Predictors Of Left Ventricular Diastolic Dysfunction Research Articles

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study

IntroductionCardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. MethodsA cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. ResultsA total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. ConclusionIn our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

High-normal diastolic blood pressure as a risk factor for left ventricular diastolic dysfunction in healthy postmenopausal women.

Left ventricular (LV) diastolic dysfunction is associated with heart failure with preserved ejection fraction, and metabolic syndrome (MetS) is a risk factor. However, there is limited knowledge regarding the metabolic factors that contribute to LV dysfunction in postmenopausal women without comorbidities. This study aimed to analyze the relationship between LV diastolic dysfunction and MetS, as well as other cardiovascular risk factors, and to determine risks for LV diastolic dysfunction. Postmenopausal women without hypertension, diabetes mellitus, LV systolic dysfunction, or other heart diseases underwent physical examinations, including echocardiography. The study participants were diagnosed with LV diastolic dysfunction based on several echocardiographic parameters. Logistic regression analyses of LV diastolic dysfunction and cardiovascular risk factors were performed. Of the 269 postmenopausal women examined, 29 (10.7%) and 40 (14.9%) had MetS and LV diastolic dysfunction, respectively. Abnormal diastolic blood pressure (odds ratio, 3.6; 95% confidence interval, 1.16-10.9; P < 0.05) and age (odds ratio, 1.1; 95% confidence interval, 1.07-1.19; P < 0.01) were predictors of LV diastolic dysfunction. In healthy postmenopausal women, high-normal diastolic blood pressure was the only independent risk factor for LV diastolic dysfunction, and it thus may be a useful predictor of diastolic heart failure during routine physical examinations.

The relationship between left ventricular diastolic dysfunction and hemoglobin A1c levels in the type 2 diabetes mellitus patient population

Objectives: This study aimed to investigate the relationship between hemoglobin A1c (HbA1c) levels, which is a good marker for determining glycemic levels, and left ventricular diastolic dysfunction (LVDD) in the type 2 diabetes mellitus (DM) patient population. Patients and methods: This retrospective study was conducted with 116 type 2 DM patients (62 males, 54 females; mean age: 58.4±9.5 years; range, 18 to 65 years) between July 2019 and November 2021. The patients were divided into two groups as those without LVDD (n=55, Group 1) and those with LVDD (n=61, Group 2). Early to late diastolic transmural flow velocity (E/A) ratio, the mean ratio (E/e') of mitral inflow (E) and mitral annular (e'), HbA1c levels, other hemogram and biochemical parameters, and demographic data were recorded. Results: The HbA1c level was significantly higher in the group with LVDD (6.96±1.23 vs. 9.00±2.19, p&lt;0.001). While the mean E/e' ratio was 9.69±2.73 in the group without LVDD, it was 16.00±1.69 in the group with LVDD, and there was a significant difference between the two groups (p&lt;0.001). The mean E/A ratio was significantly higher in the group without LVDD (1.25±0.51 vs. 1.02±0.53, p=0.021). In regression operating characteristics analysis, a HbA1c cut-off value of 7.35 and was found to be a predictor of LVDD in the type 2 DM patient group with a sensitivity of 80% and specificity of 80% (AUC: 0.805; 95% confidence interval: 0.718-0.892; p&lt;0.001). Conclusion: Providing close glycemic follow-up and monitoring the HbA1c level can reduce heart failure and other comorbid conditions that may develop, particularly after LVDD.

First-pass perfusion cardiovascular magnetic resonance parameters as surrogate markers for left ventricular diastolic dysfunction: a validation against cardiac catheterization

