy used and mortality and readmission for acute heart failure during follow-up were analyzed. ResultsPrevious medical history was similar in the two groups. At admission, the continuous infusion group met criteria for worse prognosis: lower systolic blood pressure (p=0.011), more severe renal injury (p=0.008), lower left ventricular ejection fraction (p=0.016) and higher incidence of restrictive pattern of diastolic dysfunction (p=0.032). They were more often treated with vasopressors (p=0.003), inotropes (p=0.010), renal support therapy (p=0.003) and non-invasive ventilation (p<0.001). They had longer hospitalizations (p=0.014) and a higher incidence of cardiorenal syndrome (p=0.009); however, at discharge, there were no differences in renal function between the groups. In-hospital mortality was similar, and during follow-up there were no differences in mortality or readmission for acute heart failure. ConclusionsContinuous infusion was preferred in patients presenting with worse clinical status, in whom renal dysfunction was transiently worse. However, in-hospital mortality and creatinine at discharge were similar. Continuous infusion thus appears to counteract the initial dire prognosis of more unstable patients.

Continuous infusion or bolus injection of loop diuretics for patients admitted for severe acute heart failure: Is one strategy better than the other?

Introduction and ObjectivesIntravenous loop diuretics are an essential part of acute heart failure management; however, data to guide their use is sparse. Our aim was to compare continuous intravenous infusion of loop diuretics with intravenous bolus administration in terms of efficacy and adverse events in patients admitted with severe acute heart failure. MethodsOver a period of three years, 110 patients were admitted to our cardiac intensive care unit with acute heart failure. Clinical, laboratory and prognostic parameters were compared according to the diuretic strategy used and mortality and readmission for acute heart failure during follow-up were analyzed. ResultsPrevious medical history was similar in the two groups. At admission, the continuous infusion group met criteria for worse prognosis: lower systolic blood pressure (p=0.011), more severe renal injury (p=0.008), lower left ventricular ejection fraction (p=0.016) and higher incidence of restrictive pattern of diastolic dysfunction (p=0.032). They were more often treated with vasopressors (p=0.003), inotropes (p=0.010), renal support therapy (p=0.003) and non-invasive ventilation (p<0.001). They had longer hospitalizations (p=0.014) and a higher incidence of cardiorenal syndrome (p=0.009); however, at discharge, there were no differences in renal function between the groups. In-hospital mortality was similar, and during follow-up there were no differences in mortality or readmission for acute heart failure. ConclusionsContinuous infusion was preferred in patients presenting with worse clinical status, in whom renal dysfunction was transiently worse. However, in-hospital mortality and creatinine at discharge were similar. Continuous infusion thus appears to counteract the initial dire prognosis of more unstable patients.