Presence Of Left Ventricular Diastolic Dysfunction Research Articles

Association of cardiometabolic and triglyceride-glucose index with left ventricular diastolic function in asymptomatic individuals

Background and aimsObesity and insulin resistance are associated with left ventricular diastolic dysfunction (LVDD) and increased risk of heart failure. Cardiometabolic index (CMI) and triglyceride glucose (TyG) are new indexes to assess visceral obesity and insulin resistance, respectively. The study aimed to investigate the clinical usefulness of these indexes for identifying LVDD individuals. Methods and resultsOverall, 1898 asymptomatic individuals were included in this cross-sectional study. Participants underwent anthropometrics, serum biochemical evaluation, and echocardiography. Multiple linear regression analysis revealed that both indexes were independent determinants of diastolic parameters among females; while for males, CMI and TyG were not associated with A velocity. In the multivariate logistic analysis, the proportion of LVDD in the third and fourth quartiles of CMI remained significantly greater than that in the lowest quartile in females (Q3 vs. Q1: odds ratio (OR) = 2.032, 95% confidence interval (CI): 1.181–3.496; Q4 vs. Q1: OR = 2.393, 95% CI: 1.347–4.249); while in males, the incidence of LVDD was significantly greater only in the fourth quartile. For TyG, the presence of LVDD in the fourth quartile was significantly greater in both genders. The discriminant values between the CMI (AUC: 0.704, 95% CI: 0.668–0.739) and TyG (AUC: 0.717, 95% CI: 0.682–0.752) were similar in females. Both indexes performed better in females than in males to identify LVDD. ConclusionThe CMI and TyG might both serve as effective tools to identify LVDD in routine health check-ups in primary care, mainly in females. With simpler parameters, the CMI could be utilized in medically resource-limited areas.

Study of Left Ventricular Dysfunction In Type 2 Diabetes Mellitus Patients Without Known Co-Morbidities

Background: Subclinical left ventricular dysfunction in type 2 diabetes mellitus (DM) patients may precede the development of symptomatic heart failure. Detecting this dysfunction early could potentially prevent its progression. However, there is a scarcity of studies on this topic in Bangladesh. Therefore, this study aimed to explore the left ventricular function status in type 2 DM patients without any known co-morbid conditions in a tertiary care hospital. Methods: A cross-sectional study was conducted at the Department of Internal Medicine in Sir Salimullah Medical College & Mitford Hospital over a one-year period. A total of 100 patients with a diagnosis of type 2 DM, meeting the inclusion-exclusion criteria, were enrolled. Written informed consent was obtained from each participant, followed by the collection of socio-demographic data, detailed clinical history, and routine investigations. Echocardiograms were performed on all participants to assess the presence of systolic and diastolic dysfunction using various modes. Data analysis was conducted using the statistical software SPSS 23.0. Results: The mean age of the study patients was 47.23±9.13 (SD) years, with the majority in the age group of 40-49 years (43%). Female patients accounted for 58% of the sample, while male patients comprised 42%. The frequency of left ventricular diastolic dysfunction (LVDD) was 65%. The presence of LVDD was associated with longer duration of diabetes mellitus, higher HbA1C levels, older age, and increased BMI (p<.05). Conclusion: The majority of type 2 diabetic patients in this study exhibited left ventricular diastolic dysfunction, with a prevalence of 65%. Further larger-scale studies are recommended to validate these findings. Bangladesh J Medicine 2023; 34(3): 229-234

The Value of Neutrophil-to-Lymphocyte Ratio and Epicardial Adipose Tissue Thickness in Heart Failure With Preserved Ejection Fraction.

Background Using epicardial adipose tissue thickness (EATt) and neutrophil-to-lymphocyte ratio (NLR) as individual indicators provides beneficial insight into the prognosis of patients suffering from heart failure with preserved ejection fraction (HFpEF). Aim In our study, we aimed to evaluate whether the combined evaluation of NLR and EATt would provide an advantage for identifying high-risk HFpEF patients according to hospitalization for heart failure (HHF) and left ventricular diastolic dysfunction (LVDD). Method A total of 168 outpatients with HFpEF were retrospectively analyzed. The predictive performance of two inflammatory variables was assessed by the receiver operating characteristic curve and a one-way analysis of variance (ANOVA) test. The patients were stratified into three distinct risk categories based on the established cut-off values for EATt and NLR as follows: Group I, high risk; Group II, middle risk; and Group III, low risk. Results Patients in Group I had the highest risk for HHF and the presence of LVDD (p=0.001 for HHF, p=0.011 for LVDD). Patients in Group I also exhibited more symptomatic and a greater number of comorbidities. In Group I, more structural remodeling (enlargedleft ventricular end-systolic volume index (LVESVI) and left atrial volume index (LAVI)) and associated signs of increased intracardiac pressure (elevated E/A ratio, medial E/e') were observed. Conclusion The results of our study indicate that the use of both EATt and NLR among patients with HFpEF may provide better accuracy in predicting HHF and LVDD compared to the use of either EATt or NLR alone.