The non-invasive assessment of left ventricular (LV) diastolic dysfunction remains a challenge. The role of first-pass perfusion cardiac magnetic resonance (CMR) parameters in quantitative hemodynamic analyses has been reported. We therefore aimed to validate the diagnostic ability and accuracy of such parameters against cardiac catheterization for LV diastolic dysfunction in patients with left heart disease (LHD). We retrospectively enrolled 77 LHD patients who underwent CMR imaging and cardiac catheterization. LV diastolic dysfunction was defined as pulmonary capillary wedge pressure (PCWP) or LV end-diastolic pressure (LVEDP) > 12 mmHg on catheterization. On first-pass perfusion CMR imaging, pulmonary transit time (PTT) was measured as the time for blood to pass from the left ventricle to the right ventricle (RV) through the pulmonary vasculature. Pulmonary transit beat (PTB) was the number of cardiac cycles within the interval, and pulmonary blood volume indexed to body surface area (PBVi) was the product of PTB and RV stroke volume index (RVSVi). Of the 77 LHD patients, 53 (68.83%) were found to have LV diastolic dysfunction, and showed significantly higher PTTc, PTB, and PBVi (p < 0.05) compared with those without. In multivariate analyses, only PTTc and PTB were identified as independent predictors of LV diastolic dysfunction (p < 0.05). With an optimal cutoff of 11.9 s, PTTc yielded the best diagnostic performance for LV diastolic dysfunction (area under the curve = 0.83, p < 0.001). PTTc may represent a non-invasive quantitative surrogate marker for the detection and assessment of diastolic dysfunction in LHD patients. • PTTc yielded the best diagnostic accuracy for diastolic dysfunction, with an optimal cutoff of 11.9 s, and a specificity of 100%. • PTTc and PTB were found to be independent predictors of LV diastolic dysfunction across different multivariate models with high reproducibility. • PTTc is a promising non-invasive surrogate marker for the detection and assessment of diastolic dysfunction in LHD patients.

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study

IntroductionCardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. MethodsA cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. ResultsA total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. ConclusionIn our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

MO744HIGH SENSIVITY CARDIAC TROPONIN I, A POSSIBLE BIOMARKER OF DIASTOLIC DYSFUNCTION IN ASYMPTOMATIC PATIENTS IN HEMODIALYSIS

Abstract Background and Aims Impairment in the diastolic function is strongly associated with heart failure and cardiovascular disease in patients with end-stage renal disease (ESRD), with a high prevalence of 50-65% and unobvious early symptoms. Hence, it is of great importance to explore serum biomarkers for early assessment of diastolic disfunction in patients with ESRD, providing evidence for performing an early intervention. When myocardial cell membrane integrity becomes damaged, cardiac troponin is released into the circulation, inducing an elevation of serum cardiac troponin in asymptomatic patients on dialysis. We analyzed the relationship between high-sensitivity cardiac troponin I biomarker (hs-cTnI) and left ventricular diastolic dysfunction (LVDD) in a cohort of asymptomatic patients on haemodialysis at our center. Method Cross-sectional study. We include patients on haemodialysis in our center. Demographic variables (age, sex), associated comorbidity, hs-cTnI levels, and echocardiographic parameters were collected. Statistical analysis was performed with SPSS 25.0. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation, and T-student, Anova or U-mann Whitney was used to compare them. Logistic regression analysis was performed to determine independent predictors of LVDD. Statistical significance for a value of p &amp;lt;0.05. Results 80 patients, with an average age of 67.44 ± 13 years. 57.5% were men. 86.3% had high blood pressure (HBP), 52.5% were diabetic, 75% dyslipidemic, and 51.2% had overweight/obese body mass index. 32.5% had previous history of ischemic heart disease, 41.3% had moderate/severe left ventricle hypertrophy (LVH), 8.8% left ventricular ejection fraction (LVEF) &amp;lt;55% and 37.5% LVDD. Mean hs-cTnI was 31.27 ± 59.37 ng/L. LVDD was related to age (71 ± 10 years vs 65 ± 14 years p = 0.049), HBP (96.7% vs 3.3% p = 0.036), moderate/severe LVH (63.3% vs 36.7% p = 0.002), heart rate (HR) (66.96 ± 8.6 vs 77.28 ± 43.63 p = 0.036) and hs-cTnI (47.48 ± 81.97 ng/L vs 21.54 ± 38.06 ng/L p = 0.005). We divide the hs-cTnI into quartiles, with mean hs-cTnI levels 4.83 ± 1.92 ng/L in Q1, 9.86 ± 1.68 ng/L in Q2, 20.67 ± 4.26 ng L in Q3 and 89.73 ± 98.49 ng/L in Q4. We observed statistical significance for age (Q3 71 ± 10 ng/L vs 60 ± 17 ng/L p = 0.040), HBP (Q4 141.60 ± 16.68 ng/L vs Q1 123.90 ± 25, 98 ng/L p = 0.025), overweight/obesity (p = 0.001) and LVEF &amp;lt;55% (p = 0.015). The logistic regression showed that HR (OR 0.94 95% CI 0.89-0.99 p = 0.025), LVH severity (OR 5.16 95% CI 1.74-15.25 p = 0.003), and hs-cTnI &amp;gt; 20 (OR 4.11 95% CI 1.38-12.18 p = 0.011) are independent risk factors for LVDD. Conclusion hs-cTnI levels could be a biomarker of LVDD in asymptomatic patients on haemodialysis. New studies with a greater number of patients would increase the evidence for this claim, in order to carry out early intervention and treatment.

