Peak Early Diastolic Flow Velocity Research Articles

P743 Right ventricular function is important for exercise capacity in patients at risk of heart failure

Abstract Background and Purpose It is important to evaluate exercise capacity to detect the development of heart failure (HF) in patients with heart disease. The pathology of exercise capacity is multi-factorial, and cardiac function is recognized as one of the most important determinants. However, the correlation between right ventricular (RV) function and exercise capacity is not fully understood in the subjects without HF. Therefore, we assessed the relationship between RV function and exercise capacity, both in patients with HF (HF+) and in patients with heart disease but not developed HF (HF-). Methods Two hundred and fifty-two patients with heart disease who underwent both Doppler echocardiography at rest and cardio-pulmonary exercise testing (CPET) for the assessment of heart function were enrolled (HF+: n = 142, HF-: n = 110). We measured left ventricular ejection fraction (LVEF), peak early diastolic transmitral flow velocity (E), peak late diastolic transmitral flow velocity (A), early diastolic mitral annular velocity (e’), left atrial volume (LAV), and tricuspid annular plane systolic excursion (TAPSE) by echocardiography. After echocardiographic examination, symptom-limited exercise testing was performed with simultaneous respiratory gas analysis, and peak oxygen consumption (pVO2) was determined. Blood examination including hemoglobin (Hb) and brain natriuretic peptide (BNP) was done on the same day. Results There were significant relationships between pVO2 and LVEF (r = 0.16, p = 0.005), e" (r = 0.51, p < 0.0001), E/e" (r=-0.47, p < 0.0001), LAV (r=-0.21, p = 0.0002), and TAPSE (r = 0.33, p < 0.0001) in the whole subjects. In the multiple regression analyses, age, Hb, E/e" and TAPSE were selected as significant determinants for pVO2 both in HF+ (R²=0.39, p < 0.0001) and HF- (R²=0.33, p < 0.0001). Conclusion RV function is the prime determinant of exercise capacity in patients at risk of HF, as well as in patients with HF. Abstract P743 Figure.

PATTERN OF CHANGES OF CENTRAL BLOOD PRESSURE AND VOLUME DEPENDENT ECHOCARDIOGRAPHIC PARAMETERS IN MONITORING OF NORMOTENSIVE PREGNANCY

Objective: We investigated changes of brachial and central blood pressure (BP) as well as volume dependent echocardiographic parameters in different time points of pregnancy.Design and method: Data from 60 healthy pregnant women (mean age 31.4 ± 4.3 years) were analysed. Hypertensive women were excluded from the study. In all women complete echocardiographic study, brachial and central BP measurements were performed at 11–13, 20–22 and 30–32 weeks of pregnancy. Central and brachial BP was measured by Pulsecor (CardioScope) device. In echocardiography: left ventricle end diastolic volume (LVEDV), early diastolic peak flow velocity (E velocity), late diastolic peak flow velocity (A velocity), left atrium area (LAA) and left atrium volume index (LAVI) were assessed. Also E/A index was calculated. Results: Brachial systolic BP (SBP) was higher and brachial diastolic BP (DBP) was lower as compared to respectively central SBP and central DBP at all three time points (p < 0.0001- for each). Brachial and central SBP and DBP levels were higher at 11–13 as compared to 20–22 weeks, but no difference was found between 20–22 and 30–32 weeks (Table). There was a significant increase of LAVI between all three-time points. LVEDV and LAA increased between 11–13 and 20–22 weeks but not between 20–22 and 30–32 weeks. Significant decrease in E velocity between 20–22 and 30–32 weeks was observed. There were no differences in E/A between subsequent measurements (Table). There were no significant differences in heart rate between time points. Conclusions: Our results indicate that LAVI is the best echocardiographic parameter reflecting physiological changes in blood volume overload in normal uncomplicated pregnancy. We also observed that changes in brachial BP were consistent with changes in central BP. Brachial BP and LAVI are sufficient parameters in monitoring physiological pregnancy.

The potential role of testosterone in hypertension and target organ damage in hypertensive postmenopausal women.