Diastolic stress test in assessing functional state of postinfarction myocardium

Taking into account the conflicting literature data and the ambiguity in the interpretation of parameters of diastolic heart function in patients with coronary heart disease, we conducted an analysis of diastolic heart function in patients after myocardial infarction at the outpatient rehabilitation stage. Aim of the study was to investigate the diagnostic information content and the feasibility of diastolic stress testing to assess the functional condition of postinfarction myocardium. Material and methods. 86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with coronary artery stenting ad hoc. The control group consisted of 10 healthy volunteers. Structural and functional examination of the heart was performed at rest and immediately after exercise using stress echocardiography. Results and discussion. Patients after myocardial infarction have a larger indexed volume of the left atrium (30.71 ± 8.88 vs. 20.49 ± 4.04 ml/m2) and an E/e` ratio (8.45 ± 3.27 vs. 6.46 ± 1.42) in comparison with the control group. 38 (62.3 %) patients with normal left ventricular (LV) ejection fraction (EF) had unimpaired LV diastolic function, 19 (31.1 %) and 2 (3.3 %) patients had type 1 and type 2 diastolic dysfunction, respectively, 2 patients (3,3 %) had an indeterminate result. Patients with reduced LV EF have a significantly lower early diastolic mitral annular velocity (e`). The diastolic stress test revealed a significant post-exercise increase in E/e` in only one patient (from 8.92 to 18.37), who also had an initially reduced EF (32 %). The stress test showed no significant changes in diastolic heart parameters after exercise in patients suffering from heart failure with preserved EF, which may indicate relatively good diastolic reserves of the heart. Conclusions. Myocardial infarction is accompanied by the presence of LV diastolic dysfunction in 53,5 % of the patients at the 6th week of the rehabilitation period. The diastolic stress test is accompanied by a rare occurrence of stress-induced diastolic dysfunction (4 %) in patients with reduced LV EF after myocardial infarction.

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus: A Single-Centre Observational Study From a Tertiary Care Hospital in South India.

Background There is a high prevalence of left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes mellitus (T2DM). The influencing factors of LVDD in T2DM are not fully understood. Objective This study aimed at assessingthe prevalence of LVDD in T2DM as well as looking at the association between various parameters related to T2DM with LVDD in patients with T2DM. Materials and methods This wasa single-centre cross-sectional study in Kerala, India. The primary objective of the study was to assess the prevalence of LVDD in T2DM. The secondary objectives were to look for an association between higher glycated haemoglobin (HbA1c), complications of T2DM, age, and gender of the patient with the presence of LVDD. Results A total of 80 patients were included in the study. There were 40 patients with LVDD with a prevalence of 50%. There was a statistically significant positive association between increased age, longer duration of diabetes, higher HbA1C, the presence of diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy with the prevalence of LVDD. A logistic regression analysis demonstrated that the presence of diabetic retinopathy is a risk factor for LVDD in the study subjects.

Prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria: alterations in ultrasonographic parameters of both left and right ventricles before and after stress.

We estimated the frequency of cirrhotic cardiomyopathy (CCM) using all of the proposed diagnostic criteria, to describe the whole spectrum of cardiac alterations, and to investigate the role of stress in unmasking latent cases of CCM. Ninety consecutive patients were recruited. CCM was evaluated using the Montreal, the American Society of Echocardiography 2009 criteria, and the 2019 modified criteria of the CCM consortium. A dobutamine stress test was also performed. Left ventricular diastolic dysfunction (LVDD) was identified in 72 (80%), 36 (40%), and 10 (11.1%) patients based on the above criteria, respectively. None of the patients had right ventricular systolic dysfunction, either at rest or after stress. The dobutamine stress test revealed left systolic dysfunction in 4 (4.5%) patients. There was agreement among the 3 criteria that the presence of LVDD was not associated with the severity of liver disease, using Child-Pugh stage. However, patients with Child-B/C had longer QTc intervals (P=0.004), higher levels of brain natriuretic peptide (P=0.016), and greater echocardiographic E/e' ratio (P<0.001) and E/e'(s) (P=0.003), compared to Child-A patients, while a significant correlation was demonstrated between Child-Pugh score and E/e' (P<0.001), or E/e'(s) (P=0.002). The prevalence of LVDD seems to be lower than previously considered. Right ventricular function seems to remain unimpaired. A dobutamine stress uncovered only a small percentage of patients with left systolic dysfunction. Nevertheless, the aggravation of several sonographic variables during stress, particularly in Child-B/C patients, potentially indicates a higher risk for clinical heart failure during stressful invasive interventions.