Significant Association Between Left Ventricular Diastolic Dysfunction, Left Atrial Performance and Liver Stiffness in Patients with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease.

PurposeThe constitutive elements of the metabolic syndrome (MetS) are linked with both non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease. Controlled attenuation parameter (CAP), and vibration controlled transient elastography (VCTE), are able to detect and quantify NAFLD, while conventional and two-dimensional speckle tracking echocardiography (2D-STE) is capable to identify subclinical changes in cardiac function. We wanted to evaluate whether there is any correspondence between left ventricular (LV) diastolic dysfunction and different degrees of liver steatosis and fibrosis in MetS subjects with NAFLD.Patients and MethodsA total of 150 adult subjects having MetS and a normal left ventricular (LV) systolic function were recorded in the study, while 150 age- and sex- matched adults without MetS were enrolled as controls. NAFLD was established by VCTE and CAP. The left heart systolic and diastolic function was evaluated by conventional and 2D-ST echocardiography. Left atrial (LA) stiffness was calculated as the ratio between the E/A ratio and the LA reservoir-strain.ResultsIn univariate regression analysis, the variables associated with LV diastolic dysfunction in MetS patients were: liver steatosis grade ≥2, liver fibrosis grade ≥2, the longitudinal LA peak strain during the reservoir phase, the LA strain rate during ventricular contraction and the LA stiffness. In multivariate logistic regression, two variables were selected as independent predictors of LV diastolic dysfunction, namely the liver stiffness (P=0.0003) and the LA stiffness (P<0.0001). LA stiffness predicted subclinical LV diastolic dysfunction in MetS patients with a sensitivity of 45% and a specificity of 96% when using a cut-off value >0.38, and was significantly correlated with liver steatosis stage ≥2 and liver fibrosis stage ≥2.ConclusionThe present study confirms the association between liver stiffness, LA stiffness and LV diastolic dysfunction in MetS patients. Our study suggests that liver elastography and 2D-STE should become habitual assessments in MetS patients.

Relationship between plasma aldosterone and left ventricular structure and function in patients with heart failure with preserved ejection fraction

Aim. To study the relationship between plasma aldosterone level and left ventricular (LV) structure and function in heart failure with preserved ejection fraction (HFpEF).Material and methods. This prospective study included 158 patients (58 men and 100 women, mean age, 62,3±7,4 years) with compensated HFpEF. Patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. The plasma aldosterone was determined by enzyme immunoassay in all patients and the severity of structural and functional cardiac changes was assessed. The concentration of 40160 pg/ml was considered the reference values. Assessment of cardiac structure and function was carried out using transthoracic echocardiography.Results. According to the laboratory results, all patients were divided into two groups: group 1 — 99 (62,7%) patients (95% confidence interval (CI), 55,0-70,0%) with normal aldosterone levels; group 2 — 59 (37,3%) patients (95% Cl, 30,0-45,0%) with hyperaldosteronism. End-diastolic volume, left atrial volume, LV mass index, severity of LV diastolic dysfunction and the prevalence of concentric hypertrophy were significantly higher in group 2 patients compared with group 1 (p&lt;0,05 for all). Blood aldosterone levels positively correlated with E/e’ (r=0,63, p&lt;0,001). Regression analysis, adjusted for age and comorbidity, demonstrated that plasma aldosterone levels were closely associated with E/e’ (odds ratio, 3,42; 95% CI, 1,65-9,64, p=0,001) and LV concentric hypertrophy (odds ratio, 1,12; 95% CI, 1,08-3,16, p=0,042).Conclusion. The development of secondary hyperaldosteronism in patients with HFpEF is an independent predictor of LV diastolic dysfunction and unfavorable prognostic types of LV remodeling.