Objective: The aim of this study was to confirm the potential role of testosterone in hypertension and target organ damage (TOD) in hypertensive postmenopausal women.Methods: A matched group study was conducted. One hundred sixty-one hypertensive postmenopausal women between 45 and 65 years of age were enrolled as group 1. Another 161 age-matched hypertensive men were enrolled as group 2. Ambulatory blood pressure monitoring, echocardiographic imaging, vascular function, sex hormones and clinical characteristics were evaluated. Quantitative data were analyzed using independent Student’s t-test and multiple regression analysis.Results: The mean and load level of blood pressure were lower in women than in men (P<0.05), except for the mean level and load of the nocturnal systolic blood pressure (SBP) (123.77±15.72 mmHg vs 126.35±15.64 mmHg, and 50.43±30.31% vs 55.35±28.51%, P>0.05). However, the carotid-femoral pulse wave velocity (cf-PWV) in women was higher than that in men (9.68±2.23 m/s vs 8.03±2.82 m/s, P<0.05). The ratio of the early diastolic mitral peak flow velocity to early diastolic mitral annular velocity (E/Em) was obviously impaired (13.06±3.53 vs 12.05±3.68, P<0.05) in women. Furthermore, in women, a positive correlation was found between testosterone and cf-PWV (γ=0.157, P=0.046), and Cf-PWV was positively related to the mean level of nighttime SBP (γ=0.210, P=0.008). Moreover, nocturnal SBP was a risk factor for E/Em (γ=0.156, P=0.048, P<0.05).Conclusion: Testosterone may play a role in the correlation between hypertension and TOD in hypertensive postmenopausal women.Clinical Trial number: This research study was registered under the ClinicalTrials.gov PRS Website (NCT03451747).

3384 Serum Metabolites from the Trimethylamine Pathway Associate with Left Ventricular Diastolic Function: The Bogalusa Heart Study

OBJECTIVES/SPECIFIC AIMS: This population-based study aims to assess the individual and collective relationship between TMA-associated metabolites and echocardiographic parameters of left ventricular diastolic function. METHODS/STUDY POPULATION: The study cohort consisted of 1,039 adult participants of the Bogalusa Heart Study (35.13% black, 57.94% female, aged 33.60 to 57.47 years). Left ventricular diastolic function was assessed via two dimensional and tissue Doppler echocardiography. Echocardiographic parameters of diastolic function included peak early (E, cm/s) and late transmitral flow velocities (A, cm/s), septal mitral annular velocity (e’, cm/s), left ventricular isovolumic relaxation time (IVRT, ms), and peak early diastolic transmitral flow velocity deceleration time (DT, ms). Metabolomic analysis of fasting serum samples was conducted via ultrahigh performance liquid chromatography-tandem mass spectroscopy. Six metabolites in the TMA pathway, carnitine, choline, TMAO, betaine, ergothioneine, dimethylglycine, and two composite variables, the betaine/choline ratio as well as the weighted sum of the six TMA-associated metabolites (TMA score), were selected a priori and tested for association with echocardiographic parameters of diastolic function. Raw metabolite values were divided by their respective standard deviation to create an exposure variable for each individual metabolite. The betaine/choline ratio was calculated utilizing the raw value of each metabolite. The z-score method was used to transform the six metabolites to the same scale and these values were used to calculate the TMA score. Multivariable-adjusted linear regression models were employed to assess the relationship of TMA-associated metabolites with echocardiographic measures of diastolic function. Covariates adjusted for included sex, age, race, education, alcohol drinking, cigarette smoking, heart rate, systolic blood pressure, glomerular filtrate rate, body mass index, low density lipoprotein cholesterol, high density lipoprotein cholesterol, hemoglobin A1c, serum triglycerides, as well as blood pressure-, lipid-, and glucose-lowering medications. RESULTS/ANTICIPATED RESULTS: After stringent Bonferroni correction for multiple testing, four TMA-associated metabolites as well the TMA score were significantly associated with diastolic function. TMAO was inversely associated with IVRT (ß = −0.002 (0.00); p-value = 2.00E-03). Betaine (ß = 0.40 (0.08); p-value = 2.10E-07), carnitine (ß = 0.30 (0.07); p-value = 7.80E-05), dimethylglycine (ß = 0.27 (0.07); p-value = 3.00E-04), and the TMA score (ß = 0.10 (0.02); p-value = 3.40E-05), were positively associated with the septal E/e’ ratio. No significant associations were observed between metabolites or metabolite composite scores from the TMA pathway and the E/A ratio or DT. DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first population-based study to assess the role of TMA-associated metabolites in left ventricular diastolic function. Betaine, carnitine, dimethylglycine, and a metabolite score combining serum metabolites from the TMA pathway were positively associated with the septal E/e’ ratio, suggesting that a higher concentration of TMA-associated metabolites correlates with impaired diastolic function. These results suggest that both individual and grouped metabolites from the TMA pathway may serve as early biomarkers for pre-clinical diastolic dysfunction, an important causal factor for HFpEF. Future longitudinal, multi-omic studies incorporating microbiome, metabolomic and dietary analyses are needed to characterize the risk of ventricular diastolic function and HFpEF in the setting of exposure to TMA-associated metabolites.