The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis.

We sought to quantify the burden of left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) in systemic sclerosis (SSc) and assess the progression of LVDD over time and its prognostic importance. Two-hundred and twenty-five participants enrolled in the Australian Scleroderma Cohort Study were included and LVDD was assessed according to 2016 ASE/EACVI Guidelines. Logistic regression analyses and generalised estimating equations were performed to evaluate the relationship between LVDD and SSc disease characteristics and symptoms and signs of heart failure, respectively. The relationship between LVDD and mortality was assessed using Kaplan-Meier survival estimates. Thirty-four (15%) participants were diagnosed with LVDD. A further 89 (40%) participants had indeterminate diastolic function. Older age (p<0.01), hypertension (p=0.02), impaired systolic function (p=0.03) and interstitial lung disease (p=0.01) were all associated with the presence of LVDD. There was no association between the presence of LVDD and clinical signs of heart failure, however, LVDD was associated with more breathlessness and worse functional class (p=0.03). LVDD was observed to progress over time, with significant worsening of parameters of left ventricular filling pressure. There was no significant relationship between LVDD and mortality (p=0.23). Abnormal diastolic function is a common finding in SSc, progresses over time and is associated with more severe dyspnoea. Whilst patients with LVDD are more breathless, LVDD is not clearly associated with clinical findings of heart failure demonstrating that LVDD may be of importance in explaining symptoms even in the absence of HFpEF in SSc.

Association of Left Ventricular Diastolic Dysfunction With Cardiovascular Outcomes in Patients With Pre-dialysis Chronic Kidney Disease: Findings From KNOW-CKD Study.

BackgroundThe impact of left ventricular diastolic dysfunction (LVDD) on cardiovascular (CV) outcomes in patients with pre-dialysis chronic kidney disease (CKD) has been rarely unveiled. We here investigated the association of LVDD with CV outcomes and all-cause mortality in patients with pre-dialysis CKD.MethodsA total of 2,135 patients with pre-dialysis CKD from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) cohort were dichotomized by the absence or presence of LVDD, which was defined as the ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) > 14.ResultsCox regression analysis revealed that LVDD was significantly associated with increased risk of composite CV events [adjusted hazard ratio (HR) 2.194, 95% confidence interval (CI) 1.486–3.240] and all-cause mortality (adjusted HR 1.830, 95% CI 1.168–2.869). Restricted cubic splines visualized stringent linear correlations of E/e′ with both composite CV events and all-cause mortality. In the sensitivity analysis only including the subjects with left ventricular ejection fraction ≥ 50%, LVDD was still significantly associated with adverse CV outcomes (adjusted HR 1.984, 95% CI 1.325–3.000) and all-cause mortality (adjusted HR 1.727, 95% CI 1.083–2.754), suggesting that the impact of LVDD on the outcomes in patients with CKD is independent of LV systolic function. Subgroup analyses revealed that the associations were not modified by various clinical contexts, such as age, sex, burden of comorbid conditions, body mass index, estimated glomerular filtration rate, and albuminuria.ConclusionLVDD is independently associated with adverse CV outcomes and all-cause mortality in patients with pre-dialysis CKD.

Diastolic Dysfunction Is a Predictor of Poor Survival in Patients with Decompensated Cirrhosis.