Arterial stiffness as a factor of structural and functional cardiac remodeling in obesity

Aim. To analyze the association of parameters characterizing the degree of arterial stiffness and echocardiographic criteria for cardiac remodeling in patients with abdominal obesity.Material and methods. The study included 194 patients (men aged 46 to 55 years (49,0±2,3 years)), without hypertension (24-hour average blood pressure (BP) 117,5±5,5/73,0±4,1 mmHg), diabetes and cardiovascular diseases, with abdominal obesity (waist circumference &gt;94 cm, body mass index 31,3±3,5 kg/m2). Lipids and glucose concentrations were evaluated, and glomerular filtration rate was estimated using the CKD-EPI equation. We conducted 24-hour monitoring of blood pressure and arterial stiffness parameters (aortic pulse wave velocity (PWV), augmentation index (AIx) and systolic BP in the aorta), and echocardiography.Results. Left ventricular (LV) hypertrophy was detected in 14 (7,2%) patients, LV diastolic dysfunction — in 36 (18,6%) patients. The correlation of the average aortic PWV and the AIx with the LV mass index and the left atrial volume was shown. Patients with a high aortic PWV exceeding the 75th percentile of distribution (8,2 m/s) were characterized by a higher incidence of hypertrophy (18,8% vs 4,9%,p&lt;0,01) and LV diastolic dysfunction (50,0% vs 12,3%, p&lt;0,001). Patients with/with-out LV hypertrophy and diastolic dysfunction were characterized by higher values of average 24-hour aortic PWV, AIx and systolic BP in the aorta. According to the regression analysis, the predictors of LV diastolic dysfunction were age, waist circumference, aortic PWV, and AIx.Conclusion. The relationship of parameters characterizing the degree of arterial stiffness, primarily, aortic PWV and echocardiographic parameters of the structural and functional cardiac remodeling in obese patients was revealed. Patients with a high aortic PWV (&gt;8,2 m/s for men aged 46-55 years) are characterized by a higher prevalence of LV hypertrophy and diastolic dysfunction, as well as left atrial dilatation. This association is probably a reflection of one of the many pathogenesis links of HF and supraventricular cardiac arrhythmias in obese patients.

Abstract P476: Consumption Of Animal And Plant Food And Likelihood Of Left Ventricular Diastolic Dysfunction: A Prospective Study Among Black And White Adults Of The Bogalusa Heart Study

Introduction: Left ventricular diastolic dysfunction (LVDD) is one key subclinical precursor of heart failure with preserved ejection fraction (HFpEF). Whether dietary correlates serve as independent predictors of LVDD in adults without HFpEF is unknown. Hypothesis: We hypothesized that dietary habits in young adulthood would prospectively influence the likelihood of LVDD in middle age. Methods: The analysis included 456 individuals of the Bogalusa Heart Study (26.5% black, 62.7% female, baseline age=36.1 + 4.4 years) with an ejection fraction &gt; 55%. Diet was measured at baseline via food frequency questionnaires. LVDD was defined at follow-up (median=12.9 years) through echocardiographic measurement of the E/A ratio, E/e’ ratio, isovolumic relaxation time, and deceleration time. Logistic regression estimated the odds of LVDD according to protein source, adjusting for cardiovascular disease risk factors and total energy intake. Results: There were 72 cases of LVDD. Using the lowest tertile as reference, persons in the middle tertile of total protein (OR=3.31, 95% CI: 1.47, 7.46; p=8.5x10 -3 ) and animal protein (OR=2.93, 95% CI: 1.35, 6.37; p=0.03) intake had the highest likelihoods of LVDD. We observed 54% and 57% lower odds of LVDD for persons in the highest vs. lowest tertile of vegetable (OR=0.46, 95% CI: 0.22, 0.95; p=8.0x10 -4 ) and legume consumption (OR=0.43, 95% CI: 0.20, 0.92; p=0.02), respectively. Total protein, animal protein, processed meat, and eggs indicated a significant quadratic trend towards increased odds of LVDD, while legumes and vegetables indicated a significant quadratic trend toward decreased odds of LVDD ( Table ). There were no significant relationships of LVDD with other animal or plant foods. Conclusions: Animal and plant food consumption result in an increased and decreased likelihood of LVDD, respectively. Adherence to plant-based diets in young adulthood may protect against the development of LVDD, and thus future HFpEF, later in life.