Noninvasive assessment of left-ventricular diastolic electromechanical coupling in hypertensive heart disease.

There is a need to stratify patients who may develop heart failure because of the current "heart failure pandemic". We hypothesized that noninvasive assessment of diastolic electromechanical coupling by electrocardiography and Doppler echocardiography may be clinically useful for risk stratification of hypertensive patients who may develop heart failure. We measured the time from the peak to end of the T wave (TpTe) as an electrophysiological parameter, and peak early diastolic mitral flow (E) and lateral annular (e') velocities as mechanical parameters in 109 patients with hypertension. Relationships between these parameters and their association with the prognosis were evaluated. The e' was inversely correlated with TpTe (p < 0.001) and QTc (p < 0.014), whereas E/e' was positively correlated with TpTe (p < 0.001) and QTc (p < 0.001). The TpTe predicted patients with E/e' > 12. There were 24 cardiovascular events during follow-up (57 ± 20months), and Kaplan-Meier analysis showed that outcome was worse (p = 0.003) in patients with higher E/e' than lower E/e'; however, there was no difference between patients with longer TpTe (≧72ms) and shorter TpTe (< 72ms). The correlation of TpTe with e' and E/e' in hypertensive patients suggests that these parameters reflect diastolic ventricular electromechanical coupling. The E/e' predicted outcome, and an elevated E/e' should be suspected when TpTe is prolonged (> 72ms). Noninvasive evaluation of diastolic electromechanical coupling is clinically useful in patients with hypertension for predicting their outcome.

Cesarean section predominantly affects right ventricular diastolic function during the early transitional period

Although the mode of delivery is well known to affect pulmonary function, theeffects of a cesarean delivery on postnatal changes in cardiac mechanics have not been clearly defined. To evaluate whether delivery mode influences cardiac function in the early transitional period, 42 infants delivered by cesarean section (CS) and 110 by vaginal delivery (VD) were enrolled, and they underwent serial echocardiography at 0, 1, 2, and 5 days of age. Longitudinal changes in ejection fraction (EF), fractional area change (FAC), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), Tei index, ratio of peak early diastolic flow velocity (E) to peak early diastolic annular velocity (e') (E/e'), and deceleration time (DcT) were compared between the two groups. FAC and DcT of both ventricles increased during the first week, whereas Tei index of each chamber decreased irrespective of delivery mode. E/e's of both ventricles were significantly higher and MAPSE was significantly lower in the CS than VD group throughout the observation period. After adjustment for the effects of birth weight, gestational age, and oxygen administration by multivariate analysis, right ventricular E/e', which reflects diastolic function of the right ventricle, was most affected by delivery mode. CS affected diastolic function of the right ventricle in the 2nd day after giving birth and did not persist. Delayed adaptation of the neonatal myocardium and/or persistence of pulmonary hypertension might explain the hemodynamic changes in neonates born by CS.

A0748 The specific effect of testosterone on nocturnal systolic blood pressure and left ventricular diastolic dysfunction in postmenopausal hypertensive women

Objectives: To confirm The specific effect of testosterone on nocturnal systolic blood pressure and left ventricular diastolic dysfunction in postmenopausal hypertensive women. Methods: A group matching study was used. One hundred and sixty-one postmenopausal hypertensive women between 45 and 65 years of age were enrolled as group 1. Another 161 hypertensive men were enrolled as group 2, according to age, BMI, metabolic index, history of hypertension and antihypertensive medication. Ambulatory blood pressure monitoring, echocardiographic, the levels of sexual hormones and clinical characteristics were evaluated and recorded. Quantitative data were analyzed using unpaired t-test, ANOVA and multiple regression analysis. Results: Firstly, the levels of blood pressure and the load of blood pressure in women were all significantly lower than those in men (P < 0.05), except the mean level and load of nocturnal systolic blood pressure (SBP) (P > 0.05). However, one of the index of left ventricular diastolic function, the ratio of the early diastolic mitral peak flow velocity to the early diastolic mitral annular velocity (E/E′), was obviously impaired (13.06 ± 3.53 VS 12.05 ± 3.68, P = 0.012). Further more, although testosterone of women was significantly lower than men (38.81 ± 14.07 VS 414.60 ± 127.06, P = 0.001), it was negative correlated with the levels of blood pressure in men (P < 0.05). And the mean level of nocturnal SBP (γ = 0.023, P = 0.011) positively correlated with E/E′ in women, but the same relation was not observed in men. Conclusion: Testosterone was the risk factor of the levels of blood pressure in women. Moreover, the mean level of nocturnal SBP was a risk factors of left ventricular diastolic dysfunction in women. Testosterone may have the specific effect on nocturnal systolic blood pressure and left ventricular diastol