Background Left ventricular diastolic dysfunction (LVDD) appears to be the earliest cardiac disturbance in cirrhosis patients. There are many previous reports reporting the significance of severity of LVDD on the outcome of liver transplantation or TIPS insertion, a few Indian studies have addressed the role of LVDD on survival in decompensated cirrhosis. The objective of this study is to assess the effect of LVDD on the survival of decompensated cirrhotic patients. Methods We prospectively evaluated 92 decompensated cirrhotic patients from April 2015 to March 2017 at IMS and SUM Hospital, Bhubaneswar, India. 2D echocardiography with tissue Doppler imaging was used to evaluate cardiac function, as per the American society of echocardiography guidelines. The primary endpoint was to evaluate the effect of LVDD on overall mortality. Results Ninety-two decompensated cirrhotic patients were evaluated in this prospective cohort study. Twenty-eight out of 92 patients (30%) died due to liver-related complications after a follow-up of 24 months. The decompensated cirrhotic patients with MELD score ≥ 15 had a significantly higher E/e′ ratio (11.94 ± 4.24 vs. 8.74 ± 3.32, p < 0.001) suggesting severe LV dysfunction in advanced cirrhosis. Patients with E/e′ ratio > 10 had significantly higher MELD score and Child-Pugh score (19.88 ± 7.72 vs. 14.31 ± 5.83; 10.25 ± 1.74 vs. 9.02 ± 1.74, p < 0.01, respectively) as compared to theE/e′ ratio < 10 group. In Cox proportional hazard multivariate analysis, E/e′ ≥ 10 (HR 2.72, 95% CI 1.07-6.9, p = 0.03) and serum albumin (HR 0.32, 95% CI 0.14-0.7, p < 0.01) were found to be independent predictors of mortality in decompensated cirrhotic patients. Conclusion: The presence of LVDD and low serum albumin were independent predictors of mortality in decompensated cirrhotic patients. Hence, LVDD is an indicator of advanced cirrhosis and mortality.

Validation of the HFA-PEFF and the H2FPEF scores for the diagnosis of heart failure with preserved ejection fraction in Japanese patients:a report from the Japanese multicentre registry

Abstract Background The standard diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) is based on the following: 1) symptoms of HF, 2) preserved left ventricular (LV) ejection fraction (LVEF, &amp;gt;50%), and 3) presence of LV diastolic dysfunction confirmed by echocardiography or cardiac catheterisation. However, there are limits to the diagnostic accuracy of individual parameters, and what cut-off values should be applied and how they should be combined remain unclear. Diagnostic algorithms for HFpEF such as the HFA-PEFF algorithm and the H2FPEF score have been proposed; however, previous validation studies were conducted in stable chronic HF and did not include an invasive haemodynamic assessment. Thus, the diagnostic accuracy for HFpEF lacked robustness. Moreover, information on their applicability in the Asian population is limited. Purpose The aim of this study was to investigate these scores' diagnostic validity for HFpEF in Japanese patients recently hospitalised due to acute decompensated HF. Methods We examined patients with HFpEF recently hospitalised with acute decompensated HF whose HFA-PEFF and H2FPEF scores could be calculated at discharge from a nationwide HFpEF-specific multicentre registry (HFpEF group) and control patients who underwent echocardiography to investigate the cause of dyspnoea in our hospital (Non-HFpEF group). We calculated the HFA-PEFF and the H2FPEF scores among the studied population. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were computed to compare the diagnostic accuracy of these scores. Results The studied population included 372 consecutive patients (194 HFpEF group and 178 Non-HFpEF group; HFpEF prevalence, 52%). The HFA-PEFF score classified 155 (42%) of all patients into the high likelihood category (5–6 points) and only 19 (5%) into the low likelihood category (0–1 point). A high HFA-PEFF score could diagnose HFpEF with a high specificity of 84% and a positive predictive value (PPV) of 82%, and a low HFA-PEFF score could rule out HFpEF with a high sensitivity of 99% and a negative predictive value (NPV) of 89%. The H2FPEF score classified 86 (23%) of all patients into the high likelihood category (6–9 points) and 84 (23%) into the low likelihood category (0–1 point). HFpEF could be diagnosed with a high H2FPEF score (specificity, 97%; PPV, 94%) or ruled out with a low H2FPEF score (sensitivity, 97%; NPV, 93%). The diagnostic accuracy for the HFA-PEFF and H2FPEF scores was 0.82 (95% confidence interval [CI] 0.78–0.86) and 0.89 (95% CI 0.86–0.93), respectively, by the AUC of the ROC curve (P=0.004) (Figure 1A). In the HFA-PEFF sub-scores, the functional score showed little diagnostic value, while the morphological and biomarker scores showed moderate diagnostic value (Figure 1B). Conclusions The H2FPEF score may be more useful than the HFA-PEFF score in diagnosing HFpEF in Japanese patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI) Figure 1

Type 1 and 2 matrix metalloproteinases, tissue inhibitor of metalloproteinases and left ventricular diastolic dysfunction in hypertensive patients