Prevalence of left ventricular diastolic dysfunction by cardiac magnetic resonance imaging in thalassemia major patients with normal left ventricular systolic function

BackgroundThe leading cause of mortality of thalassemia major patients is iron overload cardiomyopathy. Early diagnosis with searching for left ventricular diastolic dysfunction before the systolic dysfunction ensued might yield better prognosis. This study aimed to define the prevalence of the left ventricular diastolic dysfunction (LVDD) in thalassemia major patients with normal left ventricular systolic function and the associated factors.MethodsAdult thalassemia major patients with normal left ventricular systolic function who were referred for cardiac T2* at Siriraj Hospital – Thailand’s largest national tertiary referral center – during the October 2014 to January 2017 study period. Left ventricular diastolic function was defined by mitral valve filling parameters and left atrial volume index using CMR. Patients with moderate to severe valvular heart disease, pericardial disease, or incomplete data were excluded. Baseline characteristics, comorbid diseases, current medication, and laboratory results were recorded and analyzed.ResultsOne hundred and sixteen patients were included, with a mean age of 27.5 ± 13.5 years, 57.8% were female, and 87.9% were transfusion dependent. Proportions of homozygous beta-thalassemia and beta-thalassemia hemoglobin E were 12.1 and 87.9%, respectively. The baseline hematocrit was 26.3 ± 3.3%. The prevalence of LVDD was 20.7% (95% CI: 13.7–29.2%). Cardiac T2* was abnormal in 7.8% (95% CI: 3.6–14.2%). Multivariate analysis revealed age, body surface area, homozygous beta-thalassemia, splenectomy, heart rate, and diastolic blood pressure to be significantly associated with LVDD.ConclusionsLVDD already exists from the early stages of the disease before the abnormal heart T2 * is detected. Homozygous beta-thalassemia and splenectomy were strong predictors of LVDD. These data may increase awareness of the disease, especially in the high risk groups.

The impact of peripheral artery disease on left ventricular diastolic function

BackgroundPeripheral artery disease (PAD) is often accompanied by heart failure with preserved ejection fraction (HFpEF). Left ventricular (LV) diastolic dysfunction is related to HFpEF. The aim of this study was to compare LV diastolic function between patients with or without PAD. MethodsOne thousand one hundred twenty-one patients (male 56%, mean age 68±13 years) with available preserved LV systolic function assessed by echocardiography (ejection fraction ≥50%) were enrolled from a single-center database between January 2013 and May 2015. PAD was defined as ankle brachial index <0.9 or previous history of lower extremity bypass and/or endovascular therapy. Diagnosis of LV diastolic dysfunction was based on the American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The prevalence of LV diastolic dysfunction was compared between patients with PAD and those without PAD.Multivariate analysis was performed by logistic regression analyses to assess predictors of LV diastolic dysfunction. ResultsTwo hundred patients (18%) had PAD. Patients with PAD had higher E/e′ (15.3±7.4 vs 11.8±5.5, p<0.01), tricuspid regurgitation velocity (2.37±0.33 vs 2.19±0.28m/s, p<0.01), left atrial volume index (40.6±20.2 vs 32.1±13.6mL/m2, p<0.01), and lower e′ (5.68±1.70 vs 6.38±2.07cm/s, p<0.01) than patients without PAD. The prevalence of LV diastolic dysfunction was higher (31% vs 12%, p<0.01) in patients with PAD compared to patients without PAD. Multivariate analysis showed that PAD was an independent predictor of LV diastolic dysfunction (adjusted odds ratio: 1.77, 95% confidence interval: 1.13–2.65, p=0.01). ConclusionThe prevalence of LV diastolic dysfunction was higher in patients with PAD than patients without PAD.

Association of High-Sensitivity Troponin T With Left Ventricular Dysfunction in Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is a systemic inflammatory disease, and cardiac dysfunction has not been clearly described clinically. High-sensitivity cardiac troponin T (hs-cTnT) is a noninvasive marker for subclinical myocardial injury. In this study, we aimed to investigate any relationship between hs-cTnT and left ventricular (LV) function evaluated via tissue Doppler imaging in AS patients with no known cardiac risk factor. Our study used a cross-sectional case protocol design and was conducted between January 2016 and June 2016. In total, 40 AS patients (17 females and 23 males) were age and sex matched with healthy volunteers (20 females and 20 males) and enlisted for this study. Detailed transthoracic echocardiography was performed, and tissue Doppler imaging was used to assess systolic and diastolic functions. High-sensitivity cardiac troponin T levels were measured and compared between 2 groups. Compared with control subjects, AS patients had lower early (Em)/late (Am) diastolic myocardial velocities, mitral annular plane systolic excursion, and end-diastolic distance from the mitral annulus to the LV apex. Conversely, they had greater systolic myocardial velocity (Sm), isovolumetric relaxation time, and displacement index (p < 0.001, for all). Higher hs-cTnT levels were measured in AS patients (0.45 ± 0.22 vs. 1.11 ± 0.27, p < 0.001), and multivariate logistic regression analyses revealed that hs-cTnT was an independent predictor of LV diastolic dysfunction in AS patients. These data show that AS patients had impaired LV functions and increased hs-cTnT levels. Tissue Doppler imaging may be a useful tool for detection of early functional LV abnormalities, and hs-cTnT may be valuable biomarker of diastolic LV dysfunction in AS patients.