Research of Dual-pulse wave Doppler for left ventricular diastolic function in atrial fibrillation and predicting recurrence after radiofrequency catheter ablation

Objective To explore the value of parameters obtained by dual-pulse wave Doppler to predict the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation(RFCA) and the value of the technology to evaluate the left ventricular diastolic function of the AF. Methods Sixty-seven AF patients who were subjected to ablation were selected as the case group, and 47 patients with sinus rhythm were matched as control group. The general clinical data of the case group and the control group was collected, routine ultrasound examination and dual-pulse wave Doppler examination were performed to all of them. A 24-hour Holter examination was performed at 3, 6 and 12 months after radiofrequency catheter ablation in the case group, the patients were divided into two groups with and without recurrence according to the results. Dual-pulse wave Doppler parameters included: ①the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e′) (TE-e′); ②peak early diastolic transmitral flow velocity (E) and tissue Doppler septal (S) mitral annular early diastolic velocity (e′), peak early diastolic transmitral flow velocity (E) and tissue Doppler lateral (L) mitral annular early diastolic velocity (e′), E/e′(S) and E/e′(L). The differences between the case group and the control group, and between the recurrent and the non-recurrent group were compared. The factors influencing the recurrence of AF after RFCA were analyzed with univariate and multivariate Logistic regression. Results ①The parameters E/e′(S), E/e′(L) and TE-e′ of case group were higher than those of control group (all P 0.05); ③Univariate and multivariate Logistic regression suggested that TE-e′ was an independent predictor for the recurrence of AF patients after the ablation(P=0.001). Conclusions Dual-pulse wave Doppler can evaluate left ventricular diastolic function of atrial fibrillation, TE-e′ is an independent predictor for the recurrence of AF patients after radiofrequency catheter ablation. Key words: Echocardiography; Atrial fibrillation; Radiofrequency catheter ablation; Dual-pulse wave Doppler; Recurrence

PULSE PRESSURE AMPLIFICATION AND AUGMENTATION INDEX IN ASSOCIATION WITH CARDIAC STRUCTURAL AND FUNCTIONAL DAMAGE

Objective: To investigate and compare the associations of pulse pressure amplification (PPA) and augmentation index (Aix) with asymptomatic cardiac structural and functional damage in an elderly Chinese population.Design and method: 1940 participants (mean age of 71.6 years) were included in the present study. Central blood pressure (BP) parameters were measured by SphygmoCor device. PPA and Aix were calculated as the ratio of central and brachial pulse pressures and the ratio of augmentation pressure and aortic pulse pressure, respectively. Cardiac structural and functional parameters including left ventricular mass index (LVMI), the ratio of peak early diastolic transmitral flow velocity and early diastolic lateral mitral annular velocity (E/Ea), were evaluated using standardized methods. Results: In correlation analysis, both PPA and Aix significantly correlated with LVMI and E/Ea ratio. When PPA and Aix separately put into same multivariate full-mode linear regression models, both PPA and Aix significantly associated with LVMI (regression coefficient [β] = 4.664, per 10% increase of PPA, P < 0.001; β = 1.998, per 10% increase of Aix, P = 0.02) and E/Ea ratio (β = 0.499, per 10% increase of PPA, P < 0.01; β = 0.152, per 10% increase of Aix, P = 0.18). When PPA and Aix both put into same multivariate stepwise linear regression models, only PPA were stayed in the model. When PPA and Aix separately put into same multivariate full-mode logistic regression models, only PPA was significantly associated with left ventricular hypertrophy (Odds ratio[OR]:1.242, 95% confidence interval[CI]:1.026–1.505, per 10% increase of PPA) and dysfunction (OR: 1.407, 95%CI: 1.087–1.820, per 10% increase of PPA). When PPA and Aix both put into same multivariate stepwise logistic regression models, only PPA were stayed in the model. In all multivariate models, brachial systolic BP was included and significantly associated with cardiac damage. Conclusions: PPA showed stronger BP-independent association with cardiac structural and functional damage than Aix.

Markers right ventricular diastolic dysfunction in patients with pulmonary hypertension.