Abstract The purpose of the study. To assess the level of matrix metalloproteinases of types 1 and 2 (MMP1, MMP2), as well as tissue inhibitor of metalloproteinases (TIMP) in relation to indicators of left ventricular myocardial deformation in patients with essential hypertension, depending on the presence of left ventricular (LV) diastolic dysfunction (DD). Materials and methods 114 hypertensive patients (40 women and 74 men) were involved in the study. The average age of the patients was 42±8.3 years. The diagnosis was confirmed by a thorough clinical and instrumental examination. Patients had no CVD or renal disease. LV diastolic filling parameters were assessed according to ASE/EACVI criteria (2016). The indicators of myocardial deformation were studied as well. The level of MMP1, MMP2 and TIMP was assessed by the method of enzyme-linked immunosorbent assay. Statistical methods such as Cruskell-Walles criteria and Spearman's correlation coefficient were used. Results 1st group consisted of 66 patients with normal LV filling parameters, 2nd group was represented by 48 patients with LV DD, control group consisted of 35 healthy men and women, matching by age. The level of MMP1 in group 2 was increased by 112% compared with group 1 and by 117% compared with the control group (101.1±10.4, 47.7±13.2 ng/ml and 46.6±26.1 ng/ml, respectively, p&amp;lt;0.01). In group 2 patients, there was an increased level of MMP2 by 107% compared with patients in group 1 and by 112% compared with the control group (2519.0±233.9 ng/ml, 1216.1±189.8 ng/ml and 1186, 9±64.0 ng/ml, respectively, p&amp;lt;0.01). The TIMP level was higher in hypertensive patients with LV DD: 2.3 times higher than in the group of patients without diastole disturbance, and 2.4 times higher than in the control group (158±24 ng/ml, 68.2±18.8 ng/ml and 66.3±14.0 ng/ml, respectively, p&amp;lt;0.05). Differences between groups 1 and controls were not found for any of the studied parameters. The study of global longitudinal myocardial deformation (Avg) depending on the presence of LV DD showed that in the 2nd group patients this indicator was 22.8% lower than in 1st group patients (p&amp;lt;0.05). Compared with healthy people in groups 1 and 2, there was a decrease in Avg by 23.3% and 40.7%, respectively (p&amp;lt;0.05). The analysis revealed a moderate negative correlation between the global longitudinal LV deformity and the level of MMP2 (r=−0.64, p&amp;lt;0.05). Conclusion Thus, in hypertensive patients with LV DD, an increase in the level of MMP1, MMP2, and TIMP interrelated with global myocardial deformation was revealed, which suggests the participation of these markers in the formation of impaired LV diastolic filling in hypertension. Funding Acknowledgement Type of funding sources: None.

Role of NT-proBNP in Detection of Left Ventricular Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Patients with Preserved Ejection Fraction: A Cross-sectional Study

Background: Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy and is initially subclinical. Early diagnosis enables earlier treatment and stops further progression of the disease. Tissue Doppler Imaging (TDI) is a new diagnostic modality with high sensitivity and specificity to know ventricular diastolic function. N-terminal pro brain natriuretic peptide (NT-proBNP) is a cardiac neurohormone that can be used to identify the changes in ventricular diastolic function. We aimed to estimate the concentration of NT-proBNP and correlate its value with TDI for LVDD in asymptomatic type 2 Diabetes Mellitus.&#x0D; Methods: In this comparative cross-sectional study, we enrolled 100 asymptomatic type 2 diabetic patients and 100 healthy people aged 30-60 years. In both groups, NT-proBNP levels were measured and the presence of LVDD was determined by TDI. The primary outcome parameter was the level of NT-proBNP in diabetics and healthy people. The secondary outcome parameter was the correlation of NT-proBNP level with various grades of LVDD.&#x0D; Results: In patients with LVDD, NT-proBNP levels [median (IQR)] were 123 (102,194) pg/ml in diabetics and 72 (67, 77) pg/ml in the control group. In patients without LVDD, NT-proBNP levels [median (IQR)] were 69 (59, 76) pg/ml in diabetics and 57 (49, 63) pg/ml in the control group. The level of NT-proBNP was significantly higher in those with LVDD (p &lt; 0.001). NT-proBNP concentration significantly increased as grades of LVDD increased.&#x0D; Conclusion: NT-proBNP is a good marker for detection of preclinical LVDD in patients with uncontrolled diabetes prone to develop cardiovascular complications.

Impact of left ventricular diastolic dysfunction on liver transplantation outcomes based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations.