The association between plasma thiol levels and left ventricular diastolic dysfunction in patient with hypertension

The balance of oxidant and antioxidant status plays an important role in the left ventricular diastolic dysfunction (LVDD) in patients with hypertension (HT). Thiol is an important part of antioxidant system in the body. The aim of this study was to investigate the relationship between plasma thiol levels and LVDD in patients with HT. A total of 138 patients with newly diagnosed essential hypertensive and 20 age-gender matched subjects as control group enrolled in the study. After echocardiographic assessment, the hypertensive patients were divided into three groups: Group 1: without LVDD (n = 41); group 2: with LVDD grade 1 (n = 57); and group 3: with LVDD grade 2 (n = 40). Plasma thiol, lipid and glucose levels were measured in all subjects. Plasma thiol levels were significantly different between the groups (all of p < 0.05). While the lowest thiol level was in the group 3, the highest level was in the control group. The presence of LVDD was correlated with age, systolic and diastolic blood pressure, thiol levels, and history of coronary artery disease and hyperlipidemia (all of p < 0.05). Age and thiol were however independent predictors of LVDD in multivariate analyses (β = 0.318, p < 0.001, and β = − 0.314, p < 0.001, respectively). ROC-curve analysis revealed that thiol levels over 163 μmol/L predict LVDD in hypertensive patients with 75% sensitivity and 70% specificity (AUC = 0.783; 95% CI: 0.714–0.852). Plasma thiol is an independent predictor for the presence of LVDD. This suggests that thiol plays a role in the pathogenesis of diastolic function. Increased thiol levels may provide protection against the development of diastolic dysfunction.

The Yin and Yang of dyspnea in the emergency department: heart failure or COPD?

Dear Editor, In a recent issue of your journal, we were grateful to read the enjoyable article by Caram et al. (1), which evaluated the prevalence of electrocardiographic and echocardiographic abnormalities in patients with chronic obstructive pulmonary disease (COPD) according to disease severity (25 mild/moderate and 25 severe/very severe COPD patients). The study showed that COPD patients have a high prevalence of left ventricular diastolic dysfunction (LVDD) and that this dysfunction is associated with disease severity. The authors also concluded that because of this close association, it is important to exclude decompensated heart failure (HF) during the evaluation of COPD exacerbation. Heart failure and COPD are the most common causes of mortality worldwide (2). The two diseases have significant overlap with regard to risk factors and pathophysiological mechanisms (including systemic inflammation), resulting in diagnostic and therapeutic challenges for both emergency department and outpatient physicians (3,4). Approximately 10–40% of patients with HF have reported concomitant COPD (3). Additionally, the prevalence of unrecognized HF was 20.9% in patients with COPD or asthma presenting to the emergency department (5), and this prevalence was reported as 20.5 and 17% in community patients with stable COPD (6,7). In addition to the similarity in mechanism, both conditions may present with highly similar symptoms, including dyspnea, orthopnea, coughing, exercise intolerance, fatigue, muscle weakness, disturbed sleep, anorexia, and anxiety (8). Caram et al. (1) noted that patients with COPD have significant echocardiographic abnormalities, independent of disease severity (98%). The most frequently noted echocardiographic abnormality was mild LVDD (88%). Of the several studied risk factors, COPD severity was the only significant predictor of LVDD, which might explain the common pathophysiological pathways in both conditions. However, this association should be coupled with follow-up data demonstrating that the concurrent presence of HF and COPD can increase morbidity and mortality. The findings of Caram et al. (1) demonstrated that HF and COPD are common and frequently concomitant conditions in patients with COPD that can be screened for using transthoracic echocardiography, an acceptable, safe, valid, and reliable imaging modality applicable to the COPD population. In addition to imaging techniques, concurrent HF and COPD exacerbations can be differentiated by biochemical tests, including natriuretic peptides (such as brain natriuretic peptide). Natriuretic peptides provide additional diagnostic accuracy and might be the most effective tool in refining the diagnosis for this patient population, given the high negative predictive value of a normal result. However, through the effects on pulmonary artery pressure and right-ventricular overload, COPD can also cause elevated circulating levels of natriuretic peptides (9,10). Despite this potential confounding factor, the negative predictive accuracy of natriuretic peptides for ruling out acute decompensated HF appears to be preserved, even in cohorts of patients with both HF and COPD diagnoses (5,11). In conclusion, this study demonstrated that patients with COPD have significant electrocardiographic and echocardiographic abnormalities, independent of disease severity. Among all of the pathological findings, LVDD is of great importance because of the prognostic role it plays in patients with COPD. As diagnosing cardio-pulmonary interaction is a complex process, LVDD in COPD patients can be best addressed through simple clinical measures, including natriuretic peptides and objective measurements of ventricular dysfunction by echocardiography.