Objective. To study the indices of the right ventricle filling (RV) in patients with pulmonary chronic pathology with and without pulmonary hypertension (PH). Material and methods. 244 people were examined (181 male; age 63.5 [61,0-71,0] years) The study included patients with pathology of respiratory organs without PH (n = 139), patients with echocardiographic signs of PH (n = 45) and healthy people as a control group (n = 60). At an echocardiography evaluated tricuspid blood flow parameters: peak early diastolic flow velocity (Et), the flow of atrial systole (At), indicators of spectral tissue Doppler of the tricuspid valve ring (e't, a't, e't/a't). We assessed the frequency of detection of RV diastolic dysfunction using the ratio Et/t, ratio Et/e't and the propagation velocity of the tricuspid flow (Vpt). Results. The incidence of the main markers of RV diastolic dysfunction was 18.7% in the control group, 27.8% in the group of patients with pulmonary pathology without symptoms of PH and 35% in patients with PH. Vpt reduction &lt;35 cm/sec, was found in 12.2%, 49.5% and 64.6% of patients, respectively. When used together, the markers incidence of diastolic dysfunction of RV in the control group was 27% in patients without lung pathology PH - 57.6%, and patients with the presence of PH - 75.9%. Conclusion. RV diastolic dysfunction in patients with pulmonary pathology manifests itself not only the deterioration of its main markers, but to a greater degree to reduce the spread of its filling flow rate. With the development of PH noted a further decline of this indicator. The combined use of key indicators and the propagation velocity of the tricuspid flow can improve the detection of RV diastolic dysfunction in diseases of the lungs before the development of PH.

The relation between blood pressure components and left atrial volume in the context of left ventricular mass index

Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP).The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume.The mean age of 205 patients (136 females—66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P < .001) and ratio of early diastolic mitral peak flow velocity to early diastolic mitral annulus mean velocity in tissue Doppler imaging (E/e′) (r = 0.24, P = .04).In the group of LVMI below the median, LAVI correlated with pulsatile and steady BP components. LAVI was independently predicted by mean arterial pressure (MAP) obtained from both ambulatory (MAP24h, β= 0.15; P = .045) and office measurements (MAPoffice, β = 0.35; P = .004), but not by pulse pressure.LV mass and function are the main determinants of LAVI. However, in persons with lower LV mass, LAVI depends on the steady component of blood pressure, but not pulsatile one. Increased LAVI reflects early changes in response to systemic blood pressure elevation.

PP.04.01] LEFT ATRIUM FUNCTION IN SYSTEMIC ARTERIAL HYPERTENSION

Objective: Assessment of left atrium (LA) mechanic by 2-Dimensional Speckle tracking Imaging (STI) recently has been discussed as useful method for LA function estimation. The purpose of this study was to assess the relationship between LA function (particularly reservoir function) and LA structural remodeling in patients with systemic arterial hypertension. LA evaluation was made using conventional echocardiography, tissue Doppler, and 2-Dimensional STI. Design and method: 48 hypertensive patients without left ventricular hypertrophy and 36 healthy controls (age and gender matched), underwent routine transthoracic echocardiography and speckle tracking echocardiography of the left atrium. LA volume was calculated by the biplane Simpson's method. Peak early diastolic transmitral flow velocity, peak early diastolic mitral annular motion velocity (E/E1) and peak systolic LA strain were messured. Results: LV Mass was 132.7 ± 16.5 grams in control and 180.2 ± 60.4 grams in the hypertensive patients. Left atrium volume indexed to body surface area was 19.4 ± 5.4 versus 29.4 ± 4.3 ml/m2 in controls and hypertensive subjects respectively (p < 0.001). There were also significant differences between the measurements of transmitral flow velocities (E, A), and E/E1 and E/A ratios in both groups. Left atrium anteroposterior diameter was higher in the hypertensive group 4.20 ± 0.58 versus 3.4 ± 0.28 cm in the contols (p < 0.001). Left atrial longitudinal strain was 24.05 ± 3.18 in hypertensive patients and 32.7 ± 2.8 among controls (p < 0.001). Conclusions: Speckle tracking imaging might be assumed as method for early detection of LA function impairment in arterial hypertension.