Aim of the studyCirrhotic cardiomyopathy encompasses systolic dysfunction, left ventricular diastolic dysfunction (LVDD), and conduction abnormalities. This study aims to investigate the impact of LVDD on mortality in patients undergoing liver transplantation (LT).Material and methodsA retrospective review of 400 consecutive patients who underwent LT at our institution was performed. Patient demographics, clinical data, and transthoracic echocardiogram (TTE) were reviewed to identify LVDD. The total cohort consisted of 266 patients after excluding patients with insufficient TTE data (n = 56), patients with indeterminate LVDD (n = 71), and patients with ejection fraction (EF) < 55% (n = 7). Statistical analysis was performed using descriptive statistics. Cox regressions with hazard ratios (HRs) and 95% confidence intervals (CI) were applied to predict 5-year all-cause mortality. Kaplan-Meier survival analysis was conducted to understand the impact of LVDD on 5-year all-cause mortality.ResultsPatients with LVDD have higher incidence of hyperlipidemia (36% vs. 17%, p = 0.003), hypertension (50% vs. 27%, p = 0.001) and diabetes (52% vs. 30%, p = 0.003). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 24%, p = 0.001). A multivariate logistic regression analysis was performed with age, body mass index (BMI), NASH, alcoholic cirrhosis, hepatitis C, history of diabetes, history of hyperlipidemia, and history of hypertension. In this multivariate logistic regression analysis, NASH (odds ratio [OR] = 4.43 [1.10-17.8], p = 0.04), and history of hypertension (OR = 2.33 [1.16-4.66], p = 0.01) were independent predictors of LVDD. The Kaplan-Meier survival analysis and multivariate Cox regression demonstrated that the presence of LVDD had no impact on 5-year all-cause mortality (log-rank test nonsignificant).ConclusionsThis study indicates that LVDD in end-stage liver disease (ESLD) patients does not affect immediate post-transplant outcomes or 5-year all-cause mortality.

Revelation of subclinical left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus using 2016 ASE/ EACVI guidelines.

Background:Few studies have used the 2016 American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI) guidelines to detect left ventricular diastolic dysfunction (LVDD) among asymptomatic normotensive type 2 diabetes mellitus (T2DM) patients.Methods:200 asymptomatic non-hypertensive diabetic cases and 281 controls matched for age and body mass index without evidence of arrhythmias, valvular, myocardial, pericardial or coronary artery disease underwent diastology assessment using 2 dimensional and M-mode echocardiography along with tissue Doppler imaging.Results:The presence of LVDD was seen to be significantly higher among the members of the diabetic group compared to the controls (35 vs. 14; P=0.001). The diabetics with LVDD had a longer duration of diabetes {8.04±7.75 vs. 5.27±5.49 years; P=0.04}, along with higher glycated hemoglobin (HbA1c) {8.40±1.38 vs. 7.80±1.60% ; P=0.05}, fasting blood glucose (FBS) {211.35±78.15 vs. 187.89±107.90 mg/dL; P=0.009, 2 hour post prandial blood glucose} (PPBS) {237.89±107.9 vs. 211.35±78.15 mg/dL; P=0.04}, serum triglyceride (TG) {246.91±171.82 vs. 163.44±99.37 mg/dL; P=0.008} yet had lower serum very low density lipoprotein levels (VLDL) {19.74±15.01 vs. 27.61±17.89 mg/dL; P=0.01}.Conclusion:This is one of the few studies so far to have demonstrated a higher occurrence of LVDD specifically among asymptomatic normotensive T2DM patients using the 2016 ASE/EACVI guidelines.

Abstract 16096: Successful Pulmonary Vein Isolation Improve Diastolic Dysfunction and Sympathetic Nerve Activity in Atrial Fibrillation Patients

Introduction: Atrial fibrillation (AF) is associated with diastolic dysfunction (DD) at a high rate and the presence of left ventricular DD is also associated with increased muscle sympathetic nerve activity (MSNA). Catheter ablation (CA) of AF was reported to improve cardiac function, including the reverse remodeling of left ventricle and atrium. However, little is known about the effect of CA on MSNA and DD in AF patients. Purpose: The purpose of this study was to evaluate the effect of CA on MSNA and DD and the difference in therapeutic effect between two groups with and without DD. Methods: This study was conducted as a prospective, observational study. AF patients who were scheduled for CA were enrolled. The patients were divided into two groups, E/e’ ratio≧11 and &lt;11. We measured blood pressure, HR, body weight, echocardiogram parameters, and MSNA before and 12 weeks after CA. Results: 28 AF patients participated in this study. After CA, in the patients with DD(the group of E/e’≧11, n=12), E/e’ ratio, the MSNA burst incidence(BI) and frequency(BF) were significantly decreased (13.4±2.1 to 10.6±3.0, p&lt;0.01. 64.4±15.8 to 34.0±12.0 bursts/100beats, P&lt;0.01, 39.7±9.3 to 23.5±9.2 bursts/min, p&lt;0.01 respectively). In the patients without DD (the group of E/e’&lt;11, n=16), the BI and BF were significantly decreased (59.7±11.8 to 43.5±11.7 bursts/100beats, P&lt;0.01, 38.1±10.5 to 29.2±8.4 bursts/min, p&lt;0.01 respectively) while there was no difference in E/e’ ratio. Interestingly, in the patients with DD, decrease in BI and BF were more pronounced compared in the patients without DD(-30.4±15.9 to -16.2±11.5 bursts/100beats, P&lt;0.05. -16.3±11.5 to -8.9±13.8 bursts/min, P=0.145 respectively). In both groups, no significant changes were observed in EF and peak acceleration rate of mitral E velocity. Conclusion: CA reduced MSNA in AF patients. In the patients with DD, the reduction of MSNA tended to be more remarkable than without DD. These findings suggest that changes of MSNA might reflect the improvement of DD and reduction of AF burden.