Resting heart rate is an independent predictor of left ventricular diastolic dysfunction in obese patients with or without arterial hypertension

Background: Left Ventricular Diastolic Dysfunction (LVDD) represents one of the cardiac consequences in overweight and obese patients. Resting heart rate (RHR) is an easy measure but important indicator of cardiovascular health. In this study, we sought to assess if RHR is a reliable determinants of LVDD in obese patients with or without arterial hypertension. Methods and results: A perspective echo-Doppler study was performed in 154 consecutive asymptomatic patients with grade 1-to-3 obesity (body mass index [BMI]: 43±8) who averaged 47 years in age (women 80%). All patients had a LV ejection fraction (EF) ≥50% and no history of heart failure or coronary artery disease. LVDD was identified by an E/A ratio >1.5 and an E/A ratio <0.8. Long-axis function was assessed by global longitudinal strain. For means of comparison, 56 age-matched subjects with or without hypertension were also studied. Prevalence of hypertension was 42% in obese patients, while it was 29% in the control group. LVDD was present in 46 obese patients (30%) and in 12 controls (21%). Patients with grade 3 obesity (BMI ≥40) exhibited higher LV volumes and mass (p<0.0001), cardiac output (p<0.0001), left atrial size (p<0.0001), stroke volume (p<0.0001) and RHR (p<0.0001), and a worse LV long-axis function (p<0.001) as compared to patients with grade 1-2 obesity (BMI between 30 and 40) and the control group. In patients with grade 2-to-3 obesity, BMI directly correlated with stroke volume (r=0.24; p=0.003) and cardiac output (r=0.37; p<0.0001), RHR inversely correlated with LV end-diastolic volume index (r=-0.48; p<0.0001), LV end-systolic volume index (r=-0.42; p<0.0001) and LV mass index (r=-0.40; p<0.0001). RHR (hazard ratio [HR]:1.06, p=0.003) and age (HR: 1.05, p=0.025) were independently associated with LVDD in patients with grade 2-to-3 obesity. Conclusion: In obese patients with or without hypertension, RHR was a major predictor of LVDD and negatively correlated with LV mass and volumes. Obese patients with a disproportionate increase in RHR are likely to carry inadequate allometric scaling of LV mass and volumes relative to their BMI values.

Impact of Body Mass Index on Left Ventricular Diastolic Dysfunction

The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m(2) ), group 2 (BMI 25.0-29.9 kg/m(2)), group 3 (BMI ≥ 30-39.9 kg/m(2)), and group 4 (BMI ≥ 40 kg/m(2)). Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A' were significantly higher whereas septal E' and lateral E' were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A', deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E' ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus.

ASSOCIATION OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION WITH ELEVATED NT-pro-BNP IN GENERAL INTENSIVE CARE UNIT PATIENTS WITH PRESERVED EJECTION FRACTION