Effect of sitagliptin on the echocardiographic parameters of left ventricular diastolic function in patients with type 2 diabetes: a subgroup analysis of the PROLOGUE study

BackgroundDiabetes is associated closely with an increased risk of cardiovascular events, including diastolic dysfunction and heart failure that leads to a shortening of life expectancy. It is therefore extremely valuable to evaluate the impact of antidiabetic agents on cardiac function. However, the influence of dipeptidyl peptidase 4 inhibitors on cardiac function is controversial and a major matter of clinical concern. We therefore evaluated the effect of sitagliptin on echocardiographic parameters of diastolic function in patients with type 2 diabetes as a sub-analysis of the PROLOGUE study.MethodsPatients in the PROLOGUE study were assigned randomly to either add-on sitagliptin treatment or conventional antidiabetic treatment. Of the 463 patients in the overall study, 115 patients (55 in the sitagliptin group and 60 in the conventional group) who had complete echocardiographic data of the ratio of peak early diastolic transmitral flow velocity (E) to peak early diastolic mitral annular velocity (e′) at baseline and after 12 and 24 months were included in this study. The primary endpoint of this post hoc sub-analysis was a comparison of the changes in the ratio of E to e′ (E/e′) between the two groups from baseline to 24 months.ResultsThe baseline-adjusted change in E/e′ during 24 months was significantly lower in the sitagliptin group than in the conventional group (−0.18 ± 0.55 vs. 1.91 ± 0.53, p = 0.008), irrespective of a higher E/e′ value at baseline in the sitagliptin group. In analysis of covariance, sitagliptin treatment was significantly associated with change in E/e′ over 24 months (β = −9.959, p = 0.001), independent of other clinical variables at baseline such as blood pressure, HbA1c, and medications for diabetes. Changes in other clinical variables including blood pressure and glycemic parameters, and echocardiographic parameters, such as cardiac structure and systolic function, were comparable between the two groups. There was also no significant difference in the serum levels of N-terminal-pro brain natriuretic peptide and high-sensitive C-reactive protein between the two groups during the study period.ConclusionsAdding sitagliptin to conventional antidiabetic regimens in patients with T2DM for 24 months attenuated the annual exacerbation in the echocardiographic parameter of diastolic dysfunction (E/e′) independent of other clinical variables such as blood pressure and glycemic control.Trial registration UMIN000004490 (University Hospital Medical Information Network Clinical Trials). https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000005356; registered November 1, 2010

Comparison of central and peripheral hemodynamics in association with left ventricular diastolic dysfunction in the community-based elderly Chinese

The aim of the study was to investigate the association of left ventricular diastolic dysfunction (LVDD) with central and peripheral hemodynamics. A total of 1599 community-based senior residents (aged ≥ 65 years) in northern Shanghai, China, were recruited as of August 2015. Echocardiography was performed for each participant using the MyLab30 Gold CV system. According to the recommendations from the American Society of Echocardiography, the ratio of E (peak early diastolic transmitral flow velocity) to E′ (early diastolic lateral mitral annulus velocity) was assessed for the evaluation of LVDD. Central blood pressure (BP) components were measured using the SphygmoCor system. In community older population (72.7 ± 6.01 years), brachial systolic BP (mm Hg) was higher than central systolic BP (141.9 ± 19.5 vs. 130.3 ± 20.1 mm Hg). A total of 214 subjects (13.4%) showed LVDD, and female showed higher prevalence of diastolic dysfunction than male (17.3% vs. 8.4%, P < .01). After adjustment for confounding variables, only central systolic BP, not brachial systolic BP, was significantly associated with E/E′ in the total population. Similar result was found in the subgroup analysis (participants without antihypertensive agents treatment, man, woman). Similar findings were obtained for the pulse pressure (PP) analysis. Within central hemodynamics, only central PP, but not central systolic BP or augmentation pressure, was significantly associated with E/E′ after adjustment. When LVDD was defined by E/E′ and other echocardiographic parameters, our findings remained unaltered in the multivariate logistic regression with similar adjustment in the total population and subgroup analysis. In the Chinese elderly cohort, central hemodynamics, especially central PP, is superior to other BP components in identifying LVDD (NCT02368938).

探讨双脉冲多普勒技术测量Tei指数在成人健康体检中评估左室舒张功能的应用价值

目的：探讨双脉冲多普勒技术测量Tei指数在成人健康体检中评估左室舒张功能的应用价值。方法：选取体检中心健康成人113例，根据脉冲多普勒二尖瓣下血流E/A值及组织多普勒二尖瓣环运动速度e’/a’比值分为组1 (41例完全正常)、组2 (40例E/A、e’/a’ 1而e’/a’ 1, e'/a' < 1). Three groups were measured by double pulse Doppler synchronous of left ventricular function, Tei index and E peak early diastolic mitral flow velocity of mitral annulus E ratio (E/e) and other parameters, and SPSS 19 statistical software was used for data analysis. Results: The Tei index in group 3 and group 2 were significantly higher than that in group 1, and there were differences between the three groups (P < 0.05). The group 2 was higher than group 1. Tei index has correlation with isovolumic IVRT, early diastolic mitral flow E, mitral annulus tissue Doppler e' (septal and lateral wall side) and E/A (P < 0.05). Diastolic dysfunction has a strong correlation with hypertension and family history of diabetes, smoking (1 packs/day) and alcohol, staying up late and sleep poorly, work pressure and other mental factors, obesity, lacking of exercise. Conclusion: Double pulse Doppler can measure Tei index synchronously, and improve the accuracy of diagnosis of left ventricular diastolic dysfunction.