A rare cause of erectile dysfunction: left ventricular diastolic dysfunction.

The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease. A total of 80 patients with LVDD and without a history of coronary artery disease were compared with 80 age- and gender-matched healthy controls. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. LVDD and its relation with ED severity were assessed. The mean age, Body Mass Index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control groups (P>0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r=-0.635, P<0.05). Additionally, the left atrial volume index, peak TR velocity and E/e' ratio were independent risk factors for lowering the IIEF-5 score. This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men.

Association of increased arterial stiffness with diastolic dysfunction in ischemic stroke patients: the Norwegian Stroke in the Young Study.

Young and middle-aged ischemic stroke survivors have a high prevalence of hypertension, increased arterial stiffness and abnormal left ventricular (LV) geometry, which all are associated with the presence of LV diastolic dysfunction. However, the prevalence and covariates of diastolic dysfunction in these patients have not been reported. To explore diastolic dysfunction in ischemic stroke patients aged 15-60 years included in the Norwegian Stroke in the Young Study. Data from 260 patients with acute ischemic stroke was analyzed. Diastolic dysfunction was assessed by combining transmitral peak early flow (E), early diastolic mitral annular velocity (e'), E/e' ratio, left atrial volume index and peak tricuspid regurgitant jet velocity, following current European guidelines. Carotid-femoral pulse wave velocity at least 10 m/s by aplanation tonometry was defined as increased arterial stiffness. Prevalent diastolic dysfunction was found in 20% of patients (13% with diastolic dysfunction grade 1 and 7% with diastolic dysfunction grades 2-3). Patients with diastolic dysfunction were older and more likely to have hypertension, overweight, increased arterial stiffness, higher LV mass and less percentage nightly reduction in mean blood pressure (BP) (all P < 0.001). In a multivariable logistic regression analysis, diastolic dysfunction was associated with increased arterial stiffness [odds ratio 2.86 (95% confidence interval 1.05-7.79), P < 0.05] independent of age more than 45 years, overweight, hypertension, night-time BP reduction and LV mass. Among young and middle-aged ischemic stroke survivors, diastolic dysfunction was found in 20%. The presence of diastolic dysfunction was associated with increased arterial stiffness independent of higher age, overweight, hypertension, night-time BP reduction and LV mass.

Left ventricular diastolic dysfunction in liver transplantation: a stronger association with non-alcoholic steatohepatitis.

Aim of the studyCardiovascular death is an important cause of mortality in end stage liver disease (ESLD) patients undergoing orthotopic liver transplant (OLT). Left ventricular diastolic dysfunction (LVDD) is often the early manifestation and only measurable manifestation of cirrhotic cardiomyopathy. Therefore, it is important to understand the risk factors for LVDD in ESLD patients undergoing OLT and its immediate impact post-operatively.Material and methodsElectronic medical records (EMR) of 100 consecutive patients who underwent OLT were reviewed at the University of Tennessee/Methodist University Hospital in Memphis, Tennessee, USA. Transthoracic echocardiogram (TTE) reports were accessed to evaluate for LVDD based on the latest 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The clinical and demographic variables were obtained and variable quality measures, incidence of cardiac arrhythmias, and 30-day all-cause mortality were compared.ResultsPatients with LVDD were older (62.7 ±6.3 years vs. 55.9 ±12.3 years, p = 0.017) and were more often female (57% vs. 31%, p = 0.026). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 12%, p = 0.001). In contrast, patients with alcoholic liver disease were less likely to have LVDD (10% vs. 33%, p = 0.032). In a multivariate logistic regression analysis, NASH (OR = 4.4 [95% CI: 1.33-14.5], p = 0.015) and female gender (OR = 3.31 [95% CI: 1.09-9.99], p = 0.033) were independent predictors of LVDD.ConclusionsIn our cohort of patients, the presence of NASH was associated with a higher risk of LVDD. However, presence of LVDD did not influence immediate post-transplant outcome or 30-day all-cause mortality.