The mechanisms of the N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) release in intensive care unit (ICU) patients with preserved ejection fraction (EF) are unclear. We investigated whether left ventricular (LV) dysfunction, as assessed by tissue Doppler imaging (TDI), is related to NT-pro-BNP levels in ICU patients with preserved EF and has a complementary value to NT-pro-BNP in the determination of in-hospital mortality. We examined 58 mechanically ventilated patients with no history of heart failure (age, 60 +/- 18 years; EF, 63% +/- 7%). The systolic (S) and early diastolic (E') velocity of the mitral annulus by TDI and the E/E' as well as NT-pro-BNP, troponin, lactate acid, blood oxygen (P(O2)/Fi(O2)), sepsis, and ICU mortality were assessed. Systolic, E', and E/E' correlated with age, P(O2)/Fi(O2), lactate acid, NT-pro-BNP, troponin, history of arterial hypertension, and diabetes (P < 0.05). By multivariate analysis, the determinants of NT-pro-BNP were S (P = 0.024), E/E' (P = 0.017), and sepsis (P = 0.015). An NT-pro-BNP greater than 941 pg/mL was a reliable predictor of LV diastolic dysfunction defined as a composite of E' less than or equal to 8 cm/s and/or mean E/E greater than or equal to 13 (area under the curve, 75%; P = 0.03). Patients with combined NT-pro-BNP greater than 941 pg/mL and abnormal TDI markers had increased creatinine levels and a lower MAP, P(O2)/Fi(O2), and survival rate than those with abnormal TDI or NT-pro-BNP alone or patients with normal TDI markers and NT-pro-BNP (25%, 60%, 70%, and 84%, respectively; P < 0.05). The addition of abnormal TDI in a model including NT-pro-BNP and sepsis increased the model's value for in-hospital mortality (P for change = 0.01). In ICU patients with preserved EF, LV diastolic dysfunction and sepsis determine NT-pro-BNP levels. Tissue Doppler imaging markers and NT-pro-BNP have a complementary value for in-hospital mortality.

Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: Implication for diagnosis of diastolic heart failure

Left atrial volume index (LAVI) is increasingly recognised as a relatively load-independent marker of left ventricular (LV) filling pressures. We assessed the capacity of LAVI to predict LV diastolic dysfunction in comparison with N-terminal pro B-type natriuretic peptide (NTproBNP) in patients with suspected heart failure and a normal ejection fraction (EF). 137 patients with suspected heart failure (HF), referred from the community for echocardiography, prospectively underwent Doppler echocardiography, LAVI and NTproBNP estimation. Raised LAVI and reduced LV systolic function were defined as >26 ml/m2 and LV EF <50% respectively. Of 137 patients, 21 were excluded (2 with significant mitral valve disease and 19 with atrial fibrillation). Of the remaining 116 subjects, 92 showed normal LV systolic function. The univariate predictors of serum log NTproBNP were age (p < 0.001), LA dimension (p = 0.001), LAVI (p < 0.001), A wave (p = 0.001), E:A (p = 0.07) and septal wall thickness (p = 0.004). However on multivariate analysis, LAVI was found to be the most consistent and significant predictor of NTproBNP. The area under the curve of the receiver operating characteristic (ROC) curve for NTproBNP in detecting patients with LVEF > or = 50% and LAVI >26 ml/m2 was 0.81 (p < 0.0001) and for patients with LAVI > 26 ml/m2 with and without LVEF > or = 50% was 0.82 (p < 0.0001). This data confirms that LAVI on resting echocardiography, specifically in patients with suspected HF and normal LV systolic function is a powerful independent predictor of LV diastolic dysfunction as predicted by serum NTproBNP. In a population with a high suspicion of diastolic heart failure, LAVI may significantly contribute to diagnostic precision.

Left ventricular diastolic dysfunction in patients with chronic renal failure: impact of diabetes mellitus

Left ventricular (LV) hypertrophy and LV diastolic dysfunction are cardiac changes commonly observed in patients with chronic renal failure (CRF) as well as hypertension. Although the impairment of LV diastolic function in patients with diabetes mellitus has been shown, little is known about the specific effect of diabetes on LV diastolic function in patients with CRF. The present study was designed to investigate the impact of diabetic nephropathy on LV diastolic dysfunction, independent of LV hypertrophy, in CRF patients. In 67 patients with non-dialysis CRF as a result of chronic glomerulonephritis (n = 33) or diabetic nephropathy (n = 34), and 134 hypertensive patients with normal renal function, two-dimensional and Doppler echocardiographic examinations were performed, and LV dimension, mass, systolic function, and diastolic function were evaluated. LV mass was increased and LV diastolic dysfunction was advanced in subjects with CRF compared with hypertensive controls. In the comparison of echocardiographic parameters between the two groups of CRF patients, i.e. chronic glomerulonephritis and diabetic nephropathy groups, all indices of LV diastolic function were more deteriorated in the diabetic nephropathy group than in the chronic glomerulonephritis group, although LV structure including hypertrophy and systolic function did not differ between the groups. In a multiple regression analysis, the presence of diabetes (i.e. diabetic nephropathy group) was a significant predictor of LV diastolic dysfunction in CRF subjects, independent of other influencing factors such as age, blood pressure, renal function, anaemia and LV hypertrophy. The present findings suggest that LV diastolic dysfunction, independent of LV hypertrophy, is specifically and markedly progressed in patients with CRF as a result of diabetic nephropathy.