Association between circulating fibroblast growth factor-23 and age-related cardiovascular-renal parameters in a healthy Chinese population.

Previous studies showed that circulating fibroblast growth factor-23 (FGF23) is a new biomarker linked to cardiovascular and kidney diseases. Here, we explored the association between serum FGF23 and aging-related cardiovascular-renal parameters in a healthy Chinese population. A total of 314 healthy participants aged 36-87 years were enrolled. Cardiovascular structure and function were assessed by the left ventricular ejection fraction, the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity at the mitral leaflet tips, carotid intima-media thickness, the diameter of the bilateral common carotid artery, blood systolic peak and end diastolic velocities, which were measured by M-mode ultrasonography. Glomerular filtration rate was evaluated using the Chronic Kidney Disease Epidemiology Collaboration equation and Chronic Kidney Disease Epidemiology Collaboration equation for Asians. Serum FGF23, 1, 25-dihydroxy vitamin D3 and parathyroid hormone were measured by enzyme-linked immunosorbent assay. For all participants, intima-media thickness/diameter of the bilateral common carotid artery gradually decreased with the progression from low to high FGF23 concentration (P < 0.05). After adjusting for all possible confounders, FGF23 remained significantly associated with intima-media thickness/diameter of the bilateral common carotid artery (P = 0.016). In women, serum FGF23 was significantly associated with serum creatinine, cystatin C and estimated glomerular filtration rate in the Spearman correlation analysis. FGF23 remained significantly associated with serum creatinine (P = 0.046) and estimated glomerular filtration rate (P = 0.034) after full adjustment. However, no such relationship was apparent in men. Serum FGF23 was correlated with aging-related cardiovascular-renal parameters even in healthy people. Measurement of serum FGF23 can provide valuable information to predict cardiovascular-renal function in healthy people, especially in older female adults. Geriatr Gerontol Int 2017; 17: 1221-1231.

0318 : Left ventricular diastolic dysfunction in asymptomatic type 1 diabetic children: two-dimensional echocardiography study

Diabetic cardiomyopathie (DCM) is a distinct new entity. Pathophysiological mechanisms are not well known. It's defined as the presence of abnormal myocardial performance or abnormal structure in the absence of epicardial coronary artery disease, hypertension and significant valvular disease. The relationship between type 1 diabetes (T1D) and cardiac function in children is not well established. Demonstration of an early diastolic and systolic dysfunction help us to diagnose children's DCM, and is important for the timely interventions. The objective of this study was to characterize diastolic function abnormalities using two-dimensional echocardiography in T1D children. Twenty four T1D children were compared to 20 healthy control matched for age, gender and body mass index and having normal echocardiography. A standard 12-lead electrocardiogram was recorded followed by measurement of blood pressure. Laboratory investigations included mean hemoglobin (HbA1c). Echocardiography with simultaneous ECG (standard lead II), including standard echocardiographic views and tissue Doppler imaging (TDI), was performed using Vivid 9, GE Ultrasound. Left ventricular end-diastolic diametre (LV-EDD), interventricular septal end-diastolic diametre (IVS-EDD) were measured. LV conventional Doppler parameters of diastolic function were obtained: peak early (E) and peak late (A) diastolic flow velocities, E-wave deceleration time and E/A ratio were measured on the basis of transmitral flow velocities. LVEF was assessed using the biplane Simpson's method in apical four and two chamber views. TDI was performed in four apical view. The following TDI variables were evaluated: peak systolic (S), peak early diastolic (E’) and peak late diastolic (A). The mean age was 11.13 years±0.54. The T1D children and control group were comparable with respect to age, gender and heart rate. Diabetic children were asymptomatic and had normal physical examination. The mean duration of diabetes was 7±0.54 years. The mean HbA1C was 8.79%±0.25. LVEDD was 41.8±0.84 mm and LVESD was 26.33±0.73 mm. The average of IVS was 5.5±0.19 mm. LVEF was preserved with an average of 67.88±1.18%. The left atrial area was 10.78±0.33 and the volume was 24.35±1.72 ml. For diastolic function, in the diabetic group, E wave was 1.07±0.03cm/s, A wave was 0.58±0.04cm/s and E/A ratio was 4.4±2.08. In the control group, the E wave was 1.04±0.01cm/s, the A wave was 0.59±0.14 and the E/A ratio of 1.78±0.046. There were no significant differences between the two groups. The TDE was however significantly shorter in the diabetic group 146.54±3.69 ms Vs 161.42 ms±2.38 for the control group, with p = 0.005. Similarly, E ’septal wave were significantly decreased in diabetic children compared to controls (0.16±0.006 Vs 0.20±0.007, p = 0.001). The E / E ’ ratio was significantly higher in the diabetic group compared to the control group (6.72±0.33 vs. 5.21±0.15, p = 0.0011). Subclinical left ventricular impairment has been well demonstrated. Our study showed that diastolic function is affected whereas the parameters of systolic function are still preserved. The author hereby declares no conflict of interest