Significance of left atrial overload by electrocardiogram in the assessment of left ventricular diastolic dysfunction.

Although assessment of left ventricular (LV)diastolic function (DF) using echocardiography is important, it is not always feasible in the clinical practice. On the other hand, left atrial (LA) overload shown by electrocardiogram (ECG) indicates LA pressure rise and LA dilatation. The purpose of this study is to examine whether LA overload by ECG can be used as an aid for evaluation of LVDF. There were 117 subjects who underwent echocardiography and ECG on the same day. The duration of P-wave (P-duration) in lead II, the amplitude and duration of P-wave negative phase in lead V1 were measured by ECG, and terminal force (PTFV1) was calculated. We analyzed the relationships between LVDF grades and LA overload signs. P-duration showed a good correlation with LA volume index (LAVi) (r = 0.673, P < 0.0001) and PTFV1 showed reasonable correlations with both LAVi and average E/e' (both, r = 0.575, P < 0.0001). Both P-duration and PTFV1 showed significant differences among the LVDF classes (P < 0.0001). Among the ECG indices, P-duration [Formula: see text] 110ms was the most powerful to judge the presence of LV diastolic dysfunction with 86% of sensitivity and specificity. P-duration ≥ 110ms is useful to suggest the presence of LVdiastolic dysfunction. Conventional ECG criteria (P-duration ≥ 120ms and PTFV1 [Formula: see text] 0.04mm·s) are highly specific and suggest the presence of LV diastolic dysfunction with LA pressure rise. Echocardiography and ECG should be used in a complementary way when LVDF grades are indeterminate.

P3457Oxidative stress and left ventricular remodeling in postmenopausal women

Abstract Purpose To asses the level of oxidative stress in postmenopausal women in dependence of LV structural and functional changes and its filling parameters. Methods 203 postmenopausal women were included in the investigation: 142 women with surgical menopause (average age 44,3±5,4 years, menopause duration 3,8±2,4 years); and 61 women with natural menopause (average age 46,2±4,7 years, menopause duration 4,3±2,1 years). All patients underwent general clinical examination, menopausal index evaluation, ambulatory blood pressure (BP) monitoring (Cardiotens-01, Meditech, Hungary), echocardiographic examination with systolic and diastolic left ventricular (LV) function assessment. We also measured erythrocyte thiobarbituric acid reactive substances (TBARs), ultimate products of lipid peroxidation (Shiff bases), catalase activity and plasma general antioxidant activity. Control group consisted of 35 healthy menstruating women (mean age 39,2±4,2). Statistical methods such as Cruskell-Walles criteria and χ2 test were used. Results Only 39 postmenopausal women (19,2%) had normal LV geometry; 89 pts (43,8%) demonstrated LV concentric hypertrophy, 57 pts (28,1%) – concentric remodeling and 18 women (8,9%) –eccentric hypertrophy. All postmenopausal women showed signs of activation of oxidative stress while reducing the power of antioxidant protection systems, however, these changes were most pronounced in groups of patients with eccentric and especially concentric LV hypertrophy Nobody of included postmenopausal women had LV systolic function failure. Presence of LV diastolic function disturbance was the same in the patients with surgical and natural menopause (54,1% (33 pts) and 59,1% (84 pts), respectively, p=0,231) and did not depend on BP level: 59,1% (52 pts) in hypertensive and 56,5% (65 pts) in normotensive women, p=0,118. We detected that Shiff bases level in postmenopausal women with diastolic dysfunction was increased in 1,5 times in comparison with healthy menstruating women and in 1,3 times in comparison with those postmenopausal women who had no diastolic function disturbance (p&lt;0,01). The level of erythrocyte TBARs in this group was increased in 1,3 and 1,2 times respectively (p&lt;0,05). Erythrocyte catalase activity and plasma general antioxidant activity were decreased in all postmenopausal women in comparison with healthy ones (p&lt;0,01). The presence of LV diastolic dysfunction correlated positively with erythrocyte Shiff bases level (τ=0,47, p&lt;0,01) and negatively – with erythrocyte catalase activity and plasma general antioxidant activity (τ=−0,35 and τ=−0,35, p&lt;0,01 respectively) Conclusions Thus, oxidative stress may play important role in left ventricular remodeling and diastolic dysfunction formation in postmenopausal women.