Assessment of the left ventricular function in normotensive prediabetics: a tissue Doppler echocardiography study.

Several studies have shown that left ventricular (LV) dysfunction is increased in individuals with diabetes. However, there are scarce data about LV function in prediabetics. This study assessed the early changes in LV diastolic and systolic myocardial function in normotensive prediabetics using tissue Doppler echocardiography (TDE). We evaluated 94 patients with prediabetes (mean age of 50.8 ± 6.9 years, 78 female) without known cardiovascular diseases and 70 healthy volunteers with similar demographic characteristics. Systolic and diastolic function of the left ventricle was evaluated with transthoracic echocardiography according to the latest consensus recommendations including TDE. The mean results of septal and lateral parts of the mitral annulus Pulsed wave TDE showed that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em to atrial peak velocity (Am) ratio were significantly lower whereas early diastolic peak flow velocity (E) to Em ratio, myocardial isovolumetric relaxation time (IVRTm), myocardial isovolumetric contraction time (IVCTm) and myocardial performance index (MPI) values were significantly higher in patients with prediabetes (preDM). In addition, mean left atrium (LA) diameter measured with M-mode echocardiography was significantly higher in prediabetics than controls. PreDM is associated with subclinical LV systolic and diastolic dysfunction as evaluated by TDE.

Contributions of Nondiastolic Factors to Exercise Intolerance in Heart Failure With Preserved Ejection Fraction

BackgroundHeart failure with preserved ejection fraction (HFpEF) has a complex etiology. Factors responsible for development of impaired exercise tolerance and disease progression are incompletely defined. ObjectivesThe authors sought to define the contributions of contractile reserve, ventriculo-arterial coupling (VAC) reserve, and chronotropic response to the progression of HFpEF. MethodsWe performed echocardiography at rest and immediately post-cardiopulmonary exercise test in 207 patients (63 ± 8 years of age) with stage C heart failure (HF) (exertional dyspnea, New York Heart Association functional class II to III, exercise capacity <80% of normal, left ventricular ejection fraction >50%, and diastolic dysfunction) and 60 patients with stage B HF (normal exercise tolerance with left ventricular hypertrophy, and/or reduced global longitudinal strain, with diastolic dysfunction). ResultsSymptomatic patients were grouped as stage C1 (ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity [E/e′] <13 both at rest and exercise; n = 63), C2 (E/e′ >13 only at exercise; n = 118), and C3 (E/e′ >13 both at rest and exercise; n = 26) HF. Exercise capacity and cardiovascular functional reserve were less impaired in stage C1 than in stages C2 and C3. Chronotropic response was more disturbed in stage C3 than C1 and C2. Changes from rest to exercise in E/e′ (−0.6 ± 1.7 vs. 3.7 ± 2.8; p < 0.0001), global longitudinal strain (2.9 ± 2.0 vs. 1.6 ± 2.8; p < 0.002), VAC (−0.21 ± 0.17 vs. −0.09 ± 0.15; p < 0.0001), and in VO2-HR gradient (0.30 ± 0.07 vs. 0.26 ± 0.11; p < 0.01) were significantly different in stages B and C. ConclusionsNormal E/e′ response to exertion in symptomatic HFpEF is associated with less profound impairment of exercise capacity and is accompanied by derangements of contractile state and VAC. The transition from asymptomatic to overt HFpEF is linked to diastolic, systolic, and chronotropic deficits and an increasing degree of hemodynamic disturbances in stage C HF.

How Does Subclinical Hyperthyroidism Affect Right Heart Function and Mechanics?

Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals. We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations. Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Two-dimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV end-diastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level. Right ventricular and RA function as evaluated by 3DE and speckle-tracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population.